Lecture 5, 4th level

Root Canal Sealers

 Mohammed Al-Khawlani
 Assist. Professor Of Endodontics, Conservative Dept. Thamar Uni.
Functions of Root Canal Sealers
Root canal sealers are used in conjunction with filling materials for the following purposes:
1. Antimicrobial agent: many used sealers contain some antibacterial agent,
2. Sealers are needed to fill in the discrepancies between the filling material and the dentin
walls to:
• prevent periapical exudates from diffusing into the unfilled
part of the canal
• to avoid reentry and colonization of bacteria
• to block residual bacteria from reaching the periapical tissues
“so creating what is called a fluid tight seal”
3. Binding agent: Sealers act as binding agent between the filling
material and the dentin walls.
4. As lubricant: using sealers facilitate insertion of obturating
materials.
5. Radiopacity: All sealers display some degree of
radiopacity; thus they can be detected on a radiograph.
This property can disclose the presence of auxiliary canals,
resorptive areas, root fractures, and the shape of apical
foramen.
Requirements of an Ideal Root Canal Sealer

Grossman listed eleven requirements and characteristics of a good root canal sealer:
1. It should be tacky when mixed so as to provide good adhesion between it and the
canal wall when set.
2. It should create hermetic seal.
3. It should be radiopaque so that it can be visualized in the radiograph.
by adding salts of heavy metals such as silver, barium, bismuth.
4. The particles of powder should be very fine so that they can be mixed easily with
the liquid.
5. It should not shrink upon setting.
All of the sealers shrink slightly on setting, and gutta-percha also shrinks when
returning from a warmed or plasticized state to cold state.
6. It should not stain tooth structure.
most of sealers stains variably. So, leaving any sealers in the pulp chamber should
be avoided.
7. It should be bacteriostatic or at least not encourage bacterial growth.
many root canal sealers exert antimicrobial activity to a varying degree and specially
those containing paraformaldehyde. However, toxicity is of concern.
8. It should set slowly.
The working and setting times of sealers must be long enough to allow
placement and adjustment of root filling if necessary.
9. It should be insoluble in tissue fluids.
10. It should be tolerant, nonirritating to periradicular tissue.
11. It should be soluble in a common solvent
e.g. if it is necessary to remove the root canal fitting
The most popular sealers are :
Zinc oxide–eugenol formulations,
Calcium hydroxide sealers,
Glass ionomer sealers,
Resin-based (epoxy resin or methacrylate resin) sealers,
Calcium silicate–based sealers.
 Zinc Oxide and Eugenol sealers
Advantages:
- Resorbed if extruded into the periradicular tissues.
- Exhibit a slow setting time,
-Has antimicrobial activity
- Disadvantages:
- shrinkage on setting
- solubility
- stain tooth structure.
For many years, zinc oxide-containing sealers have been the most popular and widely
used sealers.
There are many formulations and brands of sealers that have zinc oxide as the primary
ingredient, differing only by other components added to the sealers.

Grossman’s original formula contained zinc oxide, staybelite resin, bismuth

subcarbonate, barium sulfate, and sodium borate with eugenol as the liquid component.
It has been marketed as Procosol sealer, as well as other product names.
Roth’s sealer is essentially the same as Grossman’s
original formulation, with the substitution of bismuth
subnitrate for bismuth subcarbonate.

Rickert’s formula (Kerr’s Pulp Canal Sealer.): it was largely acceptable sealer.
Its major drawbacks were:
- The staining of tooth structure from the silver that was used for radiopacity.
- Rapid setting time, especially with heat
To overcome this disadvantage, researchers formulated Pulp Canal Sealer EWT
(Extended Working Time) for 6 hours
Tubli-Seal is a two-paste system contained in two separate tubes.
Developed as a nonstaining alternative to the silver-containing Pulp
Canal Sealer (barium sulfate ), Tubli-Seal is easy to mix but has the
disadvantage of rapid setting time.
Tubli-Seal EWT has the same properties as the regular setting Tubli-
Seal but has an extended working time.

Wach’s Sealer contains Canada balsam, which gives the material a sticky or
tacky property that softens the gutta-percha into a more homogeneous mass when used
with lateral compaction.
Nogenol was developed to overcome the irritating quality of eugenol.
Base is ZnO with Barium sulfate as radiopacifier along with vegetable oil.
Set is accelerated by hydrogenated rosin, chlorothymol and salicylic acid
 Calcium Hydroxide Sealers (Seal Apex)
Calcium hydroxide sealers were developed for therapeutic activity. It was thought
that these sealers would exhibit antimicrobial activity and have osteogenic–
cementogenic potential. Unfortunately, these actions have not been demonstrated

Disadvantages
• Calcium hydroxide may dissolve, leaving obturation voids.
• There is no objective proof that a calcium hydroxide sealer provides any added
advantage of root canal obturation or has any of the its desirable biological effects.
• Although calcium hydroxide has dentin regenerating properties, the formation of
secondary dentin along the canal wall is prevented by the absence of vital pulp tissue.
 Glass Ionomer Sealers (Ketac-Endo)

Glass ionomer cement is the reaction product of an ion-leachable glass powder and
a polyanion in aqueous solution. On setting it forms a hard polysalt gel, which
adheres tightly to enamel and dentin. Because of its adhesive qualities, it can be
used as root canal sealer
Advantages
1. Shows bonding to dentin
2. Shows minimum number of voids.
3. Low surface tension.
4. Optimal flow property

Disadvantages
It cannot be removed from the root canal in the event of retreatment as there is no
known solvent for glass ionomer. However, Toronto/Osract group has reported that
Ketac- endo sealer can be effectively removed by hand instruments or chloroform
solvent followed by 1 minute with an ultrasonic No. 25 file.
Activ GP consists of a glass ionomer–impregnated gutta-percha cone with
a glass ionomer external coating and a glass ionomer sealer.
This single cone technique is designed to provide a bond between the
dentinal canal wall and the master cone (monoblock).
 Resin Sealers

Resin sealers have a long history of use, provide adhesion, and do not contain
eugenol. There are two major categories: epoxy resin–based and methacrylate
resin–based sealers.
 Epoxy resin–based sealers
AH-26

Properties
1. Good adhesive property.
2. Good flow
3. Antibacterial
4. Contracts slightly while hardening
5. Low toxicity and well tolerated by periapical tissue.
6. The addition of a hardener, hexamethylene tetramine, makes the cured resin inert
chemically and biologically.
AH 26 consists of a yellow powder and viscous resin liquid and mixed to a thick creamy
consistency.
The setting time is 36 to 48 hours at body temperature and 5-7 days at room
temperature.
AH 26 produces greater adhesion to dentin especially when smear layer is removed. Smear
layer removal exposes the dentinal tubules creating an irriguler surface thus enhancing
adhesion.
 Epoxy resin–based sealers
AH Plus
Developed from its predecessor AH26
This is the material of choice where aesthetic demands are high because it does
not discolor teeth.
Minimal shrinkage upon setting as well as outstanding long-term dimensional
stability and sealing properties.
Epoxy resin–based sealers
 Methacrylate Resin Based sealers
1.First generation:

- Hydron was introduced in mid 1970.

- (poly{HEMA} is the major ingredient rendering the sealer hydrophilic.

- Hydron was designed to be injected into root canal.

- Disadvantages: A) severe inflammatory reaction

B) severe leakage, water sorption, swelling

2 .Second generation:

- EndoREZ is a dual cured radioopaque hydrophillic sealer

- Can be used in wet environment and very effective in penetrating dentinal tubules and
adapting closely to the canal walls
- EndoREZ can be used either with conventional gutta percha or endoREZ points.
To facilitate rapid cure of EndoREZ, an accelerator that is compatible with EndoREZ
has recently become availilbe.
3. Third generation:

(Fiberfill root canal sealer, Resilon/Epiphany system, Resinate, Realseal, and Smart
systems)

. Contain self-etching primer and dual cured resin root canal sealer.
4. Fourth generation:

(MetaSEAL sealer, Realseal SE)

- These are Self Adhesive sealers as combined etchant, primer and bonding agent into one step.

- Advantages:

- a) reduces the application time.

- B) reduce errors that might occur during each bonding step .

- MetaSEAL sealer should be used only with Lateral compaction technique since heat had
and adverse effects on the sealing ability and bond strength when used with MetaSEAL
sealer.
 Silicone based Sealers

RoekoSeal is a polydimethylsiloxane that has been reported to expand slightly on

setting

GuttaFlow and GuttaFlow2 are cold flowable matrices that are triturated.

They consist of gutta-percha added to RoekoSeal

The technique involves injection of the material into the canal, followed by placement
of a single master cone.

Evidence suggests that the material fills canal

irregularities with consistency and is biocompatible

 Calcium Silicate based Sealers
Based on mineral trioxide aggregate (MTA)

MTA primarily is composed of tricalcium silicate, dicalcium silicate, and a radiopaque

powder, bismuth oxide.

Bismuth oxide discolor the tooth, so some types of sealers contain zirconia dioxide
(zirconia) or tantalum oxide.

Tricalcium silicate cements/sealers set by reaction with water and form a highly alkaline
(pH of about 12) mixture consisting of a rigid matrix of calcium silicate hydrates and
calcium hydroxide.

MTA Fillapex , iRoot SP, Endo CPM Sealer, and MTA Plus.
 Medicated Sealers
Sealers containing paraformaldehyde are strongly contraindicated in endodontic
treatment

Patient treated with Sargenti paste in her mandibular left second premolar and first molar.
A, Pretreatment radiograph exhibits an osteolytic response associated with the premolar and a proliferative response
associated with the molar.
B, Posttreatment radiograph of the teeth.
C, One-year follow-up radiograph exhibiting osseous regeneration apical to the second premolar.
N2 sealer

N2 was introduced by Sargenti and Ritche

containing 6.5% paraformaldehyde as well as lead and mercury

The object of introducing formaldehyde within the root-filling is to obtain a continued

release of formaldehyde gas which causes prolonged fixation and antiseptic action.

Toxicity

Degree of irritation is severe with the overfilling when N2 is forced into the
maxillary sinus or mandibular canal that could result in persisting paresthesia
RC2B is similar to N2 formulation with removal of the heavy metals.

Other paraformaldehyde sealers include Endomethasone, SPAD, and Reibler’s paste.

The toxic effects of these materials on the pulp and periapical tissues have been
demonstrated over time
 METHODS OF SEALER PLACEMENT
Various methods are employed for placing sealer prior to inserting gutta percha master
cone. The common methods are:

1. Coating the master cone and placing the sealer in the canal with a pumping action.

2. Placing the sealer in the canal with a lentulo spiral.

3. Placing the sealer on the final file used at the corrected working length and turning
the file counterclockwise.

4. Injecting the sealer with special syringes.

 Sealer placement techniques vary with the status of apical foramen. If apex is open,
only apical one third of master cone is coated with sealer to prevent its extrusion into
periapical tissues. In closed apex root, any of above techniques can be used.