Bioceramic Sealer in Restorative Endodontics

and Application in Clinical Practices

Student Name: Tzu-Yi, Lin (Rico)
Professor: Beatriz Saez Prado/Caridad Gimeno Uribes
Introduction

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Bioceramic Sealer

• Tricalcium Silicate-Based Sealers

• First introduced during 1990s in the form of MTA

• Bioceramic sealer with modified radiopaque powder

(zirconium oxide)

– Whereas MTA used bismuth oxide

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Bioceramic Sealer

• pH around 12

• Once set exhibits less than 0.1% expansion

• Advantages:

– Convenience (Hydraulic Condensation)

– Time saving

– Consistent homogenous mix

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Objectives

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Objectives

• How bioceramic sealers act during root canal obturation

• Compare and evaluate the efficacy of bioceramic sealers

with previously used sealer materials

• Other clinical applications of bioceramic materials

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Materials and Methods

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Materials and Methods

• Cross-sectional cohort study (2004 – 2018)

• Keywords:

– Bioceramic sealer

– Epoxy sealer

– MTA Fillapex

• BOOLEAN search on Google Scholar

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Properties of an Ideal Root Canal Sealer
• Good adhesion • Bacteriostatic

• Hermetic seal • Slow setting

• Radiopacity • Insoluble

• Easy mix • Biocompatible

• No shrinkage • Retreatable

• No staining

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Compositions and Properties
• Compositions:

– Zirconium oxide

– Calcium silicates

– Calcium phosphate monobasic

– Calcium hydroxide

– Filler and thickening agents

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 Compositions and Properties
• Properties:
– Setting reaction:
Hydration • 2[CaO * SiO2] + 4H2O → 3CaO * 2SiO2 * 3H2O + Ca(OH)2
Reaction • 2[3CaO * SiO2] + 6H2O → 3CaO * 2SiO2 * 3H2O + 3Ca(OH)2
Precipitation • 7 Ca(OH)2 + 3Ca(H2PO4)2 → Ca10(PO4)6(OH)2 + 12H2O
Reaction

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Compositions and Properties
– Setting time, Flow:

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Compositions and Properties
– Adhesion:

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Compositions and Properties
– Biocompatibility and Cytotoxicity:

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Compositions and Properties
– Retreatability:

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Compositions and Properties
– Radiopacity and Discoloration:

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Compositions and Properties
– Antimicrobial properties:

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Compositions and Properties
– Antimicrobial properties:

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Other Clinical Applications

• Root repair: • Surgical:

– Perforation – Retrograde filling

– Resorption – Apexification

• Pulp capping: • Additional material:

– Indirect – BC Liner

– Direct

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Conclusions

• Good adhesion • Bacteriostatic

• Hermetic seal • Slow setting

• Radiopacity • Insoluble

• Easy mix • Biocompatible

• No shrinkage • Retreatable

• No staining

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Discussions

• Complete 3D root canal obturation is only part of a

successful endodontics treatment

• Benefitted both clinicians and patients

• But will require a revised retreatment protocols or a

improved common solvent

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Bibliographies
• Nasseh A. Advancements in endodontic techniques have helped both the efficacy and efficiency of this critical
treatment modality. Inside Dentistry [Internet]. 2011 [cited 6 February 2019];(6):88-89. Available from:
https://www.aegisdentalnetwork.com/id/2011/06/digital-edition/
• Bansode P, Pathak S, Wavdhane M, Chavan P. A Review of Bioceramic Sealers in Endodontic. IOSR Journal of Dental
and Medical Sciences. 2018;17(5):82-86.
• Nasseh A. The Age of Bioceramics - Improving endodontic care with innovative products. Inside Dentistry [Internet].
2015 [cited 6 February 2019];11(4):42-44. Available from: https://www.aegisdentalnetwork.com/id/special-
issues/products-in-practice/2015/11/digital-edition/
• Hargreaves K, Berman L. Cohen's Pathways of the Pulp. 11th ed. Elsevier; 2016.
• EndoSequence Bioceramic Technology [Internet]. Brasseler USA; 2012 [cited 6 February 2019]. Available from:
http://brasselerusadental.com/wp-content/files/B-3644-Bioceramic-Brochure.pdf
• Rawtiya M, Verma K, Singh S, Munuga S, Khan S. MTA-Based Root Canal Sealers. Journal of Orofacial Research.
2013;3(1):16-21.
• Kontogiannis T, Kerezoudis N, Kozyrakis K, Farmakis E. Removal ability of MTA-, bioceramic-, and resin-based sealers
from obturated root canals, following XP-endo Finisher R file: An ex vivo study. Saudi Endodontic Journal.
2019;9(1):8-13.
• Candeiro G, Correia F, Duarte M, Ribeiro-Siqueira D, Gavini G. Evaluation of Radiopacity, pH, Release of Calcium Ions,
and Flow of a Bioceramic Root Canal Sealer. Journal of Endodontics. 2012;38(6):842-845.
• TotalFill Premixed Bioceramic Materials. FKG Dentaire SA; 2018.

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Bibliographies
• S, Pushpa S, Sawhny A, Singh A, Ashraf F, Nigam SA. The Advent of Bioceramics in Dentistry: A Review. Rama Univ J
Dent Sci. 2016;3(1):6-10.
• AL-Haddad A, Che Ab Aziz Z. Bioceramic-Based Root Canal Sealers: A Review. International Journal of Biomaterials.
2016;2016:1-10.
• Candeiro G, Correia F, Duarte M, Ribeiro-Siqueira D, Gavini G. Evaluation of Radiopacity, pH, Release of Calcium Ions,
and Flow of a Bioceramic Root Canal Sealer. Journal of Endodontics. 2012;38(6):842-845.
• Zhou H, Shen Y, Zheng W, Li L, Zheng Y, Haapasalo M. Physical Properties of 5 Root Canal Sealers. Journal of
Endodontics. 2013;39(10):1281-1286.
• Lee J, Kwak S, Ha J, Lee W, Kim H. Physicochemical Properties of Epoxy Resin-Based and Bioceramic-Based Root Canal
Sealers. Bioinorganic Chemistry and Applications. 2017;2017:1-8.
• EndoSequence BC Sealer and BC Sealer HiFlow. Brasseler USA; 2018.
• TotalFill BC Sealer and BC Sealer HiFlow. FKG Dentaire SA; 2019
• M.D. Sousa-Neto, F.I. Silva Coelho, M.A. Marchesan, E. Alfredo, and Y.T.C. Silva-Sousa ― Ex vivo study of the adhesion
of an epoxy-based sealer to human dentine submitted to irradiation with Er: YAG and Nd: YAG lasers, ‖ International
Endodontic Journal, vol. 38, no. 12, pp. 866–870, 2005.
• R.S. Schwartz, Adhesive dentistry and endodontics. Part 2: Bonding in the Root Canal System — The Promise and the
Problems: A Review, ‖ Journal of Endodontics, vol. 32, no. 12, pp. 1125–1134, 2006.
• Ghoneim A, Lutfy R, Sabet N, Fayyad D. Resistance to Fracture of Roots Obturated with Novel Canal-filling Systems.
Journal of Endodontics. 2011;37(11):1590-1592.

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Bibliographies
• Loganathan M. Comparative Evaluation of Penetration Depth and Push-out Bond Strength of C Points and Gutta
percha using Bioceramic Sealer and AH Plus Sealer - An In Vitro Study. 2018.
• Poggio C, Riva P, Chiesa M, Colombo M, Pietrocola G. Comparative cytotoxicity evaluation of eight root canal sealers.
Journal of Clinical and Experimental Dentistry. 2017;9(4):574-578.
• Ersev H., Yilmaz B., Dinçol M. E., Daǧlaroǧlu R. The efficacy of ProTaper Universal rotary retreatment instrumentation
to remove single gutta-percha cones cemented with several endodontic sealers. Int Endod J. 2012; 45 (8): 756-62.
• Hess D, Solomon E, Spears R, He J. Retreatability of a Bioceramic Root Canal Sealing Material. Journal of Endodontics.
2011;37(11):1547-1549.
• 6876:2012 I. ISO 6876:2012 [Internet]. ISO. 2019 [cited 6 February 2019]. Available from:
https://www.iso.org/standard/45117.html
• Haapasalo M, Parhar M, Huang X, Wei X, Lin J, Shen Y. Clinical use of bioceramic materials. Endodontic Topics.
2015;32(1):97-117.
• EndoSequence BC Liner and EndoSequence CBM+. Brasseler USA; 2019.
• Nasseh A. This bioactive liner interfaces between bioceramic and restorative materials | Endodontic Practice US
[Internet]. Endodontic Practice US. 2019 [cited 22 April 2019]. Available from: https://www.endopracticeus.com/case-
https://www.endopracticeus.com/case-studies/bioceramic-liner-material-bridging-the-gap-between-bioceramics-
and-restorative-material/

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