Friday, October 26, 2007

Resorption of Endodontic Sealer

Endodontic sealers play an important role in the obturation (filling) of a root canal. The sealer coats the walls of the canals and fills the space between the root canal filling material and the root. Their antimicrobial activity likely plays a very important role in the overall documented success of endodontic therapy.

There are many kinds of endodontics sealers. They can be grouped into these categories:
1. Zinc Oxide-Eugenol (Roths)
2. Chloropercha (Kloroperka)
3. Calcium Hydroxide (Sealapex, CRCS, Apexit)
4. Polymers (AH26, AHPlus, Diaket, Endofill, Resilon)

I am using a Roth's sealer in my practice. Here are a couple of reasons that I like using a Roth's sealer.
1. Antimicrobial - the Zinc oxide has well known antimicrobial activity
2. No need to remove the smear layer - since I am using a gutta percha filler, I prefer to leave the smear layer
3. Resorbabilty - any sealer that is extruded past the apex will resorb over time.

Here is an example of a case where a significant amount of sealer was extruded.



At a 2 year recall, you can see that the majority of the sealer has resorbed.



6 comments:

Aly said...

Do you put Resilon in the Polymer category?

Also why does one not need to remove the smear layer for a ZOE sealer?

Ameloblast said...

I use Roth also. I do sometimes think about the solubility of the sealer and thus that coronal leakage is more of a problem with ZOE sealers.

I have yet to be convinced that smear layer removal increases the prognosis of endo in infected cases. As far as I know there's no definitive in vivo evidence of this.

Jason J. Hales D.D.S., M.S. said...

Yes, Resilon would be in the polymer category.

Keeping in mind that most studies regarding the smear layer are in-vitro, micro-leakage studies...

Kennedy (1986) found removal of smear layer improved the sealing of root canals.
Evans & Simon (1986)found removal of smeal layer had no effect on leakage.
Karagox-Kucukay and Bayirili (1994) found no difference with or without smear layer. But when sealer CRCS was used, presence of smear layer increased leakage.
Economides (1999) found that removal of smear layer decreased leakage with AH26 (resin) sealer, but presence or absence of smear layer had no significant effect with Roth 811.
I would recommend a read of this last study. Economides, N., Liolios, E., Kolokuris, I., Beltes, P. "Long Term Evaluation of the Influence of Smear Layer Removal on the Sealing Ability of Different Sealers", 1999, JOE 25:2, p 123-125.

The smear layer is made up of organic and inorganic debris.
If the smear layer is removed, then supposedly, the resin sealer should bond to the dentin tubules and provide a better seal. If the smear layer is present, then there can be no "bonding" of the resin sealer to the dentin.
For a ZOE sealer, the smear layer may actually improve the seal. A ZOE sealer is is not "bonding" so it doesn't need direct contact to the dentin walls.

anas said...

what about cortizomol from 3m espe co

Anonymous said...

I used EndoSequence BC Sealer.
This is a BioCeramic (Calcium Phosphate Silicate) Cement, which is for resorpiton of Endo Sealer.

New BioCeramic Sealer is the next generation Endodontic sealer.

Rina said...

I know my teachers who are using ZNOE from so many years and they are getting effective results.it all depends upon ur cleaning and shaping