Endodontic obturation is the last but not least step of the root canal treatment. The sequential procedures during the rigorous treatment protocol are critical for a successful outcome in endodontics, starting from a correct diagnosis, access opening and cleaning and shaping of the root canal system. Obturation is important because it will help prevent the penetration of microorganisms through the canal system and promote the healing of the periapical tissues with an end result of saving the tooth. Placement of the final restoration returns the tooth to proper function and esthetics.

Obturation techniques have changed over the years, not only by the development of new devices but also by the development of new materials to overcome the clinical challenges in endodontics. Instruments such as the Optura warm (flowable) gutta percha gun and the resin-based sealers are some of examples.

Recently, bioceramic sealers have been shown to be very promising for the improvement of endodontic obturation.  Bioceramic cements, such as Mineral Trioxide Aggregate (MTA) have been used for more than 20 years in Endodontics to seal perforations, the prepared apex in apicoectomy procedures, and on the exposed pulp in vital pulp therapy. These cements have high biocompatibility and also have the advantage of setting even in the presence of moisture. Bioceramic materials are hydrophilic – maintaining their properties even in the warm humid climate of the root canal system.  As we know, the dentinal root canal walls are wet in nature due to dentinal and periapical tissue fluids.

Clinical situations such as, perforations, resorptions, open apices and apical preparation (apicectomies), can be complex situations due to the difficulty in controlling humidity due to bleeding. The bioceramic cements are able to set under these conditions and have the added benefit of a chemical bond to dentin creating a tight seal. These cements in contact with periapical tissues or dental pulp can act as a natural scaffold for stem cells to attach and grow, initiating a matrix synthesis and mineralized tissue formation, such as dentin or bone.

The latest advance in bioceramic sealers, has been the decrease in particulate size. Bioceramics are now made with nanoparticles. Extremely small particle size makes them more flowable and easy to manipulate. In addition,  they can be distributed into root canal irregularities and anatomical variations such as lateral canals, fins and isthmuses.

The main composition of these sealers is a combination of tricalcium silicates (with zirconia as radiopacifier) that react by hydration and form calcium silicate hydrate and calcium hydroxide. In contrast with the previous cement formulation that used bismuth-oxide and aluminum, these metals are no longer added resulting in a minimal chance to discolor the natural teeth and making the new endodontic bioceramic sealers safer to use in our patients.

Biocompatibility, optimum seal, insolubility, good tissues response, as well as easy manipulation make the bioceramic sealers an optimal choice in modern endodontics. These bioceramic sealers have also minimal expansion instead of shrinkage making the seal better and more predictable. Although there is a high pH that gives some antibacterial effect and can also affect the tissue attachment, in general the biocompatibility is very high. There is mounting evidence that these new sealers induce cell attachment and bone healing.

Sealers have traditionally served as auxiliary materials to the core material, mostly gutta-percha. The properties of these new sealers make them much more favorable as the core material and a new technique called single cone obturation has been developed and supported for at least the last 5 years. The best evidence has been demonstrated by retrospective studies showing as high as 90% success healing and no significant difference as compared with resin-based sealers. More clinical trials longer follow-up time are needed to give best evidence and support.

Professional Endodontics group has adopted this new endodontic bioceramic sealer and single cone technique to give to our patient and referring dentist the best optimal service for a successful outcome and satisfaction.

About Professional Endodontics

Professional Endodontics has been exceeding the standard of care in Wayne and Macomb counties for over 50 years.  The team specializes in treating issues with the inside of the tooth and goes out of its way to provide a safe easy environment for patients. Each member of the practice is dedicated to providing excellence in patient care and values high-quality relationships with referring dentists and specialists.  Each endodontist at Professional Endodontics has been individually chosen as Hour Detroit Magazine’s Best Dentists.  Thanks to contemporary advances in endodontics, Professional Endodontics is able to use innovative technology to treat and save teeth that have suffered damage to the soft tissue within the roots of the tooth.

Professional Endodontics offers state-of-the-art facilities in Clarkston, Clinton Township, St. Clair Shores, and Southfield.  All locations offer the latest in advanced dental delivery systems, microscopy, and digital radiography.

Clarkston
6803 Dixie Highway
Suite 3
Clarkston, MI 48346
(248) 358-2910

Southfield
29201 Telegraph Road
Suite 110
Southfield, MI 48034
(248) 358-2910

Clinton Township
Henry Ford Hospital Medical Pavilion
16151 19 Mile Rd, Suite 101
Clinton Township, MI 48038
(586) 286-7000

St. Clair Shores
St. Clair Professional Plaza
23829 Little Mack, Suite 300
St. Clair Shores, MI 48080
(586) 779-9690

References:

  1. Trope M, Bunes A, Debelian G. Root filling materials and techniques: bioceramics a new hope? Endodontic Topics 2015, 32, 86–96.

  2. Almeida L, Moraes RR, Morgental RD, Pappen FG. Are Premixed Calcium Silicate–based Endodontic Sealers Comparable to Conventional Materials? A Systematic Review of In Vitro Studies. J Endod 2017;43:527-535.

  3. Parirokh M, Torabinejad M, Dummer PMH. Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview – part I: vital pulp therapy. Int Endod J. 2018 Feb;51(2):177-205.

  4. Chybowski EA, Glickman GN, Patel Y, Fleury A, Solomon E, He J. Clinical Outcome of Non-Surgicalm Root Canal Treatment Using a Single-cone Technique with Endosequence Bioceramic Sealer: A Retrospective Analysis. J Endod. 2018 Jun;44(6):941-945.

  5. Angerame D, De Biasi M, Pecci R, Bedini R. Filling ability of three variants of the single-cone technique with bioceramic sealer: a micro-computed tomography study. J Mater Sci Mater Med. 2020 Oct 21;31(11):91

  6. Yanpiset K, Banomyong D, Chotvorrarak K, Srisatjaluk RL. Bacterial leakage and micro-computed tomography evaluation in round-shaped canals obturated with bioceramic cone and sealer using matched single cone technique. Restor Dent Endod. 2018 Jul 5;43(3).

  7. Wang Y, Liu S, Dong Y. In vitro study of dentinal tubule penetration and filling quality of bioceramic sealer. PLoS One. 2018 Feb 1;13(2).

  8. Candeiro GTM, Lavor AB, Lima ITF, Vasconcelos BC, Gomes NV, Iglecias EF, Gavini G. Penetration of bioceramic and epoxy-resin endodontic cements into lateral canals. Braz Oral Res. 2019 May 27;33:e049.

  9. Al-Hiyasat AS, Alfirjani SA. The effect of obturation techniques on the push-out bond strength of a premixed bioceramic root canal sealer. J Dent. 2019 Oct;89:103169.

  10. Garrib M, Camilleri J. Retreatment efficacy of hydraulic calcium silicate sealers used in single cone obturation. J Dent. 2020 Jul;98:103370.

  11. Roizenblit RN, Soares FO, Lopes RT, Dos Santos BC, Gusman H. Root canal filling quality of mandibular molars with EndoSequence BC and AH Plus sealers: A micro-CT study. Aust Endod J. 2020 Apr;46(1):82-87.