Endodontics sealers
Reading File
Finding Sources
Finding Sources
Searching Images
endodontic root canal sealer types classification
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Searching PubMed
endodontic sealers classification properties
Searching the Web
endodontic sealers classification types properties 2024
The library doesn't contain dentistry/endodontics books. I have solid information from PubMed and web sources to compose a thorough answer now.
Endodontic Sealers
Endodontic sealers are adhesive cements placed between the core filling material (usually gutta-percha) and the root canal walls during obturation. They fill accessory canals, lateral canals, and irregularities that the core material cannot physically reach, providing a fluid-tight seal that prevents bacterial reinfection.
Ideal Properties (Grossman's Criteria)
| Property | Detail |
|---|---|
| Adhesion | Bonds to both dentinal walls and core filling material |
| Radiopacity | Distinguishable from surrounding tissues on radiograph |
| Dimensional stability | Minimal shrinkage on setting |
| Biocompatibility | Non-toxic, non-irritating to periapical tissues |
| Antimicrobial | Inhibits residual bacteria |
| Insolubility | Resists tissue fluids after setting |
| Retreatability | Removable when needed |
| Flow/consistency | Low viscosity to penetrate canal irregularities |
| Slow set | Adequate working time |
| Non-staining | Does not discolor tooth structure |
Classification by Chemical Composition
1. Zinc Oxide-Eugenol (ZOE) Based Sealers
The oldest and historically most-used group.
Examples: Grossman's sealer, Rickert's formula (Kerr), Tubliseal, Wach's paste, Procosol, Nogenol
Composition (Grossman's):
- Powder: zinc oxide, staybelite resin, bismuth subcarbonate, barium sulfate, sodium borate
- Liquid: eugenol
Properties:
- Good radiopacity, long working time, easy manipulation
- Eugenol is mildly irritating and cytotoxic initially
- Soluble over time - main drawback
- Antibacterial due to eugenol release
- Classic "gold standard" against which newer sealers are compared
Uses: Still widely used for routine obturation, especially in cases with no eugenol allergy
2. Calcium Hydroxide-Based Sealers
Designed to provide ongoing antibacterial activity and promote hard tissue formation.
Examples: Sealapex, Apexit, Apexit Plus, CRCS, Calcibiotic (CRCS), Vitapex, Calapex
Composition: Ca(OH)₂ as active component in various polymer/resin bases
Properties:
- Releases OH⁻ ions - strong antimicrobial, pH >12
- Promotes periapical healing and hard-tissue bridge formation
- Highly soluble over time (major disadvantage) - released Ca(OH)₂ leaves voids
- Poor long-term sealing ability due to dissolution
- Biocompatible, biodegradable
Uses: Immature teeth, open apices, cases requiring apical stimulation; however, long-term sealing is inferior to resin-based sealers
3. Epoxy Resin-Based Sealers
Currently the most widely used group in clinical practice; considered the clinical benchmark.
Examples:
- AH 26 (Dentsply) - bisphenol diglycidyl ether, silver powder
- AH Plus (Dentsply Sirona) - paste-paste system, improved version of AH 26 (no silver, less formaldehyde release)
- Diaket - polyvinyl resin
- Epiphany / Resilon - methacrylate resin
- EndoRez (Ultradent)
Properties:
- Excellent adhesion to dentinal walls via chemical bonding (amine groups react with collagen)
- Very low solubility and dimensional stability
- Good radiopacity
- AH 26 releases formaldehyde initially - cytotoxic; AH Plus is significantly less toxic
- Excellent long-term sealing ability
- Difficult to remove during retreatment (bonds strongly)
- No antimicrobial properties per se
Uses: Gold standard for obturation in most routine endodontic cases
4. Calcium Silicate (Bioceramic) Sealers
The fastest-growing group; now considered superior in biocompatibility and sealing.
Examples:
- iRoot SP / EndoSequence BC Sealer / TotalFill BC Sealer / Edge Endo Sealer (Brasseler/FKG)
- BioRoot RCS (Septodont) - tricalcium silicate
- MTA Fillapex (Angelus) - MTA + resin
- Ceraseal, Endoseal MTA (Maruchi)
- AH Plus Bioceramic (Dentsply Sirona)
- Bio-C Sealer (Angelus)
Composition: Calcium silicates (tricalcium silicate, dicalcium silicate), calcium phosphate, calcium hydroxide, zirconium oxide (radiopacifier), water
Setting reaction:
Calcium silicate + H₂O → calcium silicate hydrate gel + Ca(OH)₂ → hydroxyapatite (HA) forms at the sealer-dentine interface
Properties:
- Superior biocompatibility - rated highest among all sealers
- Hydrophilic - requires moisture to set (advantageous in clinical conditions)
- Produces hydroxyapatite on setting - chemical bonding with dentinal wall
- Dimensional stability or slight expansion on setting
- Antibacterial (high pH)
- Promotes periapical healing and hard tissue regeneration
- Premixed, single-syringe form - convenient
- Less retrievable than ZOE-based sealers
- Calcium silicate-based sealers meet ISO 6876:2012 specifications
Uses: Current preference in single-visit endodontics, open apices, MTA-associated techniques; recent PMC review (2024) confirms superior sealing and biological properties
5. Silicone-Based Sealers
Polydimethylsiloxane (PDMS)-based materials.
Examples: Endo-Fill, Roeko Seal, GuttaFlow, GuttaFlow 2, GuttaFlow Bioseal
Properties:
- GuttaFlow contains gutta-percha powder suspended in silicone - acts as both sealer and core material
- Excellent biocompatibility
- Slight shrinkage is negligible
- Radiopaque (silver powder in GuttaFlow)
- No antimicrobial properties
- Good flowability at body temperature
Uses: Single-cone technique combined with injectable sealer; suitable for retreatment cases
6. Glass Ionomer-Based Sealers
Examples: Ketac-Endo (3M ESPE), Endion
Properties:
- Chemical adhesion to dentin via polyalkenoate chains
- Fluoride release - antimicrobial, anti-caries
- Hydrophilic setting
- Rigid after set - difficult to remove during retreatment
- Moderate biocompatibility
- Less popular due to poor long-term clinical outcomes
7. Medicated/Paraformaldehyde-Based Sealers
Examples: N2 (Sargenti), Endomethasone, RC2B, Endomethasonum
Composition: Paraformaldehyde + corticosteroids (dexamethasone/prednisolone)
Properties:
- Strong antimicrobial - paraformaldehyde releases formaldehyde continuously
- Significant tissue toxicity - apical and periapical damage documented
- Risk of neurotoxicity if expressed beyond apex
- Anti-inflammatory (corticosteroid component)
- Controversial - not recommended by most endodontic associations (AAE, ESE)
- Largely abandoned in modern practice
Comparison Summary
| Sealer Type | Biocompatibility | Solubility | Adhesion | Antimicrobial | Retreatability |
|---|---|---|---|---|---|
| ZOE-based | Moderate | High | Moderate | Yes (eugenol) | Easy |
| Ca(OH)₂-based | Good | Very high | Poor | Yes | Easy |
| Epoxy resin | Moderate-Good | Very low | Excellent | Poor | Difficult |
| Bioceramic | Excellent | Very low | Excellent | Yes (pH) | Moderate |
| Silicone | Good | Very low | Moderate | Poor | Moderate |
| Glass ionomer | Moderate | Low | Good | Yes (F⁻) | Difficult |
| Medicated | Poor | Moderate | Poor | Excellent | Moderate |
Current Clinical Trends
- Bioceramic sealers are increasingly favored due to their combination of excellent biocompatibility, sealing ability, and regenerative potential. A 2024 review in Histology and Histopathology (PMID 37747049) confirmed bioceramic sealers outperform traditional materials on most ideal property criteria.
- AH Plus remains the epoxy resin benchmark and is still widely used in clinical research as a positive control.
- The single-cone technique with bioceramic sealer has gained traction as evidence supports comparable outcomes to warm vertical compaction when appropriate canal shaping is achieved.
- Medicated sealers (N2, Endomethasone) are condemned by the AAE and ESE due to paraformaldehyde toxicity.
- Research focus is shifting toward nanoparticle incorporation (silver, chitosan, chlorhexidine nanoparticles) into existing sealer bases to enhance antimicrobial performance.
This is a shared conversation. Sign in to Orris to start your own chat.