endodontic sealers

Endodontic Sealers- Their Properties Endodontic Sealers- Their Properties and Effects on Fiber Post Retentionand Effects on Fiber Post Retention

To obtain fiber post retention To obtain fiber post retention with 2 endodontic sealers and with 2 endodontic sealers and 2 cements2 cements

PurposePurpose

11stst part of the study- part of the study- Post Indications Post Indications

The primary purpose of post The primary purpose of post is to retain the core build up is to retain the core build up material or to reinforce the material or to reinforce the remaining tooth structure to remaining tooth structure to provide retention for the provide retention for the final restoration.final restoration.

Rosenstiel of fixed prosthodontics.9Rosenstiel of fixed prosthodontics.9thth Ed. Ed.

Post Classification

Custom Prefabricated

Can be cast from:-Direct pattern in pt mouth

- In direct pattern in laboratory

•Noble alloy•Carbon fiber posts•Composite fiber posts•Ceramic (zirconia) posts

– ceramic composite

•William C. A review of the management of endodontically treated teeth: post and core and the final William C. A review of the management of endodontically treated teeth: post and core and the final restoration.2005; J Am Dent Assoc.restoration.2005; J Am Dent Assoc.

Evolution of the Fiber PostEvolution of the Fiber Post1995: C-POST

1997: AESTHETI-POST

1998: U.M. AESTHETI-PLUS

1999: AESTHETI-PLUS

1999:LIGHT-POST

2001

D. T. (double-taper)LIGHT-POST®

Advantages of Composite Advantages of Composite Fiber PostFiber Post Can bonded to the tooth with resin Can bonded to the tooth with resin

cementcement Modulus of elasticity similar to dentinModulus of elasticity similar to dentin Ease of removal for retreatmentEase of removal for retreatment Excellent estheticsExcellent esthetics Non corrosiveNon corrosive

• Richard S.S.Post placement and restoration of edodontically terated teeth.2004; J EndodRichard S.S.Post placement and restoration of edodontically terated teeth.2004; J Endod

Fiber posts absorb stress as a result have different root fracture location

Twin luscent. Light transmitting esthetic posts for endodontically treated teeth

Fracture with metal postsFracture with metal posts

FracturedFracturedrootroot

Vector Vector of of

ForceForce

FracturedFracturedrootroot

Vector Vector of of

ForceForce

Fracture location with Fracture location with fiber postsfiber posts

DisadvantagesDisadvantages

Their retention is based on the bond Their retention is based on the bond strength – technique sensitive.strength – technique sensitive.

Many fiber posts are not radiopaqueMany fiber posts are not radiopaque

• Richard S.S.Post placement and restoration of edodontically terated teeth.2004; J EndodRichard S.S.Post placement and restoration of edodontically terated teeth.2004; J Endod

Types of luting cementTypes of luting cement

Etch-and-rinse adhesiveEtch-and-rinse adhesive Self-etch adhesiveSelf-etch adhesive Self-adhesiveSelf-adhesive Glass-ionomer adhesiveGlass-ionomer adhesive

Factors affecting post Factors affecting post retentionretention Post lengthPost length

--Increased Increased Length = More Length = More RetentionRetention

-Longer -Longer Length = More Length = More PerforationPerforation

Post diameterPost diameter Post designPost design Luting cementLuting cement Canal shape Canal shape

William C. A review of the management of endodontically treated teeth: post and core and the final restoration.2005; J Am William C. A review of the management of endodontically treated teeth: post and core and the final restoration.2005; J Am Dent AssocDent Assoc

Literature reviews- post Literature reviews- post retention (push out tests)retention (push out tests)

Francesca Z et al.(2008), 50 extracted teeth Francesca Z et al.(2008), 50 extracted teeth Panavia F, Clearfil, Panavia F, Clearfil, Variolink II, Rely X Unicem, Experimental GCVariolink II, Rely X Unicem, Experimental GC. . No significant No significant difference among coronal, middle, apical sections for post retention difference among coronal, middle, apical sections for post retention or sealor seal. Clearfil (14.6± 4) and Panavia (12.6 ±2) significantly higher . Clearfil (14.6± 4) and Panavia (12.6 ±2) significantly higher than the othersthan the others

Vivian JJW. Ya-ming C et al.(2008), measured post retention for Vivian JJW. Ya-ming C et al.(2008), measured post retention for two fiber reinforced post types two fiber reinforced post types ( carbon fiber post – quartz fiber ( carbon fiber post – quartz fiber reinforced posts)reinforced posts) cemented with (total etch resin cement cemented with (total etch resin cement/C&B and a /C&B and a self-adhesive resin cement Rely X Unicemself-adhesive resin cement Rely X Unicem), ), The total etch The total etch adhesive had significantly better post retention the self adhesive adhesive had significantly better post retention the self adhesive cement. BScement. BS coronal→ apical coronal→ apical

Ayse D et al.(2007), Compared retention produced by a total etch Ayse D et al.(2007), Compared retention produced by a total etch resin cement (Variolink II) and a self adhesive cement (Unicem) for resin cement (Variolink II) and a self adhesive cement (Unicem) for 4 reinforced posts using a push-out test. 4 reinforced posts using a push-out test. Fiber composite posts with Fiber composite posts with Variolink II had the greatest bond strength.Variolink II had the greatest bond strength.

22ndnd part- Microleakage part- Microleakage

Passage of fluid and bacteria Passage of fluid and bacteria between the sealer and the dentin.between the sealer and the dentin.

Coronal leakageCoronal leakage Apical leakage Apical leakage

AM Yung.AM Yung.Direct Aesthetic Dental Restoratives: Microleakage and adhesionDirect Aesthetic Dental Restoratives: Microleakage and adhesion

Coronal microleakage leads toCoronal microleakage leads to: : DiscolorationDiscoloration Recurrent cariesRecurrent caries Apical microleakage leads to:Apical microleakage leads to: Apical infection Apical infection


Microleakage (cont’d)

Causes of MicroleakageCauses of Microleakage

Polymerization shrinkage of the sealerPolymerization shrinkage of the sealer Sealer porositySealer porosity Poor adhesion of the sealerPoor adhesion of the sealer


Types of SealersTypes of Sealers

Eugenol based sealers:Eugenol based sealers: – Zinc – oxide eugenolZinc – oxide eugenol

Non- Eugenol based sealers:Non- Eugenol based sealers: Calcium – hydroxide cementCalcium – hydroxide cementResin based cementResin based cementGlass ionomer cementsGlass ionomer cements

Ingle J.Endodontics.4Ingle J.Endodontics.4thth Ed Ed

Good adhesion to root dentinGood adhesion to root dentin Produce a hermitic seal Produce a hermitic seal RadiopaqueRadiopaque Have low shrinkageHave low shrinkage Slow set Slow set BacteriostaticBacteriostatic Insoluble in tissue fluidInsoluble in tissue fluid Non-irritatingNon-irritating Soluble in common solventSoluble in common solvent Non stainingNon staining Ingle J.Endodontics.4Ingle J.Endodontics.4thth Ed Ed..

Ideal root canal sealersIdeal root canal sealers

Microleakage measuredMicroleakage measured

Dye penetrationDye penetration

*Dyes used:*Dyes used: -India Ink-India Ink -Methylene Blue-Methylene Blue -Silver Nitrate -Silver Nitrate

Cristina BX. Ruben W. Root end filling materials: apical microleakage and marginal Cristina BX. Ruben W. Root end filling materials: apical microleakage and marginal adaptation.2005adaptation.2005

Dye penetrationDye penetration

Factors affecting dye penetration techniques:Factors affecting dye penetration techniques:

Air bubbles in the canalAir bubbles in the canal pH of the dyepH of the dye Molecular weight of the dyeMolecular weight of the dye Immediate immersion / delayed immersion in the dyeImmediate immersion / delayed immersion in the dye Tooth anatomyTooth anatomy Skill of the operatorSkill of the operator Type of sealerType of sealer

A.Tamse .A. Katz F. Kablan.Comparison of apical leakage shown A.Tamse .A. Katz F. Kablan.Comparison of apical leakage shown by four different dyes with two evaluating methods.1998by four different dyes with two evaluating methods.1998

--Streptococcus mutans Streptococcus mutans mostly usedmostly used

--Viability of the freshly Viability of the freshly inoculated bacteria is inoculated bacteria is requiredrequired

Francesca M. efficacy of two contemporary single- cone filling techniques in Francesca M. efficacy of two contemporary single- cone filling techniques in preventing bacterial leakage.2006preventing bacterial leakage.2006

Bacterial filtrationBacterial filtration

Fluid Filtration TechniqueFluid Filtration Technique

Hasan O, et al. Apical Leakage of Resin Based Root Canal Sealers with a New Computerized Fluid Filtration Meter JOE 2005

Microleakage Literature ReviewMicroleakage Literature Review

F.Kont Cobenkara et al. (2002) Measured F.Kont Cobenkara et al. (2002) Measured microleakage of endodontic fillings using 4 root microleakage of endodontic fillings using 4 root canal sealers (AH Plus, Roeko seal, Ketac-Endo, canal sealers (AH Plus, Roeko seal, Ketac-Endo, Sultan) by aSultan) by a fluid filtration method, fluid filtration method, Roeko Seal and Roeko Seal and AH Plus had better seal than Ketac-Endo or Sultan.AH Plus had better seal than Ketac-Endo or Sultan.

Fernando G et al.(1995), compared the sealing Fernando G et al.(1995), compared the sealing ability of Ketac-Endo and Tubli Seal. Teeth using ability of Ketac-Endo and Tubli Seal. Teeth using India ink 7 day immersion and cleared. Stain India ink 7 day immersion and cleared. Stain measured at X50.measured at X50.No significant difference between No significant difference between groups.groups.

33rdrd Part -Effects of Eugenol Part -Effects of Eugenol on Post Retentionon Post Retention

Most sealers contain zinc oxide eugenol (ZOE)Most sealers contain zinc oxide eugenol (ZOE)

Adversely affects composite resins…Adversely affects composite resins…

Reduced transverse or bending strength Reduced transverse or bending strength (Reisbick 1971)(Reisbick 1971)

Decreased surface hardness Decreased surface hardness (Rosenstiel & Gegauff 1988)(Rosenstiel & Gegauff 1988)

Interfere with dentinal bonding of resins Interfere with dentinal bonding of resins (Hansen& Asmussen 1987)(Hansen& Asmussen 1987)

Literature ReviewLiterature Review

No significant difference in post retention in teeth No significant difference in post retention in teeth containing eugenolcontaining eugenol and non-eugenol root canal and non-eugenol root canal sealers. S.T Davis et al.(2007)sealers. S.T Davis et al.(2007)

The group filled with GP and The group filled with GP and ZOE sealerZOE sealer had had lower lower bond strength than the one without sealerbond strength than the one without sealer. Edson A . Edson A et al.(2006) et al.(2006)

No significant influence on the mean retention of No significant influence on the mean retention of endodontic post luted with composite resin endodontic post luted with composite resin cementcement .Teeth were obturated with GP and different .Teeth were obturated with GP and different root canal sealers (ZOE, AH 26,CaOH). Hagge et al.root canal sealers (ZOE, AH 26,CaOH). Hagge et al.(2002),(2002),

No difference in post retention with ZOE or CAOHNo difference in post retention with ZOE or CAOH when prefabricated posts luted with resin cement. when prefabricated posts luted with resin cement. David R B et al.(2000) David R B et al.(2000)

Specific AimsSpecific Aims

In endodontically treated teethIn endodontically treated teeth To measure and compare the leakage of To measure and compare the leakage of

glass ionomer and zinc oxide eugenol glass ionomer and zinc oxide eugenol sealers.sealers.

To evaluate the retention of 40 fiber post To evaluate the retention of 40 fiber post using 2 cements-a self-etching and a self- using 2 cements-a self-etching and a self- adhesive.adhesive.

HypothesesHypotheses

There will be no significant difference in leakage There will be no significant difference in leakage when using glass ionomer (Activ-GP) or zinc oxide when using glass ionomer (Activ-GP) or zinc oxide eugenol (Roth’s) eugenol (Roth’s)

There will be no significant difference in post There will be no significant difference in post retention when the posts are cemented with a self-retention when the posts are cemented with a self-adhesive (Rely X Unicem) or dual-cure (Panavia F adhesive (Rely X Unicem) or dual-cure (Panavia F 2.0) cement.2.0) cement.

There will be no effect on post retention of either There will be no effect on post retention of either cement by the zinc oxide eugenol or glass ionomer cement by the zinc oxide eugenol or glass ionomer

sealerssealers

Study DesignStudy Design

40 mandibular

premolars

10 teeth +ZOE+ fiber post+

Rely X Unicem

10 teeth+ ZOE + fiber post+

Panavia F 2.0

10 teeth + GICs+ fiber post

+Rely X Unicem

10 teeth+ GICs+fiber post

+Panavia F2.0

Gutta-perchaGutta-percha

Paper pointPaper point

SealersSealers

FilesFiles

Finger spreaderFinger spreader

MaterialsMaterials

Fiber Post -3M Fiber Post -3M ESPEESPE

RelyX UnicemRelyX Unicem

Panavia F 2.0Panavia F 2.0

Materials (con’t)Materials (con’t)

Extracted single canal premolars Extracted single canal premolars were selected and calculus and were selected and calculus and soft tissues removedsoft tissues removed

Two radiographs made- 1 from Two radiographs made- 1 from mesiodistally & 1 from mesiodistally & 1 from buccolingualbuccolingual

Each tooth was sectioned with Each tooth was sectioned with diamond disc under water spray diamond disc under water spray 1mm coronal to CEJ1mm coronal to CEJ

MethodsMethods

Specimens were instrumented to # 45 file and filled with GP using lateral condensation

Sodium hypochlorite solution (5%) was used to irrigate canal throughout instrumentation

The canals were dried with paper points and obturated with MC 45, sealer using finger spreader and lateral condensation method

Coronal orifice was sealed and stored in incubator at 37° C for 7 days before proceeding

Methods (cont’d)Methods (cont’d)

F. Zicari.E.Couthino. Jan DM. Bonding and sealing ability of fiber post bonding.2008F. Zicari.E.Couthino. Jan DM. Bonding and sealing ability of fiber post bonding.2008

Post PreparationPost Preparation

Control length withPeeso Reamer

Post space prepared With Drill

Injecting self etchingprimer

Injecting self etchingprimer

Injecting mixed Panavia F2

Post placement

Light curing 20 sec

Self- adhesive SystemSelf- adhesive System

Mixing Unicem Coating post with Unicem

Unicem cemented post Cured for 20 sec

Universal Testing Machine (Instron) Universal Testing Machine (Instron) Push-out TestPush-out Test

MicroleakageMicroleakage

Apical sections were coated with two layers of nail Apical sections were coated with two layers of nail polish leaving the apical 1 mm exposedpolish leaving the apical 1 mm exposed

The teeth immersed into a 50% wt silver nitrate dye The teeth immersed into a 50% wt silver nitrate dye for one hour then washed by distilled water for 1 for one hour then washed by distilled water for 1 minuteminute

Inserted in photo developing solution and exposed Inserted in photo developing solution and exposed them to light for 12 hthem to light for 12 h

Washed with running water and the nail polish Washed with running water and the nail polish cleanedcleaned

All specimens were cleared using the 5%nitric acid, All specimens were cleared using the 5%nitric acid, followed by washing for 2 h and dehydrated in followed by washing for 2 h and dehydrated in ascending concentration of alcohol (80%, 90%, and ascending concentration of alcohol (80%, 90%, and 100%)100%)

The roots were subsequently cleared using methyl The roots were subsequently cleared using methyl salicylatesalicylate

The cleared specimen examined under a 3D The cleared specimen examined under a 3D microscope (100X)microscope (100X)

Suspended apical section

Suspended apical sectionCoated with nail polish

Keyence Microscope (3D)Keyence Microscope (3D)

Measuring dye penetration

Cleared specimens

Gutta -perchaGutta -perchaDye Dye

SEM EvaluationSEM Evaluation

The Three Way Analysis The Three Way Analysis (ANOVA) of Post Bond Strength(ANOVA) of Post Bond Strength

Source Source MeanMean

SquareSquare

P-valueP-value

Third SectionThird Section 12.19212.192 0.060120.06012

SealerSealer 1.0801.080 0.83180.8318

Cement Cement 76.98676.986 0.07520.0752

Sealer*Cement Sealer*Cement 11.52911.529 0.48840.4884

Bond Strength (MPa) -Mean Bond Strength (MPa) -Mean and Std of four groupand Std of four group

SealerSealer CementCement MeanMean±SD±SD

Glass Glass Ionomer Ionomer

Panavia F Panavia F 2.02.0

7.77.7± 2.6± 2.6

Glass Glass IonomerIonomer

Rely X Rely X UnicemUnicem

10.310.3± 1.3± 1.3

Zinc Oxide Zinc Oxide Eugenol Eugenol

Panavia F Panavia F 2.02.0

88±1.2±1.2

Zinc Oxide Zinc Oxide EugenolEugenol

Rely X Rely X UnicemUnicem

1212±2.5±2.5

Interaction between Post Interaction between Post Retention, Sealer Type and Retention, Sealer Type and CementCement

0

2

4

6

8

10

12

14

16

Panavia F 2.0 Rely X Panavia F 2.0 Rely X

GICs GICs ZOE ZOE

Bon

d S

tren

gth(

MP

a)

Failure MechanismFailure Mechanism

Resin cement adhered to the post surface.Resin cement adhered to the post surface.

100X

SEM EvaluationSEM Evaluation

PanaviaF2- Root Canal PanaviaF2- Root Canal DentinDentin

Mean Mean ±SD±SD for Microleakage (mm) for Microleakage (mm)

SealerSealerGlass Glass

IonomerIonomerZinc OxideZinc Oxide

EugenolEugenol

Mean Mean ±SD±SD 1.5 1.5 ± 0.3± 0.3 2.1 2.1 ± 0.4± 0.4

0

0.5

1

1.5

2

2.5

3

Glass Ionomer Zinc Oxide Eugenol

Mic

role

akag

e (m

m)

Mean Mean ±SD±SD for Microleakage for Microleakage

Results were Results were higherhigher for both for both cements compared to Goracci et cements compared to Goracci et al who used a “thin slice’’ push- al who used a “thin slice’’ push- out test and transmission electron out test and transmission electron microscopy. The microscopy. The tested adhesive tested adhesive cements were VariolinkII (10cements were VariolinkII (10±3 ±3 MPa) Rely X Unicem(5.05± 3) MPa) Rely X Unicem(5.05± 3) Panavia (5.04±3)Panavia (5.04±3)

This study showed no difference in bond strength This study showed no difference in bond strength between the coronal, middle, apical third between the coronal, middle, apical third with both with both cements in contrast to Carlos 2007 thesis.cements in contrast to Carlos 2007 thesis.

This study agrees with Zicari F et al, who reported This study agrees with Zicari F et al, who reported not significantly difference among the coronal. not significantly difference among the coronal. middle and apical sectionsmiddle and apical sections for each luting cements for each luting cements

BS was measured for Panavia 21(12.6BS was measured for Panavia 21(12.6±3) ±3) Unicem(11± 4) VariolinkII(11±4Unicem(11± 4) VariolinkII(11±4))

A 20 gauge Endo-Eze tip that reached the A 20 gauge Endo-Eze tip that reached the apical root canal area ensured the delivery of apical root canal area ensured the delivery of the conditioner to the deepest part portion of the conditioner to the deepest part portion of the canalthe canal

The type of sealer used has no effect on The type of sealer used has no effect on values of bond strength which agrees with S.T values of bond strength which agrees with S.T Davis et al, Davis et al, no significant difference with non eugenol no significant difference with non eugenol (190(190±55) and eugenol (183± 56)±55) and eugenol (183± 56)

Teeth were irrigated with water for cleaning Teeth were irrigated with water for cleaning purpose before cementation. purpose before cementation. No sodium No sodium hypochlorite were used. Which might effect hypochlorite were used. Which might effect retention. retention. A study by Hale A et al.(2003) showed A study by Hale A et al.(2003) showed that 5% NaOCL reduce the bond strength to that 5% NaOCL reduce the bond strength to dentin of Panavia F,C&B Metabond, ViriolinkIIdentin of Panavia F,C&B Metabond, ViriolinkII

Dye penetration technique was subjectiveDye penetration technique was subjective

Sealing the root canal coronal and apical Sealing the root canal coronal and apical parts of the root canal is equally important parts of the root canal is equally important for the success of treatmentfor the success of treatment

The results agreed with the null hypothesis The results agreed with the null hypothesis in both experimentsin both experiments

Within the limitation of the study, it can be Within the limitation of the study, it can be concluded that the use of self- adhesive or concluded that the use of self- adhesive or self-etch luting system had the same action self-etch luting system had the same action on retentionon retention

The eugenol containing and Glass Ionomer The eugenol containing and Glass Ionomer containing sealer have no effect on values containing sealer have no effect on values of bond strength of bond strength

ZOE and Glass Ionomer did not show ideal ZOE and Glass Ionomer did not show ideal sealing, and both groups had leakagesealing, and both groups had leakage

Future Studies Future Studies

Further research on other aged teeth with Further research on other aged teeth with eugenol, does fresh eugenol have a greater eugenol, does fresh eugenol have a greater effect?effect?

Comparing total etch with different delivery Comparing total etch with different delivery systems to self adhesive cements all three systems to self adhesive cements all three with the same delivery system. with the same delivery system.

More studies should be conducted using resin More studies should be conducted using resin materials to improve the bond strength to materials to improve the bond strength to dentin with the endodontic treated teeth. dentin with the endodontic treated teeth.

endodontic sealers

Education