Problem solving endodontics – obturation with a bioceramic sealer
Specialist endodontist, John Rhodes presents an interactive, practical and problem-solving solution in endodontics. Here, John looks at a technique for obturating the root canals with a bioceramic sealer.
The introduction of bioceramic sealers has been very topical in endodontics. In this interactive article, John Rhodes describes a hybrid single cone technique that can be used to obturate the root canal system using these exciting and innovative materials.
Bioceramic sealers fall into two types, those based on Portland cement. (For example ProRoot MTA (Denstply Sirona). And those made from tricalcium silicate. (Such as Bioroot Septodont). Although technically not a ceramic they do offer excellent biological sealing properties and biocompatibility. This is why Bioceramics are recommended for use in root end surgery, pulpotomy and regenerative endodontics.
The sealers produce a seal by chemically bonding to dentine and releasing calcium ions. They are highly biocompatible, so much so that periodontal stem cells have been shown to proliferate on the surface of the material. The sealers are not affected by moisture in the root canals. They actually perform better when the canal is not completely dry.
Antimicrobial activity is enhanced by the use of EDTA as a final rinse.
Case example (view the video at: https://youtu.be/OSOhwAdPh5o)
In this case Bioroot (Septodont) was used as the sealer, it consists of a tricalcium silicate that is mixed manually with a liquid. The setting time of the sealer is dramatically reduced by application of heat. The manufacturers recommend that it is used with a single cone technique rather than vertical compaction methods.
The maxillary left first molar (UL6) had recently been restored with a crown but unfortunately became necrotic. The case was referred for root canal treatment after the patient became symptomatic.
A pre-operative radiograph showed that the tooth was associated with periapical periodontitis (Figure...