Dentaltown November 2017 - 83

(zirconium oxide) and marketed in the U.S.
as EndoSequence BC Sealer, (Brasseler USA,
Savannah, Georgia). The sealer is similar
in chemical composition (calcium silicates,
zirconium oxide, tantalum oxide, calcium
phosphate monobasic and fillers). They are
hydrophilic, insoluble, radiopaque, aluminum-free, high pH, and require moisture
to set. The singular most important feature
is the gap between the sealer and the core
is eliminated and as such the sealing of the
root filling is optimally potentiated.24-25
The properties of the bioceramic sealer
enact changes in the root filling procedure:
1. Being hydrophilic, naturally occurring moisture in the canal and tubuli
is an advantage.
2. When unset, the bioceramic sealer
has a pH above 12, thus its antibacterial properties are similar to calcium
hydroxide.25 Setting is dependent on
physiologic moisture in the canal;
therefore it will set at different rates
in different environments, but since it
is a high pH, any delay in setting can
arguably be beneficial.
3. The sealer does not shrink but
expands slightly, and it is insoluble in
tissue fluids.26
The afore-referenced properties should
change the enduring-albeit antiquated-
rule that the core material in root fi llings
should mask the deficiencies of the sealer
by keeping it as thin as possible. In theory,

the need for any core/filler material should
prove debatable if it were possible to fi ll
the canal homogeneously with bioceramic
sealer. As it stands, the gutta-percha is used
to deliver the bioceramic sealer through
hydraulic condensation and the sealer can
be the main component of the root fi lling.
The gutta-percha is used primarily as the
delivery device (plugger) to allow cold
hydraulic movement of the sealer into the
irregularities of the root canal and accessory
canals. In addition, it will act as a pathway
for post preparation and retreatment.
As the root filling paradigm shifts to
bioceramic sealers, the practitioner can execute a
biominimalistic antimicrobial protocol for root
canal treatment leaving a thicker and stronger
root. When the taper is not excessive and the
gutta-percha point is used as a condenser to
move the sealer into the canal irregularities
and accessory canals, a radiographic picture
consistent with the classic vertical condensation
technique is seen (Figs. 5a, 5b).

Technique troubleshooting
As the EndoSequence BC sealer is premixed, storage should be at room (ambient)
temperature. As discussed previously, unlike
traditional sealers, the setting reaction of
bioceramic sealers is initiated by moisture
in the canal, therefore refrigeration is to
be avoided.27 The booster tip of the XP-3D
Shaper provides a unique apical seat, which
will minimize sealer extrusion.

Fig 5a. Radiograph of a root filled tooth showing EndoSequence BC Sealer
hydraulically moved by the gutta-percha point apical terminus. Note that the
cold hydraulic technique results in lateral canal "puffs" similar to the warm
vertical condensation technique. (Courtesy of Dr. Gilberto Debelian)

Fig 5b. Molar filled using the cold hydraulic technique. Note the biominimalistic shaping of the coronal and middle third of the canals
resulting from the use of the XP-3D Shaper and Finisher. (Courtesy
of Dr. Frank Setzer)

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