Epoxy v Bioceramic sealers: Friday Questions 

i guess Im asking randomly but does anyone know of a tool to log back into an Instagram account?? I was stupid forgot my account password. I appreciate any help you can give me!

@Juan Tobias Instablaster =)

@Gregory Abraham I really appreciate your reply. I got to the site thru google and im trying it out atm. Looks like it's gonna take quite some time so I will reply here later when my account password hopefully is recovered.

@Gregory Abraham It worked and I finally got access to my account again. Im so happy:D Thanks so much, you saved my ass :D

@Juan Tobias you are welcome :D

Thank you Dr. Salim! 👍

+Obaid Shams If you're waiting for a long term prospective study you'll be waiting for a long time. There are no such thing on AH Plus either! Prospective, randomized multi center, clinical studies with large patient populations are virtually nonexistent in Endo. Such studies are expensive and no one is willing to pay for them. In the mean time, we're all left to follow material properties and which one comes closest to the biological requirement and physical requirements of ideal material. That's all. Good luck.

Julian, using non coated cones with BC sealer is risking not having a bond to the cone, which is no different than all other obturation systems (no sealer bonds to the gutta percha)... but if possible, it's better to use the BC Coated gutta percha. If not available, then use the cone and do some mild lateral condensation. Good luck!

If it's rationally indicated there it's rationally indicated every time! The reason why C-Point itself is indicated is because dentin and tooth is hydrophilic and we've been using hydrophobic sealers because we haven't had hydrophilic sealers until now. I think you just answered your own question!

Roeko's Guttaflow has no antimicrobial properties and has no advantage at all over any of the bioceramics. BioRoot is ok and better than guttaflow as it's a bioceramic but it's hand mixed and not premixed.

@@AANasseh Thank you very much for the quick reply. I agree that automix is much more convenient. BioRoot brochure mentions though that they purposefully made it hand mixed, because it keeps 90% of fibroblasts vital in contrast to the other sealers that keep 50% vital due to the effect of the matrix material in the pastes. I'm not sure if there is a clinical significance for this though. Concerning Guttaflow, the only advantage, as I see it, is the setting time (15-30min) because it permits to potentially create space for a post in the same appointment. Both BC sealer and Bioroot have setting times ~4 hours, according to the instructions of use.

san sa A Ca(OH)2 cement?! Like what? Dycal? I don’t know. No studies to show that. That’s why BC Liner was used. That’s it’s main purpose.

@@AANasseh no like calcimol. its a calcium hydroxide paste that you can polymerize. its just to use a quick isolation from bc sealer instead of glass ionomer... unfortunately in the clinic I work the only glass ionomer is ketac which is not practical and really expensive... I mean I'm just looking for a quick material separate the bc sealer from the composite. and what do you think about a normal primary teeth sealer? that's what I used after obturation with zoe cement and guttapercha

san sa I’m sorry I have no experience with that material. Is that in the US? Either way, I can’t tell you if it works or not. Try it in a hydrated extracted tooth (hydrate for 24 hours. Put a thin layer of BC sealer on the chamber floor. a layer of your material over it. Then cotton and Cavit and dump the tooth in a cup of saline and let it set for one week (since it’s not at 37degrees.) Then open it and cut through it and look at the transition line in a thin sawed saguaro sections.

@@AANasseh it's just a simple calcium hydroxide for pulp capping.. I don't know any brands... anyway thanks for the suggestions. I will try the experiment! 😊

Thanks! Yes, Epoxy cements resorb to some extent if pushed out… the problem is that it will also resorb from inside the canal over long term and why it should still be used with classical Obturation techniques like vertical and lateral compaction instead of Hydraulic Condensation (single cone.) And no, it’s different resin formula from acrylic. These are epoxy resins.

You need a pure calcium silicate cement as the least potentially irritating cement.

I only use the EndoSequence obviously as I helped develop it. But there are a few of them out there now. I've tried the Sirona already for the past month and since several people have already asked will likely review it soon. You might as well get the Maruchi if you're outside of the US as it's the same as Sirona. It would be less expensive. Cheers! :)

@@AANasseh Thank you for your reply :)

Generally, a sealer puff has no practical purpose and should be avoided if possible. A small puff, according to some, confirms canal patency and clearance to the apex. So, it might be desired (different philosophies.) So, if you have a small puff having a biocompatible sealer is helpful compared to one that can cause more inflammation. This would translate into less post operative pain.

Sir/ma'am can u explain what is puff?

Basically, almost everyone is now on board using it. It’s the fastest growing Obturation system and everyone is trying to copy the material. That sums up the atmosphere at this point. Cheers!

Here we go. Download the link associated with this video: realworldendo.com/videos/bioceramic-sealer-research-bibliography

+RealWorld Endo thank you very much for quick response. As I understood after having a quick look those studies are all in vitro using e.g tested only on fibroblasts and animal studies. I wonder we can extrapolate this to actual clinical situation and human body. Further more do you think it will affect our outcome? Since we don't do leakkage studies anymore because of their limitations we can not comment about the sealability of bc sealer. I see more possibilities in nano scans of extracted root filled teeth. I think every sealer has got its pros and cons and we should be careful by making statements one is better than the other. I agree btw about not using of ZnO sealers, mainly because of their cytotoxicity, although outcome wise we are still struggling between 80-93% success since 1956 :(. Greetings

+miraamshah yes primarily in vitro studies but 8million cases are already done in vivo based on these studies. It's about understanding chemistry. The material is a nano particulate version of MTA. It has plenty of support by predicate and its chemistry just by MTA. Furthermore, Dr. Nasseh has done over 5000 cases over the past 8 years with it with excellent results. As far as not saying better or worse why not? The material properties of this compound are superior to epoxy resins based on every objective test when it comes to Dr. Grossman's definition of ideal cements for RCT. So, why cant someone who understands this say that? It's a fairly objective statement based on research on its material properties. Endodontists are already filling canals whole with MTA. This is the same chemistry but easier application. Of course, you have the right to be skeptical and you can wait for the 20 year studies. Good luck because there are not such studies for ZOE and Resin Sealers either.

+RealWorld Endo excuse my language sir but what you telling is completely BS. BS is not MTA and not its chemistry. So far there is zero study which shows it is bioactive. I am sure mr Nasseh is an excellent clinician and has got the best intentions but so are hunderds who use epoxy resins and ZnO sealers who claim they have got 10-30 yr experience. expert opinion is the lowest form of evidence. The key properties for a sealer or root filling is that it must be sealing well and is biocompatible what is not the same us bioactive! Our body is one who does the healing and we are the one who try to create the right circumstances. I am sure 8 million cases have been done. But I would like to see a rct clinical study with histology when you make such bold claims. By the way mta is not a magic product. It is just biocompatible and seals well so avoiding bacteria to penetrate, thats it! It doesn't do the healing itself but the pulp or periapical tissue does in absence of bacteria.

+miraamshah You've misunderstanding the point of his video. The question that was posed is what's the difference between these two type sealers and what's better. The fact that bioceramics are better in terms of their properties (as defined by Dr Grossman's definition of an ideal sealer) doesn't mean that epoxy is below the standard of care or its use should be illegal! You're trying to legitimize your own use of epoxy through this response. Dr. Nasseh did not say do not use epoxy, did he? Insofar as better based on the properties mentioned, of course Bioceramics are better. Several studies have done a head to head comparison and BC compounds have always come on top. Epoxys are popular because they're cheaper and bioceramics are not available everywhere. So, if you're using epoxy or ZOE you're not committing a crime! But which sealer is closer to Dr. Grossman's definition of an ideal sealer? Bioceramics!

Interesting. Yes, Let's definitely agree to disagree as I'm surprised that someone who requires such high level of evidence before clinical application is actually using C-Point! I mean, if that's not cognitive dissonance then I don't know what is! Best wishes and good luck!