Dentaltown November 2019 - 88

When to treat?
When to refer?
Learn more and
earn CE credit
The treatment standards
for dentists performing
endodontic care are the
same for generalists and
specialists. How do you best
assess the case difficulty
of proposed treatment and
decide whether to treat
or refer? Dr. Jason Hales'
online CE course, "The
Good, the Bad and the
Ugly: Finding Success with
Endodontics in Your Practice,"
is designed to teach general
dentists more about case
selection. To watch the
course, and take the test to
earn 1.5 CE credits, go to
dentaltown.com/ce.

NOVEMBER 2019 // dentaltown.com

These sealers and obturation technique
give me the best opportunity for a set, seal
and success and are considered the gold
standard of root canal sealers.14-16 I want a
sealer that you can throw against the wall
and it will set-one that sets all of the time,
not just some of the time.
Since I've gone back to warm vertical
obturation and these sealers, fewer patients
present with problems of long-term postoperative discomfort. There were still a
few, of course, mostly bruxers, but if you
perform root canal treatment, that's part of
the game. The majority of my cases looked
"better" sealed with a well-condensed fill,
and I stopped seeing the lateral voids that
came along with the single-cone technique,
and I started seeing success results like those
I'd seen from 2004 to 2012: Apical lesions
were healing and filling in with new bone
consistently.
I understand that this is anecdotal, but
clinical experience and clinical patterns of
success and failure are important in our
journey for success. I wanted to share the
patterns that I as one endodontist have
observed after completing 10,000 cases using
various sealers and obturation techniques.
This is a story based on patterns of success
and failure where shaping, cleaning and
disinfection all stayed nearly the same-what
changed was the sealer and the obturation
technique. This is a story of postoperative
discomfort, failure to heal consistently,
and poor obturation outcomes with apical
and lateral voids. This is my single-cone
obturation story, and I wanted to share my
opinions in hopes of helping dentists increase
their endodontic success rate.
Like all clinicians, I hate failure and
I loathe re-treating my own work three
to six months after the initial root canal.
It's embarrassing, it costs revenue and,
most importantly, the poor patients have
to sit in the dental chair for another one

or two hours. In my hands, warm vertical
obturation using traditional, tried, true and
tested sealers gives me the best success with
the fewest postoperative problems. This
makes me happy, and I hope it makes you
happy too. ■

References
1. Branstetter, J. and von Fraunhofer, J.A. The physical properties
and sealing action of endodontic sealer cements: a review of
the literature. J Endod. 1982; 8: 312-316.
2. Wang, Z. Bioceramic materials in endodontics. Endod Topics.
2015; 32: 3-30
3. Versiani MA, Abi Rached-Junior FJ, Kishen A, et al. Zinc oxide
nanoparticles enhance physicochemical characteristics of
Grossman sealer. J Endod 2016;42:1804-10.
4. American National Standards/American Dental Association.
Specification no. 57 for endodontic sealing materials.
Chicago, IL: American National Standards/American Dental
Association; 2000. p. 1-12.
5. International Organization for Standardization. ISO 6876:
dental root canal sealing materials. Geneva, Switzerland:
International Organization for Standardization; 2012.
p. 3-4.
6. Jafari F, Jafari S. Composition and physicochemical properties
of calcium silicate based sealers: A review article. J Clin Exp
Dent. 2017 Oct; 9(10): e1249-e1255. Published online
2017 Oct 1
7. Elyassi Y., Moinzadeh, A., Kleverlaan C. Characterization of
Leachates from 6 Root Canal Sealers. J Endod 2019; 45:
623-27.
8. Nagas E., Uyanik M., Eymirli A., et al. Dentin Moisture Conditions Affect the Adhesion of Root Canal Sealers. J Endod.
2012; 38: 240-44.
9. Xu, H.H., Carey, L.E., Simon, C.G. Jr. et al. Premixed
calcium phosphate cements: synthesis, physical properties, and
cell cytotoxicity. Dent Mater. 2007; 23: 433-441
10. Chyboswski E.,, Glickman G.,, et al. Clinical Outcome of
Non-Surgical Root Canal Treatment Using a Single-cone
Technique with Endosequence Bioceramic Sealer: A Retrospective Analysis. J Endod. 2018; 44: 941-45.
11. Borges, R.P., Sousa-Neto, M.D., Versiani, M.A. et al. Changes
in the surface of four calcium silicate- containing endodontic
materials and an epoxy resin-based sealer after a solubility
test. Int Endod J. 2012; 45: 419-428.
12. Zordan-Bronzel C, Torres F. Et al. Evaluation of Physicochemical Properties of a New Calcium Silicate-based Sealer,
Bio-C Sealer. J Endod 2019; Vol. In Press: 1-5.
13. Zhou H.,Shen Y., Zheng W., et al. Physical Properties of 5 Root
Canal Sealers. J Endod 2013; 39: 1281-86.
14. Bouillaguet, S., Shaw, L., Barthelemy, J. et al. Long-term
sealing ability of Pulp Canal Sealer, AH-Plus, GuttaFlow
and Epiphany. Int Endod J. 2008; 41: 219-226.
15. Versiani, M.A., Carvalho-Junior, J.R., Padilha, M.I. et al. A
comparative study of physicochemical properties of AH Plus
and Epiphany root canal sealants. Int Endod J. 2006; 39:
464-471.
16. Versiani MA, Abi Rached-Junior FJ, Kishen A, et al. Zinc
oxide nanoparticles enhance physicochemical characteristics of
Grossman sealer. J Endod 2016;42:1804-10.

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Dentaltown November 2019

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