Root canal sealers

Endodontic filling 

materials

Root filling materials 

1. Stop coronal leakage 

2. Entomb surviving microbes 

3. Block influx of water and nutrients 

1 2 

3 

from Sundqvist & Figdor, in ’Essential Endodontology’, 1998

Core Materials 

• Gutta-percha 

• Metal points 

• Plastics 

• Combinations

Thermoplasticized gutta-percha: 

’hot-warm-soft’ 

injectable 

carriers

’alpha-phase’ versus ’beta-phase’ 

Alpha-guttapercha is supposedly more fluid 

and soften at a lower temperature. Some 

sophisticated declarations describe a core 

of beta- under a surface of alpha-guttapercha. 

Beta phase is made when heated 

alpha phase is rapidly cooled to room 

temperature. There is little if any 

documentation that this distinction is of 

importance.

All gutta-percha filling 

techniques, including 

compaction and other 

methods of softening 

gutta-percha, always end 

up requiring a sealer.

A sealer is what should meet the 

hard and soft tissues; the gutta- 

percha is merely a piston

Gutta-percha 

- adaptability 

ZEUG 

- dimensionally stable 

Silicon 

- biocompatible 

Chloroform 

- adaptability 

Chloropercha 

- biocompatible 

N2 & Endométhasone 

- antibacterial 

Glassionomer 

- why not? 

Colophony 

- adhesion 

Ca(OH) 2 

- bio-active 

Epoxy 

- hardness and adhesion

Endodontic Sealers 

• ZnO-eugenol-based 

• ZnO-’non-eugenol’-based 

• Polymeric cements 

• Glass ionomers 

• Silicones 

• Solvent-based 

• Ca(OH) 2 pastes

ZnO-Eugenol-Based 


• Rickert’s sealer ⇒ Kerr PCS 

• Grossman’s sealer ⇒ Roth’s, 

ProcoSol 

• Wach’s paste 

• Robin’s paste ⇒ N2, RC2B

ZnO-eugenol-sealers 

•Pro’s 

– Used for a century 

– Clinical documentation 

–Goodseal 

• Con’s 

– Local toxicity 

– Allergen 

– Poor stability?

ZnO-’Non-Eugenol’-Based 


• Several proprietary brands 

• Poor if any documentation

Glass Ionomer-Based 


•Endion 

•Ketac-Endo

Glass-ionomer-sealers 

• Pro’s 

– Biocompatible 

– Clinical documentation? 

• Con’s 

– Leakage 

–Shrinkage

Glass ionomer sealer 

Of 378 followed-up teeth, there 

was 78.3% success, 15.6% 

incomplete healing, and 6.1% 

failure. 

Friedman et al., 1995

Polymer-Based 

Endodontic Cements 

•AH series 

•Diaket 

• Poly(methyl-methacrylate) 

• Resorcinol-formaldehyde 

• Composite resins

Epoxy-resin-sealers 

•Pro’s 

– More than 40 years 

–Clinical 

documentation 

–Stable 

•Con’s 

– Toxic when fresh 

– Allergen 

– Leakage?

RealSeal 

Why do we call it RealSeal? Because it is the endodontic filling material that 

provides a REAL seal. And Resilon, the primary component of RealSeal, has 

also been proven to be biocompatible, nontoxic and nonmutagenic.1 RealSeal 

is: 

•Leak-Resistant. Unlike gutta percha, RealSeal leaves no gap for leakage. 

Coronal and apical leakage are substantially reduced. 

•Strengthening. Gives the root significant toughness. 

•Technique-Compatible. Works with your current filling method. 

•Retreatable. With chloroform and/or heat. Like Grossman’s formula, 

retreatments are easy. 

•Radiopaque. Just like your current method of obturation, detection is not a 

problem. 

Company website

”EndoREZ is a UDMA resin-based, root 

canal sealer with hydrophilic properties that 

improve sealing ability even in canals that are 

moist with water.This resin-based formula 

prevents EndoREZ from compromising 

bonding agents. In addition to its 

biocompatible, methacrylate formula, 

EndoREZ also offers the advantage of 

radiopacity. EndoREZ is as radiopaque as 

gutta percha, thus simplifying radiographic 

interpretation.” 

Ultradent, company website

EndoREZ Points 

”Resin Coated Gutta Percha Points 

EndoREZ Points are standard ISO-sized gutta percha 

points overlayed with a thin resin coating. The resin 

coating allows EndoREZ Points to bond chemincally 

with EndoREZ and other resin-based sealers. 

Historically, gutta percha has only maintained a 

weaker, chemical bond with canal sealers. EndoREZ 

Points are the first-ever gutta percha points to create a 

stronger, chemical bond by bonding gutta percha to 

EndoREZ.” 

Ultradent, company website


with Ca(OH) 2 

•Sealapex 

•Apexit 

•CRCS

Ca(OH)2-based sealers 

•Pro’s 

–20 years 

– Clinical documentation 

–Goodseal 


• Con’s 

– Unstable? 

– Poor x-ray contrast 

– Low mechanical 

strength

Changes in pH at the dentin surface 

in roots obturated with 

calcium hydroxide pastes. 

12 

pH at midroot 

surface 

11 

10 

9 

8 

7 

Control 

Sealapex 

Apexit 

Sealer 26 

Ca(OH)2 

6 

0 3 7 14 21 28 45 

TIME, days 

Esberard RM, Carnes DL Jr, del Rio CE J Endod 1996 Aug;22(8):399-405

Silicone-Based 


•Lee Endofil 

•RoekoSeal 

• Gutta-Flow

Silicon-based sealers

Silicon-based sealers 

•Pro’s 

–Verygood 

documentation 

– Clinically tested 


• Con’s 

– No effect on microbes? 

– Poor mechanical strength 

– Short history

Picture: M.J. 

Roggendorf 

Picture: M. J. Roggendorf

Solvent-Based 


• Rosin-chloroform (Johnston-Callahan 

technique) 

• Chloropercha techniques 

• Kloroperka

Solvent-baserte sealers 

• Pro’s 


– Clinical documentation? 

• Con’s 

– Leakage 

–Shrinkage 

No brand shown: 

Not to be promoted?

Technological tests

a 

b 

c 

d 

e 

f

DIMENSIONAL CHANGE, % 

6 

4 

2 

0 

0 4 8 12 16 20 24 28 32 36 40 44 48 

TIME, weeks 

AH 26 

AH 26 SF 

AH Plus 

Fig 3a


8 

6 

4 

2 

0 

-2 

0 4 8 12 16 20 24 28 32 36 40 44 48 

TIME, weeks 

Grossman's 

Proco-Sol 

PCS 

Tubli-Seal 

Fig 3b


1 

0 

-1 

0 4 8 12 16 20 24 28 32 36 40 44 48 

TIME, weeks 

Roeko-Seal 

RS 4823wet 

RS 4823dry 

Fig 3c


1 

0,5 

0 

-0,5 

-1 

-1,5 

0 4 8 12 16 20 24 28 32 36 40 44 48 

TIME, weeks 

Apexit 

Apexit H2O 

Ketac-Endo 

Fig 3d

0 

Hoop stress - 

(tension) 

Radial stress - 

(pressure) 

1 mm 

3 mm

100 

Tangential stress [MPa] 

10 

1 

0,1 

0,01 

0,001 

Composite 

Elastomer 

0 0,2 0,4 0,6 0,8 1 

Linear expansion of material [%]

Physical properties of endodontic 

sealers: radio-opacity, working time, 

flow and compressive strength 

measurements 

Ayce Unverdi Eldeniz 

Guest Researcher, Scandinavian Institute of Dental 

Materials, Haslum, Norway 

Dag Ørstavik 

Oslo University, Faculty of Dentistry, Head of the 

Department of Endodontics, Oslo, and the Scandinavian 

Institute of Dental Materials, Haslum, Norway

Root canal sealers tested: 

AH Plus 

Component A 

Epoxy resin 

Calcium tungstate 

Zirconium oxide 

Aerosil 

Iron oxide 

Component B 

Adamantane amine 

N,N-Dibenzyl-5-oxanonane 

TCD-Diamine 

Calcium tungstate 


Aerosil 

Silicone oil


GuttaFlow 

Gutta-percha powder 

Polydimethylsiloxane 

Silicone oil 

Paraffin oil 

Hexachloroplatinic acid 


Nano-silver 

(preservative)


AcroSeal 

Calcium hydroxide 

DGEBA 

Radiopaque excipient 

Glycyrrhetic acid 

(enoxolone) 

Methenamine 

Radiopaque excipient


EndoRez 

30% Urethane dimethacrylate


Epiphany 

Dual-cure, urethane-based 

dental composite cement

12,0 

10,0 

8,0 

6,0 

4,0 

2,0 

0,0 

Root canal sealers’ 

radiopacity 

Radiopacity (n=3) 

Endo-REZ 

Epiphany 

RC Sealer 

Roeko Seal 

Gutta Flow 

Apexit 

Acroseal 

AH Plus

Root canal sealers’ film 

thickness 

Film Thickness (n=15) 

50 

45 

40 

35 

30 

25 

20 

15 

10 

5 

0 

AH Plus 

Endo-REZ 

Epiphany 

RC Sealer 

Roeko Seal 

Gutta Flow 

Apexit 

Acroseal

Root canal sealers’ flow 

Flow (n=15) 

50 

45 

40 

35 

30 

25 

20 

15 

10 

5 

0 

AH Plus 

Endo-REZ 

Epiphany 

RC Sealer 

Roeko Seal 

Gutta Flow 

Apexit 

Acroseal

Root canal sealers’ 

compressive strength 

Compressive strength (Mpa) by time (h) 

400 

350 

300 

250 

200 

150 

100 

50 

0 

0 50 100 150 200 

? 

AH Plus 

Endo-REZ 

Epiphany 

Apexit 

Acroseal

Smear layer removal 

• Opens tubules for 

medicament 

activity 

• Removes (infected) 

smear and 

substrate for 

microbial growth 

• Allows permeation 

of filling material 

• Shows little effect 

on adhesion of 

filling 

• Penetration by 

bacteria may be 

enhanced: 

– Between sessions 

– After filling

Gr. 

1,20 

1,00 

0,80 

0,60 

0,40 

0,20 

0,00 

Native 

Phosph. Acid 

Citric acid 

EDTA 

Gr. 

APX 

KE 

AH Plus 

RS+P 

RS 

APX 

KE 

RS 

RS+P 

AH Plus 

Saleh et al., 2001: 

Adhesion of 

root canal sealers 

to pretreated dentin

Antimicrobial 

activity 

• Toxic chemicals 

– disinfectants 

– antiseptics 

• Antibiotics

Iodine-containing gutta-percha 

(Lone Star)

Current antimicrobial 

additions 

•Formaldehyde 

•Eugenol 

•Thymoliodide 

•Amines 

• Calcium hydroxide

Clinical biocompatibility 

• Local 

•Regional 

• Systemic 

Severity 

Frequency

PN Liston, RF Walters 

Foreign bodies in the maxillary antrum: A case report 

Australian Dental Journal 2002;47(4):344-346

14d 

AH-materials give a strong 

reaction after 14d, but show little 

effect on tissues after 3 months 

3 months 

14d

Sealapex: Induction of hard 

tissue formation 

7 

6 

5 

4 

3 

2 

1 

Closure 

Partial closure 

No closure 

Inflammation 

0 

Sealapex 

Kerr PCS 

Holland & de Sousa 1985

Periapical reactions to 

sealers in monkeys 

8 

7 

6 

5 

4 

3 

2 

1 

0 

Sealapex CRCS AH26 

None 

Mild to moderate 

Severe 

27 teeth in 3 monkeys, 8-14 months 

Tagger & Tagger 1985

Allergy 

• (Almost) All endo materials contain 

allergens 

• The exposure to sensitive tissues is 

extremely small 

• Exposure to skin, mucosal surfaces of 

patients and the skin of staff may 

deserve more attention

Mutagenicity - Carcinogenicity 

• Mutagenicity– the ability to cause 

changes in the genes of an individual 

• Carcinogenicity– the ability to cause 

cancer in an individual 

• 70-90% of mutagens are carcinogens 

and vice versa

In vitro model for coronal leakage 

Upper chamber 

with bacteria 

Sterilised, root 

filled root 

Barthel et al, 1999 

Wax seal 

Lower chamber, sterile 

medium 

Bacteria penetrating the root filling multiply in the clear 

medium of the lower chamber, making it turbid.

% Microbial leakage over 30 days 

100 

90 

80 

70 

60 

50 

40 

30 

20 

10 

0 

S. mutans 

E. faecalis 

S. mutans and 

E. faecalis 

% of microbial leakage 

V GP - Epiphany sealer 

L GP - Epiphany sealer 

V GP - AH26 sealer 

L GP - AH26 sealer 

V Resilon - Epiphany sealer 

L Resilon - Epiphany sealer 

V Resilon - Epiphany sealer 

L Resilon - Epiphany sealer 

Negative Control 

Positive Control - GP 

Positive Control - Resilon 

Groups 

Epiphany – 

’an appearance or manifestation especially of a divine being’

Bacterial leakage 

100 

80 

60 

40 

20 

0 

Leaking teeth, % 

•AH Plus 

•EndoRez 

•RC Sealer 

•Roeko-Seal 

•Ketac-Endo 

•Acroseal 

•Apexit 

•Gutta-Flow 

•Epiphany

Bacterial leakage 

• AH Plus 15/15 

• EndoRez 15/15 

• RC Sealer 15/15 

• Epiphany 4/15 

• Acroseal 9/15 

• Apexit 5/15 

• Roeko-Seal 5/15 

• Gutta-Flow 5/15 

• Ketac-Endo 14/15

Saleh et al. 2003 

5 

Mean Log CFU 

4 

3 

2 

1 

0 

-1 

CT KE RSP AP RS CH GS AH 

CT KE RSP AP RS CH GS AH 

Sealer 

(CT: control; KE: Ketac-Endo; RSP: RoekoSeal Automix + Primer; AP: 

Apexit; RS: RoekoSeal Automix; CH: Calcium Hydroxide; GS: 

Grossman’s sealer; AH: AH Plus)

Clinical/Radiographic Follow- 

•Pain 

Ups 

• Success-failure 

analyses 

• Disease – no disease 

•Sizeoflesion 

• Periapical index 

• Computer technology

Time-course of postoperative pain following 

root filling with either Roeko Seal or 

Grossman’s sealer. Average values 

6 

Relative pain intensity, % 

4 

2 

Roeko Seal 

Grossman 

0 

D1S D1Be D2Br D2L D2S D2Be D3Br D3L D3S D3Be 

Coefficient of variation: 118-400%

EndoREZ 

Am J Dent. 2004 Feb;17(1):19-22. 

Clinical and radiographic evaluation of a resin-based 

root canal sealer. 

Zmener O, Pameijer CH

Clinical Study – EndoRez 

100 

90 

80 

70 

60 

50 

40 

30 

20 

10 

0 

91,3 89,1 

92,2 

All teeth CAP NAP 

'Success' 

’Feasibility study’

Cumulative PAI Scores 

AH KP PS 

0 1 2 3 4 

0 1 2 3 4 

0 1 2 3 4 

TIME: 0 to 4 years

Clinical Evaluation 

•Prevention 

– failure: AP developing where none 

existed 

– AH26 vs ProcoSol (Grossman’s sealer) vs 

Kloroperka: Significantly poorer results 

for Kloroperka in one clinical study

Healing of apical periodontitis following 

root filling with 3 different sealers 

PERIAPICAL STATUS, ridit 

0,5 

0,4 

0,3 

0,2 

0 1 2 3 

Total 

ProcoSol 

Sealapex 

CRCS 

TIME, years 

Range of s.e. of means: 0.02-0.07

Preoperative Healthy Periodontium: 

Effect of Sealer 

PERIAPICAL STATUS, 

ridit 

0,3 

0,2 

0,1 

0 

0 1 2 3 

TIME, years 

Total 

ProcoSol 

Sealapex 

CRCS 

Range of s.e. of means: 0.03-0.17

X-ray 

healing 

AP 

N 

AP 

N 

Digital 

change 

AP/N < 1 AP/N ≅ 1

Numbers are average gray values in the 

defined areas: 255=white; 0=black 

130 

130 

80 

115 

Digital 

change 

AP/N =0,62 AP/N 0,88

AP/N 

1,2 

Sound 

Diseased 

1 

0,8 

0,6 

0 4 8 12 16 20 24 

TIME, months

From Trope et al., 1998

Healing by AP/N Ratio 

PA Status, P/N ratio 

80 

60 

40 

0 5 10 15 20 25 

TIME, weeks 

PS 

SA

Healing by PAI Score 

PA Status, PAI ridit 

1 

0,8 

0,6 

0,4 

0 5 10 15 20 25 

TIME, weeks 

PS 

SA

Comparative clinical testing 

• ProcoSol, Grossman’s sealer: 

REFERENCE 

– AH26: as good or better 

– Sealapex: as good or better 

– CRCS: no worse 

– RoekoSeal no worse 

– Kloroperka poorer 

– Epiphany as good or better

Healed cases, per cent 

100 

Prospective study of factors related to 

healing of AP 

90 

80 

70 

60 

Preop 

AP 

No 

preop 

AP 

Warm 

vertical 

Cold 

lateral 

Cliinical variables 

Single 

root 

2+ roots 

Farzaneh et 

al. 

JOE April 

2003, OR 45 

The Toronto 

study: 

outcome of 

initial 

endodontic 

treatment - 

phase II

New methods for filling root canals 

must be viewed with regard to 

their ability to aid in achieving the 

prevention of new or persistent 

apical periodontitis; the acid test 

being roots with preoperative 

apical periodontitis

’Predictable disinfection’: how 

much can we improve? 

• instrumentation 90/10* 95/20 

• irrigation 99/50 99,9/95 

• ‘medication’ 99,9/95 99.99/98 

• Root filling 100/100?

Predictable disinfection 

1. Complete physical and 

chemical disinfection in one 

session? 

(’Dauerantisepticum’, CHX?) 

2. Prevention of regrowth 

(antibacterial sealer?) 

3. Block influx of nutrients 

(improved seal?) 

AP 

P 

PDL

’Predictable disinfection’: can 

we improve? 

Standard methods 

Improvement? 

Microbes Canals Microbes Canals 

• instrumentation 90 10 95 50 

• irrigation 99 50 99,9 95 

• dressing 99,9 95 99.99 98 

• Root filling 100 100? 

Thank you for your attention!

Root canal sealers

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