The Age of Bioceramics

Improving endodontic care with innovative products

Ali Allen Nasseh, DDS, MMSc

Eight years ago, a new endodontic sealer was introduced to the profession that promised to make possible a new era of adhesive endodontics. The pure, nano-particulate bioceramic root canal sealer (EndoSequence^® BC Sealer^™, Brasseler USA, www.brasselerusa.com) (Figure 1 and Figure 2) was formulated from a family of compounds that migrated from orthopedic medicine into endodontics and promised to change the use of endodontic cements. Since its introduction, this premixed sealer was developed into a root repair material, putty, and now fast-set putty (Figure 3), which have together transformed endodontic obturation and root repair through the use of a universal compound to address all endodontic cement needs for both nonsurgical and surgical use.

On the nonsurgical side, the material properties of the bioceramic sealer have made endodontists re-engineer the old endodontic shaping concepts that have historically produced the expected radiographic look of our cases. For example, since the bioceramic material bonds to the hydroxyapatite in the root canal walls, the resulting chemical bond has been shown to increase the tooth’s fracture resistance. Furthermore, because the material is dimensionally stable and wash-out resistant in the root canal after setting, a simpler obturation technique such as hydraulic condensation using a single synchronized cone has become possible. The latter has not only increased the simplicity of root canal obturation, but because of eliminating the need for the thermoplastic techniques, it has resulted into root canal preparations that are more conservative coronally. This conservative coronal preparation saves important tooth structure during preparation that was previously lost due to obturation needs of thermoplastic techniques. Millions of procedures are performed annually using this simple and predictable obturation technique, resulting in simpler procedures for practitioners and optimal outcomes for patients.

On the surgical front, bioceramics were originally introduced to endodontics more than 2 decades ago. Mineral trioxide aggregate (MTA) was the first material in its class. However, MTA’s excellent biocompatibility and seal was often dwarfed by its difficult clinical handling properties. As a result, clinicians often resorted to using less optimal materials simply because they found MTA manipulation too technique-sensitive. The unique formulation of EndoSequence^® BC RRM-Fast Set Putty^™ allows clinicians to roll the material into cones even before the surgery begins, and apply to the surgical site with unprecedented speed. This is due to the unique setting properties of the material, where the setting reaction begins only after exposure to the oral cavity and not outside the mouth.

Furthermore, the hydrophilic qualities of the material help better adaptation during surgery and its biocompatibility reduces any surgical inflammation due to the material chemistry. Lastly, the basic nature of the material allows a welcome quality of bone induction during the healing phase of the bone.

Today, as a result of improvements in material science and particularly in the field of pure, nano-particulate bioceramic cements, we not only obturate root canal differently, but more importantly, we have begun to change the way we view endodontics.

About the Author

Ali Allen Nasseh, DDS, MMSc, is an endodontist practicing in Boston, Massachusetts. Dr. Nasseh holds a part-time staff position at Harvard School of Dental Medicine in the post-doctoral endodontic program, and is the editor of the Harvard Dental Bulletin. In addition to serving as the clinical director of Real World Endo, Dr. Nasseh lectures extensively in surgical and nonsurgical aspects of endodontic therapy. He is also a director of MicroSurgical Endodontics, an educational center for hands-on training in surgical and nonsurgical endodontics, as well as an Editorial Board Member and Endodontics Section Editor for Inside Dentistry.