Root Canal Sealers vs. Reparative Cements: What’s the Difference?

Of the various products used in endodontics, two materials are often used for successful endodontic treatments: root canal sealers and reparative cement. Both materials are essential in dental procedures as both have distinctive properties, uses, and applications. This blog delves into the key differences crucial for clinicians in choosing appropriate root canal instruments and materials depending on the specific types, patient needs, and treatment goals.

What are Root Canal Sealers?

Root canal sealer is radiopaque dental cement used to seal the root canals and fill the voids during obturation. The primary goal of root canal sealers is to prevent bacteria re-entry and provide a hermetic seal that enhances the long-term success of the treatment.

Types of Root Canal Sealers:

Several types of root canal sealers are used:

Zinc Oxide Eugenol (ZOE) Sealers: These sealers are a common choice for filling root canals during obturation and have good antimicrobial and anti-inflammatory properties. They are absorbed well into the surrounding tissues if extruded.

Calcium Hydroxide Sealers: Calcium hydroxide sealers exhibit antimicrobial properties. They have a high pH that encourages repair and active calcification and have mild cytotoxicity effects.

Resin-based Root Canal Sealer: epoxy resin-based root canal sealers or endo sealer material exhibit properties like high radiopacity, flow ability, biocompatibility and dimensional stability. They are more resistant to shrinkage.

Bioceramic Root Canal Sealers: Of all sealers, these endo sealer materials are the most advanced and widely accepted by dental practitioners because of their properties like biocompatible, prompt tissue regeneration and help in preventing re-infection.

What are Reparative Cements?

Reparative cement is a dental material widely used to treat various dental issues, such as perforations, internal resorption, pulp capping, acetogenesis, and apexification, and to restore the structural integrity of a tooth after trauma. It is mainly used to protect the dental pulp during procedures and seal the dentine.

These root canal instruments and materials promote reparative dentine formation and help stimulate the tooth’s natural healing process, thus providing the foundation for future restorations.

Types of Reparative Cements:

Several types of Reparative cements used in dentistry are:

Calcium hydroxide cement: As calcium hydroxide has high pH and good antimicrobial properties and promotes dentin formation, these are used for traditional capping procedures of pulp.

Mineral Trioxide Aggregate(MTA): It is an alkaline cementitious dental repair material and is used mainly in creating apical plugs during apexification, treating internal root resorption and repairing root perforations, encouraging hard tissue formation with minimal inflammatory response.

Glass ionomer Cement: Properties like fluoride release and good adhesion offer good protection to the tooth surface.

Zinc Oxide Eugenol Cement: Mainly used as temporary filling materials, they are useful as reparative cement, however, due to their solubility these are not commonly used in permanent procedures.

Key Differences between Root Canal Sealers and Reparative Cements:

A.  Purpose and Function:

The primary difference between root canal sealers and reparative cements lies in their purpose. Root canal sealers are intended to be used mainly for sealing the root canal after cleaning and shaping during the obturation procedure to provide a tight seal free of voids and prevent re-entry of bacteria, whereas reparative cements are used to protect the pulp and stimulate hard tissue formation of tooth structures.

B.  Composition and Material:

Root canal sealers are generally composed of resilons, calcium hydroxides, epoxy resins or zinc oxide materials. These root canal instrument materials are designed to bond well with the root canal walls to create a tight seal. Reparative cements, on the other hand, are often based on calcium hydroxide, MTA or glass ionomers, these root canal filling materials are selected for biocompatibility and help in the promotion of healing in the tooth’s structure.

C.  Application Techniques

Application techniques also differ for both root canal sealers and reparative cement, as root canal sealers are typically applied, once the canal is cleaned and shaped using gutta-percha points or with the help of lentulo spirals, whereas reparative cement is applied directly to pulp or dentin area, as some material sets in light while other requires moisture.

D. Longevity and Durability:

Root canal sealers are intended to last long ensuring the integrity of the root canal treatment should be life-long. Its durability depends on the chemical composition as epoxy-based resins and bioceramics offer long-lasting results compared to zinc oxide sealers. Reparative cements are not for longer use as they are typically designed for healing and repair, often forming the foundation for further restorative procedures. its durability varies with the material as MTA is highly durable and resistant to leakage, whereas calcium hydroxide is more transient.

When to Use Root Canal Sealers v/s Reparative Cements?

Root canal sealers are used when performing root canal therapy, during the obturation phase to completely seal the root canal to prevent re-infection and support tooth structure, whereas reparative cements are used in pulp capping, deep cavity fillings approaching near pulp or there is a need for dentine regeneration.

Conclusion:

Both root canal sealers or endo sealer materials and reparative cement are indispensable root canal filling materials used in modern-day dentistry that serve differently. On one hand root canal sealers mainly focus on sealing the root canal system after cleaning and shaping, whereas reparative cements are used to protect the pulp and promote tissue healing. The choice of root canal filling materials and procedures depends on the material properties, goals of the procedure and choice of practitioner.

FAQs

Q. Can both sealers and cement be used together?

Yes, both can be used in certain procedures together. For instance, MTA is used for pulp capping while root canal sealer is used later to fill the root canal space if the tooth requires further root canal treatment

Q. What happens if the wrong material is used?

Using the wrong material can subsequently hamper the overall treatment, for example, if a root canal sealer that is not biocompatible used in pulp capping can cause irritation or inflammatory response, similarly reparative cement that doesn’t provide adequate sealing used in root canal treatment can lead to re-infection or treatment failure.

Q. How long does Reparative cement take to set?

Setting time varies with the root canal filling materials and the chemical properties. Calcium hydroxide generally sets quickly, whereas MTA usually takes several hours to harden, and GIC usually takes 24 hours to reach to its full strength.

Q. Which is better for pulp capping: Calcium hydroxide or MTA?

MTA is generally considered superior when compared with calcium hydroxide for pulp capping, as it provides a better seal, is less likely to cause an inflammatory response and encourages dentine formation. Still, calcium hydroxide is used commonly due to its cost-effectiveness and ease of application.