Adhesion and

endodontic
bonding in root canal
SUPERVISOR:[Link] ELGENDY
DONE BY ABEER ABDULKARIM
Outline
Introduction of adhesion
Mechanisms of adhesion
Types of endodontic resin sealers
Concept of monoblocks
Concept of hypridazation
Limitation of dentine bonding
Efforts to overcome the problems with resin adhesive
Adhesion
Adhesive
Adherent
Adhesive failure
Classification of adhesion

Mechanical

micromechanical macro mechanical

 Goals of endodontic treatments
oReduction or elimination of microorganism
oSeal the root canal system from outside environments and entombing any residual microorganism
So ideal sealer!!
What will happen if the treated root canal not sealed
well?
several culture and molecular biology studies have revealed that Enterococcus faecalis is the most
frequent species in root canal– treated teeth, with prevalence values reaching up to 90% of cases.*
 Posttreatment apical periodontitis lesions in root canal– treated teeth. In poorly treated canals, the microbiota is
similar to primary infections. In cases apparently well treated, fewer species are found. Regardless of treatment
quality, persistent or secondary intraradicular infections are the main causative agents of endodontic treatment
failure.
Enterococcus faecalis

Live and persist in poor nutrient environment

Survive in the presence of several medications (e.g., calcium hydroxide) and irrigants (e.g.,
sodium hypochlorite)
Invade and metabolize fluids within the dentinal tubules and adhere to collagen
Acquire antibiotic resistance
Survive in extreme environments with low pH, high salinity and high temperatures
adhesion
An ideal endodontic filling material should form a good adhesion and create a "monoblock“

What does monoblock means?

THE CONCEPT OF MONOBLOCK
a single unit.
canal space become perfectly filled with gap-free, solid mass that consists of different materials
that interfaces with the purported advantage of simultaneously improving the seal and fracture
resistance of the filled canals
monoblocks
Primary Secondry Tertiary
Hydron Resilon Fiber post
 Development of adhesive root canal
Materials utilizing dentin adhesive technology
has been borrowed from restorative dentistry
and adapted to obturating materials
 Methaacrylate
generations
resin

Resin sealer
AH-26
Epoxy resin
AH
 METHYLMETHACRYLATE RESIN
SEALER

FIRST generation Third generation

• Two steps
• Hydrophilc • a self-etching primer
• a dual-cured resin composite sealer
Second generation
• non etching and hydrophilic fourth generation
• An etchant, a primer, a sealer in one
in nature
self etching, self adhesive sealer
• does not require the
adjunctive use of adenine
adhesive.(SELF priming)
Hydron

•introduced in the mid 1970s

•poly(2-hydroxyethyl Methacrylate (poly HEMA), which rendered the sealer
hydrophilic.
•obsolete in the 1980s
It was reported to be:
oNon irritating
oHighly adaptable to the canal walls
oNon supportive for bacterial growth
oAble to be calcified in the event of inadvertent extrusion into the periapical area.
osevere inflammatory reactions.
oAbsorption of the material occurred
oSevere leakage
 EndoREZ (Ultradent Products Inc, South Jordan, UT)

UDMA(Urethane dimethaacrylate)
•flow into accessory canals and dentinal tubules
•resin tag formation
•smear layer removal with NaOCl and ethylene diamine tetraacetic acid (EDTA)
 EndoREZ (Ultradent Products Inc, South Jordan, UT)

oVery low bond strength is reported*

oPerformed poorly in leakage studies compared to other sealers**
oNo anti microbial effect***
oRecommended for use with either conventional gutta-percha or resin coated gutta-percha.. (coating did
not prevent gap formation and leakage`
o91.3% success rate at 14-24 months( study)``

No advantage yet over other sealers.

* `
** ``
***
Third generation (self etching sealers):
.

1. An acidic primer
2. The acidic primer is air-dried
3. a dual-cured, moderately filled flowable resin composite sealer is applied and
polymerized.
 Hybridization concept
•the primary process used today to bond hydrophobic(water hating) restorative resin materials to wet
dentine*
•The hybrid layer is the resin infiltrated collagen matrix
• 2-5 micrometre in thickness**

.
*Nakabayashi N, Kojima K,Masuhara E. The promotion of adhesion by the infiltration of monomers into tooth substrates. J Biomed
Mater Res 1982;16:265–9.
**Van Meerbeek B, De Munck J, Yoshida Y, et al. Buonocore memorial [Link] to enamel and dentin: current status and
future challenges. Oper Dent 2003;28:215–35.
Resilon/ephany
Resilon (Research LLC, Madison, CT), a dimethacrylate-containing polycaprolactone-based
thermoplastic root filling material
The three initial published studies were sponsored by the manufacturer

In the first study, obturation with the Resilon system was shown to strengthen
the teeth slightly*
o Theseresults are countered by a recent independent study in which Resilon was not
found to reinforce immature teeth**
oWilliams, et al., reported that neither Resilon nor gutta-percha has adequate stiffness
to reinforce teeth***
oSimilar minor strengthening effects have also been reported for AH-26 and Ketac
Endo`
oIt is doubtful that any of these findings are clinically significant
* `
**
***
The second company sponsored study

Reported less leakage in vitro with the Resilon system than with AH-26 after 3
weeks*
Draw backs:
 Three weeks is not adequate aging of the specimens.
 Bonds were not stressed during the storage period.

These results are supported by a recent Canadian study**, but countered by a study by Tay et al. who
found no difference in microleakage with the same materials***

*
**
***
The third study

utilized dogs and compared Resilon/Epiphany with gutta-percha/AH26 that was intentionally
contaminated with microorganisms*
Teeth obturated with the Resilon system had less periradicular inflammation after 3 months

*
• Bond strengths of less than 2 MPa are reported between Epiphany and Resilon*
•one study reported lower bond strengths than with gutta-percha and AH 26 **. This is not
surprising, because unpolymerized resin must be available in both materials to achieve co-
polymerization***. There is no unpolymerized resin in Resilon.
• A recent study found gaps present in teeth obturated with Resilon/Epiphany as well as gutta-
percha/AH 26, and there was no difference in microleakage . The gaps in the Resilon/Epiphany
group were between Epiphany and the dentin wall. In the other group the gaps were between
AH26 and gutta-percha
•. None of the specimens exhibited a mono-block.
• These findings challenge the concept of a monoblock and the results of a previous study that
Resilon/Epiphany strengthens the tooth`

*Teixeira FB, Teixeira EC, Thompson JY, Trope M. Fracture resistance of roots endodontically treated with a new resin filling material. J Am
Dent Assoc 2004;135:646–52
** Gesi A, Raffaelli O, Goracci C, Pashley DH, Tay FR, Ferrari M. Interfacial strength of Resilon and gutta percha to intraradicular dentin. J
Endod 2005;31:809–813
*** Tay FR, Loushine RJ, Weller RN, et al. Ultrastructural evaluation of the apical seal in roots filled with a polycaprolactone-based root
canal filling material. J Endod 2005;31:514–9.
`Gesi A, Raffaelli O, Goracci C, Pashley DH, Tay FR, Ferrari M. Interfacial strength of Resilon and gutta-percha to intraradicular dentin. J
Real seal
 MetaSEAL™ (Parkell Inc.)

Based on the inclusion of the acidic resin monomer 4-META, 4-

methacryloyloxyethyl trimellitate anhydride

Real seal SE (Sybron Endo): functionally analogous to MetaSEAL.v

 
 
 
Bonds to common gutta percha. In this micrograph of a cross-sectioned point, you can see where MetaSEAL
penetrated the gutta percha to create a hybrid bond.
The strength of this bond actually exceeds the cohesive strength of the point.
In vitro Leakage Studies Associated with the Use of Methacrylate-Resin based Sealers
JOE — Volume -, Number -, - 2009 Methacrylate Resin–based Root Canal Sealers
In Vitro Fracture Resistance Studies Associated with the Use of Methacrylate Resin–based Sealers and Bondable Root Filling Materials
Epoxy Resin
•Epoxy resin sealear are polymer composed of an epoxy amine
•characterized by the reactive epoxide ring polymerized by anionic ring-opening reaction
Diaket
• 1st resin sealer ,1951 by sheuffle
• Formed between ZnO and polyvinyl resin dissolved in liquid diketone
• initially intended for use as a root canal sealer, has been advocated for use as a root-end filling material
• used as a root canal sealer, biocompatibility studies showed that it was cytotoxic in cell culture and
generated long-term chronic inflammation in osseous and subcutaneous tissues. BUT when mixed at
the thicker consistency advocated for use as a root-end filling material, it has shown good
biocompatibility with osseous tissues.
• Good sealing efficiency
• Setting time 6-8min
 BUT
•Cytotoxic and generate long term chronic inflammation
•This material is no longer available in the United States
 AH26:

•recommended by Shroeder in 1957.

•Slow reaction
Composition:
Poweder: Bismuth oxide,Hexamethylene tetramine, Silver powder,
Titanium oxide. 
Liquid: Bisphenol diglycidyl ether

 
.
advantages

•Good adhesive properties

•Good flow
•Antibacterial
•Contracts slightly on hardening
•Produces greater adhesion to dentin when smear layer is removed
•Film thickness is 39 microns.
Disadvantages:
•When it sets release formaldehyde
•AH-26 gives a distinct color shift towards gray
•Setting time is 36-48 hours at body temperature and 5-7 days in room temp.
 AH Plus (Dentsply, International)
Also marketed as Thermaseal plus (Dentsply, Tulsa)
Epoxy-bis-phenol resin
Developed from its predecessor AH26; because of color and shade stability.
It is available as a paste in 2 collapsible tubes and recently as AH Plus® Jet™ Mixing Syringe for direct intra-
oral application, offering a more precise, convenient and faster procedure.
Biocompatible, no formaldehyde release
Does not cause staining
Setting time is 8 hours
Half solubility when compared to AH26 (0.31%)
Film thickness is 20 microns (half that of AH26)
Shrinkage (1.76%)
Calcium Silicate phosphate
 Endosequences bioceramic Sealer
Bioaggregate,iRoot SP and iRoot BP
 

 Composition

-Zirconium Oxide, Calcium Silicates, Calcium Phosphate,

Calcium Hydroxide, filler and thickening agents.
 
Properties of the bioceramic sealer
• highly hydrophilic
•When unset, the bioceramic sealer has a pH of above 12. Thus its antibacterial
properties are similar to calcium hydroxide
•The sealer does not shrink, but expands slightly
•it is insoluble in tissue fluids
• If used with coated gutta-percha point with nano particles of bioceramic, it will
bond to the core point thus eliminating the gap between the core and sealer.
MTA based Sealer; ProRoot MTA (Dentsply).

•developed by Dr Torabinejad at Loma Linda University in 1993

•Composition
It is available in two colors—white and gray color
Tricalcium silicate
Dicalcium silicate
Tricalcium aluminate
Bismuth oxide
Calcium sulfate
Tetracalcium aluminoferrite.
•White color: It has same composition as that of gray color MTA
except the lack of tetracalcium aluminoferrite.
• pH of MTA is 12.5 (When set)
• Setting time is 2 hours and 45 minutes
• Compressive strength is 40Mpa immediately after setting and 70 MPa after 21 days
• Contrast to Ca(OH)2 it produces hard setting non resorbable surface
• hydrophilic in nature
• low solubility
• resistanceto marginal leakage
• reduces bacterial migration
• excellent biocompatibility in relation with vital tissues
• The compressive strength of MTA is equal to IRM and super EBA but less than that of
amalgam
Glass ionomers sealer
 
1- Ketac-Endo (3M ESPE)
•the reaction product of an ion leachable glass powder and a polyanion in aques solution.
•Enables adhesion between the material and the canal wall.
•Optimal physical properties
•Minimum number of voids
•Low surface tension
•Good flow properties

 
Disadvantages:
• Removal if retreatment is required, since it does not dissolve in common solvents.
•However, Toronto/Osract group has reported that ketac-endo sealer can effectively be removed by hand
instruments or chloroform solvent followed by 1 minute with an ultrasonic No.25 file.
2-Active G.P. (Brasseler USA)
• a glass ionomer/impregnated gutta-percha cone with a glass ionomer external coating and a glass
ionomer sealer
• Available in 0.04 and 0.06 taper cones, the sizes are laser verified to ensure a more precise fit.
 A bacterial leakage study comparing active
G.P./glass ionomer sealer, Resilon/epiphany,
and gutta-percha (GP)/AH Plus demonstrated
no statistically significant differences at 65
days*

*Fransen JN, He J, Glickman GN, et al: Comparative assessment of Activ GP/glass 
ionomer sealer, Resilon/Epiphany, and gutta-percha/AH Plus obturation: a bacterial 
leakage study, J Endod 34:725, 2008.
 
Effective bonding in the environment of the root canal system is a
challenge because of:
• anatomy
•limitations in the physical and mechanical properties of the
adhesive materials.
 The limitation of dentine bonding
1. Polymerization shrinkage of resin based materials.
* the force of polymerization contraction often exceeds the bond strength of adhesive to dentin.
2. The root canal system has an unfavourable geometry for resin bonding.
3. Deterioration of resin bond with time.
[Link] shrinkage of resin based materials
SEM demonstrating microgap formation with
AH 26 epoxy sealer due to polymerization
shrinkage

[Link]
leakage-prevention
 [Link] root canal system has an unfavourable geometry for resin bonding.

[Link]/configuration factor

Unbounded surfaces stress on the bonded surfaces from polymerization contraction.

[Link] of resin bond with time
Is radicular dentin different than
coronal dentin?

66
1. In the apical one-third of the root there are fewer dentinal tubules (less
resin tags), more intertubular dentin is available for hybridization.
2. In some apical areas the dentin is irregular and devoid of tubules.
3. Recent article reported that radicular dentin in the apical third is often
sclerotic and the tubules are filed with minerals that resemble those
from peritubular dentin.

67
Do you think that‘s points are the only challenges in
bonding within root canal?
[Link] problems of using adhesive materials deep
in the root canal system.

a) Application of primer or adhesive in the

apical one
b) volatile carrier must be evaported

69
 • application and drying of the primer
• acetone or alcohol carries is not completely removed

c) Contact between components in adhesive materials and the apical

tissue
2. The problems with irrigating solutions and
medicaments.
 Sodium hypochlorite
 Hydrogen peroxide leaves an oxygen rich surface
 No loss of bond strength is reported from chlorhexidine use with resins or resin
modified glass-ionomer materials.
 Caries detector did not affect resin bond strengths.
 Chloroform and halothane cause loss of bond strength.
 Sodium hypochlorite & EDTA have been shown to degrade the mechanical
properties of dentin.

71
3. The problems with Dual – Cured & Self – Cured resin
The slower chemical polymerization processes
allow material to flow, so provides some stress
relief from polymerization contraction.
Self – cured resins have less conversion of
monomer to polymer than light – cured, so less
forces from polymerization contraction.
Air bubbles incorporated into the resin during
mixing process provide stress relief mechanism.
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 [Link]

inhibits polymerization reaction resins and can interfere

with bonding of bonded posts.

Use strong acid to demineralize the dentin surface

 3- step etch & rinse allow effective bonding to

eugenol contaminated dentin surface.
Self etching should be avoided
 Eugenol has no effect on Glass Ionomer cements.
73
5. Other barriers to effective bonding.
a) Debris & remnants of the pulp.
b) Calcium hydroxide
c) Alcohol.

74
Does removal of smear layer is
matter?

75
This question remains somewhat controversial.
Removal of smear layer has been shown to increase the dentin bond
strength for glass ionomer materials and unbounded resin materials,
although bond strengths are still quite low.
Removal of smear layer is reported to reduce microleakage for most
sealers.
Removal of smear layer in infected teeth help in reducing bacteria
which are one of its components.
Care must be used not to over treat the dentin surface.

76
Efforts to overcome the problems with
resin adhesive
1) New innovative delivery methods

2) Use of reducing agents

3) Use of three-step etch &rinse adhesive systems

4) development of shrink free obturating
materials

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Thank you