European International Journal of Multidisciplinary Research
and Management Studies
84
https://eipublication.com/index.php/eijmrms
TYPE
Original Research
PAGE NO.
84-87
DOI
OPEN ACCESS
SUBMITED
20 February 2025
ACCEPTED
19 March 2025
PUBLISHED
21 April 2025
VOLUME
Vol.05 Issue04 2025
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Use of New Silers In the
Treatment of Apical
Periodontitis of
Permanent Teeth
Shukurova Nodira Tillaevna
Assistant of department of therapeutic dentistry, Samarkand state
medical university, Uzbekistan
Abstract:
To obtain clinical experience of using new
silers in treatment of apical periodontitis of permanent
teeth.Treatment of chronic apical periodontitis of
permanent teeth with root canal obturation with new
siler based on epoxy resin and bioceramic siler has been
carried out.
Keywords:
Endodontic
treatment,
root
canal
obturation, sealer, new materials.
Introduction:
The experience of using new sealers in
endodontic treatment of permanent teeth allows us to
state that they are convenient in work and allow to
obtain good clinical results in treatment.
Endodontics is one of the most difficult sections of
therapeutic dentistry. Significant difficulties in
endodontic treatment create a variety of nosological
forms of pulp and apical periodontal diseases,
complexity and variability of the anatomy of the root
canal system, a variety of approaches to mechanical
and medical intervention in the endodontium, methods
and systems for obturation of root canals and methods
of post-endodontic restoration. The tasks of filling the
system of root canals elimination of communication
between the root canal and the crown part of the tooth
cavity and isolation of microorganisms left preventing
the ingress of tissue fluid from periapical tissues into
the canal. Filler (gutta-percha is currently preferred)
and siler are used for filling. Siler functions are
considered to be filling of microspaces and dentinal
tubules, smoothing of irregularities of the canal wall,
providing sliding of gutta-percha pins. At present the
following groups of silers are distinguished: resin-based
European International Journal of Multidisciplinary Research
and Management Studies
85
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European International Journal of Multidisciplinary Research and Management Studies
(“AH Plus”, “Acroseal”, “EndoRez”); mineral trioxide
aggr
egate (MTA) and its base (“MTA
-
Fillapex”,
“Aureoseal”);
silicone
-
based
(“RoekoSeal”,
“GuttaFlow”); glass ionomer cements (“Ketac Endo”,
“Endosil”); zinc
-oxide-
eugenol cements (“Roth”, “Kerr
PCS”, “Endomethasone N”, “Canason”); containing
calcium hydroxide
(“Sealapex”, “Apexit”); based on
dentin adhesives (“Epiphany”); bioceramic (“Sure
-Seal
Root”). At present in clinical practice the most
widespread are silers based on organic resins. Their
advantages include biocompatibility, good germetism,
low viscosity and convenient working time. The
disadvantages of this group of silers are sensitivity to
moisture (the canal should be perfectly dried before
filling), sensitivity to traces of oxidants in the canal (the
last instillant should not be hydrogen peroxide), post-
filling pain during effusion (dynamic verification of the
working length is necessary). The epoxy resin-based
sealer “BJM Root Canal sealer” (BJM) is one of the latest
developments in this group. The IABT (Immobilized
Antibacterial Technology) makes this material unique.
The technology is based on the addition of “Biosafe
HM4100” (BioSafe Inc., USA) molecules (quaternary
ammonium compound) to the siler. The mechanism of
action of these positively charged molecules is
associated
with
electrostatic
interaction
with
negatively charged bacterial cells, which leads to a
change in the permeability of their membranes and
subsequent death. Among the important properties of
BJM Root Canal sealer are high radiopacity, good
wetting and flowability (more than many other epoxy-
based sealers!), long-term stability due to good
hermeticity and moderate flexibility, which prevents
cracking of the cured material, as well as low shrinkage.
In the cold gutta-percha technique, the following steps
of working with BJM Root Canal sealer can be
distinguished: - drying of the root canal (after
mechanical and medical treatment), - introduction of
the siler (e.g. on a paper pin), - introduction of gutta-
percha pins moistened with siler (and their
condensation). It should be emphasized that this siler is
universal, as it can also be used with all types of heated
and thermoplasticized gutta-percha.
Clinical case 1 Patient M. came for consultation
regarding the possibility of therapeutic treatment of
tooth 3.6. From the anamnesis: the tooth had been
previously treated for caries. Due to the loss of a filling,
the patient applied to a general dentist, who was
directed to extract tooth 3.6. Clinical picture. On the
chewing surface of tooth 3.6 there is a deep carious
cavity, on the distal surface there is a fragment of an old
filling. Probing along the bottom of the carious cavity
and percussion are painless. The mucous membrane in
the projection of tooth 3.6 is unchanged. On the
radiograph: a fragment of a filling and a deep carious
cavity in tooth 3.6, communicating with the tooth
cavity. The lumen of root canals is visualized. In the area
of apices there are foci of bone tissue destruction with
indistinct contours, 0.4×0.5 and 0.6×0.7 cm in size (Fig.
1). Diagnosis: Chronic apical periodontitis of tooth 3.6.
The patient was proposed a treatment plan for tooth
3.6 including the following steps.
Primary mechanical and medical treatment of root
canals with apexlocation and subsequent filling with
aqueous calcium hydroxide for 2 weeks.
Repeated mechanical and medical treatment of root
canals with apexlocation and subsequent filling with
gutta-
percha pins with “BJM Root Canal sealer”.
Delayed filling with photocomposite material.
Dynamic follow-up in 3, 6, 12 months. Informed
consent of the patient was obtained for the above plan,
after which items 1-2 were performed. The patient
came for a control examination 4 months after filling.
She had no complaints (including post-restoration
pain). On clinical examination, the restoration in tooth
3.6 was tight, percussion of the tooth was painless and
there was no mucosal reaction in the projection of the
tooth. On the radiograph: root canals were filled
densely, with contrast, throughout the whole length; in
periapical tissues there was a decrease in the size of foci
of destruction with signs of healing. The next control
examination took place one year after filling. The
patient did not present any complaints, during visual
and tactile examination the condition of tooth 3.6 was
unchanged. The radiograph showed a slight widening of
the periodontal gap in the area of the apex of the mesial
root of the tooth.
Bioceramic sizers are a new group of materials, which
include zirconium oxide, calcium silicates, calcium
dihydroorthophosphate, calcium hydroxide and other
components. The first material from this group
registered in the Republic of Belarus was “Sure Seal
Root” (“Sure Dent”). The most important properties of
this material are:
Absence of shrinkage.
Provision of 3D obturation.
Hydrophilicity. Formation of hydroxyapatite.
Biocompatibility and osteogenicity.
Chemical bonding with dentin.
Antibacterial action (pH>12).
Radiopacity.
Convenient working time and curing time (25 minutes
to 2.5 hours).
Ease of use (ready-to-use paste).
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European International Journal of Multidisciplinary Research and Management Studies
Clinical Case 2 Patient M. complained of discoloration
of the crowns of the upper central incisors. From the
anamnesis: these teeth were treated endodontically at
school age. Clinical picture. The crowns of teeth 1.1, 2.1
are discolored, on the proximal and palatine surfaces
there are complete fillings. Cold test is negative.
Percussion is painless. The mucous membrane in the
projection of the upper incisors is unchanged. On the
radiograph: in the root canals of teeth 1.1, 2.1 there are
traces of obturation materials, in the periapical area
there are foci of bone tissue destruction with clear
contours 0.4-0.5 cm in size.
Diagnosis: Chronic apical periodontitis of teeth. A
treatment plan was proposed and agreed upon for the
patient. The treatment included the following stages:
Isolation of teeth. cofferdam, removal of old fillings.
Filling of root canals and their passage with K-file #15.
Determination of apexlocator working length and its
verification radiologically (1.1 - 24 mm, 2.1 - 25 mm.
Treatment of cervical and middle thirds of the canals
with SX/S1 and S2 protapers, respectively.
Treatment of the apical third of the canals and their
shaping with protapers F1, F2, F3, F4, F5.
Verification of the working length with an apex locator
after each instrument and medicalization with sodium
hypochlorite (3%) and EDTA (17%). After completion of
treatment - additional treatment with iodides,
hydrogen peroxide, distilled water. Activation of all
solutions with endoactivator for 30-60 seconds.
Obturation of canals by the method of lateral
condensation of gutta-percha with bioceramic sealer
“Sure Seal Root” and delayed filling with glass ionomer
cement.
CONCLUSION
The experience of using new silers in the treatment of
apical periodontitis of permanent teeth allows us to say
that they are convenient in operation, effective and can
be recommended for wide clinical use in dental
practice.
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