Dental cements used in endodontics play a fundamental role in both root canal system obturation and the repair of perforations, apical sealing and other clinical procedures. However, not all materials perform the same function. Some act as endodontic sealers in combination with gutta-percha, while others are specifically designed to repair defects or create biocompatible barriers.
In this article, we analyse the main types of dental cements used in endodontics, their properties and their clinical applications.
What Is an Endodontic Cement?
An endodontic cement is a material used to seal spaces within the root canal system or repair communications between the canal and the periradicular tissues. During obturation, gutta-percha cones form the main core, but they cannot adapt completely to every anatomical irregularity. The sealer helps fill the spaces between the gutta-percha and the dentinal walls, as well as certain irregularities, lateral canals and hard-to-reach areas.
Obturation is part of a clinical sequence that also includes diagnosis, instrumentation, irrigation and disinfection. Therefore, the cement does not replace proper canal preparation but completes its three-dimensional seal.
What Properties Should an Endodontic Cement Have?
Although their characteristics vary according to their composition and indication, a good endodontic cement should provide:
- Sealing ability.
- Flowability and adaptation to the canal anatomy.
- Dimensional stability.
- Low solubility once set.
- Biocompatibility.
- Sufficient radiopacity to facilitate radiographic assessment.
- An adequate working time.
- Easy handling and application.
- The possibility of retreatment when necessary.
The importance of each property will depend on the obturation technique, the anatomy of the case and the clinician’s preferences.
Difference Between a Sealer and a Repair Cement
Before choosing a material, it is important to distinguish between two main groups.
An endodontic sealer is used during root canal system obturation, usually in combination with gutta-percha cones. A repair cement, on the other hand, is used to treat perforations, resorptions, open apices or retrograde cavities, among other indications. Although some materials share components, such as calcium silicates, their formulation, consistency and clinical application may differ.
Types of Endodontic Sealers
Endodontic sealers can be classified primarily according to their composition.
1. Bioceramic or Calcium Silicate Cements
Bioceramic cements used in endodontics are mainly manufactured from calcium silicates. They are hydrophilic materials, meaning that they use the moisture present in dentine to initiate or complete their setting process. Their characteristics include:
- Biocompatibility.
- Bioactivity.
- Ability to promote hydroxyapatite formation on their surface.
- Dimensional stability.
- High pH during certain stages of setting.
- Good adaptation to canal irregularities.
Their introduction has encouraged sealer-based obturation techniques, such as the matched single-cone technique. In these procedures, the gutta-percha cone helps distribute the cement throughout the root canal system. Retreatment must be considered during clinical planning, as completely removing a set bioceramic material may be more difficult in certain cases.
2. Epoxy Resin-Based Cements
Epoxy resin-based endodontic sealers are widely used due to their sealing ability, flowability, radiopacity and dimensional stability.
They generally provide:
- Good adaptation to dentinal walls.
- Low solubility.
- A long working time.
- Good stability after setting.
- Documented clinical experience.
They can be used with different obturation techniques, always in accordance with the manufacturer’s instructions.
3. Zinc Oxide-Eugenol Cements
Zinc oxide-eugenol cements are traditional materials used in endodontics. They generally offer familiar handling, good flowability and antimicrobial activity initially associated with eugenol. However, their potential solubility, dimensional changes and tissue response in the event of extrusion should be considered when selecting the product and controlling the amount applied.
4. Calcium Hydroxide-Based Cements
Sealers containing calcium hydroxide were developed to take advantage of its alkalinity and biological properties. Their characteristics include:
- High pH.
- Antimicrobial activity during certain stages.
- Good biological tolerance, depending on the formulation.
Their solubility and dimensional stability may vary, so the specific characteristics of each product should be consulted.
5. Silicone-Based Cements
Silicone-based sealers are known for their ease of handling, biocompatibility and dimensional stability. Some formulations contain gutta-percha particles to improve their integration with the core obturation material. Their properties and application technique depend on the specific commercial system.
6. Glass Ionomer Cements
Glass ionomer endodontic cements are characterised by their adhesion to dentine and low shrinkage. However, they are currently used less frequently than bioceramic or epoxy resin-based sealers. One of their main limitations may be the difficulty of removing them during retreatment.
Repair Cements in Endodontics
Repair cements are designed to create a stable, biocompatible barrier in areas where communication with the periradicular tissues exists. They may be indicated for procedures such as:
- Repair of root perforations.
- Treatment of resorptions.
- Apexification.
- Creation of apical barriers.
- Retrograde filling in apical surgery.
- Pulp capping.
- Pulpotomies and vital pulp therapy procedures.
MTA and Bioceramic Repair Cements
MTA, or mineral trioxide aggregate, was one of the first calcium silicate cements to be widely adopted in endodontics. Its biocompatibility and sealing ability allowed its use to be extended to perforation repair, apexification, apical surgery and vital pulp therapy. Current bioceramic formulations aim to retain these properties while improving aspects such as handling, consistency, setting time and colour stability.
How Should You Choose an Endodontic Cement?
There is no single cement that is best for every situation. The choice should be based on factors such as:
- Type of procedure.
- Root canal system anatomy.
- Obturation technique.
- Required moisture level.
- Working and setting times.
- Flowability and consistency.
- Biocompatibility.
- Possibility of retreatment.
- The clinician’s experience.
- The manufacturer’s instructions.
It is also essential to determine whether a flowable material is needed for canal obturation or a thicker cement is required for a repair procedure.
Sealers for Endodontic Obturation
The following are some of the alternatives used to seal the root canal system.
NeoSEALER Flo by Zarc
NeoSEALER Flo is a premixed bioceramic sealer indicated for endodontic obturation. Its calcium silicate-based formulation promotes bioactivity and hydroxyapatite formation when it comes into contact with moisture. Its main characteristics include:
- Ready-to-use presentation.
- Flowable consistency.
- Biocompatibility.
- Antimicrobial activity associated with its alkaline pH.
- Dimensional stability.
- Direct application into the canal.
It is designed for use with gutta-percha cones, following the technique and instructions established by the manufacturer.
EssenSeal by PDSA
EssenSeal is a zinc oxide-based sealer containing Melaleuca essential oil. Its flowability facilitates adaptation to the walls and irregularities of the root canal system. It is indicated for gutta-percha obturation techniques and is designed to provide:
- Good flowability.
- Coating of the canal walls.
- Easy insertion of gutta-percha points.
- Adaptation to complex root canal anatomies.
AH Plus by Dentsply Sirona
AH Plus is a two-component epoxy-amine resin-based sealer. It is used in combination with gutta-percha for the permanent obturation of root canals. Its main characteristics include:
- Good dimensional stability.
- Low solubility.
- Radiopacity.
- Adequate flowability.
- A long working time.
- Extensive clinical experience.
The choice between an epoxy resin-based sealer and a bioceramic sealer will depend on the technique used, the characteristics of the case and the clinician’s preferences.
Bioceramic Repair Cements
When the objective is not to obturate the entire canal but to repair a perforation or create an apical barrier, a different consistency from that of a flowable sealer is required. Bioceramic repair products such as NeoPUTTY or NeoMTA 2 may be used, according to their specific indications, in repair procedures, vital pulp therapy or apical sealing. It is important not to use a sealer and a repair material interchangeably: although both may contain calcium silicates, they have been formulated for different clinical purposes.
Conclusions
Dental cements used in endodontics can be employed to obturate the root canal system or to repair perforations and other defects. Bioceramic sealers, epoxy resin-based cements and zinc oxide materials are among the main alternatives for obturation. Calcium silicate repair cements, such as MTA and current bioceramic materials, can be used to treat perforations, open apices and resorptions, as well as to perform vital pulp therapy procedures. The choice of material should be based on its indication, properties, clinical technique and the manufacturer’s instructions.