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Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 49-52

Nonsurgical healing of periapical lesion using single cone with bioceramic sealer

Department of Conservative Dentistry and Endodontics, College of Dental Sciences, Davangere, Karnataka, India

Date of Web Publication17-May-2019

Correspondence Address:
Dr. Kanika Chhillar
Post Graduate, Department of Conservative Dentistry and Endodontics, College of Dental Sciences, Davangere
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijohs.ijohs_43_18

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An important goal of root canal treatment is to properly seal the canal system after cleaning and shaping. However, irregularities such as fins, isthmuses, and lateral canals are often present can pose challenge to clinician during obturation. The importance of three-dimensional obturation of the root canal system cannot be overstated, with the ability to achieve this goal primarily dependent on the quality of canal cleaning and shaping as well as clinical skill. Other factors that influence the ultimate success or failure of each case include the materials used and how they are used. Root canal sealer not only helps to enhance impervious seal but can also act as lubricant and can flow to lateral and accessory canals. This case report states the importance of bioceramic-based sealers in nonsurgical healing of periapical lesion.

Keywords: Bioceramic sealer, nonsurgical healing, periapical lesion

How to cite this article:
Basavanna R S, Shivanna V, Chhillar K. Nonsurgical healing of periapical lesion using single cone with bioceramic sealer. Int J Oral Health Sci 2019;9:49-52

How to cite this URL:
Basavanna R S, Shivanna V, Chhillar K. Nonsurgical healing of periapical lesion using single cone with bioceramic sealer. Int J Oral Health Sci [serial online] 2019 [cited 2022 Aug 18];9:49-52. Available from: https://www.ijohsjournal.org/text.asp?2019/9/1/49/258573

  Introduction Top

The main goal of endodontic therapy is to prevent or heal apical periodontitis. The goal can be accomplished by paying attention to four main aspects that include awareness about root canal anatomy and morphology of entire root canal system, chemical cleaning and disinfection, three-dimensional (3D) obturation, and sound restoration. However, irregularities such as fins, isthmuses, and lateral canals are often present and can pose challenges to clinicians during obturation.[1] The inability to fill and seal these anatomic spaces can have a detrimental effect on success of endodontic treatment.[2] Success of root canal treatment does not confine to lack of pain, but tooth should have adequate clinical function.[3]

Root canal obturation involves the 3D filling of the entire root canal system and is a critical step in endodontic therapy as it eliminates all avenues of leakage from the oral cavity or the periradicular tissues into the root canal system; and the seals irritants within the root canal system that remain after appropriate shaping and cleaning of the canals, thereby entombing these irritants.

Obturation technique and properties of sealer define the fate of filling. The prime reason of failure is inability to eliminate etiologic factors and to prevent further irritation as a result of continued contamination of the root canal system.[4],[5]

The use of a sealer during root canal obturation is essential for success of root canal treatment. The sealer has various functions:

  • Attainment of impervious seal
  • Filler for canal irregularities and minor discrepancies between the root canal wall and core-filling material
  • Expressed through lateral or accessory canals
  • Can assist in microbial control
  • Act as lubricant
  • Can have adhesive property to dentin.[6]

In the era of adhesive dentistry, bioceramic-based sealers have overpowered other sealers because of their biocompatibility and due to calcium phosphate which enhances the setting properties of bioceramics and results in a chemical composition and crystalline structure similar to the tooth and bone apatite materials, thereby improving sealer-to-root dentin bonding. The purpose of this is to emphasize the importance of bioceramic sealer in nonsurgical root canal treatment.

  Case Report Top

A 50-year-old patient reported to the Department of Conservative Dentistry and Endodontics, College of Dental Sciences, Davangere, Karnataka, with pain in the upper front tooth region and difficulty in mastication.

The pain was rapid on onset which lasts for few minutes, relieved on taking medication,, and reoccurred spontaneously. Tooth was markedly tender on percussion and the patient had localized sense of fullness over that region.

The patient had faulty prosthesis (improper overjet and overbite) in relation to the upper front tooth region which she got fabricated around 6 months before from the day of reporting.

On radiographic examination, a large periapical lesion of about 5 cm × 4 cm was noticed around root of 22 and radiopaque material was noticed in root canal space of 12 suggestive of improper obturation (incorrect working length and width) [Figure 1]. Access opening was initiated on the very same day with determination of working length and initial Biomechanical preparation (BMP) till 30, 0.02 with copious irrigation. Calcium hydroxide dressing was given for 1 week and the patient had been kept on antibiotics for 5 days. After 1 week, BMP was again initiated and step back technique was used with proper irrigation and recapitulation. The canal was obturated with single-cone technique using Bioroot sealer and postendodontic restoration with glass ionomer cement.
Figure 1: Radiograph of the upper front tooth region with periapical lesion in relation to 22

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The patient had been kept on follow-up and radiographs had been taken at interval 1 month [Figure 2] and 3 months [Figure 3]. There was no appreciable reduction in periapical radiolucency and surgery was planned, but the patient did not turn up for 9 months. After a year periapical healing was noticed [Figure 4].
Figure 2: Radiograph of follow-up after obturation (1-month follow-up)

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Figure 3: Radiograph of follow-up (3 months)

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Figure 4: Radiograph with follow-up (1 year)

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  Discussion Top

Various evidence suggest that under most conditions, bacterial biofilms in the complex root canal system can be greatly reduced, but not eliminated by conventional endodontic procedure. If microbes in root canal system are effectively eliminated or entombed within the root canal by filling material, if canals adequately sealed and protected from coronal microleakage, then periradicular tissue has ability to restore their original structure by means of repair/regeneration process.[7]

Bioceramic sealer (BiorootTM, Septodont) possess outstanding adhesion to dentin and gutta-percha points.[8] It forms chemical bond with dentin as it forms hydroxyapatite in the presence of moisture because of it hydrophilic nature. The nature of bond between sealer and dentin depends on its chemical composition. Bioroot RCS interaction with dentin leads to formation of mineral infiltration zone. The mineral infiltration zone is the ion exchange layer that appears in the interface between dentin and tricalcium silicate-based cement attributed to a dual effect of the calcium-hydroxide-releasing cement: alkaline caustic etching followed by mineral diffusion.[8] Hence, it eliminates any space between sealer and dentinal wall. It is composed of pure minerals with no resin content, henceforth no staining and zero shrinkage. It demonstrates great flowability thus sealing auxiliary canals.[9] Obturation technique followed was hydraulic condensation technique where main hydraulic force generated through synchronicity, which is the act of cementing close-fitted master cone to shaped canal. It can be considered as cold vertical condensation where gutta-percha act as condenser and bioceramic sealer as thermoplasticized gutta-percha.

According to the recent study, the overall success rate of nonsurgical endodontic treatment using bioceramic and single-cone obturation technique was 90.9%.[10] Bioroot RCS proved to possess increased alkaline pH with time contributing to antibacterial property, biocompatibility, and osteogenic potential.[11] A study conducted to evaluate the interaction of irrigating solution and sealer with dentin and concluded that antimicrobial activity of Bioroot sealer enhanced after using ethylenediaminetetraacetic acid as final irrigant.[12]

Celikten et al.[13] evaluated sealing ability of single cone, lateral compaction, and thermafill technique using bioceramic sealer. They found no significant difference in obturation technique in proportion of sections with voids.

In this present case, we used single-cone obturation technique using bioroot sealer and found healed periapical lesion (>5 mm wide) under follow-up of 1 year.

  Conclusion Top

It is not necessary that large periapical lesion can be healed after surgical intervention only. These can be managed successfully using bioceramic-based sealers.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Estrela C, Rabelo LE, de Souza JB, Alencar AH, Estrela CR, Sousa Neto MD, et al. Frequency of root canal isthmi in human permanent teeth determined by cone-beam computed tomography. J Endod 2015;41:1535-9.  Back to cited text no. 1
Kim S, Jung H, Kim S, Shin SJ, Kim E. The influence of an isthmus on the outcomes of surgically treated molars: A retrospective study. J Endod 2016;42:1029-34.  Back to cited text no. 2
Seltzer S. Root Canal Failure in Endodontology. 2nd ed. 1988. p. 439-70.  Back to cited text no. 3
Gutmann JL. Clinical, radiographic, and histologic perspectives on success and failure in endodontics. Dent Clin North Am 1992;36:379-92.  Back to cited text no. 4
Rud J, Andreasen JO. A study of failures after endodontic surgery by radiographic, histologic and stereomicroscopic methods. Int J Oral Surg 1972;1:311-28.  Back to cited text no. 5
Kokkas AB, Boutsioukis AC, Vassiliadis LP, Stavrianos CK. The influence of the smear layer on dentinal tubule penetration depth by three different root canal sealers: Anin vitro study. J Endod 2004;30:100-2.  Back to cited text no. 6
Hargreaves KM, Berman LH, editors. Cohen's Pathways of Pulp. Gurgaon: Unit Printing Press; 2011.  Back to cited text no. 7
Atmeh AR, Festy F, Banerjee A, Mannocci F, Watson TF. Mineral Interaction Zone; a Chemo-morphological Chracterization of the Dentine-Biodentine Interface. Biomaterials, Biomimetrics and Biophotonics. London, UK: King's College London Dental Institute; 2012.  Back to cited text no. 8
Bentley K, Janyavula S, Cakir D, Beck P, Ramp LC, Burgess JO. Mechanical and Physical Properties of Vital Pulp Materials. School of Dentistry, University of Alabama at Birmingham, Birmingham, AL.  Back to cited text no. 9
Chybowski EA, Glickman GN, Patel Y, Fleury A, Solomon E, He J, et al. Clinical outcome of non-surgical root canal treatment using a single-cone technique with endosequence bioceramic sealer: A retrospective analysis. J Endod 2018;44:941-5.  Back to cited text no. 10
Poggio C, Dagna A, Ceci M, Meravini MV, Colombo M, Pietrocola G, et al. Solubility and pH of bioceramic root canal sealers: A comparative study. J Clin Exp Dent 2017;9:e1189-94.  Back to cited text no. 11
Arias-Moliz MT, Camilleri J. The effect of the final irrigant on the antimicrobial activity of root canal sealers. J Dent 2016; 52:30-6.  Back to cited text no. 12
Celikten B, Uzuntas CF, Orhan AI, Tufenkci P, Misirli M, Demiralp KO, et al. Micro-CT assessment of the sealing ability of three root canal filling techniques. J Oral Sci 2015;57:361-6.  Back to cited text no. 13


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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