Powder: methenamine 25%–50%, titanium dioxide 2.5%–10%, silver 2.5% Liquid: bisphenol A/epichlorohydrin resin 50%–100% Ivoclar Vivadent AG, Schaan, Liechtensteinīase: calcium hydroxide/calcium oxide 36.9%, hydrated colophonium 54%, fillers and other auxiliary materials 9.1% Activator: disalicylate 47.6%, bismuth hydroxide/bismuth carbonate 36.4%, fillers and other auxiliary materials 16% Powder: zinc oxide 65.68%, nitrate bismuth 15.17%, carbonate bismuth 10.1%, paraformaldehyde 4%, titanium dioxide 4.76%, red ferric oxide 0.1%, zinc stearate 0.075%, dehydrate zinc acetate 0.075%, yellow ferric oxide 0.04% Liquid: eugenol 77%, peanut oil 20%, rose oil 1.8%, lavender oil 1.2%īase: N-ethyl-o (or p)-toluenesulfonamide 30%–60%, calcium oxide 30%–60%, zinc oxide 1%–5%, zinc distearate 1%–5% Catalyst: methyl salicylate 10%–30%, 2,2 dimethylpropane-1,3-diol 1%–5%, isobutyl salicylate 1%–5% Powder: zinc oxide, staybelite resin, bismuth sub-carbonate, barium sulfate, sodium borate Liquid: eugenol However, calcium hydroxide-based sealers are not physically robust, as demonstrated by their significant leakage. With these advantages, it has been widely used as a pulp capping agent for intracanal medicament and as a root canal sealer. It is characterized by its biocompatibility and high pH due to the hydroxyl ion, which induces hard tissue formation and antimicrobial activity. Calcium hydroxide was introduced to endodontics by Herman in 1920 for pulpal repair. In 1958, Grossman introduced a non-staining ZOE sealer as a substitute for Rickert’s formula, and this formula was used for a considerable amount of time. However, the sealer contained silver, which caused discoloration. The earliest, a ZOE-based root canal sealer, was introduced by Rickert in 1931. The sealers included in this review are outlined in Table 1. Root canal sealers are classified according to their composition as zinc oxide-eugenol (ZOE), calcium hydroxide, glass ionomer, silicone, resin, and bioceramic-based. Since the initial development of root canal sealers in the early 20th century, various root canal sealers have been developed to more adequately meet those requirements. Grossmann suggested that excellent sealing ability, dimensional stability, slow setting time, insolubility, and biocompatibility are required for an ideal root canal sealer. A root canal sealer should display appropriate physicochemical and biological properties. Root canal sealers seal off of the root canal system, entombing the remaining bacteria and filling irregularities in the prepared canal. Instead, developments in root canal filling materials have focused on the chemical and physical properties of the sealer. Since gutta-percha was introduced to dentistry as a root canal filling material in the mid-19th century, no significant advancements have been made over the past 170 years except for the introduction of silver cones. To achieve this goal, complete removal of bacteria from the canal is important, as is the choice of filling material. The goal of root canal therapy is to remove and prevent apical periodontitis. Therefore, further studies aiming to improve the physical properties of calcium silicate-based sealers are needed. Although the physical properties of calcium silicate-based sealers meet International Organization for Standardization recommendations, and they have consistently reported to be biocompatible, they have not overcome conventional resin-based sealers in actual practice. Sealers displaying lower microleakage and stronger push-out bond strength are also needed to endure the dynamic tooth environment. Because of the hydrophilic environment in root canals, water resorption and solubility of root canal sealers are important factors contributing to their stability. Drawing upon the advantages of mineral trioxide aggregate, calcium silicate-based sealers were introduced with high levels of biocompatibility and hydrophilicity. However, it still has limitations, including possible mutagenicity, cytotoxicity, inflammatory response, and hydrophobicity. Epoxy resin-based sealers are currently widely used, and several studies have considered AH Plus to be the gold-standard sealer.
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