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How often and over what time period will any excess root canal cement/sealer dissolve?

Blue light toothThis question was submitted by a general dentist: If expressed through the apical foramen during RCT, how often and over what time period will any excess root canal cement/sealer dissolve?

Dr. Mary Dabuleanu from Dabuleanu Dental and Dr. Suham Alexander provided this quick initial response: 

 

 

 

 

 

Root canal sealers or cements play an important role in endodontic treatment such as:

  • filling irregularities between the filling material and root canal walls
  • filling accessory canals and foramina of canals
  • binding agent for gutta percha or other core material to the dentin
  • illustrates presence of areas of resorption, internal shape of canals, apical foramina and other structures due to its radiopaque properties
  • lubricating the canal space during placement of gutta percha cones

According to the American Dental Association (ADA), overfilling by more than 2mm past the radiological apex represents a technical error ascribable to over-instrumentation, inadequate measuring, or a lack of an apical stop. 

Over-instrumentation of canals can lead to the extrusion of infected debris as well as cement beyond the apex of a tooth which may hinder tissue healing in the periapical region.  More often than not, any irritation that occurs is transitory with subsequent resorption of excess material and complete healing within a few months.  However, the prognosis ultimately depends upon the reaction of the periradicular tissues to the obturation material and is dependent on the interaction between the extruded root canal filling materials and the host’s defences.

Additionally, it is important to note that overfilled or overextruded root canal filling materials may migrate or be displaced and cause symptoms such that surgical intervention is warranted, at times, to achieve a satisfactory resolution and long-term outcome.

References

  1. Chhabra A, Teja, TS, Jindal V, Singla MG, Warring K. Fate of Extruded Sealer: A Matter of Concern. J Oral Health Comm Dent 2011;5(3) 168-172.
  2. Santoro V, Lozito P, De Donno A, Grassi FR, Introna F. Extrusion of Endodontic Filling Materials: Medico-Legal Aspects. Two Cases. The Open Dentistry Journal. 2009(3) 68-73.
  3. Sari S, Duruturk L. Radiographic evaluation of periapical healing of permanent teeth with periapical lesions after extrusion of AH Plus sealer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104:e54-e59 
  4. Ektefaie MR, David HT, Poh CF. Surgical Resolution of Chronic Tissue Irritation Caused by Extruded Endodontic Filling Material. J Can Dent Assoc 2005; 71(7): 487-90.

 

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4 comments

  1. Thank you for this interesting post. Unfortunately this post does NOT answer the initial question posed by the dentist. If there’s no clear answer to this question, then that should be stated.

  2. The authors need to answer the question “over what time period will any excess root canal cement/sealer dissolve”

  3. Although the answer provided to this question presents some good information, I don’t think that it answers the initial question.

  4. All your comments are well taken. Extruded root canal sealer into periapical tissue will eventually dissolve. The period of resorption is highly variable and depends on the amount of extruded material and differences in the host’s immune response to the foreign material. Extruded sealer has been documented in case reports to resorb as quickly as a few weeks to 3 months, (Chhabra , 2011) . Cases of extruded AH Plus sealer were followed for a period of 4 years by Sari et al (OOOE 2007). At the 4 year follow up, extruded sealer was still present radiographically either unchanged or reduced in 43.9% of completely healed canals. Moreover, there was no relation seen between the start of resorption of extruded sealer radiographically and the time elapsed until complete resolution of sealer was observed. For example, partial resorption of sealer could be seen at 3 months in a particular case but resorption remained incomplete at 4 years whereas, another case showed no change in the amount of sealer extruded at the 3 year follow up but complete resorption could be seen at the 4 year follow up, (Sari et al, 2007).
    Sealer extrusion does not preclude endodontic success, as long as proper cleaning, shaping and sealing of the canal has taken place. Moreover, the study by Sari (2007) does prove the point that sealer resorption is not a prerequisite to periapical tissue healing.

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