Double seal

Introduction
Ultimate goal of root canal therapy is to conquer the complex root canal system by perfect
obturation.
Even after a three dimensional obturation of the system, coronal restoration may fail to provide a
perfect seal and may permit the movement of microorganisms or their toxins along the canal wall
to the periapical tissue, leading to the failure of the treatment.
It has been reported that the bacteria are capable of penetrating coronally into the root filled
canals leading to reinfection, which has been confirmed by many investigators.
Role of coronal seal
High success rates of endodontically treated teeth and the fact that root fillings per se are not leak
proof, the quality of the coronal restoration seems to be important in preventing bacteria from
corono-apical penetration.
Because no sealer cement or obturation technique consistently prevents percolation through the
canal, it is critical to maintain adequate coronal seal to prevent microleakage into the canal
space.
Over the years, various materials referred to as Intraorifice barriers have been sought by
investigators to prevent coronal micro leakage and help produce a secondary seal for obturated
teeth.
Various causes for coronal leakage are:
Delay in placing the coronal restorative material,
Dissolution of the restoration,
Inadequate thickness of the restoration,
Fracture of the tooth
Fracture of the restoration
The coronal restoration may also be affected by various chemicals like the intracanal
medicaments or bleaching agents used.

Materials used for coronal seal

These include Amalgam, Intermediate Restorative Material, Glass Ionomer, Composites, Cavit,
Resin bonded cements, Dental Adhesives, Super-EBA, TERM, Coltosol, White and Grey MTA.
All of the above materials have been examined individually except for Glass Ionomer,
Intermediate Restorative Material and Cavit which were examined in combination.
Double seal
It is technique of coronal seal using combination of materials to overcome the disadvantages of
each whilst utilizing the advantages of both.
Different Conventional restorative materials used in Double-seal technique as coronal
sealants:
1) Cavit over gutta-percha followed by IRM as the final seal
It involves placing cavit as deeper layer material inside the pulp chamber and access cavity. IRM
is then used as the outer material which is exposed to loading and the oral cavity.
This double layer functions in several ways:
The outer layer of IRM is an antibacterial agent
IRM is less soluble, wear is less and is stronger
The inner layer of cavit prevent any moisture from reaching the root canal system
The white color of IRM material is readily visible when the clinician needs to remove it at a
subsequent visit
IRM is also a cheaper material that is easily and quickly mixed and placed in the tooth
It sets quickly and therefore no waiting period after placement
2) Glass Ionomer Type II over gutta-percha followed by Light cure Composite Resin as the
final seal
This laminate or sandwich technique has been suggested primarily for decreasing
microleakage.
The combined ionomer-composite restoration provides a reliable chemical bond to dentin,
micromechanical bonding of the composite to ionomer surface, and an acceptable esthetic result.
3) Mineral Trioxide Aggregate over gutta-percha followed by Intermediate restorative material
as the final seal

4) Mineral Trioxide Aggregate over gutta-percha followed by Glass Ionomer Type II as the
final seal
A study was conducted by Hardy et al using MTA for furcation repair showed a better seal when
a secondary seal was placed over MTA rather than when used alone.
5) Dycal over gutta-percha followed by Glass Ionomer Type II as the final seal
This combination is routinely used in direct and indirect pulp capping restoration procedures and
a double seal of glass ionomer successfully used for producing an optimal coronal seal.
Problems associated with individual material:
Composite:
Polymerization shrinkage and inadequate adhesion to cavity walls are problems with the
composites. Leakage in composites may also be attributed to the C-factor or configuration factor
of the root canals, which refers to the ratio of bonded to unbonded surfaces, which may increase
the polymerization shrinkage. Hence this might have contributed to the microleakage.
GIC:
The imperfect sealing of the GIC linings might be explained by their hydrophilic properties,
microgaps, and/or porosities. Initial bond strength to dentin of GIC is not strong enough to
withstand immediate loading stresses.
Chemically cured GIC has shown significant leakage in various microleakage studies by Arnold
et al, Alhadainy, Banomyong et al and Hardy et al
Also when GIC was used in thickness of 2mm as a coronal barrier, leakage was significantly
more when compared to a 4mm thickness in a study done by Barthel et al, owing to the
importance of different thickness of the material.
IRM:
Several studies have been carried out to evaluate the sealing ability of IRM and have shown
controversial results.
Arnold et al, Pisano et al, Barthel et al and Tselnik et al which have shown the poor sealing
ability of IRM, but is different with the studies by Jacquot et al, Imura et al and Zaia et al which
has shown IRM to possess better sealing abilities.
The poor sealing ability of IRM may be linked to the fact that powder and liquid have to be
mixed together to produce the paste to be inserted. This mixing is the cause of reduced
homogeneity. IRM seems to be more difficult to pack into an access cavity than other materials.