Introducing BioRoot Flow: The Next Generation of Endodontic Sealer

Septodont’s BioRoot™ RCS marked a major paradigm shift in root canal sealing. With outstanding adhesive properties, high biocompatibility, superior purity, and zero shrinkage, this bioactive mineral formulation offered both general dentists and endodontic specialists significantly greater long-term success with cold obturation techniques. 

Despite the advances in cold obturation, warm techniques have remained the preference of some practitioners, especially amongst the endodontic specialist community. That’s why Septodont is very excited to introduce BioRoot™ Flow, the next generation of Active BioSilicate Technology™ that provides excellent clinical outcomes with both cold and warm obturation methods. 

 

What is BioRoot™ Flow?

 

BioRoot™ Flow is a next-generation hydrophilic mineral root canal sealer. Presented as a ready-to-use paste in a syringe, the bioactive tricalcium silicate cement can be delivered directly into the canals, where it reacts with in situ water, adheres strongly to dentin, and gutta-percha points, and provides an outstanding hermetic seal. 

 

Bioactive technology

 

This hydraulic cement is based on Septodont’s patented Active BioSilicate Technology™ (ABT™). Most tricalcium silicate materials are made from Portland cement, but the manufacturing process leaves only 68% active tricalcium silicate, and results in toxic trace elements like aluminum that can leach into the patient’s tissues. BioRoot™ Flow, however, is made with ultra-pure tricalcium silicate using a tightly controlled proprietary process.

Thanks to its high purity and bioactive properties, BioRoot Flow™ is very well-tolerated by the endodontic tissues. In fact, a scratch wound healing model demonstrated the potential to increase human periodontal ligament cell proliferation and colonization; inhibit pro-inflammatory cytokine secretion and macrophage recruitment and activation, and interact favorably with human bone marrow mesenchymal cell and endothelial cells. It performed similarly to BioRoot™ RCS, but the opposite pro-inflammatory and anti-regenerative effects were observed to varying extents in competing products. (1)

 

Effective, stable, and durable obturation 

 

The primary obstacles to successful obturation are sealer shrinkage and instability, particularly in cold techniques that lead to a thick layer of sealer. If the material shrinks over time, voids are created between the core material and the walls of the canal. Subsequent infiltration by bacteria and/or fluid can then lead to the need for re-treatment. 

Because ABS™ technology is monomer-free, BioRoot™ Flow does not shrink like resin material, and it is highly stable thanks to a very low 1.5% solubility rate. (2)

In a study testing the sealing ability of BioRoot™ Flow when used in a single-cone gutta-percha cold obturation, no sealing defects or micro-leakages were detected after seven days. (3) In another study using the single cone technique, BioRoot™ Flow showed a comparable level of resistance to dye infiltration as BioRoot™ RCS and greater resistance than a competing hydraulic sealer. (4) 

In a separate study using micro CT evaluation, radiographs demonstrated that obturations conducted with BioRoot™ Flow remained well-condensed after 13 weeks, with no voids observed between the sealer and the root canal walls. (2) Porosity, and therefore structural strength, of BioRoot™ Flow, was comparable or superior to BioRoot™ RCS, with root canals filled at 80-85% and 75-80% respectively. (5)

 

Compatible with your preferred technique 

 

Before BioRoot™ RCS, cold lateral condensation and single cone techniques were easier and more cost-effective than warm obturation methods but were unable to match their success. BioRoot™ RCS leveled the playing field, making cold obturation techniques as effective as they were accessible. (6) However, the many who still preferred warm obturation were not able to benefit from this advanced bioactive technology.

BioRoot™ Flow, on the other hand, draws water from the root canal only. It is, therefore, less sensitive to heat and is able to maintain its optimal film thickness and flowability, making it suitable for both warm and cold techniques. 

 

Not just a sealer 

 

BioRoot™ Flow is a biological filler as well as a sealer. Upon contact with biological fluids in the root canals, BioRoot™’s tricalcium silicate cement undergoes a hydration reaction, releasing calcium ions and forming hydroxyapatite crystals. Unlike the “sealer plugs” formed by resin sealers, the reaction forms a hybrid, mineral-rich layer at the interface between the sealer and the dentin. Mineral re-crystallization can also be seen at the entrance to the dentin tubules, creating micro-mechanical anchorage and strong adhesion. 

BioRoot™ Flow demonstrates excellent adhesion with the core material, too (typically gutta-percha points). Electronic microscopy and X-ray analysis have confirmed a dense, tight seal between the material, the root canal walls, and the core, even when using the single cone obturation technique. (3) 

 

Prohibits bacterial growth

 

Because it is not possible to eliminate all bacteria before sealing the canals, it is important to limit the proliferation of any remaining bacteria. With a high pH between 8.5 and 11.5 and the continued release of calcium ions, BioRoot™ Flow creates and maintains an alkaline environment unfavorable for bacterial survival, promoting the long-term success of the obturation. (2)

In a study examining its pH properties, BioRoot™ Flow was shown to display alkalizing activity comparable to that of BioRoot™ RCS after three days, and greater than that of a resin-based competitor product. (2) 

 

Easier than ever to deliver

 

According to research, manually mixed sealers are more prone to subjective operator influences that can introduce structural defects and weaknesses. BioRoot™ Flow is a ready-to-use paste with no preparation or mixing required, offering reliably homogeneous consistency and replicable success. 

BioRoot Flow™ is administered via syringe directly into the canals. The syringe is ergonomically shaped for easy handling, while the plunger offers less resistance and requires less pressure for product extrusion (30N compared to 45N for similar products). The flexible 21-gauge tip allows for precise intracanal placement and can adapt to fit diverse root anatomies, limiting the risk of overfilling. (2)

 

Offers reliable access to auxiliary canals

 

Auxiliary canals present an additional challenge to the endodontist; they can be difficult to visualize and therefore difficult to adequately fill, increasing the risk of failure and re-treatment. In the case of complex root anatomy, there is also a risk of perforation or apical extrusion. 

BioRoot Flow™’s excellent 23.2 mm flowability and hydrophilic qualities combine to meet this challenge. The tricalcium silicate cement seeks out residual water in accessory canals and tubules, easily flowing into and filling these hard-to-reach areas without the need for compaction. This is evidenced on radiographic images, showing successful obturation of critical zones such as radicular canals. 

 

Allows for quick, easy, and effective re-treatment 

 

One common belief about bioactive types of cement is that they eliminate the ability to re-treat. This is not the case! Just like its predecessor, BioRoot Flow™ can be removed to working length with hand files or rotary files in less than ten minutes. (2)

BioRoot Flow™ is an exciting next step in bioactive endodontic sealer technology. Whether you’re a general dentist or an endodontic specialist, practicing warm techniques or cold, it’s now easier than ever to provide effective, safe, and long-lasting obturations for your patients.

For more information about BioRoot Flow™, click here!

 

(1) PA 1704 Inflammation and regeneration potentials; About 2021 

(2) Internal data on file. 

(3) BioRoot Flow SEM interfaces. Source Dr. Camilleri

(4) Endodontic Implantation test. June 2020

(5) Internal data. Pr Colon report

(6) Zavattini et al. Outcome of Root Canal Treatments Using a New Calcium Silicate Root Canal Sealer: A Non-Randomized Clinical Trial, J Clin Med., 2020 Mar 13;9(3)