Effect of two irrigation protocols and obturation techniques on the apical sealing ability of different root canal sealers: An in vitro study

Abstract

Abstract Aim: The aim of this study was to compare the influence of two irrigation protocols and obturation techniques on the apical seal of three endodontic sealers. Materials and Methods: Crowns of 130 single-rooted teeth were cut and 10 roots were selected as controls, and the remaining roots were divided into four experimental groups (n = 30) according to the type of irrigation protocol and obturation technique. Each group was divided into three subgroups (n = 10) according to the type of root canal sealer. All root canals were prepared with size F4 Protaper Universal and irrigated with 3% sodium hypochlorite (NaOCl) + 3% hydrogen peroxide (H2O2) (Groups 1 and 3) or 3% NaOCl + 2% chlorhexidine (CHX) (Groups 2 and 4). Two gutta-percha obturation techniques were used: single-cone (Groups 1 and 2) and continuous wave (Groups 3 and 4) techniques. The following sealers were tested: MTA Fillapex (Subgroup A), AH Plus (Subgroup B), and Realseal SE (Subgroup C). The apical seal was assessed using dye penetration method, and the data were statistically analyzed. Results: In the first group, AH Plus showed the best apical seal (0.46 ± 0.098 mm), while RealSeal SE system showed the worst apical seal (3.47 ± 0.434 mm). In the second group, MTA Fillapex (0.58 ± 0.115 mm) and AH Plus (0.63 ± 0.109 mm) showed the best apical seal. In the third and fourth groups, all types of sealers showed similar high leakage patterns. Marked increase in the apical seal of RealSeal was observed in the third group (1.71 ± 0.453 mm). Conclusions: The type of irrigation protocol and obturation technique could affect the apical seal of tested sealers. When the single-cone technique was used, AH Plus with NaOCl + H2O2 and MTA Fillapex with NaOCl + CHX irrigation protocols showed significantly a high apical seal. RealSeal SE showed the worst apical seal when canals were irrigated with NaOCl/H2O2 and filled with the single-cone technique. All sealers showed inferior results when used with the continuous wave technique.