The Effect of Different Filling Techniques on the Penetration of AH Plus Bioceramic Paste into Lateral Canals


 Introduction: Root canal treatment is done to maintain the teeth to last as long as possible in the oral cavity. This can be done with three main stages, such as biomechanical preparation, sterilization and root canal filling. The hermetic seal of root canal filling has an important role in the success of root canal treatment.
 
 Objective: The aim of this in-vitro study is to compare the microbial leakage of root canals filled with RealSeal sealer/Resilon Points and AH Plus sealer/conventional gutta-percha points using single cone obturation technique and warm vertical compaction technique.
 
 Methods: Thirty-two extracted human mandibular premolars with single canals were decoronated to a standardized root length of 15 mm and prepared using crown-down technique to a master apical file size 30/.09. Teeth were divided into four experimental groups (n = 7 each group) and controls (n = 1 each group). Teeth in the first group were obturated using single master gutta percha cone and AH Plus sealer and second group were obturated with single Resilon gutta percha cone using RealSeal sealer. Third experimental group was filled with warm vertical condensed gutta-percha using AH Plus sealer and fourth group was filled with warm vertical condensed Resilon gutta-percha using RealSeal sealer. The coronal chamber of each sample were inoculated with Enterococcus faecalis.
 
 Results: There were no significant differences between the four experimental groups (P = 0.182). The differences occurred only in the survival time from each group. Group 4 (Warm Vertical Condensation - RealSeal) has the lowest leakage rate among other groups and the fastest leakage occurred in group 1 (Single Cone - AH Plus).
 
 Conclusion: The single-cone techniques does not insure durable apical seal against bacterial leakage. Warm vertical compaction technique using Resilon gutta-percha and RealSeal sealer appears to be more effective in minimizing bacterial leakage than gutta-percha and AH Plus sealer.

Introduction: Root canal treatment is done to maintain the teeth to last as long as possible in the oral cavity. This can be done with three main stages, such as biomechanical preparation, sterilization and root canal filling. The hermetic seal of root canal filling has an important role in the success of root canal treatment. Objective: The aim of this in-vitro study is to compare the microbial leakage of root canals filled with RealSeal sealer/Resilon Points and AH Plus sealer/conventional gutta-percha points using single cone obturation technique and warm vertical compaction technique. Methods: Thirty-two extracted human mandibular premolars with single canals were decoronated to a standardized root length of 15 mm and prepared using crown-down technique to a master apical file size 30/.09. Teeth were divided into four experimental groups (n = 7 each group) and controls (n = 1 each group). Teeth in the first group were obturated using single master gutta percha cone and AH Plus sealer and second group were obturated with single Resilon gutta percha cone using RealSeal sealer. Third experimental group was filled with warm vertical condensed gutta-percha using AH Plus sealer and fourth group was filled with warm vertical condensed Resilon gutta-percha using RealSeal sealer. The coronal chamber of each sample were inoculated with Enterococcus faecalis. Results: There were no significant differences between the four experimental groups (P = 0.182). The differences occurred only in the survival time from each group. Group 4 (Warm Vertical Condensation - RealSeal) has the lowest leakage rate among other groups and the fastest leakage occurred in group 1 (Single Cone - AH Plus). Conclusion: The single-cone techniques does not insure durable apical seal against bacterial leakage. Warm vertical compaction technique using Resilon gutta-percha and RealSeal sealer appears to be more effective in minimizing bacterial leakage than gutta-percha and AH Plus sealer.

Lateral root canals, which often branch from the main root canal system, contain pulp tissue and may harbor pathological processes requiring endodontic intervetion. Effective identification, cleaning, and obturation of these lateral canals are crucial for the long-term success of root canal treatment. This study compares two commonly used obturation techniques: the single-cone technique using gutta-percha with AH Plus Bioceramic® sealer, and the Thermafil® technique with AH Plus® sealer. Standardized training blocks containing artificial root canal and two lateral canals (coronal and apical) were used. All canals were prepared using ProTaper Next® rotary files. Half of the samples were obturated using the single-cone technique with AH Plus Bioceramic® sealer, and the other half with the Thermafil® technique using AH Plus® sealer. Radiographs and photographs were obtained to evaluated whether lateral canals were filled, partially filled, or unfilled, and to identify the material responsible for the filling. Radiographic evaluation demonstrated successful obturation in 90% of coronal lateral canals and 56.7% of apical lateral canals, resulting in an overall success rate of 73%. No statistically significant differences were observed between the single-cone and Thermafil® techniques for either coronal or apical lateral canals (p > 0.05). Photographic assessment showed a non-significant trend toward improved apical filling with Thermafil® (p = 0.063). Coronal canals were significantly more likely to be filled than apical ones (p < 0.001). The presence of gutta-percha combined with sealer significantly increased the filling rate compared to sealer alone, particularly in apical canals treated with Thermafil® (p < 0.001). Although no significant differences were observed between techniques, Thermafil® exhibited a trend toward improved apical filling. Overall, coronal lateral canals were more successfully filled than apical canals, and the combination of gutta-percha and sealer was more effective than sealer alone.

Objective: The aim of this study was to compare the performance of the new endodontic sealer GuttaFlow 2 with conventional sealers (AH Plus and EndoFill) in filling artificial lateral and secondary root canals, using two obturation techniques (cold lateral condensation and Tagger’s hybrid technique). Methods: Sixty single-rooted human teeth were selected and submitted to root canal preparation. Next, specimens were subjected to a tooth decalcification and clearing method. Artificial lateral and secondary canals were created at 2, 5, 9 and 12 mm from the root apex. The specimens were divided into 6 groups (n=10) according to the endodontic sealer (GuttaFlow 2, AH Plus or EndoFill) and the obturation technique (cold lateral condensation or Tagger’s hybrid technique). Filling of lateral and secondary canals was analyzed by stereomicroscopy. Images were obtained and transferred to the ImageJ software. Mean percentages of filling were calculated, considering total linear measurements of artificial canals and their filled portions. Data were compared by two-way ANOVA, followed by Bonferroni post-hoc test, at 5% significance level. Results: All materials showed the capacity of penetrating into artificial lateral and secondary canals. There was no significant difference (P>0.05) between sealers and obturation techniques. Only GuttaFlow 2 showed significant better flow into lateral canals compared to secondary canals (P

The purpose of this study was to evaluate and compare the efficiency of two obturation techniques in filling artificially designed lateral canals using three different endodontic sealers. Twenty-four resin blocks were used, each containing four main canals and eight lateral canals, with four located in the apical region and four in the coronal region. The primary canals were instrumented, and the blocks were divided into two groups (n = 12 per group) based on the obturation technique: Group I utilized the single-cone technique, while group II used the lateral condensation technique. Each group was further divided into three subgroups (n = 4 per subgroup) according to the type of sealer: subgroup A used AH Plus, subgroup B used BioRoot RCS, and subgroup C used GuttaFlow 2. After canals obturation, the lateral canals were examined under a stereomicroscope to measure penetration depths of sealers and fill percentages, with data subjected to statistical analysis. The lateral condensation technique achieved significantly better lateral canal filling compared with the single-cone technique (p < 0.05). The lateral canals in the apical region showed better filling compared with the coronal lateral canals in both obturation methods. For the lateral condensation technique, AH Plus (99.51%) and GuttaFlow 2 (99.26%) provided the highest filling performance of apical lateral canals, while BioRoot RCS (83.05%) outperformed others in filling coronal lateral canals. In the single-cone technique, BioRoot RCS (80.13%) was the most effective in the filling of the apical lateral canals, while all sealers exhibited similar performance in the filling of the coronal lateral canals. The efficiency of filling the lateral canals was influenced by the obturation technique, the location of lateral canals, and the type of sealer. BioRoot RCS demonstrated versatility in filling apical and coronal lateral canals, while AH Plus and GuttaFlow 2 excelled primarily in filling the apical lateral canals. These findings offer valuable guidance to clinicians in selecting optimal sealers and obturation techniques to enhance the filling of lateral canals. How to cite this article: El Sayed MAM, El Sayed NM. Comparative Evaluation of Two Obturation Techniques and Three Endodontic Sealers in Filling Lateral Canals: An In Vitro Study. J Contemp Dent Pract 2025;26(1):25-33.

Key Clinical MessageA major cause for endodontic failure is the inability to treat all anatomy. Studies report endodontic retreatments contain 42% missed canals. This case illustrates dentin preservation of a molar with an uninstrumented mesiobuccal‐3 canal revealed post‐GentleWave Procedure. Efficient cleaning and disinfection with maintained healing to 18 months is demonstrated.

Objectives: This study evaluated and compared the sealing ability and elemental composition of a resin-based endodontic sealer (AH Plus) used with three root canal obturation techniques: single cone (SC), lateral compaction (LC), and warm vertical condensation (WVC). The investigation focused on microstructural characteristics, interfacial integrity, and elemental distribution within filled root canals. Material and Methods: Sixty extracted single-root teeth were instrumented using the ProTaper Gold system and randomly assigned to three groups (n = 20) according to the obturation technique. The AH Plus Jet sealer was applied in all cases. Following obturation, samples were subjected to radiographic investigation and analyzed using optical microscopy and scanning electron microscopy (SEM) coupled with energy-dispersive X-ray spectroscopy (EDX) to assess the sealing performance and chemical composition. Results: Radiographic and microscopic assessments indicated that the SC method showed strong gutta-percha adhesion to dentin with a thin cement layer, whereas WVC provided excellent adaptation and penetration of gutta-percha. The LC technique demonstrated good adhesion but displayed occasional structural irregularities. SC has the thicker adhesion layer with uneven distribution regarding coronal, median, and apical, regions ranging from 45 to 80 μm, while WVC ensures a thin and uniform sealing layer of about 35 μm in all regions. SEM and EDX analyses detailed the interfacial microstructure and confirmed the presence of carbon (C), oxygen (O), calcium (Ca), zinc (Zn), barium (Ba), and sulfur (S) across all groups. Conclusions: All three obturation techniques (SC, WVC, LC) achieved effective sealing when combined with the AH Plus sealer. The main difference between the methods consists of the sealer layer thickness and its even distribution regarding gutta-percha cones.

Objective: This study aimed to evaluate the fracture resistance of endodontically retreated roots after obturation using two obturation techniques with two types of sealers. Methods: Eighty extracted single-rooted lower premolars with single-oval canals were selected for the study. After decoronation, the canals were instrumented with ProTaper Next rotary files and randomly split into two main groups according to the obturation techniques: Group A (n=40) Cold Lateral Condensation obturation techniques (CLC) and Group B (n=40) Warm Vertical Compaction obturation technique (WVC). Then, the main groups were divided into two subgroups according to different sealers: Subgroup A1: (n=20) using gutta-percha with AH Plus sealer, Subgroup A2: (n=20) using gutta-percha with MTA Fillapex sealer, Subgroup B1: (n=20) using gutta-percha with AH Plus sealer, Subgroup B2: (n=20) using gutta-percha with MTA Fillapex sealer. All the root canal fillings were removed using XP endodontic retreatment files for retreatments. A universal testing machine was used for the fracture resistance test. The data were evaluated statistically by using analysis of variance (one-way ANOVA) (P &lt; 0.05). Results: Cold lateral condensation with AH Plus sealer showed the highest mean fracture resistance (984 N). Meanwhile, WVC with AH Plus sealer showed the lowest fracture resistance (879 N). Statistical analyses showed a non-significant difference between all tested groups (P &gt; 0.05). Conclusions: The highest fracture resistance was offered by CLC with AH Plus sealer. However, WVC using gutta-percha with AH Plus sealer resulted in the greatest decrease in fracture resistance compared to the other groups.

Effect of three obturation techniques on the filling of lateral canals and the main canal

ObjectivesThe aim of this retrospective study was to compare the clinical results of two root canal sealers and three obturation techniques used for non-surgical root canal treatment.Materials and methodsA total of two hundred eighty-three root canal treated teeth in two hundred thirty-seven patients with minimum a 6-month follow-up was included for this study. The canals were filled with three different modes: 1) cold lateral condensation (CLC) and AH Plus Sealer; 2) continuous wave condensation technique (CWC) and AH Plus Sealer, and 3) sealer-based obturation technique (SBO) and AH Plus Bioceramic Sealer. The treatment outcome was analysed based on clinical signs and symptoms, and periapical radiograph (periapical index, PAI).ResultsThere were no significant differences in treatment outcome between various sealers and filling techniques applied. The sealer extrusion was found most frequently in the CWC group (60.67%), followed by SBO (59.21%) and CLC (21.19%) with statistically significant differences (p < .05). The initial diagnosis, previous treatment and sealer extrusion (p < .05) were prognostic factors that affected treatment outcome.ConclusionsBased on the findings of this study, neither the sealer type nor the filling technique affected the treatment success while preoperative diagnosis, previous treatment and sealer extrusion had significant effect on the outcome.Clinical relevanceA bioceramic sealant applied along with the single-cone technique might be considered as an alternative method in root canal obturation.

This study aimed to compare the penetration depths of AH Plus, BioRoot RCS, and GuttaFlow 2 into simulated lateral canals when used with the cold gutta-percha lateral compaction technique. Twelve resin training blocks (4 canals perch each resin block) were used. Each primary artificial canal had two lateral canals (apical and coronal). The main canals were instrumented with WaveOne Gold and irrigated with distilled water. The resin blocks were divided into three groups (N = 4 each/16 artificial canals), according to the type of root canal sealer; Group I: AH Plus, Group II: BioRoot RCS, and Group III: GuttaFlow 2. All canals were obturated with the cold lateral condensation technique. The linear extension of each endodontic sealer into the apical and coronal lateral canals was measured using a digital stereomicroscope and measuring software. Data were statistically analyzed using a one-way analysis of variance. The percentages of filling of the lateral canals were calculated and statistically compared using the Mann-Whitney test. The experimental sealers exhibited variable penetration depths into the lateral canals. All sealers showed significantly better penetration ability into the apical lateral canals than the coronal lateral canals (P < 0.05). AH Plus (3.184 ± 0.012 mm/99.5%) and GuttaFlow 2 (3.176 ± 0.017 mm/99.25%) were significantly better than BioRoot RCS (3.096 ± 0.026 mm/96.75%) in filling the apical lateral canals (P < 0.05). BioRoot RCS was the best sealer to fill coronal lateral canals (3.322 ± 0.085 mm/83.05%). During the lateral condensation technique, the filling of the lateral canals is affected by the type of root canal sealer and the location of the lateral canals All the sealers tested have a good ability to fill the apical lateral, while BioRoot RCS was effective in filling both the coronal and apical lateral canals.

Background This study aimed to assess the dentinal tubule penetration of bioceramic sealer(DTPB) using EndoSequence® Bioceramic Sealer HiFlow™ (BCHF). Three obturation techniques were compared, namely, single cone (SC), cold lateral condensation (CLC), and warm vertical compaction (WVC) using scanning electron microscopy (SEM). Methodology A total of 45 intact mandibular premolars were decoronated, instrumented, and irrigated with uniform procedures. Subsequently, they were randomly assigned into the following three groups according to the gutta-percha and BCHF obturation technique: Group 1 (n = 15) with the SC technique, Group 2 (n = 15) with the CLC technique, and Group 3 (n = 15) with the WVC technique. Afterward, the roots were sectioned at three levels (coronal, middle, apical) from the apex and examined using SEM to determine the maximum distance of DTPB in µm. The collected data were analyzed using SPSS software (IBM Corp., Armonk, NY, USA) using the one-way analysis of variance test and Bonferroni tests. The level of significance was set at α of 0.05. Results Significant differences were observed in the maximum distances of DTPB values among the three levels across groups (p < 0.05). Both the WVC and CLC groups exhibited higher values compared to the SC group (p < 0.05). Specifically, the DTPB maximum distance at the apical third was significantly higher in the CLC group than in the WVC and SC groups (p < 0.05). Additionally, the coronal third in each group demonstrated significant DTPB maximum distance (p < 0.05) compared to the other groups. Conclusions BCHF with the WVC and CLC obturation technique showed the best performance in DTPB maximum distance values at the three levels.

Aim:The aim is to assess and compare the microcrack formation in radicular dentin after obturating the root canals with cold lateral condensation (CLC), warm vertical condensation (WVC), and injectable gutta-percha (IGP) techniques using micro-computed tomography (CT).Materials and Methods:Human extracted mandibular premolar teeth (n = 60) were haphazardly assigned based on the obturation technique into three experimental groups (n = 20 each). Root canals are cleaned and shaped with M Two rotary files and 3% sodium hypochlorite irrigant. Cross-sectional images were taken with Micro-CT to record the baseline defects present on root samples. After root canal obturation either with CLC or WVC or injectable obturation techniques, micro-CT images were captured again to analyze the increase in the number and type of dentinal defects. Statistical analysis of data was performed using the Mann–Whitney U test and the Mcnemar test at 5% significance level.Results:An increase in the number of radicular micro-cracks was identified in samples obturated with lateral condensation technique (1.66%). No change in the percentage of micro-cracks was recorded after obturation with warm vertical or injectable guttapercha (IGP) techniques (P > 0.05). The three obturation techniques were not statistically different in the occurrence of micro-cracks after obturation.Conclusion:The three obturating techniques tested showed no significant increase in radicular dentin defects' occurrence or propagation.

ObjectiveThis study aimed to evaluate the obturation ability of simulated lateral canal in mandibular premolars at three levels (3, 5, and 7 mm) from the apex using gutta-percha and BC Sealer HiFlow (BCHiF) with different obturation techniques, including continuous wave compaction (CWC), cold lateral condensation (CLC), and single cone (SC) techniques, by a 3D assessment method of the obturation volume with cone beam computed tomography (CBCT) and MIMICS software analysis.MethodsThirty intact human mandibular premolars were decoronated, instrumented up to #30 taper 4%, and uniformly irrigated with 5.25% NaOCl and 17% EDTA. Six simulated lateral canals (3 pairs) were prepared at 3, 5, and 7 mm from the apex in each root, using #10 modified C-file. CBCT images were obtained, and lateral canal volumes were calculated using MIMICS software. The samples were divided into three groups: CWC (n = 10), CLC (n = 10), and SC (n = 10). All groups were obturated with BCHiF and gutta-percha. Another CBCT image was taken post-obturation, and 3D lateral canal obturation volume percentages were calculated using MIMICS software. Data were analyzed using SPSS software with One-way ANOVA and Sidak tests (α = 0.05).ResultsSignificant differences were observed in the 3D lateral canal obturation volume percentage at all three levels (P < 0.05). Both CWC and CLC techniques demonstrated higher 3D lateral canal obturation volume percentages (x¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\bar{x}$$\\end{document} = 89.64% and x¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\bar{x}$$\\end{document} = 73.28%; respectively) compared to the SC group) x¯\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\bar{x}$$\\end{document} = 43.10%).ConclusionBCHiF combined with the CWC technique has a higher ability to achieve preferable 3D obturation volume in the simulated lateral canal at 3, 5, and 7 mm.Clinical relevanceIn cases requiring endodontic treatment with lateral canals, the CWC obturation technique using BCHiF with gutta-percha may offer better outcomes compared to other obturation techniques.

To evaluate and compare the sealing efficacy of three root canal filling techniques: AH plus with warm vertical compaction (WVC), iRoot SP with the single-cone technique, and ultrasonic-assisted iRoot SP single-cone technique. Ninety premolars extracted for orthodontic purposes at Dalian Stomatological Hospital between March 2022 and March 2024 were collected. After standardized root canal preparation, specimens were randomly assigned to three groups: AH plus group (WVC technique + AH plus), iRoot SP group (single-cone + iRoot SP), and US-iRoot SP group (ultrasonic-assisted single-cone + iRoot SP). Apical microleakage was assessed using dye leakage tests. Sealer penetration at 3 mm, 5 mm, and 8 mm from the apex was evaluated using optical microscopy and confocal laser scanning microscopy (CLSM). Stereomicroscopy and scanning electron microscopy (SEM) were used to analyze sealer distribution within the root canal. The US-iRoot SP group exhibited significantly less apical microleakage than the AH plus and iRoot SP groups (P<0.05). CLSM analysis revealed significantly greater average and maximum sealer penetration depths in the US-iRoot SP group at all evaluated levels (P<0.05). Stereomicroscopy showed the smallest gap between sealer and gutta-percha in the US-iRoot SP group. SEM confirmed improved adaptation of the sealer to the dentin wall and deeper penetration into dentinal tubules. The ultrasonic-assisted iRoot SP single-cone technique significantly enhances root canal obturation quality compared to both the conventional iRoot SP single-cone technique and the AH plus with WVC technique.