Bio-C Sealer Research Articles

Outcomes of Endodontic-Treated Teeth Obturated with Bioceramic Sealers in Combination with Warm Gutta-Percha Obturation Techniques: A Prospective Clinical Study.

The objective of this clinical study was to collect short-term endodontic outcomes of endodontic-treated teeth (ETT) obturated with different kinds of bioceramic sealers used in combination with warm gutta-percha obturation techniques. Methods: A total of 210 endodontic treatments in 168 patients were performed. At baseline, 155 sample teeth (73.8%) showed symptoms (tenderness or pain to percussion) and 125 (59.5%) showed periapical radiolucency. Periapical radiolucency was present in 125 cases (59.5%); of these, 79 showed a lesion of 5 mm or bigger (63.2%) while lower than 5 mm in 46 cases (36.8%). Regarding ETT with radiolucency, 105 of them (84%) were in coincidence with their need for retreatment and the other 20 (16%) were necrotic teeth. The obturation techniques that were used in this study were: the continuous wave of condensation technique in 75% of cases, and carrier-based technique in 25%. Four bioceramic sealers were used: CeraSeal in 115 cases, BioRoot in 35 cases, AH Plus Bio in 40 cases, and in 20 cases, BIO-C SEALER ION. Preoperative and recall radiographs of the roots were each assigned a periapical index (PAI) score by 2 blinded, independent, and calibrated examiners. The teeth were divided into outcome categories based on the following classification: healed, unhealed, and healing. The healed and healing categories were classified as success, and the unhealed category was classified as failure on the basis of loose criteria. Minimum follow-up period was 18 months. Results: The overall success rate was 99%, with 73.3% healed, 25.7% healing, and 0.95% not healed. The success rate was 100% for initial treatment and 98.2% for retreatment. Fifty-four (N = 54) teeth showed ongoing healing. All of them were retreatment cases with periapical lesions. Regarding the success (healed and healing) versus not healed, no significant difference was found between teeth with or without periapical lesions (p < 0.05). A statistically significant difference in the distribution of healed, healing, and not-healed teeth was found between the groups of teeth with baseline lesions < 5 mm and >5 mm in diameter (p < 0.01) and those with sealer groups (p < 0.01). The success rate of used bioceramic sealers was not statistically significant different (99.1%, 100%, 97.5% and 100%, respectively, for CeraSeal, BioRoot, AH Plus Bio, and BIO-C SEALER ION). Nonetheless, the distribution of healed, healing, and not-healed teeth was different between teeth sealed with different materials (p < 0.01). From the findings of this clinical study, the following conclusion can be drawn: a correct filling of root canals made with warm gutta-percha technique combined with a bioceramic sealer allows a high success rate in endodontically treated teeth.

Biocompatibility analysis in subcutaneous tissue and physico-chemical analysis of pre-mixed calcium silicate–based sealers

To evaluate the biocompatibility, physical and chemical properties of three pre-mixed calcium silicate-based sealers and an epoxy resin-based material were assessed. Pre-mixed sealers supposedly obtain water from the root canal moist to hydrate and set. Polyethylene tubes were filled with the materials Bio-C Sealer Ion+, Bio-C Sealer, EndoSequence BC Sealer and AH Plus Jet, or left empty and surgically implanted in the subcutaneous tissue of Wistar rats. The animals were euthanised and the tubes and tissue were removed for histological analysis and scanning electron microscopy (SEM) coupled with energy-dispersive spectrometry (EDS). Materials' surface chemical characterisation was assessed using Raman spectroscopy and SEM/EDS. Flow, setting time (in two conditions), solubility, radiopacity and pH were also analysed. ANOVA and Bonferroni correction were performed for comparisons (P < 0.05). Inflammatory response observed in the tissues subsided from 7 to 30 days. Tungsten migration could be detected in the surrounding tissue following AH Plus Jet implantation. All calcium silicate-based sealers exhibited zirconium oxide (radiopacifier) and tricalcium silicate peaks before and after implantation. All materials exhibited flow values above 17 mm. An approximately tenfold difference was observed between the plaster- and metal-mould setting times of the calcium silicate cements indicating its sensitivity to moist variations and solubility above 8% was also observed for these materials. Pre-mixed materials exhibited variable setting time and solubility with a decreasing inflammatory response. The variable moist-dependant setting time with high solubility poses a concern for the clinical use of these pre-mixed sealers.

Marginal gaps and voids using two warm compaction techniques and different sealers: a micro-CT study.

To assess the percentage of marginal gaps and voids in oval-shaped canals obturated by using two warm compaction techniques with a Bio-C sealer and AH Plus Jet. Forty canines with oval canals were scanned by microcomputed tomography (micro-CT), and root canal preparation was performed with an XP-endo Shaper system and irrigated with 5.25% sodium hypochlorite. Then, the specimens were paired into four groups (n=10) according to the root canal filling technique and endodontic sealer: Bio-C sealer and continuous wave of condensation, Bio-C sealer and Tagger's hybrid, AH Plus Jet and continuous wave of condensation, and AH Plus Jet and Tagger's hybrid. After root canal filling, a new scan was performed. The percentage of marginal gaps and voids was calculated with the ImageJ software, and the data were analyzed statistically using two-way ANOVA and Tukey tests, with a significance level of 5%. The percentage of marginal gaps was significantly lower in the Bio-C sealer than in AH Plus Jet (p=0.021) regardless of the technique. However, no difference was found in the percentage of voids between root canal filling techniques and the endodontic sealer (p>0.05). Both sealers and techniques demonstrated good quality of root canal filling. However, the use of the Bio-C sealer enhanced the filling ability by reducing marginal gaps, regardless of the root canal filling technique. This study highlights the better performance of the Bio-C sealer in the quality of the root canal filling, reducing marginal gaps when compared to AH Plus Jet independent of the technique.

Hydraulic calcium silicate-based root canal sealers mitigate proinflammatory cytokine synthesis and promote osteogenesis in vitro

Background/purposeThe mineralized tissue-inductive ability and anti-inflammatory properties of hydraulic calcium silicate-based (HCSB) sealers have not been fully elucidated. This study aimed to evaluate the effects of the HCSB sealers Bio-C sealer (BioC), Well-Root ST (WST), and EndoSequence BC sealer (BC), on osteoblastic differentiation/mineralization and proinflammatory cytokine synthesis by macrophages. Materials and methodsDiluted extracts of set sealers or calcium chloride solutions of approximately equivalent Ca2+ concentrations were applied to a mouse osteoblastic cell line (Kusa-A1 cells) and lipopolysaccharide-stimulated mouse macrophage cell line (RAW264.7 cells). Expressions of osteoblastic markers in Kusa-A1 cells and proinflammatory cytokines in RAW264.7 cells were evaluated by reverse transcription-quantitative polymerase chain reaction and enzyme-linked immunosorbent assays. Mineralized nodules were detected by Alizarin red S staining. Cell proliferation was assessed by WST-8 assay and cell attachment on set sealers was examined by scanning electron microscopy. ResultsThe three sealer extracts significantly upregulated osteocalcin and osteopontin mRNA, and promoted significant mineralized nodule formation in Kusa-A1 cells. The three sealer extracts significantly downregulated the mRNA expressions of interleukin (IL)-1α, IL-1β, IL-6, and tumor necrosis factor (TNF)-α and protein levels of IL-6 and TNF-α in RAW264.7 cells. Calcium chloride solutions induced osteoblastic differentiation/mineralization. AH Plus Jet (a control sealer) extract did not. The three HCSB sealers did not interfere with the growth and attachment of Kusa-A1 cells. ConclusionBioC, WST, and BC were biocompatible, upregulated osteoblastic differentiation/mineralization, and downregulated proinflammatory cytokine expression. Ca2+ released from HCSB sealers might be involved, at least in part, in the induction of osteoblastic differentiation/mineralization.

Comparative Evaluation of Fracture Resistance in Endodontically Treated Teeth Using Epoxy Resin-based Sealer and Bioceramic Sealer: An In vitro Study

Background: The aim of this study was to compare the fracture resistance of endodontically treated teeth using epoxy resin-based sealer and bioceramic sealer. Materials and Methods: Twenty-eight single-rooted, single-canal mandibular premolars extracted for orthodontic purposes were used in this in vitro study. The teeth were decoronated using a wheel diamond bur to a standard length of 14 mm under water lubrication. The canals were irrigated between successive filings. All teeth were instrumented (biomechanical preparation) by ProTaper rotary files up to F2. These teeth were then divided into two groups based on the type of root canal sealer used. Gutta-percha was used for all the samples: Group I: Bio-C root canal sealer and Group II: AH Plus root canal sealer. The teeth were embedded in acrylic resin blocks, and fracture force was measured using a universal testing machine. Independent sample t-test/unpaired t-test was performed to assess significant differences between the two groups. This comparison showed statistically significant differences between the two groups (P &lt; 0.05). Results: Group I, i.e., Bio-C (bioceramic based) sealer, showed higher resistance to fracture than Group II, i.e., AH Plus (resin based) sealer. Conclusion: Based on this in vitro study, the Bio-C sealer was more effective as compared to the resin-based AH Plus sealer.

Influence of bioceramic intracanal medication on the bond strength of bioceramic root canal sealer.

To investigate the influence of the remaining volume of a new intracanal medication based on bioceramic compounds on the bond strength (BS) and formation of an adhesive interface between calcium silicate-based and epoxy resin-based root canal sealers. For this purpose, the specimens were distributed according to the intracanal medication (n = 26): Bio-C Temp (BCT) and Ultracal XS (UXS). The roots were scanned in microCT, and after 7 days, the medication was removed. Then a new scan was performed to evaluate the volume of medication remaining. Subsequently, 40 specimens were redistributed into 2 subgroups (n = 10) and filled according to the sealer used: AH Plus (AHP) and Bio-C Sealer (BCS), to assess the bond strength by using the push-out test, and the adhesive interface by confocal laser fluorescence microscopy (CLSM) and scanning electron microscopy (SEM). The t test showed a smaller remainder of BCT (1.77 ± 0.86) compared with UXS (10.47 ± 5.78), irrespective of the root third evaluated. The BS showed that teeth with BCT + BCS had higher bond strength values (3.70 ± 1.22) when compared to the other groups: BCT + AHP (2.15 ± 1.07), UXS + BCS (3.18 ± 1.09) and UXS + AHP (2.11 ± 1.02) (p<0.001). The cervical third had higher BS when compared with the middle and apical thirds (p < 0.001), and higher number of adhesive failures. The adhesive interface in SEM and CLSM images showed better adaptation for the association between BCT + BCS. Intracanal medication and silicate-based endodontic sealer appeared to interact chemically by forming a biomineralizing layer, allowing for an increase in the bond strength and forming an adhesive interface between the materials, with no or less gap formation.

Micro- CT evaluation of sealers removal by reciprocal instrumentation followed by continuous ultrasonic irrigation in teeth with oval root canals.

The ability of the Reciproc system (R40) followed by continuous ultrasonic irrigation (CUI) to remove filling material from oval root canals of mandibular premolars filled with gutta-percha and AH Plus or Bio-C Sealer was evaluated by microtomography (micro-CT). The straight and oval root canals of 42 mandibular premolars were prepared with the ProDesign R 35.05 reciprocal file and randomly divided into two groups according to the material used to fill the canals (n=21): Group AH - Master Cone and AH Plus; Group BC - Master Cone and Bio-C Sealer. After filling and provisional sealing, the teeth were stored at 100% relative humidity and a temperature of 37°C for 30 days. The filling material was then removed with an R40 file. The material was considered completely removed when the R40 file reached the working length (WL), and no remaining filling material was visible on the canal walls. CUI was then performed. The teeth were scanned by micro- CT before and after removal of the filling material. The remaining filling material was measured in mm in the last apical 5 mm. The data were analyzed with the nonparametric Friedman test and subsequently with the Dunn test. The Mann-Whitney U test was also performed. Statistical significance was accepted at the 5% level. After instrumentation with the Reciproc R40, the volume of residual filling material was significantly greater in the BC group than in the AH group (P = 0.035). After CUI, there was no difference in the volume of residual material between the two groups (P = 0.705). Bio-C sealer was more difficult to remove with the Reciproc file than AH Plus. CUI improved the removal of residual filling material regardless of sealer type. However, no technique was able to completely clear the canals of filling material. Key words:Bioceramic cement, CUI, micro-CT, reciproc, retreatment.

In vitro Evaluation of Osteoblasts Exposed to Different Bioceramic Root Canal Sealers

Background: This study aimed to evaluate the cytotoxicity and cell viability of two calcium silicate-based sealers. Material and Methods: Test specimens were made in a silicone matrix and divided into 4 groups (n=3) according to the sealer evaluated: control; Bio-C Sealer; EndoSequence BC and AH Plus. The sealers were weighed, sterilized with ethylene oxide, and cultured in Dulbecco’s modified Eagle’s medium supplemented with 15% fetal bovine serum and 1% antibioticantimycotic for 24 h (37±1°C). MTT and alkaline phosphatase (ALP) assays were performed in osteoblast-like SAOS-2 cells (Alizarin red staining). Data were analyzed by ANOVA and Tukey’s test (p&lt;0,05). Results: The greater cell vitality was observed in the control group at 24 h and in AH Plus at 48 h. At 72 h, there was no significant difference in MTT assay results between the groups (p&gt;0.05). At 7 days, the control group had the best ALP assay result. At 10 days, the best results were found for the control group, Bio-C Sealer, and AH Plus, with a significant difference from EndoSequence BC (p&lt;0.05). Conclusion: AH Plus sealer had higher levels of cell viability and bioactivity similar to the calcium silicate-based sealers, EndoSequence BC and Bio-C Sealer at 24 and 48 h.

Effect of endodontic sealers on push-out bond strength of CAD-CAM or prefabricated fiber glass posts

This study aimed to evaluate the effect of endodontic sealer (ES) on bond strength (BS) of prefabricated or milled-CAD-CAM (computer-aided design and computer-aided manufacturing) glass-fiber-posts (GFP). Canals of 90 single-rooted teeth were prepared for filling by the single-cone technique with gutta-percha and one of the following ES: AH Plus (epoxy resin), Endofill (zinc-oxide and eugenol), and Bio-C Sealer (calcium-silicate). After post-space preparation, tooth-specimens were equally divided in half according to type of GFP to be used. In the half to receive milled-CAD-CAM posts, tooth specimens were molded with acrylic resin to obtain replicas. These were scanned to enable the laboratory to produce the milled-CAD-CAM GFPs (Fiber CAD Lab, Angelus) by the subtractive technique. The other half of samples received prefabricated GFPs (Exacto, Angelus) (n=15). The GFPs were cemented with dual-cure resin cement (Panavia F2.0, Kuraray). Each root was sectioned into two slices per root region (cervical, middle, apical) that were subjected to the push-out BS test, in a universal testing machine. Failure mode (FM) was classified by scores. The BS data were submitted to generalized linear model analyses, while FM was analyzed using the chi-square test (a=0.05). BS showed no significant difference among the three ES (p > 0.05). BS was significantly higher for prefabricated (mean 10.84 MPa) versus milled-CAD-CAM GFPs (mean 6.94 MPa) (p <0.0001), irrespective of ES. The majority showed mixed failures. It could be concluded that type of ES did not affect BS of GFPs to dentin, and prefabricated-GFPs had higher bond-strength than customized-milled-CAD-CAM GFPs.

Analysis of methodologies for evaluating the solubility of calcium silicate-based sealer Bio-C Sealer

Resumo Introdução Cimentos endodônticos à base de silicato de cálcio demonstram maior solubilidade em água destilada. Emprego de metodologias alternativas pode auxiliar em melhor compreensão sobre a solubilidade desses materiais. Objetivo Avaliar o efeito da solução de imersão e do tipo de modelo experimental na solubilidade de cimento pronto para uso Bio-C Sealer. Material e método Modelos circulares de polietileno ou dentina bovina (n = 16) foram confeccionados. Após inserção do cimento, os espécimes foram mantidos em estufa a 37 °C por 48 horas. Posteriormente, as amostras foram pesadas em balança de precisão para determinação da massa inicial. Na sequência, os espécimes foram imersos em 7,5 mL de água destilada (pH 6,5) ou PBS (pH 7,0) (n = 8) por 28 dias. Após isso, as amostras foram removidas das soluções e pesadas a cada 24 horas até a estabilização da massa final (0,001g). Corpos de prova confeccionados com Bio-C Sealer foram empregados como controle. A solubilidade foi avaliada de acordo com a diferença entre a massa inicial e final em porcentagem. Teste ANOVA Two-Way e teste post-hoc de Tukey foram realizados (α = 0,05). Resultado Imersão em água destilada proporcionou maior solubilidade em comparação com PBS, independentemente do modelo experimental (p &lt; 0,05). Corpos de prova apresentaram maior solubilidade, seguidos dos modelos de polietileno e dentina imersos em água destilada (p &lt; 0,05). Não houve diferença entre os modelos experimentais imersos em PBS (p &gt; 0,05). Conclusão Bio-C Sealer apresenta solubilidade significativamente maior em água destilada do que em PBS em todas condições. Modelo experimental empregando dentina bovina e PBS como solução de imersão demonstra diminuir a perda de massa de Bio-C Sealer e pode ser uma alternativa valiosa para avaliar a solubilidade de cimentos biocerâmicos.

Does the ultrasonic activation of calcium silicate-based sealers affect their physicochemical properties?

This study aimed to evaluate the influence of ultrasonic activation (UA) on the physicochemical properties of hydraulic calcium silicate-based sealers. Nine experimental conditions were created based on the hydraulic calcium silicate-based sealers (Bio-C Sealer, Sealer Plus BC and Bio Root RCS) and the ultrasonic activation (no activation [NA], 10 seconds, and 20 seconds). Then the experimental groups were BC-NA, BC-10, BC-20, SPBC-NA, SPBC-10, SPBC-20, BR-NA, BR-10, and BR-20. Activation was performed with an ultrasonic insert 20/.01. The mold for the physicochemical analysis was filled and evaluated according to the ANSI/ADA specification nº. 57: initial and final setting time, flow, radiopacity and solubility. Tests were also performed to evaluate pH and calcium ion release with experimental periods of 1, 24, 72, and 168 hours with a pH meter and colorimetric spectrophotometer. Data were analyzed by one-way analysis of variance and post-hoc Tukey tests. The significance level was set at 5%. The time of UA progressively delayed the initial setting time for all hydraulic calcium silicate-based sealers (p < 0.05). Twenty seconds of UA increased the mean flow values of Sealer Plus BC and Bio-C Sealer compared to NA (p < 0.05). UA did not influence the radiopacity and solubility of the tested sealers (p > 0.05). UA for 20 seconds enhanced the pH levels and the calcium ion release of Sealer Plus BC and Bio-C Sealer at 168h (p < 0.05). UA for twenty seconds interferes with some physicochemical properties of hydraulic calcium silicate-based sealers.

Characterization of chemical elements of calcium silicate-based cements

The aim of this study was to characterize the chemical elements and surface of the cements: Biodentine®, Bio-C Sealer®, Endosequence® BC Sealer, MTA Angelus® and Portland Cement (PC). Material and methods: The cements were manipulated according to manufacturer’s recommendations, inserted in polyethylene tubes and kept in a 95% humidity incubator for 72 hours. The analysis of the chemical elements was performed by energy dispersive X-ray spectroscopy (EDS) coupled to a low vacuum Scanning Electron Microscope (SEM). The surface analysis was performed according to the distribution pattern, shape and particle size in images obtained using Field Emission Gun SEM (SEM-FEG). Data were analyzed descriptively for EDS chemical composition spectra and qualitatively for SEM-FEG images. Results: EDS analysis showed that all evaluated cements contained calcium and silicon rich particles. MTA Angelus® presented bismuth-rich particles, while Biodentine®, Bio-C Sealer® and Endosequence® presented zirconium-rich particles, the latter having tantalum in its composition. All materials showed a uniform distribution pattern of particles on the surface. Biodentine® and Endosequence® showed similarly shaped particles. Conclusion: The cements present particles with uniform distribution pattern and similar chemical composition, differentiating the presence of bismuth or zirconium.

Immediate and Long-Term Radiopacity and Surface Morphology of Hydraulic Calcium Silicate-Based Materials.

The present study aimed to evaluate and compare the radiopacity and surface morphology of AH Plus Bioceramic Sealer (AHPB), Bio-C Sealer (BIOC), Biodentine (BD), BioRoot RCS (BR), Grey-MTAFlow (GMF), White-MTAFlow (WMF), TotalFill BC Sealer (TF), and TotalFill BC Sealer HiFlow (TFHF) at different time moments—30 min, 24 h, and 28 days. Ten specimens of each material were prepared according to the ISO-6876:2012 standard and radiographed next to an aluminum step wedge using a digital sensor. The specimens were stored in a gelatinized Hank’s balanced salt solution at 37 °C between assessments. The mean grayscale values of each specimen were converted into equivalent aluminum thickness by a linear regression model. Characterization of the surface morphology was performed by using a scanning electron microscope at ×4.0k and ×10.0k magnifications. The radiographic analysis revealed that all the tested materials exceeded the ISO-specified limit of 3 mm Al, with the highest radiopacity presented by AHPB and the lowest by BD. None of the tested materials demonstrated considerable variances between the 30 min and the 24 h radiopacity level (p < 0.05), and statistically significant long-term radiopacity changes were exhibited by BR, TFHF, and TF (p > 0.05). All the specimens demonstrated a common feature of limited precipitate formation, with numerous unreacted particles still presented on the surface after 24 h, whereas the particle rearrangement and the deposition of precipitates were clearly observed after 28 days.

Influence of root canal moisture conditions on the bond strength of endodontic sealers to dentin

Objective: To investigate the influence of intraradicular moisture conditions on the bond strength of 3 different endodontic cements in the coronal, middle, and apical thirds of the root canal. Materials and Methods: 90 single-rooted teeth were instrumented with a reciprocal R#50 file and randomly divided into 3 experimental groups: Dry group: dry canals with absorbent paper tips; Moist group: suction syringe and capillary tip coupled to a vacuum pump; Wet group: aspiration with endodontic suction. The groups were divided according to the endodontic sealer used: AH plus (Denstply), Hiflow (Brasseler) and Bio-c Sealer (Angelus). Obturation was performed using Tagger's hybrid technique with a single cone. The teeth were subjected to the "push-out" test to evaluate the bond strength of the cements. Results: Data were analyzed using the Kolgomorov-Smirnoff normal distribution test and the Mann Whitney U test to compare means within and between groups. The standard error established was 5% at a significance level of 95%. AH plus showed better results regardless of canal moisture conditions. Hiflow showed better bond strength in the dry group compared to the moist group (p=0.023) in the cervical area. Bio-C Sealer showed no statistically significant differences (p &gt; 0.05). Conclusion: Moisture conditions affected the bond strength values of endodontic cements. The prevalence of failure moduli was mixed in all root thirds, regardless of the cement used.

Effect of obturation technique on penetration of calcium silicate-based sealer into dentinal tubules after endodontic retreatment of mandibular premolars.

Confocal laser scanning microscopy (CLSM) was used to investigate the penetration of endodontic sealers into the dentinal tubules after retreatment using two different obturation techniques. Thirty mandibular premolars were prepared up to instrument F3 (ProTaper Universal, Dentsply) and filled with Endofill using the single cone technique. The canals were retreated using Mtwo instruments. Reobturation was performed with the Bio-C sealer mixed with a fluorophore dye (Fluo-3) using either the lateral condensation technique (group LC) or the single cone technique (group SC) (n = 15). Teeth were sectioned 2, 4, and 6mm from the apex and analyzed with CLSM to assess the penetration of the sealer into the canal perimeter and the maximum depth of penetration of the sealer into the dentinal tubules. Data were analyzed using ANOVA and the Student-t and Holm-Sidak tests. In the apical segment, the penetrated perimeter was significantly higher in the LC group than in the SC group (p < 0.05); no significant difference was found in the middle and cervical segments (p > 0.05). In terms of penetration depth, no significant differences were found for any of the segments studied (p > 0.05). The LC technique promoted a higher percentage of canal circumference penetrated by the sealer than the SC technique in the apical segment after endodontic retreatment. CLSM demonstrated that the LC technique promoted a higher percentage of canal perimeter penetrated by the Bio-C sealer than the SC technique in the apical segment of mandibular premolars after retreatment.

In vitro evaluation of cytotoxicity in human osteoblastic cells and antimicrobial activity in the biofilm of different root canal sealers

Objective: Evaluate the cytotoxicity in human osteoblastic cells and antimicrobial activity in different root canal sealers in vitro. Methods: BioRoot RCS, TotalFill BC Sealer, and Bio-C Sealer were used in experimental groups, and AH Plus was used as a control. Human osteoblast-like cells and MTT quantitative colorimetric assay were used to evaluate cytotoxicity. Saos-2 cells were exposed to undiluted sealer extracts for 24 h. The supernatant was then collected and the formazan crystals resulting from MTT reduction were dissolved in pure dimethyl sulfoxide. Absorbance was measured in an automated spectrophotometer at a wavelength of 540 nm. Antimicrobial activity was analyzed by the direct contact test using a polymicrobial biofilm composed of Enterococcus faecalis, Candida albicans, and Streptococcus mutans. At 24, 48, and 72 h, colony-forming units were counted on agar plates. A nonparametric Kruskal-Wallis test was used for the statistical analysis. The level of significance was set at 5%. Results: AH Plus showed the lowest cytotoxicity after 24 h, with a significant difference in relation to BioRoot RCS and Bio-C Sealer (p ≤ 0.01). There was no significant difference in cytotoxicity between TotalFill BC Sealer and Bio-C Sealer (p &gt; 0.05). At 24 h, TotalFill BC Sealer and AH Plus showed the least microbial growth compared to Bio-C Sealer (p &lt; 0.05). At 48 and 72 h, there were no significant differences between sealers (p &gt; 0.05). Conclusions: AH Plus had the lowest cytotoxicity. TotalFill BC Sealer and AH Plus yielded greater reductions in microbial counts in the first 24 h compared to Bio-C Sealer. Clinical Relevance: 2c.

Comparison of Fracture Resistance between Single-cone and Warm Vertical Compaction Technique Using Bio-C Sealer® in Mandibular Incisors: An In Vitro Study

The aim of the study was to compare the fracture resistance of the single-cone technique with the warm vertical compaction technique (WVCT) in mandibular incisors using Bio-C sealer®, by applying a compressive force using a universal testing machine (UTM) (Instron 5943; Instron, Norwood, Massachusetts, USA). Twenty-two mandibular incisors were selected and divided into two groups after applying the same shaping protocol. To assess the influence of the wave vertical compaction technique on the fracture resistance, the first group was obturated by a single-cone obturation technique (SCOT) (n = 12), and the second group was obturated with a WVCT (n = 10). Bio-C sealer® (Angelus, Hague Netherlands) was used in the two obturation techniques. Wax-coated roots were put in an acrylic mold and loaded to compressive strength fracture in a mechanical material testing machine (UTM) (Instron 5943; Instron, Norwood, Massachusetts, USA), with Bluehill 3 software (version 3.15.1343) recording the maximum load at fracture. Fracture loads were compared statistically, and data were examined with the Mann-Whitney U test with a level of significance set at p ≤0.05. No statistically significant difference was registered between the SCOT (264.97 ± 83.975 N) and WVCT (313.35 ± 89.149 N) concerning the endodontically treated mandibular incisors' fracture resistance (p = 0.159). Warm vertical compaction technique (WVCT) did not affect the fracture resistance of endodontically treated mandibular incisors when compared to SCOT canal preparation. General practitioners and endodontists face challenges during root canal treatment such as cracks and root fractures. This article aims to guide experts in choosing between the single-cone and the continuous WVCT aiming for higher long-term quality of root canal filling.

Effect of ultrasonic agitation on the penetration depth of different root canal sealers

Aim: The present in vitro study was taken to compare penetration depth of five different root canal sealers to radicular dentin by confocal laser scanning microscope. Materials and Methods: 100 extracted intact single- rooted human teeth were collected. Teeth were decoronated, shaping and cleaning was done with rotary file system till #25 number file with 0.06% taper. Half of the samples (n=50) were irrigated without ultrasonic agitation while other half (n=50) samples were irrigated with ultrasonically agitation. Teeth were obturated and divided into five groups on the basis of five different sealer used (Group A: Zinc oxide eugenol sealer (control group), Group B: Apexit Plus, Group C: AH Plus, Group D: MTA Fillapex, Group E: Bio-C sealer). Samples were sectioned horizontally at 2mm, 4mm and 6mm from the apical region and penetration depth was observed under confocal laser scanning microscope. Data obtained was statistically analysed using Independent t test and Tukey Test. Results: Among the groups, Bio- C sealer (Group E) revealed greatest penetration depth at 2mm and 4mm while zinc oxide eugenol (Group A) had the least penetration depth. Among the subgroups, samples irrigated with ultrasonic agitation showed rise in penetration depth of the sealers.

Response of periodontal ligament stem cells to lipopolysaccharide and calcium silicate-based materials.

This study was conducted to assess the in vitro response of human periodontal ligament stem cells (hPDLSCs) to bacterial lipopolysaccharide (LPS) activation and application of three calcium silicate-based materials (CSBM): Bio-C Sealer, MTA Fillapex and Cimmo HP. Characterization of the CSBM was performed by FTIR (n = 3). Extracts of Bio-C Sealer, MTA Fillapex and Cimmo HP were prepared and diluted (1:1, 1:4 and 1:16). Culture of hPDLSCs was established and treated or not with LPS from Escherichia coli (1 µg/mL) for 7 days. MTT assay was used to assess cell viability at 24, 48 and 72 h (n = 9). Alkaline phosphatase (ALP) activity was indirectly assayed at day 7 (n = 5). TNF-α and Il -1 0 cytokines were quantified by ELISA at 24h-cell supernatants (n = 6). Data were analyzed by ANOVA and Tukey's test (α = 0.05). The cell viability of the LPS-activated hPDLSCs were higher than untreated control (p < 0.05). The application of CSBM affected the cell viability of untreated and LPS-activated cells (p < 0.05). ALP activity was higher for Bio-C Sealer and Cimmo HP in untreated and LPS-activated cells, respectively (p < 0.05). Application of CSBM normalized the TNF-α secretion in the LPS-activated cells (p < 0.05). Only MTA Fillapex in untreated hPDLSCs presented higher values of Il -1 0 (p < 0.05). Taken collectively, the results suggests that the simulation of the inflammatory process by LPS affect the in vitro response the hPDLSCs to the application of the CSBM.

Radiopacity of premixed and two-component Calcium silicate-based Root Canal sealers

Background/Aim: Radiopacity enables radiographic visualization, which is significant in diagnostic procedures and assessment of the quality of endodontic filling. It is important to compare newly developed endodontic sealers with materials that are already in clinical use in order to promote evidence-based dentistry. The aim of our study was to evaluate radiopacity of different calcium silicate-based sealers in comparison with control, epoxy resin-based sealer. The null hypothesis was that there were no statistically significant differences in radiopacity of the tested sealers. Material and Methods: Premixed (TotalFill BC Sealer, EndoSequence BC Sealer, Ceraseal, Bio-C Sealer), two-component (BioRoot RCS, MTA Fillapex, Bioceramic Root Canal Sealer, GuttaFlow Bioseal) calcium silicate-based sealers and AH Plus, as a control, were used. Specimens were radiographed using a Radiovisiography (RVG-4) CCD (charge-coupled devices)-based digital sensor. Results: Ceraseal had the highest, while Bioceramic Root Canal Sealer had the lowest radiopacity. Bioceramic Root Canal Sealer and MTA Fillapex had radiopacity significantly lower than all other sealers. Radiopacity level of AH Plus, was similar to premixed and significantly higher than radiopacities of all two-component endodontic sealers. Conclusions: Calcium silicate-based sealers radiopacity ranged from slightly above minimal required value (3mm), to a value higher than control sealer. Premixed endodontic sealers showed similar radiopacity as AH Plus which suggests that their clinical performance, in terms of visibility on dental radiograms, should be similar