Bioactive Sealer Research Articles

Biocompatibility of Bioactive Sealers Bio-C Sealer vs MTA Repair HP in Human Fibroblasts

Bioactive cements based on tricalcium silicate have been introducedto the market for use in dentistry, with a variety of clinical applications. These cements are in contact with vital tissues such as dental pulp or periodontium in cases of unintentional extrusion; thus, it is important to know the genotoxicity and cytoxicity of these materials. The objective of this study was to evaluate the cytotoxicity and genotoxicity of bioactive sealers, Bio-C® Sealer and MTA Repair HP®, in human fibroblasts. Discs of bioactive sealers Bio-C® Sealer, and MTA Repair HP®, were prepared and set for 24h under sterile conditions. The discs were placed in culture medium at 2.5mg/mL inside a SRT6D roller mixer (Stuart, UK) at 60rpm for 24h. The eluates obtained were incubated for 24h with previously activated and cultured ATCC cell line fibroblasts at 80% confluence. The cytotoxicity was evaluated by Alamar Blue® and LIVE/DEAD assays, as well as the analysis of the Tunel and Mitotracker assays to evaluate genotoxicity using the confocal laser-scanning microscope. In the Alamar Blue® assay, the Bio-C® Sealer presented a cell proliferation of 87%, while the MTA Repair HP® Sealer was 72%. A statistically significant difference was found between the MTA Repair HP® Sealant and the negative control (p=<0.001). Regarding the genotoxicity tests, in the Tunel assay, both materials stain the nucleus of the fibroblast cells exposed to the eluates, while in the Mitotracker assay, the MTA Repair HP® Sealer showed greater mitochondrial function than the Bio-C® Sealer. Calcium silicate-based sealers, Bio-C® Sealer and MTA Repair HP®, are not cytotoxic and have low genotoxicity.

Characterization and Crystallinity of Two Bioactive Sealers: Qualitative and Quantitative Analysis

Since the crystallinity of hydroxyapatite created by bioactive sealers could affect their solubility percentage, this study aimed to analyze the degree of crystallinity and mineral maturity of hydroxyapatite crystals formed by bioactive (Cerafil and Endosequence) root canal sealers. Set discs of each sealer were submerged, either in deionized water or phosphate buffer solution (PBS). After 30 days, the crystallinity indices, crystal size, and mineral maturity were determined. The data were statistically analyzed using ANOVA and Student’s t tests with significance set at p < 0.05. After immersion in PBS, Endosequence had the most significant value of mineral maturity (1030/1110Raman) and PO4/amide IFTIR ratio. However, the CO3/PO4 ratio was reduced by both solutions, particularly by PBS. There was no significant difference between both bioactive sealers. Compared to Endosequence, Cerafil had the highest crystallinity indices for CIXRD, CIFTIR, and CIRaman. AH-26 had a significantly greater crystal size (p < 0.001). There was no significant difference in the crystal size of the Cerafil and Endosequence bioactive sealers (p > 0.05). Overall, Cerafil and Endosequence successfully formed hydroxyapatite crystals when exposed to PBS, with high CIs obtained by Cerafil. The crystallinity and mineral maturity of Cerafil and Endosequence were comparable. On the other hand, AH-26 failed to produce hydroxyapatite.

Interfacial adaptation of newly prepared nano-tricalcium silicate-58s bioactive glass-based endodontic sealer.

The sealer's interfacial adaptability is one of the critical factors for successful root canal therapy. This study evaluated and compared the interfacial adaptability of newly prepared nano-tricalcium silicate-58s bioactive glass-based endodontic sealer (C3 S-BG-P) to root dentin with two bioactive sealers Nishika Canal Sealer BG and BioRootTM RCS. Thirty newly extracted single-rooted lower premolars were decoronated and instrumented. The roots were assigned to three groups: C3 S-BG-P, Nishika Canal Sealer BG, and BioRootTM RCS (n=10) and obturated with the single-cone method. Each root was sectioned horizontally to obtain three slices at 2, 5, and 10 mm from the apex. The width of the gaps at the sealer‒dentin interface from each section's mesial and distal sides was measured under a field emission scanning electron microscope (FESEM) at×1.0 using the Digimizer software program. One-way ANOVA and post hoc Tukey tests for multiple comparisons were used to interpret and analyze the collected data. The mean gap width at the sealer‒dentin interface of C3 S-BG-P and Nishika Canal Sealer BG was significantly less than that of BioRootTM RCS at all root sections (P≤0.05). However, the mean gap width at the sealer‒dentin interface of C3 S-BG-P was not significantly different from Nishika Canal Sealer BG (P>0.05). Moreover, there were greater interfacial gaps at the apical level than at the coronal level for all the tested sealers. C3 S-BG-P exhibited interfacial adaptation that was nearly comparable to Nishika Canal Sealer BG and superior to BioRootTM RCS.

A Micro-CT Analysis of Initial and Long-Term Pores Volume and Porosity of Bioactive Endodontic Sealers.

The evaluation of the porosities within the interface of root canals obturated with endodontics materials is extremely important for the long-term success of endodontic treatments. The aim of this study was to compare initial and long-term volume of pores (total, open, closed) and porosity (total, regional) of three bioactive endodontic sealers: GuttaFlow Bioseal, Total Fill BC Sealer, and BioRoot RCS. Root canals were obturated with three “bioactive” sealers using the single-cone technique. The volume of open and closed pores and porosity were calculated using a micro-computed tomography (MCT) method. The measurements were performed after 7 days (initial) and after 6 months (long-term) of incubation. Statistical significance was considered at p < 0.05. The total volume of pores remained unchanged after the 6-month storage. GuttaFlow Bioseal exhibited significantly higher long-term volume in open pores than Total Fill BC Sealer. The total porosity in all the tested sealers presented no statistically significant change after the 6-month storage, except for BioRoot RCS. The total porosity values of this latter material significantly increased after long-term incubation, especially in the apical region. In conclusion, the use of bioactive sealers with excessive tendency to create porosities both in shorth- and long-term periods of storage may compromise the long-term success of endodontic treatments.

Periapical Healing following Root Canal Treatment Using Different Endodontic Sealers: A Systematic Review.

The healing of the periapical tissues is crucial to the success of root canal treatment. The review studies effectively examine various endodontic root canal sealants in terms of periapical healing. This systematic review was formulated following the PRISMA 2020 guidelines and registered in the international prospective register of systematic reviews (PROSPERO) number-CRD42021239192. To find relevant articles, PubMed Central and Medline databases (until February 2022) were searched. Studies that evaluated healing following the application of different endodontic sealers were analysed. A primary outcome measure was the resolution of periapical lesions following the endodontic treatment. In vivo studies comparing radiographic treatment outcomes and articles with a minimum of 6-month follow-up were included. A total of 9 clinical trial studies that met all the inclusion criteria were included in the analysis. The overall risk of bias was high in four studies out of nine studies. Periapical lesions showed significant healing after endodontic treatment regardless of sealer type, although bioceramic and bioactive sealers had shown better results.

A comprehensive in vitro comparison of the biological and physicochemical properties of bioactive root canal sealers

ObjectivesTo evaluate the biological and physicochemical features of bioactive root canal sealers.Materials and methodsHuman periodontal ligament fibroblasts (hPDLF) and human osteoblasts (hOB) were exposed to eluates of three bioactive root canal sealers, GuttaFlow® bioseal (GF), BioRoot™ RCS (BR), and TotalFill® BC Sealer (TF), and the epoxy resin–based sealer AH plus® (AH). Cytotoxicity and cellular inflammatory response were evaluated. The osteogenic potential was examined using human mesenchymal stem cells (hMSC). Film thickness, flowability, and pH were assessed. Root canal treatment was performed on human extracted teeth to evaluate the sealers’ tightness towards bacterial penetration. The antibacterial activity against common pathogens in primary root canal infections was tested.ResultsAH was severely cytotoxic to hPDLF and hOB (p < 0.001). The bioactive sealers were generally less cytotoxic. IL-6 levels in hPDLF were elevated in the presence of AH (p < 0.05). AH and GF suppressed IL-6 production in hOB (p < 0.05). AH and BR stimulated the PGE2 production in hPDLF and hOB (p < 0.05). BR was the only sealer that led to calcium deposits in hMSC (p < 0.05). TF and AH showed the lowest film thickness and the highest flowability. Bacterial tightness was best in teeth filled with AH and BR. All sealers showed similar antimicrobial activity, but the overall antimicrobial efficacy was moderate as the bacteria were reduced by just one log scale (p < 0.05).ConclusionsThis study revealed favorable in vitro results regarding the biocompatibility of the bioactive root canal sealers.Clinical relevanceBioactive root canal sealers may be a useful alternative to epoxy resin–based sealers.

A Bioactive Enamel Sealer Can Protect Enamel during Orthodontic Treatment: An In Vitro Study

Background: This study aimed to evaluate the effectiveness of an experimental bioactive enamel resin sealer in protecting the enamel adjacent to orthodontic brackets against erosion. Methods: Orthodontic brackets (n = 50) were bonded to freshly extracted, sound maxillary premolars using Transbond™ XT Primer (3M Unitek, Monrovia, CA, USA) and Transbond Plus Color Change adhesive (3M Unitek, USA). Five experimental groups (n = 10) had the following treatments applied: a resin bioactive sealer with 45S5 bioglass, 35% by weight; a resin sealer without bioactive glass; fluoride; the orthodontic sealer, Opal Seal (Opal-Orthodontics, South Jordan, UT, USA); and, in the control group, an untreated surface. All the specimens were stored for 18 min in 1% citric acid. All the specimens were examined by SEM and electron dispersive spectroscopy (EDS). The Wilcoxon signed-rank test was used to compare the enamel surfaces covered by the sealers before and after the acid challenge. Attenuated total reflectance Fourier transform infrared spectroscopy detected the degree of the experimental resins’ conversion to verify their suitability for clinical use. Results: The percentage of the bioactive resin sealer and Opal Seal groups’ protection against enamel erosion was 100%, which was significantly more than the other groups, p &lt; 0.05. The degree of conversion for the bioactive and unfilled resins was 42.4% ± 3.6% and 48.57% ± 5%, respectively. Conclusion: The bioactive resin sealer and the Opal Seal both protected the enamel from erosion.

The Efficiency of Fluoride Bioactive Glasses in Protecting Enamel Surrounding Orthodontic Bracket

Objectives The aim of this study was to evaluate the protective effect of using four different fluoride bioactive enamel sealers against an acidic erosion challenge. Materials and Methods A sample of 50 freshly extracted sound upper premolars had their buccal surface bonded to 50 orthodontic brackets using Transbond PLUS color change adhesive; the first four groups had four compositions of fluoride bioactive glasses based on 37 mol% SiO2, 43.9-53.9 mol% CaO, 6.1 mol% P2O5 and CaF2, and 0-10 mol% of Na2O applied to their surfaces and the fifth group served as control (which was not treated by any bioactive sealer). All specimens were challenged by 1% citric acid for 18 minutes which was stirred by a magnetic stirrer. The enamel surfaces next to the orthodontic brackets were examined by SEM. The Wilcoxon signed-rank test was used to compare the area covered by the fluoride bioactive pastes before/after erosion (p < 0.05). Samples from the layer formed on top of the examined teeth were tested before/after erosion to be examined by the attenuated total reflectance Fourier-transform infrared spectroscopy (FTIR/ATR). Results The FTIR/ATR test showed that fluoride bioactive pastes' applications resulted in the formation of a hydroxyapatite-rich layer; the SEM analysis showed that the aforementioned layer significantly resisted erosion challenge when compared to the control group (p < 0.05). Conclusions Fluoride bioactive pastes can efficiently protect the enamel surfaces next to orthodontic brackets from acidic erosion challenges.

Obturación endodóntica de las raíces mesiales de molares inferiores con sellador Bio-C Sealer y AHPlus

La obturación del conducto radicular se realiza con conos de gutapercha y un sellador endodóntico, el cual rellena los espacios entre la pared dentinaria y el material obturador; y las irregularidades del conducto radicular. El sellador Bio-C Sealer es un cemento biocerámico con propiedades bioactivas, mientras que el sellador AH Plus es un cemento a base de resina. La hipótesis del presente estudio fue que el sellador Bio-C Sealer ocupa mayor volumen y superficie, respecto del sellador AH Plus.OBJETIVO: Comparar el uso del sellador Bio-C Sealer con el sellador AH Plus en la obturación de conductos mesiales de molares inferiores.MATERIALES Y MÉTODOS: Se seleccionaron 40 conductos (20 mesio-vestibulares y 20 mesio-linguales) de 20 raíces mesiales de molares inferiores permanentes. Los conductos fueron instrumentados con limas Wave One Gold Small (Dentsply, Maillefer) y WaneOne Gold Primary e irrigados con hipoclorito de sodio. Para la obturación, la muestra se dividió en dos grupos de 20 conductos cada uno, de acuerdo al sellador endodóntico utilizado. Grupo A: sellador AH Plus (Dentsply, Maillefer) y Grupo B: sellador Bio-C Sealer (Angelus). Finalizada la obturación, se utilizó la microtomografía computada (micro-CT) de alta resolución con un detector tipo flat-panel certificado de la compañía Varian R (USA) modelo PaxScan 2020+ para obtener 180 proyecciones tomográficas de cada muestra. Luego se reconstruyó la imagen 3D de la muestra utilizando algoritmos específicos dedicados en el software MatLab (MathWorks, USA), y con desarrollos propios del equipo de investigación en lenguaje Python en las instalaciones del LIIFAMIRx de la Universidad Nacional de Córdoba. Los datos obtenidos fueron analizados estadísticamente mediante el test de Mann Whitney.RESULTADOS: No se encontraron diferencias significativas en el volumen de obturación entre las muestras tratadas con sellador AH Plus y sellador Bio C- Sealer (p&gt;0,05). Respecto al volumen de espacios vacíos, la frecuencia de casos en los cuales pudieron detectarse volúmenes de vacíos mensurables (≥ 0,01 mm3) fue del 15%; registrándose 2 en el grupo BIO-C sealer (5%) y 4 en AH Plus (10%). CONCLUSIÓN: Bajo las condiciones de este estudio, puede concluirse que ambos selladores AH Plus y Bio-C Sealer resultaron adecuados para la obturación de los conductos mesio-vestibulares y mesio-linguales de molares inferiores. Sin embargo, el volumen de espacios vacíos fue menor cuando se usó el sellador biocerámico Bio-C Sealer.

A 12-month follow-up of primary and secondary root canal treatment in teeth obturated with a hydraulic sealer

ObjectivesThis randomized, controlled, pilot study assessed the outcome of non-surgical primary/secondary root canal treatments either with a novel bioactive sealer and the single-cone technique or with gutta-percha, zinc oxide-eugenol sealer (ZOE), and warm vertical compaction.Materials and methodsSixty-nine patients were randomly divided into two groups that were treated using the single-cone technique with BioRootTM RCS (Septodont) (BIO group) or warm vertical compaction with gutta-percha and ZOE sealer (PCS group). Two subsamples (BIOAP and PCSAP) comprised the cases with apical periodontitis. Treatment was undertaken by four residents using a standardized instrumentation and disinfection protocol. The periapical index (PAI) was recorded, and clinical and radiographic follow-up performed at 1, 3, 6, and 12 months. Treatment success was assessed according to “periapical healing” and “tooth survival”. The test for the equality of proportions, t tests for the equality of means, and non-parametric K-sample tests for the equality of medians were applied when appropriate.ResultsThe survival rate was similar in the BIO and PCS (p = 0.4074) and the BIOAP and PCSAP groups (p = 0.9114). The success rate was higher in the BIO groups, but not statistically significant (p = 0.0735). In both BIOAP and PCSAP groups, a progressive decrease in the PAI was observed.ConclusionAt 12 months, both techniques showed reliable results. Further studies and longer follow-ups are needed.Clinical relevanceThis study documents the feasibility of using a bioactive sealer in conjunction with the single-cone technique to obturate the root canal and obtaining a predictable outcome.Trial registrationClinicalTrials.gov Identifie: NCT04249206

Structural, fluoride release, and 3D interfacial adhesion analysis of bioactive endodontic sealers.

The experimental bioactive sealers were synthesized by incorporating fluoridated-nano-bioactive glass (F-nBG; 2.5 and 5wt%) in AH Plus® (Dentsply DeTrey, Konstanz, Germany) sealer and denoted as AH-FBG2.5 and AH-FBG5, respectively. Structural pattern, setting time, flowability, and water sorption analysis were performed. The fluoride release behavior was evaluated periodically over the course of 40 days using inductively coupled plasma optical emission spectroscopy. For sealing ability, post-extraction single-rooted teeth were obturated with sealers. The percentage of voids and sealing ability were evaluated periodically using micro-computed tomography (micro-CT) followed by push-out bond strength. The Fourier transform infrared spectra showed a change in peak height with an increase in the concentration of fillers. The setting time, flowability, and water sorption of experimental groups were within the acceptable clinical range. The fluoride release, sealing ability, and bond strength of experimental sealers were significantly high. The experimental sealers have potential to overcome sealing ability issues of sealers.

Effect of final irrigant on depth of tubular penetration of resin-based root canal sealer and bioactive sealers using confocal laser scanning microscope

Background: Deep dentin tubular penetration of the sealer provides a three dimensional sealing of root canal space Aim: To evaluate the effect of final irrigant on depth of tubular penetration of resin based root canal sealer and bioactive sealers using Confocal Laser Scanning Microscope (CLSM) Materials and Method: Ninety- six freshly extracted human mandibular first premolar teeth were decoronated at 15 mm from the apex. Cleaning and shaping procedure was accomplished using Hyflex CM rotary files till F3. The sample were divided into three groups(n=32) according to final irrgant used : Group A (17 % EDTA), Group B (QMix 2 in 1), Group C (Distilled water). The final irrigation in each respective group was performed with EndoVac system. The samples were further subdivided into 4 subgroups (n=8) according to the type of sealer used for obturation with 6% guttapercha cones - Subgroup I (AH Plus), Subgroup II (Gutta Flow Bioseal), Subgroup III ( Endosequence BC ), Subgroup IV (EndoSeal MTA). Two mm horizontal sections were obtained at 2 mm (apical sections), 5 mm (middle sections) and 7 mm (coronal sections) from the root apex using CLSM to evaluate the maximum depth and percentage of sealer penetration into the dentinal tubules by using Kruskal-Wallis test for overall analysis and a series of Mann-Whitney U tests for pairwise comparison. Result: Endosequence BC showed maximum depth of penetration and penetrated percentage perimeter, while Gutta Flow Bioseal showed least values. Q Mix 2 in 1 showed better penetration values than EDTA and distilled water. Conclusion: Irrigants, nature of sealer and level of root canal affected sealer penetratio.

Dentin moisture conditions strongly influence its interactions with bioactive root canal sealers.

ObjectivesIt is known that bioactive materials interact with the dentin to undergo biomineralization. The exact role of moisture in this interaction is unknown. Here, we investigate the effects of dentin moisture conditions on the dislocation resistance of two bioactive root canal sealers (MTA Fillapex [Angelus Solucoes Odontologicas] and GuttaFlow BioSeal [Colténe/Whaledent AG]) at 3 weeks and 3 months after obturation.Materials and MethodsMandibular premolars (n = 120) were prepared and randomly divided into 3 groups based on the dentin condition: group 1, dry dentin; group 2, moist dentin; group 3, wet dentin. Each group was divided into 2 subgroups for root canal filling: MTA Fillapex and GuttaFlow BioSeal. Dislocation resistance was evaluated by measuring the push-out bond strength at 3 weeks and 3 months. Failure modes were examined under a stereomicroscope. Data were statistically analyzed by Kruskal-Wallis test with a significance level of 5%.ResultsMoist dentin resulted in higher bond strength values for both materials at both time points. This was significantly higher than wet and dry dentin for both the sealers at the 3 months (p < 0.05), while at 3 weeks it was significant only for GuttaFlow Bioseal. The different moisture conditions demonstrated similar trends in their effects on the dislocation resistance of the 2 root canal sealers.ConclusionsThe dentin moisture conditions had a significant impact on its interaction with the bioactive materials tested. Maintaining moist dentin, but not dry or wet dentin, may be advantageous before the filling root canals with bioactive sealers.

Cleanliness Efficacy of Neolix and Silk Rotary Systems in Root Canal Retreatment

Aim: Comparing the cleanliness efficacy of Neolix and Silk nickel-titanium rotary systems used in root canal retreatment with and without Carvene solvent. Method: Forty extracted maxillary anterior teeth having single root canal were collected. Root canals were prepared and obturated with size 40 gutta-percha and Guttaflow bioseal, bioactive sealer. The root canals were distributed into two groups stated to the method of obturating material removal using (Neolix and Silk file systems). Further the groups were subdivided into two subgroups by using Carvene as a solvent or not. Roots were separated in bacco-lingual direction into two equal halves then cleanliness was analyzed using Stereomicroscope at the cervical, middle and apical regions. Results: Neolix system recorded higher cleanliness than Silk file system. Treatment with no-solvent recorded higher cleanliness than with using Carvene. Cervical region recorded the highest cleanliness followed by middle then apical region. Conclusion: Neolix file system without using solvent were more efficient for removing root canal obturating materials.

Micro-CT and nano-CT analysis of filling quality of three different endodontic sealers.

To investigate voids in different root canal sealers using micro-CT and nano-CT, and to explore the feasibility of using nano-CT for quantitative analysis of sealer filling quality. 30 extracted mandibular central incisors were randomly assigned into three groups according to the applied root canal sealers (Total BC Sealer, Sure Seal Root, AH Plus) by the single cone technique. Subsequently, micro-CT and nano-CT were performed to analyse the incidence rate of voids, void fraction, void volume and their distribution in each sample. Micro-CT evaluation showed no significant difference among sealers for the incidence rate of voids or void fraction in the whole filling materials (p > 0.05), whereas a significant difference was found between AH Plus and the other two sealers using nano-CT (p < 0.05). All three sealers presented less void volume in the apical third; however, higher void volumes were observed in the apical and coronal thirds in AH Plus using micro-CT (p < 0.05), while nano-CT results displayed higher void volume in AH Plus among all the sealers and regions (p < 0.05). Bioactive sealers showed higher root filling rate, lower incidence rate of voids, void fraction and void volume than AH Plus under nano-CT analysis, when round root canals were treated by the single cone technique. The disparate results suggest that the higher resolution of nano-CT have a greater ability of distinguishing internal porosity, and therefore suggesting the potential use of nano-CT in quantitative analysis of filling quality of sealers.