Calcium Silicate Sealers Research Articles

A laboratory study to assess the physico-chemical properties of BioRoot RCS and BioRoot Flow exposed to citric acid and EDTA irrigating solutions.

To assess physico-chemical properties of BioRoot RCS (powder-to-liquid formulation) and BioRoot Flow (pre-mixed formulation) after exposure to citric acid (CA) and EDTA. BioRoot RCS and BioRoot Flow specimens (5 × 2mm) were incubated for 28 days at 37°C before being treated with test solution (distilled water, 17% EDTA, 10% CA, 20% CA or 40% CA). Changes in mass, ion release (inductively coupled plasma optical emission spectroscopy), phase composition (X-ray diffraction and Raman spectroscopy), surface morphology (scanning electron microscopy and energy dispersive spectroscopy) were evaluated. The Shapiro-Wilk, Levene and one-way ANOVA, followed by Tukey's test, were used for statistical analysis (p < 0.05). The greatest mass loss, ion release and surface morphological changes (pores and cracks) of BioRoot RCS and BioRoot Flow occurred in 10% and 20% CA. No significant differences were identified between BioRoot RCS and BioRoot Flow in distilled water and EDTA (p > 0.05), whereas BioRoot Flow was significantly more soluble than BioRoot RCS in all CA solutions (p < 0.001). The main phase identified for both materials was zirconium oxide, which remained unaffected by the solutions. Within the limitations of the study, 10% and 20% CA were more effective than distilled water, 17% EDTA and 40% CA in terms of dissolving BioRoot RCS and BioRoot Flow. The BioRoot Flow was significantly more soluble in all CA solutions than BioRoot RCS. 10% and 20% CA solutions may have a potential to be used as a solvent for hydraulic calcium silicate sealers during endodontic retreatment.

Influence of sonic activation of epoxy-resin and calcium silicate sealer on postoperative pain: a patient-blinded, parallel group, randomized clinical trial

BackgroundThis clinical study aims to compare postoperative pain after single-visit root canal treatment of teeth with asymptomatic apical periodontitis using epoxy-resin-based AH Plus and calcium silicate-based Endosequence BC sealers with or without sonic activation.MethodsThis study included 72 individuals with one first or second mandibular premolar tooth with asymptomatic apical periodontitis. They were randomly divided into four groups according to the root canal sealer (AH Plus or Endosequence BC) and activation protocol (sonic activation or non-activation) (n = 18). The participants were ask to rate their postoperative pain intensity on a NRS scale as none, minimal, moderate, or severe after 24 h, 48 h, 72 h, and 7 days following treatment. Patients were also asked to record the number of prescribed analgesic medication tablets (400 mg of ibuprofen) taken. Statistical analysis were performed using the Mann-Whitney U test, the Friedman test, the Spearman’s correlation test, the Chi-square test. Significance level was established at 0.05.ResultsThere was no statistically significant difference in postoperative pain scores or analgesic intake between AH Plus and Endosequence BC sealers regardless of the activation protocol (p > 0.05). There was no statistically significant difference in postoperative pain scores between the sonic activation and non-activation groups (p > 0.05). A weak positive correlation was detected between Endoactivator sonic activation and sealer extrusion (r = 0.36).ConclusionsAH Plus and EndoSequence BC root canal sealers showed similar results in terms of prevalance and intensity of postoperative pain. Sonic activation and non-activation groups had similar postoperative pain scores.Clinical trial registrationThe study was retrospectively registered with ClinicalTrials.gov (NCT06403293). Date of Registration: 07/05/24.

Marginal adaptation of customized gutta percha cone with calcium silicate based sealer versus MTA and biodentine apical plugs in simulated immature permanent teeth (an in vitro study)

BackgroundThis study aimed to compare the marginal adaptation of a single customized gutta percha cone with calcium silicate-based sealer versus mineral trioxide aggregate (MTA) and Biodentine apical plugs in simulated immature permanent teeth.MethodsThirty-nine extracted human maxillary anterior teeth were selected, prepared to simulate immature permanent teeth with an apical diameter 1.1 mm, placed in moist foam and divided into three groups. Group 1: Obturation with a single customized gutta percha cone and calcium silicate sealer. Group 2: MTA apical plug. Group 3: Biodentine apical plug. After incubation, teeth were horizontally sectioned at 1 mm and 3 mm from the apex and marginal adaptation was evaluated using scanning electron microscope (SEM).ResultsBiodentine showed the least mean gap size at both 1 and 3 mm from the apex with no statistically significant differences compared to MTA (p > 0.05). The single customized cone with calcium silicate based sealer showed the greatest mean gap size at both 1 and 3 mm from the apex with a statistically significant difference compared to the other groups (p < 0.001).ConclusionBiodentine and MTA apical plugs provide a significantly better marginal adaptation to the dentinal walls than a single customized gutta percha cone with calcium silicate based sealer in simulated immature permanent teeth.

Comparative evaluation of physical properties of resin and calcium silicate-based root canal sealers

ABSTRACT Aim: The aim of this study was to evaluate the flow, solubility, and pH of AH Plus sealer, Bio-C Sealer, and Cerafill RCS. Materials and Methods: The selected sealer materials were mixed according to instructions of the manufacturers under aseptic conditions. For flow and solubility, the recommendations of ISO 6876/2012 and ANSI/ADA 2000 standards were followed (n = 10). Additionally, pH changes during the setting of selected sealers (n = 10) were measured at regular intervals of time using a digital pH meter. Data were statistically analyzed using Kruskal–Wallis ANOVA test with post hoc Dunn’s test. Results: The flow of Bio-C Sealer was significantly higher than Cerafill RCS (P &lt; 0.05). Among the sealers, Bio-C Sealer exhibited the highest solubility, whereas AH Plus exhibited the least solubility. Calcium silicate-based sealers showed higher pH than resin-based sealer. Conclusions: The results of the present study indicate that resin-based sealer and calcium silicate-based sealers have acceptable flow, whereas calcium silicate sealers exhibited high solubility and an alkaline pH.

Mechanical and Physicochemical Characteristics of a Novel Premixed Calcium Silicate Sealer.

The aim of the present in vitro study was to evaluate specific mechanical and physicochemical properties of three calcium silicate-based sealers, BioRoot™ Flow (BRF), CeraSeal (CRS) and TotalFill® (TF). Samples were prepared to evaluate different physicochemical and mechanical properties of the tested sealers. These evaluations were accomplished by investigating the pH changes over time, porosity, roughness, flow properties, compressive strength and wettability. The results were statistically evaluated using one-way analysis of variance. All three sealers demonstrated an alkaline pH from 1 h of immersion in water to 168 h. A higher porosity and hydrophily were detected in BRF samples compared to CRS and TF. No significant difference was found between the tested materials in the flow properties. Lower compressive strength values were observed for BRF compared to TF and CRS. Differently shaped structures were detected on the three materials after 7 days of immersion in PBS. The three materials demonstrated a higher solubility than 3% after 24 h of immersion in water (CRS < BRF < TF). The novel premixed calcium silicate sealer (BRF) had comparable physicochemical properties to the existing sealers. The lower compressive strength values could facilitate the removal of these materials during retreatment procedures. Further studies should investigate the biological effects of the novel sealer.

Post-operative pain in non-surgical root canal treatment after sealer-based obturation versus warm vertical compaction: A randomized clinical trial.

Post-operative pain may occur after non-surgical root canal treatment (NSRCT). The root filling technique and choice of sealer may be contributing factors. This randomized controlled clinical trial compared post-operative pain and analgesics intake after NSRCT using a sealer-based obturation technique (SBO) with single-cone gutta-percha and calcium silicate sealer (CSS) versus a warm-vertical compaction (WVC) technique with gutta-percha and a resin-based sealer (RBS). This study was designed as a parallel-two arm, double-blind, randomized superiority clinical trial registered at www. gov (NCT04753138). Patients referred for NSRCT fulfilling the inclusion criteria participated in this study. Pre-operative periapical radiographs and CBCT scans were taken and numerical rating scale (NRS) pain scores were recorded. Upon completion of canal instrumentation, participants were randomly allocated to either Group SBO: SBO with CSS or Group WVC: Warm-vertical compaction with RBS. Post-operative pain and analgesics intake were recorded at 1, 3 and 7 days after endodontic treatment completion. Non-parametric Mann-Whitney U and Friedman tests and a generalized estimating equation were used to assess differences in pain scores between the groups, within each treatment group at different time points and for correlations, respectively. The study included 195 participants (212 teeth). One participant declined to submit the NRS form. Therefore, 194 participants (211 teeth) were included in the final analysis (99.5% response rate). No statistically significant differences in post-operative pain or analgesic intake existed between the two groups at any time point (p > .05). Age, pre-operative pain, apical diagnosis and post-operative analgesic intake were significantly related to post-operative pain (p < .05). Sealer-based obturation technique with CSS was associated with similar post-operative pain levels and analgesics intake as WVC with RBS. Regarding post-operative pain, SBO with CSSs may be a suitable clinical alternative.

Effect of ultrasonic activation on setting time, pH and calcium ion release, solubility, and chemical structure of calcium silicate sealers.

This study evaluated the setting time, pH, calcium ion release, solubility, and chemical structure of four calcium silicate sealers after ultrasonic activation (UA). Five sealers were evaluated: Sealer Plus (SP - control); Sealer Plus BC (SPBC), Bio C Sealers (BCS), Endosequence BC Sealer (EBC), and BioRoot RCS (BR). Ten groups were created based on the use or not of ultrasonic activation: SP; SP/UA; SPBC; SPBC/UA; BCS; BCS/UA; EBC; EBC/UA; BR; and BR/UA. Setting time was performed based on ISO 6876:2012 and ASTM C266-07 specifications. Solubility at 24hs, based on ISO 6876:2012. pH and calcium release were evaluated at 1, 24, 72, and 168hs. Raman spectroscopy was used to evaluate structural changes. Quantitative data were analyzed using One-Way ANOVA and Tukey post-hoc test (α=5%). Raman spectroscopy results were qualitatively analyzed. Setting times and solubility of all sealers were not affected by UA (p>0.05). The highest solubility was found for BCS, BCS/UA; and BR, BR/UA (p<0.05). After 24hs, calcium silicate sealers had higher pH than SP and SP/UA (p<0.05). BR and BR/UA had the highest pH at all time points. SP and SP/UA had stable pH at all time points. SP and SP/UA had the lowest calcium release values at all time points (p<0.05). EBC and EBC/UA calcium release significantly differ at 24,72 and 168hs (p<0.05). No chemical changes were observed during Raman spectroscopy. In conclusion, ultrasonic activation affected calcium ion release only for EndoSequence BC Sealer. Ultrasonic activation did not influence the initial and final setting time, solubility, pH, and chemical structure of any investigated sealers.

Influence of sealer and supplementary approach on filling material removal during endodontic retreatment.

Both root canal sealer-based and supplementary protocols may influence removal of filling material during endodontic retreatment. Mesial root canals of extracted mandibular molars were prepared using HyFlex EDM 25/.08, and filled with a calcium silicate sealer (Bio-C Sealer), or an epoxy resin (AH Plus), using the single cone technique (n = 12). Retreatment was performed using ProDesign Logic (PDL) RT and PDL 35/.05. The specimens were randomly divided into two experimental groups (n = 12), and the sealers were distributed similarly. A supplementary protocol was performed with PDL 50/.01 or XP-endo Finisher. Root canal transportation and volume, in addition to the remaining filling material percentage were evaluated using high-resolution (5 µm voxel size) micro-CT. Statistical analysis was performed using t-tests (α = 0.05). Root canals filled with AH Plus presented high residual filling material (p < 0.05). Both protocols decreased residual volume of filling material in the apical third (p < 0.05). PDL 50/.01 increased the apical root canal volume (p < 0.05). No difference was observed between the systems regarding canal transportation (p > 0.05). In conclusion, AH Plus is more difficult to remove from the apical third than Bio-C Sealer. PDL 50/.01 and XP-endo Finisher enabled greater removal of filling materials in the apical third, in the retreatment of curved root canals, without promoting apical transport.

Post-operative pain after root canal filling with two different obturation techniques: A prospective study.

Post-operative pain (POP) is a major problem in endodontics. This prospective study aims to investigate POP and the rate of analgesic intake after root canal treatment (RCT) using two obturation techniques: warm vertical compaction with epoxy resin-based sealer (WVT) versus sealer-based obturation (SBO) using a single-cone gutta-percha with calcium silicate-based sealer. All RCT were carried out by the same endodontist, following a standardized protocol, and using two different obturation techniques: WVT with AH Plus sealer, and SBO with single-cone gutta-percha and AH Plus Bioceramic sealer. Patients finally assessed were 29 in the SBO group and 34 in the WVT group. After RCT, patients completed a 10-cm visual analogue scale (VAS) that ranked the level of pain. Results were analysed statistically using the Chi-square, ANOVA tests and logistic regression analysis. Sex, age, number of roots, pulp diagnosis, periapical status, previous intake of NSAIDs or antibiotics did not affected POP. In the WVT group, 38.2% of patients felt some pain 24 hours post-treatment, while in the SBO group this percentage was 20.7% (p = 0.07). There were no significant differences in the need for analgesics in the week following treatment. The obturation technique used did not affect significantly the POP of patients after RCT. Although the percentage of patients in the SOB group showing POP was lower, there were no significant differences in the need to take analgesics. Key words:Calcium silicate sealer, endodontic pain, post-operative pain, resin based sealer, sealer based obturation, single cone obturation, warm vertical compaction.

Effect of heat application on the physicochemical properties of new endodontic sealers: an in vitro and SEM study.

Understanding the properties of endodontic sealers is vital for treatment planning. Calcium silicate-based sealers are important in modern endodontics. This study investigates the effect of heat on the physicochemical properties of new calcium silicate sealers, addressing concerns raised by clinicians seeking to combine their benefits with the gutta-percha obturation technique. Five endodontic sealers (AH Plus Bioceramic®, Total Fill® BC®, One-fil® Bioceramic, K-Biocer, Any-seal®) were evaluated. Each sealer (n = 16/group) was either kept at 37°C or subjected to heat at 60 or 200°C for 30s. ISO 6876-2012 standards were used to measure setting time, flow, film thickness, and dimensional changes over time. SEM and EDS were utilized for surface and chemical analysis. Data analysis employed IBM SPSS Statistics version 26 with a 5% significance level for two-sided tests. The sealers' setting times were shortened by heat, except for Total Fill® BC with extended setting time. All sealers had significantly longer setting times than manufacturer specifications. Film thickness increased with temperature, while flow values decreased. K-Biocer sealer showed the highest flow (16.89 ± 0.57mm) at 200°C, while Total Fill® sealer had the lowest (15.32 ± 0.62mm). Shrinkage was significant at 60°C and 200°C, with greater shrinkage at 200°C. Heat caused surface deformations in all sealers. The 200°C groups exhibited more voids in AH Plus Bioceramic®, Any-seal®, and One-fil® sealers, and higher void area in Total Fill®, One-fil®, and K-Biocer sealers (p value < 0.001). EDX analysis confirmed heat-induced chemical and elemental changes in all tested sealers. Elevated temperature affects the physicochemical properties and structure of the tested endodontic sealers. The consideration of endodontic sealer compatibility is essential when warm gutta-percha obturation techniques are used.

Photodynamic therapy on the extrusion bond strength of gutta-percha to radicular dentin sealed with bioceramic and conventional sealers.

The aim of this study was to evaluate the influence of photodynamic therapy (PDT) on the extrusion bond strength (EBS) of gutta-percha to radicular dentin sealed with bioceramic sealers. Sixty human-extracted mandibular premolars were used in the present study, being decoronated up to the cementoenamel junction, and secured in heat cure acrylic resin for root canal therapy. The specimens were randomly divided into groups based on conventional [2.25% sodium hypochlorite (NaOCl) + 17% EDTA] and disinfection protocols (2.25% NaOCl + PDT + 17% EDTA) (n = 10). Specimens in groups 1, 3, 5: conventional treatment modality (2.25% NaOCl + 17% EDTA). Samples in groups 2, 4, 6: adjunctive PDT treatment modality (2.25% NaOCl+ PDT+ 17% EDTA). Specimens in groups 1 and 2 were sealed with AH Plus sealer (AH). Specimens in groups 3 and 4 were sealed using Endo Sequence BC sealer, and samples in groups 5 and 6 were sealed with MTA Fillapex. All specimens were cut in the coronal and middle segments and positioned in a universal testing machine (UTM) for assessment of extrusion bond strength (EBS). ANOVA and Post-Hoc Tukey multiple comparison tests were applied for performing statistical analysis (p < 0.05). Coronal root samples in group 1 (2.25% NaOCl + 17% EDTA) sealed with AH Plus sealer demonstrated the highest EBS value (9.21 ± 0.62 MPa) whereas the middle-third of specimens in group 6 (2.25% NaOCl + PDT + 17% EDTA) sealed with MTA Fillapex exhibited the lowest EBS value (5.07 ± 0.17 MPa). Intergroup comparison revealed that group 3 (2.25% NaOCl + 17% EDTA) sealed with Endo Sequence BC Sealer and group 5 (2.25% NaOCl + 17% EDTA) sealed with MTA Fillapex disclosed comparable EBS results to group 1 (p > 0.05) while group 2 (2.25% NaOCl + PDT + 17% EDTA) sealed with AH Plus sealer and group 4 (2.25% NaOCl + PDT + 17% EDTA) sealed with Endo Sequence BC Sealer unveiled analogous EBS values to group 6 (2.25% NaOCl + PDT + 17% EDTA) MTA Fillapex (p > 0.05). The most noticeable failure mode in the coronal and middle thirds of non-PDT subjected groups was cohesive. Combination of 2.25% NaOCl with PDT and 17% EDTA for canal disinfection with AH Plus sealer, calcium silicate sealer, and MTA-based bioceramic sealers have an unfavorable effect on the EBS of gutta-percha to the root canal wall.

Influence of Thermal and Mechanical Load Cycling on Fracture Resistance of Premolars Filled with Calcium Silicate Sealer

The aim of this study was to evaluate the aging effect of thermomechanical cyclic load on fracture resistance of lower premolars obturated with AH Plus and BioRoot RCS root canal sealers. Forty-eight single-rooted premolars teeth were instrumented with REVO-S files up to SU/0.06 taper. The teeth were randomly assigned into 2 main groups (n = 24) according to the selected two root canal sealers (AH Plus or BioRoot RCS). All teeth were obturated using matching gutta-percha. Each main group were further divided into 3 subgroups (A, B and C) (n = 8). Group A acted as the negative control group (non-Thermomechanical aging). Whereas Group B and C were subjected first to thermal variations in a thermal cycling machine (7500 and 15,000 thermal cycles), then two different dynamic loading periods namely 3 × 105 and 6 × 105 in a masticatory simulator with a nominal load of 5 kg at 1.2 Hz which simulate approximately 1 ½ and 3 years of clinical function respectively. The roots were decoronated and fracture resistance were measured using a universal testing machine. After thermal-mechanical aging, BioRoot RCS showed significantly higher fracture resistance (p &lt; 0.05) than AH Plus. As the thermal-mechanical cycles increased both AH Plus and BioRoot RCS exhibited a significant decrease in fracture resistance (p &lt; 0.05). It could be concluded that thermomechanical aging had a significant impact on the outcome of the fracture resistance of AH Plus and BioRoot RCS.

Inflammatory response to epoxy resin and calcium silicate sealers preheated with different temperatures: an in vivo study.

To determine the impact of heat exposure of different sealers on inflammatory cytokine secretions and tissue response in vivo. Silicone tubes were prefilled with epoxy resin (ER) or calcium silicate (CS) sealers, preheated at 37, 60, or 120 °C, and implanted in rat subcutaneous site. Peri-implant exudate and tissue were analyzed after 1 and 4 weeks for cytokine secretions and tissue organization. At 1 week, 120 °C-preheated CS and ER induced higher secretions of tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6), respectively, as compared to sham/empty tube groups. At 4 weeks, whereas TNF-α secretion was reduced in CS, it increased in ER group, particularly for 120 °C. Both sealers revealed high IL-6 after 4 weeks as compared to sham/empty tube, and generally, higher IL-6 secretions were associated with ER. Histology at 1 week revealed lower degree of inflammatory infiltrate in the groups of the highest preheating temperature (120 °C). Nonetheless, at 4 weeks, whereas fibrous capsule area and inflammatory infiltrate remained low in the CS120 group, they were high in ER120. Preheating ER sealer to 120 °C induced high and prolonged secretion of proinflammatory cytokines (TNF-α and IL-6), whereas this effect was transient for the CS sealer. This was associated with increased fibrous capsule and inflammatory infiltrate in response to 120 °C-preheated ER. Heat-induced changes in sealer properties alter the inflammatory response in vivo, which may affect the clinical outcome. This will not only help appropriate selection of obturation technique for different sealers, but also for optimizing the properties of new generation of sealers.

Kalcijum-silikatni cementi u endodonciji

Introduction: Endodontic root canal sealers serve the purpose of providing a fluid-tight seal, sealing off accessory canals and multiple foramina, while comprehensively confining the bacteria. Of late, rather than seeking a hermetic seal of the root canal, a more biological perspective is being tackled in which, sealers resolve to interact with root dentin, resulting in bioactivity. Tricalcium silicate sealers set the bioactivity in motion on the material surface after contacting the tissue fluids. The Aim: The purpose of this paper is to review the properties of calcium silicate sealers in addition to the recent advances of the same and their clinical applications. Results: Although calcium silicate sealers possess subpar physical properties in comparison to resin-based sealers, they manifest promising properties like biocompatibility, antimicrobial potential along with their propensity for bioactivity. Conclusion: Beneficial properties of calcium silicate sealers render these sealers beneficial in the long-term success of root canal treatment. With newer competent sealers being put forth in the market on a regular basis, it is imperative to study their properties to simplify the clinician's selection of sealer, where indicated.

Physicochemical and Mechanical Properties of Premixed Calcium Silicate and Resin Sealers.

The aim of the present in vitro study was to evaluate specific mechanical and physicochemical properties of two calcium silicate based sealers, (AH Plus Bioceramic "AHPB"; Well-Root ST "WRST"), and a conventional resin sealer (AH Plus "AHP"). These aims were accomplished by assessing the porosity, pH, compression strength, roughness, wettability and cell attachment of the tested materials. The results were compared statistically using the one-way ANOVA test. Higher pH values were obtained in both AHPB and WRST compared to AHP at 3, 24 and 72 h (p &lt; 0.05). A greater level of porosity and wettability was detected for both AHPB and WRST compared to the resin sealer AHP (p &lt; 0.05). Evident cell growth characterized by elongated morphology was observed on the surface of AHPB and WRST, while only a thin layer of cells was seen on the surface of AHP. A significant lower compression strength and modulus were obtained in the specimens created using AHPB compared to those made with AHP and WRST (p &lt; 0.05). The removal of calcium silicates may be quite tricky during endodontic retreatment. In conclusion, considering the limitations of the present in vitro study, both calcium silicate sealers demonstrated good physicochemical properties. However, the lower compression strength and modulus of AHPB may facilitate its removal and make the retreatment procedures considerably easier.

Gap volume and sealer penetration of C-shaped root canals obturated with cold hydraulic technique and calcium silicate sealer.

This study compared the gap volume and sealer penetration in C-shaped root canals prepared with adaptive core rotary files and obturated with cold hydraulic compaction using calcium-silicate sealer, warm vertical hybrid compaction, or lateral compaction using epoxy-resin sealer. Thirty-six extracted mandibular molars with pulpal floor configuration Types I and III were used. The teeth were prepared using XP-Shaper and XP-Finisher and obturated with: group 1: cold hydraulic compaction/calcium silicate, group 2: warm vertical hybrid compaction/epoxy resin, or group 3: lateral compaction/epoxy resin. The gap volume was evaluated using μ-CT. The sealer penetration depth and area were evaluated using confocal laser scanning microscopy. The gap volume in groups 1, 2, and 3 was 0.82%, 0.24%, 0.80%, respectively, which were not significantly different (p> 0.05). The gap volumes in the obturated C-shaped canals were not significantly different among the CHC/CSBS, WHC/ERS, or LC/ERS groups. CHC/CSBS was the most convenient technique.

Premixed Calcium Silicate-Based Root Canal Sealer Reinforced with Bioactive Glass Nanoparticles to Improve Biological Properties.

Recently, bioactive glass nanoparticles (BGns) have been acknowledged for their ability to promote interactions with the periapical tissue and enhance tissue regeneration by releasing therapeutic ions. However, there have been no studies on calcium silicate sealers with bioactive glass nanoparticle (BGn) additives. In the present study, a premixed calcium silicate root canal sealer reinforced with BGn (pre-mixed-RCS@BGn) was developed and its physicochemical features and biological effects were analyzed. Three specimens were in the trial: 0%, 0.5%, and 1% bioactive glass nanoparticles (BGns) were gradually added to the premixed type of calcium silicate-based sealer (pre-mixed-RCS). To elucidate the surface properties, scanning electron microscopy, X-ray diffraction, and energy-dispersive spectroscopy were used and flowability, setting time, solubility, and radiopacity were analyzed to evaluate the physical properties. Chemical properties were investigated by water contact angle, pH change, and ion release measurements. The antibacterial effects of the bioactive set sealers were tested with Enterococcus faecalis and the viability of human bone marrow-derived mesenchymal stem cells (hMSCs) with this biomaterial was examined. In addition, osteogenic differentiation was highly stimulated, which was confirmed by ALP (Alkaline phosphatase) activity and the ARS (Alizarin red S) staining of hMSCs. The pre-mixed-RCS@BGn satisfied the ISO standards for root canal sealers and maintained antimicrobial activity. Moreover, pre-mixed-RCS@BGn with more BGns turned out to have less cytotoxicity than pre-mixed-RCS without BGns while promoting osteogenic differentiation, mainly due to calcium and silicon ion release. Our results suggest that BGns enhance the biological properties of this calcium silicate-based sealer and that the newly introduced pre-mixed-RCS@BGn has the capability to be applied in dental procedures as a root canal sealer. Further studies focusing more on the biocompatibility of pre-mixed-RCS@BGn should be performed to investigate in vivo systems, including pulp tissue.

Clinical and Radiographic Outcome of Non-Surgical Endodontic Treatment Using Calcium Silicate-Based Versus Resin-Based Sealers-A Systematic Review and Meta-Analysis of Clinical Studies.

The aim of this paper is to systematically analyse the effect of calcium silicate-based sealers in comparison to resin-based sealers on clinical and radiographic outcomes of non-surgical endodontic treatment in permanent teeth. Methods: The study was conducted according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. The literature search was performed using PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, DOAJ and OpenGrey with no language restrictions. Two reviewers critically assessed the studies for eligibility. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) was carried out to assess the evidence. Meta-analysis of the pooled data with subgroups was carried out using the RevMan software (p < 0.05). Results: Results from the included studies showed that there were no significant differences between the groups in the 24 h post-obturation pain levels (mean difference (MD), −0.19, 95% CI = −0.43–0.06, p = 0.14, I2 = 0%), but at 48 h (MD, −0.35, 95% CI = −0.64–0.05, p = 0.02, I2 = 0%), a significant difference was observed in favour of calcium silicate sealers. Furthermore, there were no significant differences between the two sealers due to risk of onset or intensity of postoperative pain, need for analgesic and extrusion of the sealer. The heterogeneity assessed using Q test between the included studies was 97% (I2). Conclusions: Within the limitations of this review, the paper shows that calcium silicate-based sealers exhibited optimal performance with similar results to resin-based sealers in terms of average level of post-obturation pain, risk of onset and pain intensity at 24 and 48 h. The observations from the included studies are informative in the clinical evaluation of calcium silicate-based sealers and provide evidence for the conduction of well-designed, controlled randomised clinical trials for a period of at least four years in the future.

Evaluation of new bioceramic endodontic sealers: An in vitro study.

The biophysical properties of root canal sealers (RCSs) positively affect the success of endodontic treatment. It is important to ensure an impermeable apical seal after the thorough eradication of the infection. Since bioceramic sealers release bioactive and concomitantly biocompatible products after setting, chemical bonding to dentin and favorable healing is achieved. This study evaluated the chemical composition and elemental distribution of 4 RCSs (1 resinbased and 3 bioceramic-based) by using energy dispersive X-ray spectroscopy (EDX), field emission scanning electron microscopy (FE-SEM) and elemental mapping after root canal obturation, both coronally and apically. Forty extracted single-rooted teeth were shaped, cleaned and randomly divided into 4 groups according to the type of sealer used for obturation. After the sealer set, the teeth were sectioned horizontally to obtain coronal and apical standardized sections. The sections were qualitatively and quantitatively assessed in terms of chemical composition of the tested sealers, using SEM images and elemental mapping as well as the EDX analysis. All of the calcium silicate sealers showed significantly higher peaks of calcium at the periphery of the root canals, contacting dentinal moisture, and high peaks of zirconium, while tungsten was significantly high in AH Plus™. TotalFill® BC™ and BioRoot™ RCS showed higher calcium, oxygen and silicon content coronally than apically, while phosphorus was only detected more apically, which was different for EndoSeal® MTA. All sealers revealed small amounts of different heavy metals, not described by their manufacturers, and a uniform particle distribution with almost regular surfaces. All of the tested sealers except AH Plus revealed high calcium/phosphorus ratio peaks, suggesting regenerative potential in vivo, with acceptable purity and surface texture, and supporting their biocompatibility, with chemical bonding to root dentin.

Effect of two calcium-silicate sealers and a resin sealer on collagen matrix integrity of root dentin after different treatments. An in vitro and in vivo study

Introduction: This research aimed to examine and compare the effect of two calcium silicate sealers with AH plus resin sealer on collagen extraction and surface collagen degradation of dog's root dentin, using different irrigants.Materials and Methods: In vitro part; 180 standardized root dentin cylinders obtained from dog's incisors were randomly allocated into three groups (n = 60) according to the final irrigant used; Group A: 17% Ethylenediaminetetraacetic acid, Group B: 2.5% NaOCl, Group C: 0.9% saline. Each group was classified into 4 subgroups (n = 15) according to the type of sealer used for obturation; subgroup 1: BioRoot RCS, subgroup 2: Total Fill BC, subgroup 3: AH Plus sealer, and subgroup 4: Unfilled (control). After preparation, irrigation, obturation, and aging in a storage medium; hydroxyproline (HYP) released in the medium was determined after 1 day, 1 and 3 months using spectrophotometer. In vivo part, sixty incisors of five dogs were randomly allocated as in the vitro part into three groups and four subgroups in accordance to the type of irrigation and sealer used. After 3 months of preparation, irrigation, and obturation, dogs were euthanized and teeth were extracted for the assessment of surface collagen degradation using scanning electron microscope. HYP released was analyzed using repeated-measures analysis of variance and post hoc of Bonferroni. Surface collagen degradation was analyzed using Kruskal–Wallis test and Dunn's test.Results: BioRoot RCS and TotalFill BC showed a significant higher (P < 0.001) HYP release and surface collagen degradation than AH plus sealer and control with all irrigants.Conclusions: Calcium silicate sealers significantly affected the collagen microstructure of dentin surface. AH Plus resin sealer has no effect on collagen dissolution or microstructure.