EndoSequence BC Research Articles

Apical Sealing Ability of Experimental Apatite Calcium Phosphate based Coated Gutta-percha Points

Aims: This study aimed to assess the apical sealing ability of experimental apatite-coated gutta-percha points compared to various coated gutta-percha root filling materials.
 Study Design: Experimental in-vitro study.
 Place and Duration of Study: Department of Restorative Dentistry, University of Malaya, June 2014 and November 2014.
 Methodology: Ninety-six extracted permanent maxillary central incisors were standardized and prepared by ProTaper universal rotary files. The specimens were allocated into six groups (n=15) and filled using matching single cone technique as follows; EndoREZ points with EndoREZ sealer, Bioceramic coated points (BCGP), Active GP (ActiV GP), Conventional gutta-percha (GP), apatite coated GP (HAGP) all in combination with Endosequence BC sealer. The sixth group was filled using cold lateral compaction of Conventional GP and Endosequence BC sealer. The specimens were subjected to a dye leakage test. The remaining six teeth were divided equally to be used as a negative and positive control. One-way analysis of variance (ANOVA) followed by the post hoc Dunnett T3 test was performed for data analysis, and the significance value was set at P =.05.
 Results: ActiV GP had the least leakage followed by BCGP, HAGP, cold lateral compaction, conventional GP, and EndoRez.
 Conclusion: HAGP as root canal filling showed favourable sealing ability comparable to ActiV GP, BCGP, and conventional GP and it was superior to EndoREZ.

In vitro evaluation of the antibacterial effect of four root canal sealers on dental biofilms.

To dynamically evaluate the effect of four root canal sealers on the killing of biofilms within dentinal tubules. Dentin blocks were prepared for infection of the dentinal tubules. Enterococcus faecalis VP3-181 and multi-species bacteria from two donors were cultured. After 3days of incubation, the infected dentin specimens were rinsed with sterile water for 1min and subjected to treatment. Additionally, multi-species bacteria from donor 1 were incubated for 3weeks to allow biofilm maturation and then the specimens were subjected to treatment. Gutta-percha-treated dentin specimens comprised the control group. A root canal sealer (bioceramic sealers: EndoSequence BC Sealer, ProRoot Endo Sealer, or GuttaFlow Bioseal; and a traditional silicone-based sealer: Guttaflow 2) was spread onto the canal walls of the dentin. The specimens were examined with confocal laser scanning microscopy at 7, 30, or 60days. In the 3-day-old biofilm group, the proportion of killed bacteria decreased significantly from the first 7days of treatment to 60days of treatment for all sealers (p < 0.05). In the 3-week-old biofilm group, 60days of exposure to bioceramic sealers resulted in more significant dead bacteria than 7-day exposures of the biofilms (p < 0.05). Bioceramic sealers were more effective in killing bacteria than the GuttaFlow 2 sealer (p < 0.05). Calcium silicate-based sealers showed good antimicrobial effects against biofilms within dentinal tubules, especially in the first week in young biofilms. There is no substantive antibacterial activity observed for the examined root canal sealers against young dentinal tubule biofilms. The bioceramic root canal sealers examined demonstrate minimal additional antibacterial effects after long-term exposure to young biofilms.

Effect of therapeutic fractionated radiotherapy on bond strength and interfacial marginal adaptation of Adseal, MTA Fillapex, and EndoSequence BC sealer: An in vitro study

Introduction: The study aimed to assess the impact of fractionated radiation on push-out bond strength of sealer to dentin interface and on marginal adaptation of the sealer (Adseal, MTA Fillapex, and EndoSequence BC sealer) to irradiated dentin.Materials and Methods: Ninety maxillary central incisors were randomly divided into two groups: with irradiation (n = 45) and without (n = 45). All the samples to be radiated were exposed to fractionated dosage (60 Gy) through Co-60 gamma (1.17 and 1.33 Mev) photons. Specimens were prepared and subdivided into three subgroups (n = 15 each) according to assigned sealer Adseal, MTA Fillapex, and EndoSequence BC sealer. Later, the samples were sectioned into a 1 mm thick segment at each root third for bond strength and scanning electron microscope (SEM) analysis. SEM micrographs were analyzed with an ORION version 6 image analyzer. The percentage of failure mode after debonding was evaluated with a stereomicroscope. Bond strength data were analyzed using two-way analysis of variance and the Tukey's post hoc test.Results: Bond strength was significantly (P < 0.0001) decreased after radiotherapy (0.76 ± 0.12 Mpa) versus without radiation (0.93 ± 0.18 Mpa). Furthermore, when the pooled average of sealers was compared, significantly highest bond strength was perceived in Adseal (0.98 ± 0.18 Mpa) followed by EndoSequence BC (0.84 ± 0.13 Mpa). Coronal sections showed significantly (P < 0.0001) higher bond strength (0.99 ± 0.16 Mpa) compared to the middle (0.81 ± 0.14 MPa) and apical third (0.74 ± 0.12 Mpa). Qualitative SEM revealed a higher interfacial gap between sealer and irradiated radicular dentin. The percentage of mean change was recorded significantly high in MTA Fillapex (52%), then in EndoSequence BC (31%), and least was in Adseal (17%).Conclusions: Irradiated teeth resulted in consequential decreased adhesiveness and bond strength of dentin to root canal filling material. In addition, the highest bond strength was noticed in Adseal.

Coronal and apical leakage among five endodontic sealers.

The aim of this study was to use dye penetration to measure apical and coronal leakage simultaneously in single-canal teeth that had been treated endodontically using a single-cone obturation technique. One hundred single-canal, extracted human teeth were cleaned and shaped with ProTaper NEXT rotary files to size-X5 (50/.06), then randomly assigned to five sealer groups for single-cone gutta-percha obturation. The teeth were soaked in 0.6% rhodamine B at 37°C for seven days, then the roots were ground mesiodistally and the maximum apical and coronal dye penetration was measured. Differences in leakage among the sealer groups were examined using the Kruskal-Wallis test. Pairwise comparisons were made using the Mann-Whitney test with Bonferroni correction. The mean values (mm) of dye penetration for AH Plus, Pulp Canal Sealer, NeoSEALER Flo, EndoSequence BC, and Super-Bond RC Sealer were 0.200, 0.300, 0.675, 0.850, and 0.900 apically, whereas 1.675, 2.075, 4.800, 6.500, and 4.125 coronally. Pairwise comparisons showed significant apical differences between AH Plus/Super-Bond RC Sealer (P = 0.047) and significant coronal differences between AH Plus/NeoSEALER Flo (P = 0.001), AH Plus/EndoSequence BC (P < 0.01), AH Plus/Super-Bond RC Sealer (P < 0.01), Pulp Canal Sealer/NeoSEALER Flo (P = 0.010), Pulp Canal Sealer/EndoSequence BC (P < 0.01), and Pulp Canal Sealer/Super-Bond RC Sealer (P < 0.01). Coronal leakage was worse than apical leakage for all sealers. AH Plus exhibited the least leakage apically and coronally; Super-Bond RC Sealer showed the most leakage apically, and EndoSequence BC showed the most leakage coronally.

Use of micro-CT to examine effects of heat on coronal obturation.

The aim of this study was to categorize the effects of heat on coronal obturation with gutta-percha and sealer using X-ray micro-computed tomography (micro-CT). Ten single-rooted, extracted human teeth were shaped using ProTaper NEXT files to size X5 (#50/Taper 6%) with 2.5% NaOCl irrigation. A single ProTaper NEXT X5 gutta-percha point was then inserted with epoxy resin (AH Plus) or tricalcium silicate (EndoSequence BC) sealer (n = 5/group), and cut at the cemento-enamel junction. The teeth were scanned using micro-CT (SkyScan1272) to obtain 11 sagittal 2-D images. Three calibrated raters categorized the coronal 0.5 mm of the images into four categories: "swirled sealer and/or gutta-percha without voids" (I), "uniform voids and sealer/gutta-percha" (II), "non-uniform voids and sealer/gutta-percha" (III), and "swirled sealer and/or gutta-percha with voids" (IV). Intra-rater and inter-rater reliability were then calculated. Chi-square tests were conducted to determine the significance of differences in each category between sealers. The intra-class correlation coefficient was 0.55 (same rater/two different times) and Fleiss' kappa (different raters/same image) was 0.34. Categories I, II, III, and IV accounted for 16.4%, 4.2%, 30.3%, and 49.1% for AH Plus, and 6.7%, 4.2%, 27.3%, and 61.8% for EndoSequence BC, respectively. Category IV was most common and Category II the least common. Significant differences were evident between sealers for Category I (P < 0.01).

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

Toxicity of bioceramic and resinous endodontic sealers using an alternative animal model: Artemia salina.

Aims:The present study assessed the toxicity of a novel calcium silicate-based root canal sealer (Bio-C Sealer) in comparison to Endosequence BC Sealer and AH Plus through a lethality assay involving brine shrimp (Artemia salina).Methods:Brine shrimp cysts were incubated for 24 h for the hatching of the larvae, which were then exposed to different concentrations (2.5, 5, 10, 20, 40, 80, and 100 μg/mL) of the test endodontic sealers for 24 h, followed by the determination of the survival rate.Statistical Analysis Used:One-way repeated-measures ANOVA and the Newman–Keuls post hoc test were used to compare the different materials as well as different concentrations of the same material. Dunnett's test was used to compare the different concentrations and different sealers to the control. The lethal concentration of each endodontic sealer necessary to kill 50% of the brine shrimp larvae (LC50) was also determined.Results:The toxicity of Bio-C (10, 20, 40, 80, and 100 μg/mL) and Endosequence BC Sealer (20, 80, and 100 μg/mL) was lower than that of AH Plus. No significant difference was found between Bio-C and Endosequence BC Sealer or among the different intragroup concentrations of these sealers. In the AH Plus group, concentrations ≥5.0 μg/mL exhibited greater toxicity compared to the concentration of 2.5 μg/mL and the control. AH Plus had the lowest LC50 (59.95 μg/mL), whereas Bio-C and Endosequence BC Sealer had LC50 values >200 μg/mL.Conclusions:Bio-C Sealer proved to be less toxic than AH Plus and exhibited similar toxicity to that of Endosequence BC Sealer.

Evaluation of in vitro experimental model for analysis of bioceramic sealers

This study aimed to evaluate physicochemical properties of three ready-to-use calcium silicate-based endodontic sealers: Endosequence BC Sealer, Bio C Sealer, and Sealer Plus BC. Radiopacity was evaluated using specimens of 10 mm in diameter and 1 mm in height, along with an aluminum step wedge. For the flow test, 0.5 mL of each sealer was deposited between glass plates and the mean of the measurement of two diameters was considered the cement flow value. For pH and calcium release, root canals of 30 prototypes of upper incisor acrylic resin teeth were filled with sealer and gutta percha point and then immersed in containers with 13 mL of ultrapure water. Both pH and release of calcium ions (atomic absorption spectrophotometer) were measured at 3, 24, 72, and 168 h. Acrylic resin teeth were scanned by Micro-CT 1174 at the time of pH and calcium ion readings for volumetric change analysis. The data were analyzed by ANOVA, Tukey’s, Kruskal-Wallis, and Dunn’s tests. Endosequence BC Sealer presented the lowest, and Bio C Sealer the highest volumetric change after 72 h and 168 h (p < 0.05). Endosequence BC Sealer presented higher radiopacity (p < 0.05). All materials showed alkalinization capacity. All of them presented calcium ion release, with a higher value for Sealer Plus BC. All materials presented alkalinization, calcium release capacity, radiopacity, and flow above the minimum values required by the ISO standard. The highest volumetric loss was experienced by Bio C Sealer and the lowest one by Endosequence BC Sealer.

Successful regenerative endodontic treatment in a tooth with incomplete root apex and posttreatment apical periodontitis: A case report

This case report describes the procedure and outcome of regenerative endodontic treatment (RET) in a tooth with incomplete root apex and posttreatment apical periodontitis. A 44-year-old patient was referred to the endodontist because of a periapical lesion on tooth #21 and a recent episode of acute periapical abscess. On clinical and radiographic examination, this tooth presented with tenderness to percussion and palpation, periapical radiolucent lesion, external apical resorption, and incomplete apex formation. After coronal access, the filling material was removed, and the canal was gently prepared with hand files, using 1% NaOCl as the main irrigant followed by final irrigation with 17% EDTA, activated with XP-endo Finisher (FKG Dentaire, La Chaux-de-Fonds, Switzerland). The root canal was filled with a double antibiotic paste with ciprofloxacin and metronidazole (1:1). After three weeks, RET was performed by stimulating bleeding into the canal, and when a clot was formed, a bioceramic (EndoSequence BC Sealer, Brasseler USA, Savannah, GA) plug was placed on it, followed by coronal restoration. The tooth remained asymptomatic since RET was concluded. Clinical and radiographic follow-ups showed complete repair of the apical periodontitis lesion and the absence of symptoms after eight months. This satisfactory outcome was confirmed after 34 months. Key words:Bioceramic material; ciprofloxacin; metronidazole; persistent apical periodontitis; regenerative endodontic treatment.

Physicochemical properties and osteoclastogenesis for three premixed calcium silicate-based sealers post set.

Solubility, pH, ion release, cytotoxicity, and osteoclastogenesis inhibition in bone marrow-derived monocyte macrophages (BMMs) were evaluated in EndoSequence BC Sealer (END), Bio-C Sealer (BC), and Sealer Plus BC (SPBC). pH was determined after immersion of the sealers in deionized water (DW) and Minimum Essential Medium Alpha (α-MEM). Solubility was obtained by mass loss. Ion release was measured by using X-ray fluorescence spectroscopy (XRF). Cytotoxicity was evaluated by MTT assay. Inhibition of osteoclastogenesis was evaluated by tartrate-resistant acid phosphatase (TRAP). Data were analyzed using the t-test, ANOVA and Tukey/Dunnett's post-hoc tests (α = 0.05). END had the highest pH in DW (p < 0.05), and BC, in α-MEM (p < 0.05). Solubility in DW was the lowest for SPBC (p < 0.005). The highest calcium release was observed for BC in DW at 12 h (p < 0.05), and in α-MEM at 12 and 24 h (p < 0.05). The lowest toxicity was detected for END (p < 0.05). BC had the highest inhibitory effect on osteoclasts (p < 0.05). Overall, the highest solubility and pH values were found in DW. However, the calcium silicate-based sealer showed higher solubility than the ISO standards. Calcium release was the highest for BC. END showed the highest cell viability, and BC, the highest osteoclast inhibition.

Single Visit Root Canal Treatment: Intensity of Postoperative Pain Using AH Plus Sealer Versus Endosequence BC Sealer in Patients with Asymptomatic Apical Periodontitis (A Randomized Clinical Trial)

Single Visit Root Canal Treatment: Intensity of Postoperative Pain Using AH Plus Sealer Versus Endosequence BC Sealer in Patients with Asymptomatic Apical Periodontitis (A Randomized Clinical Trial)

Evaluation of the Physicochemical and Biological Properties of EndoSequence BC Sealer HiFlow

IntroductionUnderstanding the physicochemical and biological properties of endodontic sealers is important for endodontic treatment planning. This study evaluated the properties of EndoSequence BC Sealer HiFlow (BCH; Brasseler USA, Savannah, GA), EndoSequence BC Sealer (BC, Brasseler USA), and AH Plus (AHP; Dentsply DeTrey, Konstanz, Germany). The effect of temperature on the setting time and flow of these sealers was also evaluated. MethodsThe setting time, flow, radiopacity, pH, solubility, and calcium release were investigated following ISO guidelines. The morphology and chemical composition of the sealers were evaluated by scanning electron microscopy and energy-dispersive spectroscopy. The antibacterial activity of sealers was tested against 2 strains of Enterococcus faecalis. Sealer cytotoxicity and the effects on messenger RNA expression of proinflammatory and mineralization genes were also investigated. Data analysis was performed using analysis of variance, Tukey, Kruskal-Wallis, and Dunn multiple comparison tests. P ≤ .05 was considered statistically significant. ResultsThe setting time and flow rate of all sealers were affected by heat (P ≤ .05). The setting times and solubility of BCH and BC were significantly higher than AHP (P ≤ .0001). The radiopacity of AHP was higher than BCH and BC (P ≤ .0001). All sealers were alkaline and had antibacterial effects. Cell viability was higher for BCH and BC than AHP (P ≤ .0001). No significant differences in messenger RNA expression of proinflammatory and mineralization genes were observed. ConclusionsOverall, BCH and BC had similar physicochemical and biological properties. The observed high solubility of BCH and BC as well as the high cytotoxicity of AHP might negatively impact the clinical performance of these materials. The application of heat affected the setting time and flow of all sealers.

A comparative clinical study of bioceramic and calcium hydroxide based root canal sealer in the treatment of non-vital permanent tooth with periapical lesion

Introduction: The use of Bioceramic sealer in the obduration of the root canal system has been expected by many of the previous studies. However, the clinical outcome has not yet been established. Objective: To compare the effectiveness of bioceramic and calcium hydroxide based root canal sealer in treatment of non-vital permanent teeth with periapical lesion (Periapical periodontitis). Materials and Methods: A total 100 mature permanent anterior teeth were selected after clinical and radiological examination which had non-vital pulp with periapical lesion. Clinically pulp vitality test, palpation and percussion test was performed maintaining standard procedure. Following cavity preparation and biomechanical preparation, each canal was obturated either with bioceramic (Endosequence BC) or calcium hydroxide based sealer (Sealapex, Kerr). All participants were evaluated immediately after obturation, at 3 and 6 months for the assessment of change in size of periapical lesion, condition of periodontal ligament space, lamina dura and incidence of post-operative pain, swelling. Statistical analysis was performed using Chi- square(X2) test and t-test. A value of p&lt;0.05 was considered as statistically significant. Results: Bioceramic was more effective in reducing the lesion size than that of calcium hydroxide. At 6 months, the mean lesion size was reduced from 3.52±0.7 to 1.30±0.462 mm in Bioceramics and from 3.48±1.07 to 1.58± 0.498 mm in sealapex treated teeth.. Furthermore, 98% of bioceramic treated teeth and 94% of sealapex treated teeth showed absence of swelling. The differences between two groups were statistically significant (p&lt;0.05). Conclusion: In this short period of study, Bioceramics based sealer seems to be more effective than calcium hydroxide based sealer in repair of periapical lesions of the nonvital teeth. Update Dent. Coll. j: 2021; 11(2): 26-31

The effect of atmospheric cold plasma on the dentinal tubule penetration of calcium silicate‐based sealer used with different obturation techniques: A confocal laser scanning microscopy study

The aim of this study was to evaluate the effect of atmospheric cold plasma (ACP) on dentinal tubule penetration of EndoSequence BC. Sixty premolars were divided into four groups according to the obturation technique and plasma treatment. Root canals were filled with single cone in Group 1 (SC), single cone after ACP application in Group 2 (SC-P), warm vertical compaction in Group 3 (WVC), warm vertical compaction after ACP application in Group 4 (WVC-P). Horizontal sections were imaged using confocal laser scanning microscopy. The maximum penetration and percentage of penetration values were measured. These data were statistically analysed (P < 0.01). In the coronal region, the percentage of penetration values were higher in SC-P and WVC-P than in SC and WVC. In the middle region, SC-P and SC showed a higher penetration percentage than WVC and WVC-P. In the apical region, WVC showed a higher percentage of penetration value than SC-P, WVC-P and SC did. Maximum penetration of WVC was higher than of SC and SC-P. Within the limitations of this study, ACP improved the percentage of penetration values of EndoSequence BC when used with single-cone technique.

Micro–computed Tomographic Evaluation of the Quality of Root Canal Fillings in Mandibular Molars after Obturation for 54 Months

IntroductionThe present study evaluated the percentage volume of voids in root canals of mandibular molars that had been obturated for 54 months. MethodsThirty extracted human mandibular molars were instrumented and debrided. The teeth were assigned to 3 groups (n = 10) according to the filling technique and sealer used: the single-cone technique using AH Plus sealer (AHS; Dentsply Sirona Endodontics, Tulsa, OK) or EndoSequence BC sealer (BCS; Brasseler USA Dental LLC, Savannah, GA) and the warm vertical compaction technique using AH Plus sealer (AHW). The specimens were stored at 37°C and 100% humidity. Micro–computed tomographic imaging was used to scan each specimen 1 day 54 months after obturation. Data were analyzed using 1-way analysis of variance and the paired t test. ResultsThe percentage volume of voids in the teeth 1 day after obturation in the AHS group was higher than in the BCS group and the AHW group (P < .05). After 54 months, the proportion of voids decreased in all groups (P < .05). No significant difference was observed between the AHS group and the BCS group after 54 months. Teeth in the AHW group contained fewer voids than the AHS group (P < .05). ConclusionsVoids in root canal filling were reduced 54 months after obturation. The warm vertical compaction technique achieved better root canal filling quality in mandibular molars than the single-cone technique when using AHS after long-term storage at 100% humidity.

Assessment of Root Canal Sealers Loaded with Drug-Silica Coassembled Particles Using an In Vitro Tooth Model

IntroductionThe purpose of this study was to assess the antimicrobial activity of root canal sealers modified with novel highly loaded antimicrobial drug-silica coassembled particles (DSPs) on Enterococcus faecalis–infected root canal dentin. MethodsDSPs were synthesized through coassembly of silica and octenidine dihydrochloride (OCT) surfactant drug (35% w/w OCT). DSPs (1% wt of the total mass of the sealer) were mixed homogenously with either epoxy resin sealer (AH Plus [AH]; Dentsply Sirona, Tulsa, OK) or calcium silicate–based sealer (EndoSequence BC Sealer [BC]; Brasseler, Savannah, GA). To assess the antimicrobial activity of DSP-loaded sealers, the apical third of single-rooted teeth was obtained and infected with E. faecalis for 3 weeks followed by the application of experimental (DSP-loaded) sealers or corresponding controls for up to 28 days. Microbiological analysis and laser scanning confocal and scanning electron microscopy were used to determine the colony-forming unit (CFU)/mL, the percentage of live bacteria, and the intratubular bacterial and sealer penetrations. Factorial analysis of variance and Tukey post hoc tests were used to assess the antimicrobial effect of DSPs on different sealers. ResultsAll experimental groups showed significant reductions in CFUs at all-time points compared with positive controls (P < .05). The addition of DSPs to BC significantly reduced the CFUs (2.11 ± 0.13, 2.22 ± 0.19, and 2.25 ± 0.17 at 1, 7, and 28 days, respectively) compared with the unmodified sealer (3.21 ± 0.11, 4.3 ± 0.15, and 4.2 ± 0.2 at 0, 7, and 28 days). DSPs enhanced the antimicrobial performance of AH only at 1 day (4.21 ± 0.17 vs 5.19 ± 0.12, P < .05). AH and AH + DSPs showed higher bacterial viability compared with BC and BC + DSPs at all incubation periods (P < .05). ConclusionsLoading endodontic sealers with DSPs had a material-dependent effect on the antimicrobial properties and could reduce the incidence of secondary infections.

Comparison of calcium and hydroxyl ion release ability and in vivo apatite-forming ability of three bioceramic-containing root canal sealers.

Bioceramic-containing root canal sealers promote periapical healing via Ca2+ and OH- release and apatite formation on the surface. This study aimed to compare Ca2+ and OH- release and in vivo apatite formation of three bioceramic-containing root canal sealers: EndoSequence BC sealer (Endo-BC), MTA Fillapex (MTA-F), and Nishika Canal Sealer BG (N-BG). Polytetrafluoroethylene tubes filled with sealers were immersed in distilled water for 6 and 12h and for 1, 7, 14, and 28days to measure Ca2+ and OH- release. Additionally, tubes filled with sealers were implanted in the backs of rats for 28days, and in vivo apatite formation was analyzed using an electron probe microanalyzer. Endo-BC released significantly more Ca2+ than the other sealers at 6 and 12h and 1day. Ca2+ release was significantly lower from N-BG than from Endo-BC and MTA-F at 14 and 28days. OH- release was significantly higher from Endo-BC than from the other sealers throughout the experiment, except at 1day. OH- release was lower from N-BG than from MTA-F at 6h and 7days. Only Endo-BC implants exhibited apatite-like calcium-, phosphorus-, oxygen-, and carbon-rich spherulites and apatite layer-like calcium- and phosphorus-rich, but radiopaque element-free, surface regions. Ca2+ and OH- release is ranked as follows: Endo-BC > MTA-F > N-BG. Only Endo-BC demonstrated in vivo apatite formation. Endo-BC could promote faster periapical healing than MTA-F and N-BG.

Efficacy of XP-endo instruments in removing 54 month-aged root canal filling material from mandibular molars

ObjectiveTo investigate the effectiveness of XP-endo Shaper (XPS) and XP-endo Finisher R (XPFR) instruments in removing aged root filling material from root-treated mandibular molars. MethodsThirty mandibular molars were instrumented and divided into three groups: single-cone obturation using AH Plus sealer (AHS) or EndoSequence BC sealer (BCS), and warm vertical compaction using AH Plus sealer (AHW). The specimens were stored at 100% humidity and 37 °C for 54 months. Retreatment was performed using XPS and XPFR. Micro-computed tomography was used to scan the specimens after 54 months, after XPS retreatment and after the supplementary approach using XPFR. ResultsThe XPS removed more filling material in the BCS and AHS groups, compared with the AHW group (P < 0.05). After supplementary instrumentation XPFR, the proportion of the remaining filling material decreased significantly in all groups (P < 0.05). The XPFR instruments were more efficient in removing filling material in the BCS group than in the AHS or AHW group (P < 0.05). The combined use of XPS and XPFR instruments efficiently removed filling material in the BCS group, followed by the AHS and AHW groups (P < 0.05). ConclusionsAlthough the combined use of XPS and XPFR instruments helped remove the bulk of aged root filling material from mandibular molars, material removal from canals filled using warm vertical condensation in the critical apical area remains a concern. Clinical SignificanceRemoval of the aged filling materials using XP-endo instruments from the apical area is challenging when instrumented root canals are filled using warm vertical condensation.

Influence of different irrigation regimens on the dentinal tubule penetration of a bioceramic-based root canal sealer: a confocal analysis study.

This study aims to assess the efficacy of various irrigation protocols on the dentinal tubule penetration of a bioceramic-based endodontic sealer. Sixty-four single-rooted extracted human mandibular incisors were used. After instrumentation, teeth were randomly divided into the following four groups (n = 16 each) according to the final irrigation technique: group 1, conventional endodontic needle (CEN); group 2, EndoActivator (EA); group 3, Er,Cr: YSGG laser; group 4, XP-endo Finisher (XPF). The root canals were finally irrigated with 17% EDTA and 5.25% NaOCl for 1min (min) respectively. The teeth were then obturated with Endosequence BC Points and rhodamine B dye-labeled BC Sealer. After 2weeks, 1-mm-thick transverse sections were cut 2 and 5mm from the apex, and examined by confocal laser scanning microscopy at 5 × magnification. The total percentage of sealer penetration (TPSP), sealer penetration area (SPA), and maximum sealer penetration depth (MSPD) was measured. Data were analyzed by Kruskal-Wallis, Dunn's multiple comparison, and Wilcoxon tests, with significance set at P < 0.05. At 2mm level, no significant differences were detected among the groups (P > 0.05). At the 5mm level, the XPF group showed significantly higher values for both TPSP and SPA in comparison with the Er,Cr: YSGG laser and CEN groups (P < 0.05), but no significant difference was observed with the EA group. The choice of different final irrigation techniques can affect dentinal tubule penetration.

Methodological proposal for evaluation of adhesion of root canal sealers to gutta‐percha

To compare the bond strength of an epoxy resin-based sealer and two calcium silicate-based sealers (CSS) to gutta-percha discs using a new method. Round discs of gutta-percha (n=60), measuring 10mm in diameter and 2mm in thickness, were placed on a glass plate and a drop of each sealer (AH Plus, EndoSequence BC Sealer and EndoSeal MTA) was placed on their surface. Another identical disc was placed onto the first one and a standardized weight (0.0981N) applied over them using a specially developed apparatus. Ten samples prepared for each sealer were submitted to a microshear bond strength test accomplished by a specially designed set-up coupled to a universal testing machine. The Kruskal-Wallis test followed by a post hoc procedure was used to compare groups considering the preliminary analysis of the raw data had indicated the nonadherence to a Gaussian distribution (Shapiro-Wilk, p<.05). Alpha error was set at 5%. Overall, no premature failure occurred. All sealers had some degree of adhesiveness to gutta-percha discs but with a significant difference amongst them (Kruskal-Wallis, p=.019). The epoxy resin-based sealer (AH Plus) had significantly higher median shear bond strength values (1.43MPa; 1.40-1.83) compared to EndoSeal MTA (0.53MPa; 0.46-0.73) (p=.021) and EndoSequence BC Sealer (0.45MPa; 0.34-0.46) (p=.023), whilst the lowest median value was observed with EndoSequence BC Sealer (0.45MPa; 0.34-0.46) (p<.05). CSS sealers had weaker bonding to gutta-percha when compared to the epoxy resin-based AH Plus sealer. The proposed methodology is an innovative and reproducible method for testing the bond strength of root canal sealers to gutta-percha.