EndoSequence Bioceramic Research Articles

Assessment of the impact of XP-Endo Finisher file on push-out bond strength of various endodontic sealers.

An endodontic treatment is considered a success after thorough chemomechanical debridement coupled with obturating root canals in a concrete way thereby providing hermetic seal. Gutta-percha being nonadherent necessitates use of a sealer to achieve hermetic seal. Adequate adhesion of root canal sealer with gutta-percha core and radicular dentin ensures lack of apical leakage. Sixty extracted mandibular premolars with single root canal decoronated at cementoenamel junction were selected and randomly allocated to two groups (n = 30). Samples in Group 1 were prepared with BT Race file, while Group 2 samples were prepared with BT Race alongwith XP Endo file. Absorbent paper points were used for canal drying and samples were randomly divided into six subgroups. In Subgroup I, obturation was done with bio-ceramic (BC) sealer (Endosequence BC) and BC gutta-percha. In Subgroup II, resin-based (AH plus) sealer and gutta-percha were used. In Subgroup III, calcium hydroxide-based (Sealapex) sealer and gutta-percha were used. Sectioning of root samples was done perpendicularly into coronal, middle, and apical segments of 3 mm each. A universal testing machine was used for sample testing, in which push-out bond strength corresponded to the highest value obtained. Stereomicroscopic (×20) study of the samples determined the failure mode at dentin/sealer/main cone interface. Analysis of variance and post hoc Tukey's tests were used for data analysis. Endosequence BC with XP-Endo files showed the highest mean push-out bond strength (16.31 MPa), whereas Sealapex without XP-Endo file had the lowest values (12.76 MPa). Mixed failure of adhesive and cohesive mode was observed for most samples. Adjunctive irrigation agitation technique utilizing XP-Endo Finisher facilitates biofilm eradication from difficult niches in root canals, thereby improving adhesion of sealer and subsequently the sealer bond strength.

The Outcome of Contemporary Intentional Replantation: A Retrospective Study

Introduction: Intentional replantation is a clinical procedure in which a tooth is extracted and then replanted back into its original socket after root end endodontic treatment. This procedure is typically performed as a last resort when other treatment options, such as root canal therapy or apical surgery are not feasible or have failed. The success of intentional replantation depends on several factors including the length of time the tooth was out of the socket, the condition of the root surfaces and the skills of the clinician. This retrospective case series aimed to assess the success rate of the intentional replantation procedures done in the Endodontic Department at the University of Pennsylvania and a faculty endodontic practice. Methods: Thirty teeth met the inclusion criteria. Teeth were a-traumatically extracted. All the procedures were done under high-power magnification with the use of the surgical operating microscope. Teeth were kept hydrated with Hank's Balanced Salt Solution. Contemporary root end surgery was performed on the teeth outside the socket. Retrograde preparation and filling were performed with the use of Mineral Trioxide Aggregate or Endosequence Bioceramic Putty. The outcome of IR was determined by clinical and radiographic evaluation. The cases were categorized as completely healed, healing, or failed. Results: Teeth with a minimum of 6 months follow up were included in the study. The mean follow-up period was 18 months. Twenty-two out of the thirty teeth showed complete healing, four were healing and four were considered failures. The overall success rate of the cases was 86.7% Conclusion: Despite the small sample size, our results showed that intentional replantation is a reliable and predictable procedure; when indicated, with a very high success rate if it was done correctly in a timely manner and the periodontal ligament integrity was preserved as much as possible.

The Effect of Bioceramic HiFlow and EndoSequence Bioceramic Sealers on Increasing the Fracture Resistance of Endodontically Treated Teeth: An In Vitro Study.

Background/purpose Root fractures after endodontic treatment are a serious complication, and it often causes tooth loss, several studies have found a correlation between root canal preparation and filling, and the possibility of root fracture. Therefore, this study aimed to evaluate the root fracture resistance of the endodontically treated mandibular premolars after preparing and filling by EndoSequence Bioceramic (BC), EndoSequence BC HiFlow, and AH Plus (AHP). Materials and methods The study sample consisted of 75 single-rooted and single-canal mandibular premolars, they were randomly distributed into five groups: Group I: root canals preparation and fillings with AHPsealer;Group II: root canals preparation and fillings with EndoSequence BC sealer;Group III: root canals preparation and fillings with BC HiFlow sealer;Group IV (Negative Control): without root canals preparation; and Group V (Positive Control): canals preparation without root canals filling. A glide path was established by #10 hand K-file, then the crowns were cut, and the canals were prepared and filled. All teeth were restored with glass ionomer cement and kept in an incubator at 37°C for a week. All samples were placed within acrylic bases and a vertical force was applied using a Testometric machine and the fracture resistance force was recorded. Results EndoSequence BC and BC HiFlow groups showed slightly better fracture resistance (494.440, 496.960 N respectively) than AHPgroup (492.680 N). However, no statistically significant difference was found between the two groups (P-value >0.05). The greatest mean fracture force was observed in the positive control group (736.040 N) with statistically significant difference between the other groups (P-value <0.01) and the least mean fracture force was shown in the negative control group (318.040 N) with statistically significant difference between the other groups (P-value <0.01). Conclusion Based on this in vitro study, the use of EndoSequence BC, BC HiFlow, and AHPenhanced the fracture resistance in root-filled single-rooted premolar teeth. While, the application of EndoSequence BC, BC HiFlow, and AHPdid not increasethe fracture resistance of roots compared to that of unprepared root canals.

Lack of Correlation Between the Penetration of Two Types of Sealers and Interfacial Adaptation to Root Dentine.

ObjectiveThis study aimed to determine the correlation between sealer penetration into dentinal tubules and interfacial adaptation to root canal walls using a hydraulic calcium silicate-based sealer, Endosequence Bioceramic Sealer (Brasseler USA, Savannah, GA, USA), and an epoxy resin-based sealer, AH Plus (Dentsply DeTrey, Konstanz, Germany).MethodsSixty-four maxillary central incisors were endodontically prepared with nickel-titanium rotary instruments and randomly assigned into two groups (n=32). Roots were filled with gutta-percha using a single-cone technique in conjunction with one of the two sealers, AHP or BCS. Sealers were mixed with Rhodamine B and analysed under a confocal laser scanning microscope. Transverse sections at 5 mm from root apex were obtained. The circumference of the root canal wall was first outlined and measured to determine the circumferential percentage of sealer penetration. The regions along the canal walls where the sealer had penetrated the dentinal tubules were delineated and measured. Then, the outlined distances were divided by the canal circumference. The width of each gap was measured and pooled for each specimen for comparison to determine the interfacial adaptation. The measurements were repeated twice to ensure reproducibility. Mann-Whitney tests were performed to compare continuous variables between AHP and BCS groups. The correlation between gap width and percentage of sealer penetration was investigated using the Spearman correlation coefficient.ResultsNo significant difference was observed between groups regarding the percentage of sealer penetration (P>0.05) and the gap width (P>0.05). Also, there was no significant correlation between the two variables analysed for AHP (r=0.165; P>0.05) and BCS (r=-0.147; P>0.05) and in the overall sample (r=0.061; P>0.05).ConclusionThe present results show no correlation between interfacial adaptation and sealer penetration in dentinal tubules in the total sample and among sealer subgroups. The ability of root canal sealers to penetrate dentinal tubules cannot be considered a sign of better interfacial adaptation.

Sealing ability of three different materials to repair furcation perforations using computerized fluid filtration method.

Background. The present study aimed to evaluate the sealing ability of three different calcium silicate-based materials in furcation perforations. Methods. Seventy-six human mandibular molar teeth were selected. Perforations were created in the center of the pulp chamber floor. The experimental teeth were randomly divided into three groups (n=22). Perforations were repaired with MTA Angelus, Endocem MTA, or EndoSequence BioCeramic Root Repair Material Fast Set Putty (BC-RRM Putty). Microleakage of the different repair materials to be tested was measured by computerized fluid filtration method at 24- and 72-hour intervals. Results. For each time interval, no statistically significant difference was observed between the groups. For Endocem MTA and BC-RRM Putty groups, the difference between the leakage values measured at both periods was not statistically significant (P > 0.05). However, there was a significant difference for the MTA Angelus group (P < 0.05). Conclusion. All the calcium silicate-based materials used in the present study showed similar performance in repairing furcation perforations at 24- and 72-hour intervals.

Tooth Discoloration Induced by Different Calcium Silicate-Based Cements: A Two-Year Spectrophotometric and Photographic Evaluation in Vitro.

Calcium silicate-based cements (CSCs) may lead to coronal staining in young permanent teeth over the time. The purpose of this study was to evaluate and compare the long-term tooth discoloration induced by different CSCs. Ninety freshly-extracted human molars were assigned randomly into 6 groups (n=15/group) according to the CSC used as a pulpotomy material: ProRoot MTA, MTA Angelus, NeoMTA, EndoSequence Putty, Biodentine and Negative control (No cement). The color was assessed at baseline, and thereafter at 3, 6, 12 and 24 months by using both a spectrophotometer and digital images taken with and without a cross-polarizing filter. The time-dependent changes in color (ΔE) were compared within and among groups using Analysis of Variance. Angelus MTA and ProRooT MTA showed severe coronal discoloration (p>0.05) starting at 3 months. ΔE values of NeoMTA, EndoSequence Bioceramic Putty and Biodentine were below the perceptibility threshold, with Biodentine showing greater ΔE values than NeoMTA and EndoSequence Putty in the absence of statistical significance (p>0.05). Discoloration elicited by CSCs may develop soon after placement, and continue to increase for up to two years. Angelus MTA and ProRooT MTA cannot be recommended for vital pulp therapies in the esthetic zone of young individuals.

Drug-Silica Coassembled Particles Improve Antimicrobial Properties of Endodontic Sealers

IntroductionThe purpose of this study was to assess the antimicrobial activity and flow of root canal sealers after incorporating novel highly loaded antimicrobial drug-silica coassembled particles (DSPs). MethodsDSPs were synthesized through coassembly of silica and octenidine dihydrochloride (OCT) antimicrobial surfactant. DSPs were loaded (1% and 2% wt) into epoxy resin sealer (AH Plus [AH]; Dentsply DeTrey GmbH, Konstanz, Germany) or calcium silicate–based sealer (EndoSequence Bioceramic Sealer (BC); Brasseler, Savannah, GA). OCT release from DSP-modified sealers was determined using liquid chromatography. Antimicrobial activity of sealers against planktonic or biofilm form Enterococcus faecalis was assessed using direct contact and membrane restricted tests. Sealer flow was tested according to ISO6876:2012. ResultsOCT release from BC + 1% or 2% DSPs was above the minimum inhibitory concentration following 2 days throughout the 30-day experiment, whereas OCT release from AH + 1% or 2% DSP was significantly below the minimum inhibitory concentration against E. faecalis (4 μg/mL) over the whole 30-day experimental period. All materials (with or without DSPs) killed planktonic bacteria initially. AH ± 1% or 2% DSPs had no antimicrobial activity after 7 days. BC + 1% or 2% DSPs maintained antibacterial activity over the 30-day period. Both modified and unmodified sealers completely inhibited the growth of E. faecalis biofilms after 24 hours of contact. DSPs decreased the flow of AH and BC sealers; for AH, the reduction was proportional to the amount of DSPs added. All modified and unmodified sealers, except for AH + 2% DSPs, were within the acceptable limits of ISO 6876 flow tests. ConclusionsDSPs enhanced the antimicrobial performance of BC but not AH, whereas the material’s flow remained compliant with ISO 6876 standards. Depending on the sealer, DSPs may enhance antimicrobial efficacy in root canal treatment and potentially improve treatment outcome.

IN VITRO EVALUATION OF THE ANTIMICROBIAL EFFECT OF ENDOSEQUENCE BC AND AH PLUS ROOT CANAL SEALERS ON ENTEROCCOCUS FAECALIS

INTRODUCTION: Remaining microorganisms after chemo-mechanical cleaning and disinfection may be eliminated or rendered harmless by entombing them through complete obturation with gutta percha points and sealer. Adequate antimicrobial effect is of optimum importance to achieve root canal treatment success.OBJECTIVES: The aim of this study was to investigate the antimicrobial potential of two types of sealers against Enterococcusfaecalis present in dentinal tubules, over a 30 day period.MATERIALS AND METHODS: Cells of Enterococcus faecalis were introduced into the dentinal tubules by incubation in brain-heart infusion broth for 3 weeks. AH Plus and Endosequence BioCeramic sealer (BC sealer) were coated on the root canal wall of the dentin specimens and cold lateral obturation technique was preformed, specimens were then stored for one, seven, and 30 days at 37°C. At the end of each incubation period, dentin powder was collected by sequential removal of dentin by the use of peeso reamers throughout the sample thickness, total bacterial count was assessed by Colony forming units (CFU) count.RESULTS: No significant difference was observed in the total bacterial count among the three groups in day one. AH Plus showed statistically significant lower bacterial counts in comparison to the positive control group in day 7 and day 30, while Endosequence BC showed a statistically significant lower bacterial count in comparison to the positive control group at day 30.CONCLUSIONS: AH plus exhibited a stronger antibacterial affect after setting and therefore is more effective than Endosequence BC in eliminating Enterococcus faecalis from the root canal system. In addition, both sealers lose their antibacterial effect with time.

Comparison of the sealing ability of various bioceramic materials for endodontic surgery.

ObjectivesEndosequence Bioceramic Root Repair Material (BC-RRM) is used in endodontic microsurgery. It is available as a paste and a putty. However, no studies to date have examined the sealing ability of these forms alone or in combination as root-end filling materials. Hence, this study aimed to compare the sealing properties of these 2 forms of BC-RRM.Materials and MethodsForty-two extracted upper anterior teeth were divided into 3 experimental groups, a positive and negative control. After the root canal treatment, the root ends were resected, retroprepared and retrofilled with either putty, paste + putty or mineral trioxide aggregate (MTA). The teeth were mounted in tubes so the apical 3 mm was submerged in Brain Heart Infusion (BHI) broth. The coronal portions of the canals were inoculated with Enterococcus faecalis and BHI broth and incubated for 30 days. The broth in the tubes was analyzed for colony forming units to check for leakage of bacteria from the canal. The teeth from the groups were sectioned and analyzed using scanning electron microscopy (SEM). The Kruskal-Wallis test and analysis of variance were used to analyze the data with a significance level p < 0.05.ResultsThe BC-RRM and MTA groups showed similar sealing ability. The positive control showed leakage in all samples. The SEM imaging showed the presence of bacteria in all experimental groups at the material-tooth interface.ConclusionsNo significant differences were noted in the experimental groups, providing sufficient evidence that any combination could be effectively used during endodontic microsurgery.

Retreatability of bioceramic and GuttaFlow bioseal root canal sealers using ProTaper universal system retreatment files: An Ex vivo study

Introduction: To evaluate the retreatability of Bioceramic and GuttaFlow Bioseal sealers using ProTaper Universal System Retreatment files aided by dental microscope analysis. Materials and Methods: Root canals of forty single-rooted human mandibular premolar teeth were prepared with ProTaper Next rotary system and obturated with single-cone obturation technique (n = 20 each) using EndoSequence Bioceramic root canal sealer (Group 1) and GuttaFlow Bioseal root canal sealer (Group 2). All specimens were retreated with ProTaper Universal Retreatment System files. The working time of retreatment procedure was calculated. Samples were sectioned, and the residual filling remnants were observed under dental operating microscope. Statistical analysis was performed using SPSS software. Results: The least total working time was observed in GuttaFlow Bioseal group (2.35 min). Overall, less residual filling materials was found in Bioceramic sealer group specimens in all root levels compared to GuttaFlow Bioseal group (P = 0.000, 0.022, and 0.000, respectively). Conclusion: The retreatment technique used was incapable of complete removal of filling material within root canal walls.

Comparison of push-out bond strength of bioceramic sealer with bioceramic coated and non-bioceramic coated Gutta-percha: an in vitrostudy

Background: The goal of the endodontic treatment is to achieve a fluid-tight impervious seal to prevent the ingress of bacteria and the occurrence of any pathology in future. The endodontic sealer plays a crucial role in obtaining the hermetic seal by filling all the spaces and by binding to the root dentin and to the core obturating material, which is usually gutta-percha. Aim: This study aimed to compare the push-out bond strength of Endosequence BC sealer with bioceramic coated gutta-percha and non-bioceramic coated gutta-percha. Materials and methods: A total of 36 extracted human maxillary central incisors were decoronated to standardize the root length of 15mm. Working length was determined and Biomechanical preparation for all the samples was done with a Mtwo (VDW Company) rotary file till 40/.06. Samples were randomly divided into three groups containing 12 teeth in each group based on the obturation procedure, namely Group 1: Endosequence BC sealer along with Endosequence bioceramic coated gutta-percha (n=12), Group 2: Endosequence BC sealer along with normal gutta-percha (n=12), Group 3: AH Plus sealer along with normal gutta-percha. All the samples were obturated using single cone technique. The specimens were sectioned orthogonally at middle third to obtain three sections of 1mm thick. All the samples were subjected to the push-out bond strength test with the universal testing machine. The data were subjected to one-way Analysis of Variance (ANOVA) followed by post hoc analysis. Results: Samples obturated with Endosequence BC sealer with Endosequence bioceramic coated gutta-percha showed the maximum push-out bond strength followed by Group 3 and Group 2. One-way Anova showed significant differences (p=0.021) among the groups. In posthoc analysis, the specimens from group 1 exhibited significant differences (p=0.016) with the group 2 specimens. Conclusion: The push-out bond strength of Endosequence Bioceramic sealer with Endosequence Bioceramic coated gutta-percha was significantly higher than that of Endosequence Bioceramic sealer with normal gutta-percha and AH Plus sealer with normal gutta-percha.

Cytocompatibility and cell proliferation evaluation of calcium phosphate-based root canal sealers.

ObjectivesThis study aimed to evaluate the cell viability and migration of Endosequence Bioceramic Root Canal Sealer (BC Sealer) compared to MTA Fillapex and AH Plus.Materials and MethodsBC Sealer, MTA Fillapex, and AH Plus were placed in contact with culture medium to obtain sealers extracts in dilution 1:1, 1:2 and 1:4. 3T3 cells were plated and exposed to the extracts. Cell viability and migration were assessed by 3-(4,5-dimethyl-thiazoyl)-2,5-diphenyl-tetrazolium bromide (MTT) and Scratch assay, respectively. Data were analyzed by Kruskal-Wallis and Dunn's test (p < 0.05).ResultsThe MTT assay revealed greater cytotoxicity for AH Plus and MTA Fillapex at 1:1 dilution when compared to control (p < 0.05). At 1:2 and 1:4 dilutions, all sealers were similar to control (p > 0.05) and MTA Fillapex was more cytotoxic than BC Sealer (p < 0.05). Scratch assay demonstrated the continuous closure of the wound according to time. At 30 hours, the control group presented closure of the wound (p < 0.05). At 36 hours, only BC Sealer presented the closure when compared to AH Plus and MTA Fillapex (p < 0.05). At 42 hours, AH Plus and MTA Fillapex showed a wound healing (p > 0.05).ConclusionsAll tested sealers demonstrated cell viability highlighting BC Sealer, which showed increased cell migration capacity suggesting that this sealer may achieve better tissue repair when compared to other tested sealers.

Comparison of the sealing ability of apical plug materials in simulated open apices: An in vitro study

Background: The aim of this study was to evaluate the microleakage of apical plugs made of four different materials in simulated immature teeth. Materials and Methods: Ninety extracted single-rooted teeth were selected and randomly divided into six groups according to the materials used: NeoMTA, EndoSequence Bioceramic Root Repair Material Fast Set Putty (BC RRM-FS), Biodentine, Endo Repair, negative control, and positive control group. Microleakage was evaluated by using a stereomicroscope to assess the penetration of methylene blue solution. Data were analyzed using descriptive statistics and Pearson's Chi-square test (P Results: EndoRepair group showed the highest leakage, and NeoMTA group exhibited the best sealing ability of apical plugs. The sealing ability of Biodentine was similar to NeoMTA and BC RRM-FS. On the other hand, the sealing ability of BC RRM-FS significantly lower than NeoMTA, but it provided a better sealing than EndoRepair. Conclusion: According to the results of this study, NeoMTA and Biodentine can be used safely as apical plug material in single-session apexification in immature teeth. The BC RRM-FS, on the other hand, provided an acceptable sealing, although not as successful as the NeoMTA. However, the sealing properties of Endo Repair need to be improved.

Evaluation of filling ability of Guttaflow Bioseal sealer to the simulated lateral canal by scanning electron microscope

Background and objectives: Lateral canals establish a connection between the main root canal and periodontal ligament. Any necrotic tissue and bacteria residing in the lateral canals influence the efficiency of the filling of the root canal and the outcome of root canal therapy. The aim of this study was to determine which type of root canal sealer among GuttaFlow Bioseal, AH-Plus and Endosequence BC sealer provides deeper penetration into artificially prepared lateral canals. Methods: Thirty mandibular first premolars with single canals and mature roots were instrumented using Protaper universal rotary system after decoronation and standardisation of length (12mm). Three lateral canals were prepared in the coronal, middle and apical thirds in each root (at 3, 6, and 9 mm) using #15 engine-driven reamer. The specimens were divided into three groups (n = 10), according to the filling material, (I): Guttaflow Bioseal seal, (II): AH Plus sealer, (III): Endosequence Bioceramic sealer. In all groups, specimens were obturated using the corresponding Protaper universal gutta-percha and accessory cones. Specimens in each group were cross sectioned. Depth of sealer penetration was measured using a scanning electron microscope. Results: The data were subjected to ANOVA and Tukey’s HSD tests, with significance level of 5%. There was no difference among the tested sealers for filling the lateral canals. Concerning the positions of lateral canals, no differences were also found among sealer types, except for middle portion (at 7 mm from the apex); statistically there is a significant difference between three types of sealer (P value= 0.05), where GuttaFlow Bioseal showed a significantly greater penetration depth than AH Plus sealer.

Influence of different endodontic irrigants on the push-out bond strength of an epoxy-resin based sealer and newly introduced bioceramic sealer to root dentin: An in-vitro study

Aim: The present in-vitro study evaluated the influence of different organic and inorganic root canal irrigants used during chemomechanical preparation on the push-out bond strength of an Epoxy-resin based AH Plus sealer and a Bioceramic Endosequence BC sealer. Materials and Methods: Eighty extracted permanent human mandibular single rooted premolar teeth were used and randomly assigned to four major groups [according to irrigation protocol using sodium hypochlorite (NaOCl) with MTAD (mixture of tetracycline, acid and detergent) or ethylenediaminetetraacetic acid (EDTA) or phosphoric acid or normal saline (NS) as control group]. The root canals were instrumented using rotary nickel-titanium Hyflex® CM file system to size 30/0.06 taper, at the working length, as final shaping and finishing file, following different irrigation protocols, as per group allocation. The samples were further subdivided into two groups, with ten samples each (n=10), based on endodontic sealer; roots were obturated with gutta-percha and test sealers (AH-Plus or Endosequence Bioceramic sealer). The teeth were decoronated and obtained samples of eighty obturated roots of eight groups were cut to obtain 2mm thick coronal root slices (10 root section in each group), using hard tissue microtome. Bond strength of sealers was then measured by subjecting each root section to a compressive load via Instron Universal testing machine. The data were tabulated and statistically analyzed using analysis of variance (ANOVA) and Tukey’s HSD along with Bonferroni’s post-hoc test and level of significance set at a p value Results: The highest mean push-out bond strength of 5.38 MPa for AH Plus sealer was obtained in Group 2A followed by 3.94 MPa for Endosequence BC sealer (Group 2B), when phosphoric acid was used as chelating agent. However, mean bond strength of AH Plus sealer was significantly decreased (p Conclusion: The Bioceramic based Endosequence BC sealer and gutta-percha core combination was n

Clinical Outcome of Non-Surgical Root Canal Treatment Using a Single-cone Technique with Endosequence Bioceramic Sealer: A Retrospective Analysis

IntroductionOne of the important steps in root canal treatment is to create a well-sealed root canal system. EndoSequence BC Sealer (BC; Brasseler USA, Savannah, GA) has several beneficial properties and thus has been incorporated into the practitioner's armamentarium. No studies to date have evaluated the clinical success of using BC. The purpose of this study was to evaluate the outcome of nonsurgical root canal treatment using a single-cone and BC technique and to identify factors associated with success or failure. MethodsThis retrospective cohort study included patients treated in a private practice environment between 2009 and 2015. All cases, including initial and retreatment, were obturated with BC using a single-cone technique with a minimum of a 1-year recall. Patient and treatment factors were analyzed to determine their significance as prognostic factors. Outcome was evaluated based on clinical and radiographic findings at recall. Teeth were classified as healed, healing (success), or not healed (failure). Statistical analysis of potential prognostic factors was performed using the chi-square test (α = 0.05). ResultsThree hundred seven teeth were included in the analysis, and the average follow-up time was 30.1 months. The overall success rate was 90.9%. Lesions <5 mm in diameter had a significantly higher success rate than lesions >5 mm in diameter. Sealer extrusion was observed in 47.4% of the cases. The presence of sealer extrusion did not have any significant effect on the treatment outcome. ConclusionsBC used with a single-cone technique is a viable option for obturation.

Different Setting Conditions Affect Surface Characteristics and Microhardness of Calcium Silicate-Based Sealers.

Objective To investigate the effect of different setting conditions on surface microhardness and setting properties of calcium silicate-based sealers. Methods Three sealers, EndoSequence Bioceramic (BC; Brasseler USA, Savannah, GA, USA), Endoseal MTA (ES; Maruchi, Wonju, Korea), and Well-Root ST (WR; Vericom, Chuncheon, Korea), were compared. Specimens were exposed to either butyric acid (pH 5.4) or phosphate-buffered saline (PBS [pH 7.4]) for 48 h and stored at 100% humidity for 12 days. The control specimens were stored at 100% humidity for 14 days. Surface microhardness was measured, topographic changes were observed, and phase analysis was performed using X-ray diffraction. Microhardness according to storage conditions was compared using one-way analysis of variance and Tukey's multiple comparison tests (P < .05). Results The BC and ES sealers exhibited decreased microhardness when stored in acid or PBS compared with control (P < .05). In the WR group, acid exposure lowered microhardness of the specimens compared with control (P < .05). Scanning electron microscopy revealed different topographies in specimens from all tested sealers exposed to acid or PBS. Conclusion The surface microhardness of calcium silicate-based sealers was reduced by exposure to either acid or PBS. Acid solutions, however, had a more detrimental effect than PBS.

Micro Push-out Bond Strength and Bioactivity Analysis of a Bioceramic Root Canal Sealer.

Introduction:Bioactive endodontic sealers have been developed to improve the quality of root canal obturation. EndoSequence Bioceramic (BC) Sealer is amongst calcium silicate-based materials recently developed for permanent root canal filling. The objective of this study was to evaluate the bioactivity of BC Sealer and its micro push-out bond strength to dentin compared to AH-Plus (AH) sealer. Methods and Materials:To perform the micro push-out test, 24 root canals of mandibular premolars were instrumented and divided into two groups (n=12). Each root was cut into 4 slices and lumens of the canals were filled with the sealers and submitted to micro push-out test. Failure mode was assessed using scanning electron microscopy (SEM). Bioactivity of BC sealer was investigated with scanning electron microscopy/energy-dispersive X-ray (SEM/EDS) and X-ray diffraction (XRD). Bioactivity assessments were reported descriptively. Bond strength data were analyzed by parametric t-test (α=5%). Results:In micro push-out test AH had higher bond strength mean values (16.29 MPa) than BC sealer (9.48 MPa) (P<0.05). Both groups had low amount of adhesive failure. SEM showed the presence of a mineral precipitate after 30 days and EDS analysis showed that those precipitates have high proportion of Ca. XRD showed peaks of crystalline phases of calcium carbonate compatible with the bioactivity.Conclusion:BC sealer showed indications of bioactivity and lower bond strength to dentine compared to AH.

Effect of Intra-Canal Calcium Hydroxide Remnants on the Push-Out Bond Strength of Two Endodontic Sealers.

Introduction:The aim of this study was to evaluate the effect of intra-canal calcium hydroxide (CH) remnants after ultrasonic irrigation and hand file removal on the push out bond strength of AH-26 and EndoSequence Bioceramic sealer (BC Sealer). Methods and Materials:A total of 102 single-rooted extracted human teeth were used in this study. After root canal preparation up to 35/0.04 Mtwo rotary file, all the specimens received CH dressing except for 34 specimens in the control group. After 1 week, the specimens with CH were divided into 2 groups (n=34) based on the CH removal technique; i.e. either with ultrasonic or with #35 hand file. Then specimens were divided into two subgroups according to the sealer used for root canal obturation: AH-26 or BC Sealer. After 7 days, 1 mm-thick disks were prepared from the middle portion of the specimens. The push out bond strength and failure mode were evaluated. Data were analyzed by the two-way ANOVA and Tukey’s post hoc tests. Results:The push out bond strength of both sealers was lower in specimens receiving CH. These values were significantly higher when CH was removed by ultrasonic (P<0.05). The dominant mode of failure in all subgroups was of mixed type except for the BC Sealer specimens undergoing CH removal with hand file which dominantly exhibited adhesive mode of failure. Conclusion:CH remnants had a negative effect on the push out bond strength of AH-26 and BC Sealer. Ultrasonic irrigation was more effective in removing CH.

Outcome of Revascularization Procedure: A Retrospective Case Series

IntroductionThe purpose of this retrospective case series was to investigate the outcome of the revascularization procedure in necrotic immature teeth. MethodsThe residents and faculty members at the University of Pennsylvania endodontic department were invited to submit consecutive revascularization cases treated by them, irrespective of the outcome, during the time period of 2009 to 2012. Twenty-eight of 35 submitted necrotic immature teeth met the inclusion criteria. The treatment protocol included minimal instrumentation and irrigation with 3% sodium hypochlorite and 17% EDTA. Triple antibiotic paste was placed for a minimum of 21 days. After blood clot induction, either EndoSequence Bioceramic Putty (Brasseler, Savannah, GA) or mineral trioxide aggregate was placed below the cementoenamel junction, and composite was used as a final restoration. The follow-up period ranged from 7 to 72 months. The outcome was assessed as complete healing (the absence of clinical signs and symptoms, complete resolution of periradicular radiolucency, increase in the root dentin thickness/length, and apical closure), incomplete healing (the absence of clinical signs and symptoms, the periapical lesion completely healed without any signs of root maturation or thickening, the periapical lesion either reduced in size or unchanged with/without radiographic signs of increasing root dentin thickness/length, or apical closure), and failure (persistent clinical signs and symptoms and/or increased size of the periradicular lesion). ResultsTwenty-one of 28 cases (75%) healed completely, 3 cases (10.7%) failed during the observation period and needed further treatment, and 4 cases (14%) presented with incomplete healing. ConclusionsWithin the limitation of this study, the outcome of revascularization, wherein healing of periapical periodontitis and maturation of roots occurs, is fairly high, making it a viable treatment option in comparison with apexification.