Epoxy Resin-based Endodontic Sealers Research Articles

Contemporary Concepts of Adhesive Cementation of Glass-Fiber Posts: A Narrative Review.

(1) Background: Cementation of glass fiber posts to root canals has been associated with various failures, especially debonding. This narrative review aims to present the contemporary concepts concerning the adhesive cementation of glass fiber post and to discuss the optimal management of these factors. (2) Methods: Electronic search was performed in MEDLINE/Pub Med and Google Scholar using selected keywords examining the parameters post length, surface treatment of glass fiber posts, post space preparation and dentin pretreatment, resin cement selection, adhesive systems and hybrid layer formation, and clinical techniques. (3) Results: The search led to the selection of 44 articles. Epoxy resin-based endodontic sealers are recommended and the use of temporary cement in the root canal should be avoided. The minimum length of a glass fiber post adhesively cemented to a root canal is 5 mm. Irrigating the root canals with chlorhexidine, MTAD, or EDTA (alone or in combination with NaOCl) after post space preparation seems to enhance the bond strength. Silane application on the surface of the post seems to be beneficial. Concerning resin cements and adhesive systems, the results were rather inconclusive. Finally, resin cement should be applied inside the root canal with an elongation tip and photoactivation should be delayed. (4) Conclusions: Contemporary concepts of adhesive cementation of glass fiber posts can indeed improve the bond between glass fiber posts, resin cement, and root canal dentin, however, evidence coming from long-term randomized prospective clinical trials is needed in order to obtain safer conclusions.

Inflammatory response to bioceramic and epoxy resin-based endodontic sealers implanted in mice subcutaneous tissue: An in vivo study.

To evaluate the inflammatory tissue response to BioRoot™ RCS (BR) and AH Plus Jet (AHPJ) sealers implanted in mice subcutaneous tissue. It was hypothesized that the inflammatory tissue response to BR would be milder than to AHPJ. An in vivo study was carried out using isogenic mice. The sealers were implanted during standardized surgical procedures. The inflammatory response was evaluated by microscopic analysis and von Kossa reaction in the reactionary tissue around the specimens after 7, 21, and 63 days. For comparisons, a zinc oxide and eugenol sealer (ZOE) was used as a positive control, in addition to a negative control without a sealer (n = 10 per group/period). All statistical analyses considered a significance level of 5%. All endodontic sealers triggered an inflammatory tissue response after 7 days. BR had a higher inflammatory cell count and a thicker fibrous capsule when compared with AHPJ, but both were less inflammatory than ZOE (p < .001). After 21 days, BR continued to trigger an intense inflammatory tissue response, higher in both microscopic parameters compared to AHPJ, and a thicker fibrous capsule than ZOE (p < .001). After 63 days, the inflammatory tissue response decreased in BR, matching the fibrous capsule thickness with AHPJ and ZOE. BR promoted intense calcium precipitation in all study periods. After 63 days, AHPJ and BR sealers were more biocompatible to subcutaneous mice tissue, but AHPJ present better early inflammatory response, as well as BR showed potential bioactivity. RESEARCH HIGHLIGHTS: The inflammatory tissue response triggered by a bioceramic endodontic sealer (BR) was not milder than that triggered by an epoxy-resin based endodontic sealer (AHPJ) during the first 3 weeks, considering the microscopic analysis of the reactionary tissue.

In silico toxicity and immunological interactions of components of calcium silicate-based and epoxy resin-based endodontic sealers.

The present study aimed to determine in silico toxicity predictions of test compounds from hydraulic calcium silicate-based sealers (HCSBS) and AH Plus and computationally simulate the interaction between these substances and mediators of periapical inflammation via molecular docking. All chemical information of the test compounds was obtained from the PubChem site. Predictions for bioavailability and toxicity analyses were determined by the Molinspiration Cheminformatics, pkCSM, ProTox-II and OSIRIS Property Explorer platforms. Molecular docking was performed using the Autodock4 AMDock v.1.5.2 program to analyse interactions between proteins (IL-1β, IL-6, IL-8, IL-10 and TNF-α) and ligands (calcium silicate hydrate, zirconium oxide, bisphenol-A epoxy resin, dibenzylamine, iron oxide and calcium tungstate) to establish the affinity and bonding mode between systems. Bisphenol-A epoxy resin had the lowest maximum dose tolerated in humans and was the test compound with the largest number of toxicological properties (hepatotoxicity, carcinogenicity and irritant). All systems had favourable molecular docking. However, the ligands bisphenol-A epoxy resin and dibenzylamine had the greatest affinity with the cytokines tested. In silico predictions and molecular docking pointed the higher toxicity and greater interaction with mediators of periapical inflammation of the main test compounds from AH Plus compared to those from HCSBS. This is the first in silico study involving endodontic materials and may serve as the basis for further research that can generate more data, producing knowledge on the interference of each chemical compound in the composition of different root canal sealers.

Tissue Response to a Heat Resistant Silicate-Based and an Epoxy Resin-Based Endodontic Sealer Implanted in Rat Tibias

Introduction: The effect of high temperatures on the properties of endodontic sealers during warm compaction of gutta-percha may be a matter of concern. This study aimed to evaluate the effect of heat on the biocompatibility and bioactivity of EndoSequence BC Sealer HiFlow (ESHF; Brasseler, Savannah, GA, USA) and AH Plus (AHPS; Dentsply, De Trey, Konstanz, Germany) when implanted into the bone tissue of rat tibias. Methods: Medical-grade silicone tubes containing freshly prepared ESHF or AHPS were heated to 100 °C and then cooled down to 65 °C before being implanted in the tibias of 24 Wistar rats. The outer walls of the tubes served as controls. After 10, 30 and 90 days, the animals were euthanized and the implants and their surrounding tissues were dissected, fixed in formalin, and processed for microscopic evaluation. Results: After 10 days postoperatively, a severe inflammatory reaction without reactionary bone formation was observed in contact with ESHF and AHPS. The severity of the reaction had decreased at the 30-day observation period for both sealers but only ESHF samples showed new bone formation adjacent to the sealer. After 90 days, no inflammatory cells were found in contact with ESHF, while a thin fibrous tissue capsule and complete bone reparation of the surrounding areas were observed in contact with the material. For AH Plus, a fibrous connective tissue containing scarce remaining inflammatory cells could be observed in most of the samples, however, in the absence of new bone formation. No significant differences (p &gt; 0.05) between ESHF and AHPS were found at the 10-day observation period. At the 30 and 90-day, significant differences (p &lt; 0.05) between both materials were observed. The reaction to the controls showed significant differences with ESHF and AHPS for all experimental periods. Significant differences (p &lt; 0.05) for the total effect of time were also found between both sealers (p &lt; 0.05). Conclusions: At the end of the experiment, heated ESHF reacted as a biocompatible/bioactive material and stimulated continued development of new healthy bone. Although AHPS was tolerated well by the surrounding tissues, the sealer did not promote new reparative bone formation.

Effect of Carbodiimide (EDC) on the Bond Strength Longevity of Epoxy Resin-based Endodontic Sealer to Root Dentin: An In-Vitro Study.

EDC (1-ethyl-3-(3-dimethylaminopropyl)carbodiimide hydrochloride) can increase dentin bonding longevity. This study aimed to evaluate the effect of final irrigation of the root canal with EDC on the bond strength (BS) longevity of an epoxy resin-based root-canal sealer. Twenty maxillary canines were sectioned and standardized for root length at 17 mm. Roots were instrumented and distributed into 2 groups according to the final irrigation protocol: EDTA 17%+NaOCl 2.5% (C) and EDTA 17%+NaOCl 2.5%+EDC 0.5M (EDC). The canals were dried and filled with AH Plus (Dentsply Sirona). Three slices were obtained per third, and the first slice from each third was used for the immediate push-out test (i) followed by analysis of the failure pattern (n = 10); the second slice from each third was used for the push-out test after 6-month aging (A) followed by analysis of the failure pattern (n = 10); the third slice from each third was used to examine the adhesive interface under confocal laser scanning microscopy (CLSM) (n = 10). Data were analyzed with ANOVA, Fisher's exact and Kruskal-Wallis tests. Higher BSs were found for EDC-A (5.6 ± 1.9) than for EDC-I (3.3 ± 0.7), C-i (2.5 ± 1.0) and C-i (2.6 ± 1.0) (p = 0.0001), while C-A values were in some cases similar to C-i and in others similar to EDC-i. No statistically significant difference was observed between the thirds (p > 0.05), except for EDC-i, which showed lower BS for the cervical (2.79 ± 0.46) compared to the apical third (3.8 ± 0.5), while the middle third in some cases had values similar to those of the apical and in others to the cervical third (3.2 ± 0.7) (p = 0.032). More mixed adhesive failures were found in the cervical third, and more adhesive failures to the sealer occurred in the middle and apical thirds (p = 0.014). A significant difference was observed between treatments in terms of adaptation of the adhesive interface, with a higher percentage of good adaptation using EDC (66.7%) than using C (40%), and a lower percentage of poor adaptation with EDC (10%) compared to C (20%) (p < 0.05). Root canal irrigation with EDC increased the longevity of the adhesive interface of an epoxy resin-based root-canal sealer.

Cleaning and microstructural effects of amyl acetate on pulp chamber dentin impregnated with epoxy resin-based endodontic sealer.

To evaluate the cleaning potential of 95% ethanol, acetone, and amyl acetate solutions used solely or in association, to remove epoxy resin-based sealer residues from pulp chamber dentin and their microstructural effects. One hundred and eighty bovine incisor specimens were divided into nine groups according to the cleaning protocol: ET (ethanol); AC (acetone); AA (amyl acetate); E1: AA+AC; E2: AA+ET; E3: AC+ET; E4: AA+AC+ET; PC (positive control), and NC (negative control). All groups were impregnated with epoxy resin-sealer, except NC. Ninety specimens were divided into groups (n=10) for evaluation of persistence of residues and amount of open dentinal tubules by SEM analysis and evaluation of chemical compounds on the dentin surface after cleaning with electron dispersive spectroscopy. The others 90 specimens were submitted to Knoop microhardness evaluation. Persistence of residues data were submitted to the Kruskal Wallis and Dunn tests (α=0.05). Open dentinal tubules and microhardness data were submitted to one-way ANOVA and Mann Whitney tests (α=0.05). AA and E4 protocols showed the lowest persistence of residues. E4 group had the highest incidence of open dentinal tubules. E3 and E4 groups showed no changes in the atomic ratio Ca/P, which was similar to NC group. E4 group did not present W, an element presents in all the other groups. ET and E4 protocols showed the smallest reduction in dentin microhardness. The combination of amyl acetate, acetone and ethanol is the most effective and safe protocol to remove epoxy sealer residues on pulp chamber dentin. Moreover, it has the lowest microhardness reduction. The combined use of amyl acetate, acetone, and ethanol enhanced the cleaning of pulp chamber dentin with minimal microstructural damage.

On the biocompatibility of endodontic sealers.

Periapical tissue may be exposed to root canal filling materials in consequence of root canal therapy. There is scant scientific data about the biocompatibility of root canal filling materials of various chemistry on the periapical area. This study aimed to investigate the effects of different root canal sealers and their eluates on human alveolar osteoblasts in terms of cell proliferation, adhesion, morphology and gene expression in vitro. Five endodontic sealers (AH Plus®, Apexit®, Tubli-Seal®, Real Seal SE®, EndoRez®) and one gutta-percha obturation material (BeeFill®) were tested. Human alveolar osteoblasts derived from 3 different donors following incubation with sealer eluates after 24 h and 72 h were investigated by means of qPCR (gene expression). Morphological reactions of the alveolar osteoblasts were measured by culturing the cells for 3 d, and 7 d and 14 d, respectively, followed by scanning electron microscopy (morphology, adhesion) and fluorescence imaging of the actin cytoskeleton (morphology, proliferation). A repeated measures analysis was performed and p-values were adjusted by Tukey. While all sealers influenced the cell morphology and the expression of genes associated with apoptosis (Casp3), proliferation (histone H3), and inflammation (interleukin-6 and matrix metalloproteinases 1 and 3), mainly AH Plus® and Apexit® yielded a regular actin cytoskeleton and beneficial gene expression patterns. Regarding cell adhesion, only AH Plus® supported proper anchorage for alveolar osteoblasts. Our results provide evidence for the biocompatibility of epoxy resin-based endodontic sealers, i.e. AH Plus®, while other sealers proved cytotoxic for alveolar osteoblasts. Further studies are needed for understanding the bone cell reactions after endodontic treatment and the clinical decision-making regarding the sealer of choice for root canal fillings.

Impact of cleansing protocols to remove endodontic sealer residues on the adhesive interface: Bonding with universal adhesive systems.

The aim of this study was to evaluate the effectiveness of cleansing protocols to remove sealer residues using different cleaning strategies and the effect of bond strength of two universal adhesives to dentin impregnated with epoxy resin-based sealer. Fifty bovine dentin specimens were impregnated with epoxy resin-based sealer containing calcium hydroxide (Sealer Plus) and submitted to cleansing protocols (n=10): negative control (NC), positive control (PC), 95% ethanol (ET), xylol (XI), and amyl acetate (AA). Specimens were evaluated by scanning electron microscope (SEM). Other 100 specimens were submitted to the same protocols (n=20). Each protocol was divided into subgroups (n=10) according to the universal adhesive system used: Scotchbond Universal (SU); Ambar Universal (AU). Bond strength was evaluated by micro-shear bond test (μSBT). Persistence of residues data were assessed with Kruskal-Wallis and Dunn's tests. μSBT data were analyzed with two-way ANOVA (α=5%). ET presented higher persistence of residues compared to AA and XI (p < 0.05). AA and XI were similar from each other (p > 0.05). AU and SU presented similar μSBT values, regardless of the cleansing solution (p > 0.05). SU-NC presented the highest μSBT among all conditions (p < 0.05). The bond strength of universal adhesives was not affected by different amounts of sealer residues after different cleaning protocols. Non-polar substances such as amyl acetate and xylol are effective for removing residues from epoxy resin-based endodontic sealers.

Localized contact urticaria due to epoxy resin-based endodontic sealer

Localized contact urticaria due to epoxy resin-based endodontic sealer

Cytotoxicity, antibacterial and physicochemical properties of a new epoxy resin-based endodontic sealer containing calcium hydroxide.

BackgroundThis study evaluated the cytotoxicity, antibacterial and physicochemical properties of a new epoxy resin-based endodontic sealer containing calcium-hydroxide Sealer Plus. AH Plus was used as a reference for comparison. Material and MethodsCytotoxicity evaluation was performed according to ISO-10993-5 specifications using MTT assay to check the 3T3 cells viability at 1- to 4-week periods. Antibacterial activity was evaluated using a direct contact test against Enterococcus faecalis. Radiopacity, solubility and flow evaluations were performed according to ISO-6876/2012 specifications. Setting time was assessed following the ANSI/ADA-standard-n.57. The pH level was measured at 3,24,48,72, and 168 hours. Data were statistically analyzed using t-test. The significance level adopted was P<0.05. ResultsAH Plus and Sealer Plus showed cytotoxic effects after 24 hours and 1 week of manipulation and become noncytotoxic after 2 weeks. No differences were observed in the cytotoxicity of both tested sealers (P>0.05). Direct contact results revealed that both freshly prepared sealers has antibacterial effects against Enterococcus faecalis. However, after 7 days both sealers had lost much of their antibacterial effects. Although AH Plus presented higher radiopacity and flow than Sealer Plus (P<0.05), both sealers showed minimum required values. No differences were observed in the solubility of both sealers (P>0.05). AH Plus showed a higher setting time when compared to Sealer Plus (P<0.05). AH Plus and Sealer Plus showed a neutral pH during all tested periods (P<0.05). Conclusions It can be concluded that Sealer Plus showed suitable properties to be used as an endodontic sealer, comparable with those obtained by AH Plus. Key words:Cytotoxicity, root canal filling materials, root canal obturation.

Comparison of the antibacterial activity of calcium silicate- and epoxy resin-based endodontic sealers against Enterococcus faecalis biofilms: a confocal laser-scanning microscopy analysis.

This study assessed the antibacterial activity of BioRoot RCS in comparison with that of the Totalfill BC and AH Plus sealers against Enterococcus faecalis biofilms in dentinal tubules using confocal laser-scanning microscopy. Sixty-six root dentin halves were prepared and sterilized. Three sections were used to ensure sterilization. The remaining were inoculated with E. faecalis. Three specimens were examined to verify the viability of biofilms. The sixty specimens were randomly divided into four groups: AH Plus, BioRoot RCS, Totalfill BC sealer, and no sealer. The specimens were incubated for 1, 7, and 30days. The specimens were stained and four corners of each disc were scanned. Statistical analysis was performed using two-way ANOVA and Tukey's post hoc test. Almost half of the bacteria were dead in BioRoot RCS group on day 1 and in Totalfill BC group on day 7. All sealers killed significantly more bacteria than the control after 30 days (P < .05). On day 7, Totalfill BC showed a significantly higher percentage of dead bacteria than BioRoot RCS (P < .05). On day 30, the BioRoot RCS group registered the highest percentage of dead cells (61.75%), which was significantly higher than the percentages of the AH Plus and Totalfill BC groups (P < .05). Calcium silicate-based root canal sealers exerted antimicrobial effects against E. faecalis biofilms. The antibacterial activity of BioRoot RCS was significantly higher than that of the Totalfill BC and AH Plus sealers after 30 days of exposure.

In vitro evaluation of the cytotoxic activity of three epoxy resin-based endodontic sealers.

The aim of the study was to evaluate the cytotoxicity of three epoxy resin-based endodontic sealer, AH Plus, Sicura Seal and Top Seal. Direct and indirect cytotoxicity were evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay and LIVE/DEAD® Viability/Cytotoxicity Assay on MG63 osteoblasts-like cells. Data were statistically analyzed by analysis of variance and Tukey test, setting a significance level of 5%. Both results related to direct and indirect cell viability tests showed that all groups were significantly more cytotoxic than the negative control group. The cytotoxicity activity after one week of culture showed the absence of direct cytotoxicity, while a medium rate of indirect cytotoxicity. All the three epoxy resin-based sealers (AH Plus, Top Seal and Sicura Seal) showed a medium rate of cytotoxicity on osteoblasts-like cells in vitro. No significant difference was found among the sealers analyzed.

Effect of retreatment on the push-out bond strength of MTA-based and epoxy resin-based endodontic sealers.

Background. Further studies on the adhesion properties of MTA-based materials seem necessary due to their growing use in endodontic treatment. This research aimed to assess the effect of retreatment on the bond strength of MTA-based (MTA Fillapex) and epoxy resin-based (AH Plus) sealers.Methods. ProTaper rotary files were applied to prepare the root canals of 80 human mandibular premolars. Then, the roots were randomly divided intotwo groups of A (n=40) and B (n=40), which were obturated with gutta-percha and MTA Filla-pex and AH Plus sealer, respectively. In both groups, the teeth were randomly subdivided into 2 subgroups. No retreatment was carried out in subgroups A1 and B1, while subgroups A2 and B2 were retreated with rotary files and a solvent. Then, a push-out test was performed on four 2-mm slices of each tooth at a distance of 2 mm from the coronal surface after two weeks of incubation. Data were analyzed with two-way ANOVA and statistical significance was set at P<0.05.Results. Regardless of the procedure followed (P<0.001), significant differences were detected in the mean bond strength values between the two sealers. Irrespective of the sealer type (P=0.3), no significant differences were revealed by comparing the mean bond strength values of the study subgroups. Furthermore, no statistically significant interaction (P=0.5) was found between the treatment and sealer types.Conclusion. AH Plus sealer exhibited a higher bond strength compared to MTA Fillapex. Retreatment using rotary files and chloroform had no statistically significant effect on the bond strength of sealers evaluated in this study.

The effect of different irrigating solutions on the push out bond strength of endodontic sealer to dentin and assessing the fracture modes: An In-vitro study

Aim: To evaluate the effect of smear clear, 7% maleic acid, 10% citric acid, and 17% EDTA on the push-out bond strength of epoxy resin-based endodontic sealer to dentin. Materials and Methodos: Fifty extracted mandibular premolars were collected. After decoronation using a diamond disc and water spray to obtain approximately 14 mm long root segments, canal patency and working length were established by inserting K file #15 (Mani). The root canals were enlarged using Protaper nickel-titanium rotary instruments to size #F3 at the working length irrigating with 3 mL of 2.6% sodium hypochlorite between each file size. The roots were then randomly divided into four groups (n = 10) according to the final irrigation regimen Group1: Saline (control). Group 2: 17% EDTA, Group 3: 7% maleic acid, Group 4: 10% citric acid, Group 5: Smear clear. Obturation was done using gutta-percha with AH Plus sealer. Each root section was then subjected to a compressive load via a universal testing machine, to measure the push out bond strength followed by assessment of fracture pattern under stereomicroscope. Results: The data was collected and submitted to statistical analysis by one-way analysis of variance (ANOVA) test. Group 3: NaOCl/maleic acid/distilled water showed greater bond strength (2.2+/-0.278 MPa) as compared to other groups. Mixed type of bond failure was predominant. Conclusion: Removal of smear layer with maleic acid as a final rinse enhanced the adhesive ability of AH plus sealer, followed by EDTA and smear clear.

Correlation between sealer penetration into dentinal tubules and bond strength of two new calcium silicate-based and an epoxy resin-based, endodontic sealer

The relationship between sealer penetration into dentinal tubules and the bond strength of two new calcium silicate-based and epoxy resin-based endodontic sealers was evaluated. Thirty recently extracted human maxillary incisors were instrumented and divided into three groups according to the sealer used: (1) AH Plus; (2) iRoot SP; and (3) MTA Fillapex. Sealer penetration into dentinal tubules was measured using CLSM. Then, a universal testing machine was used to compare the push-out bond strengths of the sealers to the root canal dentin. AH Plus and MTA Fillapex exhibited significantly higher sealer penetration than iRoot SP did (p > .05). The push-out bond strengths of AH Plus and iRoot SP were higher than that of MTA Fillapex. We concluded that greater penetration of the sealer into the dentinal tubules was not associated with higher bond strength among the three sealers tested.

Bilateral mandibular canines with two roots and two separate canals: case report

The mandibular canine is usually considered a single-rooted tooth with a single root canal. However, two canals and more rarely two roots may also occur. This paper reports the case of a patient with bilateral mandibular canines with two roots and two root canals. The initial periapical radiographs of the mandibular right and left canines for endodontic treatment revealed the presence of two roots in each tooth. After coronal opening, the cervical third was prepared with a SX file of the ProTaper system and root canal length was confirmed using Root ZX electronic apex locator. Root canal preparation was completed with the series of ProTaper instruments and the root canal was filled with gutta-percha and an epoxy resin-based endodontic sealer according to Tagger's hybrid technique. The final radiographs showed two well-obturated canals ending at the electronically located apexes. The 6-month posttreatment follow-up showed apparent clinical and radiographic success. Clinicians should always consider the presence of anatomical variations in the teeth during endodontic treatments. Despite the low prevalence, variations may occur in the number of roots and root canals of mandibular canines, as demonstrated in this case report.