MTA Fillapex Research Articles

ASSESSMENT OF PUSH-OUT BOND STRENGTH AND INTERFACIAL ADAPTATION OF TWO NEW ENDODONTIC SEALERS; ENDOSEQUENCE BC AND MTA FILLAPEX TO ROOT CANAL DENTINE (AN IN VITRO STUDY).

14Mar 2018 ASSESSMENT OF PUSH-OUT BOND STRENGTH AND INTERFACIAL ADAPTATION OF TWO NEW ENDODONTIC SEALERS; ENDOSEQUENCE BC AND MTA FILLAPEX TO ROOT CANAL DENTINE (AN IN VITRO STUDY). Almqayyad Tamer Nafiz , Zakhary Siza Yacoub and Segari Wafaa Ahmed. Master?s Degree in Endodontics, Faculty of Oral and Dental Medicine, Cairo University, Egypt. Professor in Endodontics Department, Faculty of Oral and Dental Medicine, Cairo University, Egypt. Lecturer in Endodontics Department, Faculty of Oral and Dental Medicine, Cairo University, Egypt.

Bond Strength of Experimental Root Canal Sealers Based on MTA and Butyl Ethylene Glycol Disalicylate.

This study investigated the bond strength of two experimental root canal sealers based on MTA and butyl ethylene glycol disalicylate: MTAe and MTAe-HA. The reference materials used for comparison were AH Plus and MTA Fillapex. Twenty human upper incisors were selected and one 1 mm slice was obtained from the cervical third of each root. On the coronal surface of each slice, four 0.9 mm wide holes were drilled through the dentine. Standardized irrigation was performed and holes were filled with one of the four tested sealers: AH Plus, MTA Fillapex, MTAe, and MTAe-HA. The filled slices were stored in a PBS solution (pH 7.2) for 7 days at 37 °C. A push-out assessment was performed with a 0.7 mm plunger tip. Load was applied at a crosshead speed of 0.5 mm/min until sealer displacement. The results were expressed in MPa. The Kruskal-Wallis test was applied to assess the effect of each sealer on the push-out bond strength. Mann-Whitney with Bonferroni correction was used to isolate the differences. The alpha-type error was set at 0.05. Significant differences among medians values obtained by materials were observed (p<0.001). AH Plus displayed the highest value of bond strength (p<0.001). In contrast, MTA Fillapex presented the lowest bond strength among all tested sealers (p<0.001). Experimental sealers showed intermediary bond strength values, with no statistical differences between them (p>0.05). In conclusion, experimental root canal sealers presented suitable bond strength outcomes when compared to MTA Fillapex.

Reduced interleukin-6 immunoexpression and birefringent collagen formation indicate that MTA Plus and MTA Fillapex are biocompatible

Considering that endodontic sealers release some components which may promote delay in the repair process, our purpose was to evaluate the tissue reaction promoted by MTA Plus and MTA Fillapex in comparison with AH Plus (standard control) and Endofill, which has a long clinical track record. One hundred rats were distributed into five groups: MTA Plus (Avalon Biom Inc., Bradenton, FL, USA), MTA Fillapex (Angelus, Londrina, PR, Brazil), AH Plus (Dentsply DeTrey GmbH, Konstanz, Germany), Endofill (Dentsply, Petrópolis, RJ, Brazil) and CG (control group, empty polyethylene tubes). The polyethylene tubes filled with sealers or empty (CG) were implanted into subcutaneous. After 7, 15, 30 and 60 days, the tubes surrounded by capsules were paraffin-embedded. In HE-stained sections, the volume density of inflammatory cells (VvIC) was estimated in the capsules. The number of interleukin-6-immunolabelled cells (IL-6), a pro-inflammatory cytokine, was also computed in the capsules. The birefringent collagen content was quantified in picrosirius-stained sections. Data were analysed by ANOVA and Tukey tests (p ≤ 0.05). At 7 days, the capsules showed moderate inflammatory reaction. In all groups, VvIC and IL-6-immunostained cells reduced significantly from 7 to 60 days. At 60 days, IL-6 immunoexpression was reduced significantly in MTA Plus and MTA Fillapex in comparison with AH Plus; no difference was found in the VvIC among MTA Plus, MTA Fillapex, AH Plus and CG whereas Endofill exhibited the highest VvIC. The reduction in VvIC was parallel to an increase in the collagen in all the groups, except Endofill. MTA Plus, MTA Fillapex and AH Plus induce a response that culminates in the regression of inflammation and formation of a fibrous capsule over time. The lower IL-6 immunoexpression in the capsules of MTA Plus and MTA Fillapex than AH Plus suggests that the immune response is suppressed more rapidly in the MTA-based sealers.

Interfacial Characteristics and Cytocompatibility of Hydraulic Sealer Cements

IntroductionThe stability and long-term success of root canal obturation depends on the choice of sealer because the sealer bonds to the dentin and stabilizes the solid cone. Furthermore, the sealer needs to be nontoxic because sealer toxicity will certainly lead to treatment failure. The aim of this study was to assess the sealer-dentin interface of 3 hydraulic root canal sealers and to evaluate their cytocompatibility compared with AH Plus (Dentsply DeTrey GmbH, Konstanz, Germany). MethodsFour dental root canal sealers were assessed. AH Plus, MTA Fillapex (Angelus, Londrina, Brazil), BioRoot RCS (Septodont, Saint-Maur-des-Fossés, France), and Endoseal (Maruchi, Wonju-si, Gangwon-do, South Korea) were characterized using scanning electron microscopy and energy-dispersive spectroscopy. The sealer-tooth interface was assessed by confocal microscopy and scanning electron microscopy, and biocompatibility was measured by assessing the cell metabolic function using direct contact assays and alkaline phosphatase activity. ResultsThe tricalcium silicate–based sealers presented a different microstructure and elemental composition despite their similar chemistry and classification. BioRoot RCS was free of aluminum, and all sealers presented different radiopacifying elements. The sealer penetration in the dentinal tubules and interfacial characteristics were different. The migration of silicon was evident from sealer to tooth for all sealers containing tricalcium silicate. MTA Fillapex and BioRoot RCS exhibited the best cytocompatibility in both the direct contact test and alkaline phosphatase activity. ConclusionsThe use of hydraulic calcium silicate–based sealers has introduced a different material type to endodontics. These materials are different than other sealers mostly because of their hydraulic nature and their interaction with the environment. Although the sealers tested had a similar chemistry, their cytocompatibility and bonding mechanisms were diverse.

Porosity analysis of mineral trioxide aggregate Fillapex and BioRoot cements for use in endodontics using microcomputed tomography.

Aim:The purpose of this study is to compare the porosity of two sealant cements, mineral trioxide aggregate (MTA) Fillapex® and BioRoot® root canal sealer (RCS). These samples were analyzed using microcomputed tomography.Materials and Methods:Sixteen samples were used in the study that were divided according to the composition of the materials used. MTA Fillapex® (n = 8) and BioRoot® RCS (n = 8) were the samples prepared according to the manufacturer's instructions. They were placed in silicone molds of 5 ± 0.1 mm in height and an internal diameter of 5 ± 0.1 mm; 24 h after its preparation, the samples were scanned through a microcomputed tomography, and the porosity results were analyzed statistically by independent t-tests.Results:It is evident that MTA Fillapex® has better porosity properties than BioRoot® RCS. The results of the study quantify a smaller number of pores per surface, a smaller volume in each pore per mm3, and a lower total porosity present in samples of MTA Fillapex® unlike BioRoot® RCS samples which is larger in both.Conclusions:The results obtained in computerized microtomography endodontic biomaterial samples concluded that MTA Fillapex® has a lower porosity than BioRoot® RCS.

Comparative Evaluation of Cytotoxicity of Root Canal Sealers on Cultured Human Periodontal Fibroblasts:In vitroStudy

To evaluate and compare the cytotoxic effects of different types of root canal. The sealers were eluted with culture medium for 1 hour, 7 days, and 14 days. Cell viability was estimated by 3-(4,5-dimethyl-thiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTT) assay and trypan blue exclusion method on human periodontal ligament (PDL) fibroblast cells. Sealers used are mineral trioxide aggregate (MTA)-based sealer (MTA Fillapex, Angelus), calcium hydroxide-based sealer (Apexit Plus, Ivoclar Vivadent), resin-based sealer (AH Plus, Dentsply), and zinc oxide eugenol-based sealer (Tubli Seal, SybronEndo). The order of cytotoxicity through MTT assay, at the end of the second week, was observed as MTA Fillapex> Tubli Seal> Apexit Plus > AH Plus. The percentage cell viability obtained after trypan blue exclusion method decreased in the order of Apexit Plus> Tubli Seal> AH Plus> MTA Fillapex, which was similar to the reported cytotoxicity from the MTT assay after 1 hour. Each type of sealer showed moderate-to-severe cytotoxic response when compared with the control. The MTA Fillapex was found to be the most cytotoxic sealer. Use of resin-based material as a root canal sealer may result in a more favorable response to PDL fibroblasts. Having knowledge of the cytotoxicity of various sealers will help in increasing patient's comfort.

Prevention of coronal discoloration induced by root canal sealer remnants using Dentin Bonding agent: An in vitro study.

Introduction:Among the various causes of tooth discoloration after root canal treatment, percolation of sealer remnants into the dentinal tubules of the pulp chamber is the most common cause.Objectives:The aim of this study is to evaluate the efficacy of dentin bonding agent (DBA) in preventing coronal discoloration caused by four different root canal sealers- MTA Fillapex, Sealapex, Zical and Z. O. B seal at different time intervals by measuring chromatic alterations using digital images analysis method.Methodology:Ninety mandibular premolars were collected and sectioned at 1 mm below the cementoenamel junction. Standard access cavity preparations of dimensions (depth-3 mm, width-0.8 mm, and length-3 mm) were prepared with a No. 245 bur through the cervical access. Following the standard irrigation protocol, specimens were then randomly divided into nine groups (four groups without DBA [1–4] +4 groups with DBA [5–8] +1 negative control [9]). In Groups 1–4, four different root canal sealers (MTA Fillapex, Sealapex, Zical, and Z.O.B seal) were applied to the walls of the pulp chamber. For Groups 5–8, the samples were etched with 37% phosphoric acid and DBA application was done before the respective root canal sealer application. The cervical access in all specimens was sealed using glass ionomer cement. Digital photographs were taken under standard lighting and environmental conditions at different time intervals: preprocedural, postprocedural, and after 1, 2, 3, and 4 months. These images were analyzed using Adobe Photoshop CS6 from which laboratory values and subsequently Delta E values were obtained.Results:Statistical analysis performed using repeated measures ANOVA and post hoc Tukey's tests show that the groups with DBA application had significantly lower mean Delta E values (P < 0.05) compared to the groups without DBA application.Conclusion:DBAs applied to the dentinal walls of the pulp chamber before obturation can effectively reduce the sealer-induced coronal discoloration.

Antimicrobial Efficacy of Different Endodontic Sealers against Enterococcus faecalis: An In vitro Study.

ObjectiveThe aim of this in vitro study is to compare the antimicrobial efficacy of four different endodontic sealers against Enterococcus faecalis.Material and Method:Four different endodontic sealers, namely, resin based (AH Plus), zinc oxide-eugenol based (Tubliseal), calcium hydroxide based (Sealapex), and mineral trioxide aggregate (MTA Fillapex) based were tested for their antimicrobial efficacy against E. faecalis using agar diffusion method. Four wells were made by the removal of agar at equidistant points and filled with freshly mixed respective root canal sealers and were inoculated with E. faecalis. All the three plates were incubated for a period of 72 h at 37°C under aerobic conditions. The diameter of inhibition zones was measured at 24, 48, and 72 h time intervals. Data obtained were statistically analyzed using one-way analysis of variance and unpaired t-test.Results:All the tested sealers showed some bacterial growth inhibition of E. faecalis. Their efficacy in descending order of antibacterial activity was as follows: Sealapex > AH Plus > Tubliseal > MTA Fillapex. The efficacy of the root canal sealers decreased marginally with increase in their duration of action.Conclusion:Antimicrobial efficacy of calcium hydroxide-based sealer was highest followed by resin-based sealer and was the least with MTA based sealer.

Comparative Study of the Effect on Apical Sealability with Different Levels of Remaining Gutta-Percha in Teeth Prepared to Receive Posts: An in vitro Study.

Objective:The objective of this study is to compare the apical sealability of mineral trioxide aggregate (MTA) Fillapex and Endosequence BC sealer at three different lengths of remaining gutta-percha after postspace preparation.Materials and Methods:A total of 80 freshly extracted human maxillary anterior teeth were decoronated, biomechanically prepared, and randomly divided into four groups; Group A and Group B served as positive and negative control with 10 teeth each. The teeth in Group C and Group D (with 30 teeth each) were obturated with gutta-percha using MTA Fillapex sealer and Endosequence BC sealer, respectively. Teeth in Group C and Group D were further subdivided into three subgroups depending on the length of remaining apical gutta-percha, i.e., 3, 4, and 5 mm after postspace preparation. Apical leakage was assessed using dye penetration method under stereomicroscope.Results:In both the Groups C and D, there was overall no statistically significant difference in leakage; however, Group C showed slightly more leakage than Group D. There was a statistically significant difference in leakage at 3 mm and 5 mm level in both groups.Conclusion:Although less microleakage occurred, the bioceramic sealers could not totally eliminate leakage.

Cement AH Plus Adhesiveness Assessment Associated with Mineral Trioxide Aggregate in Different Proportions (Push-out Test)

The aim of the study is to evaluate the adhesiveness of the AH Plus plug cement, plus the mineral trioxide aggregate (MTA) in different proportions, through the push-out test. The authors utilized fifty premolars with a single conduit, which were divided into five groups with 10 teeth. In group 1, the authors performed an obturation with AH Plus cement, group 2 was filled with AH Plus cement with 10% of MTA, group 3 was filled with AH Plus cement plus 20% MTA, group 4 was filled with AH Plus with 30% of MTA and group 5 filling was performed with the MTA Fillapex endodontic cement. The specimens were sectioned in 2 mm slices and submitted to the push-out test in a universal testing machine. The authors cataloged the data and follow through with statistical analysis based on T-test for independent samples, with a significance level of 5%. There was no statistical difference in group 2. Groups 3 and 4 presented better adhesion than AH Plus cement and MTA Fillapex. There was no statistical difference between the AH Plus cement and the MTA Fillapex. The authors concluded that the addition of MTA in the proportion of 10% to the AH Plus does not alter its adhesive property. They also observed that when the MTA increased by 20% and 30% there was an increase in the adhesiveness of the material when submitted to the push-out test. The relevance of this study refers to the MTA inducing the deposition of mineralized tissue. However, it is necessary to compare it to the AH Plus cement considered "Gold Standard" in physical-chemical properties tests.

Apical dye leakage of two single-cone root canal core materials (hydrophilic core material and gutta-percha) sealed by different types of endodontic sealers: An in vitro study.

Aim of the Study:The aim of this study was to compare the apical sealing ability of two single-cone filling materials when sealed with different types of root canal sealers.Materials and Methods:Eighty extracted maxillary and mandibular canines were selected and their crowns were cut. The root canals were prepared using ProTaper Universal rotary system until size F4 and then divided into seven experimental groups (n = 10 each) and two control groups (n = 5 each). Samples of Groups 1, 2, and 3 were filled with single-cone gutta-percha and AH Plus, MTA Fillapex, and EndoSequence BC, respectively. Samples of Groups 4, 5, and 6 were filled similar to the previous groups with the exception of using a single-cone CPoint. Samples of Group 7 were filled with cold gutta-percha lateral condensation technique. To assess apical microleakage, the apical linear dye penetration was measured microscopically and data were statistically analyzed.Results:All experimental groups showed significantly different dye apical leakage values (P = 0.000). No significant differences were found between Groups 1, 2, 4, 6, and 7 (P < 0.05). The lowest mean leakage value was observed in Group 6 (0.95 ± 0.56 mm) while Groups 3 (2.68 ± 0.71 mm) and 5 (2.61 ± 0.71 mm) showed significantly higher mean leakage values.Conclusions:The lowest apical leakage value was observed with single-cone CPoint/EndoSequence BC but without significant differences when compared with single-cone gutta-percha/AH Plus, single-cone gutta-percha/MTA Fillapex, single-cone CPoint/AH Plus, and lateral condensation technique. Higher apical leakage values were observed with single-cone gutta-percha/EndoSequence BC and CPoint/MTA Fillapex.

Biological and physico-chemical properties of new root canal sealers.

BackgroundThe purpose of the present study was to compare the biological and the physico-chemical properties of bioceramic-based root canal sealers, calcium hydroxide-based, MTA-based and epoxy resin-based root canal sealers.Material and MethodsTwo bioceramic-based sealers, one calcium hydroxide-based sealer, one MTA-based sealer and two epoxy resin-based sealers were tested.ResultsEasySeal and MTA Fillapex showed severe citotoxic activity, AH Plus and SealapexTM moderate cytotoxicity, BioRoot™ RCS and TotalFill BC Sealer were both cytocompatible. Except for TotalFill BC Sealer, all root canal sealers caused inhibition zones when tested with E. faecalis. The highest inhibition zone was observed for EasySeal, followed by AH Plus. BioRoot™ RCS, SealapexTM and MTA Fillapex showed the lowest inhibition zone. All the tested materials showed different degree of antibacterial activity by using direct contact test (DCT). The highest values were observed for BioRoot™ RCS, TotalFill BC Sealer and EasySeal, followed by MTA Fillapex and SealapexTM. Except for BioRoot RCS and TotalFill BC Sealer, all the root canal sealers fulfilled the requirements of the ISO 6876 standard, demonstrating a weight loss less than 3%. Bioroot RCS, TotalFill BC Sealer and SealapexTM exhibited high alkaline pH with an increase both for BioRoot™ RCS and TotalFill BC Sealer after 24 hours.ConclusionsThe new bioceramic-based sealers showed acceptable physico-chemical properties, but BioRoot™ RCS and TotalFill BC Sealer seems to be too soluble, not respecting ISO 6876 requirements. Key words:Antibacterial activity, cytoxicity, pH, root canal sealers, solubility.

Wettability of endodontic sealers on the root surface using different irrigants

Objetivo: o presente estudo teve como objetivo avaliar a molhabilidade de diferentes cimentos em contato com a dentina tratada com irrigantes utilizados na remoção da smear layer, após o uso da clorexidina como substância auxiliar química. Material e Métodos: trinta dentes unirradiculares foram utilizados. As coroas foram removidas e as raízes seccionadas verticalmente, resultando em dois segmentos, que foram então achatados. Assim, foram obtidas 120 amostras medindo 5 mm. Eles foram imersos em gel de clorexidina 2% (CHX) por 10 minutos e lavados com água destilada (AD) antes de serem submetidos ao irrigante final para remoção da smear layer. Os seguintes protocolos de irrigação foram avaliados: grupo controle - CHX + AD + AD + AD; grupo E-CHX + AD + 17% EDTA + AD; grupo Q-CHX + AD + QMix + AD; grupo Et-CHX + DA + 18% HEBP + DA. As amostras foram secas e o ângulo de contato foi analisado por meio de um goniômetro. Os selantes avaliados foram: AH Plus (AH), Pulp Canal Sealer EWT (PCS) e MTA Fillapex (MTAF). Em cada gota de cimento, 60 medidas foram feitas e o fluxo foi observado por 1 minuto. A molhabilidade dinâmica dos selantes foi calculada. Os dados foram analisados ??estatisticamente. Resultados: em todos os cimentos, a presença de smear layer desfavoreceu a molhabilidade. EDTA e QMix favoreceram a molhabilidade de AH e PCS. Para o MTAF, o QMix apresentou o melhor desempenho, seguido pelo EDTA. A HEBP apresentou resultados estatisticamente inferiores, semelhantes ao controle. Conclusão: As soluções utilizadas para remoção da smear layer, após o uso de clorexidina durante o preparo, influenciaram a umectabilidade dos selantes AH Plus, Pulp Canal Sealer EWT e MTA Fillapex.

The Influence of Humidity on Intra-tubular Penetration and Bond Strength of AH Plus and MTA Fillapex: An In Vitro Study.

Objective:The aim of this study was to evaluate the influence of humidity on the intra-tubular penetration, bond strength and failure mode associated with AH Plus (AH) and MTA Fillapex (MTAF) sealers.Methods:For this analysis, an apparatus was created to maintain the humidity of the specimens. Sixty bovine single-rooted teeth with similar anatomy were used. The teeth were randomly divided into 4 groups (n=15): G1 - AH/moist, G2 - AH/dry, G3 - MTAF/moist and G4 - MTAF/dry. A laser scanning confocal microscope was used to analyse the penetrability of the sealers into the dentinal tubules. A push-out test was performed to examine the diameter and height of the root canal fillings. The failure mode was analysed under a stereomicroscope at 40× magnification. The data were submitted to non-parametric Kruskal-Wallis and Dunn’s tests. The significance level was P<0.05.Results:The MTAF sealer exhibited higher intra-tubular penetration values compared to AH Plus (P<0.05) sealer. AH Plus showed the highest bond strength values. Regarding the type of failure mode, a majority of cohesive failures was identified, irrespective of the moisture conditions, which were not statistically significant among the sealers (P<0.05).Conclusion:Humidity conditions did not influence the intra-tubular penetration, bond strength and failure mode of AH Plus and MTAF sealers.

Comparative Evaluation of Radicular Push-out Bond Strength of EndoSequence BC, MTA FillApex, Apexit Plus and AH Plus Sealers as Affected by the Modified Plunger: Base Orifice Size Relation

Comparative Evaluation of Radicular Push-out Bond Strength of EndoSequence BC, MTA FillApex, Apexit Plus and AH Plus Sealers as Affected by the Modified Plunger: Base Orifice Size Relation

Effect of root canal sealers on human periodontal ligament fibroblast viability: ex vivo study

The aim of the study was to compare ex vivo the toxic effects of six root canal sealers immediately after mixing or setting on human periodontal ligament fibroblasts (HPdLF). Freshly mixed (I group) or set (allowed to dry for 24 h) (II group) specimens of AH Plus Jet (AH), Apexit Plus (AP), MTA Fillapex (FL), GuttaFlow (GF), MetaSEAL Soft (META), and Tubli-Seal (TS) were prepared. HPdLF were exposed for 24 h to the specimens. 3-(4,5-dimethylthiazolo-2-yl)-2,5-diphenyltetrazolium bromide assay was used to examine the effect of the root canal sealers on mitochondrial metabolic activity. Fluorescein isothiocyanate (FITC)-annexin V (AnV) and propidium iodide staining followed by flow cytometry was used to identify the effects of the materials on cell apoptosis/necrosis. Statistical analyses were performed by one-way ANOVA followed by post hoc tests, and significance was determined at P < 0.05. Most materials from the two groups reduced the viability of the cultured cells compared with the control group (P < 0.05). Statistical analysis showed significant differences in HPdLF viability between the individual materials in each group (P < 0.001). AH and AP induced a significant increase in the percentage of apoptotic cells, while TS, FL, and META elevated the proportion of necrotic cells compared with other materials and the controls (p < 0.05). The cytotoxic effects of the tested root canal sealers (both fresh and set) on HPdLF varied. Both forms of sealers were able to cause toxic effects by inducing apoptosis and necrosis in HPdLF. The cytotoxicity of FL, META, TS was mainly associated with necrosis, while AH and AP with apoptosis.

Influence of environment on testing of hydraulic sealers

In vitro material testing is undertaken by conducting a series of tests following procedures outlined in international standards. All material properties are measured in water; however biological behavior is undertaken in alternative media such as Dulbecco’s modified eagle medium (DMEM) or simulated body fluid. The aim of this study was to characterize four dental root canal sealers and study their properties in different media. Four dental root canal sealers were assessed. They were characterized by a combination of techniques and the sealer properties were tested as specified by ISO 6876 (2012) and also in alternative media. The sealer biocompatibility was measured by cell function and proliferation assays of elutions. All sealers complied with ISO specifications. The material properties were effected by the type of soaking medium used and the surface micromorphology and elemental composition were dependent on the soaking solution type. Both BioRoot and MTA Fillapex showed cytotoxicity which reduced at higher dilutions. The material chemistry, presentation, environmental conditions and testing methodology used affected the sealer properties. Standards specific to sealer type are thus indicated. Furthermore the methodology used in the standard testing should be more relevant to clinical situations.

Wear profile of canal wall surfaces and bond strength of endodontic sealers after insitu acid challenge.

To evaluate the wear of root wall surfaces, the bond strength of sealers to dentine and the demineralization around root filling materials after canals were exposed to acid challenge in situ. Eighty-seven roots of mandibular incisors were selected. Thirty-two were used in the laboratory bond strength study (n=8), and 55 in the insitu study (n=11). Root canals were prepared biomechanically and then filled with gutta-percha and AH Plus, MTA Fillapex, Sealapex or Endofill. For 14days, 11 participants used intra-oral devices with five sterilized roots (four experimental and one control - only canal prepared). Drops of sucrose were dripped onto roots allowing the accumulation of biofilm on canal surfaces. Roots were removed, sectioned and analysed for the following: bond strength of filling material using a push-out test and also wear profile and dentine demineralization using confocal microscopy. Bond strength (MPa) was evaluated by two-way anova and Tukey test (α=0.05), and wear profile was assessed by Kruskal-Wallis and t-tests (α=0.05). AH Plus had the highest bond strength values. Intermediate results were found in roots with MTA Fillapex and Endofill, whilst Sealapex had inferior results (P<0.05). No significant differences were found amongst root thirds (P>0.05). For wear profile, samples were associated with degradation of the filling materials after exposure to the oral environment (P<0.05). Roots had signs of demineralization around the filling material when Sealapex and Endofill were used. Sealers were not able to prevent degradation of the adhesive interface and dentine. AH Plus and MTA Fillapex had superior bond strength to dentine and less intense demineralization around the root filling.

Sealer penetration and adaptation in root canals with the butterfly effect.

The butterfly effect is a phenomenon seen in some roots and is related to density of dentinal tubules. The aim was to investigate penetration depth and adaptation quality of root canal sealers and ProRoot MTA into bucco-lingual and mesio-distal aspects of roots with and without the effect. One hundred and twenty teeth were decoronated at the cemento-enamel junction. Canals were prepared and assigned to obturation groups: gutta-percha with a sealer (AH Plus, EndoREZ, Kerr Pulp Canal Sealer, MTA Fillapex) or ProRoot MTA alone (each containing 10 butterfly and 10 non-butterfly roots). Root sectioning yielded coronal and middle samples. Confocal laser scanning and scanning electron microscopy were used to assess penetration and adaptation. Teeth with the effect had greater mean penetration bucco-lingually (766μm) than mesio-distally (184μm, P=0.003). Coronal sections had greater penetration (430μm) compared with middle (247μm, P=0.006). In conclusion, greater penetration in roots with the effect may improve treatment outcomes.

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications.

Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.