Root Canal Cements Research Articles

Epoxy resin-based root canal sealers: An integrative literature review.

The correct obturation of the root canal system achieved by means of a core and a cement is essential for the success of endodontic treatment. There are several root canal cements (RCCs) on the market; however, because of their excellent characteristics, epoxy resin-based sealers (ERBSs) have been widely used. The main aim of this review was to analyze and integrate the available information on different ERBSs. An electronic search was performed in the PubMed and Scopus databases, using "epoxy resin" AND "root canal treatment", and "epoxy resin" AND "endodontics" as search terms. In general, ERBSs have good flow properties, film thickness, solubility, dimensional stability, sealing capacity, and radiopacity. They are also able to adhere to dentin while exhibiting low toxicity and some antibacterial effects. However, their main disadvantage is the lack of bioactivity and biomineralization capability. A large number of ERBSs are available on the market, and AH Plus keeps being the gold standard RCC. Yet, information on many of them is limited or non-existent, which could be due to the fact that some of them are relatively new. The latter emphasizes the need for relevant research on the physicochemical and biological properties of some ERBSs, with the aim of supporting their clinical use with sufficient evidence via prospective and long-term studies.

The flow behavior and sealing ability of calcium silicate root canal cement containing dimethyl sulfoxide: An in vitro study

IntroductionTo develop a calcium silicate (CaSi)-based cement containing dimethyl sulfoxide (DMSO) and cement deliver device for new root canal filling technique, and to assess the flow behavior, leakage, and root canal filling quality of CaSi containing DMSO. MethodsCaSi containing DMSO (CSC-DMSO) and CaSi containing PEG (CSC-PEG) were prepared, and the flow characteristics of both cements were compared in gypsum and resin channels using a high-speed camera. Eight root canals were obturated by CSC-DMSO or CSC-PEG using a cement delivery device, and root canal filling quality was assessed in terms of filling length using periapical radiographs. The filling length was evaluated by ‘apico-coronal extension,’ measuring length in reference to apical constriction. Microleakage was measured for thirty human molars that were randomly filled with CSC-DMSO, CSC-PEG, or gutta-percha and AH plus. Preliminary obturation of CSC-DMSO with cement delivery device in human teeth was analyzed in terms of filling length and void, using periapical radiographs. Statistical analysis was performed with the Kruskal Wallis test for simulated root canal fillings and one-way ANOVA for leakage test. ResultsThe flow speed of CSC-DMSO reduced in gypsum channels compared to resin channels, but CSC-PEG did not exhibit significant differences in the channels. The median absolute value of apico-coronal extension was significantly lower in CSC-DMSO compared to CSC-PEG (p < 0.05). Microleakage did not statistically differ between the groups (p > 0.05). In the preliminary obturation, the mean apico-coronal extension of CSC-DMSO was −0.297 ± 0.724 mm, while CSC-PEG was not feasible due to excess apical extrusions. ConclusionsCSC-DMSO could be considered as an alternative filling material for root canal obturation.

Antifungal Effectiveness between Tricalcium Silicate-White Portland Cements Added Bi2O3 and Mineral Trioxide Aggregate Against Candida albicans

Background Candida albicans is the most dominant fungus found in root canal reinfection cases. This microorganism can withstand extreme pH, low oxygen levels, lack of nutrients, and penetrate the dentinal tubules so that it can resist the intracanal medicament. Root canal cement helps prevent microorganisms and causing root canal reinfection. MTA is one of the root canals cement which is widely used and has an excellent antifungal activity, but it is less beneficial economically. Tricalcium silicate-white Portland cement (WPC) has a similar main composition as MTA, except there is no Bi2O3 content that functions as a radiopacifier. Objectives: To fabricate a mixture of tricalcium silicate-WPC with Bi2O3 through a simple solution method and investigate antifungal activity's effectiveness between tricalcium silicate-WPC added Bi2O3 and MTA to C. albicans. Materials and Methods: The 80 g of tricalcium silicate-WPC was mixed with 20 g of Bi2O3 through the simple solution method using 99.9% isopropanol as a solution. This sample solution is stirred until homogeneous, then centrifuged. The precipitate was dried until a dry powder was obtained. The powder was analyzed using X-Ray fluorescence spectrometry to identify its chemical composition and concentration. A total of 30 samples were divided into two experimental groups of tricalcium silicate-WPC added Bi2O3 and ProRoot MTA. The vials, which contain cement and C. albicans, respectively, were incubated at 37°C for 24 hours and diluted to obtain a suspension 104, 106 (0.5 in McFarland’s nephelometer) and then inoculated with sterile cotton swabs onto Saboroud Dextrose Agar Plates. The plates were incubated at 37°C for 24 hours. The measurement of colony number of C. albicans was counted by colony counter (CFU/ml). Results: The Bi2O3 was revealed in tricalcium silicate-WPC based on XRF characterization, and the antifungal test showed that both materials were effective against C. albicans. There was no statistically significant difference in the number of C. albicans colonies between tricalcium-WPC added Bi2O3 and MTA (p&gt;0.05). Conclusion: The mixture of Bi2O3 in tricalcium silicate-WPC was successfully fabricated through a simple solution method, and both samples were effective against the C. albicans.

Development of a Basic Root canal Treatment (BRT) for primary oral health care — evaluation after one year

Atraumatic Restorative Treatment (ART) was a major step forward in community dentistry but treatment options for deep carious lesions or pulp involvement still focus on tooth extraction in under-served areas worldwide. To bridge the gap between ART and extraction this pilot study aimed to develop and follow-up a basic root canal treatment for rural dental health facilities in the Republic of The Gambia (West Africa), faced with an environment lacking technical equipment and developing primary oral health care. 25 single rooted teeth with acute irreversible pulpitis were root canal treated with a standardised endodontic instrument kit and a specific procedure. A step-back technique was used with intermittent chlorhexidine 0.2% and saline irrigation. Root canal obturation was performed using a single-cone technique with gutta-percha using Grossman's root canal cement. Coronal filling was carried out by using ART. Clinical examinations were documented before treatment, one day, five days, six months and twelve months postoperatively. None of the root canal fillings had to be revised due to postoperative complications. In 9 out of 25 teeth, transitory apical pain disappeared after a few days. After six months, all ART fillings appeared clinically acceptable, two fillings had to be corrected. Four class II restorations and three class IV restorations needed replacement after 12 months. Patients' assessment of health related quality of life improved significantly, especially concerning dental pain, chewing ability and fitness for work. Preliminary clinical follow-ups showed encouraging results for the basic root canal treatment approach. Longitudinal clinical studies with greater populations are required to substantiate these results. Modifications in the coronal filling technique are preferable to improve the clinical performance of extended ART cavity restorations.

In vitro study of the periapical sealing ability of three root canal sealing cement

Objective: The objective of this study was to determine the sealing ability of different root canal cement: resin AH Plus®, calcium hydroxide Sealapex®, and eugenol zinc oxide Pulp Canal Sealer® by measuring the apical penetration of a dye. Methods: One hundred straight single-canal teeth were biomechanically prepared to 0.5 mm of the apical foramen. The teeth were divided into four groups, three experimental groups, with thirty teeth in each group, and a control group, with ten teeth. The following sealants were selected: AH Plus®, Sealapex®, and Pulp Canal Sealer®. The root canal was not sealed in the control group. Lateral condensation was performed on the experimental groups using gutta-percha. The teeth were immersed in Indian ink to determine leakage. Results: In the experimental groups, ink penetration was observed in about 50% of the teeth. The lowest mean penetration was observed in the AH Plus® group (30.9 (±42.9)), and the highest was observed in Pulp Canal Sealer® (94.35 [±79.9]), (P

2 リン酸4カルシウム系ルートキャナルセメントの生体親和性 (第416回 大阪歯科学会例会)

2 リン酸4カルシウム系ルートキャナルセメントの生体親和性 (第416回 大阪歯科学会例会)

Adaptability of different canal sealers to the root canal dentin - scanning electron microscopy analysis

Introduction. The aim of this in vitro study was to test and analyze the sealing ability of three endodontic materials used for permanent obturation, in between the dentin walls and the gutta-percha points, using a scanning electron microscope. Material and Methods. Forty-five recently extracted single-root teeth, treated by a step-back technique, were divided into three groups (15 teeth in each); the canals were filled with three different permanent obturation materi?als: N2 - zinc oxide root canal cement, Gutta Flow (Coltene), and Endomethasone N (Septodont). Their sealing ability and adhesive properties were analyzed using field emission gun scanning electron microscope, at the time when they were applied between the dentin walls of the canal and the gutta-percha. Results. The results of the scanning electron microscope analysis have shown that all the three sealers have good adhesion properties when used over the root canal walls in the apical third. Good adaptation of the filling used for the root canal walls in the middle and the cervical third was found only in teeth obturated using Gutta Flow, while samples obturated by N2 - zinc oxide root canal cement and Endomethasone showed the weak?est adhesion, and greatest number of cracks between the sealer and the canal wall. Conclusion. When using a single-cone obturation technique, compared to other obturation materials, Gutta Flow shows considerably better adaptation to the root canal wall and the gutta-percha points in the apical, middle, and the cervical third of the root.

Effect of particle sizes in India ink on its use in evaluation of apical seal.

We investigated the use of India ink as an indicator of root canal sealing ability. Sealing ability is one of the most important factors required of root canal cements. Various dyes have been used for this purpose. Methylene blue, radioisotopes and India ink have all been tried. However, there is no evidence that India ink is suitable as an indicator. We measured the particle size distribution of India ink to determine how this factor affects test results. In addition, we observed the surface texture of an experimentally developed calcium phosphate sealer and a commercially available root canal sealer using SEM. We found that a portion of the India ink particles were smaller than cracks on the two sealer surfaces, indicating, that India ink could pass through these cracks. We concluded that India ink is suitable as an indicator of root canal seal.

Perawatan endodontik konvensional pada gigi molar pertama kanan rahang bawah dengan kista radikuler Conventional endodontic treatment in lower right first molar with radicular cyst

Abnormalities of the teeth that have had periapical endodontic treatment generally due to recurrent infections of root canal. Infection of the root canal is caused by leakage due to poor quality of coronal restoration and iatrogenicfactors. Root canal treatment of the tooth with periapical cyst generally do conventionally. Medication materialsused for healing of periapical lesions is calcium hydroxide, since it has properties not irritating, alkaline pH andantibacterial capabilities, so it is a biological stimulator for the formation of hard tissue in the area of damage andis expected to accelerate the healing process. It was reported the case of a 23-year-old student came to the Dentalclinic of Conservation Specialist RSGM Sekeloa with complaints lower right back teeth has restored with amalgam,no pain, but less comfortable when chewing. The results obtained after treatment with calcium hydroxide andmedikamen gutta percha filling with resin-based root canal cement. Approximately 4 months later, the periapicalradiolucent area had thinned. So it was concluded that conventional endodontic treatment proved to heal periapicallesions including cysts, as long as the treatment is taken adequately.

The Influence of Root Canal Sealer on Extended Intracanal Survival of Enterococcus faecalis With and Without Gelatinase Production Ability in Obturated Root Canals

Enterococcus faecalis can survive for extended periods in obturated root canals. In this study, the hypotheses tested were that long-term survival of E. faecalis is dependent on (1) the type of endodontic sealer and (2) the capacity for microbial gelatinase activity, a potential "virulence" trait identified previously in clinical isolates. Root canals of extracted human canines (n=95) were inoculated with either E. faecalis OG1RF or its gelatinase-negative mutant E. faecalis TX5128. After 48 hours of incubation at 37 degrees C, canals were obturated with gutta-percha and either the epoxy-resin-based AH-Plus (Dentsply, De Trey, Konstanz, Germany), the silicone-based RoekoSeal (Coltène/Whaledent, Langenau, Germany), or zinc oxide eugenol-based Roth's sealer (Root Canal Cement Type 801; Roth International Ltd, Chicago, IL). Access cavities were sealed. After 8 months of incubation at 37 degrees C, viable E. faecalis was recovered from more teeth sealed with RoekoSeal (95%) compared with AH-Plus (40%) (p=0.0004, Fisher's exact test) and Roth's sealer (45%) (p=0.0012, Fisher's exact test). In the RoekoSeal groups, viable counts of E. faecalis OG1RF were higher than E. faecalis TX5128 (p=0.03, Mann-Whitney U test) suggesting that gelatinase activity plays a role in long-term survival of E. faecalis in obturated root canals.

Aspergillus mycetoma of the Maxillary Sinus Secondary to Overfilling of a Root Canal

In nonimmunocompromised patients aspergillosis of the paranasal sinuses is a relatively rare disease. Root canal treated teeth with overextension of the root canal sealer or solid materials such as gutta-percha or silver cones into the sinus might be the main etiological factor for aspergillosis of the maxillary sinus in healthy patients. Root-filling materials based zinc oxide-eugenol is considered to be a growth factor for aspergillus. Aspergillus fumigatus needs heavy metals such as zinc oxide for proliferation and metabolism. Prognostic and histological studies showed that instrumentation and obturation should not extend beyond the apical foramen. When the sealer and/or gutta-percha is extruded within the sinus, this produce an inflammatory reaction and then Aspergillus growth. We report one case of healthy 60-yr-old male with overextension of root canal sealer in maxillary sinus. After surgical procedure, microscopic examination revealed aspergillosis. Overextension into the maxillary sinus with root canal cements has to be avoided.

The Effect of Chlorhexidine Gluconate as an Endodontic Irrigant on the Apical Seal: Long-term Results

The purpose of this study was to determine whether chlorhexidine gluconate (0.12%), used as an endodontic irrigating solution, would affect the apical seal of three root canal cements. One hundred, extracted, human, single-canal teeth were divided into 9 experimental groups of 10 teeth each, in addition to a positive and negative control group of 5 teeth each. The teeth were decoronated at the level of the CEJ, accessed, instrumented to a Master apical file #50, irrigated with either sterile saline, 5.25% NaOCl, or 0.12% chlorhexidine gluconate, and dried using paper points. Obturation was accomplished using lateral condensation and one of three endodontic sealers: Roth's 811, AH 26, or Sealapex. Postobturation apical leakage was measured at 270- and 360-day observation periods using the fluid filtration method. Using the mixed-model repeated-measures ANOVA test with Tukey's honest significance difference multiple comparison procedure, the results showed the saline-Sealapex combination had significantly more leakage (p < 0.05) than either the Peridex-Sealapex or saline-Roth's combinations at 270 days. No other significant differences were noted between any sealer-irrigant combination at 270 days. The saline-Sealapex combination had significantly more leakage than the saline-Roth's combination at 360 days. No other significant differences were noted at 360 days. Under the conditions of this study, chlorhexidine gluconate irrigant did not adversely affect the apical seal of three root canal cements at 270 and 360 days.

Comparison of canal shaping methods with GT™ rotary file and condensation methods

The purpose of this study was to compare the shaping time of two shaping methods and the leakage of three different obturation techniques. Ninty three canaled human molar teeth were used, which were randomly divided into two groups of forty teeth each and ten control teeth. After working length determination, the one group was prepared crown-down technique using rotary root canal instruments of GT rotary files .12/20, .10/20, .08/20 and .06/20 taper(Maillefer Instrument SA. Switzerland). The other group was instrumented with Gates Glidden burs(#1, #2, and #3) to coronal preparation and GT rotary files .08/20 and .06/30 taper to apical preparation. Shaping time was measured. After root canals were instrumented, they were divided to three subgroups and obturated as follows : Subgroup 1, obturated with single cone method Subgroup 2, obturated with lateral condensation : Subgroup 3, obturated with continuous wave technique. Three subgroups were obturated using non-standardized gutta-percha cone(Diadent, Korea, .06 or .08 taper) and AH-26(Dentsply DeTrey, Germany) as a root canal cement. Ten unobturated teeth served as positive and negative controls. After immersion in 2% methylene blue solution for 1 month, the teeth were washed during 24h. The teeth were demineralized in 10% nitric acid and dehydrated by immersion in 80, 90 and 100% ethyl alcohol. The teeth were finally cleared and stored in 100% methylsalicylate, and apical dye penetration was evaluated under stereomicroscope(Leica M420, LC, U.S.A)at 8.75 magnification. Liner measurement of dye penetration was assessed with the use of digitalized image analysing system (analySIS, GmbH, Germany) The data were analysed statistically using independent T-test and Two-way ANOVA and Tukey test. The result were as follows 1. In canal prepared with GT rotary file, shaphing time taked more than the group of using Gates Glidden drill to coronal preparation without statistical significance (p>0.05) 2. The group of single cone obturation using canal preparation of GT rotary files showed significantly more apical leakage than those of lateral condensation and continuous wave technique regardless of shaping method (p rotary files and Gates Glidden drill showed significantly more apical leakage than those of continuous wave technique regardless of shaping method (p0.05). 5. The group of single cone obturation using canal preparation of GT rotary files and Gates Glidden drill showed more apical leakage than the group of lateral condensation using same shaping method with-out statistical significance (p＞0.05).

Effects of Chlorhexidine Gluconate as an Endodontic Irrigant on the Apical Seal: Short-Term Results

The aim of this study was to ascertain whether chlorhexidine gluconate (0.12%), used as an endodontic irrigating solution would affect the apical seal obtained when using three different root canal cements. One hundred extracted human single-canal teeth were divided into 9 experimental groups of 10 teeth each and a positive and negative group of 5 teeth each. The teeth were decoronated at the level of the cementoenamel junction, then accessed, instrumented to a Master Apical File #50, irrigated with either sterile saline, 5.25% NaOCl or 0.12% chlorhexidine gluconate, and dried using paper points. Obturation was accomplished using lateral condensation and 1 of 3 endodontic sealers: Roth's 811, AH26, or Sealapex. At 90 and 180 days after obturation apical leakage was measured using the fluid filtration method. Using the ANOVA test the results showed no significant difference in seal related to the irrigant at both the 90- and 180-day observation periods.

Aspergillosis of the Maxillary Sinus as a Complication of Overfilling Root Canal Material into the Sinus: Report of Two Cases

Aspergillosis of the maxillary sinus is a relatively rare disease in nonimmunocompromised patients. In recent years a number of cases of aspergillosis of the maxillary sinus have been reported in association with overextension of root canals fillings with certain root canal cements. It has been suggested that zinc oxide-based root canal cements might promote the infection with the Aspergillus species. In particular Aspergillus fumigatus has been found to be associated with the maxillary sinus infection. Radiographically the unique appearance of a dense opacity foreign body reaction in the maxillary sinus was considered a characteristic finding in maxillary sinus aspergillosis. Because this association of overfilling of root canal cements and aspergillosis of the maxillary sinus is not too well known we report two cases of young healthy female patients with the characteristic findings, both radiographically and clinically. In both patients the first maxillary molar was involved. Patients were symptomless and the diagnosis was made accidently. However at surgical inspection both patients revealed aspergillomas, including the overextended root canal cement. The surgical procedure is described as are the microscopic findings in both cases showing the characteristic branching hyphae and conidophores typical of Aspergillus. Overextension into the maxillary sinus with root canal cements has to be avoided; material has to be removed from the sinus because otherwise aspergillosis infection may ensue.

歯科用ユージノール製剤によるアレルギー性接触皮膚炎発症の可能性

Eugenol is a main ingredient of clove oil, and either eugenol or clove oil is important constituent in various dental preparations. Rather strong allergenicity of eugenol was confirmed in examination with two methods of modified guinea pig maximization test, which is called adjuvant and patch test, and ear swelling test in mice. Possibility that delayed contact hypersensitivity is induced by use of an eugenol preparation must be admitted. It is found that eugenol in various dental preparations is applied to contact with gingiva or teeth in an enough concentration to cause hypersensitivity especially in the case of some zinc oxide-eugenol preparations such as periodontal dressings and root canal cements. On the other hand clove oil and eugenol are more widely and frequently used for cosmetic and food processing than for dental treatment, and there would be many opportunities in man to get hypersensitivity to eugenol. Even in the case of a new patient the correlation between the allergic symptoms and dental treatment will give rise to the supposition that an eugenol preparation is causing the trouble.

Effect of different grades of gum rosins and hydrogenated resins on the solubility, disintegration, and dimensional alterations of grossman cement

In the present study, we investigated the effect of the addition of different grades of gum rosins and hydrogenated resins to Grossman cement on dimensional stability, solubility and disintegration. pH and conductivity, which may affect these properties, were also determined. The experiments were performed according to Specification 57 of the American Dental Association for root canal cements using Grossman cements containing three gum rosins (grades X, WW, and WG) and two hydrogenated resins (Staybelite and Staybelite ester 10). The results showed that the solubility, disintegration, and dimensional stability of Grossman cement containing Staybelite and Staybelite ester 10 were inferior to the values considered acceptable by the American Dental Association Specification 57.

Apical sealing ability of glass ionomer sealer with and without smear layer

The effect of two different root canal cements and removal of the smear layer on the apical seal in roots obturated with Thermafil obturators was tested. Thirty extracted human mandibular first molars with 60 canals (mesial roots) were instrumented with the use of a step-back technique. Teeth were placed into 6 groups of 10 canals each. The first three groups had the smear layer removed with EDTA and NaOCl, and the other three groups were irrigated with NaOCl only. Canals were obturated using Thermafil without sealer cement or Thermafil with Ketac-Endo or Thermafil with zinc oxide-eugenol cement. All roots were placed in India ink for 4 days. The roots were cleared, and the degree of linear dye penetration was measured. The study showed that root canal cement significantly improved the apical seal of the Thermafil obturation technique (p < 0.05), whether the smear layer was removed or not. The apical seal exhibited by Ketac-Endo was not significantly different from that provided by zinc oxide-eugenol cement (p > 0.05), regardless of the presence or absence of a smear layer.

Effect of moisture on the apical seal of laterally condensed gutta-percha

Eighty-five single-rooted human teeth were cleansed and shaped for obturation with gutta-percha and Proco-Sol root canal cement. Two of the three experimental groups had their canals contaminated with either 0.05 ml of NaOCl or saliva immediately prior to obturation. The remaining group of 25 teeth had dry canals prior to obturation. All teeth were obturated by the lateral condensation technique, covered with two coats of nail polish, immersed in India ink, and subjected to a vacuum for 15 min. The teeth were then cleared to allow visual assessment of the dye penetration through the apical seal. Positive and negative controls verified the experimental method. The recorded measurements were statistically analyzed and no significant differences were found among the groups.

The effect of essential oil type on the setting time of Grossman's sealer and roth root canal cement

Setting times were determined for mixtures consisting of the powder components of Grossman's sealer or Roth root canal cement with either eugenol, oil of pimento or oil of Melaleuca. The powder component of Grossman's sealer, when mixed with eugenol or oil of pimento, had a significantly shorter setting time than did the powder component of Grossman's sealer mixed with oil of Melaleuca or Roth root canal cement mixed with eugenol, oil of pimento, or oil of Melaleuca.