Root Canal Sealers Research Articles

An in vitro study on the influence of laser-activated irrigation on infiltration and leakage of a dual curing-resin cement as an endodontic sealer.

The study aims to investigate the effects of laser-activated irrigation on infiltration and microleakage of a dual-curing resin cement applied as a root canal sealer. Thirty-eight extracted upper molars were attributed to four experimental groups. Roots were mechanically enlarged and disinfected (NaOCl). Control samples (n = 11) were irrigated with conventional needles and three different lasers were used to activate the irrigant in the other groups (n = 9): 2.94 µm Er:YAG laser, 9,300 µm CO2 laser and 808 nm diode laser with a modified black coated laser tip. Final irrigation was performed in each group with ethylenediaminetetraacetic acid (EDTA), sodium hypochlorite (NaOCl) and sodium chloride (NaCl) activated with lasers and in the control without activation.Dentin tubules were then labeled with a red fluorophore (Rhodamine B) and the root canals were sealed with a dual-curing resin cement (Paracore). The cement fixed the dye on the sealed and infiltrated dentin parts. To remove the Rhodamine not fixed by the cement, roots were then sectioned horizontally and immersed in hydrogen peroxide (H2O2). The empty dentin tubules spaces were then labeled with a green fluorophore (Fluorescein) allowing the visualization of infiltration and microleakage by confocal microscopy. Percentages of infiltration were significantly higher in the middle root third of the control and Er:YAG laser-activated samples compared to CO2 or diode laser groups. Microleakage was present in all experimental groups but significantly less after CO2 laser activation. Laser-activated irrigation impacted resin cement infiltration and microleakage dependent on the applied wavelength. Er:YAG laser activation led to higher values of infiltration and microleakage compared to CO2 and diode lasers.

Filling Material Bond Strength to Dentin Is Positively Influenced by the Agitation of Endodontic Final Irrigating Solutions.

The final step of irrigation has been considered to of increase the bonding strength of filling material to dentin. This study investigated the impact of three final-step irrigation methods on the endodontic sealer bond strength to dentin by using a micro push-out test. Palatal roots of human maxillary molars were cleaned and shaped and randomly divided in six groups (n=15) according to the final-step irrigation method and the type of root canal sealer used. The solutions used for the final-step irrigation were 17% ethylenediaminetetraacetic acid and 2.5% sodium hypochlorite, which underwent three methods: 1) syringe-needle irrigation/conventional, 2) passive ultrasonic irrigation, and 3) XP-endo Finisher agitation. The root canal sealers used were: EndoSequence BC Sealer, and AH-Plus sealer. Roots were obturated with the single cone technique and then, cross-sectioned in 2-mm-thick slices (3 slices from each root). Push-out test was performed on the sliced specimens (cervical, middle, and apical thirds) with a universal testing machine. Bond strength values were recorded in megapascal (MPa). Subsequently, each specimen was longitudinally split to verify the type of failure. Data analysis was performed using Johnson transformation, three-way analysis of variance, Tukey's post-hoc tests, and the partial Eta squared test. There were significant differences in bond strength between the sealers [AH: 4.46±2.24 and BC: 3.47±2.19 MPa (P<0.001)]; between final-step irrigation methods [passive ultrasonic irrigation: 4.52±2.25, XP-endo Finisher: 3.93±3.93 and syringe-needle irrigation/conventional: 3.37±2.51 MPa (P<0.001)], and between the root canal thirds represented by the sliced specimens [cervical: 5.45±2.39, middle: 4.14±1.99 and apical: 2.30±1.30 MPa (P<0.001)]. The interaction between the variables had no significance (P>0.05). Agitation of the final irrigating solution may improve the bonding of the sealer to canal walls. AH-Plus sealer had the highest bond strength. The bond strength reduced significantly towards the apical third.

Performance of obturation techniques in anatomical irregularities located at different thirds of the root canal system.

This study aimed to compare the quality of root canal obturation (ratio of area occupied by gutta-percha (G), sealer (S), and presence of voids (V)) in different anatomical irregularities (intercanal communications, lateral irregularities, and accessory canals) located at different thirds of the root canal system of mandibular molar replicas. Sixty-seven 3D printed replicas of an accessed mandibular molar were prepared using ProGlider and ProTaper Gold rotatory systems. Three specimens were randomly selected to be used as controls and did not receive further treatment. The rest were randomly distributed in 4 experimental groups to be obturated using either cold lateral compaction (LC), continuous wave of condensation (CW), and core-carrier obturation (ThermafilPlus (TH) or GuttaCore (GC)) (n=16 per group). AHPlus® sealer was used in all groups. The three controls and a specimen from each experimental group were scanned using micro-computed tomography. The rest of the replicas were sectioned at the sites of anatomical irregularities and examined at 30× magnification. The G, S, and V ratios were calculated dividing the area occupied with each element by the total root canal area and then compared among groups using the Kruskal-Wallis test. Voids were present in all obturation techniques with ratios from 0.01 to 0.15. CW obtained a significantly higher G ratio in the irregularity located in the coronal third (0.882) than LC (0.681), TH (0.773), and GC (0.801) (p<0.05). TH and GC achieved significantly higher G ratios in those located in the apical third (p<0.05). The worst quality of obturation was observed in the loop accessory canal with all obturation techniques. Whitin the limitations of this study, it can be concluded that CW and core-carrier obturation are respectively the most effective techniques for obturating anatomical irregularities located in the coronal and the apical third.

Evaluation of the Push-Out Bond Strength and Penetration of Guttaflow bioseal, Endoseal MTA and Guttaflow 2 versus AH-Plus Root Canal Sealers into the Dentinal Tubules in Mandibular Premolar Teeth (A Randomized in vitro comparative study)

Evaluation of the Push-Out Bond Strength and Penetration of Guttaflow bioseal, Endoseal MTA and Guttaflow 2 versus AH-Plus Root Canal Sealers into the Dentinal Tubules in Mandibular Premolar Teeth (A Randomized in vitro comparative study)

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.

Evaluation of the root dentin bond strength and intratubular biomineralization of a premixed calcium aluminate-based hydraulic bioceramic endodontic sealer.

This study evaluated the dentin bonding strength and biomineralization effect of a recently developed premixed calcium aluminate-based endodontic sealer (Dia-Root Bio Sealer) in comparison with existing calcium silicate-based sealers. The root canals of 80 mandibular premolars were filled with Dia-Root Bio Sealer, Endoseal MTA, EndoSequence BC Sealer, and AH Plus Bioceramic Sealer. Medial and apical specimens were then obtained by sectioning. The push-out bond strength was measured using the medial specimens, and the failure mode was recorded. Intratubular biomineralization in the apical specimens was analyzed using scanning electron microscopy and energy-dispersive X-ray spectroscopy (EDS). The data were analyzed using one-way analysis of variance followed by the Tukey test (P < 0.05). The push-out bond strength of Dia-Root Bio Sealer was significantly higher than that of the other tested materials, and a cohesive failure pattern was observed in all groups. Dia-Root Bio Sealer also exhibited a significantly higher degree of biomineralization than the other groups, and EDS analysis indicated that the biomineralized precipitates were amorphous calcium phosphate. The results of this study indicate that Dia-Root Bio Sealer has the potential to be used as an adequate root canal sealer due to its favorable bonding performance.

Influence of root canal sealer composition on postoperative pain after endodontic treatment of permanent teeth: a systematic review and meta-analyses

Influence of root canal sealer composition on postoperative pain after endodontic treatment of permanent teeth: a systematic review and meta-analyses

The effect of storage time on dislocation resistance of core material to root canal sealer in standardized root canals: A laboratory study

The effect of storage time on dislocation resistance of core material to root canal sealer in standardized root canals: A laboratory study

Can activation of root canal sealer enhance the penetration into lateral canals?

Can activation of root canal sealer enhance the penetration into lateral canals?

Interfacial Adaptation and Penetration Depth of Recent Bioceramic Root Canal Sealers to Dentin: An In Vitro Study

Interfacial Adaptation and Penetration Depth of Recent Bioceramic Root Canal Sealers to Dentin: An In Vitro Study

Comparison of EDTA and Boric Acid Irrigation in Terms of Root Canal Dentin Microhardness and Sealer Penetration Depth

Chemo mechanical preparation is one of the important stages for successful endodontic treatment, and Boric acid has been proposed as an alternative irrigation solution for root canal treatment. Objective: The purpose of this study was to evaluate the effect of irrigation with boric acid (BA) and EDTA on the mineral content and microhardness of dentin and penetration of the AH Plus root canal sealer. Methods: 63 single-rooted teeth were instrumented. Microhardness analysis, 45 teeth were cut longitudinally and then transversely to obtain dentin. Pre- and post-treatment microhardness values were measured. The samples were randomly assigned into 3 groups (n = 15) for irrigation solution: distilled water, 17% EDTA, and 5% BA. The 18 roots were irrigated with three solutions (n = 6). Nine of the roots were filled with AH-Plus for confocal laser scanning microscopy analysis, and the others were used for XRD analysis. Results: The results were evaluated with the ANOVA test. BA caused a significant decrease in microhardness value in apical and coronal parts (p &lt; 0.05), while EDTA reduced only in coronal parts (p &lt; 0.05). Conclusion: BA provided higher sealer penetration ability. BA reduced the microhardness and provided better sealer penetration.

Cytotoxic and Antibacterial Properties of Piper betle Combined with Selected Root Canal Sealers

Exploration in endodontic material had been made to maximise the elimination of microorganisms in root canal system to improve the treatment success rate. Inappropriate use of antibiotics can cause antibiotic resistance hence alternative is needed. Piper betle (PB), a medicinal herb to be used for its effective antibacterial properties against Enterococcus faecalis. Therefore, this study aims to investigate the cytotoxicity and antibacterial effects of ethanolic extract of PB in combination with AH Plus (AH) and BioRoot RCS (BR) and sealers alone. Four tested materials were used: AH Plus (AH); PB and AH plus (PBAH); BioRoot RCS (BR); and PB and BioRoot RCS (PBBR). At 24, 48, and 72 h, MTT assay on HPdLF was performed to measure the cytotoxicity. Antibacterial effect was evaluated with modified direct contact test (MDCT) against E. faecalis at fresh, day1-set and day-7-set state of tested materials. Data were analysed with SPSS version 25 with Tukey’s post-test at the level of significance of p = 0.05. PBAH showed significant lower cytotoxicity than AH (p = 0.028) at 48 h, with a higher percentage of cell viability compared AH (26.35%). PB reduce antibacterial effect of BR at all times at significant level (p = 0.000, 0.014, 0.032). Conclusion, PBAH has significant reduced cytotoxicity as compared to AH on HPdLF at 48 h. PBBR was cytotoxic to HPdLF at 24 and 48 h. Both AH and PBAH exhibited antibacterial property against E. faecalis, followed by BR and PBBR. In conclusion, PBAH is a potential enhanced root canal sealer and may be further studied to fully elicit its profound properties.

In vivo cytotoxicity analysis of bioceramic root canal sealers on zebrafish embryo.

This study evaluated the cytotoxicity of four bioceramic root canal sealers (RCSs) in vivo. The embryonic zebrafish characteristics, such as mortality, survival, hatching, and general morphology, served as the parameters for assessing cytotoxicity. The RCSs, namely GuttaFlow Bioseal, MTA Fillapex, CeraSeal Bioceramic, and iRoot SP, were mixed according to the manufacturer's guidelines. The extract solution was prepared by immersing the set RCS into 1X dilution of E3 solution. Then, the extract solution was delivered into a Petri dish where zebrafish embryos were allowed to develop. Cytotoxicity was evaluated 24, 48, 72, and 96 hours after fertilization. The Kruskal-Wallis test showed that except for GuttaFlow Bioseal, the mortality, survival, and hatching of zebrafish embryos for the remaining three bioceramic RCSs were significantly different from the negative controls (P<0.05). Significant differences were also evident in the mortality, survival, and hatching of zebrafish embryos between GuttaFlow Bioseal and three other RCSs (P<0.05). GuttaFlow Bioseal was less cytotoxic than other bioceramics RCSs; MTA Fillapex, CeraSeal Bioceramic root canal sealer, and iRoot SP root canal sealer exhibited comparable cytotoxicity.

Comparative Analysis of Marginal Adaptation of Different Root Canal Sealers Using Scanning Electron Microscope

Aims:The present study aimed to evaluate and examine the degree of marginal adaptation of several root canal sealers using a scanning electron microscope (AH Plus, MTA-Fillapex, Total-Fill, and GuttaFlow Bioseal) to root dentine.&#x0D; Methods and Material:Forty extracted mandibular premolars with completely formed apices and a single root were selected. The root canals were instrumented after the decoronation of teeth. The samples (n = 10) were divided randomly into four groups. Group (1) was sealed with a resin-based sealer (AH Plus), Group (2) with an MTA-based sealer (MTA-Fillapex), Group (3) with a bioceramic sealer (TotalFill BC), and Group (4) with a silicone-based sealer (GuttaFlow Bioseal). After horizontally slicing samples with a diamond disk, marginal adaptability was evaluated using SEM.&#x0D; One-way ANOVA test and the multiple Post hoc test of Tukey was reliant on the statistical analysis of the data.&#x0D; Results: TotalFill BC has shown significantly higher marginal adaptation than MTA-Fillapex and GuttaFlow Bioseal (P &lt; 0.05). There is no significant difference between apical and coronal sections in the four tested groups under SEM (P &lt; 0.05).&#x0D; Conclusions: Total fill BC outperformed the other tested sealers in terms of marginal adaptability.

A comparative study of biological properties of three root canal sealers.

The aim of this study was to evaluate the effects of Hiflow with other two kinds of root canal sealers on the biological behavior of stem cells from the apical papilla (SCAP), the influence on inflammatory cytokines release and its antibacterial effects. Material extracts of Hiflow, iRoot SP, and AH Plus were prepared. Then, SCAP was incubated with extracts. The effects were evaluated by CCK-8, wound healing assay, ALP staining, alizarin red staining, and qRT-PCR. Meanwhile, polymorphonuclears (PMNs) and monocytes were isolated and treated with extracts for 4h and 24h respectively. Cell viability was analyzed by Annexin-V/PI double staining flow cytometry. The effects on the release of cytokines were observed by ELISA. The antibacterial effects of different sealers were tested against three kinds of bacteria found in chronic apical periodontitis. A series of results of SCAP showed that Hiflow and iRoot SP could promote cell proliferation, migration, and osteogenesis (p < 0.05). Although Hiflow was associated with greater cell apoptosis and necrosis when incubated with PMNs and monocytes (p < 0.05), it had an approximate release of anti-inflammatory cytokines with iRoot SP, which was higher than AH plus (p < 0.05). The co-culture showed that Hiflow and iRoot SP inhibited the colony formation of F. nucleatum (p < 0.05). However, both sealers had no obvious antibacterial effect on E. faecalis and P. gingivalis (p > 0.05). In summary, Hiflow and iRoot SP both had positive biological stimulus on SCAP. Meanwhile, Hiflow showed a better induction on anti-inflammatory cytokines over the others. All the properties mentioned above and its antibacterial effect of F. nucleatum promise Hiflow a bright application prospect in endodontic uses. References for clinical work to use BC Sealer Hiflow as a good biological root canal sealer.

Evaluation of Push-out Bond Strength of Bioceramic Root Canal Sealers with Different Final Irrigation Protocols

This study aims to evaluate the bond strength of bioceramic root canal sealers, with different final irrigation protocols. A total of 104 human upper incisor teeth were selected for applying four different irrigation solutions (Ethylene diamine tetraacetic acid (EDTA), Chlorine Hexidine Gluconate (CHX), Sodium Hypochlorite (NaOCl), and Distilled Water (D.W)) and two root canal sealer protocols (Endosequence BC (BC), Well-Root ST (ST)), in this in vitro study. After root canal treatment specimens were sectioned to three parts (coronal, middle, and apical). Push-out bond strength test was performed in a universal testing machine (Zwick-Roel, Germany) at a crosshead speed of 1 mm/min. Regardless of the irrigation protocol and sealer used, the highest bond strength values were obtained from the apical section ($$p&lt;0.05$$). 5.25% NaOCl + 17% EDTA + 5.25% NaOCl and 2% CHX + 17% EDTA + D.W statistically showed the highest bond strength value and 2% CHX + 17% EDTA + 2% CHX group showed the lowest value in this study ($$p&lt;0.05$$). The bond strength values of Endosequence BC Sealer were statistically higher than the bond strength values of Well Root ST ($$p&lt;0.05$$). According to the final irrigation, Endosequence BC Sealer and Well Root ST root canal sealers showed the highest bonding strength in CHX + EDTA + D.W and NaOCl + EDTA + NaOCl groups.

Dentin Bond Strength of Calcium Silicate-Based Materials: A Systematic Review of In Vitro Studies

Background: Dentin adhesion is a basic aspect to consider in a root canal sealer. Calcium silicate-based cements are materials that have excellent biocompatibility and bioactivity. Bioactivity is closely related to dentin bond strength. One of the tests that is most used to evaluate the adhesive property of a sealing cement is the “push-out bond strength” test, which consists of applying tensile forces to the root to measure the resistance of the bonding of a material to root dentin. Aim: The aim of this systematic review is to perform a qualitative synthesis of available evidence on the adhesion of calcium silicate-based sealers to dentin. Methods: An advanced search of the literature was performed in five databases, limited to in vitro studies on human teeth published in the last 5 years. Results: 42 studies were eligible for the review, and data were collected according to the number of teeth studied, the canal preparation, the irrigant used, the mechanical test used, the root thirds and the type of sealer studied. A qualitative synthesis of the evidence is presented. Conclusions: TotalFill BC sealer and EndoSequence Root Repair Material appear as the calcium silicate-based materials with the highest bond strength to dentin. In addition, using 17% EDTA as a final irrigant increases the bond strength of calcium silicate-based sealers.

Evaluation of Antimicrobial Effectiveness of Root Canal Sealers Modified with Various Herbal Extracts against Candida Albicans and E Faecalis.

The aim of the study was to assess the effectiveness of ZOE-based, calcium hydroxide, and epoxy resin-based sealers on modification with three herbal extracts. Methanolic extracts of selected herbs were combined with ZOE-based, calcium hydroxide, and epoxy resin-based sealers. Cultures were prepared from E. faecalis and C. albicans and agar plates prepared. Prepared mixtures were inoculated in punched holes, and inhibitory zones were measured. No statistical significance was obtained on comparing mean scores of test groups. None of the combinations used was found to be significantly better than others.

Endodontic sealers after exposure to chlorhexidine digluconate: An assessment of physicochemical properties

ObjectivesFinal root canal irrigation should ideally maintain the physicochemical stability of root canal sealers. We seek to assess the effect of contact with 2% chlorhexidine digluconate (CHX) on the physicochemical properties of AH Plus, BioRoot™ RCS, and Pulp Canal Sealer (PCS). MethodsMixed sealers were placed in cylindrical teflon molds and allowed to set for 1.5x the manufacturers’ setting time. Half of the specimens had their free surface in contact with CHX for the first minute of their setting period. Solubility, radiopacity, surface roughness, microhardness and wettability of the sealers were assessed up to 28 days after setting. Elemental analysis of sealer surfaces and their leachates together with pH measurements were also performed. Appropriate parametric and non-parametric analysis with post hoc tests were performed (p < 0.05). ResultsExposure to CHX had no effect on solubility and radiopacity of all sealers. CHX altered the surface roughness of PCS and BioRoot RCS (p < 0.05). Contact with CHX reduced the microhardness of AH Plus and PCS (p < 0.05). AH Plus was more hydrophilic after CHX contact, whereas PCS became more hydrophobic (p < 0.05). AH Plus and PCS surfaces appeared to adsorb CHX as exhibited by chlorine peaks after contact with CHX. Sealer leachates’ alkalinity was not affected. CHX increased elution of silicon and zirconium for BioRoot and zinc for PCS leachates. SignificanceIn our study, CHX affected sealers’ physicochemical properties to various extents. Further studies are needed to confirm the obtained results by investigating various final irrigation strategies and correlating to biological properties.

Investigating best practice for specimen preparation for biological testing of root canal sealers

IntroductionBiological characterization of root canal sealers is important as it assesses the ability of the root canal sealer to exert antimicrobial properties thus avoiding treatment failures caused by microbial challenge and also assess the cytotoxic effect on the periapical tissues. Assessment of the biological testing of root canal sealers necessitates the sterilisation of the materials prior to evaluation. This study aims to analyse the influence of various sterilisation techniques conducted prior to biological testing on the microstructure and surface properties of endodontic sealers. Assessment of the initial microbial contamination on the material was also undertaken. MethodsFour commercial sealers were investigated. The sealers were either prepared in a laminar flow cabinet or on a laboratory bench top under ambient conditions. Each group was further divided into 5 groups (n = 3) based on the sterilization technique:1) ethanol-10 mins, 2) ultraviolet-1 h, 3) ethanol-10 mins + ultraviolet-1 h, 4) autoclave, and 5) no sterilisation (control). Microbial levels in the materials were assessed by plate streaking technique. The materials were characterized by scanning electron microscopy and energy dispersive spectroscopy, and Fourier transform infrared spectroscopy, before and after sterilisation, to assess any changes in microstructure and chemical composition. ResultsAll the materials did not exhibit contamination when prepared in laminar flow chamber in sterile conditions compared with sealers prepared on the bench top. Three of the commercial materials showed changes in microstructure while one (TotalFill) was not affected by the sterilisation. AH Plus and BioRoot RCS exhibited alterations in water and alcohol peaks in FT-IR while the single syringe sealers (TotalFill and BioRoot Flow) showed no changes. ConclusionsSterilisation methods cause physical and chemical alterations to sealers. Material preparation should be performed in a laminar flow cabinet and a test for sterility should be performed prior to any biological testing being undertaken. If the materials are not sterile, assessment of the effects of the sterilization methods is recommended.