Sealer Group Research Articles

Root canal cleanliness and debris extrusion following retreatment of thermoplastic injection technique and bioceramic-based root canal sealer.

To evaluate the amount of apically extruded debris and to determine the remaining filling material on the root canal walls by microcomputed tomography (micro-CT), following the root canal retreatment of root canals filled with different obturation techniques (single cone technique, thermoplasticised injection technique) and the different root canal sealers [bioceramic-based, epoxy resin-based root canal sealer]. 60 single rooted human premolar teeth were prepared with the ProTaper Gold system (Dentsply Maillefer) up to the F4 file and the samples were divided into 4 groups according to obturation procedures: Single cone technique + AH Plus sealer(epoxy resin-based root canal sealer, Dentsply International Inc., York, PA, USA); Single cone technique + Sure-Seal Root(bioceramic-based root canal sealer, Sure Dent Corporation, Gyeonggi-do, South Korea); thermoplastic injection technique[Calamus Dual Obturation System(Dentsply-Tulsa Dental, Tulsa, OK, USA)] + AH Plus(Dentsply International Inc.); Sure-Seal Root(Sure Dent Corporation) + Calamus Dual Obturation System (Dentsply-Tulsa Dental). The teeth were inserted into preweighed Eppendorf tubes and retreatment was performed. The tubes were kept in an incubator at 37°C for 14days to obtain the dry debris weight. Following the removal of the root canal fillings, the samples were scanned with a micro-CT device to analyse the volume of filling residues. Retreatment of samples obturated with epoxy-resin or bioceramic based root sealers combined with Calamus system resulted in higher amount of apical extrusion compared to their combination with single cone technique (p = 0.026 for Single cone technique + AH Plus sealer vs Calamus + AH Plus sealer and p = 0.005 for Single cone technique + Sure-Seal root sealer vs Calamus + Sure-Seal root sealer). The most debris was observed in the Calamus + Sure-Seal root sealer group, the least debris was observed in the Single cone technique + AH Plus sealer group. The percentage of residues was the highest in the Single cone technique + Sure-Seal root sealer and the lowest in the Calamus + AH Plus sealer group, but there were no significant differences between groups (p = 0.463). No correlation was observed among the groups in terms of extruded debris and remnants inside the root canal. When combined with bioceramic based sealer, thermoplasticised injection technique did not affect the cleanliness of root canal walls; however, it increased its apical extrusion potential during retreatment. The obturation method does not play a role in the removability of bioceramic based root canal sealer, however the use of bioceramic-based root canal sealers with cold obturation techniques may be beneficial in preventing apical extrusion.

Immediate and delayed shear bond strength evaluation between root canal sealers and restorative materials: an experimental study

BackgroundSeveral calcium silicate-based sealers have recently emerged in endodontics. This study aimed to compare the immediate and delayed shear bond strength between the bioceramic and calcium hydroxide-based sealers and different resin-based restorative materials.MethodsOne hundred and twenty specimens with a 3-mm depth and a 3-mm diameter were prepared. They were evenly divided into two groups, the bioceramic sealer and calcium hydroxide-based sealer groups. Each primary group was subdivided into two subgroups based on the restorative material used; i.e., the flowable resin composite and resin-modified glass ionomer subgroups. Moreover, each subgroup was further divided into the restoration process’s timing: either immediately post-sealing or delayed after setting the sealers for seven days. The mode of failure was assessed by stereomicroscopic examination.ResultsThe highest shear bond strength was found when the bioceramic sealer was used and restored with the flowable resin composite. The strengths were 8.45 (1.17) and 6.67 (1.60) megapascals (MPa) in the immediate and delayed restoration groups, respectively. In contrast, the lowest strength, 2.91 (1.22) MPa, was recorded when calcium hydroxide-based sealer was employed and restored after allowing the sealer to set completely with resin-modified glass ionomer. Notably, there were no cohesive fractures within the tested restorative materials. All observed fractures occurred within the sealer materials, at the interface of the sealer and restorative material, or in combination. Moreover, the most common failure was a mixed failure.ConclusionsWhen flowable resin composite was used immediately before complete setting, bioceramic sealers showed a higher bond strength than calcium hydroxide-based sealers.

Comparative evaluation of wettability of AH plus, Ceraseal and Guttaflow bioseal root canal sealers on root canal dentin: An in vitro study

Abstract Context: Effective root canal treatment relies on the ability of sealers to wet and penetrate the root canal system, ensuring a tight seal and preventing bacterial leakage. The current study investigates the wetting ability of newer root canal sealers by evaluating their contact angle. Aim: The objective of the present study was to evaluate and compare the wetting behavior of Guttaflow bioseal, Ceraseal, and AH plus root canal sealers. Materials and Methods: Decoronation and apical third resections of thirty extracted singlerooted human mandibular premolars were done. The roots were then split longitudinally into two halves buccolingually. The root dentin surfaces were treated using 10 mL 3% sodium hypochlorite for 5 min, 10 mL of 17% ethylenediaminetetraacetic acid for 5 min, and 2% chlorhexidine for 10 min. Then, these sixty dentin bars were randomly divided into three groups (n = 20): Group 1 – AH Plus, Group 2 – Ceraseal, and Group 3 – Guttaflow bioseal. The controlled volume of 0.1 mL sealer has been dispensed onto the dentin specimen using a micropipette. The contact angle of a drop of sealer was measured after 5 min using Ossila goniometer. Statistical Analysis Used: The data were analyzed using one-way analysis of variance and Tukey post hoc tests. The statistical significance was at P < 0.05. Results: The mean contact angle values for AH Plus sealer were lower when compared to the other two sealer groups which is statistically highly significant. Conclusions: AH Plus showed lesser contact angle thereby better wettability than Ceraseal and Guttaflow bioseal on the root canal dentin surface.

Analysis of Tissue Repair of a New Cement Based on Calcium and Strontium Aluminates: A Triple-Blinded, Randomized, Controlled Trial in an Animal Model.

The focus of this triple-blind randomized study was to evaluate the biocompatibility of a new root canal filling sealer (RCFS) based on tristrontium aluminate and dodecacalcium hepta-aluminate in living tissue. Forty-five Wistar rats (Rattus norvegicus) were divided into three groups: control (polyethylene), sealer (Bio-C Sealer, Londrina, PR, Brazil), and experimental (tristrontium aluminate and dodecacalcium hepta-aluminate). The tissues were analyzed under an optical microscope to assess different cellular events at different time intervals (7, 15, and 30 days). Data were analyzed using the Kruskal-Wallis and Dunn (p < 0.05) tests. In the initial period, a moderate inflammatory infiltrate was observed, similar between the endodontic cements groups (p = 0.725). The intensity of the infiltrate decreased with time, with no significant difference among the groups (p > 0.05). The number of young fibroblasts was elevated in all groups evaluated at 7 days. The experimental group showed the highest number of cells at all time intervals, but the difference with the sealer group at 7 (p = 0.001) and 15 days (p = 0.002) and the control group at 30 days was not significant (p = 0.001). Regarding tissue repair events, the amount of collagen fibers increased over the experimental intervals, with no significant difference between the sealer and control groups (p > 0.05). The experimental RCFS based on calcium and strontium aluminates proved to be biocompatible for use in close contact with periapical tissue, inducing a low inflammatory reaction and favoring rapid tissue repair.

Cytotoxicity and cell migration evaluation of a strontium silicate-based root canal sealer on stem cells from rat apical papilla: an in vitro study

BackgroundCalcium silicate-based bioceramics have been applied in endodontics as advantageous materials for years, many chemical components and new synthesizing methods were used to improve the base formulation of the materials for positively affecting the sealers properties. Recently, a novel biomaterial formulation, grounded in strontium silicate, has been introduced to the market, offering potential advancements in the field.ObjectiveTo comparatively analyze the cytotoxicity and cell migration effects of a novel strontium silicate-based bioceramic material (CRoot SP) and those of calcium silicate-based (iRoot SP) and epoxide amine resin (AH Plus) sealers on stem cells derived from rat apical papilla(rSCAPs).MethodsrSCAPs were isolated and characterized in vitro and subsequently cultured in the presence of various concentrations of CRoot SP, iRoot SP and AH Plus extracts. Cytotoxicity was assessed by CCK-8 assay, and cell-migration capacity was assessed by using wound healing assays .ResultsNo significant differences in cell viability were observed in the 0.02 mg/mL and 0.2 mg/mL sealer groups. The cell viability of CRoot SP was consistently greater than that of iRoot SP at concentrations of 5 mg/mL and 10 mg/mL across all time points. Maximum cytotoxic effect was noted on day 5 with 10 mg/mL AH Plus.The scratch was partly healed by cell migration in all groups at 24 h, and the 0.02 mg/mL, and 0.2 mg/mL CRoot SP exerted beneficial effects on rSCAPs migration.ConclusionsCRoot SP exhibited less cytotoxic than the iRoot SP and AH Plus extracts after setting. A lower concentration of CRoot SP thus promotes the cell migration capacity of rSCAPs, and it may achieve better tissue repair during root canal treatment.

Fracture resistance of endodontically treated root obturated with different root canal sealers( A comparative in vitro study)

Aim: The aim of this study is to evaluate and compare the fracture resistance of endodontically treated root obturated with four different root canal sealers.. Methods: Sixty extracted palatal root of upper molars were collected and sectioned to get a 11mm root length. All root canals were instrumented using edge endo X7 system rotary files and 35# size was the final size used to finish all the canals. After instrumentation the samples were divided into four groups of 15 samples in each according to the type of sealer used, a single cone obturation technique was used: Group 1: obturated with AH Plus sealer and gutta-percha. Group 2: obturated with Neosealer BC sealer and gutta-percha. Group 3: Obturated with MTA-Fillapex sealer and gutta-percha. Group 4: Obturated with OneFill BC sealer and gutta-percha. After incubation period of 7 days at 37°C and 100% humidity the samples covered with thin layer polyvinylsiloxane impression material to simulate a periodontal membrane and then molded in acrylic blocks so as to set the samples ready for fracture resistance test using universal testing machine at a cross head speed of 0.5mm/min., One-way ANOVA and Posthoc tests assessed the data statistically. Results: The results showed that fracture resistance was significantly higher in those canals that were filled with Neosealer BC sealer (69.90N) in comparison to the other different sealers used in the study (p≤0.05). Conclusion: Under the condition of this study, the following conclusions can be derived: The application of any root canal sealers resulted in an enhancement of the resistance to fractures in teeth that have undergone endodontic treatment. Neosealer Bioceramic sealer group showed the highest fracture resistance than other groups. Followed by Onefill bioceramic, MTA Fillapex and Ah plus.

Micro-Computed Tomography Analysis of Resin and Calcium Silicate Based Sealers Removal in Mandibular Molars Curved Canals.

The removal of the root canal sealer is an important factor in nonsurgical retreatment. The aim of this study was to compare the removal of AH Plus, Well Root ST, and AH Plus Bioceramic Sealer using Protaper Universal retreatment files. The curved mesio-buccal canals of extracted mandibular molars were prepared with the Protaper Gold file system (up to F2). Specimens were randomly divided into 3 groups and filled with the single cone technique using AH Plus, Well-Root ST, and AH Plus Bioceramic Sealer, respectively. After two weeks, the root canal filling of all specimens was removed using Protaper Universal retreatment files. All specimens were scanned using micro-CT. The remaining volume of the root canal filling was recorded in total and the coronal, middle, and apical third of each specimen. Well-Root ST and AH Plus Bioceramic Sealer groups had a higher percentage of total remaining filling material than the AH Plus group (P<0.05). This study has shown that the volume of remaining root canal filling was significantly higher in the samples filled with calcium silicate-based sealers.

The ability of different compositions of calcium silicate and epoxy sealers to withstand gutta percha removal via in vitro pull-out testing

Objectiveexamination of the influence of chemical composition changes on the ability of sealers to withstand a pull-out test.Materials and methodsFifty distal or palatal canals of extracted teeth were prepared by Dc Taper files. The teeth were divided into five groups: AH Plus, BJM RCS, Total Fill BC,AH Plus Bioceramic and a group with Gutta Percha with no sealer added. Ten days after obturation, each cone was subjected to the “pull-out test” with the Shimadzo Universal Testing Machine until it was torn or removed from the canal. A force to Stroke graph was generated and the maximum vertex of this graph was recorded. The number of times the cone was torn or removed was recorded.ResultsThe amount of force needed to remove or rupture the cone was significantly higher in all sealer groups compared to the AH Plus Bioceramic group. The force needed for the AH Plus group was double that needed for the AH Plus Bioceramic group 4 (1.87 ± 0.53 N vs 0.93 ± 0.48 N, respectively, P < 0.001). All of the cones (n = 10) in the AH Plus Bio Ceramic Sealer group were removed in their entirety (P = 0.01 compared to each of the other groups).ConclusionsThe addition of macromolecules to epoxy sealer does not change the material’s ability to withstand the pull-out test. Decreasing the amount of tri- and di-calcium silicate compounds combined with increasing amounts of zirconium oxide in a Bioceramic sealer significantly decreased the material’s ability to withstand the pull-out test.

Comparative Evaluation of Postoperative Pain in Response to Three Different Endodontic Sealers Using Visual Analog Scale

Abstract Background: The present study aimed to evaluate and compare postoperative pain after root canal treatment using three different base endodontic sealers. Materials and Methods: Root canal treatment was initiated in 60 patients diagnosed with symptomatic irreversible pulpitis, root canal treatment was completed, and different base endodontic sealers were used for obturation were selected based on the random allocation of the participants to the following groups NanoSeal, Dia Proseal, and CeraSeal. Postoperative pain was recorded using a 100 mm Visual Analog Scale at 24 h, 48 h, and 7 day after obturation. Statistical analysis was done using the Kruskal–Wallis test and one-way ANOVA. Results: Statistically significant pain reduction was observed in both NanoSeal-S and Dia-Proseal groups post-obturation. In NanoSeal-S, pain peaked after 24 hours (2.25 ± 1.74), decreased at 72 hours (0.5 ± 0.89), and was minimal by day 7 (0.25 ± 0.55). Dia-Proseal exhibited similar trends with peak pain at 24 hours (0.25 ± 0.55), further reduction at 72 hours (0.1 ± 0.31), and negligible pain by day 7 (0.0 ± 0.0). Comparable outcomes were noted with CeraSeal sealer group. Conclusions: CeraSeal showed less postoperative pain compared to Dia-Proseal and NanoSeal-S.

Effect of diode laser and ultrasonic activation on post-obturation push-out bond strength of non-eugenol based sealers: An in vitro study

Aim: The study aimed to assess the postobturation push-out bond strength of noneugenol-based sealers among different activation groups. Methods: One hundred sixteen single-rooted extracted mandibular premolar teeth were obtained. They were split into six groups-Group I: conventional cleaning and shaping (CCS) and sealing with AH Plus; Group II: CCS with MTA Fillapex; Group III: diode laser group with AH Plus; Group IV: diode laser group with MTA Fillapex; Group V: ultrasonic activation group with AH Plus; and Group VI: ultrasonic activation group with MTA Fillapex. Coronal and apical horizontal root sections were obtained from each sample and subjected to push-out bond strength. An independent t-test was done to compare the two groups of sealers. Results: A comparison of the irrigation activation in each sealer group was made using one-way analysis of variance and post hoc Tukey test. A comparison of the coronal and apical groups was made by paired t-test. Both the sealers exhibited higher push-out bond strength values after ultrasonic irrigation in the apical section. Higher values were obtained when AH Plus sealer was used. Push-out bond strength tests between MTA Fillapex and AH Plus with various irrigation activation regimes revealed that AH Plus had a stronger bond to the root dentin when combined with ultrasonic activation in the apical third of the root dentin. Conclusion: The study concluded that the higher values of push-out bond strength were noted in the AH Plus sealer group in the ultrasonic activation group in the apical root dentin section.

Comparative Evaluation of Supplementary Cleaning Techniques for Removal of Bio-C Sealer and AH-Plus from Oval Root Canals: A Micro-CT Analysis.

This study aimed to compare the effectiveness of two endodontic cleaning techniques, passive ultrasonic irrigation (PUI) and the XP-endo Finisher R (XPR) system, in removing residual filling material during endodontic retreatment procedures. Forty mandibular premolars with oval canals were divided into four groups based on the sealer used (AH-Plus or Bio-C Sealer) and the cleaning technique employed (PUI or XPR). To ensure uniformity of canal volume among groups, initial micro-CT scans were conducted. The canals were instrumented, filled, and then re-instrumented before undergoing either PUI or XPR cleaning techniques. Residual filling material volumes were assessed through micro-CT scans, and statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney U tests. Following instrumentation, there was no significant difference in residual filling material volumes between AH-Plus and Bio-C Sealer groups (1.35 mm3and 1.02 mm3, respectively; P>0.05). However, after supplementary cleaning techniques, XPR-cleaned specimens exhibited significantly less residual material compared to PUI-cleaned specimens (0.01 mm3 and 0.29 mm3 for Bio-C Sealer, and 0.07 mm3 and. 0.30 mm3for AH-Plus, P<0.05). The XPR system was found to be more effective than PUI in removing residual filling material from Bio-C Sealer-filled root canals. This highlights its potential as a useful supplementary cleaning technique in endodontic retreatment procedures.

Antimicrobial Activity of Five Calcium Silicate Based Root Canal Sealers against a Multispecies Engineered Biofilm: An In Vitro Study.

The present study's objective was to compare the impact of CerasealR, total fill BC SealerR, Bio-C SealerR, AH Plus BioceramicR, and K-BiocerR on the elimination of a multispecies' endodontic biofilm at 3, 7 and 14 days. A total of 20 freshly extracted, caries-free premolars were prepared for the study to create dentinal disks. For the multispecies biofilm formation, Enterococcus faecalis, Proteus mirabilis, Pseudomonas aeruginosa, and Candida albicans were cultured and used to inoculate hydroxyapatite discs. After incubation, the biofilms were placed on blotting papers in petri dishes with an orthodontic bend. Different root canal sealers, including CeraSeal, total Fill BC Sealer, Bio-C Sealer, AH Plus Bioceramic, K-Biocer, and Sealite, were injected into the bend, facilitating contact with the biofilms. The samples were divided into seven groups, including a negative control. At specific intervals, 3, 7, and 14 days, 3 biofilm samples from each group were collected, diluted, and plated on Agar media for colony counting and analysis. In all tested groups, the total bacterial count significantly decreased between day 3 and 14 (p < 0.05) with no statistically significant differences among the different sealers' groups at all-time points for the total bacterial count, E. faecalis count, and P. mirabilis count. However, Sealite demonstrated the most consistent effectiveness in reducing bacterial counts across multiple categories. The sealite group was capable of decreasing the C. albicans count significantly between day 3 and day 14 (p < 0.05) in comparison with the bioceramic groups. All sealers had antibacterial activity against the multispecies biofilm between day 3 and day 14. The ascending order of sealers in terms of their effectiveness in killing bacteria, based on the provided results, is as follows: Sealite, Bio-C Sealer, AH Plus, CeraSeal, TotalFill, and K-Biocer. However, there were no statistically significant differences in the bacterial counts among the different sealer groups at any time point. The role of sealers in combating biofilm-associated infections highlights their potential clinical utility in preserving root canal health. Understanding the antimicrobial properties of these sealers is vital for informed decision-making in selecting the most effective materials for improved treatment outcomes and long-term success in endodontic procedures.

Effect of Dentine Conditioning with Silver Diamine Fluoride on Wettability of Root Canal Sealers.

To test the null hypothesis that dentine treatment with silver diamine fluoride (SDF), a potent antimicrobial agent, following use of proteolytic and chelating agents does not influence the wettability of an epoxy resin (AH Plus, Dentsply Sirona, Charlotte, NC, USA) and a tricalcium silicate sealer (BioRoot RCS, Septodont, Saint-Maur-des-Fossés, France). Seventy-two intraradicular dentine specimens were divided into six groups based on the final irrigation solutions used: 2.5% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA) (NaOCl-EDTA) (group 1); NaOCl-EDTA-NaOCl (group 2); NaOCl-EDTA followed by 3.8% SDF, NaOCl-EDTA-SDF (group 3); NaOCl-EDTA-NaOCl-SDF (group 4); SDF (group 5) and saline (group 6). After irrigation, the specimens were divided into subgroups according to the sealer used, AH Plus or BioRoot RCS. Contact angles were measured using a contact angle analyser. The data were analysed using an independent t test, one-way analysis of variance (ANOVA) and Tamhane T2 post hoc test, with the level of significance set at P < 0.05. In the epoxy resin sealer group, dentine surfaces treated with only SDF showed the lowest contact angle. This was significantly less than the groups in which NaOCl was used as the final irrigant (P < 0.05). In the tricalcium silicate-based sealer group, the groups treated with SDF showed significantly greater contact angles when compared to the control group (P < 0.05). It was concluded that SDF conditioning of dentine favours the wettability of epoxy resin sealer but is detrimental to the wettability of tricalcium silicate sealer.

An Evaluation of the Effectiveness of Calcium Hydroxide as A Root Canal Sealer Constituent

A descriptive, comparative study was conducted in the Department of Conservative Dentistry and Endodontics, Dhaka Dental College Hospital, Bangladesh, from December 2014 to November 2015, to evaluate the effectiveness of calcium hydroxide as a root canal sealer constituent. A total of 60 patients were selected by purposive sampling technique. Patients were divided into two equal groups of 30: group-I had zinc-oxide eugenol [ZOE] cement as a root canal sealer, while group-II had calcium hydroxideor sealapex [Ca(OH)2] cement as a root canal sealer. Total number of teeth treated by single-visit root canal therapy. Out of 60 patients, 37(61.7%) patients were male. In ZOE group, the highest incidence was in age group 21-30 years, where as in Ca(OH)2 group, it was in 11-20 years. The mean age of the patients was 27.62±6.20 years in ZOE group and 25.0±6.14 years in Ca(OH)2 group. 21(70.0%) mentioned trauma as an etiological factor followed by caries 4(13.33%) in ZOE group, while 18(60.0%) patients mentioned trauma followed by caries 6(20.0%) in Ca(OH)2 group. In ZOE group, the incidence of pain was 23(76.67%), and in Ca(OH)2 group, 22(73.33%) reported pain. Periapical radiolucency follow-up findings were significantly better at 3-month and 6-month follow-ups in the Ca(OH)2 group. The difference inthe final outcome of effectiveness in both ZOE and Ca(OH)2 group in the management of periradicular pathosis was statistically not significant (P&gt;0.05). The present study findings revealed that single-visit root canal therapy was equally effective in the management of endodontically involved teeth with periradicular pathosis. After 12 months, in follow-up with post-operative clinical and radiological evaluations, Ca(OH)2 sealer group showed better results than ZOE sealer group. However, in shorter follow-ups, Ca(OH)2 sealer group showed significantly better findings as compared to ZOE sealer groups. &#x0D; CBMJ 2023 July: vol. 12 no. 02 P: 141-149

Comparative Analysis of Microleakage Associated with Various Endodontic Sealers: An in-vitro Study

Introduction: The purpose of the root canal obturation is to provide a hermetic seal, that inhibits the microleakage and canal reinfection, thus the health of the periapical tissues can be preserved. It has been observed that the sealer used during endodontic therapy has a direct link with the longevity of the treatment and the occurrence of postoperative pain.&#x0D; Aim: The goal of the present study was to assess microleakage in extracted teeth of four separate endodontic sealers (AH Plus, Sealapex, MTA Fillapex, and Ceraseal) using the dye penetration method.&#x0D; Materials and Methods: In this in-vitro study, 84 freshly extracted single-rooted teeth were endodontically treated and obturated using four different sealers and divided into four groups along with two control groups based on the sealer used. Microleakage was checked in apical sections using the dye penetration method under the stereomicroscope.&#x0D; Results: The maximum dye penetration was seen in Sealapex whereas the least microleakage was shown by Ceraseal endodontic sealer.&#x0D; Conclusion: Maximum microleakage was seen with calcium hydroxide based (Sealapex) while the least microleakage was noticed in bioceramic based (Ceraseal) sealer group.

The solubility, pH value, chemical structure, radiopacity, and cytotoxicity of four different root canal sealers: an in vitro study.

The aim of this study was to investigate solubility, pH value, chemical structure, radiopacity, and cytotoxicity of AH Plus BC, TotalFill BC, AH Plus, and AH Plus Jet sealers. Cytotoxicity analysis with direct and extraction tests at 3 different concentrations (1:1, 1:2, 1:4 v/v%) and time (24 h, 48 h, and 72 h) on Saos-2, PdLF, and THP-1 cell lines, chemical structure with scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) analysis, solubility, pH, and radiopacity values of AH Plus BC, TotalFill BC, AH Plus, and AH Plus Jet were evaluated. For statistical analyses of the groups, repeated measures, factorial, and one-way ANOVA tests were used. The statistical significance level was set at p < .05. Resin-based sealers showed higher cytotoxicity values than the bioceramic-based sealers (p < 0.05). Time and concentrations were effective on the cell viabilities for celllines. Higher peaks of calcium were detected bioceramic-based sealers and higher amount of zirconium was detected in AH Plus BC (p < 0.05). AH Plus BC showed similar radiopacity value with AH Plus, AH Plus Jet, whereas TotalFill BC showed the lowest radiopacity (p < 0.05). Bioceramic-based sealers had higher pH values in all experiment periods, and the difference between resin- and bioceramic-based sealer groups was significant (p < 0.05). However, the solubility values of the tested root canal sealers revealed no differences (p > 0.05). The newly produced AH Plus BC Sealer showed similar properties with TotalFill BC, and their biological properties were better than AH Plus and AH Plus Jet. AH Plus BC could be a possible alternative to other bioceramic- or resin-based sealers.

Quantitative evaluation of artifact expression in conebeam computed tomography of mesoporous calcium silicate nanoparticles as a promising root canal sealer

We aimed to quantitatively compare the area and volume of artifacts in cone beam computed tomography produced by mesoporous calcium silicate nanoparticles (MCSNs), AH Plus sealer, and iRoot SP sealer when used as root canal sealers. We prepared 40 single-rooted mandibular premolars and divided them into an MCSN sealer group, an AH Plus sealer group, an iRoot SP sealer group, and a no-sealer (control) group. We filled the canals with gutta-percha using the single-cone method and subjected them to conebeam computed tomography before and after the placement of root fillings using the same exposure parameters. We evaluated the images to quantify the areas of hyperdense and hypodense artifacts and non-affected teeth and reconstructed 3-dimensional image models of the materials to study volume distortion artifacts. The MCSN sealer group produced a significantly smaller hyperdense and volume distortion artifacts than the AH Plus and iRoot SP groups (P < .01), but the area and volume of hypodense artifacts did not differ significantly among the groups (P > .05). When used as a root canal sealer, MCSNs generate a significantly smaller area and volume of hyperdense artifacts than AH Plus and iRoot SP sealers. By significantly reducing the generation of high-density artifacts, MCSNs may facilitate the evaluation of root canal filling quality and the diagnosis of root canal abnormalities.

Outcomes of Endodontic-Treated Teeth Obturated with Bioceramic Sealers in Combination with Warm Gutta-Percha Obturation Techniques: A Prospective Clinical Study.

The objective of this clinical study was to collect short-term endodontic outcomes of endodontic-treated teeth (ETT) obturated with different kinds of bioceramic sealers used in combination with warm gutta-percha obturation techniques. Methods: A total of 210 endodontic treatments in 168 patients were performed. At baseline, 155 sample teeth (73.8%) showed symptoms (tenderness or pain to percussion) and 125 (59.5%) showed periapical radiolucency. Periapical radiolucency was present in 125 cases (59.5%); of these, 79 showed a lesion of 5 mm or bigger (63.2%) while lower than 5 mm in 46 cases (36.8%). Regarding ETT with radiolucency, 105 of them (84%) were in coincidence with their need for retreatment and the other 20 (16%) were necrotic teeth. The obturation techniques that were used in this study were: the continuous wave of condensation technique in 75% of cases, and carrier-based technique in 25%. Four bioceramic sealers were used: CeraSeal in 115 cases, BioRoot in 35 cases, AH Plus Bio in 40 cases, and in 20 cases, BIO-C SEALER ION. Preoperative and recall radiographs of the roots were each assigned a periapical index (PAI) score by 2 blinded, independent, and calibrated examiners. The teeth were divided into outcome categories based on the following classification: healed, unhealed, and healing. The healed and healing categories were classified as success, and the unhealed category was classified as failure on the basis of loose criteria. Minimum follow-up period was 18 months. Results: The overall success rate was 99%, with 73.3% healed, 25.7% healing, and 0.95% not healed. The success rate was 100% for initial treatment and 98.2% for retreatment. Fifty-four (N = 54) teeth showed ongoing healing. All of them were retreatment cases with periapical lesions. Regarding the success (healed and healing) versus not healed, no significant difference was found between teeth with or without periapical lesions (p < 0.05). A statistically significant difference in the distribution of healed, healing, and not-healed teeth was found between the groups of teeth with baseline lesions < 5 mm and >5 mm in diameter (p < 0.01) and those with sealer groups (p < 0.01). The success rate of used bioceramic sealers was not statistically significant different (99.1%, 100%, 97.5% and 100%, respectively, for CeraSeal, BioRoot, AH Plus Bio, and BIO-C SEALER ION). Nonetheless, the distribution of healed, healing, and not-healed teeth was different between teeth sealed with different materials (p < 0.01). From the findings of this clinical study, the following conclusion can be drawn: a correct filling of root canals made with warm gutta-percha technique combined with a bioceramic sealer allows a high success rate in endodontically treated teeth.

Influence of Phosphoric Acid Etching on Bond Strength for Calcium Silicate-Based Sealers

IntroductionThis study evaluated the microtensile bond strength of calcium silicate-based sealers and epoxy resin-based sealer, depending on the use of phosphoric acid (PA) etching before immediate resin restoration. MethodsExposed dentin surfaces of extracted human third molars were randomly assigned to 3 groups depending on sealer type (AH Plus [Dentsply DeTrey], CeraSeal [Meta Biomed Co.], and EndoSeal MTA [Maruchi]). Half of the samples were treated with PA for 30 seconds, and the other half were cleaned with water. Completely untreated specimens were used as controls. Self-etching adhesive (Clearfil SE Bond, Kuraray) was applied and composite resin (Tetric N-Ceram, Ivoclar Vivadent) was used to create build-ups. After 24 hours, the microtensile bond strength was measured (EZ Test, Shimadzu Co.). The failure mode was determined by light microscopy and scanning electron microscopy. One-way analysis of variance with the Bonferroni correction was used to analyze the data (P < .05). ResultsThe bond strength of the water-washed dentin surfaces in the calcium silicate-based sealer groups did not differ significantly from those of the control surfaces but the PA-pretreated surfaces exhibited relatively low-bond strength. The AH Plus-treated group had lower bond strength than the control group when no PA treatment was applied, but PA treatment restored the bond strength. The adhesive failure mode was most frequently found in the AH Plus group without PA etching. ConclusionsWhen a water-soluble calcium silicate-based sealer is used, sufficient bond strength can be obtained by washing with water alone, with no need for PA use.

Dimensional changes of endodontic sealers-An in vitro model simulating a clinical extrusion scenario during 18 months.

To examine the dimensional changes of endodontic sealers during 18 months using three-dimensional (3D) surface scanning and subtraction radiography in a novel in vitro sealer-extrusion model. Fifty endodontically instrumented acrylic teeth were randomly allocated to five groups (n = 10) filled with Apexit Plus, AH Plus, BioRoot RCS, TubliSeal EWT, and gutta-percha (control). Freshly mixed sealers were intentionally extruded during obturation. All teeth were immersed in a physiologic solution for up to 18 months. Blinded 3D surface scans (resolution: ~10 μm) and digital radiographs of the teeth were obtained at baseline (immediately after obturation); and then after 1 week, and at 1, 3, and 18 months. For blinded assessment of sealer dimensional change, 3D models and radiographs were superimposed using specific software. Volumetric differences, root mean square (RMS), and area change from subtraction radiography measured at each period within each sealer group were thereafter calculated. Repeated measures analyses were done with Bonferroni adjustment for multiple comparisons; standard errors, p values, and 95% confidence intervals (CI) were reported. Analyses of the volumetric data confirmed significant, progressive material loss for Apexit Plus when compared to the other investigated sealers or the control group (p ≤ 0.02). Immersion period significantly influenced the volumetric dimensional changes of Apexit Plus already after 1 month (p < 0.01). For TubliSeal EW, the effect of the immersion period on the dimensional changes was noted after immersion for 3 months (p ≤ 0.02), while for BioRoot RCS this was evident only at 18 months (p < 0.01). Same trends were noted for the RMS data, whereas progressive dimensional changes using subtraction radiography only revealed significant changes for Apexit Plus (p = 0.01). The largest dimensional changes were shown by Apexit Plus, followed by Tubliseal EWT and BioRoot RCS. AH Plus remained stable throughout 18 months.