TotalFill BC Sealer Research Articles

Impact of Final Irrigation Protocol on the Push-Out Bond Strength of Two Types of Endodontic Sealers.

Aim: The aim of this study was to assess the impact of the final irrigation protocol on the push-out bond strength of calcium silicate-based sealers when compared to an epoxy resin-based sealer. Materials and Methods: Eighty-four single-rooted mandibular human premolars were shaped using the R25® instrument (Reciproc, VDW, Munich, Germany) and then divided into three subgroups of 28 roots each depending on the final irrigation protocol: EDTA (ethylene diamine tetra acetic acid) and NaOCl activation, Dual Rinse® HEDP (1-hydroxyethane 1,1-diphosphonate) activation or sodium hypochlorite (NaOCl) activation. Then, each subgroup was divided into two groups (14 each) according to the sealer used (AH Plus Jet® or Total Fill BC Sealer®) for single-cone obturation. Dislodgement resistance using a universal testing machine, samples' push-out bond strength and failure mode under magnification were determined. Results: EDTA/Total Fill BC Sealer® showed significantly greater values of push-out bond strength compared with HEDP/Total Fill BC Sealer® and NaOCl/AH Plus Jet®, with no statistical difference with EDTA/AH Plus Jet®, HEDP/AH Plus Jet® and NaOCl/Total Fill BC Sealer®, whereas HEDP/Total Fill BC Sealer® showed significantly lower values of push-out bond strength. The apical third demonstrated higher means of push-out bond strength compared with middle and apical thirds. The most common failure mode was cohesive but showed no statistical difference compared to other types. Conclusions: Irrigation solution and final irrigation protocol affect the adhesion of calcium silicate-based sealers.

Effect of calcium silicate-based endodontic sealers on tooth color: A 3-year in vitro experimental study

ObjectiveTo analyze the change in tooth color produced by two hydraulic and one resin-based sealers by means of spectrophotometry for 3 years. MethodsForty maxillary anterior teeth were selected (n = 10 per group). Root canals were prepared by rotary instrumentation and irrigation was performed with NaOCl, which was also used in the final irrigation, followed by saline and activated with Endoactivator. Root canals were then filled using single cone technique. Negative control (NC): gutta-percha filling; Positive control: gutta-percha and AH Plus; experimental groups: gutta-percha and Bioroot RCS/TotalFill BC Sealer. Gutta-percha was cut 2 mm below the cementoenamel junction, the pulp chamber was sealed with flowable composite. The teeth were kept in PBS. Color was measured in the cervical and incisal halves before root canal treatment (RCT), one and six months after RCT, and after one, two and three years, with the Vita EasyShade spectrophotometer; positioned using an individualized splint. ΔEab and ΔE00 were calculated. Two-way ANOVA repeated measures test followed by Bonferroni post-test were performed to analyze the ΔL, Δa*, Δb*, ΔEab, and ΔE00, considering treatment groups and evaluation periods. Statistical significance was set at p < 0.05. ResultsIn the incisal half, in decreasing order of darkening, the groups at three years were ordered according to the ΔEab: AH Plus > NC > TotalFill > Bioroot. ΔE00 values were: 1.38 ± 0.61 NC, 2.37 ± 0.70 AH Plus, 1.86 ± 0.60 BioRoot and 1.53 ± 0.85 TotalFill. In the cervical half, the ΔEab values, showed the same descending order, except for Bioroot and TotalFill which alternated the order. The ΔE00 values were 1.86 ± 0.61 NC, 3.01 ± 0.70 AH Plus,1.89 ± 0.58 Bioroot and 1.65 ± 0.41 TotalFill, with no significant differences between groups and times in both locations. ConclusionsAll groups presented some degree of discoloration. Lightness and b* component were the most influential. Calcium silicate-based cements (Bioroot RCS and TotalFill BC Sealer) produced acceptable levels of discoloration at the end of follow-up.

Bioactivity analysis of calcium silicate-based sealers and repair cements on the phenotype and cytokine secretion profile of CD14+ monocytes: An ex vivo study.

This study evaluated the immune bioactivity of testing media (TM) obtained from different calcium silicate-based sealers and cements on monocyte morphology, activation, differentiation and cytokine secretion. Blood-derived CD14+ monocytes were isolated and cultured for 5 days with 25% TM from the following calcium silicate-based materials: TotalFill BC RRM Fast-Set Putty, Biodentine, TotalFill BC Sealer and BioRoot-Root-Canal-Sealer (RCS). A resin-based endodontic cement was used as a control. The expression of surface markers such as CD86, HLA-DR, CD16, CD309 and CD209, and cytokine secretion were analysed by flow cytometry. Data were analysed using the one-way repeated measures analysis of variance (anova) multiple comparison test and a Holm-Sidak multiple comparison post-hoc test (p < .05). This comparative analysis revealed that monocytes co-cultured with calcium silicate-based materials showed a spindle-shaped morphology compared with the round shape observed in the control. Regarding activation markers, BioRoot-RCS and Biodentine significantly increased CD86 expression compared with the control sample, whereas no significant differences (p > .05) were observed in HLA-DR expression. In addition, no differences were observed among the differentiation markers. When the inflammatory cytokines were analysed, BioRoot-RCS increased the secretion of IL-1β, IL-6, IL-10 and TNF-α, whereas BioRoot-RCS and Biodentine significantly decreased IL-8 production (p < .05). These data showed that the calcium silicate-based materials tested changed the morphology of CD14+ monocytes; however, only BioRoot-RCS and Biodentine significantly upregulated CD86. In addition, BioRoot-RCS was the sealer with the highest immunomodulatory properties for cytokine production which means that it can contribute with the in vivo healing process and regeneration of periapical lesions.

Short and Long-Term Solubility, Alkalizing Effect, and Thermal Persistence of Premixed Calcium Silicate-Based Sealers: AH Plus Bioceramic Sealer vs. Total Fill BC Sealer.

This study aimed to investigate the short- and long-term solubility, alkalizing potential, and suitability for warm-vertical compaction of AH Plus Bioceramic Sealer (AHBC), and Total Fill BC Sealer (TFBC) compared to the epoxy-resin sealer AH Plus (AHP). A solubility test was performed according to ISO specification 6876 and further similar to ISO requirements over a period of 1 month in distilled water (AD) and 4 months in phosphate-buffered saline (PBS). The pH of the immersion solution was determined weekly. Sealers were exposed to thermal treatment at 37, 57, 67, and 97 °C for 30 s. Furthermore, heat treatment at 97 °C was performed for 180 s to simulate inappropriate implementation of warm vertical filling techniques. Physical properties (setting time, flow, film thickness according to ISO 6876) and chemical properties (Fourier transformed infrared spectroscopy) were assessed. AHBC and TFBC were associated with significantly higher solubility than AHP over 1 month in AD and 4 months in PBS (p < 0.05). AHBC and TFBC both reached high initial alkaline pH, while TFBC was associated with a longer-lasting alkaline potential than AHBC. Initial pH of AHBC and TFBC was higher in AD than in PBS. None of the sealers were compromised by thermal treatment.

In Vitro Cytotoxicity and Mineralization Potential of an Endodontic Bioceramic Material.

The interest in bioceramic materials has been steadily growing for different applications in endodontics. With the continued introduction of new bioceramic-based materials into the market, it is of great importance to assess the biocompatibility before providing recommendations on their clinical use. This study evaluated the in vitro cytotoxicity and mineralization potential of two consistencies of unset premixed bioceramic material (TotalFill BC RRM putty and TotalFill BC sealer) compared with an epoxy resin-based sealer (AH Plus) on osteoblast cells. Overall, 100% extracts were obtained by weighing 0.1 g of each material in 1 mL of cell culture media. Primary human osteoblast (HOB) cells (n = 4) were treated with different concentrations (100, 50, 25, 12.50, and 6.25%) of each extract. XTT assay and Alizarin Red S staining were used to evaluate the cytotoxic effect and the biomineralization potential, respectively. Data were analyzed by one-way analysis of variance followed by Tukey's post hoc tests. The cytotoxicity assay after 24 h treatment showed that all materials at high concentrations of the extract (100 and 50%) were toxic to HOB (p < 0.001). On the contrary to TotalFill BC RRM Putty, AH Plus and TotalFill BC sealer were toxic at 25% concentration. However, at 12.5% concentration and lower, all materials were nontoxic. The mineralization potential analyzed after 7 and 14 days showed that TotalFill BC material-treated cells could deposit mineralized nodules in the normal and osteogenic medium unlike AH plus-treated cells. At low concentrations, TotalFill BC materials showed higher biocompatibility to HOB cells than AH Plus, enhanced the viability of the cells, maintained their typical morphology, and induced the formation of mineralized nodules. Despite the encouraging data, clinical trials are needed to identify the effect of this material on the long-term outcome of endodontic treatment.

A Micro-CT Analysis of Initial and Long-Term Pores Volume and Porosity of Bioactive Endodontic Sealers.

The evaluation of the porosities within the interface of root canals obturated with endodontics materials is extremely important for the long-term success of endodontic treatments. The aim of this study was to compare initial and long-term volume of pores (total, open, closed) and porosity (total, regional) of three bioactive endodontic sealers: GuttaFlow Bioseal, Total Fill BC Sealer, and BioRoot RCS. Root canals were obturated with three “bioactive” sealers using the single-cone technique. The volume of open and closed pores and porosity were calculated using a micro-computed tomography (MCT) method. The measurements were performed after 7 days (initial) and after 6 months (long-term) of incubation. Statistical significance was considered at p < 0.05. The total volume of pores remained unchanged after the 6-month storage. GuttaFlow Bioseal exhibited significantly higher long-term volume in open pores than Total Fill BC Sealer. The total porosity in all the tested sealers presented no statistically significant change after the 6-month storage, except for BioRoot RCS. The total porosity values of this latter material significantly increased after long-term incubation, especially in the apical region. In conclusion, the use of bioactive sealers with excessive tendency to create porosities both in shorth- and long-term periods of storage may compromise the long-term success of endodontic treatments.

Immediate and Long-Term Radiopacity and Surface Morphology of Hydraulic Calcium Silicate-Based Materials.

The present study aimed to evaluate and compare the radiopacity and surface morphology of AH Plus Bioceramic Sealer (AHPB), Bio-C Sealer (BIOC), Biodentine (BD), BioRoot RCS (BR), Grey-MTAFlow (GMF), White-MTAFlow (WMF), TotalFill BC Sealer (TF), and TotalFill BC Sealer HiFlow (TFHF) at different time moments—30 min, 24 h, and 28 days. Ten specimens of each material were prepared according to the ISO-6876:2012 standard and radiographed next to an aluminum step wedge using a digital sensor. The specimens were stored in a gelatinized Hank’s balanced salt solution at 37 °C between assessments. The mean grayscale values of each specimen were converted into equivalent aluminum thickness by a linear regression model. Characterization of the surface morphology was performed by using a scanning electron microscope at ×4.0k and ×10.0k magnifications. The radiographic analysis revealed that all the tested materials exceeded the ISO-specified limit of 3 mm Al, with the highest radiopacity presented by AHPB and the lowest by BD. None of the tested materials demonstrated considerable variances between the 30 min and the 24 h radiopacity level (p < 0.05), and statistically significant long-term radiopacity changes were exhibited by BR, TFHF, and TF (p > 0.05). All the specimens demonstrated a common feature of limited precipitate formation, with numerous unreacted particles still presented on the surface after 24 h, whereas the particle rearrangement and the deposition of precipitates were clearly observed after 28 days.

Intratubular penetration capacity of HiFlow bioceramic sealer used with warm obturation techniques and single cone: A confocal laser scanning microscopic study

ObjectiveThe aim of this paper was to evaluate the intratubular penetration area of a bioceramic sealer, using continuous wave (CW), vertical condensation (VC) with two different types of gutta-percha (conventional (NG) and bioceramic-coated (BG)) and single cone (SC) technique with BG gutta-percha, in different root thirds. MethodsA total of 150 mature single-root human teeth (including incisors, canines and premolars) were prepared and randomly divided into five groups (n = 30). Teeth were filled using a bioceramic sealer (TotalFill BC Sealer HiFlow ®) and two different types of gutta-percha, with CW and VC techniques, the teeth in the control group were filled with SC technique and BG gutta-percha. The teeth were sectioned and evaluated as one-third portions in each case under a confocal laser microscope. The penetration area measurements were carried out with the Autocad ® programme. Data was analyzed using the one-factor ANOVA test (p < 0.05) and Post Hoc Test (p < 0.05). ResultsThe ANOVA Test showed significant differences in the penetration areas of the five obturation techniques (P < 0.05). The Post Hoc Test exhibited significant differences in multiple comparisons (P < 0.05). There was more dentinal tubule penetration in the coronal third than in the apical third in all techniques. ConclusionsThe intratubular penetration of the bioceramic sealer was influenced by the obturation techniques tested, but not by the different gutta-percha tested. There was more penetration of sealer in the warm obturation techniques than the SC, regardless of the type of gutta-percha used.

Preparation and filling of small oval root canals: influence of file system and sealer.

To carry out a morphometric analysis of small oval root canals prepared with different instruments (part 1) and filled with different sealers (part 2). Ninety extracted mandibular incisors with small oval root canals were instrumented with Self-Adjusting File (n = 45), XP-endo Finisher (n = 15), GentleFile (n = 15), or Reciproc (n = 15). All groups of part 1 were filled with AH Plus (n = 15 each). For part 2 (including group Self-Adjusting File/AH Plus) teeth instrumented with Self-Adjusting File were additionally filled with GuttaFlow Bioseal (n = 15) or Total Fill BC sealer (n = 15). All sealers were placed with a lentulo and filled with master point and additional points. Serial cuts were made at 1-mm intervals up to 10 mm. Total root canal area, percentage of gutta-percha filled area (PGFA), sealer, voids, and debris were evaluated using interactive image analysis software. Preparation with Reciproc caused significantly wider canals than with Self-Adjusting File, GentleFile, or XP-endo Finisher, but also resulted in the greatest PGFA and lowest percentage of sealer (P ≤ .05). Following XP-endo Finisher, the significantly greatest percentage of debris (30%) was found 1 mm from the apex (P ≤ .05). Regarding different sealers, only minor differences were found (GuttaFlow Bioseal: less percentage of sealer at 2 and 3 mm levels [P ≤ .05]). Within the limits of this study Reciproc caused the greatest substance loss, but also the most favorable PGFA. The apical debris accumulation with XP-endo Finisher needs further investigation. The sealers under investigation performed equally well.

In vitro evaluation of cytotoxicity in human osteoblastic cells and antimicrobial activity in the biofilm of different root canal sealers

Objective: Evaluate the cytotoxicity in human osteoblastic cells and antimicrobial activity in different root canal sealers in vitro. Methods: BioRoot RCS, TotalFill BC Sealer, and Bio-C Sealer were used in experimental groups, and AH Plus was used as a control. Human osteoblast-like cells and MTT quantitative colorimetric assay were used to evaluate cytotoxicity. Saos-2 cells were exposed to undiluted sealer extracts for 24 h. The supernatant was then collected and the formazan crystals resulting from MTT reduction were dissolved in pure dimethyl sulfoxide. Absorbance was measured in an automated spectrophotometer at a wavelength of 540 nm. Antimicrobial activity was analyzed by the direct contact test using a polymicrobial biofilm composed of Enterococcus faecalis, Candida albicans, and Streptococcus mutans. At 24, 48, and 72 h, colony-forming units were counted on agar plates. A nonparametric Kruskal-Wallis test was used for the statistical analysis. The level of significance was set at 5%. Results: AH Plus showed the lowest cytotoxicity after 24 h, with a significant difference in relation to BioRoot RCS and Bio-C Sealer (p ≤ 0.01). There was no significant difference in cytotoxicity between TotalFill BC Sealer and Bio-C Sealer (p &gt; 0.05). At 24 h, TotalFill BC Sealer and AH Plus showed the least microbial growth compared to Bio-C Sealer (p &lt; 0.05). At 48 and 72 h, there were no significant differences between sealers (p &gt; 0.05). Conclusions: AH Plus had the lowest cytotoxicity. TotalFill BC Sealer and AH Plus yielded greater reductions in microbial counts in the first 24 h compared to Bio-C Sealer. Clinical Relevance: 2c.

Dentin Sealing of Calcium Silicate-Based Sealers in Root Canal Retreatment: A Confocal Laser Microscopy Study.

The aim of the present in vitro study was to evaluate the intratubular penetration of three bioceramic sealers in root canal retreatment. Here, 30 single-rooted human teeth were instrumented with the Protaper Universal system and filled with gutta-percha and the epoxy-resin-based sealer AH Plus mixed with rhodamine B. After two weeks in a humid environment, they were re-instrumented with Reciproc Blue and divided into three groups according to the endodontic sealer to be used in the re-filling (n = 10): G1: CeraSeal, G2: TotalFill BC Sealer, G3: TotalFill BC Sealer HiFlow. For the filling, a single cone technique was used, and the respective sealers were mixed with fluorescein. The roots were then sectioned at 2, 5, and 8 mm (apical, medial, and coronal measurement points, respectively) from the apex, and the dentinal tubule penetration depth and percentage of penetration around the canal perimeter were evaluated by means of confocal laser scanning microscopy (CLSM). Penetration between groups was compared using the Kruskal−Wallis test, and within each group using the Wilcoxon test. Statistical significance was established at p < 0.05. A non-significant reduction was found in the penetration depths and in a percentage of penetration around the canal perimeter between AH Plus and the tested calcium-silicate-based sealers (p > 0.05). Consequently, this reduction may not affect the three-dimensional seal of the root canal system in a negative manner. The penetration depth and percentage of penetration around the canal perimeter at both the root canal treatment and retreatment were significantly reduced from the coronal to apical points in all groups (p < 0.05).

Radiopacity of premixed and two-component Calcium silicate-based Root Canal sealers

Background/Aim: Radiopacity enables radiographic visualization, which is significant in diagnostic procedures and assessment of the quality of endodontic filling. It is important to compare newly developed endodontic sealers with materials that are already in clinical use in order to promote evidence-based dentistry. The aim of our study was to evaluate radiopacity of different calcium silicate-based sealers in comparison with control, epoxy resin-based sealer. The null hypothesis was that there were no statistically significant differences in radiopacity of the tested sealers. Material and Methods: Premixed (TotalFill BC Sealer, EndoSequence BC Sealer, Ceraseal, Bio-C Sealer), two-component (BioRoot RCS, MTA Fillapex, Bioceramic Root Canal Sealer, GuttaFlow Bioseal) calcium silicate-based sealers and AH Plus, as a control, were used. Specimens were radiographed using a Radiovisiography (RVG-4) CCD (charge-coupled devices)-based digital sensor. Results: Ceraseal had the highest, while Bioceramic Root Canal Sealer had the lowest radiopacity. Bioceramic Root Canal Sealer and MTA Fillapex had radiopacity significantly lower than all other sealers. Radiopacity level of AH Plus, was similar to premixed and significantly higher than radiopacities of all two-component endodontic sealers. Conclusions: Calcium silicate-based sealers radiopacity ranged from slightly above minimal required value (3mm), to a value higher than control sealer. Premixed endodontic sealers showed similar radiopacity as AH Plus which suggests that their clinical performance, in terms of visibility on dental radiograms, should be similar

Intratubular penetration ability in the canal perimeter using HiFlow bioceramic sealer with warm obturation techniques and single cone.

BackgroundThe aim of this paper was to evaluate the intratubular penetration percentage in the perimeter of the canals of the calcium silicate-based sealer HiFlow, using three warm obturation techniques, continuous wave (CW) and vertical condensation (VC) with two different types of gutta-percha (conventional (NG) and bioceramic-coated (BG), GuttaCore (GC) and single cone (SC) with BG in different root thirds. Material and Methods180 human teeth with a single root were selected including incisors, canines and premolars were prepared and randomly divided into six groups (n=30). Teeth were filled using a bioceramic sealer TotalFill BC Sealer HiFlow (HiFlow) and two different types of gutta-percha, with CW, VC and GC techniques, the teeth in the control group were filled with SC technique and BG gutta-percha. The teeth were sectioned and evaluated as one-third portions in each case under a confocal laser microscope. The penetration ability in the canal’s perimeter was carried out with the Autocad® programme. Data was analyzed using Levene’s test (p<0,05), ANOVA test (p<0,05), Welch’s comparison test (p<0,05), Games-Howell multiple comparison test (p<0,05), Bonferroni test (p<0,05). ResultsThe percentages relative to penetration was higher in the warm obturation techniques than the SC in all thirds evaluated. Games-Howell test (p<0,05) showed up significant differences in multiple comparisons. There was greater penetration in the perimeter of the canals in the coronal third than in the apical third in all of the techniques. ConclusionsThe warm obturation techniques (CW, VC and GC) generated a greater intratubular penetration percentage in the canal perimeter of the sealer than the single cone in all thirds. Key words:HiFlow, calcium silicate-based sealer, confocal laser microscope, dentinal tubules.

In vitro antibacterial activity of endodontic bioceramic materials against dual and multispecies aerobic-anaerobic biofilm models.

The aim of this invitro study was to evaluate the antibacterial activity of calcium silicate repair cements and sealers against a dual-species planktonic aerobic model with different aging times and the ability to inhibit the formation of a mature 21-day-old multispecies anaerobic biofilm. The antibacterial activity of ProRoot MTA, MTA Angelus, Biodentine, BioRoot RCS and TotalFill BC sealer against a dual-species aerobic planktonic model, as well as measuring how materials were affected by aging, was evaluated using the Modified Direct Contact Test. Subsequently, the ability to inhibit the formation of a mature multispecies anaerobic biofilm was evaluated using scanning electron microscopy complemented with confocal laser scanning microscopy. Biodentine and BioRoot RCS had higher antibacterial action, and Biodentine was able to maintain its antibacterial action after a prolonged aging period invitro. Calcium silicate repair cement MTA ProRoot and Biodentine had higher antibiofilm action.

Minimal Dentinal Tubule Penetration of Endodontic Sealers in Warm Vertical Compaction by Direct Detection via SEM Analysis.

Sealer staining using rhodamine B dye to investigate the penetration depth of endodontic sealers was proven unsuitable for this purpose. This study aimed to investigate the sealer penetration depth into dentinal tubules by scanning electron microscopy (SEM). Root canals of 52 human upper central incisors were instrumented using the ProTaper Gold NiTi system (Dentsply Sirona, York, PA, USA) up to size F3. After irrigation with sodium hypochlorite and citric acid combined with ultrasonic activation, the root canals were either filled using the epoxy resin sealer AH Plus (Dentsply Sirona) or the calcium silicate-based sealer Total Fill BC Sealer HiFlow (TFHF, FKG Dentaire, La Chaux-de-Fonds, Switzerland) by warm vertical compaction. Root slices of 1 mm thickness were obtained at 2 to 3, 5 to 6 and 8 to 9 mm from the apex. The root slices were investigated for sealer penetration into the dentinal tubules using SEM according to four root quadrants (buccal, mesial, oral, distal). Statistical analysis was performed by the Kruskal-Wallis test (p = 0.05) as data were not normally distributed according to the Shapiro-Wilk test. AH Plus penetrated significantly deeper into the dentinal tubules compared to TFHF at each root level (p < 0.05). Dentinal sealer penetration was deeper in the bucco-oral direction compared to the mesio-distal direction. AH Plus penetrated deeper into dentinal tubules than TFHF. Warm vertical compaction exerting high pressure on the root canal filling material is not able to press sealers deep into dentinal tubules as penetration depth values did not exceed a mean of 110 µm in SEM.

Influence of Root Canal Sealers and Obturation Techniques on Vertical Root Fracture Resistance. An In Vitro Experiment

The aim of the present study was to determine the vertical root fracture (VRF) resistance of roots obturated with TotalFill BC Sealer and AH Plus sealer using lateral condensation and single cone techniques in comparison to untreated controls. Sixty single rooted mandibular premolars were sectioned and divided into six groups. Ten teeth were left untreated (positive control-Gp 1) and fifty teeth were cleaned and shaped. Ten root specimens were left unfilled (negative control-Gp 2) and the remaining roots were divided into 4 groups. Gp 3, GP and AH Plus sealer (AH Plus) using the cold lateral compaction (LC) technique; Gp 4, GP and AH Plus using the Single Cone (SC) technique; Gp 5: TotalFill GP and TotalFill BC sealer using the LC technique; Gp 6: TotalFill GP and TotalFill BC sealer with SC. VRF was performed for all specimens using a universal testing machine. Analysis of variance (ANOVA) and Tukeys post-hoc multiple comparison test was used to compare the means among tested study groups. Group 1 (positive control) displayed the highest fracture resistance (946.61 ± 166.465 N); however, the lowest fracture strength was demonstrated by the specimens in group 2 (negative control) (433.31 ± 129.350 N). Specimens treated with AH plus using different obturation techniques (group 3 and 4) showed comparable outcomes (p &gt; 0.05). Similarly, specimens treated with TotalFill BC sealer with different obturation techniques showed statistically similar outcomes (p &gt; 0.05). It was also observed that specimens in groups 3, 4, 5 and 6 demonstrated comparable outcomes of fracture strength (p &gt; 0.05). The use of TotalFill-BC sealer showed similar vertical root fracture resistance as AH plus sealer in root canal treated teeth. Use of total fill-BC and AH Plus sealer in root canal treatment showed vertical root fracture resistance comparable to untreated natural teeth (positive controls).

Physicochemical Properties, Cytocompatibility and Antibiofilm Activity of a New Calcium Silicate Sealer.

The aim of this study was to evaluate the physicochemical properties, cytocompatibility and antibiofilm activity of a new calcium silicate-based endodontic sealer, Sealer Plus BC (MK Life, Brazil), in comparison with TotalFill BC Sealer (FKG Dentaire SA, Switzerland) and AH Plus (Dentsply, Germany). Setting time and flow were evaluated based on ISO 6876 standard. The pH was evaluated after different periods, and radiopacity by radiographic analysis (mmAl). Solubility (% mass loss) and volumetric change (by micro-CT) were assessed after 30 days of immersion in distilled water. Cytocompatibility was assessed by methyltetrazolium (MTT) and neutral red (NR) assays, after exposure of Saos-2 cells to the sealer extract for 24 h. An additional analysis was performed by using MTT assay after 1, 3 and 7 days of exposure of Saos-2 to the sealers 1:8 dilution extracts. Antibiofilm activity against Enterococcus faecalis and/or Candida albicans was evaluated by crystal violet assay and modified direct contact test. The physicochemical properties were analyzed using ANOVA/Tukey tests; MTT and NR data were analyzed by ANOVA and Bonferroni tests; the antimicrobial tests were analyzed by Kruskal-Wallis and Dunn tests (α=0.05). Sealer Plus BC had proper setting time, radiopacity, flow and alkalization capacity. Sealer Plus BC was significantly more soluble than AH Plus (p<0.05) and presented volumetric change similar to AH Plus and TotalFill BC (p>0.05). Sealer Plus BC presented antibiofilm activity and no cytotoxic effect. In conclusion, although Sealer Plus BC had higher solubility, this sealer showed proper physicochemical properties, cytocompatibility, and antibiofilm activity.

The influence of different root canal irrigants on the push-out bond strength of AH plus and Bioceramic sealers

Background: The bond strength of endodontic sealers with dentin is a very important property for maintaining the integrity and seal of the root canal filling. The aim of this study was to evaluate and compare the effect of various irrigants (QMix, 17% EDTA and 2.5% NaOCl) on the push-out bond strength of AH plus and Bioceramic sealers. Materials and methods: Forty eight freshly extracted maxillary first molars human teeth with striaght palatal root were used in the study. The collected samples were randomly divided into three groups of equal sample size (n=16), according to the final irrigation regimen as follows: Group (1): QMix 2 in 1, Group (2): 17% ethylenediaminetetraacetic acid, Group (3): 2.5% sodium hypochloride. All samples were instrumented using Edge file X7 rotary instrument reaching file size 40/.04 as the final master apical file. After that each group was randomly divided into two subgroups (n=8) according to the type of sealer used: AH Plus and Total Fill BC Sealer. Obturation was conducted using single cone technique with gutta percha (GP) to all experimental roots. Two-millimeter thick slices were obtained from the middle section of the root. Bond strength of sealers was measured via a universal testing machine by using stainless steel plunger. Then, the data were statistically evaluated using two-way analysis of variance (ANOVA) and post hoc test (Bonferroni’s test). Results: The push-out bond strength was significantly increased by the “irrigant” factor (P≤0.05) and by “sealer/irrigation solution” interaction (P≤0.05). Final rinse with QMix solution with BC sealer showed the highest mean value of bond strength (5.976 MPa), with a significant difference with other groups (P≤0.05), while NaOCl with AH Plus sealer showed the lowest mean value of bond strength (3.811 MPa). Conclusion: Final irrigation of the root canals with different irrigants improved the endodontic sealer's bond strength, and QMix had a positive influence on the adhesion of BC sealer.

Efficacy of XP-endo Finisher-R in enhancing removal of bioceramic sealer from oval root canal: a micro CT study

Aim: To investigate the efficacy of the XP-endo Finisher-R (XP-FR) and manual H-filing in enhancing the removal of Totalfill BC sealer from oval root canals. Methodology: Forty mandibular incisors were prepared using ProTaper Next up to file X3 then filled with warm vertical condensation using Totalfill BC sealer. The volume of the root canal filling post-obturation and the remaining volume post-retreatment using Mani NRT-GPR system were assessed using Micro-CT (µ-CT). The total volume in 3 mm was calculated from the cervical line till the root apex using the CT-an software. Specimens were randomly divided into two equal groups n=20 according to the supplementary approach of gutta percha removal used; where Group I: XP-FR was used for 1 min, and Group II: size 30 H-file was used in a filing motion for 1 min. Specimens were again scanned using µ-CT and the remaining gutta percha volume was calculated. Data were statistically analyzed using Wilcoxon, Man-Whitney, Friedman tests with significance level of 5%. Results: Significant reduction of the remining filling material was recorded post-retreatment with percentage of reduction of 63.34%, 78.53%, and 66.21% at the apical, middle, and coronal thirds respectively using Mani NRT-GPR system. Supplementary removal approaches significantly improved filling material removal (P<0.05). XP-FR removed significantly more filling material than manual H-filing with percentage of filling material reduction of 52.22%, 34.92%, and 40.60% compared to 21.89%, 18.43%, 31.72% in the apical, middle, and coronal thirds (Man-Whitney test, P<0.001). Conclusions: Rotary retreatment files failed to totally remove the root canal filling material. Supplementary methods have improved root canal filling material removal; where XP-FR significantly removed more filling than manual H-filing.

Debunking the Concept of Dentinal Tubule Penetration of Endodontic Sealers: Sealer Staining with Rhodamine B Fluorescent Dye Is an Inadequate Method.

The aim of this study was to investigate the suitability of rhodamine B dye staining of an epoxy resin sealer (AH Plus) and calcium-silicate-based sealers (Total Fill BC Sealer, BioRoot RCS) to represent the penetration depth of the sealers into dentinal tubules after root canal obturation. In a three-step process, (1) leaching of rhodamine B from sealers into a buffer solution, (2) passive penetration of leached rhodamine B into dentinal tubules, and (3) conformity of rhodamine B penetration assessed by confocal laser scanning microscopy (CLSM), and sealer penetration assessed by scanning electron microscopy (SEM), in root-canal-filled teeth, were evaluated. Rhodamine B dye massively leached out of Total Fill BC Sealer and BioRoot RCS into the phosphate-buffered saline (PBS). A pinkish coloration of AH Plus was found after contact with PBS. Leached rhodamine B dye passively penetrated dentinal tubules from all three sealers when placed on root dentin. No correlation was observed between sealer penetration in SEM and rhodamine B penetration in CLSM. Staining of sealers using rhodamine B is an inadequate method with which to evaluate sealer penetration depth into dentinal tubules, as it overestimates the penetration of sealers into root dentin tubules.