TotalFill BC Sealer Research Articles

Impact of various endodontic sealers on HPDLF Cell viability and apoptosis

This study aimed to investigate the cytotoxicity and apoptotic activity of different endodontic sealers: Sealapex, Apexit Plus, AH Plus, MTA-Fillapex and TotalFill BC Sealer in the culture of human periodontal ligament fibroblast (HPDLF) cells. The sealers were mixed, set for 24 h, and then covered with culture medium to obtain extracts, which were diluted to 1:0, 1:1, 1:2, 1:4, and 1:8. Simultaneously, HPDLF cells (1 × 104) were seeded in 96-well plates and incubated for 24 h at 37 °C 5% CO2 conditions. The cells were then exposed to 100 µL of diluted extract medium. Cytotoxicity was evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay to check cell viability, while apoptosis was assessed by TUNEL assay. Statistical analyses were performed using Kruskal-Wallis and Dunn post hoc tests with Mann Whitney U. In MTT and TUNEL assay cells were treated with sealers both 24 and 72 h. All materials showed higher toxicity at 72 h compared to 24 h. AH Plus exhibited the highest cytotoxicity, followed by MTA-Fillapex, Apexit Plus, Sealapex, while TotalFill BC Sealer had the lowest cytotoxicity. Consuquently, it was considered that TotalFill BC Sealer had the lowest cytotoxic potency when compared to other sealers, so it can be considered biocompatible.

Effect of a novel irrigation regimen and root canal filling material versus conventional endodontic protocols on dentin wettability.

The purpose of this study was to compare the effect of different irrigation regimens on the dentin wettability of root canal sealers. The occlusal surfaces of human molar teeth (N = 90) were removed, polished, and divided into three groups (n = 30) based on the irrigation regimen: control group (SAL), standard irrigation group (NES), and test group (ODC). Each group was randomly divided into three subgroups according to the root canal sealer: AH Plus (AHP), Total Fill BC Sealer HiFlow (TOT), and OdneFill (ODF). The contact angle was determined using the sessile drop technique. The pendant droplet method assessed the work of adhesion. Surface roughness was measured using atomic force microscopy. Data were analyzed using non-parametric tests (p < .05). ODC-ODF showed significantly lower contact angle (34.80°) than ODC-AHP (66.53°, p < .001) and ODC-TOT (85.72°, p < .001). In NES, no significant difference was found between ODF and AHP (p > .05) while both groups presented significantly lower results than TOT (p < .001, p < .001, respectively). In SAL, the difference between TOT (92.84°) and AHP (83.24°) was insignificant (p > .05), whereas ODF presented significantly lower results compared to both (p < .001, p < .001, respectively). Surface roughness was lowest in ODC (31.54nm), followed by SAL (62.30nm) and NES (72.02 nms) which was significantly (p = 0.006) higher than ODC, whereas the difference between SAL and NES was insignificant (p > .05). This study highlights the wettability of a new root canal sealer and the effect of a new irrigation activation system on the wettability of different root canal sealers. OdneFill showed superior wettability compared to other sealers while exhibiting a synergistic effect with OdneClean.

A Comparison of Two Fluorescent Stains for the Evaluation of Bioceramic Sealer Penetration into the Tubular Dentine Using Confocal Microscopy

This study aimed to compare the percentage of bioceramic sealer penetration and maximum penetration sealer depending on the fluorescent staining method when evaluated with confocal laser scanning microscopy (CLSM). In total, 42 single-rooted premolars were instrumented. Two groups of 20 teeth each were filled using the single cone technique. TotalFill BC Sealer® mixed with Rhodamine B was used for the first group and TotalFill BC Sealer® mixed with Fluo-3 for the second group. Two teeth made up the control group. All teeth were sectioned at 3 and 6 mm from the apex and were analyzed with CLSM. The canal perimeter where the tubular penetration happened and the maximum penetration of each sample were calculated. There were no significant differences between the two groups in either the apical or medial sections. In terms of maximum penetration, Rhodamine B had greater tubular penetration in the apical sections, and it had similar results to Fluo-3 in the medial sections. TotalFill BC Sealer® has a higher tubular penetration in the medial slices than in the apical slices regardless of the fluorescent stain used. Rhodamine B has higher results than Fluo-3 in terms of the percentage of sealer penetration and maximum penetration.

Biocompatibility, bioactivity, porosity, and sealer/dentin interface of bioceramic ready-to-use sealers using a dentin-tube model

This study evaluated the biocompatibility, bioactivity, porosity, and sealer/dentin interface of Sealer Plus BC (SP), Bio-C Sealer (BIOC), TotalFill BC Sealer (TF), and AH Plus (AHP). Dentin tubes filled with the sealers and empty tubes (control group) were implanted in the subcutaneous tissue of rats for different periods (n = 6 per group/period). Number of inflammatory cells (ICs), capsule thickness, von Kossa reaction, interleukin-6 (IL-6) and osteocalcin (OCN) were evaluated. Porosity and voids in the interface dentin/sealers were assessed by micro-computed tomography. The data were submitted to ANOVA/Tukey’s tests (α = 0.05). Greater capsule thickness, ICs and IL-6 immunolabeling cells were observed in AHP. No significant difference in thickness of capsule, ICs, and IL-6- immunolabeling cells was detected between SP and TF, in all periods, and after 30 and 60 days between all groups. At 60 days all groups had reduction in capsule thickness, ICs and IL-6 immunolabeling cells. Von Kossa-positive and birefringent structures were observed in the capsules around the sealers. BIOC, SP, and TF exhibited OCN-immunolabeling cells. All sealers had porosity values below 5%, besides low and similar interface voids. BIOC, SP and TF are biocompatible, bioactive, and have low porosity and voids. The dentin-tube model used is an alternative for evaluating bioceramic materials.

Biocompatibility, bioactivity and immunomodulatory properties of three calcium silicate-based sealers: an in vitro study on hPDLSCs

ObjectivesTo assess the biocompatibility, bioactivity, and immunomodulatory properties of three new calcium silicate cement-based sealers: Ceraseal (CS), Totalfill BC Sealer (TFbc) and WellRoot ST (WR-ST) on human periodontal ligament stem cells (hPDLSCs).Materials and methodsHPDLSCs were isolated from extracted third molars from healthy patients. Eluates (1:1, 1:2, and 1:4 ratio) and sample discs of CS, TFbc and WR-ST after setting were prepared. A series of assays were performed: cell characterization, cell metabolic activity (MTT assay) cell attachment and morphology (SEM assay), cell migration (wound-healing assay), cytoskeleton organization (phaloidin-based assay); IL-6 and IL-8 release (ELISA); differentiation marker expression (RT-qPCR assay), and cell mineralization (Alizarin Red S staining). HPDLSCs cultured in unconditioned (negative control) or osteogenic (positive control) culture media were used as a comparison. Statistical significance was established at p < 0.05.ResultsAll the tested sealers exhibited similar results in the cytocompatibility assays (cell metabolic activity, migration, attachment, morphology, and cytoskeleton organization) compared with a negative control group. CS and TFbc exhibited an upregulation of at least one osteo/cementogenic marker compared to the negative and positive control groups. CS and TFbc also showed a significantly higher calcified nodule formation than the negative and positive control groups. Both the marker expression and calcified nodule formation were significantly higher in CS-treated cells than TFbc treated cells. WR-ST exhibited similar results to the control group. CS and TFbc-treated cells exhibited a significant downregulation of IL-6 after 72 h of culture compared to the negative control group (p < 0.05).ConclusionAll the tested sealers exhibited an adequate cytocompatibility. CS significantly enhances cell differentiation by upregulating the expression of key genes associated with bone and cementum formation. Additionally, CS was observed to facilitate the mineralization of the extracellular matrix effectively. In contrast, the effects of TFbc and WR-ST on these processes were less pronounced compared to CS. Furthermore, both CS and TFbc exhibited an anti-inflammatory potential, contributing to their potential therapeutic benefits in regenerative endodontics.Clinical relevanceThis is the first study to compare the biological properties and immunomodulatory potential of Ceraseal, Totalfill BC Sealer, and WellRoot ST. The results act as supporting evidence for their use in root canal treatment.

Premixed calcium silicate-based ceramic sealers promote osteogenic/cementogenic differentiation of human periodontal ligament stem cells: A microscopy study.

To evaluate the effects of premixed calcium silicate based ceramic sealers on the viability and osteogenic/cementogenic differentiation of human periodontal ligament stem cells (hPDLSCs). The materials evaluated were TotalFill BC Sealer (TFbc), AH Plus Bioceramic Sealer (AHPbc), and Neosealer Flo (Neo). Standardized discs and 1:1, 1:2, and 1:4 eluates of the tested materials were prepared. The following in vitro experiments were carried out: ion release, cell metabolic activity 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, cell migration, immunofluorescence experiment, cell attachment, gene expression, and mineralization assay. Statistical analyses were performed using one-way ANOVA followed by Tukey's post hoc test (p < .05). Increased Ca2+ release was detected in TFbc compared to AHPbc and Neo (*p < .05). Biological assays showed a discrete cell metabolic activity and cell migration in Neo-treated cell, whereas scanning electronic microscopy assay exhibited that TFbc group had a better cell adhesion process of substrate attachment, spreading, and cytoskeleton development on the niche-like structures of the cement than AHPbc and Neo. The sealers tested were able to induce overexpression of the CEMP-1, ALP, and COL1A1 genes in the first days of exposure, particularly in the case of TFbc (***p < .001). All materials tested significantly increased the mineralization of hPDLSCs when compared to the negative control, although more pronounced calcium deposition was observed in the TFbc-treated cells (***p < .001). Our results suggested that TFbc promotes cell differentiation, both by increasing the expression of key osteo/odontogenic genes and by promoting mineralization of the extracellular matrix, whereas this phenomenon was less evident in Neo and AHPbc. RESEARCH HIGHLIGHTS: TFbc group had a better cell adhesion process of substrate attachment, spreading, and cytoskeleton development on the niche-like structures of the cement than AHPbc and Neo. The sealers tested were able to induce overexpression of the CEMP-1, ALP, and COL1A1 genes in the first days of exposure, particularly in the case of TFbc. All materials tested significantly increased the mineralization of hPDLSCs when compared to the negative control, although more pronounced calcium deposition was observed in the TFbc-treated cells.

In Vitro Cone Beam CT Analysis of the Efficacy of Three Supplementary Steps In the Removal of Obturation Material in Endodontic Retreatment.

To evaluate and compare the efficacy of XP-endo Finisher R (FKG Dentaire, Le Locle, Neuchatel, Switzerland), EDDY (VDW Dental, Munich, Germany), and passive ultrasonic irrigation (PUI) as supplementary steps following the D-RaCe retreatment file system (FKG Dentaire) in the removal of root canal obturation material using cone beam CT. A total of 45 two-rooted permanent maxillary first premolars were selected. Following access preparation, cleaning, and shaping with Hero Shaper (Micro Mega,Besançon, BFC, France)rotary file up to 25/04%, thermoplasticized obturation was performed with TotalFill BC sealer (FKG Dentaire) and gutta-percha. The specimens were subjected to routine retreatment using the D-RaCe retreatment file system. Cone beam computed tomography (CBCT) and volumetric analysis were performed before and after this procedure. The samples were divided into group A (XP-endo Finisher R: n=15), group B (EDDY: n=15), and group C (PUI: n=15). Finally, a third CBCT was taken and a volumetric analysis was done. Statistical analysis was done using SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA). The lowest mean residual volume of obturation material was seen with XP-endo Finisher R (1.6 mm3), followed by PUI (1.7 mm3). The EDDY showed the least efficiency in complete debridement of the root canals (3.6 mm3). This difference in values was statistically significant. The XP-endo Finisher R and PUI showed superior performance than EDDY in the removal of remaining obturation material from the root canal system after retreatment with the D-RaCe retreatment file system. However, none of the systems were able to completely remove the root canal obturation materials.

Assessment of the anti-inflammatory and biological properties of Bioroot Flow: A novel bioceramic sealer.

IntroductionBioRoot Flow (BRF) is a novel premixed bioceramic sealer indicated for endodontic treatments, but the biological and immunomodulatory effects of this endodontic sealer on human periodontal ligament stem cells (hPDLSCs) have not been elucidated. MethodsTo ascertain the biological impact of BRF, TotalFill BC Sealer (TFbc), and AH Plus (AHP) on human Periodontal Ligament Stem Cells (hPDLSCs), assessments were conducted to evaluate the cytocompatibility, cellular proliferation, migratory capacity, osteo/cementogenic differentiation potential, the ability to form mineralized nodules, and the immunomodulatory characteristics of hPDLSCs following treatment with these endodontic sealers. ResultsBiological assays showed adequate cell metabolic activity and cell migration in BRF, while SEM assay evidenced that TFbc and BRF groups demonstrated a superior cell adhesion process, including substrate adhesion, cytoskeleton development, and spreading on the niche-like structures of the cement as compared to the AHP group. TFbc and BRF-treated groups exhibited a significantly lower IL6 and IL8 production than AHP (* p <.05). The bioceramic sealers stimulated heightened expression of BSP, CEMP-1, and CAP genes within a 7–14 day period. Notably, BRF and TFbc demonstrated a significant enhancement in the mineralization of hPDLSCs when compared to the negative control. Among these, cells treated with BRF showed a more substantial accumulation of calcium (*** p < .001). ConclusionsTaken together, these findings indicate that BRF can potentially enhance cell differentiation by promoting the expression of essential genes related to bone and cement formation. In addition, BRF and TFbc displayed anti-inflammatory effects.

The Impact of Citric Acid Solution on Hydraulic Calcium Silicate-Based Sealers and Root Dentin: A Preliminary Assessment.

Hydraulic calcium silicate-based (HCS) sealers have recently gained tremendous popularity due to their unique properties. However, their removal during endodontic retreatment is challenging. The solvent, which could chemically deteriorate the material, would be highly desirable for endodontic retreatment procedures. This preliminary study assessed the interplay and dissolving capability of 10% and 20% citric acid, compared to 17% EDTA, on commonly used HCS sealers (AH Plus Bioceramic Sealer, Bio-C Sealer, BioRoot RCS, TotalFill BC Sealer), and evaluated the potential impact of these solutions on root dentin structure. The interaction between tested sealers and irrigating solutions was photographed, and solubility-related mass changes were determined. The surface morphology of treated filling materials and dentin was evaluated using a scanning electron microscope (SEM). One-way analysis of variance (ANOVA) along with Tukey's test were used to detect the statistically significant differences among groups at the confidence level of 0.95. Intense gas release was observed during the interaction of HCS materials and citric acid, with no evidently visible "bubbling" after the immersion in EDTA. The mass loss of HCS sealers equally confirmed the significantly higher dissolving characteristics of 10% and 20% citric acid solutions compared to EDTA. The surface structural changes, associated with pore and crack formation, were mainly seen for HCS sealers exposed to citric acid. Meanwhile, no severe erosion was detected for dentin after root canal preparation with 10% and 20% citric acid solutions. These findings demonstrate that citric acid has the potential to dissolve HCS sealers with minimal or no negative impact on root dentin, suggesting citric acid as a solvent for HCS sealers in endodontic retreatment procedures.

Bioceramic and Resin-Based Sealers Removal Using XP-Endo Finisher: A Scanning Electron Microscopy Study

Abstract Objectives The aim of this study was to evaluate remaining filling materials of a bioceramic sealer (TotalFill BC sealer) and an epoxy resin sealer (AH Plus) after retreatment using a supplementary instrumentation (XP-endo Finisher). Materials and Methods Forty single-rooted teeth were selected for the study. The teeth were instrumented using ProTaper system and randomly divided into two groups (n = 20). Then they were obturated with either TotalFill BC/gutta-percha or AH Plus/gutta-percha using lateral compaction technique. Canals were retreated using ProTaper retreatment files and a solvent. The groups were subdivided (n = 10) according to the application or not of the XP-endo Finisher as a final step of retreatment. All roots were cleaved longitudinally and examined under scanning electron microscope to evaluate root canal filling remnants. A scoring system was utilized to quantify the amount of residual filling material at the three predetermined portions of each root canal.Statistical analysis was performed using IBM SPSS.25 with a significant value p &lt; 0.05. Data were compared using the Mann–Whitney test and Kruskal–Wallis test. Results There was no statistically significant difference in the remaining filling materials for each third of the root canal after initial retreatment procedure between the TotalFill group and AH Plus group. Similar results were observed among the TotalFill groups with or without the application of XP-endo Finisher supplementary step. However, the remaining filling materials of AH Plus in the middle third of root canal were significantly less after the XP-endo Finisher application (p = 0.015). Conclusion No retreatment protocol tested in this study allowed the total elimination of root canal filling materials. The residual root canal filling materials is similar for the bioceramic and resinous sealers. The XP-endo Finisher is not effective in improving the removal of bioceramic root canal filling material while it is able to improve the removal of resinous cement.

Evaluation of cytotoxicity and adaptability of a novel bioceramic root canal sealer: An in vitro and scanning electron microscope study.

Cytotoxicity and adaptability are among the highly imperative tests that should be performed on a novel endodontic material to ensure its successful implementation in endodontic treatment. Assess a recently introduced bioceramic root canal sealer CeramoSeal with TotalFill BC and AH plus sealers regarding the cytotoxicity and adaptability. Five sealer discs were prepared for each sealer and their extracts were cultured in 96-well plates containing human fibroblasts for 24 h. After their incubation, MTT solution was added to each well plate using an enzyme-linked immunosorbent assay plate reader was implemented to calculate the percentage of viable cells. Thirty mandibular single-rooted premolars were prepared using the Edge Endo rotary system, teeth were divided into three groups (n = 10) based on the sealer type: Group 1 CeramoSeal, Group 2 Totalfill, and Group 3 AH plus sealer. Teeth were sectioned longitudinally and viewed under a scanning electron microscope where the region with the gaps was identified and quantified as a percentage of the root canal's overall area. One-way ANOVA test was used for cytotoxicity, while Kruskal-Wallis and Friedman's tests were used for adaptability. Ceramoseal statistically significantly showed the lowest viability, at high concentrations AH plus showed the highest cell viability, while at lower concentration Totalfill BC sealer showed the highest cell viability percentage. The gap percentages were statistically significantly higher in Ceramoseal group, there was no statistically significant difference between AH Plus and Totalfill groups. Ceramoseal sealer exhibited the lowest viability and highest gap percentage compared to the other sealers.

Characterization and Assessment of Physical Properties of 3 Single Syringe Hydraulic Cement–based Sealers

IntroductionA number of sealers with different chemistries are badged as Bioceramic, implying biological activity, but have dissimilar properties, which has implications on the sealer properties and will affect the quality and outcome of root canal treatment. This study aimed to assess the physical and chemical properties of 3 hydraulic cement–based sealers, namely BC Universal sealer compared with Totalfill BC sealer and AH Plus Bioceramic. MethodsThe microstructure and composition of the sealers were assessed using scanning electron microscopy and energy dispersive spectroscopy after setting. The crystalline phases were assessed by X-ray diffraction analysis and the leachates were tested using inductively coupled plasma. All testing was performed at 0, 7, and 28 days. The physical properties of film thickness, flow, radiopacity, and solubility were evaluated using ISO 6876:2012 standards. ResultsAll 3 sealers contained calcium, zirconium, and silicon. Totalfill BC had the highest calcium release at 7 and 28 days followed by AH Plus Bioceramic and BC Universal sealer. All 3 sealers adhered to the ISO standard in terms of flow and radiopacity. BC Universal sealer was slightly over the range (>50 μm) for film thickness. All sealers exceeded the solubility range set by ISO 6876:2012. ConclusionAlthough these hydraulic cement sealers had similar components and delivery, the properties varied significantly. The testing of material properties to confirm the suitability for clinical use is necessary.

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.

The effect of sealer type and obturation technique on the fracture resistance of endodontically treated roots.

This study evaluated the effect of sealer type with various obturation techniques on the fracture resistance of root filled teeth. Eighty mandibular premolars were collected, and root canals of 70 of them were prepared by Mtwo system up to 40/04. Thirty teeth were obturated using TotalFill BC sealer, and 30 using AH Plus sealer, with one of the obturation techniques (N = 10), namely cold lateral compaction (CLC), warm vertical compaction (WVC), and single cone (SC). Ten teeth were left without obturation as a positive control, and the other 10 teeth were not prepared serving as a negative control. Teeth were stored for 3weeks, and the crowns were separated and the roots were subjected to fracture test using a universal testing machine. Data was analyzed by ANOVA followed by Tukey's test. Fracture resistance of the TotalFill groups was significantly higher than the AH Plus groups in each obturation technique, and SC had the highest fracture resistance regardless of sealer used (P < 0.05). Obturation of the root canal by TotaFill BC sealer increased the calcium/phosphorous ratio in the dentin of the root. Obturation with TotalFill BC sealer improved the fracture resistance of the roots more than AH Plus sealer, and obturation with SC resulted in higher fracture resistance than CLC and WVC. Obturation of the root canal with Bioceramic sealer with single cone obturation technique could reduce the incidence of vertical root fracture.

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.

Fracture resistance and failure pattern of endodontically treated maxillary premolars restored with transfixed glass fiber post: an in vitro and finite element analysis

The aims of the study were to determine the effect of different types of endodontic sealers and the presence of a horizontal glass fiber post (HGFP) on the fracture resistance and fracture pattern of mesio-occluso-distal (MOD) restored upper premolars and to analyze the stress distribution. Sixty extracted upper premolars received root canal treatment (RCT) and a MOD cavity preparation. All MOD cavities were restored with the same composite resin (CR). The 60 teeth were divided randomly into 6 groups (n = 10); Group1= AH Plus sealer; Group 2= TotalFill BC sealer; Group 3= BioRoot RCS sealer; Group 4= AH plus sealer + HGFP; Group 5= TotalFill BC sealer + HGFP; and, Group 6= Bio Root RCS sealer + HGFP. All specimens were thermocycled and subjected to cyclic loading. Next, the specimens were subjected to a static load using a universal testing machine. Data were analyzed using two-way ANOVA. Two micro-CTs of the same upper premolar, one without the HGFP and later one with HGFP inserted were made and used to create two finite element (FE) models. For the fracture resistance, two-way ANOVA revealed significant differences for the effect of HGFP (p = 0.029), but no differences for the effect of root canal sealer type (p = 0.561). The HGFP groups showed higher restorable fracture compared to groups without HGFP (p = 0.013). Finite element analysis showed that the inclusion of HGFP reduces stress concentration at the occlusal interface and cervical region. Therefore, it can be concluded that HGFP significantly increased the fracture resistance of endodontically treated upper premolars with MOD cavities and reduced the risk for non-restorable fractures. The FE analysis supports the mechanical test results.

Evaluation of the efficacy of rotary and reciprocating systems for the removal of filling material for various root canal filling techniques.

This study aimed to evaluate the efficacy of various filling and retreatment techniques for oval-shaped root canals. Sixty distal roots of mandibular molar teeth were included in the study. The roots were prepared using the ProTaper Next (PTN) X4 rotary system and irrigation with 2.5% NaOCl. The roots were then divided into three groups and filled with Total Fill BC Sealer (FKG Dentaire) using three different techniques (n=20): single cone (SC), GuttaCore (GC), and warm vertical condensation (WVC). The retreatment procedure was performed using two different instrumentation techniques: Reciproc 50 (R50) and PTN X5 (n=10). To analyze the remaining filling material, the roots were divided buccolingually in two parts with the help of diamond separators, and photographs were taken at x16 magnification using a dental operating microscope (DOM). The ratio of the remaining filling materials was calculated using image analysis software and statistically evaluated using the Kruskal-Wallis test. None of the assessed retreatment procedures completely removed the filling materials from the root canals. For both instrumentation techniques, more root canal filling material remained in the WVC group (P<0.05). The GC filling technique had a higher cleaning percentage than the WVC and SC techniques in the coronal region. The R50 system was found to be superior to the PTN X5 system for retreatment, and the root canal fillings applied using the WVC technique were more difficult to remove than the fillings applied using the other techniques.

Physicochemical Properties and Biocompatibility of Various Bioceramic Root Canal Sealers: In Vitro Study

IntroductionThe aim of this study was to compare the physicochemical properties and biocompatibility of various calcium silicate–based bioceramic sealers (CSBSs). MethodsFour recently developed CSBSs, including AH Plus Bioceramic Sealer (AHB), EndoSequence BC Sealer (ESB), TotalFill BC Sealer (TTB), and Bio-C Sealer (BIC), were compared with the epoxy resin–based sealer AH Plus (AHP). Their physical properties, including flow, setting time, radiopacity, dimensional stability, and pH, were evaluated according to the International Organization for Standardization (ISO) 6876. Their cytotoxicity in human periodontal ligament fibroblast (hPDLF) was assessed through the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and compared. Additionally, cell attachment to the sealer surface was analyzed using green fluorescent protein and confocal laser scanning microscopy to evaluate cell viability. Data were analyzed using a one-way analysis of variance to determine the difference between groups for categorical variables, followed by Tukey's post hoc test at the significance level of 95%. ResultsThe flow, setting time, and radiopacity of all tested CSBSs satisfied the ISO 6876/2012 standards. Further, these CSBSs showed shrinkage after immersion in distilled water for 30 days and complied with the ISO 6876/2001 requirements. The pH values of AHB, ESB, TTB, and BIC were greater than 11, whereas AHP had a pH of 6.69 after 4 weeks. CSBS showed excellent biocompatibility compared with that of AHP (P < .05). Confocal laser scanning microscopy showed that alive hPDLFs were attached well to all the tested CSBSs but not to AHP. ConclusionsCSBSs have similar physical characteristics within the ISO standards and higher biocompatibility than epoxy resin–based sealers.

Efficacy of Shock Wave-Enhanced Emission Photoacoustic Streaming (SWEEPS) in the Removal of Different Combinations of Sealers Used with Two Obturation Techniques: A Micro-CT Study.

This study sought to evaluate the efficacy of SWEEPS in the removal of epoxy-resin-based and calcium-silicate-containing endodontic sealer combined with single-cone and carrier-based obturation techniques through a micro-CT analysis. Seventy-six single-rooted extracted human teeth with single root canal were instrumented with Reciproc instruments. Specimens were randomly divided into four groups (n = 19) according to the root canal filling material and obturation technique: (1) AH Plus sealer + Reciproc gutta-percha, (2) TotalFill BC sealer + TotalFill BC Points, (3) AH Plus sealer + Guttafusion obturator, and (4) MTA Fillapex + Guttafusion obturator. All specimens were re-treated one week later using Reciproc instruments. Following re-treatment, root canals were additionally irrigated using the Auto SWEEPS modality. The differences in the root canal filling remnants were analyzed by micro-CT scanning of each tooth after root canal obturation, after re-treatment, and after additional SWEEPS treatment. Statistical analysis was performed using an analysis of variance (p < 0.05). The additional treatment with SWEEPS significantly reduced the volume of the root canal filling materials in all experimental groups compared to the removal of root canal filling using only reciprocating instruments (p < 0.05). However, the root canal filling was not removed completely from any of the samples. SWEEPS can be used to enhance the removal of both epoxy-resin-based and calcium-silicate-containing sealers, in combination with single-cone and carrier-based obturation techniques.

Real-time evaluation of the biocompatibility of calcium silicate-based endodontic cements: An in vitro study.

An ideal filling material should hermetically seal the communication pathways between the canal system and surrounding tissues. Therefore, during the last few years, the development of obturation materials and techniques to create optimal conditions for the proper healing of apical tissues has been a focus of interest. The effects of calcium silicate-based cements (CSCs) on periodontal ligament cells have been investigated, and promising results have been obtained. To date, there are no reports in the literature that have evaluated the biocompatibility of CSCs using a real-time live cell system. Therefore, this study aimed to evaluate the real-time biocompatibility of CSCs with human periodontal ligament cells (hPDLCs). hPDLC were cultured with testing media of endodontic cements for 5 days: TotalFill-BC Sealer, BioRoot RCS, Tubli-Seal, AH Plus, MTA ProRoot, Biodentine, and TotalFill-BC RRM Fast Set Putty. Cell proliferation, viability, and morphology were quantified using real-time live cell microscopy with the IncuCyte S3 system. Data were analyzed using the one-way repeated measures (RM) analysis of variancemultiple comparison test (p < .05). Compared to the control group, cell proliferation in the presence of all cements was significantly affected at 24 h (p < .05). ProRoot MTA and Biodentine lead to an increase in cell proliferation; there were no significant differences with the control group at 120 h. In contrast, Tubli-Seal and TotalFill-BC Sealer inhibited cell growth in real-time and significantly increased cell death compared to all groups. hPDLC co-cultured with sealer and repair cements showed a spindle-shaped morphology except with cements Tubli-Seal and TotalFill-BC Sealer where smaller and rounder cells were obtained. The biocompatibility of the endodontic repair cements performed better than the sealer cements, highlighting the cell proliferation of the ProRoot MTA and Biodentine in real-time. However, the calcium silicate-based TotalFill-BC Sealer presented a high percentage of cell death throughout the experiment similar to that obtained.