The outcome of combined use of iRoot BP Plus and iRoot SP for root-end filling in endodontic microsurgery: a randomized controlled trial.

OBJECTIVES: Root-end filling is important for the clinical outcome of endodontic microsurgery. Our previous study showed that combined application of iRoot BP Plus Root Repair Material (BP-RRM) and iRoot SP Injectable Root Canal Sealer (SP-RCS) in root-end filling exhibited better apical sealing as compared to the application of BP-RRM alone. The aim of this randomized controlled clinical trial was to evaluate the effect of the combined use of BP-RRM and SP-RCS on the prognosis of teeth with refractory periapical diseases after endodontic microsurgery. MATERIALS AND METHODS: 240 teeth with refractory periapical diseases scheduled for endodontic microsurgery were randomly divided into BP-RRM/SP-RCS group (n = 120) and BP-RRM group (n = 120). The patients were followed up at 3 months, 6 months, and 12 months after endodontic microsurgery. Pre- and post-operative clinical and radiographic examinations were performed to evaluate the treatment outcome. The 1-year success rate of endodontic microsurgery in BP-RRM/SP-RCS and BP-RRM groups was compared by Chi-square test. Factors that might impact the prognosis were further analyzed using Chi-square test or Fisher's exact test. RESULTS: A total of 221 teeth completed the 12-month follow-up. The 1-year success rates of the BP-RRM/SP-RCS and BP-RRM groups were 94.5% (104/110) and 92.8% (103/111), respectively. The combined use of BP-RRM and SP-RCS achieved a clinical outcome comparable to BP-RRM alone (P = 0.784). Tooth type (P = 0.002), through-and-through/apico-marginal lesion (P = 0.049), periodontal status (P < 0.0001), and Kim's lesion classification (P < 0.0001) were critical factors associated with the 1-year success of endodontic microsurgery. CONCLUSIONS: The combined use of BP-RRM and SP-RCS is a practicable method for root-end filling in endodontic microsurgery with a satisfactory 1-year clinical outcome. CLINICAL RELEVANCE: The combined application of BP-RRM and SP-RCS in EMS is an effective root-end filling method with a satisfactory 1-year clinical outcome. TRIAL REGISTRATION: This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100052174).

Efficacy of root-end filling techniques using premixed putty type bioceramic cements: an ex vivo study.

OBJECTIVES: Currently, premixed putty-type bioceramic cements (PPBCs) have become popular materials for root-end fillings. This study investigated three root-end filling techniques using PPBCs and calcium silicate-based sealers including EDTA pretreatment. MATERIALS AND METHODS: Ninety root segments were prepared and standardized with an artificial fin and lateral canal, and assigned to three groups (n = 30). Root-end fillings were placed using BC-RRM Putty alone (Group PA), injection of BC sealer followed by BC-RRM Putty (Lid Technique: Group LT) or BC-RRM Putty with BC sealer coating (Deep putty packing technique: Group DP). Half of each group was pretreated with 17% EDTA. The radiographic images of the specimens were assessed by five graders and push-out bond strength tests were conducted. The data were analyzed with a general linear model including two-way ANOVA and chi-square test at a significance level of 5%. RESULTS: DP approach demonstrated significantly higher bond strength than LT (P < 0.05). However, there was no statistically significant difference in bond strength between PA and either DP or LT. EDTA pretreatment had no significant effect on push-out bond strength. Radiographically, for the main canal, PA and DP scored significantly higher than LT. In the fin, PA scored significantly higher than others (P < 0.05). CONCLUSION: Our study highlights variations in root-end filling techniques. Injecting a bulk of bioceramic sealer before the placement of PPBCs may reduce bond strength and radiopacity. The application of PPBCs alone or in the deep putty technique demonstrates potential for favorable outcomes. EDTA pretreatment did not enhance bond-strength. CLINICAL RELEVANCE: Careful selection and application of bioceramic materials and techniques in root-end fillings may influence the outcome of endodontic root-end surgery. When PPBCs and calcium silicate-based sealers are used together for root-end fillings, sealer followed by deep putty application may offer improved bond strength and radiographic fill compared to the lid technique.

In vitro evaluation of the sealing ability of combined use of iRoot BP Plus and iRoot SP for root-end filling.

OBJECTIVES: The aim of this in vitro study was to evaluate the sealing ability of combined application of iRoot BP Plus Root Repair Material (BP-RRM) and iRoot SP Injectable Root Canal Sealer (SP-RCS) for root-end filling. MATERIAL AND METHODS: A total of 120 extracted human teeth were used in this study and were randomly divided into four groups. The BP-RRM+SP-RCS group included teeth retro-filled with combined use of BP-RRM and SP-RCS (n=45), and the BP-RRM group included teeth retro-filled by BP-RRM alone (n=45). Teeth without root-end preparation and filling were equally divided into positive control (n=15) and negative control (n=15). The apical sealing ability was evaluated by micro-CT analysis, dye penetrant examination, bacterial leakage test, and glucose leakage test. RESULTS: Micro-CT analysis showed that the total void fraction of BP-RRM+SP-RCS group was significantly lower than that of BP-RRM group, particularly at the coronal 1/3 segment of the retro-filled roots. Consistently, the maximum linear depth of dye leakage in BP-RRM+SP-RCS group was less than that of BP-RRM group. Bacterial leakage test showed that the microbial leakage in BP-RRM+SP-RCS group was significantly less than that in BP-RRM group. However, no significant difference in glucose leakage between BP-RRM+SP-RCS group and BP-RRM group was observed. CONCLUSION: Combined use of BP-RRM and SP-RCS for root-end filling promotes apical sealing in vitro. CLINICAL RELEVANCE: Combined use of BP-RRM and SP-RCS for root-end filling exhibited better apical sealing as compared to BP-RRM alone in vitro, and this may help reducing technical sensitivity and promoting clinical efficiency during endodontic microsurgery.

Effect of different root canal irrigants on push-out bond strength of two novel root-end filling materials.

BACKGROUND: The aim of this in vitro study was to evaluate push-out bond strength of different root-end filling materials using various irrigant solutions. METHODS: A push-out bond strength test was performed to evaluate the bond strength of two experimental root-end filling materials: namely, nano-hybrid mineral trioxide aggregate (MTA) and polymethyl methacrylate (PMMA) cement filled with 20% weight nano hydroxyapatite (nHA) fillers compared to conventional MTA. The irrigant solutions employed were sodium hypochlorite (NaOCl) in concentrations 1%, 2.5% and 5.25% and 2% chlorhexidine gluconate (CHX) followed by application of 17% ethylene diamine tetra-acetic acid (EDTA). A freshly extracted sixty single-rooted human maxillary central incisors were used. The crowns were removed, the canal apex was widened to simulate immature teeth. Each type of irrigation protocols was performed. After application and setting of the root-end filling materials, a slice of one mm thickness was cut transversely from the apical end of each root. Specimens were stored for 1 month in artificial saliva and were subjected to a push-out test to evaluate the shear bond strength. Data were analyzed using two-way ANOVA and Tukey test. RESULTS: The experimental nano-hybrid MTA showed the highest significant push-out bond strength values when irrigated by NaOCl at several concentrations (1%, 2.5% and 5.25%) (P< 0.05). Meanwhile, irrigation with 2% CHX resulted in highest bond strength values in nano-hybrid white MTA (18 MPa) and PMMA filled with 20% weight nHA (17.4 MPa) with nonsignificant difference between them (p = 0.25). In each root-end filling material, irrigation with 2% CHX led to the highest significant bond strength, followed by NaOCl 1%, while the least significant bond strength was produced after irrigation with NaOCl 2.5% and 5.25% (P< 0.05). CONCLUSION: Considering the limitations of this study, it may be concluded that the application of 2% CXH and 17% EDTA provides superior push-out bond strength to root canal dentin compared with irrigation with NaOCl irrigants and 17% EDTA, experimental nano-hybrid MTA root-end filling material provides enhanced shear bond strength than conventional micron-sized MTA root-end filling material.

Surface characteristics and bacterial adhesion of endodontic cements.

OBJECTIVES: To investigate the effect of inclusion of silver nano-particles (SNP) or bioactive glass (BG) on the surface characteristics and bacterial adhesion of prototype tricalcium silicate (TCS)-based cements alongside two commercial cements, under different aging periods and exposure conditions. MATERIALS AND METHODS: A basic formulation of radio-opacified TCS without (TZ-base) and with additions of SNP (0.5, 1, or 2 mg/ml) or BG (10 or 20%) was used. Biodentine and intermediate restorative material (IRM) served as reference materials. Material disks were immersed in ultrapure water or fetal bovine serum (FBS) for 1, 7, or 28 days. Surface roughness (n = 3), microhardness (n = 9), and wettability (n = 6) were analyzed by standard procedures. Adhesion of Enterococcus faecalis was assessed by fluorescence microscopy (n = 5). Data from these assays were evaluated for normality and comparisons among groups were conducted with statistical procedures (p < 0.05 for significance). RESULTS: The surface morphology of SNP- and BG-containing cements had higher roughness values than TZ-base after 28 days (p < 0.05). No differences in microhardness were observed among prototype cements (p > 0.05). Biodentine presented smooth surface characteristics and the highest hardness values (p < 0.05). The FBS-immersion resulted in surface reactions in prototype materials and Biodentine, depicted with scanning electron microscopy. All 1- and 7-day prototype cements showed negligible bacterial adhesion, while in Biodentine and IRM, noticeable E. faecalis adherence was observed from day 1 (p < 0.05). CONCLUSIONS: Incorporation of SNP or BG did not improve the antibacterial effect of the experimental cement; all 28-day aged materials failed to inhibit bacterial adherence. The measured physical parameters did not appear to be related to the degree of bacterial adhesion. Exposure of TCS-based cements in FBS resulted in surface reactions, which did not affect bacterial adhesion. CLINICAL RELEVANCE: Changes in the surface characteristics of prototype TCS-based cements by inclusion of SNP and BG or exposure to different environments did not affect bacterial adhesion. All experimental materials showed inferior physical properties and higher antibacterial effect than Biodentine.

Effects of fast- and slow-setting calcium silicate-based root-end filling materials on the outcome of endodontic microsurgery: a retrospective study up to 6 years.

OBJECTIVES: The purpose of this retrospective study was to evaluate and compare the effects of fast- and slow-setting calcium silicate-based materials (CSMs) used for root-end filling on the outcome of endodontic microsurgery. MATERIALS AND METHODS: We searched a clinical database for patients who had received endodontic microsurgery between 2001 and 2016. Included cases were divided into two groups according to the type of CSM used for root-end filling: slow-setting CSM (SCSM) and fast-setting CSM (FCSM). The cases in two groups were subjected to 1:1 nearest neighbor propensity score matching for the following variables: age, sex, tooth type, quality of canal filling, lesion type, and postoperative restoration. For each matched case, the outcome was determined as success or failure according to clinical and radiographic evaluations performed at least 1 year after surgery. Multivariate logistic regression analysis was performed to identify prognostic factors and estimate their effects. RESULTS: In total, 304 cases of endodontic microsurgery (179 SCSM and 125 FCSM) were identified, and 1:1 propensity score matching finally included 122 cases from each group. After matching, all covariates were associated with an absolute standardized difference of < 0.1. The overall success rates were 85.2% and 93.4% for the SCSM and FCSM groups, respectively (p = 0.062). Age, tooth type, lesion type, and CSM type were significantly associated with the outcome of endodontic microsurgery (p < 0.05). CONCLUSIONS: Within the limitations, the outcome of endodontic microsurgery using FCSMs was comparable with that of SCSMs. The findings suggest that the type of CSM used for root-end filling, particularly in terms of the initial setting time, could affect the outcome of endodontic microsurgery. CLINICAL RELEVANCE: FCSMs could be considered for use as root-end filling materials in endodontic microsurgery, particularly in complicated clinical situations which require rapid initial setting of the materials.

Spectrophotometric analysis evaluating apical microleakage in retrograde filling using GIC, MTA and biodentine: an in-vitro study.

BACKGROUND: The present study compares the apical microleakage of three different root-end filling materials in which the retrograde cavity is prepared by two different burs. METHODS: Eighty extracted single rooted maxillary and mandibular premolars were taken. Root canal treatment was completed. Apical 3 mm of all the teeth were resected with diamond disk. The tooth were divided into four groups with two subgroups for each group containing 10 tooth (N = 10) as: Group IA (Negative Control and IB (Positive Control); Group IIA and IIB: Prepared with round carbide bur and round diamond bur respectively, filled with GIC; Group IIIA and IIIB: Prepared with round carbide bur and round diamond bur respectively, filled with MTA; Group IVA and IVB: Prepared with round carbide bur and round diamond bur, filled with Biodentine. After applying two coats of nail varnish leaving apical 3 mm (except for negative control group) all teeth were immersed in 2% methylene blue for 3 days and again in 65% nitric acid for next 3 days for extraction of dye. The obtained solution was then transferred to eppendorf tube and centrifuged in microcentrifuges at 14,000 revolution per minutes (RPM) for 5 min. Optical density or absorbance of the supernatant solution was measured with UV spectrophotometer at 550 nm. RESULTS: The absorbance of the supernatant solution after dye extraction is decreasing in the order of positive control> GIC > MTA > Biodentine> negative control group. The significant difference was observed between GIC and MTA (p = 0.0001) and GIC and Biodentine (p = 0.0001) with two different burs but statistically non-significant difference was observed between MTA and Biodentine with Carbide bur (p = 0.127) and Diamond bur (p = 0.496) respectively. CONCLUSIONS: Within the limitations of the present study, it can be concluded that Biodentine and MTA showed less microleakage as compared to GIC. There is no significant difference between mean microleakage of MTA and Biodentine. However, the mean OD of the Biodentine was least of all evaluated materials. Preparation of the root-end using round carbide bur as well as round diamond burs showed comparable microleakage for all three filling materials.

Effects of root-end filling on the fractal dimension of the periapical bone after periapical surgery: retrospective study.

OBJECTIVE: The aim of this study was to investigate the effects of root-end filling after periapical surgery on the fractal dimension (FD) of the periapical bone. METHODS: Thirty-eight patients who underwent periapical surgery were included in this study. The cases were divided into two subgroups: (1) In the gutta-percha group, root cavity and root-end fillings were not performed after root resection. In this group, there were 14 female patients and 6 male patients. (2) In the mineral trioxide aggregate (MTA) group, the root end was filled with MTA after root resection. In this group, there were 13 female patients and 5 male patients. Each patient underwent two periapical radiographs, one shortly after periapical surgery (10-15 days) and another one 1 year after periapical surgery. Regions of interest (ROIs) located close to the infected root apex were selected for each radiograph. Periapical radiographs were digitized and processed with an FD analysis using the box-counting method. RESULTS: FD was significantly increased in both groups over time (p < 0.05). The increases in FD between groups were not significant (p > 0.05). CONCLUSIONS: Mathematical morphology combined with the box-counting method showed that the FD change was independent of the root-end filling at the 1-year follow-up after periapical surgery. CLINICAL RELEVANCE: Because of the complex anatomy of the root canal, orthograde endodontic treatment may be inadequate and periapical surgery becomes an alternative in these cases. In this study, the effect of root-end filling on the increase in trabecular bone after periapical surgery was investigated using fractal analysis.

Mineral trioxide aggregate and other bioactive endodontic cements: an updated overview - part II: other clinical applications and complications.

Mineral trioxide aggregate (MTA) is a dental material used extensively for vital pulp therapies (VPT), protecting scaffolds during regenerative endodontic procedures, apical barriers in teeth with necrotic pulps and open apices, perforation repairs as well as root canal filling and root-end filling during surgical endodontics. A number of bioactive endodontic cements (BECs) have recently been introduced to the market. Most of these materials have calcium and silicate in their compositions; however, bioactivity is a common property of these cements. These materials include the following: BioAggregate, Biodentine, BioRoot RCS, calcium-enriched mixture cement, Endo-CPM, Endocem, EndoSequence, EndoBinder, EndoSeal MTA, iRoot, MicroMega MTA, MTA Bio, MTA Fillapex, MTA Plus, Neo MTA Plus, Ortho MTA, Quick-Set, Retro MTA, Tech Biosealer, and TheraCal LC. It has been claimed that these materials have properties similar to those of MTA but without the drawbacks. In Part I of this review, the available information on the chemical composition of the materials listed above was reviewed and their applications for VPT was discussed. In this article, the clinical applications of MTA and other BECs will be reviewed for apexification, regenerative endodontics, perforation repair, root canal filling, root-end filling, restorative procedures, periodontal defects and treatment of vertical and horizontal root fractures. In addition, the literature regarding the possible drawbacks of these materials following their clinical applications is reviewed. These drawbacks include their discolouration potential, systemic effects and retreatability following use as a root filling material. Based on selected keywords, all publications were searched regarding the use of MTA as well as BECs for the relevant clinical applications. Numerous publications were found regarding the use of BECs for various endodontic applications. The majority of these investigations compared BECs with MTA. Despite promising results for some materials, the number of publications using BECs for various clinical applications was limited. Furthermore, most studies had several methodological shortcomings and low levels of evidence.

Bacterial colonization in the apical part of extracted human teeth following root-end resection and filling: a confocal laser scanning microscopy study.

OBJECTIVES: The purpose of this study was to evaluate Enterococcus faecalis colonization at the apical part of root canals following root-end resection and filling using confocal laser scanning microscopy (CLSM). MATERIALS AND METHODS: The apical 3-mm root-ends of 55 extracted single rooted human teeth were resected, and 3-mm retrograde cavities were prepared and filled using either mineral trioxide aggregate (MTA), intermediate restorative material (IRM), or Biodentine (n = 10 each); 25 teeth served as controls. The roots were placed in an experimental model, sterilized, and coronally filled with E. faecalis bacterial suspension for 21 days. Then, the apical 3-mm segments were cut to get two slabs (coronal and apical). The slabs were stained using LIVE/DEAD BacLight Bacterial Viability Kit and evaluated using CLSM. RESULTS: The fluorescence-stained areas were larger in the bucco-lingual directions compared with the mesio-distal directions (p < 0.05). The mean and maximal depths of bacterial colonization into the dentinal tubules were 755 and 1643 µm, respectively, with no differences between the root-end filling materials (p > 0.05). However, more live bacteria were found in the MTA group in comparison to IRM and Biodentine groups (p < 0.05). CONCLUSIONS: CLSM can be used to histologically demonstrate bacterial root-end colonization following root-end filling. This colonization at the filling-dentine interfaces and deeper into the dentinal tubules may be inhomogeneous, favoring the bucco-lingual aspects of the root. CLINICAL RELEVANCE: Following root-end resection and filling bacterial colonization may lead to inflammatory reactions at the periapical tissues; the viability of the colonized bacteria may be affected by the type of root-end filling material.

Push-out bond strength of three different calcium silicate-based root-end filling materials after ultrasonic retrograde cavity preparation.

OBJECTIVE: The aim of this study was to evaluate the bond strength of three calcium silicate-based root-end filling materials. MATERIALS AND METHODS: The root canals of 30 single-rooted teeth were endodontically treated; their root ends were resected and root-end cavities were prepared using ultrasonic tip. The teeth were randomly divided into three groups according to the material: (1) Micro-Mega mineral trioxide aggregate (MM-MTA), (2) Biodentine, and (3) TotalFill root repair material (RRM). Push-out test was performed using universal testing machine, and failure mode was analyzed by stereomicroscope. The data were statistically analyzed using Kruskal-Wallis and Man-Whitney post hoc tests. All p values < 0.05 were considered significant. RESULTS: TotalFill RRM exhibited significantly higher bond strength (12.69 MPa) than Biodentine (9.34 MPa, p = 0.023) and MM-MTA (7.89 MPa, p = 0.002). The difference between Biodentine and MM-MTA was not significant (p = 0.447). Mixed failures were the most noted in all three groups. MM-MTA had more adhesive failures than Biodentine and TotalFill, and no cohesive failures, but without statistical significance (p = 0.591). CONCLUSION: The bond strength was the highest for TotalFill RRM. CLINICAL RELEVANCE: In order to provide a persistent apical seal, root-end filling materials should resist dislodgement under static conditions, during function and operative procedures. TotalFill RRM exhibited higher bond strength to dentin than MM-MTA and Biodentine.

Effect of MTA particle size on periapical healing.

AIM: To examine the effect of reduction in MTA particle size on dento-alveolar and osseous healing in dogs. METHODOLOGY: Root canals of 24 mandibular premolars in four 2-year-old beagles were prepared and filled with gutta-percha and sealer. Two to four weeks later, during periapical surgery, the root-end cavity preparations in these teeth were filled with either grey ProRoot MTA or modified (reduced particle sizes with faster setting time) MTA. The animals were sacrificed 4 months later. Degrees of inflammation, type of inflammatory cells, fibrous connective tissue adjacent to the root-end filling materials, cementum formation over the resected roots and root-end filling materials and bone healing were examined. Data were analysed using the McNemar test. RESULTS: No significant differences in healing of periapical tissues were found when comparing ProRoot MTA to a modified MTA containing reduced particle sizes. CONCLUSION: Reducing the particle sizes of MTA did not impact its biological properties.

Sealing ability of two root-end filling materials in a bacterial nutrient leakage model.

AIM: To compare in vitro the sealing ability of root-end fillings with mineral trioxide aggregate (MTA) and EndoSequence BioCeramic Root Repair Material-Fast Set (BC-RRM) Putty using a novel bacterial nutrient leakage model, which provides information on whether or not intracanal bacteria are receiving nutrients from serum via leakage channels. METHODOLOGY: Sixty single-rooted decoronated mandibular incisors with instrumented root canals were subjected to root-end resection and ultrasonic preparation. The root specimens were mounted in the experimental apparatus, and the root-end cavities filled with the test materials. The positive control group used warm Gutta-percha and no sealer. In the negative controls, the entire resected surface was covered with varnish. After sterilization in ethylene oxide, the root canal was inoculated with 1.5 × 10(5) washed cells of Enterococcus faecalis. The apparatus was filled with foetal bovine serum, leaving only the apical root immersed. After 30-day incubation, samples were taken from the canal, cultured and the colony-forming units (CFUs) counted. Statistical analysis was performed using the Mann-Whitney test for quantitative and the Fisher exact test for qualitative data. RESULTS: In the MTA group, 10 of 20 (50%) specimens still had detectable viable bacteria in the canals (mean, 8.97 × 10(3)  CFUs). In the BC-RRM Putty group, 5 of 18 (28%) specimens were positive for bacterial growth (mean, 2.88 × 10(4)  CFUs). There was no significant difference when comparing the quantitative or presence/absence data from the MTA and BC-RRM Putty groups. Positive and negative controls yielded the expected results. CONCLUSIONS: MTA and BC-RRM Putty had similar sealing ability. The experimental model was effective in determining whether or not residual intracanal bacteria could survive by receiving nutrients from outside.

Effect of ultrasonic tip and root-end filling material on bond strength.

OBJECTIVES: The objective of this study was to evaluate the bond strength of three root-end filling materials (MTAA-MTA Angelus, MTAS-experimental MTA Sealer, and ZOE- zinc oxide and eugenol cement) in retrograde preparations performed with different ultrasonic tips (CVD, Trinity, and Satelec). MATERIALS AND METHOD: Ninety 2-mm root sections from single-rooted human teeth were used. The retrograde cavities were prepared by using the ultrasonic tips, coupled to a device for position standardization. The specimens were randomly divided into nine groups: CVD MTAA; CVD MTAS; CVD ZOE; Trinity MTAA; Trinity MTAS; Trinity ZOE; Satelec MTAA; Satelec MTAS; Satelec ZOE. Each resin disc/dentin/root-end filling material was placed in the machine to perform the push-out test. The specimens were examined in a stereomicroscope to evaluate the type of failure. Data were submitted to statistical analysis using ANOVA and Tukey tests (α = 0.05). RESULTS: The highest bond strength was observed for the CVD tip irrespective of the material used (P < 0.05). There was no significant difference for the Trinity TU-18 diamond and S12 Satelec tips (P > 0.05). MTAA and MTAS showed highest bond strength. The most common type of failure was adhesion between the filling material and dentin wall, except for ZOE, where mixed failure was predominant. CONCLUSIONS: The CVD tip favored higher bond strength of the root-end filling materials. MTA Angelus and experimental MTAS presented bond strength to dentin prepared with ultrasonic tips. CLINICAL RELEVANCE: Root-end preparation with the CVD tip positively influences the bond strength of root-end filling materials. MTA Angelus and experimental MTAS present bond strength to be used as root-end filling materials.

Comparative cell attachment, cytotoxicity and antibacterial activity of radiopaque dicalcium silicate cement and white-coloured mineral trioxide aggregate.

AIM: To comparatively examine the cell attachment, cytotoxicity, and antibacterial activity of radiopaque dicalcium silicate cement (RDSC) and ProRoot white-coloured mineral trioxide aggregate (WMTA). METHODOLOGY: AlamarBlue was used for real-time and repeated monitoring of MG63 cell attachment on freshly mixed and set cements. The pH changes in the growth medium at different time-points were also measured. Cytotoxicity evaluation was performed according to ISO 10993-5 specifications. The antibacterial activity of the cement specimens was evaluated using Enterococcus faecalis. RESULTS: There were no significant differences (P > 0.05) between the two cements for cell attachment either in the fresh groups or in the set groups at all culture times. Neither freshly mixed group nor set groups had significant pH differences. In the case of cytotoxicity, RDSC was significantly (P < 0.05) superior to WMTA at 12 and 24 h of incubation. RDSC and WMTA possessed similar antimicrobial activity, substantiated by the formation of growth inhibition zones and bacteriostasis ratio in E. faecalis strains. CONCLUSIONS: The cell attachment, cytotoxicity and antibacterial efficacy of RDSC were comparable to those reported for ProRoot WMTA. The results of the current study suggest that this RDSC could be used as a root-end filling material and root sealer.

Sealing ability of root-end filling materials.

BACKGROUND: The aim of this research was to compare the apical sealing ability of different root-end filling materials (SuperEBA(®), ProRoot MTA(®), thermoplasticized gutta-percha + AH-Plus(®), thermoplasticized RealSeal(®)), by means of microbial indicators. MATERIALS AND METHODS: Thus, 50 human single-rooted teeth were employed, which were shaped until size 5 0, retro - prepared with ultrasonic tips and assigned to 4 groups, retro-filled with each material or controls. A platform was employed, which was split in two halves: upper chamber-where the microbial suspension containing the biological indicators was introduced (E. faecalis + S. aureus + P. aeruginosa + B. subtilis + C. albicans); and a lower chamber containing the culture medium brain, heart influsion, where 3 mm of the apical region of teeth were kept immersed. Lectures were made daily for 60 days, using the turbidity of the culture medium as indicative of microbial contamination. Statistical analyses were carried out at 5% level of significance. RESULTS: The results showed microbial leakage at least in some specimens in all of the groups. RealSeal(®) has more microbial leakage, statistically significant, compared to ProRoot(®) MTA and SuperEBA(®). No significant differences were observed when compared ProRoot(®) MTA and SuperEBA(®). The gutta-percha + AH Plus results showed no statistically significant differences when compared with the other groups. CONCLUSIONS: All the tested materials showed microbial leakage. Root-end fillings with Super-EBA or MTA had the lowest bacterial filtration and RealSeal shows highest bacterial filtration.

Push-out bond strength of MTA with antiwashout gel or resins.

AIM: Assessment of the push-out bond strength of four MTA-based formulations for use as root-end filling materials. METHODOLOGY: MTA Plus mixed with (i) water ('MTA-W'); (ii) a proprietary water-based antiwashout gel ('MTA-AW'); (iii) Superbond C&B chemically curing resin ('MTA-Chem'); and (iv) Heliobond light-curing resin ('MTA-Light') was tested. Root slices 3 mm thick human had a 1.5 mm diameter hole drilled centrally and were treated with 17% EDTA for 60s. Forty specimens divided into groups 1-4 were prepared and filled with MTA-W, MTA-AW, MTA-Chem and MTA-Light, respectively. Groups 3 and 4 were etched with 37% phosphoric acid for 60s, and bonding agent was applied to the dentine surface. Specimens were stored for 28 days in Hanks' Balanced Salt Solution at 37 °C. Push-out strength was tested with a punch and die (punch diameter 1.3 mm, die diameter 2.0 mm, punch speed 1 mm min(-1)). Stereomicroscopy was used to classify failure mode (adhesive, cohesive or mixed type). RESULTS: The resulting push-out strengths were 5.1 MPa (MTA-W), 4.3 MPa (MTA-AW), 4.7 MPa (MTA-Chem) and 11.0 MPa (MTA-Light). MTA-W had higher push-out strength than MTA-AW (P = 0.022). The same was noted for MTA-Light relative to the other materials (P < 0.05). All materials exhibited adequate push-out strengths compared with MTA-W. Failure was predominantly mixed, except for MTA-Chem (predominantly adhesive). CONCLUSIONS: All materials exhibited adequate push-out strength. Previous studies have shown the new formulations have additional advantages including increased washout resistance and faster setting time, making them promising for future dental applications.

Interfacial adaptation of NeoMTA Plus, BioRoot RCS and MTA in root-end cavities: A micro-CT study.

AIM: This study aimed to use the micro-computed tomography to evaluate the interfacial adaptation and the presence of gaps of NeoMTA Plus, BioRoot RCS, and MTA in the root-end cavities. METHODOLOGY: Thirty standardized bovine roots measuring 15 mm in length were selected. Chemical-mechanical preparation was performed up to instrument #80 and obturation with the cold lateral compaction technique with cement based on zinc oxide and eugenol. The roots were kept at 37°C for 7 days. Afterward, apicectomy of the apical 3 mm and a root-end filling cavity was performed at 3 mm depth. Micro-computed tomography (micro-CT) was performed to measure the volume of the retroactivity. The roots were divided by stratified randomization into three groups according to the retro-end filling material: NeoMTA Plus, BioRoot RCS, and MTA. A new micro-CT was performed to assess the presence of voids in the root-end filling material and between it and the canal wall. One-way ANOVA and Tukey tests were performed using the BioEstat 4.0 program. RESULTS: There was no difference in the initial volume values of the root-end cavities (p > .05). After the insertion of root-end filling materials, the most significant volumes of voids were observed in the NeoMTA Plus group (p < .05), with no difference for the BioRoot RCS and MTA Angelus groups (p > .05). CONCLUSION: Micro-computed tomography showed that MTA and BioRoot RCS have better interfacial adaptation and presented fewer number of gaps than NeoMTA Plus when used as root-end filling materials. RESEARCH HIGHLIGHTS: Micro-computed tomography evaluation of different root-end fillings materials.

Outcome Assessment of Three Different Methods of Root-end Preparation and Filling Materials in Endodontic Surgery: A Comparative Clinical Prospective Study.

Introduction: The technique of endodontic surgery had evolved tremendously in the recent years with introduction of new instruments and materials. Aim: This study aims to compare the clinical outcome of endodontic microsurgery using three different techniques with three different root-end filling materials for 16 months. Materials and Methods: A total of 45 maxillary incisors indicated for root-end surgery were selected for the study. They were enrolled into three groups, i.e. Group A (traditional [TRS]/heat burnished gutta-percha), Group B (concave [CON]/Retroplast), and Group C (cavity/DiaRoot BioAggregate), of 15 teeth each. The clinical and radiographic outcome was recorded at 1, 6, 12, and 16 months using various criteria. Statistical Analysis: The data were analyzed by one-way analysis of variance and Tukey's post hoc test using SPSS V. 21 software (IBM Corp., Somers, NY, USA). Results: All patients had uneventful healing at the final follow-up. Radiological intratime analysis concluded a highly high significant (P < 0.0001) decrease in the size of radiolucency between the three groups at the third recall visit. Intertime analysis recorded no significant decrease in radiolucency between Groups A and B, a significant decrease in B and C, and a highly significant decrease between Groups A and C at 12 months. Conclusions: There was no significant difference in the clinical outcome after endodontic surgery when comparing TRS/heat burnished gutta-percha, CON/Retroplast, and cavity/DiaRoot BioAggregate techniques at 16 months. However, cavity/DiaRoot BioAggregate resulted in significantly rapid and predictable healing at 12 months.

The setting characteristics of MTA Plus in different environmental conditions.

AIM: Characterization and assessment of the hydration reaction of mineral trioxide aggregate (MTA) Plus exposed to different environmental conditions. METHODOLOGY: The specific surface area, surface morphology and characterization of un-hydrated MTA Plus (Avalon Biomed Inc. Bradenton, FL, USA) were investigated. The specific surface area was compared with that of ProRoot MTA (Dentsply International, Tulsa Dental Specialties, Johnson City, TN, USA). The reaction rate was determined using calorimetry, and the hydrated cement was assessed for setting time (determined using an indentation technique), and the set material was characterized using X-ray diffraction analysis, scanning electron microscopy and X-ray energy-dispersive analysis. Atomic ratio plots were drawn to establish the relationship of the hydration products. Three different environmental conditions namely dry or immersed in either water or Hank's balanced salt solution (HBSS) were used. RESULTS: Mineral trioxide aggregate Plus had a higher specific surface area than ProRoot MTA. The hydration reaction was exothermic. The setting time of MTA Plus was retarded when in contact with fluids (P < 0.001). The setting time was longer when MTA Plus was in contact with HBSS than when in contact with water (P < 0.001). Hydration of MTA Plus resulted in the formation of calcium silicate hydrate, calcium hydroxide, ettringite and monosulfate phases. Bismuth was incorporated in the calcium silicate hydrate structure. The hydration of the core material was not affected by contact with the different solutions but the periphery exhibited microcracking, leaching of calcium hydroxide, partial decalcification of calcium silicate hydrate, inhibition of hydration in contact with the physiological solution. CONCLUSIONS: The novel MTA Plus was finer than ProRoot MTA but had a similar chemical composition. MTA Plus in direct contact with fluids exhibited partial decalcification of calcium silicate hydrate in contact with the solution, microcracking and leaching of calcium hydroxide. Interaction with a physiological solution resulted in inhibition of hydration.