The impact of the filling technique with two sealers in bulk or associated with gutta-percha on the fatigue behavior and failure patterns of endodontically treated teeth.

Background: The present in vitro study aimed to evaluate the fatigue behavior of teeth filled with a calcium silicate-based sealer (Bio-C Sealer, BC) or an epoxy resin-based sealer (AH Plus, AH), in bulk or associated with gutta-percha as main core material. Methods: Seventy-two sound human maxillary anterior teeth were initially selected. Sixty of them, were randomly chosen, and had their root canals prepared using nickel-titanium reciprocating instruments, being again randomly assigned to five experimental groups (n = 12): C+ (control + prepared but not filled); BC-B (BC in bulk); BC-GP (BC+ gutta-percha); AP-B (AH in bulk); AP-GP (AH+ gutta-percha). An additional negative control group (C-) was considered (n = 12), consisting only on sound teeth, without preparation and filling. The specimens were submitted to a survival analysis after the cyclic fatigue test. Results: Sound teeth (C-) presented the best fatigue performance (P < 0.05), being similar only to the AP-GP group (P > 0.05). Despite that, all experimental groups showed similar fatigue behavior (P > 0.05) to C+ (BC-B = BC-GP = AP-B = AP-GP = C+). Based on that, it can be seen that the use of gutta-percha, as a main core material, associated with the AH Plus sealer, reestablished the mechanical fatigue performance of endodontically treated teeth comparable to sound teeth, still consisting on the most promising approach to rehabilitate such scenario. Teeth filled in bulk, had discreetly higher risk of premature failures and inferior fatigue performance.

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

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

Clinical outcomes of nonsurgical root canal treatment using NeoSealer Flo and Endosequence BC Sealer: A retrospective analysis with short-term follow-up.

OBJECTIVES: Sealers are an important component in root canal obturation to provide the seal of the root canal system. In recent years, there has been an increase in the use of hydraulic silicate sealers, commonly referred to as bioceramic sealers, due to their many advantageous properties. NeoSealer Flo (NS; Avalon Biomed USA, Houston TX) is a recently introduced premixed bioceramic sealer. There is limited evidence on its properties and clinical performance. Therefore, the purpose of this study was to evaluate the outcome of root canal treatment using NS in a sealer-based obturation technique. MATERIALS AND METHODS: The records of patients in a private practice between 2017 and 2022 were analyzed to identify both initial and retreatment cases obturated with either EndoSequence BC sealer or NS using sealer-based obturation with a minimum of one-year follow-up. Treatment outcome between NS and BC was compared with chi-square test. Logistic regression was used to identify additional prognostic factors. RESULTS: Six hundred and eighty-seven teeth met the inclusion criteria for the study. The success rate of cases obturated with BC was 94.9% and 96.5% for the cases obturated with NS. No statistically significant differences were found between the two sealer types. Presence of a periapical radiolucency or periapical radiolucency > 5.00 mm were statistically significant prognostic factors. CONCLUSIONS: Endodontic treatment using BC or NS with sealer-based obturation method is a viable treatment option. CLINICAL RELEVANCE: Root canal obturation with bioceramic sealers, such as NeoSealer Flo and Endosequence BC sealer, provide favorable clinical outcomes.

Effect of crosslinking/antioxidant agents as final irrigant on the fracture resistance of endodontically treated root after radiotherapy.

AIM: To investigate the effects of Epigallocatechin gallate (EGCG) and curcumin, as a final irrigant on the fracture resistance of irradiated root that obturated with an epoxy resin sealer. METHODOLOGY: Eighty mandibular premolars were randomly divided into non-irradiated (NIR) and irradiated (IR) groups. The teeth were irradiated at 2 Gy per fraction, 5 times a week for a total dose of 60 Gy over 6 weeks. All specimens were decoronated, remaining 13±1 mm root length. Two groups were subdivided into four groups (n = 10): 1) non-instrumented; the intact root served as control. The other roots were instrumented with a pro-taper NiTi rotary system. The final irrigation used was 17% EDTA, followed by three irrigation solution groups; 2) 2.5% NaOCl, 3) 0.02% EGCG, and 4) 0.1% curcumin. Root canals were filled with gutta-percha and AH plus. All specimens were embedded in self-curing acrylic resin and loaded vertically at 1 mm/min until fracture occurred. Also, sealer penetration was assessed by confocal laser scanning microscopy (CLSM). The data were evaluated statistically using two-way ANOVA and Tukey test (α = 0.05). RESULTS: In irradiated roots, fracture resistance of EGCG and curcumin groups did not differ from non-instrumented roots, but they were higher than the NaOCl group (P = 0.006). However, NaOCl, EGCG, and curcumin in irradiated roots had comparable strength that was higher than in the non-instrumented group (p<0.001). Difference between irradiated and non-irradiated roots was observed only for NaOCl and non-instrumented groups (P≤0.004). In irradiated roots, a higher sealer penetration was observed in EGCG and curcumin groups compared to NaOCl. CONCLUSION: EGCG and curcumin could be promising final irrigants to reverse the adverse effect of radiotherapy on the strength of irradiated roots obturated with AH Plus sealer.

Effect of three different root canal sealants on human dental pulp stem cells.

The cytotoxic effects of three root canal sealers with different bases on human dental pulp stem cells were assessed in this study using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) test. The cytotoxic effects of three root canal sealers with different bases on human dental pulp stem cells (DPSCs) were assessed in this study using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) test. The cytotoxicity of the sealers was tested after one, 4, and 7 d. Human dental pulp stem cell proliferation was concluded using an MTT assay. Cells not treated with sealer extract were used as controls. The absorption levels were measured using an Eliza spectrophotometer. P was set at 0.05 when the percentage of cell proliferation was matched between groups and observation times using one-way analysis of variance (ANOVA).During the second passage (P2), human dental pulp stem cells displayed a single morphological and phenotypic trait, with fibroblast morphology being the most common. There were no appreciable variations between the four groups after a day. There was a notable variation in the average percentage of cell proliferation between the groups after 4 and 7 days. The control group had the highest percentage, followed by the GuttaFlow Bioseal group, the Well Root St group, and the AH-Plus group, which had the lowest percentage. For every sealing group, after one day, the highest mean percentage of cell proliferation was recorded, followed by day four, and after day seven, the lowest mean percentage. The observation periods showed minimal cytotoxic effects of GuttaFlow Bioseal, whereas AH-Plus was the most cytotoxic to human dental pulp stem cells. The highest mean percentage of cell proliferation for all sealers was recorded on day one.

Effects of radiotherapy dose and application time on the load-to-failure values of teeth filled with different sealers.

BACKGROUND: The materials used in root canal filling and radiotherapy (RT) application can affect the load-to-failure of the teeth. This study aimed to compare the load-to-failure of the teeth filled with AH Plus (AHP) or AH Plus bioceramic (AHPB) before or after 60 Gy- and 70 Gy-dose radiotherapy. MATERIALS AND METHODS: One hundred and ten maxillary incisors were endodontically prepared up to ProTaper Next X4 instruments. The teeth were randomly divided into 5 main groups as: non-irradiated, root canal treatment (RCT) before 60 Gy radiotherapy, RCT before 70 Gy radiotherapy, RCT after 60 Gy radiotherapy, RCT after 70 Gy radiotherapy. These groups were divided into 2 subgroups for filling material: AHP ve AHPB. After filling and radiotherapy procedures, the teeth were fixed on the thermoplastic mask plane. The plane were placed in the middle of a rectangular prism shaped glass phantom, and irradiated via a linear accelerator device. The teeth were then embedded in cylindrical acrylic blocks and the force (N) that caused the fracture was recorded under the Universal testing device. Student t-test was used for statistical comparisons. Statistical significance level was determined as p < 0.05. RESULTS: After 70 Gy dose radiotherapy, the group filled with AHPB showed statistically significantly lower fracture strength than the group filled with AHP (p < 0.05). In the control group, before 60 Gy RT group, after 60 Gy RT group, and before 70 Gy RT group, the sealers had statistically significantly similar load-to-failure. (p > 0.05). CONCLUSION: The group filled with AHPB caused a lower fracture strength than the group filled with AHP following a 70 Gy dose of RT. The sealers in the control group, before 60 Gy RT group, after 60 Gy RT group, and before 70 Gy RT group exhibited comparable load-to-failure values.

Clinical utility index for root canal sealers.

BACKGROUND: Effective endodontic treatment requires the use of a root canal sealer with optimal properties to ensure a hermetic seal, prevent reinfection, and promote healing. Despite the availability of various sealers, a standardized evaluation system still needs to be improved. OBJECTIVES: To develop a Clinical Utility Index (CUI) that systematically evaluates and ranks root canal sealers based on their sealing ability, antimicrobial efficacy, flow rate, and solubility. METHODS: The CUI was developed through a structured process involving expert identification, panel discussions, and the establishment of scoring criteria. Five sealers were evaluated (Sealers A, B, C, D, and E). Mean values for the core properties were calculated, and sealers were ranked accordingly. The total CUI for each sealer was computed based on the assigned scores for each property. RESULTS: Sealer B achieved the highest CUI at 95%, demonstrating superior performance across all core properties. Sealer C followed with a CUI of 80%, while Sealer A ranked third with 60%. Sealers D and E showed the lowest performance, with CUIs of 30% and 35%, respectively, highlighting deficiencies in multiple properties. DISCUSSION: The CUI provides a comprehensive evaluation framework for root canal sealers, facilitating informed decision-making by practitioners. Sealer B's high CUI underscores the importance of balancing sealing ability, antimicrobial effect, flow rate, and solubility. The results align with existing literature emphasizing the critical role of these properties in endodontic success. CONCLUSION: The CUI offers a robust and balanced method for evaluating root canal sealers, aiding in selecting the most suitable sealer based on empirical data. Future research should refine the index and validate its applicability in diverse clinical scenarios to enhance endodontic treatment outcomes.

Vertical root fracture detection with cone-beam computed tomography in Biodentine™ filled teeth.

PURPOSE: This study aimed to evaluate the accuracy of detecting vertical root fractures in Biodentine™-filled teeth using the Promax 3Dmax cone-beam computed tomography (CBCT) unit compared to periapical radiographs. It tested hypotheses regarding CBCT's diagnostic superiority in non-root-filled and Biodentine™-root-filled maxillary central incisors and assessed the impact of smaller field of view and lower intensity settings on detection accuracy. MATERIALS AND METHODS: Extracted maxillary incisors were divided into groups based on fracture status and root filling material, then placed in a Thiel-embalmed skull to simulate clinical conditions. The teeth were imaged using periapical radiographs and the CBCT unit under different settings. Fracture thickness was measured with microcomputed tomography for accuracy benchmarking. Multiple observers assessed the images, and statistical analyses were conducted to evaluate diagnostic performance. RESULTS: Intra-rater reliabilities of consensus scores ranged from good to very good. Specificities were generally higher than sensitivities across all imaging modalities, but sensitivities remained constantly low. None of the Area Under the Curve scores exceeded 0.6, indicating poor overall accuracy for all imaging modalities. Paired comparisons of the area differences under Receiver Operator Characteristic curves revealed no significant differences between the CBCT and periapical radiograph techniques for detecting vertical root fractures in either Biodentine™-filled or non-root-filled teeth. CONCLUSIONS: There was no significant accuracy improvement of the current CBCT device (Promax 3Dmax, Planmeca, Finland) over periapical radiographs in detecting small vertical root fractures in both non-root-filled and Biodentine™-root-filled maxillary central incisors. A smaller field of view with lower intensity did not enhance detection accuracy. These results highlight the challenges in accurately detecting small VRFs, emphasizing the need for further research and technological advancements in this domain.

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

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

A Comparison of Conventional Root Canal Sealers With Ones That Use Green Synthesized Nanoparticles for Antimicrobial Activity: Protocol for a Systematic Review.

BACKGROUND: Root canal failure and secondary endodontic infection are frequent clinical scenarios in dentistry. The main microorganisms implicated in root canal therapy failure are persistent Enterococcus faecalis, Candida albicans, and Staphylococcus aureus. To combat the impact of disease resistance, scientists are concentrating on alternative antimicrobial root canal sealers. Nanomaterials are a recent development in endodontic materials that exhibit great antimicrobial properties, making them an ideal material choice for root canal sealers. OBJECTIVE: This systematic review aims to compare the antimicrobial properties of conventional root canal sealers to those incorporating green synthesized nanoparticles between 2010 and 2024. METHODS: A well-constructed protocol was established and registered with PROSPERO (CRD42021286373). Ethics approval was obtained from the Biomedical Research and Ethics Committee from the University of the Western Cape (UWC; BM22/1/4). PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) reporting guidelines were followed. The included criteria demonstrate the green synthesized nanoparticles studies where the nanoparticles (NPs) are incorporated in root canal sealers. MeSH (Medical Subject Headings) terms were used for the search strategy of the systematic electronic databases for articles published in English between 2010 and 2024. The selected databases included Scopus, PubMed, Web of Science, Science Direct, EBSCOhost, SpringerLink, and Wiley Online. A quality assessment tool for laboratory studies will be used to critically appraise the included studies. If applicable, statistical measures (mean, SD, etc) will be used for data analysis and presentation of the results. RESULTS: The protocol is registered with PROSPERO. A preliminary search was conducted using a determined search strategy across 8 electronic databases, and the review is now complete. CONCLUSIONS: It is anticipated that the results of this systematic review may reveal the increased interest and application for nanoparticle-enhanced root canal sealers. This will aid in the future development of root canal sealants and mitigate the risk of endodontic failure. TRIAL REGISTRATION: PROSPERO CRD42021286373; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286373. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/51351.

Influence of sonic activation of epoxy-resin and calcium silicate sealer on postoperative pain: a patient-blinded, parallel group, randomized clinical trial.

BACKGROUND: This clinical study aims to compare postoperative pain after single-visit root canal treatment of teeth with asymptomatic apical periodontitis using epoxy-resin-based AH Plus and calcium silicate-based Endosequence BC sealers with or without sonic activation. METHODS: This study included 72 individuals with one first or second mandibular premolar tooth with asymptomatic apical periodontitis. They were randomly divided into four groups according to the root canal sealer (AH Plus or Endosequence BC) and activation protocol (sonic activation or non-activation) (n = 18). The participants were ask to rate their postoperative pain intensity on a NRS scale as none, minimal, moderate, or severe after 24 h, 48 h, 72 h, and 7 days following treatment. Patients were also asked to record the number of prescribed analgesic medication tablets (400 mg of ibuprofen) taken. Statistical analysis were performed using the Mann-Whitney U test, the Friedman test, the Spearman's correlation test, the Chi-square test. Significance level was established at 0.05. RESULTS: There was no statistically significant difference in postoperative pain scores or analgesic intake between AH Plus and Endosequence BC sealers regardless of the activation protocol (p > 0.05). There was no statistically significant difference in postoperative pain scores between the sonic activation and non-activation groups (p > 0.05). A weak positive correlation was detected between Endoactivator sonic activation and sealer extrusion (r = 0.36). CONCLUSIONS: AH Plus and EndoSequence BC root canal sealers showed similar results in terms of prevalance and intensity of postoperative pain. Sonic activation and non-activation groups had similar postoperative pain scores. CLINICAL TRIAL REGISTRATION: The study was retrospectively registered with ClinicalTrials.gov (NCT06403293). Date of Registration: 07/05/24.

Tooth Discoloration Induced by Endodontic Sealers of Different Chemical Bases: A Systematic Review.

The present study aimed to assess the tooth discoloration induced by endodontic sealers and establish a correlation between their distinct chemical compositions and this aesthetic concern. Five electronic databases and grey literature were systematically screened to identify studies comparing the tooth discoloration potential of endodontic sealers with different chemical bases. Studies that did not evaluate human teeth or did not employ spectrophotometry as a method for color measurement were excluded. The risk of bias in the included studies was assessed using a modified version of the JBI Critical Appraisal Checklist for Experimental Studies. Data were grouped according to the chemical composition of the sealers and analyzed qualitatively. Fourteen studies were included. None of the studies met all domains of the risk of bias checklist. Qualitative synthesis suggested that zinc oxide and eugenol-based sealers have a greater potential for tooth discoloration. Silicone-based and calcium hydroxide-based sealers demonstrated less potential for tooth discoloration than resin-based sealers and salicylate resin-based sealers containing calcium silicate. All investigated endodontic sealers induced tooth discoloration, which is chemical and time dependent. Zinc oxide and eugenol-based sealers exhibited a greater potential for tooth discoloration, whereas silicone and calcium hydroxide-based sealers showed less potential.

Fiber post cemented using different adhesive strategies to root canal dentin obturated with calcium silicate-based sealer.

BACKGROUND: Calcium silicate-based sealer has favorable properties for root canal filling, including hydroxyapatite formation during the setting process. However, this process can cause difficulty during post space preparation when the sealer is set. Additionally, the remaining sealer could interfere with the bond strength of fiber post to root canal dentin. The different adhesive strategies and fiber post cementation time may affect the bond strength of the fiber post. Thus, the objective of this study was to evaluate the effect of etching modes of Scotchbond™ Universal Plus adhesive and post cementation time on the push-out bond strength of a fiber post cemented in root canals obturated with calcium silicate-based sealer. METHODS: Fifty-four teeth were randomly allocated to 6 groups (n = 9) based on etching modes: self-etch (SE) or etch-and-rinse (ER); post space preparation and cementation time: immediate (Im) or 7-day delayed (De): Im-Im, Im-De, and De-De. The root canals were obturated with calcium silicate-based sealer and the post space preparation was performed. The fiber post was cemented using RelyX™ Universal resin cement according to each group's design. For the push-out bond strength test, 1-mm slices of the coronal, middle, and apical regions were tested using a universal testing machine. The failure mode analysis was determined using a stereomicroscope. The data was analyzed with three-way analysis of variance. RESULTS: No negative effects of etching modes, post space preparation or cementation time on push-out bond strength were detected (p > 0.05). Additionally, the root canal region also did not significantly affect the bond strength (p > 0.05). CONCLUSION: No significant differences were observed between the etching modes, post space preparation and cementation time and among root canal regions. CLINICAL RELEVANCE: The different etching modes of adhesive and post cementation time did not affect the bond strength of fiber post in calcium silicate filled-root canal.

Ex-vivo evaluation of clinically-set hydraulic sealers used with different canal dryness protocols and obturation techniques: a randomized clinical trial.

OBJECTIVES: This 2-part randomized parallel triple-blind clinical trial adopts a unique model assessing clinically-set hydraulic calcium silicate-based sealers (HCSBS) after different root canal dryness protocols and obturation techniques. METHODS: For the first phase of the study, 24 teeth scheduled for orthodontic extractions were allocated into four groups according to the canal dryness protocol and the obturation technique. G1 (CLC-AHP): cold lateral compaction (CLC) with AH Plus sealer, G2 (CLC-ES-SD): CLC with Endosequence (ES) after standard canal(s) dryness (SD); G3 (SC-ES-SD): matching single-cone (SC) with ES after SD; G4 (SC-ES-PD): as G3 but after partial canal(s) dryness (PD). Teeth were extracted after one month of clinical service and examined for intracanal voids by micro-CT (2D & 3D). For the 2nd phase, another 24 teeth were allocated into four groups according to the root canal dryness protocol and the HCSBS used (ES or CeraSeal (CeS)). Teeth were extracted after one month and sectioned vertically for energy dispersive X-ray (EDX)/scanning electron microscope (SEM) examination. One-way ANOVA with Games-Howell post-hoc test and Chi-square test with multiple z-tests were used for statistical analysis. RESULTS: SC-PD showed the highest percentage of voids (p < 0.05). MicroCT scans as well as EDX/SEM examination showed that PD resulted in significantly larger interfacial gaps (p < 0.001) with more hydration products at the sealer/dentin interface than SD. CONCLUSIONS: Both tested dryness protocols allowed the hydration of HCSBS and the formation of hydration products, thus standard dryness is recommended to reduce the incidence of intracanal voids. CLINICAL RELEVANCE: When using the single-cone obturation technique, intentional root canal moisture negatively affects the performance of HCSBS. PROTOCOL REGISTRATION: http://www. CLINICALTRIALS: gov, ID: NCT05808062.

The impact of root end filling material type and the application of bone graft on healing of periapical tissues after endodontic microsurgery (a clinical randomized controlled trial).

To evaluate the effect of combining different bioactive root-end filling materials with composite bone graft (xenogeneic mixed with autogenous bone fragments) on the healing process of periapical tissues after endodontic micro-surgery procedure. In this triple-blinded clinical trial, 56 patients were divided into 2 main groups (28 each) according to the root-end filling material and 2 subgroups according to the presence or absence of the composite bone graft material. Group I: MTA root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Group II: TotalFill root-end filling (n = 28) in which there are Sub-group A: without bone graft (n = 14) and Sub-group B: with composite bone graft (n = 14). Healthy patients whose ages range from 20 to 50 years with small-to-medium size radiolucency in CBCT related to single-rooted maxillary teeth were included in this study. Patients were assigned a number starting from 1 to 56 and were randomly allocated to four test groups (2 main groups and 2 sub-groups) following simple randomization procedure guidelines described by IBM SPSS V23 (IBM USA) statistical analysis software. This trial was triple-blind where the patient, the outcome assessors, and the main operator were blinded to the applied intervention. Every patient was evaluated clinically and by CBCT at two main observation periods: presurgical and 12-month post-operative. They were also examined and evaluated clinically and radiographically through periapical x-rays after one week, three, and six months. Statistical analysis was performed with IBM SPSS Statistics for Windows Version 23.0. Armonk, NY: IBM Corp. Of the 56 patients enrolled in the study, 49 patients were available for the final analysis. All groups showed no statistically significant differences with regard to healing or success rates at the 12-month follow-up mark. No adverse effects were encountered. Results showed that high success rates were achieved using MTA and TotalFill in the healing of periapical lesions after endodontic surgery. The addition of bone graft in small-to-medium size lesions did not affect the success rate of endodontic surgeries.

Assessment of tooth discoloration induced by root canal filling materials in pediatric dentistry.

This study investigated the potential for tooth discoloration of root canal filling pastes used in pediatric dentistry. Sixty bovine incisors were sectioned 2 mm apical to the cementoenamel junction and allocated into 6 groups (n = 10) according to the type of filling material used: G1- Zinc oxide-eugenol sealer; G2- Zinc oxide-eugenol and iodoform paste; G3- Calcium hydroxide (CH) and zinc oxide paste; G4- CH, zinc oxide, and iodoform paste; G5- CH and iodoform paste; and G6- Control. Polyethylene glycol 400 was used as a vehicle for CH-containing pastes. Color measurements were taken at specific intervals: preceding endodontic treatment (T0) and at successive points of 1 month (T1), 2 months (T2), 3 months (T3), and 1 year (T4) after the placement of the filling material. The color change (∆E) was calculated using the CIELab formula. Statistical analysis was performed using ANOVA, followed by Tukey's post hoc test (α = 5%). Significant differences were observed among the filling materials and time intervals (p <0.001). All groups exhibited color changes over time, except G1 and G5, which showed color changes only after 1 year. G1 and G2 demonstrated the highest ∆E values, with a statistically significant difference observed only at T2 when compared to G3 (p = 0.008). Root canal filling materials used in primary teeth have the potential to induce tooth discoloration.

Effect of zinc oxide-eugenol endodontic paste on planktonic aggregates and biofilm of Enterococcus faecalis - An atomic force microscopy evaluation.

OBJECTIVE: This work aimed to evaluate the in vitro effect of zinc oxide-eugenol paste (ZOE) on planktonic aggregates (EfPA) and biofilm (EfBio) of Enterococcus faecalis, focusing on their morphological aspects observed and analyzed using atomic force microscopy (AFM). DESIGN: The eugenol and paste were characterized by Gas Chromatography coupled with Mass Spectrometry (GC-MS) and Fourier Transform Infrared Spectroscopy (FTIR), respectively. The effect of ZOE on EfPA and EfBio was evaluated by a direct-contact test through colony counting and crystal violet staining protocol. AFM images of untreated and treated EfPA and EfBio growth on bovine dentin were obtained to analyze the morphological damage caused by the treatments. RESULTS: The characterization showed high purity in the eugenol composition and chemical interaction between the components of the paste. A bactericidal effect on aggregates was observed after 6 h of exposure, and on biofilm after 24 h of treatment (p < 0.001). A disruptive effect on the biofilm was also evident. AFM images revealed the formation of EfPA, with a notable presence of an exopolysaccharide matrix. After 6 h of ZOE treatment, there was a significant increase in the size and surface roughness profile of treated cells (p < 0.05). Loss of typical cell morphology was observed after 24 h. The effect on the biofilm showed a tendency towards a less condensed biofilm pattern in the treated group, with no differences in surface roughness. CONCLUSION: ZOE presents bactericidal action on EfPA and EfBio, promoting significant morphological changes after treatment, especially in the aggregates.

The Push-Out Bond Strength, Surface Roughness, and Antimicrobial Properties of Endodontic Bioceramic Sealers Supplemented with Silver Nanoparticles.

This study evaluated push-out bond test (POBT), surface roughness, and antimicrobial properties against Enterococcus faecalis of bioceramic sealers supplemented with silver nanoparticles (AgNPs). The sealers tested were CeraSeal®, EndoSequence® BC SealerTM, and Bio-C® Sealer. The POBT was measured with a Universal Testing Machine, and the type of failure was evaluated with a stereomicroscope. The roughness average (Sa) and peak-valley height (Sy) values were evaluated by atomic force microscopy. The bacterial growth inhibition was evaluated using a disk diffusion test, and antimicrobial activity was determined with the plate microdilution method. The POBT showed no significant difference between sealers with and those without NPs in cervical and apical thirds (p > 0.05). In the middle third, the adhesion force was significant for Endosequence BC Sealer® (p < 0.05). The results showed that the Sa and Sy parameters, when AgNPs were added, did not show a statistically significant difference compared to the groups without nanoparticles (p > 0.05). All tested sealers showed bacterial growth inhibition, but no significant difference was found. Their efficacy, in descending order of antibacterial activity when AgNPs were added, is as follows: EndoSequence® BC SealerTM > Bio-C® Sealer > CeraSeal®. The incorporation of AgNPs into bioceramics improves antimicrobial activity without affecting mechanical properties.

Comparative Analysis of Calcium and Hydroxyl Ion Release from Pulp Dressing Materials in Pulpotomized Premolars.

BACKGROUND The aim of this study was to evaluate the time-dependent release of calcium (Ca⁺⁺) and hydroxyl (OH⁻) ions from 3 different pulp dressing materials used to cap root canal orifices in pulpotomized premolars. MATERIAL AND METHODS Freshly extracted (n=40) premolars were subjected to standardized pulpotomy procedure and finally restored in 5 groups using resin-modified glass ionmmer liner (RMGI) and bonded resin composite directly against the pulp chamber's floor (Control, G2) and over 3 different orifices' capping materials - Dycal (G3), Endo Sequence root repair material (ESRRM, G4), and mineral trioxide aggregate (MTA) Angelus (G5). Another 10 sound premolars served as the Reference group (G1). The restored teeth were incubated at 37±1°C in sealed containers filled with deionized water to assess Ca⁺⁺ and OH⁻ ions release after 24 h and at 1, 4, and 8 weeks. Two-way ANOVA and Tukey's comparisons at alpha=0.05 were used to statistically analyze the collected data. RESULTS Two-way ANOVA revealed significant differences in Ca⁺⁺ ions between test groups at different testing time intervals (P<0.05). Despite the constant (Tukey's, P<0.05) pH levels (OH⁻ release), Group 5 specimens exhibited higher Ca⁺⁺ ion release in comparison to Groups 4 and 3 at different testing timepoints (Tukey's, P<0.05). CONCLUSIONS Although all the assessed pulp dressing materials had equivalent and stable pH levels, ESRRM and MTA-Angelus had the highest Ca⁺⁺ ion release at the assessment intervals.

Postoperative pain after total pulpotomy and root canal treatment in mature molars according to the new and traditional classifications of pulpitis: a prospective, randomized controlled trial.

BACKGROUND: The aim of this study was to compare postoperative pain following total pulpotomy (TP) and root canal treatment (RCT) in mature molar teeth with irreversible pulpitis. To compare the traditional pulpitis classification system with the Wolters system in evaluating postoperative pain. METHODS: Eighty mandibular molars with irreversible pulpitis were included and classified according to the Wolters (moderate/severe pulpitis). The teeth were randomly assigned to two groups (RCT or TP). RCT was performed following standardized protocols. TP was performed to the level of the canal orifices, and hemostasis was achieved with 2.5% sodium hypochlorite. A 3 mm layer of MTA was placed as the pulpotomy material. The teeth were restored with glass ionomer cement followed by composite. Pain scores were recorded preoperatively and, at 6, 12, 24, 48, and 72 h and 7 days after the interventions. The data were statistically analyzed using the Mann-Whitney U test, the Friedman test, the Wilcoxon signed-rank test, and the Spearman's correlation test. The significance level was set at 0.05. RESULTS: Sixty-four patients were analyzed at the one-week follow-up and all were diagnosed as irreversible pulpitis according to the AAE; 22 teeth were classified as moderate and 42 teeth were classified as severe pulpitis according to Wolters. There was no significant difference between TP and RCT in pain scores in moderate pulpitis patients (p > 0.05). There was a significant difference between TP and RCT at 24 and 72 h of severe pulpitis; higher pain scores were observed in the RCT (p < 0.05). CONCLUSIONS: In patients with moderate pulpitis, the TP procedure allowed symptom relief more quickly than RCT. In patients with severe pulpitis, TP provided for significantly lower pain scores compared to RCT at both 24 and 72 h. CLINICAL TRIAL REGISTRATION: The study was retrospectively registered with ClinicalTrials.gov (NCT05923619). Date of Registration: 06/16/23.