The efficacy of premixed bioceramic sealers versus standard sealers on root canal treatment outcome, extrusion rate and post-obturation pain: A systematic review and meta-analysis.

BACKGROUND: Limited evidence is available regarding the superior clinical properties of bioceramic sealers comparted with traditional standard sealers. OBJECTIVES: This review aimed to answer the following research questions: 'In healthy patients requiring a root canal treatment (P), what is the efficacy of premixed bioceramic sealers (I) compared with traditional root canal epoxy resin-based sealers (C) in terms of survival, success rates (PICO1) sealer extrusion and resorption (PICO2) post-obturation pain (PICO3) (O)?' METHODS: Authors independently searched three electronic databases: PubMed (including MEDLINE), Web of Science, Embase and Scopus up to 31 October 2023. This was accompanied by both grey literature and manual search. Detailed selection criteria were applied, namely mature permanent teeth requiring root canal treatment, premixed bioceramic sealer with gutta-percha as an intervention group, a standard filling technique as control group and full-text available in English. A random-effect meta-analysis was used to synthesize the body of evidence regarding the use of bioceramic sealers in root canal treatment and their impact on post-obturation pain. Effect sizes were represented as relative risks on a logarithmic scale for binary outcomes and as mean differences for continuous outcomes. RESULTS: A total of 941 articles were identified. Fifteen Comparative clinical studies were finally included. Eleven were randomized clinical trials, and four were prospective clinical trials with control group. The follow-up of these studies was not greater than 2 years. No publication bias was observed in any study. No significant differences were observed between the two groups in terms of survival and success rates. A small non-significant lower risk of extrusion was observed for bioceramics. A small, non-significantly lower post-operative-pain within 24-h was observed when bioceramics were used. DISCUSSION: The majority of current evidence shows inconsistencies in reporting and is of short-term duration. Robust prospective long-term trials are needed in this area to better support future recommendations. CONCLUSION: This systematic review is the first to analyse several clinical outcomes using premixed sealers. Included studies differed in terms of clinical protocol and operator expertise, but reported a similar outcome when comparing bioceramic versus standard sealers. Tooth survival, treatment outcome, post-operative pain and periapical extrusion were similar and presented no significant differences between the two sealer types. REGISTRATION: PROSPERO database (CRD42023449151).

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

OBJECTIVE: This study evaluated the effect of sealer type with various obturation techniques on the fracture resistance of root filled teeth. MATERIALS AND METHODS: 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 3 weeks, and the crowns were separated and the roots were subjected to fracture test using a universal testing machine. RESULTS: 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. CONCLUSIONS: 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. CLINICAL RELEVANCE: Obturation of the root canal with Bioceramic sealer with single cone obturation technique could reduce the incidence of vertical root fracture.

Effect of Ultrasonic Irrigation Combined with Epoxy Resin Paste in Single Visit Root Canal Treatment in Chronic Pulpitis.

OBJECTIVE: To determine the clinical efficacy of ultrasonic irrigation combined with epoxy resin-based sealer in single visit root canal treatment of chronic pulpitis. STUDY DESIGN: Randomised controlled trial. Place and Duration of the Study: Department of Stomatology, Hefei BOE Hospital, Hefei, China, from March 2019 to December 2021. METHODOLOGY: Ninety patients with chronic pulpitis, comprising 104 affected teeth, were enrolled. Using a random number table, they were divided into Group A (n = 30, 35 teeth), Group B (n = 30, 35 teeth), and the control group (n = 30, 34 teeth). All underwent single visit root canal treatment. Group A received ultrasonic irrigation followed by sealing with epoxy resin-based paste; Group B had conventional syringe irrigation followed by the same sealing; the control group had syringe irrigation and closure with zinc oxide-eugenol paste. Pain during treatment, posttreatment clinical outcomes, and differences in inflammatory markers (IL-4, IL-6, hs-CRP), and quality of life (QOL) scores pre- and posttreatment over two months were observed. RESULTS: After the treatment, improvement rates for Groups A, B, and the control group were 91.4%, 65.7%, and 61.7%, respectively. Pain occurrence rates were 6.7%, 30.0%, and 36.7%, respectively. Group A outperformed both Group B and the control group in improvement and pain incidence with statistical significance (p<0.016). Posttreatment, Group A had lower IL-4, IL-6, hs-CRP levels than Groups B and the control group (p<0.05), and had higher scores for sleep, mood, and appetite (p<0.05). CONCLUSION: Ultrasonic irrigation combined with epoxy resin-based paste yields better results for chronic pulpitis treatment, reducing postoperative pain, mitigating inflammation levels, and enhancing quality of life. KEY WORDS: Chronic pulpitis, Ultrasonic irrigation, Epoxy resin paste, Root canal treatment, Therapeutic effect.

Influence of long -term thermal cycling and masticatory loading simulation on bond strength of roots filled with epoxy resin and calcium silicate based sealers.

BACKGROUND: The aim of this study was to evaluate the effect of thermal and mechanical cyclic aging using a mastication simulator on push-out bond strength of mandibular premolars obturated with AH Plus and BioRoot RCS root canal sealers. METHODS: With REVO-S files up to SU/0.06 taper, 48 single-rooted premolar teeth were instrumented. The teeth were randomly divided into two main groups (n = 24) based on the two root canal sealers used (AH Plus and BioRoot RCS). All teeth were obturated with h matched-taper single-cone. Each main group was then subdivided into three subgroups (A, B, and C) (n = 8). Group A served as the negative control group (no-thermocycling aging). While groups B and C were subjected to thermal changes in a thermocycler machine (15,000 and 30,000 thermal cycles, respectively), followed by two different dynamic loading periods, 3 × 105 and 6 × 105 in a masticatory simulator with a nominal load of 5 kg at 1.2 Hz which represent roughly 1½ and 3 years of clinical function respectively. 2 mm slice at 3 levels, apical, middle, and coronal, to obtain 3 sections were prepared and subjected to push-out test using a universal testing machine. Statistical analysis was performed using analysis of variance (ANOVA) followed by a Tukey post hoc comparisons test and an independent T-test. A significance level of 5% was used. RESULTS: After thermal-mechanical cyclic aging, the two root canal sealers showed a significantly decreased in push-out bond strength (p < 0.05), however, AH Plus had significantly higher bond strength values than BioRoot RCS after cycling aging. CONCLUSIONS: It could be concluded that thermal-mechanical cyclic aging had a significant impact on the outcome of the dislodgment resistance of AH Plus and BioRoot RCS.

Effect of continuous chelation on the dentinal tubule penetration of a calcium silicate-based root canal sealer: a confocal laser microscopy study.

BACKGROUND: This study aimed to evaluate the effect of various irrigation protocols on the penetration depth of a calcium silicate-based sealer into dentinal tubules using confocal laser scanning microscopy (CLSM). METHODS: Twenty single-rooted mandibular premolars were endodontically prepared and divided into the following two groups according to the irrigation protocol used (n = 10): Group I: NaOCl + EDTA and Group II: continuous chelation (NaOCl/Dual Rinse). Obturation was performed with the warm vertical compaction technique using TotalFill HiFlow bioceramic sealer mixed with a fluorophore dye. Samples were observed using CLSM at 10× to measure the percentage of sealer penetration and its maximum depth into the dentinal tubules. Data were analysed using one-way ANOVA followed by Tukey's post-hoc test. The significance level was set at p < 0.05 within all tests. RESULTS: Comparing the overall results of all sections tested, no statistically significant differences existed between the groups regarding the percentage of sealer penetration (p = 0.612) and maximum depth of penetration (p > 0.05). CONCLUSIONS: With both types of irrigation used, dentinal tubule penetration was higher in the coronal section than in the apical section. Continuous chelation using NaOCl/Dual Rinse HEDP performed better in the coronal segments, while irrigation using NaOCl + EDTA promoted a higher percentage of sealer penetration in the apical segment.

Efficacy of Different Solvents for Achieving Patency in Teeth Obturated Using Bioceramic Sealer.

INTRODUCTION: The retreatment of teeth obturated with bioceramic sealers has been shown to be challenging. The purpose of this study was to compare the efficacy of 10% formic acid (FA), 20% hydrochloric acid (HCl), and chloroform for achieving patency in teeth obturated with a bioceramic sealer. METHODS: Forty-five extracted single-canal teeth were instrumented and obturated 1.5 mm short of the working length using gutta-percha and EndoSequence BC Sealer (Brasseler USA, Savannah, GA). Two weeks later, gutta-percha was removed, and apical patency was attempted with a 10 C-file and a solvent (FA, HCl, or chloroform). The time to gain patency through EndoSequence BC Sealer was recorded. Five additional teeth were irrigated with the solvents, and scanning electron microscopy was used to evaluate the effect of solvents on the dentin. The Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis. RESULTS: Patency was achieved in all canals, except for 1 in the chloroform group. Regarding the time to achieve patency, no significant difference was noted between chloroform and FA (P > .05). However, there was a significant difference between chloroform and HCl (P < .05) and between FA and HCl (P < .05). The erosion of dentinal tubules was more evident when HCl was used compared with the other irrigants. CONCLUSIONS: Twenty percent HCl was superior to 10% FA and chloroform in achieving patency in teeth obturated with EndoSequence BC Sealer. Regardless of the solvent used, patency may be achieved for most of the cases obturated with gutta-percha and EndoSequence BC Sealer.

A Review of the research methods and progress of biocompatibility evaluation of root canal sealers.

The function of root canal sealer was to achieve an appropriate three-dimensional filling effect by filling the root canal and some irregular lumen, thereby inhibiting the residual bacteria. There were many types of sealers, but research to find the most suitable ones was still ongoing. In recent years, researchers had continuously improved the performance of sealers by developing new sealers or adding active ingredients to the sealers. However, most sealers exhibit varying degrees of cytotoxicity and tissue responses, which affect clinical therapy efficacy. This review describes different technical approaches, and recent research progress in the biocompatibility evaluation of root canal sealers and provides brief insights into this field by summarising the performance studies of different root canal sealers.

Comparison of the effect of post space preparation time on the apical seal of two different sealers.

BACKGROUND: The present study compared the effect of post space preparation time on the apical seal of two different sealers. METHODS: In the in vitro study, 94 central incisors were used. After the samples' root canal preparation, they were randomly assigned to four experimental groups (n = 21). The samples in groups 1 and 2 were obturated with AH Plus sealer, gutta-percha, and in groups 3 and 4 with Endoseal MTA bioceramic sealer and single cone technique. The post spaces in groups 1 and 3 were prepared immediately and in groups 2 and 4 with a delay. The samples were evaluated at 7-, 30-, and 90-day intervals for apical microleakage using the fluid filtration technique. The data were analyzed with SPSS 25, using three-way ANOVA and independent t-test. RESULTS: The apical microleakage in groups 3 and 4, obturated with Endoseal MTA bioceramic sealer and prepared immediately and after a delay, respectively, was not significantly different between the interval times. In group 2, obturated with AH Plus sealer and prepared for post space with a delay, the apical microleakage was significantly less than all the other groups. Group 1, obturated with AH Plus sealer and prepared for post space immediately, exhibited the least microleakage after seven days, but its microleakage increased over time to reach the level of groups 3 and 4. CONCLUSION: According to the results, the apical microleakage in the AH + sealer group and the delayed post-space preparation method, was significantly less than all the other groups over time.

Effect of obturation technique on penetration of calcium silicate-based sealer into dentinal tubules after endodontic retreatment of mandibular premolars.

OBJECTIVE: Confocal laser scanning microscopy (CLSM) was used to investigate the penetration of endodontic sealers into the dentinal tubules after retreatment using two different obturation techniques. MATERIALS AND METHODS: Thirty mandibular premolars were prepared up to instrument F3 (ProTaper Universal, Dentsply) and filled with Endofill using the single cone technique. The canals were retreated using Mtwo instruments. Reobturation was performed with the Bio-C sealer mixed with a fluorophore dye (Fluo-3) using either the lateral condensation technique (group LC) or the single cone technique (group SC) (n = 15). Teeth were sectioned 2, 4, and 6 mm from the apex and analyzed with CLSM to assess the penetration of the sealer into the canal perimeter and the maximum depth of penetration of the sealer into the dentinal tubules. Data were analyzed using ANOVA and the Student-t and Holm-Sidak tests. RESULTS: In the apical segment, the penetrated perimeter was significantly higher in the LC group than in the SC group (p < 0.05); no significant difference was found in the middle and cervical segments (p > 0.05). In terms of penetration depth, no significant differences were found for any of the segments studied (p > 0.05). CONCLUSION: The LC technique promoted a higher percentage of canal circumference penetrated by the sealer than the SC technique in the apical segment after endodontic retreatment. CLINICAL RELEVANCE: CLSM demonstrated that the LC technique promoted a higher percentage of canal perimeter penetrated by the Bio-C sealer than the SC technique in the apical segment of mandibular premolars after retreatment.

Clinical Efficacy of Sealer-based Obturation Using Calcium Silicate Sealers: A Randomized Clinical Trial.

INTRODUCTION: This randomized controlled clinical trial compared the clinical efficacy and outcome of a sealer-based obturation technique (SBO) with calcium silicate sealers and a continuous wave of condensation technique (CWC) with a resin-based sealer. METHODS: Root canals were prepared using rotary instruments and 2.5% sodium hypochlorite. At the next visit, patients were enrolled and randomly assigned into 2 groups on the basis of the obturation protocol: CWC with AH Plus sealer and SBO with Endoseal TCS. Patients were assessed for the level of postoperative pain using a numeric rating scale. The quality of root canal obturation was evaluated in terms of the sealer extrusion, root-filling voids, and level of root filling. The participants were recalled after at least 6 months. Healing of the teeth was determined as a decrease in Periapical Index score and resolution of symptoms. The results were statistically compared by using the χ2 test or Fisher exact test, followed by multivariate analysis with logistic regression. RESULTS: A total of 74 teeth were included in the analysis (79% recalls), and the mean follow-up period was 17 months (6-29 months). Two groups expressed identical distribution of postoperative pain (P = .973) and similar quality of root canal obturation. The total success rates were 93.2% (CWC 92.3%, SBO 94.3%) by loose criteria and 60.8% (CWC 51.3%, SBO 71.4%) by strict criteria, with no significant differences between the 2 groups. The success rate by loose criteria in teeth with sealer extrusion was significantly lower than those in teeth without sealer extrusion (P = .049). CONCLUSIONS: SBO using an Endoseal TCS could be a possible alternative to CWC using AH Plus. Sealer extrusion and postoperative pain were found to negatively impact prognosis of the endodontic treatment.

Comparing the incidence of postoperative pain after root canal filling with warm vertical obturation with resin-based sealer and sealer-based obturation with calcium silicate-based sealer: a prospective clinical trial.

OBJECTIVE: This prospective clinical study compares postoperative pain after single-visit, non-surgical root canal treatment of teeth with irreversible pulpitis using two different root canal filling techniques. MATERIAL AND METHODS: All cases were treated by endodontic residents with a standardized protocol (minimum apical size 35) and filled with one of the two techniques: warm vertical compaction technique (WVT) with gutta percha and epoxy resin-based sealer (AH Plus Jet Root Canal Sealer, Dentsply Maillefer, York, PA, USA) or sealer-based filling technique (SBT) with single cone gutta percha and calcium silicate-based sealer (EndoSequence BC Sealer, Brasseler, Savannah, GA, USA). Surveys were given to participating patients to record pain intensity on a numeric rating scale (NRS, 0-10) at 4, 24, and 48 h postoperatively. Statistical significance was set at 0.05 level. RESULTS: One hundred ninety-four surveys were distributed over eighteen months. Ninety-two patients returned the survey (41 WVT and 51 SBT), of which 38% were asymptomatic irreversible pulpitis cases. The NRS values reduced over time for both techniques. No statistical difference was found between the two groups at the three time points assessed (p > 0.05). Postoperative pain was related to age, gender, presence of preoperative pain, and sealer extrusion (p < 0.05), however not related to preoperative periapical symptoms (percussion/palpation), dental arch, root type, and experience of the provider (p > 0.05). CONCLUSIONS: The intensity of postoperative pain for the two obturation techniques was equivalent at evaluated time points. CLINICAL RELEVANCE: The obturation technique does not influence postoperative pain. After endodontic treatment of symptomatic irreversible pulpitis teeth, the pain subsides in 48 h regardless of the technique. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04462731.

Influence of cervical preflaring and root canal preparation on the fracture resistance of endodontically treated teeth.

BACKGROUND: Evaluate the fracture resistance of endodontically treated teeth after cervical preflaring and root canal preparation and to assess the volume of the root canal and the amount of remaining root dentin before and after cervical preflaring. METHODS: Forty-four mandibular incisors were selected using micro-CT scanning and distributed into 4 groups (n = 11) according to the instrument used for cervical preflaring: control group - no cervical preflaring; Gates Glidden - burs size #2 and #3; WXN - 25.07 Navigator instrument; and Easy - 25.08 ProDesign S instrument. Coronal opening was performed, and the canals were prepared with Wave One Gold Primary and filled with an epoxy-resin based sealer and gutta-percha cones. Micro-CT scans were performed before and after root canal instrumentation. All images were reconstructed and assessed for the thickness of mesial and distal root dentin at 3 mm and 5 mm from the cement -enamel junction and for the volume of cervical portion of the canal after preparation. Fracture resistance test was performed applying compressive loads at a crosshead speed of 0.5 mm/min, applied on the palatal aspect of specimens at 135° along the long axis of the tooth. The data were analyzed using ANOVA and Tukey's test (P = .05). RESULTS: Cervical preflaring and canal preparation reduced the dentin thickness (P < .05) and increased the canal volume (P < .05) in all groups at 3 mm an 5 mm. Cervical preflaring with Gates Gliden burs reduced the fracture resistance of endodontically treated teeth (P < .05). CONCLUSIONS: All instruments reduced the dentin thickness and increased the canal volume in the cervical at 3 mm and 5 mm. Gates Glidden reduced fracture resistance of mandibular incisors submitted to cervical preflaring, whereas NiTi instruments did not. CLINICAL RELEVANCE: Cervical preflaring assumes particular importance previously to the root canal preparation because it minimizes the occurrence of operative accidents, and permits more accurate determination of working length and the apical diameter.

Microfiltración apical entre dos cementos de obturación: biocerámico y resinoso en premolares unirradiculares preparadas con protaper, y obturadas con condensación lateral / Apical microfiltration between two filling cements: bioceramic and resinous in unirradicular premolars prepared with protaper and sealed with lateral condensation

Resumen Objetivo: Comparar in vitro la microfiltración apical en premolares unirradiculares obturados con cemento a base de resina epóxica y cemento biocerámico. Método: 40 piezas dentales unirradiculares fueron seleccionadas y divididas en dos grupos para ser obturadas esperando el tiempo de fraguado de acuerdo con las instrucciones del fabricante. El grupo A se obturó con cemento biocerámico Endosequence y, el grupo B, con cemento a base de resina epóxica AH-Plus: posteriormente los dos grupos fueron sellados con barniz de uñas hasta 3mm de la parte apical, luego se colocaron las muestras en la incubadora a 37ºC. Ambos fueron sometidos a 750 ciclos de termociclado, para reproducir el ambiente parecido a la cavidad oral. Para análisis de microfiltración se utilizó el método de difusión del colorante, se sumergieron en azul de metileno al 2 % por 6 días, posteriormente los especímenes fueron sometidos en una bomba de vacío. Los dientes fueron cortados longitudinalmente para ser evaluadas mediante el estereomicroscopio. El análisis estadístico fue hecho mediante T-Student y Chi-Cuadrado. Resultados: El grupo A corresponde a Endosequence obtuvo una medida de 0,55mm y el grupo B corresponde a AH-Plus 1,20mm con un estimado de significancia de p=0,013. Conclusión: El análisis de ambos cementos de obturación demostró que Endosequence posee menor microfiltración apical que AH-Plus.

Abstract Aim: To compare in vitro by the stereomiscroscope the lesser apical microfiltration in uniradicular premolars, between the cement based on Epoxy Resin and Bioceramic cement. Method: The study was performed on 40 uniradicular dental pieces divided into two groups, the samples were prepared using the protaper system and the obturation was performed using the lateral condensation technique, the first group was sealed withEndosequence bioceramic cement and the second group with Cement based on AH-Plus epoxy resin, then sealed with nail varnish up to 3mm from the apical part, then the samples were placed in the incubator at 37ºC, waiting for the set time corresponding to each group according to the manufacturer's instructions . The two groups of the present study were submitted to 750 cycles of thermocycling, to provide an environment similar to the oral cavity, then longitudinal cuts were made to the samples. The microfiltration was evaluated using the dye diffusion method, immersed in 2% methylene blue for 6 days, then the specimens were subjected to a vacuum pump. The teeth were cut longitudinally to be evaluated by the stereomicroscope. The statistical analysis was through T-Student and Chi-Square. Results: Group A corresponds to Endosequence obtained a mean of 0,55mm and Group B corresponds to AH-Plus 1,20mm with an estimated significance of p = 0,013. Conclusion: Both obturation cements have significant differences, therefore Endosequence has less apical microfiltration than AHPlus.

Post-obturation pain following the use of carrier-based system with AH Plus or iRoot SP sealers: a randomized controlled clinical trial.

OBJECTIVES: The aim of this study was to compare the postoperative pain after root canal treatment using a carrier-based obturation system and two different sealers. MATERIALS AND METHODS: In this prospective randomized clinical trial, 160 patients were selected. Patients with vital and devital teeth were randomized into four groups using a randomized block design with block sizes of 10 patients each. The groups were devital/vital teeth treated with iRoot SP sealer and devital/vital teeth treated with AH Plus sealer. Patients were prescribed ibuprofen, a 200-mg analgesic, if needed, and postoperative pain was recorded by visual analogue scale at 6, 12, 24, and 72 h after obturation. Pain score and frequency of tablet intake were recorded and statistically analyzed. RESULTS: Results showed that there was no significant difference between groups in the incidence of postoperative pain; however, iRoot SP sealer was associated with less analgesic intake compared to AH Plus sealer. CONCLUSION: The use of different sealers did not significantly affect pain levels. CLINICAL RELEVANCE: iRoot SP sealer was associated with less analgesic intake compared to AH Plus sealer.

Effect of Calcium Hydroxide Dressing on the Dentinal Tubule Penetration of 2 Different Root Canal Sealers: A Confocal Laser Scanning Microscopic Study.

INTRODUCTION: The purpose of this study was to evaluate the effect of calcium hydroxide (Ca[OH]2) dressing on the dentinal tubule penetration of epoxy resin-based sealer (AH 26; Dentsply Maillefer, Ballaigues, Switzerland) and tricalcium silicate-based sealer (BioRoot RCS; Septodont, Saint Maurdes Fosses, France). METHODS: Fifty-two single-rooted mandibular premolars were used. Four samples were assigned as the positive control. Twenty-four samples received Ca(OH)2 labeled with rhodamine B, whereas the rest did not. Ca(OH)2 was removed with passive ultrasonic activation and copious irrigation 2 weeks later. Samples were further subdivided into 2 groups, and root canal fillings were performed with a single ProTaper F4 gutta-percha cone (Dentsply Maillefer) combined with 1 of the tested sealers labeled with fluorescein green. After 2 weeks, samples were transversely sectioned at the apical, middle, and coronal levels. The penetration depth and percentage were evaluated via imaging software. Statistical analysis was performed using Kruskal-Wallis, Siegel Castellan post hoc, and Mann-Whitney U tests at P = .05. RESULTS: The mean dentinal tubule penetration depth and percentage values were lowest in the apical third for both sealers. BioRoot RCS showed higher penetrability in all thirds compared with AH 26 (P < .05) despite Ca(OH)2 dressing remnants (P < .05). Ca(OH)2 placement resulted in a shorter dentinal tubule penetration depth with BioRoot RCS statistically in the middle and coronal thirds (P < .05), whereas it did not affect the percentage (P > .05). CONCLUSIONS: Passive ultrasonic activation and copious irrigation were insufficient in removing Ca(OH)2 from root canals. BioRoot RCS presented higher dentinal tubule penetration than AH 26 even in the presence of Ca(OH)2 residues. Ca(OH)2 remnants decreased both dentinal tubule penetration depth and the percentage of the tested sealers; however, a more drastic effect was observed for AH 26.

Tubular dentin sealer penetration after different final irrigation protocols: A confocal laser scanning microscopy study.

The aim of this study was to evaluate tubular dentin sealer penetration, comparing different final irrigation protocols using a conventional needle (CONV), EndoActivator system (EAS), EndoVac system (EVS), and ultrasound (PUI). Initially, fifty-two first maxillary molars with a single canal in the palatal root, without abrupt curvatures, resorptive processes, or previous endodontic treatment were selected for this study. Then, the crowns were sectioned to obtain palatal roots 15 mm in length. The root canals were prepared with the ProTaper Universal System and irrigated with 5% NaOCl. Afterwards, the specimens were divided into four groups (n. 13), according to the final irrigation protocol: CONV, EAS, EVS, and PUI. After filling, slices at 3 mm and 5 mm from the apex were obtained for analysis by confocal laser scanning microscopy. Two-way comparisons between the groups and the levels were performed with Games Howell's test (p < .05). Tubular dentin sealer penetration was higher at 5 mm compared with 3 mm from the apex (p < .05). The EAS group showed a higher percentage of tubular dentin sealer penetration, compared with the CONV group, at both levels. At 3 mm, there was no statistically significant difference among EAS, EVS, and PUI; however, these groups showed better performance, compared with the CONV group. At 5 mm, there was no statistically significant difference between the EAS and EVS groups, but both showed higher sealer penetration than the PUI group (p < .05). The EAS and EVS groups achieved better degrees of tubular dentin sealer penetration, compared with the other groups.

Interfacial Characteristics and Cytocompatibility of Hydraulic Sealer Cements.

INTRODUCTION: The stability and long-term success of root canal obturation depends on the choice of sealer because the sealer bonds to the dentin and stabilizes the solid cone. Furthermore, the sealer needs to be nontoxic because sealer toxicity will certainly lead to treatment failure. The aim of this study was to assess the sealer-dentin interface of 3 hydraulic root canal sealers and to evaluate their cytocompatibility compared with AH Plus (Dentsply DeTrey GmbH, Konstanz, Germany). METHODS: Four dental root canal sealers were assessed. AH Plus, MTA Fillapex (Angelus, Londrina, Brazil), BioRoot RCS (Septodont, Saint-Maur-des-Fossés, France), and Endoseal (Maruchi, Wonju-si, Gangwon-do, South Korea) were characterized using scanning electron microscopy and energy-dispersive spectroscopy. The sealer-tooth interface was assessed by confocal microscopy and scanning electron microscopy, and biocompatibility was measured by assessing the cell metabolic function using direct contact assays and alkaline phosphatase activity. RESULTS: The tricalcium silicate-based sealers presented a different microstructure and elemental composition despite their similar chemistry and classification. BioRoot RCS was free of aluminum, and all sealers presented different radiopacifying elements. The sealer penetration in the dentinal tubules and interfacial characteristics were different. The migration of silicon was evident from sealer to tooth for all sealers containing tricalcium silicate. MTA Fillapex and BioRoot RCS exhibited the best cytocompatibility in both the direct contact test and alkaline phosphatase activity. CONCLUSIONS: The use of hydraulic calcium silicate-based sealers has introduced a different material type to endodontics. These materials are different than other sealers mostly because of their hydraulic nature and their interaction with the environment. Although the sealers tested had a similar chemistry, their cytocompatibility and bonding mechanisms were diverse.

Effect of Fiber Post Cementation Timing on the Bond Strength of Resin Cements in Epoxy Resin-Obturated Canals.

This study evaluated the influence of timing after endodontic treatment and type of resin cement used on the bond strength of fiber posts to epoxy resin-obturated canals. A total of 80 bovine incisor roots were divided into four groups (n = 20). Glass fiber posts were cemented at two different times, immediately or 7 days after endodontic treatment, using either a dual-curing resin cement (RelyX ARC, 3M ESPE) or a self-adhesive resin cement (RelyX U200, 3M ESPE). Following post cementation, the samples were cross-sectioned into slices containing root dentin, cement, and fiber post at the cervical, mid, and apical root thirds. The push-out test was performed on a universal testing machine. Three-way analysis of variance for randomized blocks showed no significant effect within the triple interaction (P = .394) or between the double interactions cement-timing (P = .395), cement-root thirds (P = .996), and timing-root thirds (P = .331). The main factor cement revealed a significant effect, showing that regardless of the timing and root third, RelyX ARC provided significantly higher bond strength values than U200. Regardless of root third and timing, the dual-curing resin cement showed higher bond strength to root dentin when the canals were filled with epoxy resin-based cement.

Effectiveness of different final irrigation techniques and placement of endodontic sealer into dentinal tubules.

The aim of this study was to compare two irrigation techniques and four devices for endodontic sealer placement into the dentinal tubules. Ninety-nine single-rooted human teeth were instrumented and allocated to either the control (CO) (n=11) or experimental groups according to the irrigation method: syringe and NaveTip needle (NT) (n=44), and EndoActivator (EA) (n=44). These groups were subdivided according to sealer placement into K-File (KF), lentulo spiral (LS), Easy Clean (EC), and EndoActivator (EA) subgroups. Moreover, the distances of 5 mm and 2 mm from the apex were analyzed. The teeth were obturated with AH Plus and GuttaCore X3. Analyses were performed by scanning electron microscopy associated to cathodoluminescence. The percentage and maximum depth of sealer penetration were measured. Data were evaluated by three-way analysis of variance (ANOVA) and Games-Howell test (p<0.05). EA was superior to NT in percentage of sealer penetration. EC was significantly superior to EA (subgroup) for sealer penetration, and both improved the percentage of sealer penetration when compared to LS. Better sealer penetration was observed at the distance of 5 mm from the apex. Sealer penetration into the dentinal tubules was significantly improved by sonic irrigant activation.

Evaluation of the Sealing Ability of Three Obturation Techniques Using a Glucose Leakage Test.

The aim of this study was to evaluate the sealing ability of three different canal filling techniques. Sixty-four roots of extracted human maxillary anterior teeth were prepared using ProTaper® rotary instruments. The specimens were then randomly divided into 3 experimental groups (n = 16) and 2 control groups (n = 8). The root canals were filled using cold lateral compaction (CLC group), continuous wave condensation technique using the Elements Obturation Unit® (EOU group), and ProTaper obturators (PT group). For the negative control group, 8 roots were filled using lateral compaction as in the CLC group, and the teeth were covered twice with a layer of nail varnish (NCG group). Another 8 roots were filled using lateral compaction, but without sealer, and these were used as the positive control (PCG group). A glucose leakage model was used for quantitative evaluation of microleakage for 24 hours and 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, and 12 weeks. No significant difference in the cumulative amount of leakage was found between the three experimental groups at all observation times. The lateral condensation of cold gutta-percha can guarantee a similar seal of canal fillings as can be achieved by using thermal methods, in the round canals.