The presence of smear layer affects the antimicrobial action of root canal sealers.

AIM: To assess the chemical and microstructural characteristics of dentine after the use of two irrigation protocols and correlate this with the antimicrobial properties of hydraulic calcium silicate cement (HCSC) sealers and changes to the dentine structure/chemistry after sealer placement. METHODOLOGY: Two irrigation protocols - Protocol A using 2% NaOCl used 5 mL/5 min and Protocol B with 2% NaOCl (5 mL/5 min) followed by 17% EDTA (5 mL/3 min) - were used to prepare dentine. The chemical and microstructural changes following irrigation were assessed by scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS) and Fourier transform infrared (FT-IR) spectroscopy (n = 5) on dentine obtained from the mid-root and coronal parts of extracted human teeth. Four sealers (AH Plus, BioRoot, MTA Fillapex, TotalFill) were characterized by SEM/EDS (n = 3). The ability of the sealers to eradicate intratubular Enterococcus faecalis biofilms was assessed by live/dead dye and confocal laser scanning microscopy to measure the percentage of living cells. The effect of combined irrigation and root filling on dentine was assessed by SEM and EDS analysis (n = 5). Statistical analysis was undertaken using one-way anova and a number of post hoc tests to detect intergroup differences. The F-test was used for comparison of variances in the microbiology testing. RESULTS: The use of NaOCl alone left the smear layer intact, with traces of chlorine remaining on dentine. The use of BioRoot sealer restored the calcium levels of dentine which had been depleted by the irrigation with EDTA. BioRoot exhibited antimicrobial properties against intratubular bacteria even in the presence of smear layer (Protocol A). Smear layer removal improved the bactericidal effect of all sealers and Ca2+ leaching. The use of a chelating agent was important for the intratubular sealer penetration for AH Plus but not the other sealers. CONCLUSION: The removal of smear layer was necessary for penetration of AH Plus into the dentinal tubules. BioRoot was a more effective sealer in reducing the bacterial load in the dentinal tubules than the other materials tested and the presence of smear layer did not affect its activity.

Comparative Evaluation of Root Reinforcement Using MTA-based, Epoxy Resin-based, and Silicone-based Endodontic Sealers in Canals Instrumented with Single-file Rotary System: An In Vitro Study.

AIM: To evaluate root reinforcement by four different sealers, namely, AH Plus, MTA Fillapex, Dia-ProSeal, and GuttaFlow 2, on endodontically treated teeth. MATERIALS AND METHODS: Sixty human mandibular premolars were randomly divided into four groups of 15 teeth each, according to the type of sealer used: Group I AH Plus, Group II MTA Fillapex, Group III Dia-ProSeal, and Group IV GuttaFlow 2. All samples were decoronated to a length of 13 mm from the apex. Root canals were prepared by OneShape, 25/0.06 taper file and obturated with a matching single cone gutta percha (25/0.06) using the above-mentioned sealers. All samples were subjected to load by universal testing machine until a point at which root fractured, which was recorded. RESULTS: Teeth obturated with GuttaFlow 2 showed the maximum fracture resistance followed by AH Plus, Dia-ProSeal, and MTA Fillapex. There was no significant difference in fracture resistance between AH Plus and Dia-ProSeal. CONCLUSION: Teeth obturated with GuttaFlow 2 sealer, which has powdered gutta percha particles, showed the highest fracture resistance. CLINICAL SIGNIFICANCE: According to the results obtained from this study, obturation of roots with GuttaFlow 2 increased the resistance of root canal-filled teeth to vertical root fracture.

Fracture Resistance of Endodontically Treated Teeth Obturated with Different Root Canal Sealers (A Comparative Study).

AIM: The aim of this study is to compare the effect of different root canal sealers on the fracture resistance of endodontically treated teeth using AH Plus, GuttaFlow 2, MTA-Fillapex, and TotalFill® BC™ sealers. MATERIALS AND METHODS: Sixty single-rooted mandibular premolar teeth were used in the study. After the decoronation of the crowns of the teeth, we got a 13 mm root length. All samples instrumented using ProTaper Next system reaching file size ×4 as the final master apical file. Gutta-percha (GP) with single cone as obturation technique was carried out to all experimental teeth. Then, the teeth were divided into five groups (n = 12) based on the type of sealer to be used. Group I: AH Plus sealer + GP, Group II: GuttaFlow 2 sealer + GP, Group III: MTA-Fillapex sealer + GP, Group IV: TotalFill BC sealer + GP, and Group V: control (instrumented but unobturated teeth). Embedding all teeth in acrylic resin blocks was carried out and fracture force was measured using a universal testing machine (Instron Corp., Canton, MA, USA) by using metal-like spreader tip on 0.5 mm/m speed. Then, the data were statistically evaluated using one-way analysis of variance (ANOVA) and post hoc test (Tukey's test). RESULTS: Group IV showed higher resistance to fracture than other groups significantly. There was a nonsignificant difference in fracture force between Group I, Group II, and Group III. Group V showed the least fracture resistance than other groups. CONCLUSION: Based on this in vitro study, TotalFill bioceramic-based sealer was more effective when compared with other sealers and the unobturated group showed the lowest mean fracture resistance. CLINICAL SIGNIFICANCE: The use of bioceramic sealer with BC cones enhanced the fracture resistance of endodontically treated teeth.

Evaluation of Sealing Ability of Three Root Canal Sealers: An In Vitro Study.

AIM: To evaluate the sealing ability of three different types of sealers using confocal laser microscopy. MATERIALS AND METHODS: Sixty extracted single-root premolars were selected and divided into three groups (20 teeth in each group) according to the type of sealer used, namely, mineral trioxide aggregate (MTA) Fillapex, AH Plus, and Bio C Sealer. Root canal preparation and obturation were done in all the samples. Roots was dissected transversely in apical plane. Percentage of gap from region to canal circumference was calculated using a confocal laser microscope. Samples were subjected to statistical analysis. RESULTS: High dye penetration was seen with AH Plus compared to MTA Fillapex and least with Bio C Sealer. The AH Plus is the best sealer with respect to seal ability of all the three. CONCLUSION: This study helps to appraise the sealing ability of the different types of sealers using confocal laser microscopy which is useful for the success of root canal treatment. CLINICAL SIGNIFICANCE: As sealer has to seal voids, foramina, and canals, it should have good penetration for the success of root canal treatment.

Bone tissue response to an MTA-based endodontic sealer, and the effect of the addition of calcium aluminate and silver particles.

AIM: To evaluate bone tissue reactions in rats to an MTA-based endodontic sealer with and without the addition of various concentrations of C3A or C3A + Ag. METHODOLOGY: Bone tissue reactions were evaluated in 45 Wistar rats after 7, 30 and 90 days (n = 5 per period). Three surgical cavities were prepared on the right femur and filled with 0.2 mL MTA Fillapex, MTA Fillapex + C3A and C3A + Ag at various concentrations: AH Plus (Dentsply DeTrey GmbH, Konstanz, Germany), EndoSequence BC (Brasseler USA, Savannah, GA, USA) or no sealer (negative control). By the end of each experimental period, animals were randomly euthanized. The samples were histologically processed and analysed using a light microscope. The presence of inflammatory cells, fibres and hard tissue barrier formation was evaluated. Data were analysed statistically using nonparametric tests to compare the differences between groups. Multiple groups were compared using the Kruskal-Wallis and Mann-Whitney U-tests with a Bonferroni correction at P = 0.05. RESULTS: The inflammatory response significantly decreased from 30 to 90 days (P < 0.05). Fibre condensation was similar amongst the groups at 07 and 30 days after intervention (P > 0.05). At 90 days, however, fibres were absent in most specimens of EndoSequence BC Sealer, AH Plus, MTA Fillapex and the control group, whilst they were still observed in samples of the modified sealers (P < 0.05). At 90 days, all specimens of AH Plus, EndoSequence BC Sealer and control group had complete formation of hard tissue barrier. In the MTA Fillapex group, as well as in the modified sealers groups, partial deposition of mineralized tissue was noticed. CONCLUSION: The hypothesis tested that the incorporation of C3A and C3A + Ag particles to MTA Fillapex would improve bone tissue repair was partially accepted, since modified MTA Fillapex did not have the same repair potential as the commercial bioceramic material.

Effect of Different Irrigation Solutions on the Apical Sealing Ability of Different Single-cone Obturation Systems: An In Vitro Study.

AIM: The aim of this study was to assess the effect of three root canal irrigants on the apical sealing ability of three single-cone obturation systems. MATERIALS AND METHODS: One hundred maxillary central incisors were selected and their crowns were cut. The roots were divided into three experimental groups of 30 samples each, and one control group of 10 samples (5 positives and 5 negatives). Each experimental group was divided equally into three subgroups according to the obturation system. All root canals were instrumented using ProTaper Universal rotary system and irrigated with 3% sodium hypochlorite (Group 1), 2% chlorohexidine (Group 2), 3% hydrogen peroxide (Group 3). Finally, root canals were irrigated with 17% EDTA followed by distilled water, then obturated with a single-cone technique using gutta-percha/MTA Fillapex (Subgroup A), gutta-percha/ AH Plus (Subgroup B), and Resilon/Relseal SE (Subgroup C). The microleakage was assessed using linear dye penetration method and data were statistically analyzed. RESULTS: Significant differences were found between all groups and subgroups (p < 0.005). When 3% of hydrogen peroxide was used, no leakage was observed with AH Plus sealer, and a high amount of leakage (5.82 ± 0.47 mm) was observed with Realseal SE. MTA Fillapex (0.49 ± 0.08 mm) and Realseal SE (1.11 ± 0.50 mm) showed the lowest amounts of leakage when 2% chlorohexidine and 3% sodium hypochlorite were used, respectively. CONCLUSION: The type of irrigating solution and obturation system could affect the apical leakage value when single-cone obturation technique was used. AH Plus/gutta-percha obturation system showed no apical leakage when root canals were irrigated with 3% hydrogen peroxide. The using of 2% chlorohexidine improved sealing ability of MTA Fillapex/gutta-percha. The apical sealing ability of Realseal SE/Resilon decreased when 3% hydrogen peroxide or 2% chlorhexidine was used. CLINICAL SIGNIFICANCE: Proper selection of irrigating solutions may positively influence the apical sealing ability of single-cone obturation systems.

Properties of BioRoot RCS, a tricalcium silicate endodontic sealer modified with povidone and polycarboxylate.

AIM: To evaluate the chemical and physical properties of a tricalcium silicate root canal sealer containing povidone and polycarboxylate (BioRoot RCS), a calcium silicate MTA-based sealer containing a salicylate resin (MTA Fillapex), a traditional eugenol-containing sealer (Pulp Canal Sealer) and an epoxy resin-based root canal sealer (AH Plus). METHODOLOGY: Calcium release, pH, setting time, water sorption, volume of open pores, volume of impervious portion, apparent porosity and weight loss were measured. The ability to nucleate calcium phosphates (CaP) after ageing 28 days in a simulated body fluid was evaluated using ESEM-EDX and micro-Raman spectroscopy. Data were statistically analysed (P = 0.05) using one-way anova (setting time, radiopacity, solubility, water sorption, porosity) or two-way anova (ion release tests). RESULTS: BioRoot RCS had a final setting time of 300 min and adequate radiopacity (5.2 mm Al). It demonstrated the highest (P < 0.05) and more prolonged ability to release calcium ions (721 ppm at 3 h) and to increase the pH (11-12) (P < 0.05); B-type carbonated apatite deposits were found on aged BioRoot RCS (biointeractivity-related CaP-forming ability). A final setting time of 270 min and good calcium release (17.4 ppm at 3 h) were measured for MTA Fillapex; apatite deposits were present on aged samples. No calcium release and no alkalizing activity were measured for Pulp Canal Sealer and AH Plus; no CaP nucleation was detected on aged Pulp Canal Sealer, and some apatite deposits were found on aged AH Plus (chemi/physisorption-related CaP-deposition). Higher and significantly different (P < 0.05) porosity, water sorption and solubility were measured for the two calcium silicate sealers, especially for BioRoot RCS. CONCLUSIONS: BioRoot RCS had bioactivity with calcium release, strong alkalizing activity and apatite-forming ability, and adequate radiopacity.

In vivo evaluation of the effects of hydraulic calcium silicate dental cements on plasma and liver aluminium levels in rats.

Our aim was to test whether the presence of three hydraulic calcium silicate dental cements--MTA Angelus, MTA Fillapex, and Theracal LC--in the dental extraction socket of an in vivo model, would affect the levels of aluminium (Al) in the plasma and liver. Following anesthesia, the right upper incisor of each male Wistar albino rat was extracted and polyethylene tubes filled with MTA Angelus, MTA Fillapex, or Theracal LC were inserted into the depth of the extraction socket and gingival tissue was sutured. The rats were killed 7, 30, or 60 d after the operation. Blood and liver samples were obtained from the rats before they were killed, and the levels of Al were measured by atomic absorption spectrometry. Plasma Al levels were higher in the rats in which the mineral trioxide aggregate (MTA) cements were implanted, especially MTA Angelus and MTA Fillapex, compared with control rats. In liver samples, however, the differences in Al level were not statistically significant. Our results show that Al might have been released into the circulation from the three dental cements tested, especially MTA Angelus and MTA Fillapex. Further research should be carried out on the possible biological effects of Al liberated from dental cements.

Dentinal tubule penetration of AH Plus, iRoot SP, MTA fillapex, and guttaflow bioseal root canal sealers after different final irrigation procedures: A confocal microscopic study.

BACKGROUND AND OBJECTIVE: Varied physical and chemical characteristic of root canal sealers and different irrigant agitation systems can influence the depth of penetration. The aim of this in vitro study was to use a laser scanning confocal microscope in order to assess the dentinal tubules penetration of various sealers after the application of different final irrigation techniques. STUDY DESIGN/MATERIALS AND METHODS: A total of 156 single-rooted extracted mandibular premolars were prepared up to size 40 and randomly distributed into four groups according to the sealer type (n = 39): AH Plus, iRoot SP, MTA Fillapex, and GF Bioseal. Each group was randomly subdivided into three groups according to the final irrigation protocol (n = 13): conventional needle irrigation (CI), photon-induced-photoacoustic streaming activation (PIPS), and passive ultrasonic irrigation (PUI). After the final irrigation procedures, the root canals were obturated with single gutta-percha and labeled sealer mixed with 0.1% fluorescent rhodamine B isothiocyanate. Specimens were sectioned at 2, 5, and 8 mm from the apex, and all the sections were examined under confocal microscope to calculate the dentinal tubule penetration area. Data were analyzed using three-way analysis of variance and Tukey's post hoc tests (P = 0.05). RESULTS: iRoot SP exhibited a significantly higher penetration area than the other groups (P < 0.001), although there were no statistically significant differences between AH Plus, MTA Fillapex, and GF Bioseal (P > 0.05). Er:YAG laser activation with PIPS and PUI had significantly higher penetration than CI (P < 0.001). Statistically significant differences were also determined at each root canal third (coronal > middle > apical; P < 0.001). CONCLUSIONS: The dentinal tubule penetration area was significantly affected by the selection of root canal sealer, final irrigation procedure, and root canal third. Use of iRoot with PIPS tip or PUI seems advantageous in dentinal tubule penetration.

Suboptimal push-out bond strengths of calcium silicate-based sealers.

AIM: To evaluate and compare the push-out bond strength of MTA Fillapex (Angelus, Londrina, Brazil) and iRoot SP (Innovative BioCeramix Inc., Vancouver, Canada) to the dentine walls of root canals. AH Plus (Dentsply DeTrey, Konstaz, Germany) and MTA (Angelus, Londrina, Brazil) were used as reference materials. METHODOLOGY: Sixty extracted human single-rooted teeth were selected. After standardized canal preparation and irrigation, the canals were dried with paper points and filled with one of four sealers: AH Plus, iRoot SP, MTA and MTA Fillapex. Roots were sectioned, and push-out tests were performed. The values of bond strength were analysed using the Kruskal-Wallis test. Mann-Whitney with Bonferroni correction was used to isolate the differences. The alpha-type error was set at 0.05 for the analyses. RESULTS: All specimens had measurable adhesion to root dentine and no premature failure occurred. There were significant differences amongst materials (P = 0.000). MTA-filled specimens had higher push-out bond strength values (P = 0.000). AH Plus had significantly higher bond strength than both Fillapex and iRoot SP (P = 0.000). Both Fillapex and iRoot SP had the lowest push-out bond strength amongst all experimental groups (P = 0.000). No difference occurred between the two calcium silicate-based root canal sealers (P = 0.265). CONCLUSION: The adhesion to root dentine associated with newer calcium silicate-based sealers was compromised even when well-monitored laboratory conditions were used.

Assessment of the cytotoxicity of a mineral trioxide aggregate-based sealer with respect to macrophage activity.

AIM: To assess the influence of co-culture with mineral trioxide aggregate (MTA) and MTA Fillapex (FLPX) on the viability, adherence, and phagocytosis activity of peritoneal macrophages from two mouse strains. METHODOLOGY: Cellular viability, adherence, and phagocytosis of Saccharomyces boulardii were assayed in the presence of capillaries containing MTA and MTA Fillapex. The data were analyzed using parametric (Student's t) and non-parametric (Mann-Whitney) tests. RESULTS: FLPX was severely cytotoxic and decreased cell viability, adherence, and phagocytic activity of both macrophage subtypes. Cells that were treated with MTA Fillapex remained viable (>80%) for only 4 h after stimulation. Macrophages from C57BL/6 mice presented higher adherence and higher phagocytic activity compared with macrophages from BALB/c mice. CONCLUSION: Comparison of MTA and FLPX effects upon macrophages indicates that FLPX may impair macrophage activity and viability, while MTA seems to increase phagocytic activity.

The effects of a mineral trioxide aggregate-based sealer on the production of reactive oxygen species, nitrogen species and cytokines by two macrophage subtypes.

AIM: To test the effects of a mineral trioxide aggregate-based sealer (MTA Fillapex(®)) and MTA (MTA-Ângelus(®)) on viability and on the production of cytokines, reactive oxygen species (ROS) and nitrogen species (NO) by M1 and M2 inflammatory macrophages. METHODOLOGY: M1 (from C57BL/6 mice) and M2 (from BALB/c mice) peritoneal inflammatory macrophages were obtained and cultured in vitro in the presence of original and diluted extracts of MTA and MTA Fillapex (FLPX). The cell viability, ROS release and the release of tumour necrosis factor-a, interleukin (IL)-12, IL-10 and NO in response to stimulation with interferon-γ and Fusobacterium nucleatum or Peptostreptococcus anaerobius were evaluated. The data were analysed using the Mann-Whitney test and Student's t-test. RESULTS: Fillapex was cytotoxic at the highest concentrations (1:1;1:2) and decreased the viability (P < 0.05) of both macrophage types (<20%). MTA did not interfere with cellular viability. FLPX inhibited the release of ROS and decreased NO release in F. nucleatum and P. anaerobius -stimulated M1 and M2 macrophages (≤25 µ mol L(-1)). F. nucleatum-stimulated M2 macrophage cultures released lower levels of TNF-α when FLPX was added (≤1 ng mL(-1)). M2 macrophages released higher (>5 ng mL(-1)) levels of IL-10 than M1 macrophages. Only M1 macrophage cultures produced IL-12p70. CONCLUSIONS: Fillapex impaired effector immune responses during inflammation (M1 macrophages), as well as during healing (M2 macrophages) responses.

Marginal Adaptation of BioRoot RCS, MTA-Fillapex, EpoxySeal, and Sealapex to Radicular Dentin: An In Vitro Study.

Introduction The primary goal of endodontic therapy is to achieve a three-dimensional filling of the root canal. The sealer plays a crucial role in filling the residual gaps between the gutta-percha and the canal wall, which prevents fluids and bacteria from entering the canal and causing complications. This study evaluates and compares the sealing ability of four root canal sealers to the root dentin. Methods and materials In this study, forty single-rooted mandibular premolar teeth with fully-formed apices were collected. The teeth were decoronated and instrumented. Later, the teeth were randomly divided into four groups, each comprising ten specimens, based on the sealer used for obturation. The first group was obturated with BioRoot RCS (Septodont, Septodont Holding, Paris, France), the second group with MTA-Fillapex (Angelus, Angelus Indústria de Produtos Odontológicos S/A, Brazil), the third group with EpoxySeal (Safe Endo, SafeEndo Dental India Pvt. Ltd., Gujarat, India), and the fourth group with Sealapex (Kerr, Kerr Corporation, Brea, CA). Following obturation, the teeth were sectioned vertically using a diamond disc, and the marginal adaptation of these sealers to the root dentin was assessed using scanning electron microscopy (SEM). The values were then statistically analyzed. Results EpoxySeal showed the maximum amount of marginal adaptation (5.22±0.47), followed by BioRoot RCS (5.48±0.58) and MTA-Fillapex (8.24±0.74), and the least amount of marginal adaptation was shown by Sealapex (11.64±1.35). Based on the analysis of variance (ANOVA), a statistically significant difference (p≤0.001) was observed. According to Tukey's post hoc test, the mean difference between all groups showed statistical significance (p≤0.05) except between BioRoot RCS and EpoxySeal. Conclusion Within the limitations of this in vitro study, it is concluded that EpoxySeal and BioRoot RCS exhibited superior marginal adaptation to the root dentin. BioRoot RCS can be recommended as a sealer of choice owing to its additional properties, such as antimicrobial and hydrophilic affinity during setting.

Comparative Evaluation of the Sealing Ability of Mineral Trioxide Aggregate (MTA)-Based, Resin-Based, and Zinc Oxide Eugenol Root Canal Sealers: An In Vitro Study.

Root canal therapy is a crucial procedure in endodontics that is done to achieve complete obliteration of the root canal space. The success of this therapy depends on achieving a proper seal, which is facilitated using root canal sealers. This study aimed to compare the apical sealing ability of three different root canal sealers: MTA Fillapex, AH Plus, and zinc oxide eugenol (ZOE), using the dye penetration method. Forty freshly extracted single-rooted human maxillary incisors were collected and prepared for the study. The root canals were instrumented using the ProTaper system, and the canals were then obturated using the lateral condensation technique with the respective sealers. After one week of storage, the samples were coated with nail varnish, immersed in a rhodamine B dye solution, and then sectioned longitudinally. The depth of dye penetration was measured, and the results were analyzed statistically. The results revealed significant differences in apical leakage among the three experimental groups. Group 2 (AH Plus) showed the minimum leakage with a mean of 0.13 mm, while Group 4 (no sealer) exhibited the maximum leakage with a mean of 4.49 mm. Group 3 (ZOE) showed an intermediate level of leakage with a mean of 2.37 mm. The statistical analysis confirmed the significant difference in mean leakage among the groups. The findings of this study indicate that AH Plus exhibited superior apical sealing ability compared to MTA Fillapex and ZOE. AH Plus is a resin-based sealer known for its dimensional stability. On the other hand, MTA Fillapex, a newly introduced sealer containing mineral trioxide aggregate, resin, and silica, showed promising sealing properties but had slightly higher leakage compared to AH Plus. ZOE, a traditional sealer, demonstrated relatively higher leakage than the other sealers. In conclusion, choosing a root canal sealer is crucial in achieving a successful endodontic treatment outcome. AH Plus demonstrated superior apical sealing ability among the three sealers tested. Further research and long-term clinical studies are warranted to validate these findings and assess the impact of sealer choice on treatment outcomes and post-endodontic healing.

Evaluation of The Sealing Ability of Gutta Percha with Bioroot RCS, MTA Fillapex and Sealapex - An SEM Study.

Aim of the Study: The objective of this in-vitro study was to assess the screening capabilities of three endodontic sealers, namely the BioRoot RCS, the MTA Fillapex, and Sealapex (a calcium hydroxide-based sealer), and the gutta-percha cone by using a scanning electron microscopy to the dentine walls. The results from the research are presented here. Results: ZOE exhibited more gaps in the sealing materials evaluated with the least dental sealing performance, followed by the cervical third by the MTA Fillapex, the Sealapex, and the BioRoot RCS. The ZOE, followed by Sealapex, MTA Fillapex, and BioRoot RCS, exhibited inadequate dental wall sealing capacity in the middle of the third. The third apical ZOE exhibited more deficiencies in the formation of dental walls, followed by Sealapex, MTA Fillapex, and BioRoot RCS. Conclusion: Under the constraints of the investigation, it can be stated that for the bioceramic sealer, a minimal gap was seen, with RCS of BioRoot superior to Fillapex of MTA. In the middle third, Sealapex was better adapted to the calcium hydroxide-based sealant than the MTA Fillapex sealer. MTA Filllapex had lower gap development than Sealapex in cervical or apical thirds.

In vitro toxicogenomic activity of an MTA/salicylate-based endodontic sealer.

This study was designed to investigate whether mineral trioxide aggregate (MTA) Fillapex®, an MTA/salicylate-based endodontic sealer, exerts cytotoxic and toxicogenomic effects on human gingival fibroblasts (HGFs). HGFs were exposed in vitro to MTA Fillapex® at concentrations of 5%, 10%, 20%, and 40% for 24 h. Cytotoxicity, cell survival (5 days), cell cycle kinetics (flow cytometry), genotoxicity (comet assay), and gene (TP53, BAX, and BCL2) expression profiles were evaluated using reverse-transcriptase quantitative polymerase chain reaction. MTA Fillapex® was cytotoxic to HGFs at the two highest concentrations (20% and 40%), and cell survival decreased after 5 days treatment only with 40% concentration. After MTA Fillapex® treatment, there was an increase in the expression of apoptosis-related genes BAX, BCL2, and TP53, but no increase in DNA damage. Cement also induced changes in cell cycle kinetics, apoptosis, and necrosis rates. The data show the ability of MTA Fillapex® endodontic sealer to induce cellular and genetic alterations in HGFs. Our findings suggest that this compound should be used with caution to avoid health-related risks to the buccal tissue.

The effect of four different intracanal medicaments on the push-out bond strength of root canal sealers.

This study aimed to compare the effect of 4 different intracanal medicaments on the push-out bond strength of two sealers (AH Plus and MTA Fillapex). 100 single-rooted extracted premolar teeth were divided into 5 groups, with 20 samples in each group, one group being the control group. After cleaning and shaping procedures, the canals were filled with 4 different medicaments: calcium hydroxide, tri-antibiotic paste (TAP), Metapex, or Chlorhexidine (2%) gel for 2 weeks. Following this, the medicaments were rinsed away, and the samples in those sub-groups were obturated with gutta-percha/AH Plus or MTA Fillapex sealers. After 2 weeks of incubation, a 2-mm-thick middle section from each root was evaluated to test push-out strength. The obtained data were tabulated, and appropriate statistical analysis was performed (two-way ANOVA and LSD test). When comparing the average values, the bond strength values of AH Plus were significantly higher than those of MTA Fillapex (p<0.05) in all medicament groups. Based on the findings, we concluded that AH Plus had comparatively higher bond strength than MTA Fillapex. We also observed that AH Plus had higher bond strength in the presence of calcium hydroxide, whereas MTA Fillapex in the presence of Chlorhexidine. A comparison of the push-out bond strength shows that irrespective of the root canal segment or the final irrigant used, AH Plus showed higher values among all groups. The limitation of the current study was that the effect of TAP on the bond strength of endodontic sealers was not negative.

The Effect of Primary Root Canal Treatment on Dentinal Tubule Penetration of Calcium Silicate-based Sealers during Endodontic Retreatment.

INTRODUCTION: The aim of this study was to evaluate the effect of previous root canal treatment on dentinal tubule penetration of calcium silicate-based sealers during endodontic retreatment and to compare 2 different (commonly used and modified) tubule penetration depth measurement techniques. METHODS: The crowns of mandibular premolar teeth were removed, and root canals were prepared (ProTaper Universal; Dentsply Sirona, York, PA) and obturated using AH Plus (AH; Dentsply DeTrey, Konstanz, Germany), MTA Fillapex (MTAF; Angelus, Londrina, Brazil), and WellRoot ST (WRST; Vericom, Gyeonggi-do, South Korea); 0.1% red Rhod-2 dye (Chemodex, St Gallen, Switzerland) was added to the sealers. After storage for 3 weeks (37°C, 100% humid), the following sealer combination subgroups were created (the sealer used during the primary root canal treatment/the sealer used during the retreatment, n = 8): AH/AH, AH/MTAF, and AH/WRST; MTAF/AH, MTAF/MTAF, and MTAF/WRST; and WRST/AH, WRST/MTAF, and WRST/WRST. Green Fluo-3 dye (0.1%) was added to the sealers during retreatment. Sealer penetration depths were measured at 8 points and averaged, and the ratio of the retreatment sealer to the initial sealer was recorded as the mean tubule penetration depth ratio in the first technique, whereas the percentage of the circumferential penetration area ratios of the retreatment and initial sealers was calculated in the second technique. Statistical analyses were performed using Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U tests. RESULTS: The mean penetration depth of AH and MTFA was found to be higher at the coronal third region in the control groups (P < .05). Both methods showed a significant difference among the groups at the coronal and median regions (P < .05). The AH/WRST, MTAH/AH, MTAF/MTAF, MTAF/WRSTS, and WRST/WRST groups showed deeper tubule penetration (first technique, P = .01). Both techniques showed that the penetration depth of the sealers was the same at the apical region (P > .05), whereas a difference was found among the techniques at the coronal and median regions. The sealers used in the previous root canal treatment limited the penetration depth of the sealers used during the retreatment process (P < .05). When MTAF was used as the initial sealer, the penetration depth of the second sealer did not change, whereas if WRST was the initial sealer, the penetration depth of the sealers at the median and apical regions is negatively affected during the retreatment process (P < .05). CONCLUSIONS: Previous root canal treatment affects the penetration depth of calcium silicate-based sealers. The use of AH Plus and MTA Fillapex during the retreatment process showed an advantage. Both measurement techniques showed similar performances at the apical region, whereas the results varied at the coronal and midcoronal regions; therefore, a more stable sealer penetration measurement technique is still necessary.

Comparative evaluation of retreatability of calcium silicate-based root canal sealers and epoxy resin-based root canal sealers in curved canals-An In-Vitro micro-CT analysis.

OBJECTIVE: To compare and evaluate the retreatability of calcium silicate-based root canal sealers and epoxy resin-based root canal sealers in curved canals using micro-CT scanning. MATERIALS AND METHODS: Forty-five maxillary molars with curved roots were selected after confirming with the Schneiders test. Teeth were decoronated near the cemento-enamel junction and moderate to severely curved canals were selected for the study using cone-beam computed tomography. All the samples were subjected to pre-operative micro-CT scanning. Cleaning and shaping were done using step-back preparation, obturation was done using lateral compaction technique, and homogeneous obturation was achieved. All the specimens were kept in 10 mL of phosphate buffered-saline solution at a pH of 8.4 for 48 h and transferred to a plastic container containing moistened foam with 10 mL of phosphate- buffered saline solution, and stored at 37 °C with 100% relative humidity for 4 months. Retreatment was performed for all the samples using Protaper universal retreatment files. Micro-CT scanning was performed to compare and evaluate the remaining sealer volume and resultant cracks formed in the root canal after retreatment. RESULTS: The volume of sealer remaining in the root canal and the length of a crack within the groups were analysed using kruskal-Wallis test and among the groups using post-hoc scheffe test showed that more sealer present in the Diaproseal sealer followed by MTA Fillapex and Bioroot RCS and more crack length was seen in Diaproseal sealer followed by MTA Fillapex and no visible cracks were seen in Bioroot RCS, which had statistically significant results with a P value of < 0.05. CONCLUSION: Within the limitations of the study it was concluded that in-terms of retrievability, Diaproseal sealer was the best among the tested groups followed by MTA Fillapex and Bioroot RCS.

Influence of adjunctive photodynamic therapy (curcumin) on the extrusion bond strength of radicular dentin to contemporary root canal sealers.

OBJECTIVE: The aim was to compare Photodynamic therapy (PDT) as an adjunct to NaOCl and EDTA on the extrusion bond strength (EBS) of AH Plus (AH), Sealapex (SA) and MTA Fillapex (MF) root canal sealers. MATERIALS AND METHOD: Root canal treatment for human teeth (n = 60) using protaper universal system was performed followed by irrigation with NaOCl/ EDTA. Samples were divided (n = 30) based on disinfection technique, NaOCl/EDTA and NaOCl/EDTA with PDT (Curcumin-PS-CP) as an adjunct. Specimens were divided in three subgroups (n = 10) based on sealers used (Gp 1-Na-E-AH, Gp 2-Na-E-PDT-AH, Gp 3-Na-E-SA, Gp 4-Na-E-PDT-SA, Gp 5-Na-E-MF & Gp 6-Na-E-PDT-MF). Canals were dried and obturated followed by sectioning at coronal and middle third. EBS testing was performed using a universal testing machine (UTM) and modes of failure were assessed. Analysis of variance (ANOVA) and Tukey multiple comparison tests were used to compare the means of EBS. (p < 0.05). RESULTS: Sealers showed a significant influence on EBS, as Gp 1 (Co: 9.21 ± 0.62, Mid: 8.54 ± 0.55) and Gp 2 (Co: 7.11 ± 0.68, Mid: 7.30 ± 0.37) showed higher EBS than Gp 3 (Co: 5.21 ± 0.63, Mid: 4.36 ± 0.83) and Gp 4 (Co: 5.39 ± 0.72, Mid: 4.46 ± 0.74). Gp 5 (Co: 9.04 ± 0.13, Mid: 8.14 ± 0.91) and Gp 6 (Co: 8.67 ± 0.42, Mid: 8.07 ± 0.07) exhibited higher EBS than Gp 3 and Gp 4 specimens. Adjunctive use of PDT for AH sealer (Gp 2) showed decreased EBS compared to Gp 1 specimens. EBS remained comparable for both MTA-Fillapex and Sealapex with and without PDT. CONCLUSION: AH Plus (Gp 1 and 2) and MTA-Fillapex (Gp 5 and 6) sealers displayed better EBS compared to Sealapex (Group 3 and 4). Adjunctive Application of PDT (CP) did not show a significant improvement in bond strength of sealers to root dentin.