An automated method to analyze root filling voids and gaps using confocal microscopy images.

This study evaluated the feasibility of an automated method to delimit the required area to quantitatively analyze root filling voids and gaps from cross-sectional confocal laser scanning microscopy (CLSM) images. Root canals of maxillary canines were prepared with rotary instruments and filled by lateral compaction technique using gutta-percha and AH Plus sealer. The roots were stored (100% humidity, 37 °C) for a period of 24 h and then transversally sectioned to obtain 2-mm-thick slices from the apical and middle thirds. The areas corresponding to filling materials, gaps, and voids were manually delimited or automatically demarked by ImageJ software after converting the images to the RGB color system. Based on manual and automatic delimitations, the percentages of voids and gaps were calculated. Data of voids and gaps between middle and apical thirds were individually compared by paired t-test. Pearson`s correlation test was used to assess the correlation of data between the methods. Irrespective of the method of area delimitation, no difference was observed between the root thirds for both voids and gaps, while the p-values calculated for each method were similar. Almost perfect correlations between the methods were observed for both outcomes. The proposed method to automatically delimit the areas corresponding to filling material, voids, and gaps appears to be a valid method to facilitate the quantitative analysis of defects in root canal fillings using topographic CSLM images.

Push-out bond strength and marginal adaptation of apical plugs with bioactive endodontic cements in simulated immature teeth.

OBJECTIVES: This study evaluates the bond strength and marginal adaptation of mineral trioxide aggregate (MTA) Repair HP and Biodentine used as apical plugs; MTA was used as reference material for comparison. MATERIALS AND METHODS: A total of 30 single-rooted teeth with standardized, artificially created open apices were randomly divided into 3 groups (n = 10 per group), according to the material used to form 6-mm-thick apical plugs: group 1 (MTA Repair HP); group 2 (Biodentine); and group 3 (white MTA). Subsequently, the specimens were transversely sectioned to obtain 2 (cervical and apical) 2.5-mm-thick slices per root. Epoxy resin replicas were observed under a scanning electron microscope to measure the gap size at the material/dentin interface (the largest and smaller gaps were recorded for each replica). The bond strength of the investigated materials to dentin was determined using the push-out test. The variable bond strengths and gap sizes were evaluated independently at the apical and cervical root dentin slices. Data were analyzed using descriptive and analytic statistics. RESULTS: The comparison between the groups regarding the variables' bond strengths and gap sizes showed no statistical difference (p > 0.05) except for a single difference in the smallest gap at the cervical root dentin slice, which was higher in group 3 than in group 1 (p < 0.05). CONCLUSIONS: The bond strength and marginal adaptation to root canal walls of MTA HP and Biodentine cement were comparable to white MTA.

Micro-CT evaluation of maxillary first molars: interorifice distances and internal anatomy of the mesiobuccal root.

This study aimed to describe the morphometric relationship of root canal orifices on the pulp floor in the presence/absence of mesiobuccal second canal (MB2) in the maxillary first molars and other aspects of its internal anatomy. Sixty-two maxillary first molars were scanned by micro-CT. The presence of the MB2 canal was verified. The distance between the center points of the MB1, MB2, distobuccal (DB), and palatal (P) canal orifices on the pulp floor were measured (MB1-MB2, MB1-DB, MB2-DB, MB1-P, and DB-P). The MB1-P to DB-P ratio was calculated. The distances between the anatomic apex and the MB1 and MB2 apical foramina were measured. The length of the band-shaped isthmus was also measured. Student's t-test was applied to verify the association between the presence of an MB2 canal, the interorifice distances, and the ratio of the MB1-P to DB-P distance (α = 5%). The MB2 canal was present in 43 roots (69.35%). Statistics showed significant differences when MB2 was present for the largest MB1-P distance (p < 0.05) and higher values for the MB1-P to DB-P ratio (p < 0.05). A band-shaped isthmus was detected in 25.8% of MB roots. The mean distance from the apical foramen to the isthmus floor ranged from 1.74 for MB1 canals to 1.42 for MB2 canals. Canal orifice distances on the pulp floor may predict the presence of MB2 canals. There was a high incidence of isthmus, accessory canals, and apical delta in the critical apical zone in MB roots of maxillary first molars.

Impact of Conservative Endodontic Cavities on Root Canal Preparation and Biomechanical Behavior of Upper Premolars Restored with Different Materials.

INTRODUCTION: The purpose of this study was to evaluate the impact of conservative endodontic cavities (CECs) on root canal preparation, restoration, and biomechanical behavior of teeth prepared using different shaping systems and restorative materials. METHODS: Ninety upper premolars with a bifurcated root were matched based on morphology and randomly assigned to a control group (n = 10) or 1 of the following experimental groups (n = 40): traditional endodontic cavity and CEC. Teeth were subdivided according to instrumentation (n = 10) as follows: ProTaper Universal (Dentsply Maillefer, Ballaigues, Switzerland), Reciproc (VDW GmbH, Munich, Germany), Reciproc Blue (VDW GmbH), and Hyflex EDM (Coltene/Whaledent, Altstätten, Switzerland). After canal obturation, teeth were restored using temporary material, conventional composite, regular bulk fill composite, or bulk fill flow combined with conventional composite. Before and after preparation and after obturation, the teeth were scanned using micro-computed tomographic imaging. Canal transportation (CT), the percentage of untouched canal surfaces (UCSs), voids in restoration (VRs), and residual filling material in the pulp chamber were evaluated. Finite element analysis, fracture resistance, and the failure pattern were recorded. The data were analyzed using analysis of variance and the Tukey and chi-square tests. RESULTS: CECs had greater CT, percentage of filling material, and VRs compared with traditional endodontic cavities (P < .0001). The highest CT and UCSs were observed in CEC with ProTaper Universal. Bulk fill flow combined with conventional composite showed a lower percentage of VRs compared with other restorative materials (P < .05). Finite element analysis, fracture resistance, and failure pattern revealed similar behaviors in all groups (P > .05) . CONCLUSIONS: CECs had a negative impact on root canal centralization, UCSs, cleaning of the pulp chamber, and percentage of VRs. Controlled memory instruments were the most adequate for the root canal preparation of CECs. The endodontic cavity did not influence the biomechanical behavior of restored teeth.

Micro-CT evaluation of maxillary first molars: interorifice distances and internal anatomy of the mesiobuccal root

Abstract: This study aimed to describe the morphometric relationship of root canal orifices on the pulp floor in the presence/absence of mesiobuccal second canal (MB2) in the maxillary first molars and other aspects of its internal anatomy. Sixty-two maxillary first molars were scanned by micro-CT. The presence of the MB2 canal was verified. The distance between the center points of the MB1, MB2, distobuccal (DB), and palatal (P) canal orifices on the pulp floor were measured (MB1-MB2, MB1-DB, MB2-DB, MB1-P, and DB-P). The MB1-P to DB-P ratio was calculated. The distances between the anatomic apex and the MB1 and MB2 apical foramina were measured. The length of the band-shaped isthmus was also measured. Student's t-test was applied to verify the association between the presence of an MB2 canal, the interorifice distances, and the ratio of the MB1-P to DB-P distance (α = 5%). The MB2 canal was present in 43 roots (69.35%). Statistics showed significant differences when MB2 was present for the largest MB1-P distance (p < 0.05) and higher values for the MB1-P to DB-P ratio (p < 0.05). A band-shaped isthmus was detected in 25.8% of MB roots. The mean distance from the apical foramen to the isthmus floor ranged from 1.74 for MB1 canals to 1.42 for MB2 canals. Canal orifice distances on the pulp floor may predict the presence of MB2 canals. There was a high incidence of isthmus, accessory canals, and apical delta in the critical apical zone in MB roots of maxillary first molars.

Correction: Apical periodontitis healing and postoperative pain following endodontic treatment with a reciprocating single-file, single-cone approach: A randomized controlled pragmatic clinical trial.

[This corrects the article DOI: 10.1371/journal.pone.0227347.].

Apical periodontitis healing and postoperative pain following endodontic treatment with a reciprocating single-file, single-cone approach: A randomized controlled pragmatic clinical trial.

This trial assessed post-operative pain and healing of apical periodontitis following endodontic therapy with a reciprocating system compared to a crown-down technique with hand files and lateral compaction filling. One-hundred and twenty nonvital anterior teeth with apical periodontitis were randomly treated using either a reciprocating single file followed by matching-taper single-cone filling or a hand file and lateral compaction filling. Postoperative pain was assessed during the 7 days after the treatment, using a visual analogue scale and a verbal rating scale. Apical healing was assessed using the periapical index score after a 12-month follow-up. The hypothesis tested was that both protocols were equivalent and present similar effectiveness in healing periapical lesions. Data were analyzed through two one-sided tests, t-tests, as well as Mann-Whitney and Chi-squared tests (α = 0.05). Logistic regression was used to investigate the association of clinical and demographic factors with the success of treatment. Regardless of the assessment time, no difference in incidence (38%-43% at first 24h), intensity of postoperative pain, and incidence of flare-up (≈ 3%) was observed between the two endodontic protocols. Both protocols resulted in a similar healing rate of apical periodontitis. After 12 months, the success rate ranged from 73% to 78% and the difference between the treatments fell within the pre-established equivalence margin (-0.1; -0.41 to 0.2). Endodontic treatment combining a reciprocating single file with matching-taper single cone showed similar clinical effectiveness to the treatment using hand-file instrumentation and the lateral compaction filling.

Effectiveness of a reciprocating single file, single cone endodontic treatment approach: a randomized controlled pragmatic clinical trial.

OBJECTIVES: To compare the root filling quality, the sealer extrusion, and the healing rates of apical lesions addressed via two endodontic treatment approaches. The hypothesis tested was that both techniques present similar apical periodontitis healing results. MATERIALS AND METHODS: This study was a parallel-design, pragmatic, and randomized clinical trial. One hundred twenty anterior teeth with necrotic pulps and apical periodontitis were randomly allocated to be either instrumented with hand files and obturated with the lateral compaction technique or instrumented with a single file in a reciprocating movement and obturated with a single-cone technique. The root canal filling quality, the occurrence of sealer extrusion, and apical periodontitis healing were the outcomes of interest. Data were analyzed through chi-square analysis, and the odds ratio for healing was adjusted using a logistic regression model (α = 0.05). RESULTS: No significant differences were observed between the endodontic techniques regarding the root filling quality or sealer extrusion. Six months after treatment, both endodontic techniques presented equivalent results regarding apical periodontitis healing. The healing rate was affected only by the periapical status at baseline. CONCLUSIONS: The obturation of the root canal of the anterior teeth using reciprocating file-matched single cones presented a similar quality to that obtained with manual instrumentation followed by the lateral condensation technique. Similar healing rates of apical lesions were also observed. CLINICAL RELEVANCE: For treating anterior teeth with apical periodontitis, a reciprocating single-file, single-treatment protocol was as effective as a traditional protocol combining hand instrumentation and the lateral compaction obturation technique.

Apicificação em dente desvitalizado com rizogênese incompleta, associando hidróxido de cálcio e agregado trióxido mineral: relato de caso / Apexification in non-vital teeth with incomplete root formation associating calcium hydroxide and mineral trioxide aggregate: a case report

O objetivo do presente estudo foi descrever o manejo de um caso clínico de dente com rizogênese incompleta e necrose pulpar, em um paciente do sexo masculino, 13 anos de idade, com histórico de traumatismo dentário nos incisivos centrais superiores. Após diagnóstico clínico e radiográfico, com confirmação de necrose pulpar, os dentes foram submetidos ao procedimento de apicogênese com hidróxido de cálcio e posterior apicificação com agregado trióxido mineral (MTA)e obturação dos canais radiculares com guta-percha. Após acompanhamento de 20 meses, observou-se supressão da sintomatologia dolorosa, ausência de comprometimento periodontal e, radiograficamente, redução da lesão periapical. Aos 60 meses, foi observada manutenção da saúde periodontal e completa cicatrização da lesão periapical. (AU).

Introduction: Immature teeth with pulp necrosis constitute a challenge to endodontic therapy. Our objective was to describe the management of a tooth case of with incomplete rizogenesis and pulp necrosis. Methods: Patient, male, 13-years-old, with a history of dental trauma in the maxillary central incisors. After confirmation of pulp necrosis, the teeth were submitted to calcium hydroxide intracanal and, posteriorly, apicification with MTA and obturation with gutta-percha. Results: After 20-month follow-up, suppression of the pain symptomatology, absence of periodontal impairment and reduction of the periapical lesion were observed. At 60 months, periodontal health maintenance and complete healing of the periapical lesion were confirmed. Conclusion: Association of intracanal calcium hydroxide with MTA in apicification procedure is a viable alternative to the endodontic treatment of non-vital teeth with incomplete rizogenesis (AU).

Effect of a chitosan final rinse on the bond strength of root canal fillings.

This study was designed to evaluate the effect of a final rinse with 0.2% chitosan solution on the adhesion in roots filled with gutta percha and an epoxy resin based sealer. Thirty extracted human maxillary canines selected to ensure specimen standardization were used in the study. After the coronal portion of each tooth was removed, the roots were instrumented and irrigated with 1% sodium hypochlorite (NaOCl). Roots were distributed into 3 groups according to the final rinsing solution (n = 10): 0.2% chitosan, 17% ethylenediaminetetraacetic acid (EDTA), or 1% NaOCl. The canals were irrigated with 5 mL of each solution for 5 minutes and then filled with gutta percha cones and the resin based sealer. Ten roots in each group were prepared, sectioned, and submitted to push-out testing. Data were analyzed with analysis of variance and Tukey test (P < 0.05). In the push-out test, final irrigation with chitosan (mean, 0.37 [SD, 0.12] MPa) or EDTA (0.38 [0.11] MPa) resulted in significantly greater bond strength of the sealer to the root canal (P < 0.05) than did irrigation with 1% NaOCl (0.13 [0.04] MPa). The cervical third had greater bond strength than the other thirds (P < 0.05). Adhesive failure was the most frequent type in all groups. A final rinse with 0.2% chitosan or 17% EDTA resulted in greater bond strength of root fillings to the root canal than did 1% NaOCl.

In vitro evaluation of tooth discoloration induced by regenerative endodontic therapy and the effectiveness of the walking bleach technique.

BACKGROUND: The present study evaluated the coronal discoloration induced by different materials or blood as well as the effect of internal bleaching on discoloration. METHODS: After tooth color measurement at baseline with a sphere spectrophotometer (CIE L*a*b*), the root canals of molars were partially filled with white mineral trioxide aggregate (MTA), triple antibiotic paste (TAP), or a cotton pellet with bovine blood (control) was placed into the pulp chamber. The color changes were assessed at 30, 60, and 180 days after the procedure. Following the discoloration, internal bleaching was performed with a mixture of sodium perborate and hydrogen peroxide inserted into the pulp chamber, and this mixture was replaced weekly for 3 weeks. At baseline, after staining and after bleaching, the data of each color parameter were individually analyzed by one-way ANOVA, while differences in pooled color changes (∆E00) were assessed by two-way repeated measures ANOVA (α = 0.05). RESULTS: After the staining period, the TAP-stained specimens were darker and greener than the other specimens, and no difference was observed between the teeth stained with blood and those stained with MTA. The walking bleach technique resulted in an improved tooth color without a difference in the color changes among the different groups. CONCLUSION: The TAP-stained specimens had the greatest tooth discoloration, and the discoloration remained the highest after the walking bleach technique. PRACTICAL IMPLICATIONS: This in vitro study demonstrated that TAP yielded higher tooth discoloration, and this color might hinder a satisfactory tooth color from being obtained with the walking bleach technique.

Case Reports in Maxillary Posterior Teeth by Guided Endodontic Access.

The localization of partial or completed root canal obliteration is a challenging task in endodontic practice. Recently, guided endodontics has become an alternative solution for those cases. Although this technique has already been used clinically in managing anterior teeth, in this report, we describe 3 complex clinical scenarios of calcified root canals of 1 molar and 2 premolars using guided endodontics. The clinical cases reported here show that technological evolutions should make guided endodontic procedures more widespread because their execution is relatively fast and safe even in the case of the upper molar. Additionally, 12-month clinical follow-up visits showed the effectiveness of the guided endodontic procedures.

Pattern of Disinfection of Root Canal Dentin by Alternated Acid-Base Irrigating Regimen.

OBJECTIVE: To quantify Enterococcus faecalis density in root canal dentin after chemomechanical preparation (CMP) using alternated irrigating regimen. METHODOLOGY: Root canals (RC) were contaminated with E. faecalis (ATCC 19433) for 3 weeks and evident biofilms were obtained. After initial sampling (S1), the CMP was aided by irrigants: saline solution (control; n=12), a conventional regimen (CR) (group 1; n=12) using 5.25% NaOCl and a final rinse with 17% EDTA, and an alternating regimen (AR) of intercalated use of NaOCl and EDTA (group 2, n=12), followed by a second sampling (S2). After 2 weeks, S3 was obtained. Two roots were analyzed by scanning electron microscopy. Each root was divided into cervical, mild, and apical segments and sampling of the superficial (n=90) and deep (n=90) dentin layers was obtained using Gates-Glidden burs. The E. faecalis density (CFU/mg) in log10 was categorized as residual (0 > 0.2), moderate (0.2 ≥ 0.5), or elevated (> 0.5). The prevalence of positive samples in BHI and BHI-A was analyzed by Pearson's chi-square test. The data were normalized by a log10 transformation of CFU and were analyzed by one-way ANOVA and Tukey's tests. RESULTS: Biofilms were observed only in the control root canal walls. Topographically, the controls and CR showed similar distributions of E. faecalis in the dentin. Microbiologically positive root canals harbored much E. faecalis in the adjacent dentin (p < 0.05). Irrigating saline provided moderate density of E. faecalis in the dentin while CR and AR resulted in a residual density of microorganisms (p < 0.05). CONCLUSIONS: The Enterococcus faecalis density in dentin was influenced by the irrigating regimen and the microbiological status of the root canal. The CMP aided by the alternating regimen interfered with the recolonization of the root canal and topographic distribution of Enterococcus in root dentin.

Conditioned fear stress increases bone resorption in apical periodontitislesions in Wistar male rats.

OBJECTIVE: Because the impact of conditioned fear stress on apical bone resorption is unknown, the aim of the current studywas to use a rat model to evaluate the impact of conditioned fear stress on the bone resorption of inflammatory apical periodontitis lesions. METHODS: Twenty-five animals were divided into two groups. They underwent a surgical procedure in the first left lower molar tooth to expose the dental pulp and induce inflammatory apical periodontitis lesions through the retention of contamination (bacterial infection) during a 56-day period. The animals in the case group were stressed daily by using electrical stimuli (1.10 mA), whereas the animals in the control group were absent from the stressful stimuli (shocks). The open field test was performed to validate the stress methodology. The jaws were removed and collected for histological and radiographic analyses. RESULTS: Stressed animals presented increased levels of bone loss and inflammatory cells in the root apex in comparison with the control group (P = 0.0001). However, no radiographic differences were observed between the groups (P > 0.05). CONCLUSIONS: Our results demonstrated that conditioned fear stress could modify a periapical lesion by increasing the size of bone loss there. Conditioned fear stress also increased the total number of inflammatory cells compared with the control group. Studies evaluating the impact of conditioned fear stress on human periapical inflammatory lesions should be encouraged.

Polymicrobial Leakage and Retention of MTA and Portland Cement in a Model of Apexification

Abstract Objective: To evaluate the sealing capacity and retention of apical barriers made with mineral trioxide aggregate (MTA) and Portland cement (PC). Material and Methods: Fifty-six bovine incisors were sectioned 8 mm above and 12 mm below the cement-enamel junction. The root canal was enlarged with a diamond drill to create a standard 2.5 mm diameter opening. Apical sheets of 5 mm thickness were placed using white MTA-Angelus or white PC. Fifteen samples of each material were exposed to human saliva in a dual chamber apparatus and casting was evaluated at 30 days. Samples without apical barriers and fully sealed samples were used as positive and negative controls (n = 3), respectively. Data were analyzed by Fisher's exact test (p<0.05) after 3 periods: 1 to 10 days (P1); days 11 to 20 (P2); and days 21 to 30 (P3). Then, three 1 mm thick sections were obtained at the apical level of other root samples of each material (n = 10) and the push-out test was performed Results: The leakage rates in P1, P2 and P3 were 60%, 73.3% and 100% for the MTA; and 73.3%, 86.7% and 100% for CP, with no significant difference between materials, regardless of the period analyzed. There were no significant differences between the bond strengths for both cements (p>0.05) Conclusion: Mineral trioxide aggregate and Portland cement apical barriers presented similar sealing ability and bond strength values.

Exploring different photodynamic therapy parameters to optimize elimination of Enterococcus faecalis in planktonic form.

BACKGROUND: The failure of endodontic treatment is linked to the presence of Enterococcus faecalis in the root canals. The scope of this study was to evaluate the influence of the energy dose and frequency of photodynamic therapy (PDT cycles), as well as the volume of bacterial suspensions (BS) in the elimination of Enterococcus faecalis in planktonic form. METHODS: In four successive assays BS of Enterococcus faecalis ATCC 19433 were irradiated with a diode laser (40 mW) using the photosensitizer (PS) methylene blue (MB) (0.005 µg/mL). Group 1 - Effect of energy dose: 100 µâ€¯L of BS and 100 µâ€¯L of PS were irradiated by 1, 2.5, 5, 7.5 and 10 minute s. Group 2 - Effect of PDT cycles: The BS received 1, 2, 3 or 4 PDT cycles (in each cycle 100 m L of PS was added and irradiated by 2.5 minutes). Group 3 - Effect of energy dose and bacterial suspension volume: 10 µâ€¯L of BS and 10 µâ€¯L of PS were irradiated similar to group 1. Group 4 - Effect of energy dose, bacterial suspension volume and PDT cycles: 10 µâ€¯L of BS and 10 µL of PS were irradiated according to group 2. The laser source and MB isolated represented the controls. RESULTS: The mean log reduction after separate applying laser light and MB were 0.01 and 0.07, respectively. It was found that wells with 100 µâ€¯L of BS irradiated with 2.4 to 24 J of energy did not cause significant bacterial elimination (p > 0.05), on the other hand PDT cycles above 12 J increased significantly bacterial elimination (p < 0.05). In 10 µâ€¯L wells irradiation from 12 J of energy provided higher bacterial elimination (p < 0.05) which combined with PDT cycle resulted in the logarithmic elimination of E. faecalis (p < 0.05). CONCLUSIONS: The energy dose, the volume of the bacterial suspension and, especially, the PDT cycles optimized the bacterial elimination of Enterococcus faecalis in planktonic form.

Management of Cyst-like Periapical Lesions by Orthograde Decompression and Long-term Calcium Hydroxide/Chlorhexidine Intracanal Dressing: A Case Series.

Cyst-like periapical lesions should be treated initially with conservative nonsurgical procedures. In this case series, we describe the clinical and radiographic outcomes of large cyst-like lesions that were treated by orthograde decompression and long-term intracanal use of calcium hydroxide [Ca(OH)2] mixed with 2% chlorhexidine digluconate. Ten cases of cyst-like periapical lesions involving 15 teeth from 10 patients were selected. Maximal radiographic diameters of the lesions ranged from 11 to 28 mm. Nonsurgical procedures were performed, including apical patency, orthograde puncture of cyst-like exudates, chemomechanical preparation, and placement of intracanal Ca(OH)2/CHX dressings, which were periodically replaced during 6-10 months. The root canals were then filled with gutta-percha and sealer. The follow-up periods ranged from 6 to 24 months, and the outcome was classified as healed, healing, or failure. Nine lesions drained copious exudates after canal patency. One lesion only drained bloody serous exudate after periapical overinstrumentation. In 9 patients, intracanal exudation ceased in the first follow-up visit. At the 24-month follow-up, 6 lesions (60.0%) had healed, and 3 lesions (30.0%) were healing, with the corresponding patients being without clinical signs or symptoms. The case of treatment failure was submitted to surgical treatment. Microscopically, the lesion appeared to be an apical cyst with exuberant extraradicular bacterial biofilms attached to the sectioned root apex. This case series supports the use of nonsurgical methods to resolve larger cyst-like periapical lesions.

Does MTA affect fiber post retention in repaired cervical root canal perforations?

This study evaluated the effect of mineral trioxide aggregate (MTA) on the retention of fiber posts in repaired root canal perforations. Ten-millimeter post spaces were prepared in 60 endodontically treated bovine incisors. Root perforations were created in half of the root canals in the cervical area prior to being filled with white MTA-Angelus. Fiber posts were luted into the root canals with two self-adhesive (RelyX Unicem or Set) or self-etching (Panavia F) resin cements. The posts were submitted to a pull-out test, and the data were submitted to two-way ANOVA and Tukey's post hoc tests (α = 0.05). The fiber posts exhibited reduced retention in MTA-repaired root canal perforations, regardless of the type of resin cement that was used (p < 0.001). Self-adhesive resin cements provided higher bond strength values than Panavia F, while no difference was observed between RelyX Unicem and Set (p > 0.05). The presence of MTA in repaired root perforations negatively affected post retention. In addition, self-adhesive cements seemed to be the best option to lute fiber posts within a root canal in these cases.

Root filling bond strength using reciprocating file-matched single-cones with different sealers.

The aim of the present study was to evaluate the bond strength (BS) of root canal fillings to root dentin using the reciprocating file-matched single-cone or lateral compaction techniques with resin-based and calcium-silicate-based sealers. Maxillary canine roots were prepared and filled using one of the following approaches: Reciproc R40 file and R40 single cone, WaveOne Large file and Large single cone, or ProTaper up to F4 file with lateral compaction. The root filling was performed using AH Plus, Epiphany SE or MTA Fillapex (n = 10). Three 1-mm-thick slices were obtained from each third of each root. Two slices were subjected to a push-out test, and the other slices were prepared for scanning electron microscopy (SEM) to examine the dentin-sealer interface. Data (in MPa) from the push-out tests were analyzed using a two-way ANOVA and Tukey's test (p < 0.05). Failure modes (adhesive, cohesive or mixed) were evaluated at ×25 magnification. The single-cone techniques resulted in lower BS values than the lateral compaction technique. For lateral compaction, AH Plus and Epiphany SE showed the highest and lowest BS values, respectively. Slight differences were observed between sealers when the single-cone techniques were used. A tendency to reduce the BS toward the apical third was observed. Adhesive failures were predominant for all experimental conditions. A closer adaption of the filling material on the root dentin was observed for the AH Plus and lateral compaction techniques. The Reciproc and WaveOne techniques were associated with lower BS values than the lateral compaction technique. However, the effect of the root canal filling technique appears to be sealer-dependent.

Drying protocol influence on the bond strength and apical sealing of three different endodontic sealers.

The aim of this study was to evaluate the influence of drying protocols (DP) on the apical sealing (AS) and on the bond strength (BS) of teeth filled with different sealers. The root canals of one hundred and fifty-six roots of maxillary canines were prepared with Reciproc rotary files (R50). The teeth were randomly divided into four groups (n = 39), according to the DP: GI-paper points; GII-70% isopropyl alcohol + aspiration with NaviTip points; GIII-95% ethanol + paper points; GIV-EndoVac + paper points. Each group was divided into subgroups, according to the sealer used: AH Plus, Sealapex and MTA Fillapex, using a single-cone technique. Evaluation of AS and BS was performed with fluid filtration (FF) and push-out (PO) methods, respectively. The PO test consisted of sectioning the roots, and subjecting a single slice from each third to testing and analysis for failure type. The data was submitted to two-way and three-way variance analysis (ANOVA) and Tukey (α = 5%). The AS showed no drying protocol influence. The FF results revealed a statistically significant difference between MTA and Sealapex (p < 0.05) sealers. The BS test values showed that there was no statistical significant difference among the canal thirds (p > 0.05), but that there was such a difference among the sealers (p < 0.05), among the protocols (p < 0.05), and in the interaction between sealers and protocols (p < 0.05). AH Plus revealed the highest BS values among the sealers; the highest BS results for the sealers occurred with the specimens used with isopropyl alcohol, compared with ethanol and EndoVac.