Biocompatibility of three different root canal sealers, experimental study.

OBJECTIVES: This study was assessed the biocompatibility of three different root canal sealers (Well-Root St, GuttaFlow Bioseal, and AH-Plus) following implantation in rat subcutaneous tissues, using histopathological immunohistochemical analysis. METHODS: Four groups of eighty-four male rats each underwent subcutaneous dorsal implantation of a polyethylene tube, either empty or filled. Tissues were collected, fixed, and processed for histological analysis after 7, 15, and 30 d. Slides were photographed and digitally processed to identify lymphocytes and macrophages using Cluster of differentiation 3 (CD3) and cluster of differentiation 68 (CD68) markers, respectively. P was set at 0.05, when lymphocyte and macrophage infiltration was compared between groups and observation times using one-way analysis of variance (ANOVA). RESULTS: Histopathological analysis of all groups revealed an inflammatory reaction followed by the emergence of a fibrous capsule after 7 days. After 30 days, the thickness of the fibrous capsule and the inflammatory response subsided. CD3 staining for immunohistochemical analysis revealed that the AH-Plus group had the highest mean percentage of lymphocyte infiltration at 7 and 15 days, followed by the Well-Root St, GuttaFlow Bioseal, and Control groups. After 30 days, no discernible difference was observed between the groups in terms of the mean percentage of lymphocyte infiltration. After 7, 15, and 30 days, there was a significant difference in the mean percentage of macrophage infiltration across the groups, as demonstrated by CD68 staining. After 7, 15, and 30 days, the AH-Plus group had the highest mean percentage of macrophage infiltration, followed by the Well-Root St. and GuttaFlow Bioseal groups, while the control group had the lowest mean percentage. CONCLUSION: All observational periods showed minimal inflammatory reactions to GuttaFlow Bioseal. After subcutaneous tissue implantation in a rat model, the initial inflammatory reactions to Well-Root St and AH-Plus had abated by day 30, and all tested sealers had outstanding biocompatibility.

A Comparative Evaluation of Efficacy of Various Obturating Techniques for the Presence of Voids.

Aim: Evaluation of the efficacy of different obturating techniques and assessment of the presence of voids in different regions of the canal. Materials and Methods: Sixty permanent single-rooted teeth with complete, mature root apices without any anatomic variation having straight patent root canals were included in the present study. Access cavity preparation followed by biomechanical preparation was done. Samples were divided into three groups-Group A: Single cone obturation, Group B: GuttaFlow 2, and Group C: GuttaCore, and obturation was carried out. The samples after obturation were stored at 370°C and 100% humidity in an incubator for 7 days to give adequate time for obturating materials to set. Cone beam computed tomography was performed with i-cat Cb 500 machine. The voids were checked on the root canal wall. The statistical analysis was done and the data after the statistical analysis was presented. Result: GuttaCore obturators presented a lesser volume of voids followed by GuttaFlow 2 than the single cone techniques. Conclusion: All the obturation techniques presented an inadequacy of obturation when the pre- and post-obturated volume of the root canal space was calculated. However, no statistically significant obturated volume differences were found between single cone and GuttaFlow 2 or between GuttaFlow 2 and GuttaCore system.

Endodontic Outcome of Root Canal Treatment Using Different Obturation Techniques: A Clinical Study.

OBJECTIVE: To evaluate the clinical outcome of root canal treatment by obturation technique, root canal filling quality, and tooth- and patient-related variables. METHODS: This clinical study investigated the endodontic outcome of 114 teeth treated between the years 2009 and 2012. Three different obturation methods were used: (1) adhesive obturation using the continuous wave of condensation technique with Resilon® (CWR), (2) matching-taper single-cone technique with gutta-percha and AH Plus® (SCGP), and (3) matching-taper single-cone technique with gutta-percha and GuttaFlow® (SCGF). Pre- and postoperative periapical radiographs were performed to detect the presence of endodontic lesions (PAI classification) and to assess the quality of both the obturation and the restoration. Tooth- and patient-related data were collected. RESULTS: The overall endodontic success rate was 75.4% after a mean observation period of 6.3 years. There were no significant correlations between the type or overall quality of obturation and the treatment outcome. Teeth with preoperative lesions had the highest odds ratio (factor of 4.98) for endodontic failure. Tooth- and patient-related variables had no significant effect on endodontic outcome. CONCLUSIONS: The preoperative periapical status of teeth requiring endodontic treatment was a substantial prognostic factor for endodontic outcome, whereas the type of obturation material or technique did not affect it.

Effect of Different Sealers on the Cytocompatibility and Osteogenic Potential of Human Periodontal Ligament Stem Cells: An In Vitro Study.

BACKGROUND: There is tendency for unavoidable sealer extrusion in some clinical cases. This might adversely affect host stem cells and affect healing. This study aimed to investigate the effect of different sealers on the cytocompatibility and osteogenic potential of human periodontal ligament stem cells (hPDLSCs). METHODS: The cytotoxic effect of the extracted elutes of VDW.1Seal (VDW.1), Endosequence BC Sealer HiFlow (ES), GuttaFlow-2 (GF), and ADSeal (AD-S) on the hPDLSCs was determined using the MTT assay. Cell proliferation and migration were assessed by the scratch wound healing assay. Osteogenic differentiation potential was assessed. Measurement of pH values and calcium ions release was performed. RESULTS: GF had a significantly higher percentage of viable cells. The cell migration assay showed that GF demonstrated the lowest open wound area percentage. GF and AD-S showed the highest calcium nodule deposition. GF demonstrated higher ALP activity than ES. Expression of RUNX2 and OC genes was similar for all sealers, while OPG gene expression was significantly higher for VDW.1 and GF. ES and AD-S displayed the highest pH values on day 1. Calcium ion release of ES and VDW.1 was significantly the highest. CONCLUSIONS: GuttaFlow-2 and VDW.1Seal sealers have favorable behavior toward host stem cells.

Evaluation of the Sealing Ability and Bond Strength of Two Endodontic Root Canal Sealers: An In Vitro Study.

BACKGROUND: Obturation represents a critical step in endodontic treatment, which relies on a core material and a sealer. This study aims to evaluate the sealing ability and bond strength to the root canal walls of an epoxy resin-based sealer (AH-Plus®, Dentsply Sirona, Johnson City, TN, USA) and a bioceramic sealer (GuttaFlow Bioseal®, Coltène/Whaledent, GmbH + Co. KG, Langenau, Germany). METHODS: Thirty-eight maxillary anterior teeth with single roots and identical round sections were separated into two experimental groups according to the root canal sealers used, namely, G1 = AH-Plus® and G2 = GuttaFlow Bioseal®, and two control groups, specifically, G3 = the negative control and G4 = the positive control. The sealing capacity was measured by the penetration of the radioactive isotope 99mTc. For the push-out test, the compressive force test was performed in a universal machine and the force was applied by exerting pressure on the surface of the material to be tested in the apical to the coronal direction and using three test points with different diameters. RESULTS: GuttaFlow Bioseal® exhibited superior sealing ability compared to AH-Plus® (p = 0.003). Regarding the bond strength, AH-Plus® provided higher adhesion values than GuttaFlow Bioseal® in the three sections of the tooth root (p = 0.001). CONCLUSIONS: GuttaFlow Bioseal® had significantly better sealing ability than AH-Plus® but lower adhesion values in the three zones of the root canal, with statistically significant differences between the groups. However, it is important to note that for the action of endodontic sealers to be maximized, the root-filling technique must be most appropriate.

The Influence of the Matrix on the Apatite-Forming Ability of Calcium Containing Polydimethylsiloxane-Based Cements for Endodontics.

This study aimed to characterize the chemical properties and bioactivity of an endodontic sealer (GuttaFlow Bioseal) based on polydimethylsiloxane (PDMS) and containing a calcium bioglass as a doping agent. Commercial PDMS-based cement free from calcium bioglass (GuttaFlow 2 and RoekoSeal) were characterized for comparison as well as GuttaFlow 2 doped with dicalcium phosphate dihydrate, hydroxyapatite, or a tricalcium silicate-based cement. IR and Raman analyses were performed on fresh materials as well as after aging tests in Hank's Balanced Salt Solution (28 d, 37 °C). Under these conditions, the strengthening of the 970 cm−1 Raman band and the appearance of the IR components at 1455−1414, 1015, 868, and 600−559 cm−1 revealed the deposition of B-type carbonated apatite. The Raman I970/I638 and IR A1010/A1258 ratios (markers of apatite-forming ability) showed that bioactivity decreased along with the series: GuttaFlow Bioseal > GuttaFlow 2 > RoekoSeal. The PDMS matrix played a relevant role in bioactivity; in GuttaFlow 2, the crosslinking degree was favorable for Ca2+ adsorption/complexation and the formation of a thin calcium phosphate layer. In the less crosslinked RoekoSeal, such processes did not occur. The doped cements showed bioactivity higher than GuttaFlow 2, suggesting that the particles of the mineralizing agents are spontaneously exposed on the cement surface, although the hydrophobicity of the PDMS matrix slowed down apatite deposition. Relevant properties in the endodontic practice (i.e., setting time, radiopacity, apatite-forming ability) were related to material composition and the crosslinking degree.

Postoperative pain intensity and incidence following single visit root canal treatment with different obturation techniques: a randomized clinical trial.

Background: There are few studies in the literature about the effect of obturation techniques on postoperative pain. Besides, GuttaFlow2 was used for the first time in this study regarding postoperative pain. This study aimed to compare the postoperative pain levels and incidence following single-visit root canal treatment with different canal filling techniques; cold lateral compaction (CLC), thermoplasticised solid-core carrier (GuttaCore) based filling and cold free-flow compaction (GuttaFlow2) technique. Methods: The patients (n = 93) having single-rooted teeth with a single canal diagnosed with asymptomatic irreversible pulpitis or single-rooted vital teeth with a single canal requiring endodontic treatment because of prosthetic reasons were enrolled in this study. Patients were randomized into three groups (n = 31) according to the obturation technique. A single operator performed all the treatments in a single visit. Data on obturation levels, postoperative pain and analgesic intake frequency were recorded at postoperative 6, 12 and 24 h and daily afterward until the 7th day. Postoperative pain was measured by visual analogue scale (VAS). The date were statistically analyzed with chi-squared tests (for the analyses of the categorical data), the nonparametric Kruskal-Wallis test (for the comparisons of VAS score) and with the Friedman test (for the assessments of the changes in VAS scores over time). Results: The GuttaCore group recorded the higher pain levels, except first 12 h, on the other hand, the GuttaFlow2 group recorded the lower pain levels at all time periods. Significant differences occurred among the groups during the first 4 days (p < 0.05), except at 12 h (p = 0.054). The patients in the CLC and GuttaFlow2 groups did not need to use the prescribed analgesic; however, one patient in the GuttaCore group used it once. Conclusions: Postoperative pain levels following root canal therapy were affected by the obturation technique especially first 4 days following obturation.

Preparation and filling of small oval root canals: influence of file system and sealer.

OBJECTIVE: To carry out a morphometric analysis of small oval root canals prepared with different instruments (part 1) and filled with different sealers (part 2). METHOD AND MATERIALS: Ninety extracted mandibular incisors with small oval root canals were instrumented with Self-Adjusting File (n = 45), XP-endo Finisher (n = 15), GentleFile (n = 15), or Reciproc (n = 15). All groups of part 1 were filled with AH Plus (n = 15 each). For part 2 (including group Self-Adjusting File/AH Plus) teeth instrumented with Self-Adjusting File were additionally filled with GuttaFlow Bioseal (n = 15) or Total Fill BC sealer (n = 15). All sealers were placed with a lentulo and filled with master point and additional points. Serial cuts were made at 1-mm intervals up to 10 mm. Total root canal area, percentage of gutta-percha filled area (PGFA), sealer, voids, and debris were evaluated using interactive image analysis software. RESULTS: Preparation with Reciproc caused significantly wider canals than with Self-Adjusting File, GentleFile, or XP-endo Finisher, but also resulted in the greatest PGFA and lowest percentage of sealer (P ≤ .05). Following XP-endo Finisher, the significantly greatest percentage of debris (30%) was found 1 mm from the apex (P ≤ .05). Regarding different sealers, only minor differences were found (GuttaFlow Bioseal: less percentage of sealer at 2 and 3 mm levels [P ≤ .05]). CONCLUSION: Within the limits of this study Reciproc caused the greatest substance loss, but also the most favorable PGFA. The apical debris accumulation with XP-endo Finisher needs further investigation. The sealers under investigation performed equally well.

Physicochemical properties of a novel bioceramic silicone-based root canal sealer.

Background/purpose: With introduction into endodontics, bioceramic-based sealers have gained considerable popularity for excellent properties. The aim of this study was to investigate the physicochemical properties of a novel bioceramic silicone-based sealer, GuttaFlow Bioseal, and measure heat flow of setting reactions. Materials and methods: Film thickness, flow, working and setting time of Bioseal were compared with other 4 kinds of sealers: iRoot SP, AH Plus, RoekoSeal and GuttaFlow2. Differential scanning calorimetry test was performed to measure heat flow. Results: Bioseal demonstrated the highest film thickness of 44 µm, double to triple that of the other 4 sealers (P < 0.05). The highest flow was detected in iRoot SP and RoekoSeal, with values of 27.35 and 27.20 mm, while GuttaFlow2 and Bioseal had the lowest of 22.31 and 21.43 mm (P < 0.05). For each sealer, working time at 37 °C was shorter than that at 23 °C (P < 0.05). At 37 °C, Bioseal had the shortest working and setting time of 4.5 and 16.3 min, while iRoot SP showed the longest of 105.0 and 571.7 min (P < 0.05). Differential scanning calorimetry test revealed that setting process of all the tested sealers was exothermic. Bioseal reached an exothermic peak at 14 min, with almost 1.5 times peak intensity of GuttaFlow2 and RoekoSeal. Whereas iRoot SP and AH Plus reached an exothermic peak 5 h after mixing, with intensity 1/2 to 2/3 that of Bioseal. Conclusion: The novel bioceramic silicone-based sealer Bioseal showed intense and fast exothermic reactions with characteristic physicochemical properties.

Comparison of Two Root Canal Filling Techniques: Obturation with Guttacore Carrier Based System and Obturation with Guttaflow2 Fluid Gutta-Percha.

INTRODUCTION: The aim of the present study was to compare the quality of the root canal obturation obtained with two different techniques, i.e., thermoplastic gutta-percha introduced through a carrier (GuttaCore) and fluid gutta-percha (GuttaFlow2). MATERIALS AND METHODS: The study included 40 permanent single-rooted human teeth, divided into two groups and obturated with Guttaflow (group G) and with GuttaCore (group T). The teeth were fixed and transversely sectioned, they were examined by scanning electron microscopy. The dentin-cement-gutta-percha interface and the percentage of voids produced by the two techniques were statistically analyzed. RESULTS: GuttaCore showed a better filling in the apical third of the canal with a percentage of voids equal to 5%. GuttaFlow showed a lower percentage of voids in the middle and coronal thirds of the canal, 1.6% of coronal voids. Statistical analysis showed a statistically significant difference in the percentage of voids in the two groups (GuttaCore and Guttaflow2) in each portion. CONCLUSIONS: GuttaFlow2 seems to flow optimally in the middle and coronal third of the canal, with greater difficulty in filling the apical third. Due to the rigidity of the carrier, GuttaCore is able to reach better the most apical portions of the canals, with greater difficulty in creating the three-dimensional seal at the level of the middle third and coronal third.

Effect of using calcium-silicate and silicone based root canal sealers in bulk or with main core material on bond strength.

Background: The purpose of this study was to assess the push-out bond strength of calcium-silicate and silicone based root canal sealers in bulk and with main cone. Methods: Roots (n=48) randomly divided into 4 groups (n=12) according to the obturation protocol; (1) iRoot SP in bulk; (2) iRoot SP with gutta-percha; (3) GuttaFlow Bioseal in bulk; (4) GuttaFlow Bioseal with gutta-percha. Six horizontal sections were obtained from each root (n=72). Effect of sealers on bond strength was statistically significant (P<0.05). Results: Highest mean value was obtained in iRoot-Bulk group and lowest in GuttaFlow Bioseal-GP group. Both iRoot SP groups had significantly higher bond strength values than both GuttaFlow Bioseal groups (P<0.05). There was no significant difference between iRoot-GP and iRoot-Bulk groups (P=0.603) also GuttaFlow Bioseal-GP and GuttaFlow Bioseal-Bulk groups (P=0.684). Conclusion: Based on findings, using calcium silicate-based sealer in bulk can be also suitable in clinical practice.

Evaluation of Different Root Canal Obturation Techniques in Internal Root Resorption of Three-Dimensional Printed Teeth Manufactured Using Computer Software.

The objective of this study was to evaluate and compare the filling ability of various root canal obturation techniques on the internal root resorption (IRR) cavities of replicated tooth samples manufactured using computer software and a three-dimensional (3D) printer. Orthographic images and root structures of a healthy upper maxilla central incisor in determined volumes and sizes were drawn as a prototype with the aid of computer software. Using the same software, an IRR defect was also modeled. These two images were then transferred to the AutoDesk Fusion 360 3D modeling program (AutoDesk, San Rafael, CA) for meshing. Afterward, the tooth model was transferred to a 3D modeling and prototyping program (RhinoCeros 3D; Robert McNells & Assoc., New York) and printed on a 3D printer. Eighty replicas with IRR were manufactured and divided into four groups (n = 20 per group) according to the obturating techniques as follows: Group 1: Cold lateral compaction (CLC), Group 2: Core Carrier System (GuttaCore), Group 3: Injectable Cold Filling (GuttaFlow® BioSeal), and Group 4: Continuous Wave Obturation System (Elements Free). After root canal filling, replicas were scanned with a high-resolution micro-computed tomography system (SkyScan 1172; Bruker-microCT, Kontich, Belgium), data regarding voids (unobturated areas) inside the IRR defects were statistically analyzed using nonparametric Kruskal-Wallis tests. A pairwise comparison between the tested groups showed that Groups 3 and 4 had significantly fewer voids compared with Groups 1 and 2 in IRR defects (p < 0.05). Group 1/Group 2 and Group 3/Group 4 had similar results in terms of voids and there were no statistically significant differences (p > 0.05). The injectable cold filling system (GuttaFlow BioSeal) and the injectable continuous wave obturation system (Elements Free) successfully obturated the pathological IRR irregularities when compared with CLC and core carrier (GuttaCore) systems.

Evaluation of the root filling quality with experimental carrier-based obturators: a CLSM and FEG-SEM analysis.

This study evaluated tubule penetration of GuttaFlow Bioseal with cold single cone or carrier-based technique, under confocal laser scanning microscopy (CLSM). Twenty straight single-rooted teeth were instrumented with Hyflex CM and divided in two groups (n = 10) according to the obturation method: single cold gutta-percha cones; experimental carrier-based obturators. GuttaFlow Bioseal, labelled with Rhodamine B dye, was used as sealer in both groups. Teeth transversally sectioned were observed under CLSM. Percentage of sealer penetration and integrity of sealer layer perimeter were measured. Surface and microstructural characteristics of obturators and gutta-percha cones were compared by FEG-SEM and EDX analysis. No significant differences were found between groups for each examined parameter. Significant differences (P < 0.05) were reported mainly within groups. Integrity was similar among and within groups. FEG-SEM/EDX analysis of obturators revealed the presence of Ba and Zn. Carrier-based obturation technique associated with GuttaFlow Bioseal does not seem to affect sealer penetration into dentinal tubules.

Comparison of Sealing Ability of Bioceramic Sealer, AH Plus, and GuttaFlow in Conservatively Prepared Curved Root Canals Obturated with Single-Cone Technique: An In vitro Study.

BACKGROUND: Inadequate obturation techniques of the root canal system have been found to be the most frequent reason of failure post root canal treatment. An ideal endodontic sealer should fulfill all ideal requisites. The present study aimed to compare apical sealing ability between bioceramic (BC) sealer, GuttaFlow, and AH Plus. METHODOLOGY: One hundred and twenty-five curved roots of maxillary and mandibular third molar teeth with fully formed apex were collected for this study. The root canals were cleaned and shaped using a standard single-cone preparation to file at the established working length and divided into five groups of 25 each. Dye leakage was carried out. Group A: with GP, using EndoSequence BC sealer with conventional with 4% gutta-percha (Brasseler USA, Savannah, Georgia, USA); Group B: with ceramic coated with 4% gutta-percha (Brasseler USA, Savannah, Georgia, USA); Group C: with GP, using AH Plus sealer (Dentsply, De-Trey Konstanz, Germany) with 4% gutta-percha; Group D: with GuttaFlow bioseal (Roeko-Coltène/Whaledent, Langenau, Germany) with 4% Gutta-percha; and Group E is a negative control group. Statistical analysis was done using the Statistical Package for the Social Sciences software and Student's unpaired t-test. RESULTS: The group AH Plus showed more leakage values than the GuttaFlow group and of two groups of BC sealer and negative control. Student's unpaired t-test disclosed no significant difference (P < 0.05) between the groups. CONCLUSION: None of the sealers used in the study could completely seal the apical foramen to have a fluid-tight seal.

Behaviour of different bioactive glasses incorporated in polydimethylsiloxane endodontic sealer.

OBJECTIVES: The aim of this study was to analyze the behavior of different bioactive glass fillers (BAGs) embedded in a polydimethylsiloxane matrix of an endodontic sealer. METHODS: Three different endodontic sealers were fabricated using S53P4, 45S5 and 18-06 glass fillers. Endodontic sealer Guttaflow Bioseal consisting of polydimethylsiloxane (PDMS) matrix was used as base of the experimental sealers. Behaviors of different glass fillers leaching from polymer matrix was studied in vitro for 14 days by measuring static ion dissolution profiles of Si, Na, Ca and P -ions. In addition, pH of the simulated bodyfluid (SBF) was monitored during the 14 days and all the sealer samples was examined with SEM/EDX analysis on the surface. Identical but non-glass filler containing polydimethylsiloxane-based sealer was used as a control material. RESULTS: By the time point of 24 h sealer with 45S5 had released twice as much of Si-ions compared to sealer with S53P4. No statistical differences of Na, Ca and P -ions dissolution were observed in the first 168 h for any groups whereas concentrations of Ca and P -ions decreased with 45S5 significantly after 336 h. Highest pH was measured for sealers with glass filler 45S5 and S53P4 (7.64-7.65). Visible mineral precipitation was observed only on sealer surfaces after 336 h' time period with groups of 45S5 and S53P4. However, presence of calcium and phosphorus oxides was confirmed only with 45S5. SIGNIFICANCE: Bioactive glass type 45S5 outperforms S53P4 and 18-06 by acting more dynamically in vitro set-up.

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.

Biocompatibility assessment of different root-end filling materials implanted subcutaneously in rats: An in vivo study.

BACKGROUND: Root-end filling materials are used in surgical endodontic treatment to seal the teeth periapically. Ideally, these materials should prevent bacterial leakage by tightly sealing the canal, be biocompatible with the periapical tissues, and preferably stimulate the regeneration of dentin, contributing to the success of treatment. OBJECTIVES: The purpose of this study was to evaluate and compare the biocompatibility of the GuttaFlow® Bioseal cement in relation to MTA Angelus® and Zical® after implantation into the subcutaneous tissue of rats. MATERIAL AND METHODS: Eighteen male albino rats were used in the study. Four polyethylene tubes were implanted in the backs of the rats (3 tubes containing the test materials and 1 empty tube as a control). Nine animals were sacrificed at each interval of 7 and 30 days, and the implants were removed with the surrounding tissue. The samples were evaluated for stromal inflammatory response, fibrous tissue formation, vascular reactivity, and the presence of multinucleated giant cells (MNGCs). RESULTS: On day 7, the capsules in all subgroups revealed moderate to severe inflammatory reactions with the presence of inflammatory cells, multiple irregular collagen fibers, dilated blood vessels, and MNGCs. However, on day 30, tissue organization was more evident with a reduction in the inflammatory response. In this time interval, the tissue in contact with GuttaFlow Bioseal showed progressive healing with a wellformed fibrous capsule. Conversely, the tissue close to MTA Angelus revealed a fibrous capsule of limited organization with mild pericapsular fibrosis and vascular congestion. Zical showed a mild to moderate persistent inflammatory reaction and vascular reactivity. CONCLUSIONS: The 3 cements demonstrated more severe irritation at the beginning that became milder with time. GuttaFlow Bioseal yielded better tissue organization than MTA Angelus and Zical. Thus, these findings strongly suggest that GuttaFlow Bioseal is a promising material for root-end filling.

Sealing Ability of Various Types of Root Canal Sealers at Different Levels of Remaining Gutta Percha After Post Space Preparation at Two Time Intervals.

OBJECTIVE: This study evaluated the apical sealing ability of various types of sealers (Sure-Seal Root, AH Plus, and GuttaFlow2) at different levels of remaining gutta percha after post space preparation at two time intervals (1 day and 1 week after obturation). MATERIALS AND METHODS: One hundred and two single canal mandibular premolars were decoronated at the cement-enamel junction and biomechanically prepared. Twelve samples served as negative and positive controls (n = 6). The remaining 90 samples were distributed into three groups (n = 30 each), based on the used sealer for obturation with gutta percha (Sure-Seal Root, AH Plus, GuttaFlow2). Each experimental group was divided into two subgroups (n = 15 each), subgroup I: post space prepared 1 day after obturation and subgroup II: post space prepared 1 week after obturation. For each subgroup, the post space was prepared to a length that remained 3, 4, or 5 mm of gutta percha apically for each of five samples. Then, the dye penetration technique was used to measure the apical microleakage. Data were analyzed using "ANOVA test" and "post hoc Duncan's test." RESULTS: Sure-Seal Root sealer demonstrated the best apical seal compared with other tested sealers. Post space preparation 1 day after obturation exhibited less microleakage than the group with 1 week after obturation. Additionally, 5 mm of remaining gutta percha showed superior sealing value than 3 and 4 mm. CONCLUSION: Bioceramic (Sure-Seal) sealer is the material of choice to be used when post space preparation is required. Post space preparation was preferred to be done 1 day after obturation than 1 week after obturation. Superlative apical seal was obtained with a maximum length of remaining gutta percha.

Filling of small oval root canals: influence of sealer placement and filling technique.

Objectives: The aim of this study was to carry out a morphometric analysis of small oval root canals filled with GuttaFlow 2 sealer (Coltène/Whaledent) using different methods of sealer placement and different root canal filling techniques.
Method and materials: Eighty extracted mandibular incisors with small oval root canals were instrumented with the Self-Adjusting File (Redent Nova). GuttaFlow 2 was placed using a lentulo spiral, paper point, master point, or sonically activated CanalBrush (Coltène/Whaledent), followed by the placement of a master point and accessory points (M?P+) (part 1). GuttaFlow 2 was placed using a lentulo spiral without a gutta-percha point, together with a single point, with a chloroform-dipped master point, or the latter with accessory points (ChMP+) (part 2). Serial cuts were made at 1-mm intervals up to 10 mm. The percentages of gutta-percha filled area (PGFA), sealer, voids, and debris were evaluated using interactive image analysis software.
Results: For part 1 of the study (sealer placement), significant differences regarding PGFA at 2 and 5 mm from the apex were found, whereas for part 2 (filling technique), significant differences were found at all levels besides 2 and 4 mm (Kruskal-Wallis test, P = .05). ChMP+ reached 85% PGFA at 3 mm from the apex, but only 30% near the apex. The MP+ groups showed a relatively equal distribution of PGFA by 60% to 80% at different levels. GuttaFlow 2 without a gutta-percha point exhibited significantly more voids and debris than the other groups (Kruskal-Wallis test, P = .05).
Conclusion: Within the limits of this study, MP+ could be recommended for clinical use. The presence of voids and debris for the group without a gutta-percha point needs further investigation.

GuttaFlow® Bioseal Cytotoxicity Assessment: In Vitro Study.

The sealers used for root canal treatment should be biocompatible for the peri-radicular tissues, to evaluate the cytotoxic effects of GuttaFlow® bioseal sealer and to compare them with AH26® epoxy resin. Culture media were conditioned with the GuttaFlow® bioseal and AH26® pellets. MDPC-23 odontoblast cell cultures were treated with conditioned medium and serial dilutions. To evaluate the metabolic activity and cellular viability, the MTT and SRB assays were performed. To determine the production of reactive oxygen species, the DHE and DCF-DA probes were used. Cell cycle and cell-death types were assessed by cytometry, and to evaluate the mineralization capacity, the Alizarin Red S coloration was used. Statistical analysis was performed using analysis of variance (ANOVA) when normality was found and Kruskal-Wallis on the opposite case. For the comparison with normality values, the Student t-test was used. Cells exposed to the GuttaFlow® bioseal conditioned medium maintained high metabolic activities, except at higher concentrations. Likewise, viability was maintained, but a significant decrease was observed after exposure to the highest concentration (p < 0.001), associated with cell death by late apoptosis and necrosis. When cell cultures were exposed to AH26®, metabolic activity was highly compromised, resulting in cell death. An imbalance in the production of peroxides and superoxide anion was observed. GuttaFlow® bioseal showed higher biocompatibility than AH26®.