A literature review of the effect of heat on the physical-chemical properties of calcium silicate-based sealers.

INTRODUCTION: Recently, calcium silicate-based sealers (CSSs) have gained popularity in endodontic practice due to their biocompatibility and antimicrobial properties. They are considered viable alternatives to epoxy resin-based sealers. With the increased use of CSSs and warm vertical compaction techniques in root canal treatment, evaluating the impact of heat on CSSs properties is essential, therefore this review aimed to present a qualitative synthesis of available in vitro studies assessing the impact of heat on the physical-chemical properties of CSSs. METHODS: Following the PRISMA 2020 guidelines, a systematic advanced electronic search was performed in Scoups, Embase, Medline (via PubMed), Web of Science, and Cochrane databases in November 2023 and updated in April 2024. In vitro studies that evaluated the physical-chemical properties of CSSs were eligible. PRILE 2021 guidelines were used for the assessment of the risk of bias included studies. RESULTS: The search identified a total of 6421 preliminary results and 10 studies were included for qualitative assessment. 11 different physiochemical properties were assessed by the included studies. Setting time and flow were the most evaluated property among the studies. A qualitative synthesis of the evidence on each property is presented. CONCLUSIONS: Based on the in vitro studies assessed in the present systematic review, results reveal that exposing CSSs to heat can accelerate their setting time, reduce their flow, and increase their film thickness. Concerns persist regarding solubility, viscosity, radiopacity, dimensional change, microhardness, porosity, and compressive strength; requiring further research. Certain CSSs, like MTA Fillapex and Endosequence BC sealer HiFlow, show minimal changes under heat, making them potential candidates for warm filling techniques.

Evaluation of various obturation techniques with bioceramic sealers in 3D-printed C-shaped canals.

This in vitro study compared various obturation techniques with bioceramic sealers for filling C-shaped 3D-printed replicas. A mandibular molar with a C-shaped root canal with a C1 configuration was obtained. After instrumenting with M3 Pro Gold files (United Dental, Shanghai, China) up to size #30/0.04, a CBCT scan of the tooth was taken. Sixty 3D-printed replicas of the tooth were created. The samples were obturated with EndoSeal TCS sealer (E. TCS; Maruchi, Wonju, Korea) or EndoSeal MTA (E. MTA; Maruchi, Wonju, Korea) (n = 30). The samples in each group were obturated with the following techniques (n = 10): (1) single-cone technique (SC), (2) SC with ultrasonic activation (UA), and (3) cold hydraulic compaction (CHC). Following incubation, the replicas' apical, middle, and coronal thirds were inspected under a digital microscope, and the proportion of filling material and void were calculated. Also, the obturation time and sealer extrusion were recorded. Data were analyzed using ANOVA, LSD post-hoc, and the chi-square tests (α = 0.05). The results indicated that in the apical third, E. TCS-SC, E. TCS-UA, and E. MTA-UA had the lowest void percentage among groups (p < 0.05). In the middle thirds, samples obturated with E. TCS-UA showed a significantly lower void percentage among all groups (p < 0.05). However, in the coronal third, E. TCS-CHC showed the least void percentage (p < 0.05), followed by E. TCS-UA and E. MTA-CHC. The E. TCS-SC and E. TCS-UA were the least time-consuming methods (p < 0.05). Sealer extrusion significantly differed among the groups, with E. MTA-UA and E. TCS-UA showing higher incidence (p = 0.019). It was concluded that E. TCS-UA was the most convenient obturation technique. However, care must be taken when obturating the canals with high flow and ultrasonic activation near the vital anatomical landmarks.

Development of Chlorhexidine-Loaded Lipid Nanoparticles Incorporated in a Bioceramic Endodontic Sealer.

INTRODUCTION: This study aimed to assess BioRoot RCS (BR) incorporating liposomal chlorhexidine digluconate (CHX) for its antibacterial activity, drug release capacity, and physicochemical properties. METHODS: Drug release of CHX liposomal formulations in combination with BR was evaluated spectrophotometrically and through mathematical release models for 30 days. A selected combination was evaluated for antimicrobial properties against Enterococcus. faecalis (E. faecalis) biofilm growth on human dentin. Cytotoxicity was assessed following the ISO 10993-5:2019 standard on days 1, 3, and 7. Physicochemical properties were evaluated through setting time, Fourier transform infrared spectroscopy (FTIR), solubility, contact angle, and film thickness. RESULTS: From BR, liposomal CHX released up to 7-fold higher CHX than CHX solution (p<0.05), following a triphasic drug release pattern compared to the CHX solution, which followed a quasi-Fickian diffusion. BR combined with a selected liposomal CHX completely inhibited E. faecalis biofilm growth compared to the combination of BR with CHX solution and the control group (p<0.05). Liposomal CHX decreased the contact angle (p<0.05) and solubility but increased cytotoxicity (p<0.05) of BR, staying above the ISO threshold. None of the other physicochemical characteristics tested differed from BR (p>0.05). CONCLUSION: This liposomal formulation improved CHX release from BR, enhancing the antibacterial effectiveness. It presents a promising approach for local anti-biofilm therapy in endodontics without substantially altering the physicochemical characteristics of BR.

Epoxy resin-based root canal sealers: An integrative literature review.

The correct obturation of the root canal system achieved by means of a core and a cement is essential for the success of endodontic treatment. There are several root canal cements (RCCs) on the market; however, because of their excellent characteristics, epoxy resin-based sealers (ERBSs) have been widely used. The main aim of this review was to analyze and integrate the available information on different ERBSs. An electronic search was performed in the PubMed and Scopus databases, using "epoxy resin" AND "root canal treatment", and "epoxy resin" AND "endodontics" as search terms. In general, ERBSs have good flow properties, film thickness, solubility, dimensional stability, sealing capacity, and radiopacity. They are also able to adhere to dentin while exhibiting low toxicity and some antibacterial effects. However, their main disadvantage is the lack of bioactivity and biomineralization capability. A large number of ERBSs are available on the market, and AH Plus keeps being the gold standard RCC. Yet, information on many of them is limited or non-existent, which could be due to the fact that some of them are relatively new. The latter emphasizes the need for relevant research on the physicochemical and biological properties of some ERBSs, with the aim of supporting their clinical use with sufficient evidence via prospective and long-term studies.

A Comparative Evaluation of Push-Out Bond Strength of Six Different Root Canal Sealers: An In-Vitro Study.

BACKGROUND: Adhesiveness with radicular dentin is absent with gutta-percha, leading to microleakage and hence re-infection. Root canal sealer helps to achieve an adhesive interface between gutta-percha and root dentin thereby resisting the displacement forces during the functioning of teeth which is evaluated by the push-out test. The aim of this study is to compare the push-out bond strength and to assess the relative bond failure between dentin-sealer, sealer-main cone of (1) epoxy resin, (2) silicon, (3) mineral trioxide aggregate (MTA), (4) calcium hydroxide, (5) bioceramic, (6) zinc oxide eugenol containing root canal sealers. METHODOLOGY: Sixty human permanent lower premolars with one root were collected, disinfected, and decoronated at cemento-enamel junction. Instrumentation was done with a K3 40,0.06 Ni-Ti rotary file and obturated using the main cone and sealer. Based on the sealer utilized, six groups were created: Group 1: AH-Plus, Group 2: RoekoSeal, Group 3: MTA Fillapex, Group 4: Apexit, Group 5: Smart Paste Bio, and Group 6: Procosol. One slice each was obtained from the coronal, middle, and apicalsections of all the obturated canals. Push-out bond strength and failure modes were studied. Statistics involved analysis of variance (ANOVA) followed by the post hoc Tukey test. RESULTS: All three sections exhibited the highest strength for Smart Paste Bio sealer and the least was for RoekoSeal. With all the sealers, the apical section had the highest strength followed by the middle and coronal. CONCLUSION: The smart seal system was superior to all other sealers and displayed a good bond to dentin.

Micro-computed tomographic evaluation on the quality of single-cone obturation using a modified passive-deflation sealer injection needle: an in vitro study.

OBJECTIVES: This study aimed to design a modified passive-deflation sealer injection needle and investigate its ability to improve obturation quality of single-cone technique through assessing the distribution of voids in root canals using micro-computed tomography (micro-CT). MATERIALS AND METHODS: Forty-eight mandibular incisors were divided into eight groups (n = 6), according to the taper of root canal preparation (0.06 or 0.04), the needle used for sealer injection (modified or commercial iRoot SP injection needle), and the obturation method (iRoot SP sealer-only or single-cone obturation). After obturation, each specimen was scanned by micro-CT. The volumetric percentage and distribution of all voids were first analyzed and compared among groups, then the open and closed voids were separately analyzed and compared among single-cone obturation groups. RESULTS: Compared to commercial needle groups, modified needle groups showed much less voids, especially in the apical root canal part (P < 0.05). Besides, the modified needle groups produced much less open voids than commercial needle groups despite the root canal taper (P < 0.05). CONCLUSIONS: The modified passive deflation sealer injection needle could effectively improve the quality of single-cone obturation through reducing intra-canal voids, especially open voids throughout the root canal, thus might possibly be developed as an effective intra-canal sealer delivering instrument.

Three-Dimensional Measurement of Obturation Quality of Bioceramic Materials in Filling Artificial Internal Root Resorption Cavities Using Different Obturation Techniques: An In Vitro Comparative Study.

INTRODUCTION: Pathologic conditions such as internal root resorption (IRR) may complicate root canal filling. This study aimed to evaluate and compare the obturation quality by measuring the percentage of obturation volume (POV) in root canals with artificial IRR obturated with different materials and techniques using cone beam computed tomography (CBCT). METHODS: Forty single canal extracted mandibular premolars were decoronated to standardize their length to 14 mm. Following instrumentation, the roots were cut horizontally, and artificial IRR cavities were made at the level of 7 mm from the apex. The root halves were joined using cyanoacrylate adhesive. The samples were randomly assigned to 4 groups (n = 10), and the canals were filled as follows: single-cone technique (SC), bulk-fill Bio-C Sealer (BF), and Bio-C Repair for the coronal and middle third (BCR) + cold lateral condensation technique (CLC) for the apical third and continuous wave compaction technique (CWC). The pre- and postobturation volumes and the POV were measured in the total canal and for the apical, middle, and coronal thirds separately using CBCT and Mimics Medical software. The results were analyzed statistically using one-way ANOVA and Tukey HSD test, and statistical significance was set at P < .05. RESULTS: BF group resulted in significantly lower total, coronal, middle and apical POV values compared to SC, BCR + CLC, and CWC groups (P < .05), respectively. Also, at the apical third, the BCR + CLC group showed significantly lower POV than the SC and CWC groups (P < .05), respectively. The intra-group comparison showed that BF and BCR + CLC groups had a significantly lower POV in the apical third compared to the middle third (P < .05). Conversely, the CWC group had a significantly higher apical POV than the middle third (P < .05). CONCLUSIONS: The maximum POV was obtained using the CWC technique, Bio-C Repair, and SC technique with Bio-C Sealer, making their application in IRR more preferable than the BF Bio-C Sealer.

Sealing ability of various endodontic sealers with or without ethylenediaminetetraacetic acid (EDTA) treatment on bovine root canal.

This study investigated the wettability and consistency of various endodontic sealers, both inorganic and organic, and evaluated their sealing ability of root canals using the single-cone obturation technique, with and without ethylenediaminetetraacetic acid (EDTA) treatment. Bovine root canals were endodontically prepared and filled in preparation for the dye penetration test with toluidine blue solution. All sealers exhibited contact angles similar to or lower than dentin and displayed superior consistency. Among the sealers, organic sealers used without EDTA treatment showed reduced dye penetration compared to inorganic sealers. However, some inorganic and organic sealers showed dye penetration in the sealer and dentin of root canals subjected to EDTA treatment. In conclusion, the single-cone obturation technique, combined with these endodontic sealers, achieved close contact with root canal dentin due to their wettability and consistency. However, the sealing ability of certain sealers was influenced by EDTA treatment.

Comparative evaluation of incidence of dentinal defects after root canal preparation using three different endodontic retreatment systems - An in vitro study.

Context: Safe and efficient removal of all root filling materials from the root canal system without compromising radicular dentin structure is essential for optimal nonsurgical retreatment. Aims: The aim of this study was to evaluate and compare the incidence of dentinal defects caused during root canal filling removal using conventional, rotary, and reciprocating retreatment file systems. Settings and Design: A detailed protocol explaining purpose and procedures of the study was submitted to the Institutional Ethics Committee and ethical clearance obtained. Subjects and Methods: Sixty human maxillary permanent central incisors were collected and decoronated to 12-mm standardized length. The canals prepared up to a master apical file size F3 with Protaper hand files, obturated using AH plus sealer, examined under the stereomicroscope (×40 magnification): Group I: Control (n = 15), Group II: Conventional (n = 15), Group III: Protaper Universal Retreatment Files (n = 15), and Group IV: Reciproc Blue (n = 15). After instrumentation, teeth were sectioned at 3, 6, and 9 mm from the apex to evaluate the presence of dentinal defects under the stereomicroscope. Statistical Analysis Used: Statistics were performed using the SPSS, version, 25 (SPSS Inc., Chicago, IL, USA). Initially, normality test was done using the Shapiro-Wilk test and data were not normally distributed followed by Kruskal-Wallis test. P < 0.05 is considered statistically significant. Results: Maximum percentage increase in dentinal defects was observed in Protaper Universal Retreatment Files followed by Conventional method and Reciproc Blue. Conclusions: Significantly Reciproc Blue reduced the incidence of dentinal defects after root canal preparation.

Novel bioactive nanospheres show effective antibacterial effect against multiple endodontic pathogens.

Aim: The current study evaluated the antibacterial activity of a newly developed quaternary ammonium polymethacrylate (QAPM)-containing bioactive glasses (BGs) via a two-step method by our group, namely BGs-HAEMB, and explored its cytotoxicity and biocompatibility. Methods: The antibacterial effects of the BGs-HAEMB against planktonic bacteria, bacterial biofilm formation, and experimental root canal biofilms of persistent pathogens (Enterococcus faecalis, Streptococcus sanguis and Porphyromonas endodontalis) associated with endodontic infection were evaluated in vitro by agar diffusion tests, direct contact tests and live/dead staining. The cytotoxicity and biocompatibility of BGs-HAEMB were evaluated by CCK-8 assays in vitro and a skin implantation model in vivo. Results: Compared to three clinically used endodontic sealers (Endofill, AH Plus, and iRoot SP), BGs-HAEMB exhibited the relatively strongest antibacterial effect against E. faecalis, S. sanguis and P. endodontalis after sitting for 14 and 28 days (P < 0.01). SEM images and CLSM images also showed that for each tested bacteria, BGs-HAEMB killed the most microorganism among all the experimental groups, regardless of treatment for 7 days or 28 days (P < 0.05). Besides, the BGs-HAEMB-treated groups showed a relatively low cytotoxicity (RGRs ranging from 88.6% to 102.9%) after 1, 3, and 7 days of exposure. Meanwhile, after 28 days of implantation, the inflammatory grade in BGs-HAEMB treated group was assessed as Grade I, in which the average numbers of inflammatory cells (6.7 ± 2.1) were less than 25. Conclusions: BGs-HAEMB exerted a long-term and stable antibacterial effect. The remarkable biocompatibility of BGs-HAEMB in vitro and in vivo confirmed its possible clinical application as a potential alternative in the development of the next generation of endodontic sealers.

Comparison of the Antibacterial Effect of AH26, Adseal and Beta RCS Root Canal Sealers against Enterococcus Faecalis, an in Vitro Study.

Objectives: Antibacterial activity against endodontic pathogens is a desirable feature for root canal sealers. The objective of this study was to compare the antibacterial effect of three resin-based endodontic sealers (AH26, Adseal, and Beta RCS) against Enterococcus faecalis in vitro. Materials and Methods: The antibacterial properties of the sealers were assessed against E. faecalis using agar diffusion test (ADT) for fresh state (N=10) and direct contact test (DCT) for freshly-mixed and set states of the materials (N=10). In ADT, the diameter of the zones of inhibition was measured after 24h of contact. In DCT, the colony-forming units of the bacteria were counted after 30 minutes and 180 minutes of exposure. The results were analyzed with two-way ANOVA and independent sample t-test. P<0.05 was considered significant. Results: Regarding DCT results, all test materials indicated an antibacterial effect, both in freshly-mixed and set states. The highest antibacterial effect was related to Adseal, whereas the lowest was observed in Beta RCS. There was a significant difference between all study groups (different sealers, setting states, and contact times; P<0.001), except for freshly-mixed AH26 and Adseal at 180 minutes (P>0.05). According to ADT, AH26 and Adseal represented the widest and the smallest inhibition zones, respectively (P<0.001). Conclusion: Within the limitations of this in vitro study, AH26, Adseal, and Beta RCS showed antibacterial effects against E. faecalis in both freshly-mixed and set states. The antibacterial effect increased over time in all of the studied sealers.

Physicochemical Changes in Root-Canal Sealers under Thermal Challenge: A Comparative Analysis of Calcium Silicate- and Epoxy-Resin-Based Sealers.

INTRODUCTION: We compared the effects of heat on the physicochemical properties of recently developed calcium silicate-based sealers (CSBSs), including BioRoot Flow, BioRoot RCS, and AH Plus Bioceramic sealer, with those of the epoxy-resin-based sealer (ERBS) AH Plus. METHODS: The flow, film thickness, setting time, and solubility of sealers were evaluated at 37 °C and 100 °C using ISO 6876/2012. Furthermore, pH and calcium ion release were evaluated at these temperatures. In addition, the mass change in sealers at a high temperature was assessed via thermogravimetric analysis. Then, the chemical composition and components of the sealers were analyzed using a scanning electron microscope and Fourier-transform infrared spectroscopy (FTIR). RESULTS: BioRoot Flow, AH Plus Bioceramic, and AH Plus complied with ISO standards in terms of flow and film thickness, both before and after heat application. However, BioRoot RCS exhibited significantly increased film thickness at 100 °C. The setting times of all sealers were significantly reduced at 100 °C. The solubility of CSBS was >3%, exceeding the ISO 6876/2012 standard, both before and after heat exposure. Conversely, the solubility of AH Plus complied with the standard, regardless of the thermal condition. For 4 weeks, CSBS showed a significantly higher pH than AH Plus at both 37 °C and 100 °C. After heat treatment, calcium release decreased in Bioroot RCS and BioRoot Flow, while AH Plus showed no significant differences before and after treatment. However, CSBS consistently exhibited significantly higher calcium release than AH Plus at both temperatures. An FTIR analysis revealed that the chemical composition of the sealers did not change at the high temperature, whereas a thermogravimetric analysis demonstrated a >5% weight reduction in CSBS and a 0.005% weight reduction in AH Plus at 100 °C. CONCLUSIONS: BioRoot Flow, AH Plus Bioceramic, and AH Plus possess favorable physicochemical properties, which make them suitable for application under thermal conditions. At a high temperature, BioRoot RCS did not exhibit changes in its chemical composition. However, its film thickness was increased, and pH and solubility were reduced. Therefore, caution is needed when it is applied at high temperatures, such as during the warm obturation technique.

Evaluation of Antimicrobial Effectiveness of Root Canal Sealers Modified with Various Herbal Extracts against Candida Albicans and E Faecalis.

Objectives: The aim of the study was to assess the effectiveness of ZOE-based, calcium hydroxide, and epoxy resin-based sealers on modification with three herbal extracts. Materials and Methods: Methanolic extracts of selected herbs were combined with ZOE-based, calcium hydroxide, and epoxy resin-based sealers. Cultures were prepared from E. faecalis and C. albicans and agar plates prepared. Prepared mixtures were inoculated in punched holes, and inhibitory zones were measured. Results: No statistical significance was obtained on comparing mean scores of test groups. Conclusion: None of the combinations used was found to be significantly better than others.

Sealing Ability Comparison of Three Different Obturating Systems to Intraradicular Dentin-An In Vitro Stereomicroscopic Study.

Background: Different obturation techniques are being used to improve canal sealing, thereby minimizing marginal leakage. Aims and Objectives: To evaluate the marginal leakage of three different obturating materials and techniques using stereomicroscope. Materials and Methods: Thirty freshly extracted maxillary anterior teeth were collected and were divided into three groups of 10 each for which the biomechanical preparation was done. The teeth were divided into three experimental groups according to the obturation material and technique used, Group I: gutta-percha with AH Plus root canal sealer (lateral condensation): Group II: thermoplasticized gutta-percha technique-non-carrier-based (calamus) with AH Plus sealer (backfill): Group III: C point (self-sealing root canal obturating system) with bioceramic sealer (single cone). Each specimen was subjected for testing apical sealing ability. The values of microleakage associated with different root canal sealers were evaluated using a stereomicroscope. Results: There was no statistically significant difference in the mean scores of apical dye penetration/leakage among all the three groups (P = 0.091), whereas Group I showed a higher degree of apical leakage than the other techniques tested. Conclusion: None of the tested filling materials provided a gap-free or void-free root canal filling; however, thermoplasticized gutta-percha is used with AH Plus sealer exhibited less voids and gaps when compared to other tested materials.

Effect of canal medicaments triple antibiotic paste, Bio-C Temp, and Nano-silver gel activated by visible blue light on canal dentin microhardness and extrusion bond strength of AH plus sealer: A SEM and EDX analysis.

AIM: Assessment of contemporary canal medicaments (Triple antibiotic paste (TAP), Bio-C Temp, and Nano silver gel activated by visible blue light on the dentin microhardness (MH) and push-out bond strength (PBS) of AH plus endodontic sealer. METHOD: Sixty extracted premolars were obtained and decontaminated. Canal cleaning and shaping were performed. The samples were randomly allocated into four groups based on the intracanal medicaments. Group 1= CH paste, Group 2= TAP, Group 3= Bio-C Temp, and Group 4= Nano-silver gel activated by visible blue light. MH assessment was performed using a Vickers Microhardness tester. Forty specimens, ten from each group underwent root canal obturation. PBS and failure mode evaluation were performed. ANOVA and Post Hoc Tukey test were utilized to conduct intra and inter-group comparisons. RESULTS: The maximum outcome of surface hardness was presented by Group-3 (Bio-C Temp®) specimens. However, minimum scores of MH were displayed by Group 1 (CH) treated teeth. The highest outcomes of EBS were exhibited by the cervical third of Group 3 (Bio-C Temp®) samples. The apical section of Group 4 Teeth with Nano Silver gel activated by visible blue light revealed the lowest scores of bond integrity. CONCLUSION: Bio-C Temp and TAP proved to be better intracanal medicament than other tested groups in terms of the push-out bond strength of the sealer. TAP displayed lower microhardness as compared to the Bio-C Temp.

Comparative bioactivity and immunomodulatory potential of the new Bioroot Flow and AH Plus Bioceramic sealer: An in vitro study on hPDLSCs.

OBJECTIVES: To evaluate the cytocompatibility, bioactivity, and anti-inflammatory potential of the new pre-mixed calcium silicate cement-based sealers Bioroot Flow (BrF) and AH Plus Bioceramic Sealer (AHPbcs) on human periodontal ligament stem cells (hPDLSCs) compared to the epoxy resin-based sealer AH Plus (AHP). MATERIALS AND METHODS: Standardized discs and 1:1, 1:2, and 1:4 eluates of BrF, AHPbcs and AHP after setting were prepared. The following assays were performed: cell attachment and morphology via SEM, cell viability via a MTT assay, cell migration/proliferation via a wound-healing assay, cytoskeleton organization via immunofluorescence staining; cytokine release via ELISA; osteo/cemento/odontogenic marker expression via RT-qPCR, and cell mineralized nodule formation via Alizarin Red S staining. HPDLSCs were isolated from extracted third molars from healthy patients. Comparisons were made with hPDLSCs cultured in unconditioned (negative control) or osteogenic (positive control) culture media. Statistical significance was established at p < 0.05. RESULTS: Both BrF and AHPbcs showed significantly positive results in the cytocompatibility assays (cell metabolic activity, migration, attachment, morphology, and cytoskeleton organization) compared with a negative control group, while AHP showed significant negative results. BrF exhibited an upregulation of at least one osteo/cementogenic marker compared to the negative and positive control groups. BrF showed a significantly higher calcified nodule formation than AHPbcs, the negative and positive control groups, while AHPbcs was higher than the negative control group. Both were also significantly higher than AHP group. CONCLUSION: BrF and AHPbcs exhibit adequate and comparable cytocompatibility on hPDLSCs. BrF also promoted the osteo/cementogenic differentiation of hPDLSCs. Both calcium silicate-based sealers favored the downregulation of the inflammatory cytokine IL-6 and the calcified nodule formation from hPDLSCs. BrF exerted a significantly higher influence on cell mineralization than AHPbcs. CLINICAL RELEVANCE: This is the first study to elucidate the biological properties and immunomodulatory potential of Bioroot Flow and AH Plus Bioceramic Sealer. The results act as supporting evidence for their use in root canal treatment.

Characterisation and evaluation of physical properties of AH-Plus sealer with and without the incorporation of petasin, pachymic acid, curcumin and shilajit-an invitro study.

BACKGROUND: AH Plus, an epoxy resin-based sealer, is widely used in endodontic practice, owing to its good physical properties that confers longstanding dimensional stability and good adhesion to dentin. Nevertheless, its propensity to trigger inflammation, especially in its freshly mixed state, has been extensively documented. Phytochemicals such as Petasin, Pachymic acid, Curcumin, and Shilajit are known for their anti-inflammatory and analgesic effects. This study aimed to analyze and determine the effect of these natural products on the physical properties of AH Plus sealer when incorporated with the sealer. METHODS: AH Plus (AHR) sealer was mixed with 10% petasin, 0.75% pachymic, 0.5% and 6%shilajit to obtain AHP, AHA, AHC and AHS in the ratio of 10:1 and 5:1 respectively. Five samples of each material were assessed for setting time, solubility, flow, and dimensional stability in accordance with the ISO 6876:2012 standardization. Sealers were characterized through scanning electron microscopy (SEM), X-ray energy dispersive spectroscopy, X-ray diffraction (XRD), and Fourier transform infrared (FTIR) spectroscopy. Statistical evaluation involved the Kolmogorov-Smirnov and Shapiro-Wilks tests for normality and the one-way ANOVA test for analysis. RESULTS: In this investigation, the characterisation analysis revealed a relatively similar microstructure in all the experimental root canal sealers. All experimental groups, excluding the control group, exhibited an increase in flow ranging from 11.9 to 31.4% at a 10:1 ratio. Similarly, for the 5:1 ratio, the increase ranged from 12.02 to 31.83%. In terms of dimensional stability, all groups at the 10:1 ratio showed a decrease compared to the control group. The addition of natural agents to AHR in 10:1 ratio led to a reduction in setting time by 8.9-31.6%, and at a 5:1 ratio, the reduction ranged from 8.1 to 31.5%. However, regarding solubility, the addition of natural agents did not induce any significant alterations. CONCLUSION: Based on the results of this study, it can be concluded that all tested root canal sealers exhibited properties that met the acceptable criteria outlined in the ISO 6876:2012 standardization.

Comparative Evaluation of Push-out Bond Strength of Three Different Root Canal Sealers: An In Vitro Study.

AIM: The aim of this present study was to compare the dislodgement resistance of calcium silicate-based sealer, zinc oxide sealer, and a new sealer combining both zinc oxide and calcium silicate-based sealer in vitro. MATERIALS AND METHODS: 60 single-rooted human teeth were instrumented with F3 Protaper Gold. All endodontic canals were filled using gutta percha cones using the cold lateral condensation technique in combination using one of the mentioned sealers (n = 20 per group). The teeth were divided into three groups: group A consisted of Sealite® Ultra, group B consisted of K-Sealer®, and group C consisted of BioRoot® RC. After 2 months of incubation (37°C, 100% humidity) and after cutting out 2 mm from the most apical portion of the root apex, six slices of 1 mm thickness were generated. Mechanical dislodgement resistance was examined using a universal pressure-testing machine and the push-out bond strength (POBS) was calculated. Specimens were examined under 20× magnification to define the bond failure mode. Statistical analysis was executed using ANOVA, post hoc Turkey test for pairwise comparisons and Kruskal-Wallis tests. RESULTS: The POBS of BioRoot® was significantly higher than the POBS of the two other sealers with a mean of 10.54 MPa ± 2.10 and 5.73 MPa ± 2.34, respectively (p < 0.001). Sealite® and K-Sealer® showed similar results in the median and coronal part. K-Sealer® revealed highest POBS compared with Sealite® in the apical part (p < 0.05). CONCLUSION: The POBS of the zinc oxide and calcium silicate-based sealer was significantly lower compared with calcium silicate. Sealite® and K-Sealer® exhibited almost same results. BioRoot showed the highest POBS of all sealers. CLINICAL SIGNIFICANCE: The current study was needed to evaluate the bond strength of three different cements to dentinal walls, by evaluating their respective POBS in vitro. The findings of this study may provide guidance for the clinician in the selection of an adequate endodontic sealer that guarantees an enhanced adhesive seal between the Gutta-percha and the dentinal canal walls. How to cite this article: Makhlouf MP, El Helou JD, Zogheib CE, et al. Comparative Evaluation of Push-out Bond Strength of Three Different Root Canal Sealers: An In Vitro Study. J Contemp Dent Pract 2024;25(1):15-19.

The Impact of Citric Acid Solution on Hydraulic Calcium Silicate-Based Sealers and Root Dentin: A Preliminary Assessment.

Hydraulic calcium silicate-based (HCS) sealers have recently gained tremendous popularity due to their unique properties. However, their removal during endodontic retreatment is challenging. The solvent, which could chemically deteriorate the material, would be highly desirable for endodontic retreatment procedures. This preliminary study assessed the interplay and dissolving capability of 10% and 20% citric acid, compared to 17% EDTA, on commonly used HCS sealers (AH Plus Bioceramic Sealer, Bio-C Sealer, BioRoot RCS, TotalFill BC Sealer), and evaluated the potential impact of these solutions on root dentin structure. The interaction between tested sealers and irrigating solutions was photographed, and solubility-related mass changes were determined. The surface morphology of treated filling materials and dentin was evaluated using a scanning electron microscope (SEM). One-way analysis of variance (ANOVA) along with Tukey's test were used to detect the statistically significant differences among groups at the confidence level of 0.95. Intense gas release was observed during the interaction of HCS materials and citric acid, with no evidently visible "bubbling" after the immersion in EDTA. The mass loss of HCS sealers equally confirmed the significantly higher dissolving characteristics of 10% and 20% citric acid solutions compared to EDTA. The surface structural changes, associated with pore and crack formation, were mainly seen for HCS sealers exposed to citric acid. Meanwhile, no severe erosion was detected for dentin after root canal preparation with 10% and 20% citric acid solutions. These findings demonstrate that citric acid has the potential to dissolve HCS sealers with minimal or no negative impact on root dentin, suggesting citric acid as a solvent for HCS sealers in endodontic retreatment procedures.

Premixed calcium silicate-based ceramic sealers promote osteogenic/cementogenic differentiation of human periodontal ligament stem cells: A microscopy study.

To evaluate the effects of premixed calcium silicate based ceramic sealers on the viability and osteogenic/cementogenic differentiation of human periodontal ligament stem cells (hPDLSCs). The materials evaluated were TotalFill BC Sealer (TFbc), AH Plus Bioceramic Sealer (AHPbc), and Neosealer Flo (Neo). Standardized discs and 1:1, 1:2, and 1:4 eluates of the tested materials were prepared. The following in vitro experiments were carried out: ion release, cell metabolic activity 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, cell migration, immunofluorescence experiment, cell attachment, gene expression, and mineralization assay. Statistical analyses were performed using one-way ANOVA followed by Tukey's post hoc test (p < .05). Increased Ca2+ release was detected in TFbc compared to AHPbc and Neo (*p < .05). Biological assays showed a discrete cell metabolic activity and cell migration in Neo-treated cell, whereas scanning electronic microscopy assay exhibited that TFbc group had a better cell adhesion process of substrate attachment, spreading, and cytoskeleton development on the niche-like structures of the cement than AHPbc and Neo. The sealers tested were able to induce overexpression of the CEMP-1, ALP, and COL1A1 genes in the first days of exposure, particularly in the case of TFbc (***p < .001). All materials tested significantly increased the mineralization of hPDLSCs when compared to the negative control, although more pronounced calcium deposition was observed in the TFbc-treated cells (***p < .001). Our results suggested that TFbc promotes cell differentiation, both by increasing the expression of key osteo/odontogenic genes and by promoting mineralization of the extracellular matrix, whereas this phenomenon was less evident in Neo and AHPbc. RESEARCH HIGHLIGHTS: TFbc group had a better cell adhesion process of substrate attachment, spreading, and cytoskeleton development on the niche-like structures of the cement than AHPbc and Neo. The sealers tested were able to induce overexpression of the CEMP-1, ALP, and COL1A1 genes in the first days of exposure, particularly in the case of TFbc. All materials tested significantly increased the mineralization of hPDLSCs when compared to the negative control, although more pronounced calcium deposition was observed in the TFbc-treated cells.