Influence of bioceramic sealers on dentinal tubule penetration and antimicrobial effectiveness: a systematic review and meta-analysis of in vitro studies.

The aim of this systematic review and meta-analysis (SRM) was to evaluate whether bioceramic sealers have better penetration capacity in dentinal tubules and antimicrobial activity when compared to AH Plus® sealer. This SRM was recorded in the Open Science Framework database and followed the guidelines of the PRISMA 2020. Five databases were searched by two independent reviewers. Only in vitro studies that evaluated the effects of bioceramic sealers on dentinal tubule penetration and antimicrobial activity outcomes compared to AH Plus® sealer were included. Meta-analysis was conducted using R software, using the effect measure of the standardized mean difference (SMD) and inverse variance method. A modified Joanna Briggs Institute's Checklist was used for the risk of bias assessment. A total of 1486 studies were identified, and only 54 studies that fulfilled our eligibility criteria were included in this review. There was no statistical difference between the sealers evaluated for dentinal tubule penetration, in the thirds evaluated: coronal SMD 0.58 [0.14; 1.31], p = 0.12; middle SMD 0.07 [0.54; 0.39], p = 0.75; and apical SMD 0.08 [0.73; 0.56], p = 0.80. Both sealers demonstrated similar antimicrobial action (SMD [3.42; 5.32], p = 0.67 and SMD 0.67 [1.89; 0.55], p = 0.28). The studies presented a low risk of bias. Based on the in vitro studies included and according to the limitations of the present review, the data suggest that bioceramic and AH Plus® sealers present similar penetration capacity in dentinal tubules and antimicrobial effect, making them suitable materials to be considered in clinical practice.

Comparison of Easydo Activator, ultrasonic and needle irrigation techniques on sealer penetration and smear layer removal in vitro.

The effects of Easydo Activator (EA), a new sonic irrigation system, on sealer penetration at the root apex were compared to needle irrigation (NI) and passive ultrasonic irrigation (PUI) in this study. Forty-two single-rooted teeth were prepared and randomly divided into three groups (n = 14): group 1: NI; group 2: PUI; and group 3: EA. A solution of 3% sodium hypochlorite (NaOCl) was used for irrigation. Nine teeth in each group were filled with AH Plus sealer mixed with CY5 fluorescent dye and a single gutta-percha cone. The sealer penetration area, maximum penetration depth and percentage of sealer penetration at 5 mm and 1 mm from the apex were analyzed by confocal laser scanning microscopy (CLSM). The remaining 5 teeth in each group were subjected to test smear layer scores by scanning electron microscopy (SEM). The CLSM evaluation showed that increases in the area, depth and percentage of sealer penetration were detected at 1 and 5 mm from the root apex in the PUI group compared with the NI group, and greater increases were observed in the EA group (P < 0.05). The SEM experiment showed that the lowest scores for the smear layer and debris removal were achieved by the EA group when compared with the PUI and NI groups (P < 0.05). In conclusion, EA was superior to PUI and NI regarding sealer penetration at the root apex during endodontic treatment, and it could provide a new technical idea for clinical root canal therapy.

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

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

Comparison of sealer penetration of sonic activation versus conventional needle irrigation: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Most existing studies comparing the efficiency of sonic irrigation (SI) and conventional needle irrigation (CNI) in increasing the penetration of sealers into dentine tubules are controversial; and this study aimed to determine whether the use of SI can lead to greater sealing ability than CNI, during the root canal treatment. METHODS: The EMBASE, PubMed, and Cochrane Library databases were used to find confocal laser scanning microscopy studies evaluating percentage and maximum depth of sealer penetration following the use of SI or CNI in mature permanent teeth until October 2022. The critical estimative checklist of randomized controlled trials of the standardized Joanna Briggs Institute was adopted to independently score the quality of each study. The random-effect model for meta-analysis was used to analyse for each canal segment (apical, middle, coronal). The results are shown in the forest plots as weighted mean differences (WMDs) with 95% confidence intervals (95% CIs). RESULTS: Ninety-seven articles were included in the preliminary screening, and nine of them were included in this study. Eight studies were included in the meta-analysis.The meta-analysis exhibited great increases in the coronal (WMD: 8.09, 95% CI 2.78-13.40/WMD: 165.32, 95% CI 128.85-201.80), and middle segments (WMD: 8.81, 95% CI 5.76-11.87/WMD: 132.98, 95% CI 68.71-197.25) for the percentage and maximum depth of sealer penetration, respectively. The percentage of sealer penetration in the apical thirds region was nonsignificant (WMD: 4.73, 95% CI - 2.34-11.80). However, the maximum depth of sealer penetration in the apical thirds region was significant (WMD: 121.46, 95% CI 86.55-156.38). Chi-squared analysis revealed heterogeneity scores of 0.0-70.0% and 44.0-90.0% for the percentage and maximum depth of sealer penetration, respectively. DISCUSSION: This review verified that SI significantly improves tubular dentin sealer penetration in most areas of the root canal; thus, SI may lead to better filling efficiency and anti-reinfection effects than CNI during and after the root canal therapy. Nevertheless, a large heterogeneity in the current data comparing the irrigation efficiency of SI versus CNI in the apical third of the root canal was found, implying the necessity to standardize root canal irrigation procedures and obtain more accurate results in this area. TRIAL REGISTRATION: INPLASY database (INPLASY202270116).

Influence of different irrigation regimens on the dentinal tubule penetration of a bioceramic-based root canal sealer: a confocal analysis study.

This study aims to assess the efficacy of various irrigation protocols on the dentinal tubule penetration of a bioceramic-based endodontic sealer. Sixty-four single-rooted extracted human mandibular incisors were used. After instrumentation, teeth were randomly divided into the following four groups (n = 16 each) according to the final irrigation technique: group 1, conventional endodontic needle (CEN); group 2, EndoActivator (EA); group 3, Er,Cr: YSGG laser; group 4, XP-endo Finisher (XPF). The root canals were finally irrigated with 17% EDTA and 5.25% NaOCl for 1 min (min) respectively. The teeth were then obturated with Endosequence BC Points and rhodamine B dye-labeled BC Sealer. After 2 weeks, 1-mm-thick transverse sections were cut 2 and 5 mm from the apex, and examined by confocal laser scanning microscopy at 5 × magnification. The total percentage of sealer penetration (TPSP), sealer penetration area (SPA), and maximum sealer penetration depth (MSPD) was measured. Data were analyzed by Kruskal-Wallis, Dunn's multiple comparison, and Wilcoxon tests, with significance set at P < 0.05. At 2 mm level, no significant differences were detected among the groups (P > 0.05). At the 5 mm level, the XPF group showed significantly higher values for both TPSP and SPA in comparison with the Er,Cr: YSGG laser and CEN groups (P < 0.05), but no significant difference was observed with the EA group. The choice of different final irrigation techniques can affect dentinal tubule penetration.

Smear layer removal and sealer penetration with different tapers after using photon-initiated photoacoustic streaming technique.

OBJECTIVE: To evaluate the effect of the photon-initiated photoacoustic streaming (PIPS) technique on irrigation performance with different instrumentation tapers in root canals regarding smear layer removal and subsequent sealer penetration. MATERIALS AND METHODS: One hundred twenty human mandibular molars were divided into three equal groups according to the apical preparation taper (25/4%, 25/6%, and 25/8%). Each group was divided into two equal subgroups, one received passive irrigation (PI) while the other received PIPS activation of 2.5% sodium hypochlorite and 17% EDTA. Half the samples were evaluated using electron microscope images to assess smear layer removal. The other half was obturated using gutta-percha and rhodamine B-labeled AH Plus sealer before being sectioned horizontally at different root levels (coronal, middle, and apical) to evaluate the percentage of sealer penetration using CLSM. Mann-Whitney U and Friedman tests were used to analyze smear layer scores, while sealer penetration data were analyzed using the three-way analysis of variance (ANOVA) and Tukey's post hoc test. RESULTS: Statistical analysis showed significantly better smear layer removal and better sealer penetration after PIPS activation when corresponding root thirds were compared (P<0.001). Only exception was sealer penetration in the apical third with root canal preparation of 25/4% where the difference between the irrigation methods was statistically insignificant (P>0.05). CONCLUSIONS: The use of PIPS activation in the final irrigation protocol enhanced smear layer removal and sealer penetration into dentinal tubules if the taper of the prepared canal was at least 6%. CLINICAL RELEVANCE: Increasing apical preparation taper significantly enhances PIPS performance in terms of irrigation activation thus enhancing smear layer removal and subsequent sealer penetration in dentinal tubules.

Effect of chitosan nanoparticle, QMix, and EDTA on TotalFill BC sealers' dentinal tubule penetration: a confocal laser scanning microscopy study.

The aim of the present study was to compare the effect of chitosan nanoparticle, QMix, and 17% EDTA on the penetrability of a calcium silicate-based sealer into dentinal tubules using a confocal laser scanning microscope (CLSM). Sixty mandibular premolar teeth were selected and randomly divided into three groups (n = 20) before root canal preparation according to the solution used in the final rinse protocol: chitosan, QMix, and EDTA groups. Twenty teeth of each group were filled with a TotalFill BC sealers' single gutta-percha cone and with 0.1% rhodamine B. The specimens were horizontally sectioned at 3 and 5 mm from the apex, and the slices were analyzed in CLSM (4×). Total percentage and maximum depth of sealer penetration were measured using confocal laser scanning microscopy with using Image J analysis software. Dentinal tubule's penetration depth, percentage, and area were measured using imaging software. Kruskal-Wallis test was used for statistical analysis. The level of significance was set at 5%. Results of Kruskal-Wallis analysis showed that there was a significant difference in the percentage and depth of sealer penetration among all groups at 3 and 5 mm level sections (P < 0.05). Within the groups, the minimum sealer penetration depth was recorded for chitosan nanoparticle group. Greater depth of sealer penetration was recorded at 5 mm as compared to 3 mm in all the groups. Within the limitation of the present study, it can be concluded that QMix and EDTA promoted sealer penetration superior to that achieved by chitosan nanoparticle.

Effect of chitosan on sealer penetration into the dentinal tubules.

OBJECTIVE: The objective of this study is to compare the effectiveness of final irrigation with chitosan, ethylenediaminetetraacetic acid (EDTA), and citric acid (CA) on a resin-based sealer (AH plus sealer [Dentsply DeTrey, Konstanz, Germany]) penetration into dentinal tubules using confocal laser scanning microscopy. MATERIALS AND METHODS: Seventy recently extracted human mandibular premolars were instrumented and irrigated with sodium hypochlorite (NaOCl), then divided into four groups according to the final irrigation regimen used: (1) the EDTA group: 17% EDTA + 2.5% NaOCl, (2) the CA group: 10% CA + 2.5% NaOCl, (3) the chitosan group: 0.2% chitosan + 2.5% NaOCl, and (4) the control group: 2.5% NaOCl. All teeth were obturated using the cold lateral condensation technique with gutta-percha and AH Plus sealer labeled with fluorescent dye. The apical 2 mm of specimen was discarded, and slices were obtained for apical, middle, and coronal thirds of the root with 1 mm intervals. Maximum, mean, and percentage of sealer penetration (SP) inside tubules were measured using confocal laser scanning microscopy. RESULTS: The percentage of SP was significantly higher in chitosan, EDTA, and CA group than control group for coronal thirds (P < 0.05), whereas there was no significant difference among all groups for middle and apical thirds. Chitosan and EDTA showed increased mean values of SP depth for middle thirds (P < 0.05). In all sections, the maximum depth of SP was significantly lower in EDTA group than other groups (P < 0.05). CONCLUSIONS: Chitosan, EDTA, and CA significantly improved the percentage of SP for coronal thirds.

Influence of therapeutic cancer radiation on the bond strength of an epoxy- or an MTA-based sealer to root dentine.

AIM: To evaluate the influence of radiation on root canal sealer push-out bond strength to dentine and sealer/dentine interface in teeth filled with AH Plus (Dentsply Ind. Com. Ltda, Petrópolis, RJ, Brazil) and MTA Fillapex (Angelus Ind. Prod. Odontológicos S/A, Londrina, PR, Brazil). METHODOLOGY: Thirty-two maxillary canines were selected and randomly assigned to 2 groups (n = 16): one group was not irradiated, and the other was subjected to a cumulative radiation dose of 60 Gy. Root canals were prepared with the Reciproc system (VDW GmbH, Munich, Germany), and each group was divided into 2 subgroups (n = 8) according to the sealer - AH Plus or MTA Fillapex - using the single-cone filling technique. Then, 1-mm-thick dentine slices were obtained from each root third for the push-out test to evaluate sealer bond strength to dentine and for scanning electron microscopy (SEM) to examine the sealer/dentine interface. Failure mode after debonding was determined with a stereomicroscope at ×25 magnification. Bond strength data were analysed by two-way anova with a split-plot design and post hoc Tukey's test (α = 0.05). RESULTS: Significantly lower bond strength (P < 0.0001) was obtained after irradiation (0.71 ± 0.20 versus 0.97 ± 0.29 MPa) and in specimens filled with MTA Fillapex (0.70 ± 0.18 MPa) compared with AH Plus (1.00 ± 0.27 MPa). Percentage of adhesive failures increased after radiation in all root thirds in the teeth filled with AH Plus. SEM revealed more gap-containing regions and fewer tags at the sealer/dentine interface in irradiated specimens, with more tag formation and fewer gaps with AH Plus sealer. CONCLUSIONS: Radiation was associated with a decrease in the push-out bond strength of sealers to intraradicular dentine and formation of more gaps and fewer tags at the sealer/dentine interface regardless of the sealer.

Penetration of Calcium Silicate and Epoxy Resin Sealers Into the Lateral Canals.

OBJECTIVES: The aim of this research was to compare the penetration ability of calcium silicate-based sealers (iRoot SP and TotalFill BC HiFlow) and an epoxy resin-based sealer (AH Plus) into the lateral canals using the single-cone (SC) or continuous wave compaction (CW) obturation techniques. METHODS: Ninety single-rooted human teeth received canal instrumentation and diaphanisation before artificial lateral canals were created at 3 different root levels. The specimens were randomly allocated into 6 groups based on the combination of obturation technique and sealer used. Radiographic and photographic measurements evaluated the percentage of sealer penetration. Statistical analysis was performed to compare the penetration ability amongst different types of sealers, obturation methods, and root levels. RESULTS: Although TotalFill BC HiFlow sealer combined with the CW technique demonstrated greater sealer penetration at the coronal level (P < .05), the overall penetration ability of iRoot SP, TotalFill BC HiFlow, and AH Plus was not significantly different. The deepest sealer penetration was observed at the apical root level. CONCLUSIONS: All sealers showed similar penetration abilities into the lateral canals using the SC or CW techniques in vitro. Calcium silicate-based sealers have comparable penetration ability into lateral canals compared to epoxy resin-based sealers using SC or CW obturation techniques.

Reliability of sealer penetration measurement methods and assessment of dentine penetrability after endodontic retreatment: A correlation in vitro study.

This study evaluated the reliability of sealer penetration measurement methods used with confocal laser scanning microscopy in correlation with the percentage of residual root filling and examined the effect of residual root-filling material on dentine penetrability after retreatment. Extracted teeth were randomly divided into different groups according to the obturation sealer used (n = 6); BioRoot RCS; MTA Fillapex; Bio-C and AH Plus. Root-filling material was removed before the secondary chemo-mechanical preparation and obturation using fluorescein labelled AH Plus. Multiple micro-computed tomography scans were obtained followed by confocal laser scanning microscopy to measure the penetration of the labelled sealer into the dentinal tubules using four different methods. Measuring sealer penetration into radicular dentine using the penetration percentage method was found to be the most reliable. Dentine penetrability during retreatment did not seem to be affected by the type of residual root-filling material.

Effect of Different Obturation Techniques on Sealer Penetration in Teeth with Artificial Internal Root Resorption: a Confocal Laser Microscope Analysis.

OBJECTIVE: To investigate the efficacy of different obturation techniques on sealer penetration in teeth with internal root resorption using confocal laser microscopy. METHODS: An artificial internal resorption cavity (3 mm deep and 1.2 mm in diameter) was formed in the round-shaped root canals of 45 single-rooted teeth at a distance of 7 mm from the apex, then roots were instrumented (size 40/.06). The samples were divided into three groups (n = 15) according to the obturation technique: lateral compaction (LC), warm vertical compaction (WVC) and carrier-based (CB). RESULTS: In the resorption regions, the sealer penetration depth in the CB and LC groups was significantly higher than that in the WVC group (P < 0.05). CONCLUSION: Within the limitations of this study, the penetration depth of the sealer in the resorption region was higher in the CB and LC groups as compared to that in the WVC group.

Gap volume and sealer penetration of C-shaped root canals obturated with cold hydraulic technique and calcium silicate sealer.

This study compared the gap volume and sealer penetration in C-shaped root canals prepared with adaptive core rotary files and obturated with cold hydraulic compaction using calcium-silicate sealer, warm vertical hybrid compaction, or lateral compaction using epoxy-resin sealer. Thirty-six extracted mandibular molars with pulpal floor configuration Types I and III were used. The teeth were prepared using XP-Shaper and XP-Finisher and obturated with: group 1: cold hydraulic compaction/calcium silicate, group 2: warm vertical hybrid compaction/epoxy resin, or group 3: lateral compaction/epoxy resin. The gap volume was evaluated using µ-CT. The sealer penetration depth and area were evaluated using confocal laser scanning microscopy. The gap volume in groups 1, 2, and 3 was 0.82%, 0.24%, 0.80%, respectively, which were not significantly different (p > 0.05). The gap volumes in the obturated C-shaped canals were not significantly different among the CHC/CSBS, WHC/ERS, or LC/ERS groups. CHC/CSBS was the most convenient technique.

Influence of dual rinse irrigation on dentinal penetration of a bioceramic root canal sealer: A Conofocal microscopic Analysis.

To evaluate the sealer penetration after applying dual rinse irrigant in comparison with sodium hypochlorite and 17% EDTA. Mandibular premolars were prepared by ProTaper Next and irrigated with NaOCl, NaOCl/Dual Rinse or NaOCl/EDTA and then obturated with a single-cone technique and bioceramic-based. Samples were observed using confocal laser microscopy, and the maximum depth of penetration was measured, as well as the percentage of sealer coating the canal wall and the penetration area of the sealer. One-way anova was used, followed by Tukey post hoc test. Sealer penetration area displayed a statistically significant difference between the tested groups (P < 0.05), and the highest percentage of sealer coating the canal wall and the greatest depth of sealer penetration were found in Group (NaOCl/Dual Rinse). Group (NaOCl/Dual Rinse) displayed better sealer penetration inside the dentinal tubules than Group (NaOCl/EDTA), while Group (NaOCl) showed the lowest sealer penetration.

Evaluation of the effect of calcium hydroxide paste on sealer penetration into dentinal tubules by confocal laser scanning microscopy.

The study evaluated sealer penetration after calcium hydroxide (Ca(OH)2 ) removal from the root canals. Sixty single-rooted mandibular premolars were divided into six groups. Ca(OH)2 paste placed into the root canals except for the control group (CG) was removed using the following irrigation techniques: conventional needle irrigation (CNI), EndoActivator (EA), EndoVac (EV), passive ultrasonic irrigation (PUI) and photon-induced photoacoustic streaming (PIPS) technique. After canal filling, the penetration depth, penetration area and penetration percentage of the sealer were determined using confocal microscopy. The CG and EA had a greater penetration depth than CNI in the middle section. The CG exhibited a higher dentinal tubule penetration area than CNI, EV and PUI in the middle section. EA was significantly more effective than PUI in the coronal section for the percentage of sealer penetration. EA and PIPS removed Ca(OH)2 from root canals effectively because they presented similar penetration to the CG in all sections.

The Impact of Laser-Activated and Conventional Irrigation Techniques on Sealer Penetration into Dentinal Tubules.

Objective: The present study was aimed at comparing the efficacy of 1-hydroxyethylidene-1, 1-diphosphonic acid (HEDP) and ethylenediaminetetraacetic acid (EDTA) by using various final irrigation techniques on penetration of sealer. Background: Traditional irrigation of root canals with a syringe limits the ability of sealer penetration. Various irrigants and activation techniques, including sonic and ultrasonic devices and various kinds of lasers, have been introduced to improve penetration of sealers into dentinal tubules. Methods: One hundred mandibular premolars were selected. Final irrigation was performed with HEDP or EDTA by conventional syringe irrigation (CI), EndoActivator (EA), passive ultrasonic irrigation (PUI), photon-induced photoacoustic streaming (PIPS), and shock wave-enhanced emission photoacoustic streaming (SWEEPS) methods (n = 10). After obturation of root canals with the EndoSequence BC Sealer, samples were evaluated using a confocal laser scanning microscope (CLSM), which enabled measurement of the maximum depth, percentage, and penetration area. Tests performed for analysis included the Kruskal-Wallis H and Mann-Whitney U tests. Results: In the EA method, the penetration percentage achieved using HEDP was significantly higher than EDTA at both sections (p < 0.05). Irrespective of the final irrigation solution employed, the PUI, PIPS, and SWEEPS techniques exhibited greater tubule penetration values compared with the CI and EA techniques (p < 0.05). Conclusions: HEDP and EDTA showed similar effects on the amount of penetrated sealer into the dentinal tubules, and the PUI, PIPS and SWEEPS methods provided enhanced EndoSequence BC Sealer penetration compared with the CI and EA methods. This study was approved by the Near East University institutional review board (#2020/86-1225).

The impact of irrigation protocols on epoxy sealer penetration depth in dentinal tubules. Study involving laser confocal microscopy.

The aim was to assess the impact of irrigation protocols ended with ethanol or chlorhexidine on AH Plus penetration into dentinal tubules. 45 root canals were prepared to ISO 40/04, divided into three groups and irrigated with three protocols: Group 1 (control): 5.25% NaOCl; Group 2: 40% CA (citric acid), 5.25% NaOCl, 40% CA, water, ethanol; Group 3: 40% CA, 5.25% NaOCl, 40% CA, water, 2% chlorhexidine. Canals were filled using vertical condensation technique with gutta-percha and fluorescein-stained AH Plus sealer. After 72 h, 1 mm thick cross-sections were cut at 2, 5, 8 mm from the apex. Confocal laser microscope was used to measure the sealer penetration into dentinal tubules. Mean depth of sealer penetration (in micrometres) was 107, 131, 170 (Group 1); 146, 233, 317 (Group 2); 185, 301, 542 (Group 3); in apical, middle and coronal parts, respectively. Irrigation protocol ended with chlorhexidine resulted in the deeper sealer penetration compared with alcohol.

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.

Efficacy of Photoinduced Photoacoustic Streaming and Diode Laser Irrigation Techniques on Smear Layer Removal, Sealer Penetration and Push-out Bond Strength.

Introduction: The present study aimed to test the efficiency of photoinduced photoacoustic streaming using 2940 nm Er: YAG laser and 980 nm diode laser agitation on smear layer removal, sealer penetration and push-out bond strength. Methods: Sixty single canaled human permanent teeth were collected for this study. Specimens were grouped into three experimental groups (20 teeth in each group), depending on the activation protocol used for final irrigation: Group I (needle agitation), group II (980nm diode laser agitation) and group III (photon induced photoacoustic streaming (PIPS) using 2940 nm Er: YAG laser. The quantity of irrigant was standardized in all groups to 4 ml. The irrigant was activated for 40 seconds in different groups under continuous flow. Two teeth from each group were used to check the smear layer removal, and then the remaining teeth in each group were randomly divided into three equal experimental subgroups according to methods of evaluation used: subgroup A: Sealing ability evaluated by dye penetration method; subgroup B: SEM for sealer penetration; and subgroup C: Push-out bond strength assessed by the universal test machine. Results: As regards smear layer removal, results showed that the PIPS group had opened dentinal tubules, followed by the diode laser group, while the least cleaning effect was found in the Side-vented needle group. As for Sealing ability and dye penetration, a statistically significant difference was found between all of the three groups, with the Er:YAG laser (PIPS) having the best sealing ability and sealer penetration. Push-out bond strength results showed no statistically significant difference between diode and Er:YAG groups, with a significant difference between each of them and the Side-vented needle group. Conclusion: Using the diode or Er:YAG laser (PIPS) for irrigant activation led to better irrigant penetration and smear layer removal which subsequently led to obvious sealer penetration, better sealing, and strength properties of endodontic treated teeth.

Effect of Different Irrigation Activation Techniques on Sealer Penetration: A Confocal Laser Microscopy Study.

OBJECTIVE: To compare the efficiency of a new sonic powered irrigation system named EDDY (VDW, Munich, Germany), passive ultrasonic irrigation (PUI) and conventional needle irrigation (CNI) in root canal sealer penetration. METHODS: A total of 45 mandibular premolars were instrumented up to size 30, 0.9 taper and randomly divided into three groups (n = 15) depending on the final irrigation activation technique: EDDY, PUI or CNI. After the final irrigation procedures, the root canals were obturated with labelled sealer mixed with 0.1% rhodamine B. Transverse sections at 3, 5 and 7 mm from the root apex were examined using confocal laser scanning microscopy. The maximum depth and total area and percentage of sealer penetration were measured using ImageJ analysis software (National Institutes of Health, Bethesda, MD, USA). RESULTS: In the EDDY group, the penetration depth was higher compared to the CNI group in the apical and middle sections and compared to the PUI group in the apical section (P ˂ 0.05). The penetration area in the EDDY group was higher compared to the CNI group in all sections and compared to the PUI group in the coronal section (P ˂ 0.05). The percentage of penetration was higher in the EDDY group compared to the CNI group in all sections and compared to the PUI group in the coronal section (P ˂ 0.05). CONCLUSION: In the present study, sealer penetration was superior in the EDDY group than the CNI group in the apical section. In the middle and coronal sections, sealer penetration was similar for the EDDY and PUI groups.