Cimento biocerâmico no tratamento conservador de perfuração radicular em molar inferior / Bioceramic sealer in conservative treatment of mandibular molar root perforation

Introdução: A perfuração radicular é um acidente técnico-operatório que resulta em comunicação da cavidade pulpar com os tecidos periodontais. Esse tipo de acidente pode apresentar prognóstico desfavorável, por afetar significativamente o soalho da câmara coronária ou os terços cervical, médio e apical do canal radicular. Entre os fatores que interferem no prognóstico das perfurações radiculares, destacam-se: localização, extensão, presença ou ausência de bolsa periodontal; tempo decorrido entre a perfuração e o tratamento; e tipo de material obturador. Nesse contexto, os cimentos obturadores de canais denominados biocerâmicos surgiram como uma proposta inovadora para tratamento de perfurações antes consideradas de prognóstico desfavorável. Objetivo: O presente trabalho teve por objetivo relatar o tratamento de uma perfuração radicular em molar inferior com o cimento biocerâmico EndoSequence BC Sealer, com três anos de acompanhamento. Resultados: As imagens radiográficas e os dados clínicos do paciente evidenciaram o sucesso no tratamento da perfuração, com reparo da lesão perirradicular. Conclusão: O cimento endodôntico biocerâmico EndoSequence BC Sealer associado com a retomada do trajeto original do conduto e sua instrumentação favoreceram o reparo dos tecidos perirradiculares, sugerindo propriedades biológicas promissoras de compatibilidade e bioativida (AU).

Introduction: Root perforation is a technical-surgical accident that results in communication of the pulp cavity with periodontal tissues. This type of accident may have an unfavorable prognosis because it significantly affects the floor of the coronary chamber or the cervical, middle and apical thirds of the root canal. Factors that interfere with the prognosis of root perforations include location, extension, presence or absence of periodontal pocket, time elapsed between perforation and treatment, and type of obturator material. In this context, bioceramic canal sealers have emerged as an innovative proposal for treatment of perforations previously considered to have an unfavorable prognosis. Objective: The aim of this study was to report the treatment of a lower molar root perforation with the EndoSequence BC Sealer bioceramic sealer after a 3-year follow up. Results: Radiographic images and patient clinical data showed success in the treatment of perforation with repair of the periradicular lesion. Conclusion: Endo-Sequence BC Sealer bioceramic endodontic sealer associated with the resumption of the original conduit path and its instrumentation favored the repair of periradicular tissues, suggesting promising biological properties of compatibility and bioactivity (AU).

Qualidade de três técnicas para preenchimento do canal radicular: análise in vitro de cortes transversais em molares inferiores / Quality of three techniques for root canal filling: an in vitro cross-sectional analysis in mandibular molars

Introdução: o sistema reciprocante pode preparar o canal radicular usando um único instrumento; entretanto, para garantir o sucesso endodôntico, a obturação radicular deve ser de alta qualidade. Para isso, várias técnicas podem ser usadas, e é importante que sua eficiência seja determinada. Assim, o presente estudo analisou três técnicas diferentes, considerando a capacidade de preenchimento da obturação do canal radicular. Métodos: o estudo envolveu 30 molares inferiores humanos extraídos; os canais mesiais desses dentes foram instrumentados com o sistema WaveOne e, então, divididos em três grupos, de acordo com a técnica utilizada para o preenchimento do canal radicular. A técnica de cone único, técnica híbrida de Tagger e uma técnica experimental (cone único mais o uso do condensador guta-percha) foram utilizadas para os Grupos I, II e II, respectivamente. Os dentes obturados foram cortados transversalmente em seções de 0,3 mm a 2, 4 e 6 mm do ápice do canal radicular. As seções foram, então, digitalizadas e analisadas. Os dados foram comparados estatisticamente pelos testes de Kruskal-Wallis e Dunn, com valores de p < 0,05 indicando significância. Resultados: não houve diferença significativa entre os grupos experimentais em relação às quantidades de guta-percha ou cimento utilizado. No entanto, nos Grupos II e III, houve menor ocorrência de espaços vazios no preenchimento do canal radicular do que no Grupo I (p < 0,05). Conclusão: conclui-se que as técnicas de preenchimento do canal radicular apresentadas no presente estudo geraram um baixo número de espaços vazios e que as técnicas termoplastificadoras conferem menos espaços vazios (AU).

ntroduction: Reciprocating system can prepare the root canal using only one instrument. However, to ensure successful endodontic treatment, it must result in high-quality root canal filling. In this regard, several techniques can be used, and it is important that their efficiency is determined. This study analyzed three different techniques in terms of their ability to fill root canal. Material and Methods: The study involved 30 extracted human mandibular molars. Mesial canals of these teeth were instrumented using WaveOne system and then divided into three groups according to the technique used for root canal filling. The single-cone technique, Tagger's hybrid technique, and an experimental technique (single-cone plus gutta-percha condenser) were used for Groups I, II, and II, respectively. Filled teeth were sectioned transversely into 0.3-mm sections 2, 4, and 6 mm from the root canal apex. The sections were then digitized and analyzed. Data were statistically compared using Kruskal-Wallis and Dunn tests, with p-values <0.05 indicating significance. Results: There was no significant difference among experimental groups in terms of the amount of gutta-percha or sealer used. However, in Groups II and III, there were fewer voids in root canal filling than in Group I (p < 0.05). Conclusion: The techniques for root canal filling presented in the current study yielded a low number of empty spaces, and thermoplastification techniques result infewer voids (AU).

Physicochemical properties and bioactive potential of a new epoxy resin-based root canal sealer

Abstract The aim of this study was to evaluate physicochemical properties and bioactive potential of Sealer Plus, in comparison with MTA Fillapex, Sealapex and AH Plus. Setting time, flow, and radiopacity were evaluated based on ISO 6876 Standard. Flow was also assessed in area (mm²). The solubility and volumetric change of the sealers were evaluated after 7 and 30 days of immersion in distilled water. Solubility was evaluated by the difference in mass of materials before and after immersion. Volumetric change was evaluated by using microcomputed tomography (micro-CT). The bioactive potential was observed by Scanning Electron Microscopy (SEM) after immersion in PBS. Data were compared using ANOVA and Tukey tests (α=0.05). Sealer Plus presented the shortest setting time (196 min.) and Sealapex the longest (912 min.) (p<0.05). AH Plus showed the highest radiopacity (9.5 mm Al) and MTA Fillapex the lowest (2.7 mm Al) (p<0.05). All the sealers presented flow in accordance with ISO 6876/2012 (>17 mm). Sealer Plus showed low solubility and volumetric change (<1%), and MTA Fillapex showed the highest solubility (>25%), and volumetric change (>4%) after all time intervals (p<0.05). MTA Fillapex was the only sealer that showed bioactive potential. In conclusion, Sealer Plus presented proper physicochemical properties. However, this sealer did not present a bioactive potential.

Resumo O objetivo deste estudo foi avaliar as propriedades físico-químicas e o potencial bioativo de Sealer Plus, em comparação com MTA Fillapex, Sealapex e AH Plus. Tempo de presa, escoamento e radiopacidade foram avaliados com base nas normas ISO 6876. O escoamento foi também avaliado em área (mm²). A solubilidade e a alteração volumétrica dos cimentos foram avaliadas após 7 e 30 dias de imersão em água destilada. A solubilidade foi analisada pela diferença entre as massas dos cimentos antes e após imersão. A alteração volumétrica foi avaliada por meio de microtomografia computadorizada (micro-CT). O potencial bioativo dos cimentos foi observado por Microscopia Eletrônica de Varredura (MEV) após imersão em PBS. Os dados foram comparados usando os testes ANOVA e Tukey (α=0.05). Sealer Plus apresentou o tempo de presa mais curto (196 min.) e Sealapex o mais longo (912 min.) (p<0.05). AH Plus mostrou a radiopacidade mais alta (9.5 mm Al) e MTA Fillapex a mais baixa (2.7 mm Al) (p<0.05). Todos os cimentos tiveram escoamento de acordo com as normas ISO 6876/2012 (>17 mm). Sealer Plus mostrou baixos valores de solubilidade e alteração volumétrica (<1%) e MTA Fillapex teve os valores mais altos de solubilidade (>25%) e alteração volumétrica (>4%) em todos os períodos avaliados (p<0.05). MTA Fillapex foi o único cimento que mostrou potencial bioativo. Como conclusão, Sealer Plus apresentou propriedades físico-químicas adequadas, entretanto, não apresentou potencial bioativo.

A micro-computed tomographic study of remaining filling materials of two bioceramic sealers and epoxy resin sealer after retreatment

OBJECTIVE: This study evaluated the presence of residual root canal filling material after retreatment using micro-computed tomography (micro-CT). MATERIALS AND METHODS: Extracted human teeth (single- and double-rooted, n = 21/each; C-shaped, n = 15) were prepared with ProFile and randomly assigned to three subgroups for obturation with gutta-percha and three different sealers (EndoSeal MTA, EndoSequence BC sealer, and AH Plus). After 10 days, the filling material was removed and the root canals were instrumented one size up from the previous master apical file size. The teeth were scanned using micro-CT before and after retreatment. The percentage of remaining filling material after retreatment was calculated at the coronal, middle, and apical thirds. Data were analyzed using the Kruskal-Wallis test and Mann-Whitney U test with Bonferroni post hoc correction. RESULTS: The tested sealers showed no significant differences in the percentage of remaining filling material in single- and double-rooted teeth, although EndoSeal MTA showed the highest value in C-shaped roots (p < 0.05). The percentage of remaining filling material of AH Plus and EndoSeal MTA was significantly higher in C-shaped roots than in single- or double-roots (p < 0.05), while that of BC sealer was similar across all root types. EndoSeal MTA showed the highest values at the apical thirds of single- and double-roots (p < 0.05); otherwise, no significant differences were observed among the coronal, middle, and apical thirds. CONCLUSIONS: Within the limitations of this study, a large amount of EndoSeal MTA remained after retreatment, especially in C-shaped root canals.

Comparative Histologic Study of 3-Root Canal Filling Materials for Dog's Teeth / 대한소아치과학회지

Endodontic treatment of primary molars is a great challenge to the dentists because of their complex morphology. However, there have been limited controlled in vivo studies about filling materials for primary teeth. Hence, the aim of this study is to evaluate and compare histologic responses of different calcium hydroxide canal filling materials that are used in daily clinical practice.Pulpectomies were performed in 132 teeth of the dogs. The root canals were randomly filled with either Vitapex® (n = 44), Metapex® (n = 44), or Metapaste® (n = 44). After 4 or 13 weeks, respectively after operation, the dogs were sacrificed, and teeth were processed for histologic examinations. Inflammatory reaction was evaluated and scored in a blind manner. The Fisher's exact test and Kruskal-Wallis test were used to compare the tested groups.In 4-week-group, all inflammatory responses were in normal range except for fibrosis. In 13-week-group, increased response to various inflammation reaction was shown compared to the 4-week-group. However, there were no statically significant differences between the tested groups in all inflammatory reaction.Overall, there were no significant differences among three materials in responses of apical tissues and all of them showed favorable tissue responses.

Bond strength to root dentin and fluid filtration test of AH Plus/gutta-percha, EndoREZ and RealSeal systems

OBJECTIVES: To investigate the bond strength and seal ability produced by AH Plus/gutta-percha, EndoREZ and RealSeal systems to root canal dentin. MATERIAL AND METHODS: Sixty extracted single-root human teeth, instrumented manually to size 40, were divided into three groups (n=20) according to the sealer used; G1: AH Plus, G2: EndoREZ, and G3: RealSeal sealers. After filling using the lateral condensation technique, each sealer group was randomly divided into two subgroups according to the tests applied (n=10 for µPush-out test and n=10 for fluid filtration test). A fluid filtration method was used for quantitative evaluation of apical leakage. Four 1-mm-thick slices (cervical and medium level) were obtained from each root sample and a µPush-out test was performed. Failure modes were examined under microscopy at 40x, and a one-way ANOVA was applied to analyze the permeability. Non-parametrical statistics for related (Friedman's and Wilcoxon's rank tests) or unrelated samples (Kruskal-Wallis' and Mann-Whitney's tests) allowed for comparisons of µPush-out strength values among materials at the different levels. Statistical significance was accepted for p values <.05. RESULTS: There are no significant differences among fluid filtration of the three sealers. The sealer/core material does not significantly influence the µPush-out bond strength values (F=2.49; p=0.10), although statistically significant differences were detected with regard to root level (Chi2=23.93; p<0.001). AH Plus and RealSeal obtained higher bond strength to intraradicular dentin in the ...

Sealability of MTA and calcium hydroxidecontaining sealers

OBJECTIVES: The aim of this study was to evaluate the apical sealability of Fillapex®, endo-CPM-Sealer® and Sealapex®. Material and Methods: Ninety-four freshly extracted single-rooted teeth were selected and decoronated. All teeth were radiographed to confirm the existence of a single and straight root canal, which was prepared using Protaper Universal and 2.5% sodium hypochlorite. The teeth were randomly divided in groups of 10 specimens each according to the sealer, and the canals were filled using the single cone technique and one of the sealers. Four additional teeth were used as controls. The teeth were submitted to dye leakage with Rhodamine B for 24 h but using vacuum on the initial 15 min. Thereafter, they were cut longitudinally and the leakage was measured in a linear fashion from apex to crown. Data were analyzed by ANOVA and Tukey's tests at 5% significance level. Results: Fillapex® and Sealapex® showed significantly less dye leakage than endo-CPM-Sealer® (p<0.05). Conclusions: It was concluded that Fillapex® and Sealapex® were able to prevent apical dye leakage differently from endo-CPM-Sealer®.

Bond strength of different endodontic sealers to dentin: push-out test

OBJECTIVE: The aim of this in vitro study was to evaluate the bond strength of different root canal sealers to dentin. MATERIAL AND METHODS: Forty extracted single-rooted human teeth were examined and the coronal and middle thirds of the canals were prepared with a 1.50 mm post drill (FibreKor Post System, Pentron). The teeth were allocated in two experimental groups, irrigated with 2.5 percent NaOCl+17 percent EDTA or saline solution (control group) and instrumented using Race rotary files (FKG) to a size #40 at the working length. Then, the groups were divided into four subgroups and filled with Epiphany sealer (Group 1), EndoREZ (Group 2), AH26 (Group 3) and Grossman's Sealer (Group 4). After 2 weeks of storage in 100 percent humidity at 37ºC, all teeth were sectioned transversally into 2-mm-thick discs. Push-out tests were performed at a cross-head speed of 1 mm/min using a universal testing machine. The maximum load at failure was recorded and expressed in MPa. RESULTS: Means (±SD) in root canals irrigated with 2.5 percent NaOCl and 17 percent EDTA were: G1 (21.6±6.0), G2 (15.2±3.7), G3 (14.6±4.5) and G4 (11.7±4.1).Two-way ANOVA and Tukey's test showed the highest bond strength for the Epiphany's group (p< 0.01) when compared to the other tested sealers. Saline solution decreased the values of bond-strength (p<0.05) for all sealers. CONCLUSION: Epiphany sealer presented higher bond strength values to dentin in both irrigating protocols, and the use of 2.5 percent NaOCl and 17 percent EDTA increased the bond strength values for all sealers.

Actividad antimicrobiana de diferentes tipos de cementos endodónticos

El objetivo de este estudio fue evaluar la actividad antimicrobiana de los cementos endodónticos a base de resina (Epiphany, Sealer 26 e AH Plus), cementos a base de silicona (Roeko Seal) y cementos de óxido de zinc y eugenol (Intrafill), sobre cinco diferentes especies de microorganismos. El método utilizado fue el de difusión en Agar. Una capa base fue confeccionada usando Agar Müller-Hinton (MH) y los pozos fueron formados por la remoción del Agar. Los materiales fueron colocados en los pozos después de su manipulación. Los microorganismos usados fueron: Micrococcus luteus (ATCC 9341), Staphylococcus aureus (ATCC6538), Escherichia coli (ATCC10538), Pseudomonas aeruginosa (ATCC27853), Candida albicans (ATCC 1023) y Enterococcus faecalis (ATCC 10541). Las placas fueron mantenidas a temperatura ambiente por 2 horas para pre-difusión y posteriormente incubadas a 37(0) C por 24 horas. Los resultados demostraron que el cemento Epiphany y el Sealer 26 presentaron actividad antimicrobiana sobre todas las cepas evaluadas. El cemento AH Plus y el Intrafill mostraron una acción antimicrobiana sobre todos los microorganismos excepto P aeruginosa y el Roeko Seal no fue efectivo sobre ningún microorganismo.

The aim of this study was to evaluate the antimicrobial activity of root canal sealers based on resins (Epiphany, Sealer 26 and AH Plus), silicon (Roeko Seal) and zinc oxide and eugenol (Intrafill), against five different microorganism strains. The agar diffusion method was used. A base layer was made using Müller-Hinton agar (MH) and wells were formed by removing agar. The materials were placed into the wells immediately after manipulation. The microorganisms used were: Micrococcus luteus (ATCC9341), Staphylococcus aureus (ATCC6538), Escherichia coli (ATCC10538), Pseudomonas aeruginosa (ATCC27853), Candida albicans (ATCC 10231), and Enterococcus faecalis (ATCC 10541).The plates were kept at room temperature for 2 h for prediffusion and then incubated at 37(0) C for 24 h. The results showed that Epiphany and Sealer 26 presented antimicrobial activity against all strains. AH Plus and Intrafill presented antimicrobial activity against all strains except P aeruginosa and Roeko Seal wasn’t effective against any microorganism.

Periapical repair after root canal filling with different root canal sealers

The aim of this study was to evaluate periapical repair after root canal filling with different endodontic sealers. Sixty-four root canals from dog´s teeth were filled, divided into 4 groups (n=16). Root canals were instrumented with K-type files and irrigated with 1 percent sodium hypochlorite solution. Root canals were filled in the same session by active lateral condensation of the cones and sealers: Intrafill, AH Plus, Roeko Seal and Resilon/Epiphany System. After 90 days, the animals were euthanized and the tissues to be evaluated were processed and stained with hematoxylin and eosin. For histopathological analysis, the following parameters were evaluated: inflammatory process, mineralized tissue resorption, and apical mineralized tissue deposition. Histopathological analysis demonstrated that Intrafill had less favorable results in terms of apical and periapical repair, compared to the other sealers (p<0.05). AH Plus, Roeko Seal, and Epiphany sealers had similar and satisfactory results (p>0.05). In conclusion, AH Plus and the materials Roeko Seal and Epiphany are good options for clinical use in Endodontics.

O objetivo deste estudo foi avaliar o reparo periapical após obturação de canal radicular usando os cimentos Roeko Seal e Epiphany. Sessenta e quatro canais radiculares de dentes de cães foram obturados, divididos em 4 grupos (n=16). Os canais radiculares foram instrumentados com limas tipo K e irrigados com solução de hipoclorito de sódio a 1 por cento. Os canais radiculares foram obturados na mesma sessão usando condensação lateral ativa dos cones e os cimentos: Grupo I - Intra Fill; Grupo II - AH Plus; Grupo III - Roeko Seal e Grupo IV - Sistema Resilon/Epiphany. Após 90 dias, os animais foram mortos e os tecidos a serem avaliados foram processados e corados por hematoxilina e eosina. Para análise histopatológica, os seguintes parâmetros foram avaliados: processo inflamatório, reabsorção dos tecidos mineralizados e deposição de tecido mineralizado apical. A análise histopatológica demonstrou que o Intrafill teve resultados menos favoráveis em relação ao reparo apical e periapical comparado aos outros cimentos (p<0,05). AH Plus, Roeko Seal e Epiphany demonstraram resultados similares e satisfatórios (p>0,05). Conclui-se que o AH Plus e os materiais Roeko Seal e Epiphany são boas opções para uso clínico em endodontia.