Influence of sealer type on treatment outcome of teeth with apical periodontitis: a systematic review

Abstract The purpose of this article was to Evaluate the influence of sealer on the outcome of non-surgical endodontic treatment or retreatment of permanent teeth with apical periodontitis (PROSPERO registration: CRD42020205951). Methodology: A systematic review of original clinical studies was carried out following PRISMA guidelines to answer whether the type of sealer used in endodontic treatment or retreatment influences the repair of apical periodontitis determined by clinical and radiographic parameters. Electronic searches were performed in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library database, until May 2023. Gray literature and a hand search of reference lists were also performed. The risk of bias was assessed using Cochrane RoB2 for randomized trials and the Newcastle-Ottawa Scale (NOS) for prospective and retrospective cohort and case-control studies. Results: Among 1046 studies, a total of 819 were selected by title and abstract, resulting in 23 for full-text review. In total, 11 studies met the inclusion criteria (1467 patients/teeth with apical periodontitis). The quality assessment using RoB2 included five randomized control trials, of which four had medium risk and one had a low risk of bias. According to the NOS scale, five studies were classified as low risk and one study was considered as medium risk of bias. The sealer type and obturation techniques varied, and the mean follow-up time was 3.7 years. Most studies used two-dimensional radiographic criteria to assess the treatment outcome sealers and not cements. Eight studies did not find significant differences when comparing cements. The healing rates ranged from 56.7% to 90%. Conclusions: The results of this review support that the current endodontic sealers do not seem to influence the treatment outcome of permanent teeth with apical periodontitis. Although the studies had medium and low risk of bias, the results should be interpreted with caution. More randomized studies of long-term outcomes comparing filling materials are needed to strengthen this claim and allow for a meta-analysis.

Resumo O objetivo deste artigo foi avaliar a influência do cimento no resultado do tratamento ou retratamento endodôntico não cirúrgico de dentes permanentes com periodontite apical (registro PROSPERO: CRD42020205951). Metodologia: Uma revisão sistemática de estudos clínicos originais foi realizada seguindo as diretrizes PRISMA para responder se o tipo de cimento usado no tratamento ou retratamento endodôntico influencia a reparação da periodontite apical determinada por parâmetros clínicos e radiográficos. Pesquisas eletrônicas foram realizadas no PubMed, Embase, Web of Science, Scopus e no banco de dados Cochrane Library, até maio de 2023. A literatura cinza e uma pesquisa manual das listas de referências também foram realizadas. O risco de viés foi avaliado usando Cochrane RoB2 para os estudos randomizados e Newcastle-Ottawa Scale (NOS) para coorte prospectiva e retrospectiva e estudos de caso-controle. Resultados: Entre 1.046 estudos, um total de 819 foram selecionados por título e resumo, resultando em 23 para revisão de texto completo. No total, 11 estudos preencheram os critérios de inclusão (1.467 pacientes/dentes com periodontite apical). A avaliação de qualidade usando RoB2 incluiu cinco estudos randomizados de controle, dos quais quatro tinham risco médio e um tinha baixo risco de viés. De acordo com a escala NOS, cinco estudos foram classificados com baixo risco e um estudo foi considerado com médio risco de viés. O tipo de cimento e as técnicas de obturação variaram, e o tempo médio de acompanhamento foi de 3,7 anos. A maioria dos estudos utilizou critérios radiográficos bidimensionais para avaliar o resultado do tratamento. Oito estudos não encontraram diferenças significativas ao comparar os cimentos. As taxas de reparação variaram de 56,7% a 90%. Conclusões: Os resultados desta revisão suportam que os cimentos endodônticos atuais não parecem influenciar o resultado do tratamento de dentes permanentes com periodontite apical. Embora os estudos tiveram médio e baixo risco de viés, os resultados devem ser interpretados com cautela. Mais estudos randomizados de resultados de longo prazo comparando materiais de obturação são necessários para fortalecer essa afirmação e permitir uma meta-análise.

The effects of heating on the physicochemical properties of tricalcium silicate root canal sealers

Abstract This study evaluated the effect of heating on the physicochemical properties and surface changes of tricalcium silicate sealers. Three tricalcium silicate root canal sealers (Bio-C Sealer, BioRoot-RCS, EndoSequence BC Sealer), and one epoxy resin-based sealer (AH Plus; control) were tested. The effect of heating on setting time (ST) and flowability were assessed according to ANSI/ADA 57 and ISO 6876 standards. Solubility and dimensional change (DC) of the set sealers were evaluated at 24 hours and after 30 days; the pH of the water used in the DC testing was also measured. Tests were repeated with heated sealers in an oven at 100 °C for 1 min. SEM and EDS analysis were performed. Data were analyzed using One-Way ANOVA and Tukey post-hoc tests (α=5%). Heating decreased the ST for AH Plus and EndoSequence (p<0.05). Heating reduced flowability (p<0.05) and increased pH for AH Plus (p<0.05). The solubility of Bio-C (dried specimens) was not in accordance with the ANSI/ADA standard. The solubility of EndoSequence was significantly higher (p<0.05) when it was heated and dried after 30 days. DC of Bio-C (24 h and 30 days), BioRoot-RCS (30 days) and AH Plus (24 h and 30 days) were not in accordance with the standards. SEM and EDS analysis showed significant changes in sealer microstructure after heating. In conclusion, heating decreased the ST and increased the solubility of EndoSequence BC sealer. No significant changes in flowability, DC, and pH were identified for all three tricalcium silicate sealers after heat application. However, all sealers had significant surface changes.

Resumo Este estudo avaliou o efeito do aquecimento nas propriedades físico-químicas e nas alterações superficiais de cimentos de silicato tricálcico. Três cimentos endodônticos de silicato tricálcico (Bio-C Sealer, BioRoot-RCS, EndoSequence BC Sealer) e um cimento à base de resina epóxi (AH Plus) foram testados para avaliar o efeito do aquecimento no tempo de presa (TP) e escoamento de acordo com as normas ANSI/ADA 57 e ISO 6876. A solubilidade e alteração dimensional (AD) dos cimentos foram avaliadas após 24 horas e 30 dias. O pH da água usada no teste de AD também foi medido. Os testes foram repetidos com cimentos aquecidos em um forno a 100 °C por 1 min. Análises em MEV e EDS foram realizadas. Os dados foram analisados pelos testes de ANOVA-1 via e post hoc de Tukey (α=5%). O aquecimento diminuiu o TP para AH Plus e EndoSequence (p<0,05). O aquecimento reduziu o escoamento (p<0,05) e aumentou o pH do AH Plus (p<0,05). A solubilidade do Bio-C (amostras desidratadas) não estava de acordo com o padrão ANSI/ADA. A solubilidade da EndoSequence foi significativamente maior (p<0,05) quando aquecida e desidratada após 30 dias. As AD de Bio-C (24 h e 30 dias), BioRoot-RCS (30 dias) e AH Plus (24 h e 30 dias) não estavam de acordo com as normas ADA e ISO. A análise em MEV e EDS mostrou alterações significativas na estrutura dos cimentos após aquecimento. Em conclusão, o aquecimento diminuiu o TP e aumentou a solubilidade do cimento EndoSequence BC. Não foram identificadas mudanças significativas no escoamento, AD e pH para os cimentos de silicato tricálcico após aquecimento. Porém, todos os cimentos tiveram alterações significativas na superfície.

Efectividad de las Técnicas de Retratamiento Endodóntico en la Remoción de ementos Biocerámicos como Material de Obturación Radicular: Revisión Sistemática

El retratamiento no quirúrgico es la primera opción ante el fracaso del tratamiento endodóntico, por lo que se vuelve importante asegurar el completo retiro del material de relleno del conducto radicular, para mejorar el pronóstico del procedimiento. Los cementos biocerámicos en base a silicatos cálcicos han aparecido en los últimos años, caracterizados principalmente por su bioactividad, lo que adicionalmente se puede traducir en una mayor dificultad para su retiro del conducto radicular. El objetivo de esta revisión es determinar qué técnica de retratamiento es más efectiva en la eliminación de cementos selladores biocerámicos, en base al volumen de material remanente en el conducto radicular, evaluado a través del análisis de imágenes con micro-CT. Se realizó una revisión sistemática mediante la búsqueda de publicaciones en las bases de datos Pubmed, ScienceDirect y SciELO, de los últimos 10 años, en idioma español e inglés. Se incluyeron sólo estudios in vitro de dientes obturados con cemento biocerámico y diferentes técnicas de retratamiento endodóntico, en los que se evalúe la limpieza del conducto post eliminación del relleno mediante micro-CT. De un total de 174 artículos encontrados, 7 fueron seleccionados, analizados y se incluyeron en esta revisión sistemática. Los resultados de los estudios seleccionados no encuentran diferencias significativas en la eliminación de material entre las diferentes técnicas de retratamiento evaluadas. A pesar de la heterogeneidad presente en las metodologías de los artículos analizados, ninguna técnica de retratamiento ni técnicas complementarias lograron dejar completamente limpios los conductos radiculares, por lo que se sugiere realizar nuevos estudios en el futuro que evalúen nuevas técnicas de desobturación radicular.

Non-surgical retreatment is the first option in the case of endodontic treatment failure, so it becomes important to ensure complete removal of the root canal filling material, to improve the prognosis of the procedure. Bioceramic cements based on calcium silicate have appeared in recent years, characterized mainly for their bioactivity, which can additionally translate into greater difficulty in their removal from the root canal. The aim of this review is to determine which retreatment technique is most effective in the removal of bioceramic sealer cements, evaluated through micro-CT image analysis. A systematic review was performed by searching for publications in Pubmed, ScienceDirect and SciELO databases, of the last 10 years in Spanish and English. Only in vitro studies of teeth filled with bioceramic cement and different endodontic retreatment techniques were included, in which the cleaning of the canal after removal of the filling was evaluated by micro- CT. From a total of 174 articles found, 7 were selected, analyzed and included in this systemic review. The results of the included studies did not find significant differences in the removal of material between the different retreatment techniques evaluated. Despite the heterogeneity in the methodologies of the studies, no retreatment technique or complementary techniques were able to completely clean the root canals, it is therefore suggested that new studies be carried out in the future to evaluate new techniques.

Tooth discoloration induced by endodontic sealers and cervical limit: 1-year in vitro evaluation

Abstract This laboratory study aimed to evaluate the influence of endodontic sealer and cervical limit of root filling on the discoloration of root canal treated teeth. Bovine incisors were randomly distributed into six experimental groups and control (n=21/group), according to the endodontic sealer used [AH Plus (AP); MTA Fillapex (MF) and Sealer Plus BC (SPB)] and the cervical limit of root filling [dental cervix (DC) or 2 mm in apical direction (2mm-AD)]. Tooth discoloration (ΔE) was evaluated by a digital spectrophotometer using the CIED2000 method. Color assessments were performed immediately before (baseline), 1 week, 1, 3, 6 months, and 1 year after obturation. Data were analyzed by ANOVA and Tukey's post-hoc tests (α=5%). Teeth filled with the three sealers showed perceptible tooth discoloration (ΔE≥2.7) in 1 week, maintaining similar values over time. There was a significant difference between MF and SPB sealers in the 2mm-AD groups. In addition, 2mm-AD groups promoted significantly lower discoloration than DC groups for AH (3 months) and SPB (1 and 3 months) sealer,s. Teeth filled with AP, MF, and SPB sealers displayed discoloration from 1 week to one year, with differences between MF and SPB sealers. A cervical limit of filling material at 2 mm from the dental cervix seems more advisable, promoting lower crown discoloration.

Resumo O presente estudo laboratorial teve como objetivo avaliar a influência do cimento endodôntico e do limite cervical da obturação radicular na alteração de cor de dentes tratados endodonticamente. Incisivos bovinos foram distribuídos aleatoriamente em seis grupos experimentais e um controle (n=21/grupo), de acordo com o cimento endodôntico utilizado [AH Plus (AP); MTA Fillapex (MF) e Sealer Plus BC (SPB)] e o limite cervical da obturação [Colo dentário (CD) ou 2mm na direção apical (2mm-DA)]. A alteração de cor (ΔE) foi avaliada por um espectofotômetro digital usando o método CIED2000. As avaliações de cor foram realizadas imediatamente antes (baseline), 1 semana, 1, 3, 6 meses e 1 ano após a obturação. Os dados foram analisados pelos testes ANOVA e post-hoc de Tuckey (α=5%). Dentes obturados com os três cimentos apresentaram alteração de cor perceptível (ΔE≥2.7) em 1 semana, mantendo valores semelhantes ao longo do tempo. Houve uma diferença significativa entre os cimentos MF e SPB nos grupos 2mm-DA. Além disso, os grupos 2mm-DA promoveram uma alteração de cor significativamente menor do que o grupos CD para os cimentos AH (3 meses) e SPB (1 e 3 meses). Os dentes obturados com os cimentos AH, MF e SPB apresentaram alteração de cor entre 1 semana a um ano, com diferenças entre os cimentos MF e SPB. O limite cervical do material obturador a 2mm do colo dentário parece mais aconselhável, promovendo menor alteração de cor da coroa dentária.

Análise comparativa das características composicionais, técnicas e comerciais dos cimentos endodônticos obturadores à base de silicato de cálcio / Comparative analysis of compositional, technical and commercial characteristics of calcium silicate-based endodontic root canal sealers

Introdução: os cimentos endodônticos obturadores à base de silicato de cálcio têm sido amplamente utilizados na endodontia, principalmente em razão de suas reconhecidas propriedades bioativas. Como consequência, uma quantidade expressiva de marcas comerciais foi lançada no mercado, dificultando a compreensão do profissional, principalmente no que diz respeito às diferentes composições químicas, apresentações, formas de uso e custo-benefício. Objetivos: o Objetivo deste trabalho foi analisar as diferenças composicionais, técnicas (indicações e apresentação comercial) e comerciais (custo e disponibilidade de venda) dos cimentos endodônticos obturadores à base de silicato de cálcio, disponíveis para uso e comercialização no Brasil. Metodologia: foi realizada uma busca sistemática no site da Anvisa, sendo identificados sete cimentos endodônticos obturadores biocerâmicos para uso no Brasil. As bulas dos produtos foram analisadas para verificação de composição, apresentação e indicação de uso. Sites especializados foram consultados para verificação de preço dos produtos. Resultados: observou-se que a composição química varia bastante, a depender do fabricante, sendo os silicatos tricálcico e dicálcico os componentes mais frequentes. A maioria dos cimentos é apresentada comercialmente pronta para uso, e possui óxido de zircônio como agente radiopacificador. A venda através de sites especializados ainda é restrita a alguns produtos, e o custo varia de acordo com a quantidade de material por embalagem. Conclusão: este trabalho apresentou as características composicionais, técnicas e comerciais de sete cimentos endodônticos obturadores à base de silicato de cálcio registrados na ANVISA e autorizados para uso no Brasil.

Introduction: calcium silicate-based endodontic sealers have been widely used in endodontics, mainly because of their recognized bioactive properties. As a result, a significant number of commercial brands were launched on the market, making it difficult for professionals their comprehension, especially with regard to different chemical compositions, presentations, forms of use and cost-effectiveness. Objective: the Objective of this work was to analyze the compositional, technical (indications and commercial presentation) and commercial (cost and availability) differences of calcium silicate-based endodontic sealers, available for use and commercialization in Brazil. Methodology: a systematic search was carried out on the Anvisa website, and seven bioceramic endodontic sealers for use in Brazil were identified. Product leaflets were analyzed to verify composition, presentation and indication of use. Specialized websites were consulted to verify the price of the products. Results: it was observed that the chemical composition varies a lot, depending on the manufacturer, with tricalcium and dicalcium silicates being the most frequent components. Most sealers are commercially available ready-to-use, and have zirconium oxide as a radiopacifying agent. The sale through specialized websites is still restricted to some products, and the cost varies according to the amount of material per package. Conclusion: this work presented the compositional, technical and commercial characteristics of seven calcium silicate-based endodontic sealers registered at ANVISA and authorized for use in Brazil.

Does the ultrasonic activation of calcium silicate-based sealers affect their physicochemical properties?

Abstract This study aimed to evaluate the influence of ultrasonic activation (UA) on the physicochemical properties of hydraulic calcium silicate-based sealers. Nine experimental conditions were created based on the hydraulic calcium silicate-based sealers (Bio-C Sealer, Sealer Plus BC and Bio Root RCS) and the ultrasonic activation (no activation [NA], 10 seconds, and 20 seconds). Then the experimental groups were BC-NA, BC-10, BC-20, SPBC-NA, SPBC-10, SPBC-20, BR-NA, BR-10, and BR-20. Activation was performed with an ultrasonic insert 20/.01. The mold for the physicochemical analysis was filled and evaluated according to the ANSI/ADA specification nº. 57: initial and final setting time, flow, radiopacity and solubility. Tests were also performed to evaluate pH and calcium ion release with experimental periods of 1, 24, 72, and 168 hours with a pH meter and colorimetric spectrophotometer. Data were analyzed by one-way analysis of variance and post-hoc Tukey tests. The significance level was set at 5%. The time of UA progressively delayed the initial setting time for all hydraulic calcium silicate-based sealers (p < 0.05). Twenty seconds of UA increased the mean flow values of Sealer Plus BC and Bio-C Sealer compared to NA (p < 0.05). UA did not influence the radiopacity and solubility of the tested sealers (p > 0.05). UA for 20 seconds enhanced the pH levels and the calcium ion release of Sealer Plus BC and Bio-C Sealer at 168h (p < 0.05). UA for twenty seconds interferes with some physicochemical properties of hydraulic calcium silicate-based sealers.

Resumo Este estudo teve como objetivo avaliar a influência da ativação ultrassônica nas propriedades físico-químicas de cimentos de silicato de cálcio. Nove condições experimentais foram criadas com base nos cimentos de silicato de cálcio (Bio-C Sealer, Sealer Plus BC e Bio Root RCS) e na ativação ultrassônica (sem ativação [SA], 10 segundos e 20 segundos). Os grupos experimentais foram BC-SA, BC-10, BC-20, SPBC-SA, SPBC-10, SPBC-20, BR-SA, BR-10 e BR-20. A ativação foi realizada com um inserto ultrassônico 20/.01. O molde para a análise físico-química foi preenchido e avaliado de acordo com a especificação ANSI/ADA nº. 57: tempo de presa inicial e final, escoamento, radiopacidade e solubilidade. Também foram realizados testes para avaliação de pH e liberação de íons cálcio com períodos experimentais de 1, 24, 72 e 168 horas com pHmetro e espectrofotômetro colorimétrico. Os dados foram analisados por análise de variância one-way e testes post-hoc de Tukey. O nível de significância foi estabelecido em 5%. O tempo de AU aumentou progressivamente o tempo de presa inicial para todos os cimentos de silicato de cálcio (p < 0,05). Vinte segundos de AU aumentaram os valores médios de escoamento de Sealer Plus BC e Bio-C Sealer em comparação com SA (P < 0,05). A AU não influenciou a radiopacidade e a solubilidade dos cimentos testados (P > 0,05). AU por 20 segundos aumentou os níveis de pH e a liberação de íons cálcio de Sealer Plus BC e Bio-C Sealer em 168h (P < 0,05). AU por vinte segundos interfere em algumas propriedades físico-químicas dos cimentos de silicato de cálcio.

Comparative Evaluation of Push-Out Bond Strength of AH-Plus, MTA-Fillapex and Epiphany SE Root Canal Sealers: An Ex?Vivo Study

Background: A successful root canal (RC) treatment depends upon creation of a fluid impervious seal that is commonly built by using a RC sealer along with gutta?percha. The bond strength of the RC sealer is a hallmark as it will minimize the risk of treatment failure by reducing the possibility of filling detachment from dentin. Aim: To evaluate and compare the push?out bond strength of AH?Plus and MTA?Fillapex with Gutta?Percha and Epiphany Self Etch/Resilon system using the Universal Testing Machine. Materials and Method: About 60 mandibular premolars with single canals were prepared apically with Hyflex CM files upto size #30. Out of total, 20 teeth were obturated with AH?Plus/GP (group 1), 20 with MTA?Fillapex/GP (group 2), and other 20 with Epiphany Self Etch/Resilon system (group 3). Teeth were sectioned into three slices of 2 mm each and were subjected to Universal Testing Machine. Statistical Analysis: The data obtained were tabulated and statistically evaluated using SPSS version 21.0 statistical analysis software (IBM, Chicago, Illinois, USA). Results: The mean push?out bond strength was highest for AH–Plus (14.32 MPa) followed by MTA?Fillapex (12.18 MPa) and then Epiphany SE (8.44 MPa). The results were statistically significant. Conclusion: Significantly, higher push out bond strength was displayed by AH?Plus sealer than MTA?Fillapex and least being Epiphany SE sealer. The push out bond strength was significantly highest at apical third and lowest at coronal third

Influence of endodontic sealers artifacts in the detection of vertical root fractures

Abstract The aim of this study was to compare the influence of endodontic sealers artifacts on the detection of vertical root fracture in cone beam computed tomography (CBCT). Premolars and central incisors were assigned into five different groups: Control, Pulp Canal Sealer, AH Plus, Sealer 26, and BC Sealer (n= 10, per group). VRFs were mechanically induced and the teeth were inserted into an image phantom. Subsequently, CBCT (Cranex 3Dx, Soredex, Tuusula, Finland) images were obtained and two observers were asked separately to identify root fracture, by visual analysis. For both premolar and central incisors, kappa coefficients of intraobserver agreement varied from good to excellent (K: 80% - 87%), and the values for interobserver agreement varied from fair to moderate (K: 30% - 35%). As follows, the area under the curve (AUC) of receiver operating characteristic (ROC) values for VRFs highlighted that the use of BC sealer reduced the observers' ability to discriminate VRFs relative to other sealers. Moreover, sensitivity values for premolars teeth ranged from 20% to 60%, and specificity ranged from 60% to 100%; while sensitivity values for central incisors ranged from 30% to 70%, and specificity ranged from 70% to 100%. In conclusion, the low sensitivity values, mainly for premolars, demonstrated the difficulty in VRF diagnosis. Furthermore, BC Sealer induced significantly more imaging artifacts than other sealers. These results highlighting that endodontic sealers may interfere with the diagnosis of VRFs.

Resumo O objetivo deste estudo foi comparar a influência dos artefatos de cimentos endodônticos na detecção de fratura radicular vertical (FRV) em tomografia computadorizada de feixe cônico (TCFC). Pré-molares e incisivos centrais foram divididos em cinco grupos diferentes: Controle, Pulp Canal Sealer, AH Plus, Sealer 26 e BC Sealer (n = 10, por grupo). As FRVs foram induzidas mecanicamente e os dentes inseridos em uma réplica da mandibula humana. Posteriormente, imagens de TCFC (Cranex 3Dx, Soredex, Tuusula, Finlândia) foram obtidas e dois observadores foram solicitados a identificar fratura radicular separadamente, o critério utilizado foi a análise visual. Tanto para pré-molares quanto para incisivos centrais, os coeficientes kappa de concordância intraobservador variaram de bom a excelente (K: 80% - 87%), e os valores de concordância interobservador variaram de regular a moderado (K: 30% - 35%). A seguir, a área sob a curva (AUC) dos valores da característica de operação do receptor (ROC) para FRVs destacou que o uso do cimento BC Sealer reduziu a capacidade dos observadores de discriminar FRVs em relação a outros cimentos endodônticos. Além disso, os valores de sensibilidade para pré-molares variaram de 20% a 60%, e a especificidade variou de 60% a 100%; enquanto os valores de sensibilidade para incisivos centrais variaram de 30% a 70%, e a especificidade variou de 70% a 100%. Em conclusão, os baixos valores de sensibilidade, principalmente para pré-molares, demonstraram uma dificuldade no diagnóstico de FRV. Além disso, o BC Sealer induziu significativamente mais artefatos de imagem do que outros cimentos. Esses resultados evidenciam que os cimentos endodônticos podem interferir no diagnóstico das FRVs.

In Vitro Cytotoxicity Analysis of Bioceramic Root Canal Sealers on Human Gingival Fibroblast Cells

ABSTRACT@#This study evaluated the cytotoxicity of four bioceramic root canal sealers (bioceramic sealers): GuttaFlow Bioseal (GB), MTA Fillapex, CeraSeal Bioceramic root canal sealer (CS), and iRoot SP root canal sealer (iRSP). The viability of human gingival fibroblast (HGF) cells was used to evaluate the cytotoxicity of these bioceramic sealers. HGF cells were cultured and exposed to bioceramic sealer extracts for 24 hours, 48 hours and 72 hours at 37°C in an incubator humidified with 5% CO2. The 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide or MTT assay was conducted to determine cell viability at each incubation period and compared among all bioceramic sealers. The Kruskal-Wallis test revealed statistically significant differences between the positive control group and MTA Fillapex, MTA Fillapex and GB, and between GB and iRSP with p < 0.05. However, no statistical differences were found in cell viability for each material across all the incubation periods. GB was the least cytotoxic bioceramic sealer with cell viability exceeding 90% throughout the 72-hour incubation followed by CS, iRSP, and MTA Fillapex with non-cytotoxicity after 72-hour incubation, mild cytotoxicity after 72-hour incubation, and mild cytotoxicity after 72-hour incubation, respectively. However, iRSP showed moderate cytotoxicity, and MTA Fillapex was severely cytotoxic (< 30% cell viability) after 24-hour incubation.

An Antimicrobial Activity Assessment of Three Endodontic Sealers on Enterococcus faecalis, Candida albicans, and Staphylococcus aureus by a Direct Contact Test: An In Vitro Study

Introduction: For a successful endodontic treatment, antimicrobial property of endodontic filing is mandatory. Hence, the aimof this in vitro study was to assess the antibacterial efficacy of three endodontic sealers on Enterococcus faecalis, Candidaalbicans, and Staphylococcus aureus by direct contact test (DCT).Materials and Methods: The antimicrobial efficacy of three different sealers, AH Plus, mineral trioxide aggregate (MTA)Fillapex, and Endosequence BC was tested against E. faecalis ATCC 29212, C. albicans ATCC 10231 and S. aureus ATCC25923 by DCT. Freshly mixed sealers were placed in flat bottom test tubes incubated at 37°C. Thereafter, 10 μL of suspensionwas drawn and spread over cultural plates to determine the colony count using a digital colony counter. Readings were takenat 1 h (fresh specimen), then at 24 h (after setting). The results were tabulated and statistical analysis was done using oneway ANOVA and Tukey HSD test.Results: DCT showed a significant decrease in microbial count in AH Plus, MTA Fillapex, and Endoseq BC at both the timeintervals. Group 3 (Endosequence BC) showed minimum microbial count followed by Group 2 (MTA Fillapex) and maximumfor Group 1 (AH Plus) for both the time intervals (1 h and 24 h).Conclusion: Endosequence BC showed maximum antimicrobial efficacy against all the tested microorganisms for both thetime intervals, followed by MTA Fillapex and AH Plus.

Functions of Root Canal Sealers- A Review.

Endodontic therapy is a treatment for the diseased pulp of a tooth. It will result in the removal of infection and the preservation from further microbial invasion. The principle constituents of an endodontic filling are- a core material “gutta percha” and “endodontic sealers”. All the current obturating techniques make use of the sealer to augment the seal endodontic filling material. It fills the space between canals. Endodontic sealer fills the space between the material as well as root dentin. Different types of sealers are available (resin sealers, ZOE sealers, mineral trioxide aggregate sealer, bio-ceramic containing sealers, glass ionomer containing sealer, calcium hydroxide containing sealer). Root canal sealers have different functions- antibacterial, lubricant for core material, to increase radio-opacity of core or as a filling material. Different types of microorganisms as well as microbial products cause pulpal as well as peri-radicular diseases. Microorganisms persist in the canal due to poor irrigation. We wanted to evaluate the various functions of different endodontic sealers. The perfect apical seal obtained by use of sealers is one which is stable and non-irritating in nature. It should also give us a smoother seal. Biocompatibility of root canal sealer has importance as it is placed directly in contact with the living tissue. Response of dental tissue help in the final outcome of successful endodontic treatment. Bond strength between canal walls exhibit through micromechanical retention. It helps in preventing the dislodgement of filling material. It ultimately helps in maintenance of interface between filling material and sealers. Push out test is the process to assess bond strength among filling material and sealers. Endodontic sealer has sufficient amount of radiopacity so that it can be clearly visualised among material and adjacent anatomical structures.

Effects of MTAD on the bond strength of bioceramic root canal sealer

Aim: The aim of this in-vitro study was to investigate the effects of MTAD (a mixture of doxycycline, citric acid, and a detergent) on the bond strength of AH Plus (Dentsply DeTrey GmbH, Konstanz, Germany) and EndoSequence BC sealer (Brasseler USA, Savannah, Georgia, USA). Materials & Methods: Eighty-four decoronated single-rooted human incisor teeth were prepared with Reciproc R25 files (VDW, Munich, Germany), and the canal was irrigated with 5 mL 1.3% NaOCl. The roots were randomly assigned to four groups (n = 21), according to the final irrigation protocol and sealer selection: Group 1: distilled water-AH Plus; Group 2: distilled water-EndoSequence BC; Group 3: MTAD-AH Plus; Group 4: MTAD-EndoSequence BC. For the final flush, in Groups 1 and 2, the root canals were irrigated with 5mL of distilled water; in Groups 3 and 4, 5mL of MTAD was used for 1 minute. After root canal obturation, specimens was embedded in an acrylic block and sectioned horizontally at three levels (coronal, middle, apical). Bond strength of sealer to root canal dentin was assessed via push-out test using a universal testing machine. Results: There were no significant differences among the groups in coronal and apical thirds. In the middle root third, Group 4 showed significantly lower push-out bond strength values than Group 2 (p=0.023). No significant difference was found between the two root canal sealers. Conclusions: Overall, MTAD final irrigation caused lower push-out bond strenght values than distilled water with no significancy.

Resistencia a la Fractura de Dientes Tratados Endodónticamente Obturados con Selladores Biocerámicos Versus Selladores Resinosos. Revisión Sistemática / Fracture Resistance of Endodontically Treated Teeth Obturated with Bioceramic Sealers and Epoxy Resin-Based Sealers. A Systematic Review

RESUMEN: El objetivo de este estudio fue determinar mediante la revisión de la literatura científica disponible cuál es el tipo de cemento sellador que proporciona mayor resistencia a la fractura en dientes tratados endodónticamente, los cementos a base de biocerámicos o los en base a resina epóxica. Se realizó una revisión sistemática de acuerdo a las bases de los estamentos de PRISMA, en las bases de datos Medline, SciELO, Trip Database, LILACS, Web of Science, Cochrane. Se realizó la búsqueda a 10 años y se incluyeron sólo estudios in vitro. Se encontraron 202 artículos, luego se eliminaron los artículos duplicados y se excluyeron los estudios no atingentes por título y resúmenes, quedando ocho artículos que se revisaron a texto completo. En esta etapa se excluyeron dos estudios. Un total seis estudios fueron incluidos en esta revisión. De estos, ninguno encontró diferencia significativas entre cementos selladores a base de biocerámicos y a base de resina epóxica, en cuanto a resistencia a la fractura de los dientes tratados endodónticamente. Sin embargo, en 4 estudios los valores más altos encontrados de resistencia a la fractura estuvieron dados por los selladores en base a resina epóxica. Los artículos seleccionados, teniendo en consideración las limitaciones propias de los estudios in vitro, concluyen que en cuanto a resistencia a la fractura no hay diferencias significativas entre el uso de cementos selladores a base de biocerámicos y cementos selladores a base de resina epóxica en la obturación radicular de dientes tratados endodónticamente.

ABSTRACT: The objective of this study was to determine through the review of scientific literature, the type of sealer that provides the greatest resistance to fracture in endodontically treated teeth. Bioceramic sealer or epoxy resin based sealers were considered for this analysis. A systematic review was performed according to PRISMA, in the databases Medline, SciELO, Trip Database, LILACS, Web of Science, Cochrane. The search was carried out over the last 10 years, and only in vitro studies were included; 202 articles were found and subsequently, duplicate articles were eliminated, non-inferential studies by title and abstracts were excluded, leaving eight articles that were revised to full text. In this stage, two studies were excluded. In total, six studies were included in this review. Of these, none found significant difference between sealer cements based on bioceramics and based on epoxy resin, in terms of resistance to fracture of endodontically treated teeth. However, in 4 studies the highest found values of fracture resistance were given by sealers based on epoxy resin. Taking into account the limitations inherent to in vitro studies, this review concludes that in terms of fracture resistance, there are no significant differences between the use of sealer based on bioceramics and the based on epoxy resin in the root canal obturation.

Avaliação in vitro da influência de cimentos endodônticos na resistência de união sobre estrutura dentinária da câmara pulpar de dentes restaurados imediatamente e mediatamente após obturação / In vitro evaluation of the influence of endodontic cements on bond strength on the dentin structure of the pulp chamber of teeth restored immediately and immediately after filling

Este estudo teve por finalidade avaliar a influência dos cimentos endodônticos com um protocolo de irrigação na resistência de união sobre a estrutura dentinária das paredes da câmara pulpar de dentes bovinos restaurados imediatamente e após 7 dias do tratamento endodôntico. Foram avaliados os cimentos endodônticos: Cimento à base de resina epoxy (AH Plus ­ Dentsply, DeTrey, Konstanz- Alemanha) e Cimento de óxido de zinco e eugenol (Endofill ­ Dentsply Ind.com. LTDA ­ Brasil). Para a realização das restaurações foi utilizado o sistema adesivo Single Bond 2® (3M/ESPE) e a resina composta Z 350TM (3M/ESPE). 60 faces vestibulares da câmara pulpar de dentes bovinos foram distribuídos aleatoriamente em 4 grupos experimentais (G1-AHPlus Imediato; G2-AHPlus Mediato; G3-OZE Imediato; G4-OZE Mediato) e 2 controles (G5- NaOCl + EDTA Imediato e G6-NaOCl + EDTA Mediato). O protocolo de irrigação endodôntica deu-se através da imersão dos espécimes em solução de hipoclorito de sódio a 2.5% por 30 minutos e em EDTA 17% por 3 minutos. Os cimentos testados estiveram em contato com a parede dentinária pelo tempo de presa inicial, seguido de limpeza com algodão embebido em álcool 70% por 1 minuto. Os grupos experimentais de restauração mediata foram mantidos em estufa a 37ºC por 7 dias. Após o corte e a obtenção dos palitos de +/-1,0 mm² foi aplicado o teste de microtração na Máquina de Ensaios Universal e, em seguida, observados em microscópio óptico para classificação da fratura. Os valores da resistência de união foram submetidos ao teste não-paramétrico Wilcoxon-Mann-Whitney comparando dois a dois grupos a um nível de significância de 5%. Os resultados mostraram que o grupo G5 obteve menor valor de resistência de união, com diferença estatisticamente significativa (p<0,05) para os demais. O padrão de fratura mais observado nos grupos foi a coesiva em camada híbrida. Conclui-se que a associação NaOCl + EDTA diminui a resistência de união nas restaurações imediatas e que os cimentos endodônticos não alteraram a resistência de união nos períodos testados (AU).

This study aimed to evaluate the influence of endodontic sealer with an irrigation protocol on the bond strength on the dentinal structure of the pulp chamber walls of bovine teeth restored immediately and after 7 days of endodontic treatment. Endodontic sealer were evaluated: epoxy resin-based sealer (AH Plus - Dentsply, DeTrey, Konstanz- Germany) and zinc oxide and eugenol sealer (Endofill - Dentsply Ind.com. LTDA - Brazil). To perform the restorations, the Single Bond 2® adhesive system (3M / ESPE) and the composite resin Z 350TM (3M / ESPE) were used. 60 vestibular faces of the pulp chamber of bovine teeth were randomly assigned to 4 experimental groups (G1-AHPlus Immediate; G2-AHPlus Mediato; G3-OZE Immediate; G4-OZE Mediato) and 2 controls (G5- NaOCl + EDTA Immediate and G6- NaOCl + EDTA Mediato). The endodontic irrigation protocol was carried out by immersing the specimens in 2.5% sodium hypochlorite solution for 30 minutes and in 17% EDTA for 3 minutes. The tested sealers were in contact with the dentin wall for the initial setting time, followed by cleaning with cotton soaked in 70% alcohol for 1 minute. The experimental groups of mediated restoration were kept in an oven at 37ºC for 7 days. After cutting and obtaining the +/- 1.0 mm² toothpicks, the microtensile test was applied to the Universal Testing Machine and then observed under an optical microscope to classify the fracture. The bond strength values were subjected to the non-parametric Wilcoxon-Mann-Whitney test comparing two to two groups at a significance level of 5%. The results showed that the G5 group had a lower bond strength value, with a statistically significant difference (p <0.05) for the others. The most observed fracture pattern in the groups was cohesive in a hybrid layer. It is concluded that the association NaOCl + EDTA decreases the bond strength in immediate restorations and that endodontic sealer did not change the bond strength in the tested periods (AU).

Evaluation of physicochemical properties of new calcium silicate-based sealer

Abstract This study aimed to evaluate the physicochemical properties of a calcium silicate-based sealer (Sealer Plus BC; MK Life, Porto Alegre, Brazil) compared with an epoxy-resin sealer (AH Plus; Dentsply DeTrey GmbH, Konstanz, Germany). Initial and final setting time was assessed based on ISO 6876:2012 and ASTM C266:03. Calcium ion release and pH were evaluated by filling polyethylene tubes with sealers and then immersing them in 10 mL of deionized water. Following experimental periods of 1, 24, 72 and 168 hours, the samples were measured regarding pH and calcium ion release with a pH meter and a colorimetric spectrophotometer, respectively. The flow was examined based on ISO 6876:2012. Rings of 10 mm in diameter with 1 mm thickness were prepared to analyze the radiopacity (ISO 6876:2012 and ADA n.57) and solubility (ISO 6876:2012). The data were analyzed by variance analysis, Student-T and Tukey tests (p<0.05). The calcium ion release and pH values were significantly higher for the Sealer Plus BC compared with the AH Plus (p<0.05). Lower setting time, flow and radiopacity were observed for the bioceramic sealer than for AH Plus (p<0.05). Sealer Plus BC exhibited higher solubility compared with AH Plus (p<0.05). Sealer Plus BC showed physicochemical properties as setting time, pH, calcium release, flow, and radiopacity following the required standards, but higher solubility than the minimum values required by ISO 6876:2012.

Resumo Este estudo teve por objetivo avaliar as propriedades físico-químicas de um cimento à base de silicato de cálcio (Sealer Plus BC MK Life, Porto Alegre, Brasil) e compará-las a um cimento à base de resina epóxica (AH Plus, Dentsply DeTrey GmbH, Konstanz, Alemanha). Tempo de presa inicial e final foram avaliados com base na ISO 6876:2012 e ASTM C266:03. Liberação de íons cálcio e pH foram avaliados após o preenchimento de tubos de polietileno com os cimentos e imersão em 10 mL de água deionizada. Após os tempos experimentais de 1,24,72 e 168 horas, os valores de pH e liberação de íons cálcio foram mensurados utilizando um medidor de pH e um espectofotômetro colorimétrico, respectivamente. Escoamento foi avaliado com base na ISO 6876:2012. Moldes de 10 mm de diâmetro e 1 mm de espessura foram preparados para análise de radiopacidade (ISO 6876:2012 e ADA n.57), solubilidade (ISO 6876:2012). Os dados foram analisados por análise de variância, teste T de Student e teste de Tukey (p<0,05). A liberação de íons cálcio e os valores de pH foram significativamente maiores para o Sealer Plus BC em comparação com o AH Plus (p<0,05). Menores valores de tempo de presa, escoamento e radiopacidade foram observados para o cimento biocerâmico quando comparados com o AH Plus (p<0,05). Sealer Plus BC apresentou propriedades físico-químicas de tempo de presa, pH, liberação de íons cálcio, escoamento, radiopacidade de acordo com as normas exigidas, porém maior solubilidade que aquelas previstas pela ISO 6876:2012.

Efeito do hipoclorito de cálcio na resistência de adesão do cimento obturador AH Plus à dentina / Effect of calcium hypochlorite on the bond strength of the AH Plus sealer to dentin

Objetivo: avaliar o efeito do uso de hipoclorito de cálcio (Ca(OCl)2) como irrigante na resistência de adesão do cimento AH Plus (De Trey-Dentsply, Konstanz, Alemanha) à dentina pelo teste de micro push-out. Materiais e método: trinta e três dentes humanos monorradiculares foram seccionados transversalmente na junção amelocementária e divididos em três grupos: hipoclorito de sódio (NaOCl) 2,5%, hipoclorito de cálcio 2,5% e soro fisiológico. Os canais foram preparados, irrigados ao final com EDTA 17% e obturados com cones de guta percha e cimento AH Plus. Após armazenagem por 7 dias, em 100% de umidade e a 37°C, os dentes foram seccionados transversalmente ao longo do eixo da raiz. Foram obtidas três fatias de cada dente (n=33), que foram submetidas ao ensaio de push-out. O tipo de falha foi analisado por fractografia e classificado em falha adesiva, coesiva ou mista. Os valores de resistência de união foram analisados pelo teste de Kruskal-Wallis, com nível de significância de 95%. Resultados: o grupo Ca(OCl)2 2,5% apresentou a menor média de resistência de adesão, diferindo estatisticamente do NaOCl e do soro fisiológico (p<0,05). Não houve diferença estatística entre os grupos irrigados com soro e NaOCl (p>0,05). Conclusões: a falha predominante em todos os grupos foi a do tipo adesiva. O Ca(OCl)2 2,5% teve um efeito negativo sobre a força de adesão do AH Plus à dentina radicular quando comparado ao NaOCl 2,5%. (AU)

Objective: to evaluate the effect of calcium hypochlorite (Ca(OCl)2) as an irrigant on the bond strength of the AH Plus sealer (De Trey-Dentsply, Konstanz, Germany) to dentin, using the micro push-out test. Materials and method: thirty-three single-rooted human teeth were cross-sectioned on the cementoenamel junction and divided into three groups: 2.5% sodium hypochlorite (Na- OCl), 2.5% calcium hypochlorite, and saline solution. The canals were prepared, irrigated with 17% EDTA at the end, and filled with gutta-percha cones and AH Plus sealer. After being stored for seven days at 100% humidity and 37ºC, the teeth were cross-sectioned along the root axis. Three slices of each tooth (n=33) were obtained and subjected to the push-out test. Failure mode was analyzed by fractography and classified as adhesive, cohesive, or mixed. Bond strength values were analyzed by the Kruskall-Wallis test at 95% significance level. Results: the 2.5% Ca(OCl)2 group showed the lowest bond strength mean, differing statistically from 2.5% NaOCl and saline solution (p<0.05). There was no statistical difference between the groups irrigated with saline solution and NaOCl (p>0.05). Conclusion: the adhesive failure was predominant in all groups. The 2.5% Ca(OCl)2 had a negative effect on the bond strength of AH Plus to the root dentin when compared to 2.5% NaOCl. (AU)

Obturación del sistema de conductos radiculares: revisión de la literatura / Root canal system obturation: a review of the literature

Con el paso de los años, diferentes conceptos atribuidos a temáticas del área de la endodoncia sufren modificaciones. Una de estas etapas es la obturación del sistema de conductos radiculares, este procedimiento sumamente minucioso y crítico en la obtención de un resultado exitoso ha tenido en los últimos años importantes aportaciones en términos de aparición de nuevos materiales y técnicas dentro del campo de la endodoncia. La presente revisión de literatura retoma aspectos básicos que junto al más reciente conocimiento sobre obturación endodóncica permitirán al practicante de la endodoncia enfatizar aspectos de la última etapa operatoria del tratamiento de conductos, con el objetivo de contar con diferentes alternativas de información que le permitan actualizar sus conocimientos en el área de la endodoncia (AU)

Over the years, different thematic concepts attributed to the endodontics are modified. One such step is the sealing of the root canal system, this procedure extremely thorough and critical in obtaining a successful result, it has had in recent years important contributions in terms of new materials and techniques in the field of endodontic. This literature review basic aspects resumed by the latest knowledge about endodontic filling, allow the practitioner endodontics, emphasizing aspects of the last operative stage of root canal, aiming to have alternatives that allow them information update their knowledge on the area of endodontics (AU)

Improved sealing ability promoted by calcium silicate-based root canal sealers

Aim: This study investigated the sealing ability produced by AH Plus (Dentsply DeTrey, Konstaz, Germany), EndoSequence BC sealer (Brasseler USA, Savannah, GA, USA), GuttaFlow (Coltène/Whaledent, Altstätten, France) and MTA Fillapex (Angelus, Londrina, Brazil). Methdos: A total of forty-six single-root human canines were prepared and randomly divided into four experimental groups (n=10): MTA Fillapex, EndoSequence BC Sealer, AH Plus or GuttaFlow. Teeth with intact crowns served as negative controls (n=3) and teeth filled with only gutta-percha served as positive controls (n=3). Teeth were mounted in a two-chamber apparatus and exposed to Enterococcus faecalis. The number of days over a 60-days period was recorded for the appearance of turbidity in the lower chamber. Kaplan-Meier method was used to estimate the survival curves. The nonparametric log-rank test was used to compare the survival curves using a significance level of 0.05. Results: The results at the end of the observation time were further analyzed by chi-square testing. All positive controls leaked within 24 h, whereas none of the negative controls leaked after 60 days. EndoSequence BC Sealer and MTA Fillapex had significant less bacterial leakage (P<0.05) than the other tested sealers. No significant difference between AH Plus and GuttaFlow was observed (P>0.05). Conclusion: In conclusion, calcium-silicate based root canal sealers promoted improved sealing ability when compared to other endodontic sealers

Evaluación de la citotoxicidad de tres cementos selladores endodóncicos utilizados en cirugía periapical: estudio in vitro / Cytotoxicity assessment of three endodontic sealing cements used in periapical surgery. In vitro study

Introducción: Existen diversos materiales de retroobturación, pero poco se sabe de su toxicidad sobre fibroblastos gingivales. Objetivo: Evaluar la citotoxicidad de tres materiales de retroobturación sobre fibroblastos gingivales humanos y fibroblastos de la línea L929. Material y métodos: Los medios condicionados de los materiales de retroobturación EndoSequence® BC RRMTM (ERRM), trióxido mineral agregado MTA Angelus® blanco (MTA) y material de restauración intermedia (IRM®) se obtuvieron en fresco, al tiempo de fraguado, y después de 1, 24 y 72 horas del tiempo de fraguado. La morfología celular fue evaluada por microscopia de luz y la viabilidad celular fue evaluada a través de la actividad metabólica mitocondrial con 3-(4,5-dimetiltiazol-2-il)-2,5-difenil bromuro de tetrazolio (MTT). El análisis estadístico se realizó por ANOVA. Resultados: El material ERRM no mostró efectos citotóxicos sobre los fibroblastos. Sin embargo, el MTA y el IRM® mostraron citotoxicidad moderada y alta, respectivamente. Esto revela que el MTA y el IRM® no son completamente inocuos. Conclusión: Los materiales biocerámicos como el ERRM pueden ser considerados los materiales de retroobturación más biocompatibles.

Introduction: Presently there are many retrofilling materials in themarket, nevertheless, little is known about their toxicity on gingival fibroblasts. Objective: To assess cytotoxicity of three materials tohuman gingival fibroblasts and L929 mouse fibroblasts cell line. Material and methods: EndoSequence® BC RRMTM (ERRM; rootrepair material), white MTA Angelus® (MTA) and intermediaterestoration material (IRM®) conditioned media were obtained whenmaterials were freshly mixed, at setting time and after 1, 24 and72 hours of setting time. Cell morphology was assessed with lightmicroscopy and cell viability was assessed through mitochondrialmetabolic activity with 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide (MTT). Statistical analysis was conducted withANOVA. Results: We found that ERRM material did not exhibitcytotoxic effects on used fibroblast, nevertheless, MTA and IRM® respectively exhibited moderate and severe cytotoxicity, thusindicating the materials were not fully harmless. Conclusion: Bioceramic cements like ERRM could be considered the mostcompatible retrofilling-materials.

Capacidade de selamento e penetração intratubular do MTA Fillapex e do AH Plus em dentes humanos / Sealing ability and penetration intratubular MTA Fillapex and AH Plus in human teeth

Introdução: O MTA é um importante material de uso na odontologia, com boas propriedades biológicas. As respostas experimentais aos cimentos endodônticos que utilizam este composto no selamento e preenchimento do sistema de canais radiculares, aliados a uma boa instrumentação e limpeza, podem ser importantes no processo de reparo periapical. Objetivo: Avaliar in vitro a profundidade de penetração de dois diferentes cimentos endodônticos nos túbulos dentinários e a infiltração bacteriana em obturações com os cimentos AH Plus e MTA Fillapex. Material e método: 34 pré-molares monorradiculados humanos foram selecionados, suas coroas removidas e suas raízes padronizadas em 16 mm, a seguir foram, então, divididos aleatoriamente em dois grupos de 15 espécimes e instrumentados com o sistema rotatório Pro Taper. Um grupo foi obturado com o cimento AH Plus (Grupo AH) e outro com MTA Fillapex (Grupo FI). Nestes grupos, avaliaram-se a infiltração coronária de bactérias para Enterococcus Faecalis e a profundidade de penetração nos túbulos dentinários. Para a aferição da infiltração bacteriana, usou-se o teste exato de Fisher; para a penetração intratubular, usou-se o teste-t. Resultado: Para a infiltração bacteriana, considerando o número de amostras infiltradas para AH e MTA Fillapex, houve diferença estatística significativa (p=0,0341). Na avaliação da penetração intratubular, a diferença entre os dois grupos de cimentos foi considerada estatisticamente significativa (p=0,0006). Conclusão: Ambos os cimentos apresentaram infiltração bacteriana, sendo que o MTA Fillapex teve pior desempenho. A capacidade de penetração nos túbulos dentinários do AH Plus foi significativamente maior que a do MTA Fillapex.

Introduction: The MTA is an important use in dentistry material with good biological properties. The experimental responses to sealers using this compound in the sealing and filling of the root canal system, combined with a good instrumentation and cleaning, may be important in the periapical healing process. Objective: To evaluate in vitro penetration depth of two different sealers in dentinal tubules and bacterial infiltration in fillings with AH Plus and MTA Fillapex cements. Material and method: 34 premolars human monorradiculados were selected, their removed and their standardized root crowns in 16mm, after then randomly divided into two groups of 15 specimens, and instrumented with rotary system Pro Taper. One group was obturated with cement AH Plus (group HA) and another MTA Fillapex (FI Group). These groups are evaluated for coronary infiltration of bacteria Enterococcus faecalis and the depth of penetration in the dentinal tubules. For the measurement of bacterial infiltration used Fisher's exact test for Intratubular penetration we used the t-test. Result: For bacterial infiltration, considering the number of infiltrated samples AH and MTA Fillapex, there was a statistically significant difference (p = 0.0341). In the evaluation of intratubular penetration, the difference between the two groups of cement was statistically significant (p = 0.0006). Conclusion: Both cements showed bacterial infiltration and the MTA Fillapex had worse performance, capabilities to enter the dentinal tubules AH Plus was significantly higher than the MTA Fillapex.