Vidrios bioactivos en endodoncia. Revisión narrativa de sus propiedades biológicas / Bioactive glasess in endodontics. A narrative review about their biological properties

Los vidrios bioactivos (VBa) son materiales biocerámicos que tienen una extensa aplicación en medicina y odontología. A causa de su contenido de calcio y fosfato son muy simi- lares a la hidroxiapatita del tejido óseo. Su biocompatibili- dad y bioactividad los hacen materiales muy útiles para ser aplicados en diferentes áreas de la práctica dental, tales como periodoncia, cirugía, odontología restauradora y endodoncia. En endodoncia los VBa están indicados para realizar protec- ciones pulpares directas, pulpotomías, desinfecciones y obtu- raciones del sistema de conductos radiculares. El objetivo del presente trabajo fue realizar una revisión de las propiedades biológicas de los VBa en relación a sus aplicaciones en en- dodoncia (AU)

Bioactive glasses (BGs) are bioceramic materials with extensive clinical applications in medicine and dentistry. Be- cause of their phosphate and calcium contents, they are like the hydroxyapatiteof bone tissue. Their biocompatibility and bioactivity make them very useful biomaterials in different areas of dental practice, such as periodontics, oral surgery, restorative dentistry, and endodontics. In endodontics, bioac- tive glasses are indicated for direct pulp capping, pulpoto- mies, disinfections and fillings of the root canal system. The aim of this work was to carry out a review of the biological properties of BGs in relation to its application in endodontics (AU)

Comparación de la actividad antimicrobiana de cementos selladores en endodoncia / Comparison of the antimicrobial activity of sealing cements in endodontics

Introducción: la persistencia de microorganismos en los conductos radiculares es uno de los principales factores del fracaso endodóncico. Por ello la importancia de conocer las propiedades antimicrobianas de los distintos tipos de selladores. Objetivo: realizar una comparación con base en la evidencia disponible sobre la actividad antimicrobiana de los diferentes cementos selladores en endodoncia. Material y métodos: la información fue recopilada de las bases de datos PubMed y Google Académico en el idioma inglés y español, publicados en el periodo 2014-2023. Resultados: un gran número de microorganismos se encuentran presentes en los diferentes tipos de infecciones de origen endodóncico, se han identificado más de 500 especies microbianas, entre ellas bacterias, hongos, arqueas y virus. Los cementos selladores se pueden clasificar según su composición química, en cementos a base de óxido de zinc-eugenol, hidróxido de calcio, a base de ionómero de vidrio, silicona, resina y biocerámicos. Conclusión: los cementos selladores que mostraron mayor actividad antimicrobiana contra los microorganismos persistentes fueron los cementos a base de óxido de zinc-eugenol, resina y biocerámicos. Sin embargo, se identificó que cada autor utilizó diferentes métodos y tiempos, por lo tanto, no es posible lograr definir con exactitud qué cemento sellador posee la mejor capacidad antimicrobiana (AU)

Introduction: the persistence of microorganisms in root canals is one of the main factors of endodontic failure. Therefore, the importance of knowing the antimicrobial properties of the different types of sealants. Objective: to make a comparison based on the available evidence on the antimicrobial activity of the different endodontics sealers. Material and methods: the information was collected from PubMed and Google Academic databases in English and Spanish, published in the period 2014-2023. Results: a large number of microorganisms are present in the different types of infections of endodontic origin, more than 500 microbiological species have been identified, including bacteria, fungi, archaea and viruses. Sealer cements can be classified according to their chemical composition, into cements based on zinc oxide-eugenol, calcium hydroxide, based on glass ionomer, silicone, resin and bioceramics. Conclusion: sealer cements that showed the highest antimicrobial activity against persistent microorganisms were zinc oxide-eugenol, resin, and bioceramic-based cements. However, it was identified that each author used different methods and times, therefore, it is not possible to accurately define which sealer cement has the best antimicrobial capacity (AU)

Evaluación de la filtración apical al utilizar dos selladores biocerámicos / Evaluation of apical leakage when using two bioceramic sealers

Objetivo: Evaluar con técnica de diafanización el gra-do de filtración apical al utilizar dos selladores bio-cerámicos y la técnica de cono único con taper ex vivo. Materiales y métodos: Se utilizaron 60 premola-res inferiores humanos uniradiculares extraídos. La instrumentación se realizó con lima Primary 25/.07 (WaveOne Gold, Dentsply Maillefer), según protocolo del fabricante. Se irrigó con NaOCl 2,5% y EDTAC 17%. Para la obturación, la muestra se dividió aleatoria-mente en 4 grupos (n=15). Grupo 1: Cono único y Bio C Sealer. Grupo 2: Cono único y MTA Fillapex. Grupo control negativo: no se obturó. Grupo control positi-vo: Cono único y AH Plus. En todas las muestras se aplicaron dos capas de esmalte para uñas en toda la superficie dentaria con excepción del tercio apical y del grupo control positivo, que se esmaltó en su tota-lidad. Medio de filtración: tinta china negra por difu-sión pasiva. Se diafanizó con técnica de Robertson. Se usó programa AutoCad 2022, para medir filtración en milímetros lineales. Los datos se analizaron me-diante prueba de Kruskal-Wallis seguida por compa-raciones post hoc empleando el método de Conover (p<0,05, significativo). Resultados: La filtración con Bio C Sealer, MTA Fillapex, control negativo y control positivo tuvo una media (mínimo-máximo) de 0 (0-2), 1 (0-3), 6 (2-12) y 0 (0-0); sin diferencias significativas entre Bio C Sealer y MTA Fillapex (p>0,05), ni entre Bio C Sealer y control positivo (p>0,05); pero con di-ferencias significativas entre MTA Fillapex y control positivo (p<0,05), y entre control negativo y cual-quiera de los otros tres grupos (p<0,05). Conclusión: La obturación con Bio C Sealer lograría un nivel de sellado similar al que se obtiene con el control po-sitivo; mientras que la obturación con MTA Fillapex produciría un sellado ligeramente menos efectivo que el control positivo. Sin embargo, la filtración no variaría sustancialmente entre obturaciones con Bio C Sealer y MTA Fillapex (AU)

Objective: To evaluate the degree of apical filtration with diaphanization technique, using two bioceramic sealers and single cone technique with taper, ex vivo. Materials and methods: 60 extracted single-root human mandibular premolars were used. The instrumentation was carried out with primary file 25/.07 (WaveOne Gold, Dentsply Maillefer), according to the manufacturer's protocol. Irrigation was done with 2.5% NaOCl and 17% EDTAC. For obturation, the sample was randomly divided in 4 groups (n=15). Group 1: Single cone and Bio C Sealer. Group 2: Single cone and MTA Fillapex. Negative control group: it was not obturated. Positive control group: Single cone and AH Plus. In all samples, two layers of nail polish were applied to the entire tooth surface with exception of apical third and the positive control group, which was completely glazed. Filtration medium: black Chinese ink by passive diffusion. It was diaphanized with Robertson technique. AutoCad 2022 program was used to measure filtration in linear millimeters. Data were analyzed using Kruskal-Wallis test, followed by post hoc comparisons using Conover method (p < 0.05, significant). Results: Filtration with Bio C Sealer, MTA Fillapex, negative control and positive control had a mean (minimum-maximum) of 0 (0-2), 1 (0-3), 6 (2-12) and 0 (0-0); no significant differences between Bio C Sealer and MTA Fillapex (p > 0.05), nor between Bio C Sealer and positive control (p > 0.05); but with significant differences between MTA Fillapex and positive control (p < 0.05), and between negative control and any of the other three groups (p < 0.05). Conclusion: Obturation with Bio C Sealer would achieve a level of sealing similar to obtained with the positive control; while obturation with MTA Fillapex would produce a slightly less effective seal than the positive control. However, filtration would not vary substantially between fillings with Bio C Sealer and MTA Fillapex (AU)

Root filling quality and bond strength of endodontic sealers to human and bovine dentin / Qualidade da obturação e resistência de união de cimentos endodônticos à dentina humana e bovina

Objetivo: Este estudo teve como objetivo comparar a qualidade da obturação e a resistência de união de dois cimentos endodônticos, AH Plus e Bio-C Sealer, em dentes humanos e bovinos. Métodos: Os canais radiculares de 60 dentes unirradiculares [30 humanos (H) e 30 bovinos (B)] foram preparados e obturados por condensação lateral da guta-percha e AH Plus (grupos AP-H e AP-B) ou Bio-C Sealer (grupos BC-H e BC-B). Seis fatias de 1,5 mm de espessura foram obtidas de cada raiz. Os espécimes foram observados em estereomicroscópio para avaliar a qualidade da obturação, considerando possíveis espaços vazios no material obturador. Posteriormente, as fatias radiculares foram avaliadas em termos de resistência de união por push-out e modo de falha. Os dados foram analisados pelos testes de Mann-Whitney e coeficientes de correlação de Spearman (α=5%). Resultados: A qualidade de obturação fornecida por AP e BC foi semelhante em ambos os substratos de dentina. No entanto, ao comparar dentes humanos e bovinos, os escores de espaços vazios foram maiores nas amostras bovinas, para ambos os cimentos. AP teve maior resistência de união à dentina humana e bovina do que BC. No entanto, não houve diferença significativa na resistência de união entre os substratos dentinários, para ambos os cimentos testados. Além disso, houve uma correlação positiva e moderada entre os valores de resistência de união de dentes humanos e bovinos. O modo de falha misto foi o mais prevalente. Conclusão: AP e BC fornecem qualidade de obturação semelhante, mas o primeiro apresenta maiores valores de resistência de união à dentina humana e bovina. A utilização de dentes bovinos como substitutos de amostras humanas parece ser adequada em estudos relacionados à resistência de união, mas não naqueles que testam a qualidade da obturação endodôntica.(AU)

Objective: This study aimed to compare the filling quality and bond strength of two endodontic sealers, AH Plus and Bio-C Sealer, in human and bovine teeth. Methods: The root canals of 60 [30 human (H) and 30 bovine (B)] single-rooted teeth were prepared and filled by lateral condensation of gutta-percha and AH Plus (groups AP-H and AP-B) or Bio-C Sealer (groups BC-H and BC-B). Six 1.5-mm-thick slices were obtained from each root. The specimens were observed under a stereomicroscope to assess filling quality, considering possible voids within the filling material. Subsequently, root slices were evaluated in terms of push-out bond strength and failure mode. Data were analyzed by Mann-Whitney tests and Spearman correlation coefficients (α=5%). Results: The filling quality provided by AP and BC was similar in both dentin substrates. However, when comparing human and bovine teeth, void scores were greater in the bovine samples, for both sealers. AP had higher bond strength to human and bovine dentin than BC. However, there was no significant difference in bond strength between dentin substrates, for both sealers tested. Also, there was a positive and moderate correlation between the bond strength values of human and bovine teeth. The mixed failure mode was the most prevalent. Conclusion: AP and BC provide similar filling quality, but the first presents higher bond strength values to human and bovine dentin. The use of bovine teeth as substitutes for human samples seems adequate in studies related to bond strength, but not in those testing root canal filling quality.(AU)

Análisis Elemental de las Propiedades Morfológicas, Físicas y Químicas de Dos Instrumentos Rotatorios Protaper Universal / Elemental Analysis of the Morphological, Physical and Chemical Properties of Two Protaper Universal Rotary Instruments

Los instrumentos rotatorios utilizados en el tratamiento de conductos dentales necesitan cumplir con ciertas características físicas que le confieran un uso correcto, adecuado y seguro para su uso clínico. En el mercado comercial existen una serie de instrumentos importados que dejan en duda la autenticidad de estos debido a sus bajos costos. En este estudio evaluamos física, química y morfológicamente dos kits de instrumentos rotatorios Protaper universal (Dentsply) mediante análisis de MEB, EDX, microdureza y EDS. Uno de los kits (grupo 1) se adquirió directamente de la casa comercial y otro kit importado que a simple vista no parecía cumplir con los estándares de calidad de un correcto empaquetado (grupo 2). En el análisis de MEB se observaron características morfológicas muy diferentes entre ambos kits, el grupo 2 presentó diversas irregularidades en la superficie de las limas, sin embargo, en el EDS no se encontró diferencia alguna. En cuanto al análisis de microdureza se observó una estadística estadísticamente significativa y en el EDS se observaron mayores picos de intensidad en cuanto a la aleación de Ni-Ti en el grupo 2. Estos resultados sugieren que existen instrumentos rotatorios importados que a pesar de su bajo costo pueden presentar ciertas características muy similares a los kits auténticos, sin embargo, física y químicamente pueden resultar en un riesgo para su uso clínico debido a la diferencia entre estos.

Rotatory files are instruments used in the treatment of dental canals roots. These instruments need to comply with certain physical characteristics for a correct, adequate and safe use for clinical use. In the commercial market there are a series of imported instruments that cast doubt on their authenticity due to their low costs. In this study we physically, chemically and morphologically evaluated two Protaper universal rotary instrument kits (Dentsply) using SEM, EDX, microhardness and EDS analysis. One of the kits (group 1) was purchased directly from the commercial house and another imported kit that a simple view did not seem to meet the quality standards of a correct packaging (group 2). In the SEM analysis, very different morphological characteristics were observed between both kits, group 2 presented various irregularities on the surface of the files, however, no difference was found in the EDS. Regarding the microhardness analysis, a statistically significant statistic was observed and in the EDS, higher intensity peaks were observed in terms of the Ni-Ti alloy in group 2. These results suggest that there are imported rotary instruments that despite their low cost can present characteristics very similar to authentic kits, however, physically and chemically they can result in a risk for their clinical use due to the difference between them.

Apical Sealing Efficacy of the Bioceramic Cements Bio Root and MTA Fillapex: An ex vivo Study / Eficacia del Sellado Apical de los Cementos Biocerámicos Bio Root y MTA Fillapex: Un Estudio ex vivo

The aim of this ex vivo study was to compare the ability of the apical sealing bioceramic cements BioRoot™ RCS (Septodont) and MTA-Fillapex (Angelus). One hundred and eighty-four vestibular canals were selected from ninety-two recently extracted maxillary molars. Canals were instrumented with the mechanized system ProTaper Next and obturated using the single cone technique. The sample was randomly divided into two groups (92): Group 1 was obturated with BioRoot ™ RCS, and Group 2 with MTA-Fillapex. Samples were processed for the leakage test by dye penetration and later cut longitudinally. The data obtained were tabulated and analyzed using Stata 15.0. The degree of leakage from BioRoot ™ RCS was 0.03 mm, and MTA-Fillapex was 0.31 mm p (0.00). BioRoot ™ bioceramic presented an adequate apical sealing, while MTA-Fillapex showed an accentuated leakage.

El objetivo de este studio ex vivo fue comparar la capacidad de sellado apical de dos cementos biocerámicos, el BioRoot™ RCS (Septodont) y MTA-Fillapex (Angelus). 184 conductos vestibulares fueron seleccionados de 92 molares maxilares recientemente extraídos. Los conductos fueron instrumentados con el sistema de instrumentación mecanizado Protaper Next y obturados usando la técnica de cono único. Las muestras fueron divididas aleatoriamente en dos grupos (N 92): Grupo 1 fue obturado con BioRoot™ RCS, y el grupo 2 con MTA-Fillapex. Las muestras fueron procesadas para el test de filtración por penetración de tinción, y luego cortadas de manera longitudinal. Los datos obtenidos fueron tabulados y analizados usando Stata 15.0. El grado de penetración de BioRoot™ RCS fue de 0,03 mm, y de MTA Fillapex fue de 0,31 mm (P 0.00). BioRoot™ RCSpresent un sellado apical adecuado, mientras que MTA Fillapex mostró una filtración mayor.

Capacidad de sellado de los conductos laterales con distintas técnicas de obturación del conducto radicular / Sealing capacity of lateral canals with different root canal obturation techniques

Objetivo: Estimar y comparar la eficacia de diferentes técnicas de obturación para impedir el flujo de colorante a través de los conductos laterales. Materiales y métodos: Se emplearon 50 premolares inferiores extraídos y conservados en formol neutro al 5% hasta el momento de su uso, a los cuales se les realizaron conductos laterales artificiales. Una vez instrumentados los conductos principales, los dientes fueron divididos al azar en 5 grupos (n=10) para ser obturados con cuatro técnicas distintas: A) System B + inyección de gutapercha termoplástica del sistema Elements, Extruder; B) obturadores de Thermafil, ProTaper Universal; C) técnica híbrida y D) obturación con inyección de gutapercha termoplástica del sistema Elements, Extruder. Inmersos en tinta china y diafanizadas las raíces, se evaluó la longitud de penetración de la tinta en los conductos laterales. Se empleó el análisis de la varianza para detectar diferencias significativas (P<0,05) entre los niveles medios de penetración del colorante según las técnicas de obturación y las zonas del diente, y se efectuaron pruebas de rango múltiple (HSD de Tukey) para realizar comparaciones dos a dos, manteniendo fija la tasa de error por familia. Resultados: A la técnica B le correspondió el valor medio más bajo (30,63%) de penetración de tinta china. Los valores medios más elevados (54,52% y 51,74%) correspondieron a las técnicas A y C, respectivamente. Conclusión: Ninguna de las técnicas de obturación del conducto radicular empleadas ha sido capaz de impedir la filtración del colorante en los conductos laterales (AU)

Aim: To estimate and compare the different obturation techniques to avoid the flow of colorant through lateral canals. Materials and methods: 50 extracted lower premolars preserved in 5% neutral formol until the moment of use, had artificial lateral canals made. Once canals were instrumented, the teeth were randomly divided into 5 groups (n=10) to be filled with four different techniques: A) System B + injection of thermoplastic gutta-percha, Elements system, Extruder; B) Thermafil, ProTaper Universal obturators; C) hybrid technique, and D) injection of thermoplastic gutta-percha, Elements system, Extruder. Having immersed the premolars in India ink and diaphanized the roots, the penetration length of the India ink inside the canals was assessed. Analysis of variance was used to detect significant differences (P<0.05) between the mean levels of dye penetration according to the filling techniques and tooth areas, and multiple range tests (Tukey's HSD) were performed for two-to-two comparisons, keeping the error rate per family fixed. Results: Technique B had the lowest mean value (30.63%) of penetration. The highest mean values (54.52% and 51.74%) corresponded to techniques A and C, respectively. Conclusion: No obturation technique of the root canal used was able to avoid filtration of colourant in the lateral canals (AU)

Comparative effects of final canal irrigation with chitosan and EDTA

Abstract Chitosan is a natural, biocompatible chelating substance with potential for dental use. This study compared the effects of final canal irrigation with chitosan and EDTA on dentin microhardness, sealer dentin tubules penetration capacity, and push-out strength. Methodology: Fifty canine roots were distributed according to the final irrigation protocol (n=10): G1- 15% EDTA with conventional irrigation; G2- 15% EDTA with Endovac; G3- 0.2% chitosan with conventional irrigation; G4- 0.2% chitosan with Endovac; and G5- without irrigation. Specimens were obturated (AH Plus) and sectioned in 3 slices per root third. The first slice was used for microhardness and sealer penetration assessments under a laser confocal microscope. The second was utilized in a push-out strength test. The third slice was discarded. Data were analyzed using 2-way ANOVA and Tukey's post hoc test (α<0.05). Failure mode was determined at x40 magnification. Results: Microhardness reduction was more significant in groups G2 and G4 (p<0.05). Sealer penetration through dentin was significantly greater in group G2 (p<0.05). There was no significant difference between groups G1, G3, and G4 (p>0.05). In general, all experimental groups presented similar bond resistance (p>0.05) that significantly differed from the control (p<0.001). Mixed type failures were predominant. Conclusions: In general, 0.2% chitosan and 15% EDTA solutions act in a similar manner with regard to the variables studied. The use of Endovac potentiates the effect of these solutions.

Surface and vertical dimensional changes of mineral trioxide aggregate and biodentine in different environmental conditions

Abstract Surface changes in biological environments are critical for the evaluation of physical and biological activity of biomaterials. Objective: This study investigated surface alterations of calcium silicate-based cements after exposure to different environments. Material and Methods: Forty-eight cylindrical cavities were prepared on root surfaces. The cavities were filled using ProRoot MTA or Biodentine and assigned to four subgroups (n=6): dry, wet, acidic, and blood. Surface topographies were evaluated using an optical profilometer for 28 days, and the roughness of the material surfaces was quantified. Vertical dimensional change was measured by determining the height difference between the material surface and the flat tooth surface. Data were compared with a two-way repeated measures ANOVA and Bonferroni tests. Results: In dry condition, the surface roughness of MTA or Biodentine was constant up to 3 days (p>0.05) but decreased after 28 days (p<0.05). In dry condition, ProRoot MTA presented constant surface level through time, while Biodentine showed decreased surface level after 28 days. In wet condition, the roughness and the surface levels of both materials increased after 1 day (p<0.05). Neither the surface roughness nor the levels of the materials showed significant changes in acidic conditions (p>0.05). Both materials showed the highest roughness in blood conditions on the 1st day (p<0.05), while the surface roughness in blood decreased dramatically after 28 days. The roughness of Biodentine was higher in wet conditions up to 3 days compared with ProRoot MTA (p<0.05). Likewise, in blood condition, Biodentine showed higher roughness on the 28th day than ProRoot MTA (p<0.05). Conclusions: Dry, wet, and blood conditions had a time-dependent effect on the surface roughness and vertical dimensional changes of the materials. However, acidic conditions did not affect the roughness and the surface level of the materials.

New material perspective for endocrown restorations: effects on mechanical performance and fracture behavior

Abstract The aim of this study was to investigate the mechanical performance and the fracture behavior of endocrown restorations prepared using distinct restorative materials. A total of 42 sound molars with similar crown size and shape were cut at 2 mm above the cementoenamel junction and endodontically treated. They were categorized according to the restorative material used to fabricate endocrown restorations (n=7), namely, conventional composite (Filtek™ Z350 XT), bulk fill composite (Filtek™ Bulk Fill), conventional composite modeled using resin adhesives (SBMP: Scotchbond™ Multipurpose Adhesive; or SBU: Scotchbond™ Universal Adhesive), and IPS e.max lithium disilicate (Ivoclar Vivadent; positive control). Unprepared sound teeth were used as negative control. All endocrowns were bonded using a self-adhesive cement (Rely-X™ U200). The teeth were submitted to fatigue (Byocycle) and fracture (EMIC DL500) testing. Load-to-fracture (in N) and work-of-fracture (Wf, in J/m2) values were analyzed by ANOVA (p < 0.05). The endocrowns did not fracture or de-bond upon fatigue, showing similar load-to-fracture and work-of-fracture values, regardless of the restorative material (p > 0.05). The endocrowns fabricated by combining Z350 and SBMP had the least harsh fractures, in contrast to endocrowns prepared using Z350 only, which exhibited an equilibrium between repairable and irrepairable fractures. The e.max endocrowns exhibited more aggressive failures (root fracture) than other groups, resulting in higher rates of irrepairable fractures. In conclusion, dental practitioners may satisfactorily restore severely damaged nonvital teeth using the endocrown technique. Composite endocrowns prepared using resin adhesive as modeler liquid or using bulk fill material may result in less aggressive failures, thus providing a new material perspective for endocrown restorations.

Penetration of bioceramic and epoxy-resin endodontic cements into lateral canals

Abstract: The aim of the present study was to assess the penetration capacity of two endodontic cements, Endosequence BC Sealer and AH Plus, in artificial lateral canals. Twenty-six two-rooted, maxillary first premolars were instrumented to size 40.06 using K3 files. In each root, six lateral canals of two diameters (0.06 and 0.10 mm) were created with a working length of 2, 4, and 6 mm. The specimens were randomly divided into two groups according to the endodontic cement to be used (Endosequence BC Sealer and AH Plus) and obturated by the single-cone technique. The specimens were imaged by digital periapical radiography and scores from 0 to 4 were attributed according to the degree of penetration by sealers into the lateral canals. Data were analyzed statistically by Kruskal-Wallis and Student-Newman-Keuls tests, and a significance level of p < 0.05 was adopted. No significant difference was observed between the two endodontic cements used to fill the simulated lateral canals (p > 0.05). The diameter of lateral canals only influenced the capacity of the Endosequence BC Sealer in filling the canals, and presented greater penetration in the lateral canals of diameter 0.10 mm (p < 0.05). We concluded that the bioceramic endodontic cement Endosequence BC Sealer presented similar ability as AH Plus to fill simulated lateral canals.

Cytotoxicity and biocompatibility of a new bioceramic endodontic sealer containing calcium hydroxide

Abstract: This study evaluated the cytotoxicity and biocompatibility of a new bioceramic endodontic sealer (i.e., Sealer Plus BC) in comparison with those of MTA Fillapex and AH Plus. L929 fibroblasts were cultured and Alamar Blue was used to evaluate cell viability of diluted extracts (1:50, 1:100, and 1:200) from each sealer at 24 h. Polyethylene tubes that were filled with material or empty (as a control) were implanted in the subcutaneous tissue of rats. The rats were killed after 7 and 30 d (n = 8), and the tubes were removed for histological analysis. Parametric data was analyzed using a one-way ANOVA test, and nonparametric data was analyzed via the Kruskal-Wallis test followed by the Dunn test (p < 0.05). A reduction in cell viability was observed in the extracts that were more diluted for Sealer Plus BC when compared to that of Control and AH Plus (p < 0.05). However, the 1:50 dilution of the Sealer Plus BC was similar to that of the Control (p > 0.05). Conversely, more diluted extracts of MTA Fillapex (1:200) and AH Plus (1:100 and 1:200) were similar to the Control (p > 0.05). Histological analysis performed at 7 d did not indicate any significant difference between tissue response for all materials, and the fibrous capsule was thick (p > 0.05). At 30 d, Sealer Plus BC was similar to the Control (p > 0.05) and MTA Fillapex and AH Plus exhibited greater inflammation than the Control (p < 0.05). The fibrous capsule was thin for the Control and for most specimens of Sealer Plus BC and AH Plus. Thus, Sealer Plus BC is biocompatible when compared to MTA Fillapex and AH Plus, and it is less cytotoxic when less-diluted extracts are used.

Effect of peracetic acid used as single irrigant on the smear layer, adhesion, and penetrability of AH Plus

Abstract The aim of this study was to evaluate the effect of peracetic acid (PAA) as a single irrigant on the smear layer, on the intraradicular dentinal bond strength, and on the penetrability of an epoxy-based resin sealer into the dentinal tubules. A total of 120 roots were distributed into 4 groups according to the irrigant used in root canal preparation: 1% PAA (PAA); 2.5% NaOCl followed by final irrigation with 17% EDTA and 2.5% NaOCl (NaOCl-EDTA-NaOCl); 2.5% NaOCl (NaOCl); and saline solution (SS). The smear layer was evaluated using scanning electron microscopy. The bond strength of an epoxy-based resin sealer (AH Plus) to root dentin was evaluated by the push-out test and penetrability of the sealer into dentinal tubules was observed by confocal laser microscopy. The results were analyzed by the Kruskal-Wallis and the Dunn post-test (α = 0.05). The use of 1% PAA as single root canal irrigant provided smear layer removal and improved the penetrability and bond strength of AH Plus to root dentin in a manner similar to that of the NaOCl-EDTA-NaOCl group (p > 0.05). The NaOCl and SS groups had higher values of smear layer and lower values of sealer penetrability and dentin bond strength than the PAA and NaOCl-EDTA-NaOCl groups (p < 0.05). Thus, 1% PAA has the potential to be used as a single irrigant in root canals.

Effect of sonic and ultrasonic activation on physicochemical properties of root canal sealers

Abstract Objective: To evaluate the effect of ultrasonic and sonic activation on physicochemical properties of AH Plus, MTA Fillapex, ADSeal, GuttaFlow Bioseal, and GuttaFlow 2 sealers. Methodology: Three experimental groups were formed: no activation (NA), ultrasonic activation (UA), and sonic activation (SA). The sealers were manipulated according to the manufacturers' instructions. A 3-mL syringe was adapted to receive 1 mL of sealer. Activation was performed with a 20/.01 ultrasonic insert (20 s/1W) in the UA group. A size 35.04 sonic tip was used (20 s/10,000 cycles/min-1) in the SA group. The molds for physicochemical analysis were filled and evaluated according to ANSI/ADA specification no. 57: setting time (ST), flow (FL), dimensional change (DC), solubility (SB), and radiopacity (RD). Statistical analysis was performed by Kruskal-Wallis, one-way ANOVA, and Tukey's tests (P<0.05). Results: Regarding ST, only AH Plus and GuttaFlow 2 in the NA group met the ANSI/ADA standards. All FL values were greater than 20 mm in diameter, as determined by ANSI/ADA. The tested sealers and protocols did not comply with the ANSI/ADA standards for DC. As for SB, only MTA Fillapex, regardless of the activation protocol, did not follow the ANSI/ADA standards. All of the investigated sealers, regardless of the activation protocol, presented radiographic density higher than 3 mm Al, as proposed by ANSI/ADA. Conclusions: UA and SA promoted changes in the physicochemical properties of the evaluated root canal sealers, mainly in ST and F. Thus, it is important to evaluate the physicochemical properties of endodontic sealers associated with activation techniques prior to clinical application in order to determine whether the properties follow the parameters set by ANSI/ADA, ensuring safety and quality of root canal filling.

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)

Bond strength of experimental root canal sealers based on mta and butyl ethylene glycol disalicylate

Abstract This study investigated the bond strength of two experimental root canal sealers based on MTA and butyl ethylene glycol disalicylate: MTAe and MTAe-HA. The reference materials used for comparison were AH Plus and MTA Fillapex. Twenty human upper incisors were selected and one 1 mm slice was obtained from the cervical third of each root. On the coronal surface of each slice, four 0.9 mm wide holes were drilled through the dentine. Standardized irrigation was performed and holes were filled with one of the four tested sealers: AH Plus, MTA Fillapex, MTAe, and MTAe-HA. The filled slices were stored in a PBS solution (pH 7.2) for 7 days at 37 °C. A push-out assessment was performed with a 0.7 mm plunger tip. Load was applied at a crosshead speed of 0.5 mm/min until sealer displacement. The results were expressed in MPa. The Kruskal-Wallis test was applied to assess the effect of each sealer on the push-out bond strength. Mann-Whitney with Bonferroni correction was used to isolate the differences. The alpha-type error was set at 0.05. Significant differences among medians values obtained by materials were observed (p<0.001). AH Plus displayed the highest value of bond strength (p<0.001). In contrast, MTA Fillapex presented the lowest bond strength among all tested sealers (p<0.001). Experimental sealers showed intermediary bond strength values, with no statistical differences between them (p>0.05). In conclusion, experimental root canal sealers presented suitable bond strength outcomes when compared to MTA Fillapex.

Resumo Esse estudo investigou a resistência de união de dois cimentos endodônticos experimentais à base de MTA e butiletilenoglicol dissalicilato: MTAe e MTAe. Os materiais de referência utilizados para comparação foram os cimentos endodônticos MTA Fillapex e AH Plus. Vinte incisivos superiores humanos foram selecionados e um slice dentinário de 1 mm de espessura foi obtido do terço cervical de cada raiz. Na superfície coronária de cada slice, quatro orifícios com 0,9 mm de diâmetro foram confeccionados através da dentina. Uma irrigação padronizada foi realizada e os orifícios foram preenchidos com um dos quatro cimentos endodônticos avaliados: AH Plus, MTA Fillapex, MTAe, e MTAe-HA. Os slices preenchidos foram armazenados em solução PBS (pH 7,2) durante 7 dias a 37°C. O ensaio de push-out foi realizado por meio de um dispositivo com 0,7 mm de diâmetro. A carga foi aplicada com a velocidade de 0,5 mm/min até a obtenção de deslocamento do material obturador. Os resultados foram expressos em MPa. O teste de Kruskal-Wallis foi aplicado para avaliar o efeito da resistência de união de cada cimento endodôntico. O teste de Mann-Whitney com correção de Bonferroni foi utilizado para isolamento das diferenças. O erro do tipo-alfa foi fixado em 0,05. Diferenças significantes entre os valores de medianas obtidos pelos materiais foram observados (p<0,001). O AH Plus demonstrou os maiores valores de resistência de união (p<0,001). Em contraste, o MTA Fillapex apresentou a menor resistência de união entre todos os cimentos testados (p<0,001). Os cimentos experimentais demonstraram valores intermediários, com ausência de diferenças estatísticas entre si (p>0,05). Em conclusão, os cimentos endodônticos experimentais à base de MTA e butiletilenoglicol dissalicilato apresentaram resultados adequados de resistência de união quando comparados ao MTA Fillapex.

Pentaerythritol Tetrasalicylate in the Chemical Composition of Root Canal Sealers

Abstract The aim of this study was to synthesize and evaluate physicochemical properties of a new salicylate derivative in experimental calcium-based root canal sealers. Two salicylate derivatives were synthesized for the transesterification reaction of methyl salicylate with two different alcohols (1,3-butylenoglicol disalicylate-BD and pentaerythritol tetrasalicylate -PT) in molar ratio 1:3 and 1:6, respectively. The products (BD and PT), were characterized by Fourier Transform Infrared Spectroscopy (FTIR) and Nuclear Magnetic Resonance spectroscopy (RMN). Calcium-based experimental sealers were prepared with the same catalyst paste (60% of MTA, 39% of n-ethyl-o-toluenesulfonamide, and 1% titanium dioxide) and four different concentrations of BD and PT in the base pastes (40/0 - control, 35/5, 30/10 and 20/20) with 60% of bismuth oxide. The experimental sealers were evaluated for setting time, solubility (24 h, 7, 14 and 30 days), diametral tensile strength and Young's Modulus. Data were analyzed by one- or two-way ANOVA with Tukey's test (p<0.05). The addition of PT reduced the materials setting time. After 24 h the sealer 40/0 and 35/5 had higher solubility, and after 14 and 28 days the sealer 20/20 showed the lowest solubility (p<0.05). After 7 days the sealer 20/20 stabilized its solubility. The sealer 40/0 presented the highest values and the 20/20 presented the lowest values of diametral tensile strength and Young's modulus (p<0.05). The addition of PT to calcium-based root canal sealers provides benefits to the setting time and solubility.

Resumo O objetivo neste estudo foi sintetizar e avaliar as propriedades físico-químicas de um novo derivado do salicilato em cimentos endodônticos experimentais à base de cálcio. Dois derivados de salicilato foram sintetizados por meio de uma reação de trans esterificação do salicilato de metila com dois diferentes alcoóis (1,3-butilenoglicol dissalicilato-BD e pentaeritritol tetrassalicilato-PT) na proporção molar de 1: 3 e 1:6, respectivamente. Os produtos (BD e PT), foram caracterizados por espectroscopia infravermelho transformada de Fourier (FTIR) e espectroscopia de ressonância magnética nuclear (RMN). Os cimentos experimentais à base de cálcio foram preparados com a mesma pasta catalisadora (60% de MTA, 39% de N-etil o/p toluenosulfonamida e 1% de dióxido de titânio) e quatro concentrações diferentes de BD e PT nas pastas base (40/0 - controle, 35/5, 30/10 e 20/20) com 60% de óxido de bismuto. Os cimentos foram avaliados quanto ao tempo de endurecimento, à solubilidade (24 h, 7, 14 e 28 dias), resistência à tração diametral e ao módulo de elasticidade. Os dados foram analisados por ANOVA um ou dois fatores e as médias comparadas pelo teste de Tukey (p<0,05). A adição de PT reduziu o tempo de endurecimento dos materiais testados. Após 24 horas os cimentos 40/0 e 35/5 apresentaram maior solubilidade que os demais e após 14 e 28 dias o cimento 20/20 foi o que apresentou menor solubilidade (p<0,05). Após 7 dias o grupo 20/20 estabilizou a sua solubilidade. O cimento 40/0 apresentou os maiores valores e o cimento 20/20 apresentou os menores valores de resistência à tração diametral e módulo de elasticidade (p<0,05). A adição de PT a cimentos à base de cálcio possibilita benefícios ao tempo de presa e solubilidade.

Influence of ethanol on dentin roughness, surface free energy, and interaction between AH Plus and root dentin

Abstract This study aimed to evaluate the influence of different ethanol concentrations on dentin roughness, surface free energy, and contact angle between AH Plus and the root canal dentin. One hundred human maxillary anterior teeth were split longitudinally and 200 dentin specimens were polished to make the surface flatter and smoother. An acrylic bar was positioned between two dentin specimens and impression material was added to create a block, simulating an instrumented root canal space. Specimens were removed from the mold and cleaned in an ultrasonic bath for 10 min. Thereafter, dentin specimens were divided into four groups (n = 50) according to the drying methods used: a) wet: vacuum only, b) paper points: vacuum + absorbent paper points, c) 70% alcohol: 70% alcohol (1 min) + vacuum + absorbent paper points, and d) 100% alcohol: 100% alcohol (1 min) + vacuum + absorbent paper points. A rugosimeter and a goniometer were used to verify the roughness (Ra) and to measure the surface free energy and the contact angle between the AH Plus sealer and the root canal dentin. ANOVA and Tukey tests (α = 0.05) were used for statistical analysis. The 70% and 100% ethanol groups showed significantly decreased roughness as well as increased surface free energy in the root canal dentin when compared to the wet and paper point groups. In addition, ethanol significantly reduced the contact angle between the AH Plus sealer and the root canal dentin. Ethanol solutions (70% and 100%) provide better wettability of AH Plus sealer on dentin surfaces.

Push-out bond strength of different tricalcium silicate-based filling materials to root dentin

Abstract: The aim of this study was to evaluate the bond strength of different triccalcium silicate cements to retrograde cavity using a push out test. Thirty maxillary central incisors were shaped using #80 hand files and sectioned transversally. Root slices were obtained from the apical 4 mm after eliminating the apical extremity. The specimens were embedded in acrylic resin and positioned at 45° to the horizontal plane for preparation of root-end cavities with a diamond ultrasonic retrotip. The samples were divided into three groups according to the root-end filling material (n = 10): MTA Angelus, ProRoot MTA and Biodentine. A gutta-percha cone (#80) was tugged-back at the limit between the canal and the root-end cavity. The root-end cavity was filled and the gutta-percha cone was removed after complete setting of the materials. The specimens were placed in an Instron machine with the root-end filling turned downwards. The push-out shaft was inserted in the space previously occupied by the gutta-percha cone and push out testing was performed at a crosshead speed of 1.0 mm/min. There was no statistically significant difference in resistance to push out by the materials tested (p > 0.01). MTA Angelus and ProRoot MTA showed predominantly mixed failure while Biodentine exhibited mixed and cohesive failures. The tricalcium silicate-based root-end filling materials showed similar bond strength retrograde cavity.