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.

Effect of irrigation methods on the adhesion of Resilon/Epiphany sealer and gutta-percha/AH 26 sealer to intracanal dentin / 대한치과보존학회지

The purpose of this study was to evaluate whether intracanal irrigation method could affect the adhesion between intracanal dentin and root canal filling materials (Gutta-percha/AH 26 sealer and Resilon/Epiphany sealer). Thirty extracted human incisor teeth were prepared. Canals were irrigated with three different irrigation methods as a final rinse and obturated with two different canal filling materials (G groups : Gutta-percha/AH 26 sealer, R groups : Resilon/Epiphany sealer) respectively. Group G1, R1 - irrigated with 5.25% NaOCl. Group G2, R2 - irrigated with 5.25% NaOCl, sterile saline. Group G3, R3 - irrigated with 5.25% NaOCl, 17% EDTA, sterile saline. Thirty obturated roots were horizontally sliced and push-out bond strength test was performed in the universal testing machine. After test, the failure patterns of the specimens were observed using Image-analyzing microscope. The results were as follows. 1. Gutta-percha/AH 26 sealer groups had significantly higher push-out bond strength compared with the Resilon/Epiphany sealer groups (p < 0.05). 2. Push-out bond strength was higher when using 17% EDTA followed by sterile saline than using NaOCl as a final irrigation solution in the Resilon/Epiphany sealer groups (p < 0.05). 3. In the failure pattern analysis, there was no cohesive failure in Group G1, G2, and R1. Gutta-percha/AH 26 sealer groups appeared to exhibit predominantly adhesive and mixed failure patterns, whereas Resilon/Epiphany sealer groups exhibited mixed failures with the cohesive failure occurred within the Resilon substrate.

Avaliação histopatológica do reparo apical e periapical em dentes de cães com vitalidade pulpar, após tratamento de canais radiculares utilizando dois cimentos obturadores à base de resina epóxica. Análise do pH e concentração de cálcio total / Histopathological evaluation of the apical and periapical repair of dog's teeth with vital pulp after biomechanic preparation and root canal fillings using resin-based sealers. Analysis of pH and calcium concentration

O objetivo do presente estudo foi o de avaliar comparativamente, dois cimentos obturadores de canal radicular à base de resina epóxica, AH Plus e Sealer Plus, através de duas diferentes metodologias. 1. Teste in vivo - Avaliação histopatológica em dentes de cães. Foram utilizados 36 canais radiculares de dentes pré-molares superiores e inferiores de 2 cães, com vitalidade pulpar, os quais, após o preparo biomecânico coadjuvado pela irrigação/aspiração e inundação com solução de hipoclorito de sódio a 1% (Líquido de Dakin), foram obturados pela técnica clássica complementada pela condensação lateral ativa, empregando os cimentos Sealer Plus (Grupo I) e AH Plus (Grupo II). Decorridos 90 dias após a obturação, os animais foram sacrificados por sobredose anestésica, as maxilas e mandíbulas removidas e fixadas em formol a 10%, durante 48 horas. Após processamento histológico de rotina, os cortes foram corados pela hematoxilina e eosina, pelo tricrômico de Mallory e Brown e Brenn. A análise histopatológica evidenciou que o cimento AH Plus, quanto à compatibilidade biológica, mostrou-se superior ao Sealer Plus, sendo o cimento que melhor permitiu a deposição de tecido mineralizado à nível apical, oferecendo um selamento quase completo na maioria dos casos, com infiltrado inflamatório ausente e quando presente era suave no tecido intersticial e/ou junto ao material obturador, assim como na região periapical. Já, com o cimento Sealer Plus, ocorreu predominantemente, selamento parcial, porém sempre acompanhado de infiltrado inflamatório de grau suave, no tecido intersticial, porém, mais concentrado, junto ao cimento obturador. Quando o material obturador era observado na região periapical, o infiltrado inflamatório apresentava-se, classificado como de grau moderado, concentrado próximo ao material e com reabsorção óssea alveolar. 2. Teste in vitro - Análise química. Com o objetivo de analisar o pH e liberação de cálcio total, por períodos que variaram de 0 a 5 dias, os cimentos endodônticos AH Plus e Sealer Plus, foram manipulados de acordo com as instruções dos fabricantes, e confeccionados os corpos -deprova, os quais foram pesados separadamente e colocados em água destilada, mantendo-se constante a relação massa/volume. Com relação ao pH, o cimento AH Plus ofereceu, após a reação de presa, um pH de 6,0, e logo em seguida, apresentou uma variação, tornando-se constante após 24 horas e com um pH alcalino de 7,5. Já o Sealer Plus, apresentou um pH crescente, até o 5o dia (pH =10,54). Com relação à liberação de cálcio total, os resultados obtidos mostram que o cimento Sealer Plus liberou uma grande quantidade de cálcio total, aos 5 dias (14,89 ppm), por ser mais solúvel que o AH Plus, que apresentou aos 5 dias, menor liberação de cálcio (0,144 ppm)

The scope of the present study was to evaluate comparativily, two root canal resin ­ based sealers - AH Plus and Sealer Plus through two different methodologies. 1. In vivo study ­ Histopathological evaluation in teeth of dogs. 36 root canals of lower and upper bicuspide teeth of 2 dogs with vital pulp, which after biomechanic preparation utilizing sodium hypochloride solution at 1% (Milton solution) were filling by classical technique complemented by active lateral condensation, using Sealer Plus (Group I) and AH Plus (Group II). 90 days after treatment, the animals were sacrificed by overdose anesthetical. After histopathological processing of routine, the sections were stained with hematoxiline and eosine, Mallory Trichromic and Brown and Brenn. The histopathological analysis had evidenced that the AH Plus sealer shows more biological compatibility in relation to the Sealer Plus being the sealer that shows more good deposition of mineralized tissue to the apical level, offering an almost full apical sealing in the majority of the cases, with infiltrated inflammatory absent and when present was mild in the interstitial tissue and/or together to the material sealer, as well as in the periapical region. With the Sealer Plus, partial apical sealing occurred, however always followed by infiltrated inflammatory of mild degree in the intersticial tissue, however, more concentrated, together to the filling material when in the periapical region, the inflammatory infiltrated was presented, classified as of moderate degree. 2. In vitro study - With the objective to analyze pH and clearing of total calcium by periods that had varied from 0 to the 5 days, the filling materials. AH Plus and Sealer Plus had been manipulated according to the manufacturers instructions. Samples of each sealer were prepared, which had been weighed separately and placed in distilled water, remaining at constant relation of mass/volume. In relation to the pH, the AH Plus sealer offered, after the reaction, one pH of 6.0, and soon after that, presented a variation, becoming constant after 24 hours and with pH alkaline of 7.5. Already the Sealer Plus, presented pH increasing, until 5 days (pH = 10.54). In relation to the clearing of total calcium, the results show that the Sealer Plus liberated a great amount of total calcium until 5 days (14.89 ppm), being more soluble than AH Plus, that offers until 5 days, minor calcium clearing (0.144 ppm)