Comparative Analysis of Interfacial Adaptation and Depth Penetration of Recent HiFlow versus Regular Bioceramic Sealers in Conjunction with BC Gutta-Percha Points Using Two Different Obturation Techniques-A Preliminary Report of an Ex Vivo Study.

This study aimed to assess the adaptability and penetration depth capacity of recent bioceramic systems, including regular EndoSequence (BC) versus HiFlow (BCH) sealers in the presence of BC points. A total of 54 single-rooted teeth were instrumented and obturated with either the cold or warm compaction technique (n = 9), using either BC, BCH, or AH Plus (AHP) combined with BC points. The adaptation, film thickness, and gaps/voids were evaluated by scanning electron microscopy. The sealer/dentin interface was evaluated by Raman spectroscopy, and depth penetration was evaluated by a confocal laser scanning microscope. According to the normality test, the data were statistically analyzed by ANOVA or Kruskal-Wallis and Mann-Whitney U tests at p < 0.05. BCH sealer showed the significantly thinnest film with the greatest flow (p > 0.001), with further improvement when subjected to the warm compaction technique. Moreover, it exhibited close adaptation with deep penetration into radicular dentin, forming a tag-like structure. The Raman spectra also indicated close contact with the dentin surface. The use of BC sealer with BC points exhibited homogenous, single-unit obturation, either with a cold or warm technique. Furthermore, the use of the warm compaction technique with BCH sealer achieved a gap-free interface associated with tag-like structures, which exhibit the monoblock phenomenon.

Characterisation of the Bioactivity and the Solubility of a New Root Canal Sealer.

OBJECTIVES: This study aimed to analyse the effect of using phosphate buffer solution (PBS) on the solubility, pH changes, surface structure, and elemental composition of a new bioceramic Cerafill sealer compared with Endosequence sealer and AH26 resin-based sealer. METHODS: A fresh mixture of each sealer moistened with either deionised water or PBS was subjected to a setting time test. Set discs (n = 10) were submerged in either deionised water or PBS to evaluate pH changes and solubility at 1, 7, 14, 21, and 28 days. Surface characterisation of the sealers was done before and after solubility tests using scanning electron microscopy (SEM), energy-dispersive X-ray (EDX), and Fourier transform infrared (FTIR) spectroscopy analyses. RESULTS: An analysis of variance revealed a significant delay in setting of BC-Endosequence (P < .001) with no significant difference when each sealer was moistened with deionised water or PBS (P > .05). Both bioceramic sealers exhibited highly alkaline pH (range, 9.47-10.72). When the sealer was submerged in deionised water, Endosequence exhibited significantly greater solubility, whilst Cerafill and AH26 gained weight. When the sealers were submerged in PBS, both bioceramic sealers gained more weight, with significantly greater values for Endosequence (P < .001). Hydroxyapatite formation was revealed by SEM/EDX and FTIR. CONCLUSIONS: PBS promoted the formation of hydroxyapatite crystals that protect the bioceramic sealers from dissolving.

Root fracture healing outcome after a revascularization procedure: an 8-year follow-up case report.

Pulp revascularization is the traditional protocol for treating immature necrotic teeth; however, it is not the usual management practice for traumatized teeth with horizontal root fracture. This is a case report of an 11-year-old patient subjected to trauma that occurred four years prior to treatment. The trauma led to horizontal root fracture in tooth #11, and the immature tooth #21 became necrotic with periapical radiolucency. Both teeth were treated with revascularization procedures. Each tooth was disinfected with triple antibiotic paste and a coronal seal using mineral trioxide aggregate. During the eight-year follow-up using periapical radiograph and cone beam computed tomography, tooth #21 showed periapical repair with apical closure. The fractured rooted tooth #11 was functional and asymptomatic, with evidence of bone growth inside the fracture line. From this case outcome, revascularization can be a successful treatment modality for traumatized teeth that have either root fracture or necrotic open apex.

A Prospective Study of Long-Term Regenerative Endodontics Outcomes of Necrotic Immature Permanent Teeth: An 8-Year Follow-Up.

For the management of necrotic immature teeth, regenerative endodontics offers the advantage of further root lengthening, thickening of dentin wall, and apical closure. This prospective study aimed to evaluate the long-term outcome of regenerative endodontics in immature necrotic permanent teeth. A total of 23 immature roots were medicated by triple antibiotic paste. After 21 days, bleeding was induced by over-instrumentation, and then mineral trioxide aggregate and coronal restoration were applied. Patients were scheduled for clinical and radiographic follow-up for 8 years. The radiographic changes of root dimensions were assessed using the ImageJ Plugin and statistically analyzed by Kruskal-Wallis test at a 95% confidence level. For qualitative evaluation, images were overlapped and analyzed using Photoshop software. All teeth were asymptomatic one month after the treatment. All teeth (n = 18) with preoperative periapical radiolucency showed complete resolution within 6-9 months. Recall rate at two, three, and eight years was 69.6%, 56.5%, and 34.8%, respectively. Continuous root development with a significant increase in root length and thickening of dentin wall accompanied by a significant decrease in apical canal diameter was seen at the end of the observation period (p < 0.001). In conclusion, the long-term outcome of regenerative endodontics revealed successful clinical and radiographic results with appropriate case selection.

Morphological and chemical analysis of surface interaction of irrigant-endosequence root repair material.

This study aimed to evaluate the characterization of chemical interaction of root canal irrigants on the surface of EndoSequence root repair materials using spectroscopy analysis. Round discs of putty and paste were obtained and immersed in saline, sodium hypochlorite (NaOCl), or chlorhexidine. On the surface of chlorhexidine treated putty, diffuse red pigmentation was detected by Raman analysis and diffuse black pigmentation having unusual needle-like shaped crystals was detected by scanning electron microscopy. This pigmentation formed from nitrogen-rich compounds detected by Raman, infrared spectroscopy, and X-ray diffraction analysis. Mineral/amide ratios were increased by NaOCl and significantly decreased by chlorhexidine. Carbonate/phosphate ratios showed no significant changes by NaOCl, while a significant decrease by chlorhexidine. A full half of maximum widthRaman of the phosphate band was significantly increased by NaOCl, while decreased by chlorhexidine. In conclusion; nitrogen-rich compounds produced by chlorhexidine altered the surface morphology of the putty without crystallinity reduction. However, NaOCl reduced the organic fillers that affected its binding to phosphate ions. This reaction affects the chemical properties and perfection of root repair material. The clinicians should be aware of different irrigants to be used after repairing the perforation.

Morphological and Spectroscopic Study of an Apatite Layer Induced by Fast-Set Versus Regular-Set EndoSequence Root Repair Materials.

This study aimed to evaluate the morphology and chemistry of an apatite layer induced by fast-set versus regular-set EndoSequence root repair materials using spectroscopic analysis. Holes of a 4 mm diameter were created in the root canal dentin, which were filled with the test material. Fetal calf serum was used as the incubation medium, and the samples incubated in deionized water were used as controls. The material-surface and material-dentin interfaces were analyzed after 28 days using Raman and infrared spectroscopy, scanning electron microscopy/energy dispersive X-ray, and X-ray diffraction. After incubation in fetal calf serum, both materials formed a uniform layer of calcium phosphate precipitate on their surfaces, with the dentinal interface. This precipitated layer was a combination of hydroxyapatite and calcite or aragonite, and had a high mineral maturity with the regular-set paste. However, its crystallinity index was high with the fast-set putty. Typically, both consistencies (putty and paste) of root repair material have an apatite formation ability when they are incubated in fetal calf serum. This property could be beneficial in improving their sealing ability for root canal dentin.

Induction of Osteogenic Differentiation of Mesenchymal Stem Cells by Bioceramic Root Repair Material.

This study aimed to evaluate the osteogenic activity of Endosequence Root Repair Material (ERRM) putty using rat mesenchymal stem cells (MSCs). The extract of set ERRM and ProRoot-mineral trioxide aggregate (MTA) (control) was cocultured with rat MSCs and incubated for one, three, and seven days. The cell viability and proliferation were assessed. A quantitative real-time polymerase chain reaction for bone morphogenetic protein-2 (BMP-2), alkaline phosphatase, bone sialoprotein, and osteocalcin gene expression was performed. Both materials enhanced cell viability and proliferation, which increased over time. On day seven, the cells treated with either material exhibited significantly greater cell viability compared with control untreated cells. MSCs treated with either material showed deeper alkaline phosphatase staining after three days compared to control untreated cells. Treated MSCs also exhibited upregulation of the gene expression of bone morphogenetic protein-2, alkaline phosphatase, bone sialoprotein, and osteocalcin. Both ERRM and ProRoot-MTA enhance the osteogenic differentiation of MSCs.

Effect of Irrigants on the Push-Out Bond Strength of Two Bioceramic Root Repair Materials.

The purpose of this study was to compare different irrigants' effect on two EndoSequence root repair materials' push-out bond strength. Sixty root slices were filled either with EndoSequence premixed fast-set putty or regular-set paste, and then immersed either in sodium hypochlorite, chlorhexidine gluconate, or saline (as control) for 30 min, after which the slices were subjected to the push-out test. The surface structures were evaluated with Scanning Electron Microscopy and Fourier Transform Infrared. Fast-set putty exhibited greater displacement resistance when immersed in saline and subjected to adhesive failure mode, while regular-set paste showed greater resistance when immersed in chlorhexidine and subjected to cohesive failure mode. Infrared analysis showed changes in organic filler, and carbonate and phosphate bands after using irrigants. The lowest carbonate/phosphate ratio was found for chlorhexidine in both materials. Therefore, sodium hypochlorite reduced EndoSequence root repair materials' displacement resistance markedly.