Evaluation of Cytotoxicity, Cell Attachment, and Elemental Characterization of Three Calcium Silicate-Based Sealers.

We investigated three calcium silicate-based sealers with respect to their chemical characterization, cytotoxicity, and attachment to RAW264.7 cells. BioRoot RCS (BR), Bio-C Sealer (BC), and Sealer Plus BC (SPBC) were assessed using Fourier transform infrared spectroscopy (FTIR), X-ray fluorescence spectroscopy (XRF), and energy-dispersive X-ray spectroscopy (EDX) (n = 4) for elemental characterization, and using scanning electron microscopy (SEM) to evaluate cell morphology and adhesion. Cytotoxicity was determined at different dilutions (1:1, 1:2, and 1:5) using the succinate dehydrogenase activity (MTT assay). Statistical analysis was performed for normal distribution using the Shapiro-Wilk test and for homoscedasticity using Levene's test, and one-way ANOVA, Tukey's/Dunnett's post hoc tests for cell viability and XRF (α = 0.05). Calcium silicate hydrate and calcium hydroxide were detected by FTIR in all groups. EDX detected a higher calcium content for BR and SPBC and aluminum only in the premixed sealers. XRF detected the highest calcium release in BR (p < 0.05). The surface morphology showed irregular precipitates for all the sealers. SPBC at a 1:2 dilution resulted in the lowest cell viability compared to BR (p < 0.05) and BC (p < 0.05). The calcium silicate-based sealers produced a statistically significant reduction in cellular viability at a 1:1 dilution compared to the control group (p < 0.0001). All the sealers maintained viability above 70%.

Physicochemical properties and osteoclastogenesis for three premixed calcium silicate-based sealers post set.

Solubility, pH, ion release, cytotoxicity, and osteoclastogenesis inhibition in bone marrow-derived monocyte macrophages (BMMs) were evaluated in EndoSequence BC Sealer (END), Bio-C Sealer (BC), and Sealer Plus BC (SPBC). pH was determined after immersion of the sealers in deionized water (DW) and Minimum Essential Medium Alpha (α-MEM). Solubility was obtained by mass loss. Ion release was measured by using X-ray fluorescence spectroscopy (XRF). Cytotoxicity was evaluated by MTT assay. Inhibition of osteoclastogenesis was evaluated by tartrate-resistant acid phosphatase (TRAP). Data were analyzed using the t-test, ANOVA and Tukey/Dunnett's post-hoc tests (α = 0.05). END had the highest pH in DW (p < 0.05), and BC, in α-MEM (p < 0.05). Solubility in DW was the lowest for SPBC (p < 0.005). The highest calcium release was observed for BC in DW at 12 h (p < 0.05), and in α-MEM at 12 and 24 h (p < 0.05). The lowest toxicity was detected for END (p < 0.05). BC had the highest inhibitory effect on osteoclasts (p < 0.05). Overall, the highest solubility and pH values were found in DW. However, the calcium silicate-based sealer showed higher solubility than the ISO standards. Calcium release was the highest for BC. END showed the highest cell viability, and BC, the highest osteoclast inhibition.

Physicochemical properties and osteoclastogenesis for three premixed calcium silicate-based sealers post set

Abstract: Solubility, pH, ion release, cytotoxicity, and osteoclastogenesis inhibition in bone marrow-derived monocyte macrophages (BMMs) were evaluated in EndoSequence BC Sealer (END), Bio-C Sealer (BC), and Sealer Plus BC (SPBC). pH was determined after immersion of the sealers in deionized water (DW) and Minimum Essential Medium Alpha (α-MEM). Solubility was obtained by mass loss. Ion release was measured by using X-ray fluorescence spectroscopy (XRF). Cytotoxicity was evaluated by MTT assay. Inhibition of osteoclastogenesis was evaluated by tartrate-resistant acid phosphatase (TRAP). Data were analyzed using the t-test, ANOVA and Tukey/Dunnett's post-hoc tests (α = 0.05). END had the highest pH in DW (p < 0.05), and BC, in α-MEM (p < 0.05). Solubility in DW was the lowest for SPBC (p < 0.005). The highest calcium release was observed for BC in DW at 12 h (p < 0.05), and in α-MEM at 12 and 24 h (p < 0.05). The lowest toxicity was detected for END (p < 0.05). BC had the highest inhibitory effect on osteoclasts (p < 0.05). Overall, the highest solubility and pH values were found in DW. However, the calcium silicate-based sealer showed higher solubility than the ISO standards. Calcium release was the highest for BC. END showed the highest cell viability, and BC, the highest osteoclast inhibition.

Effect of irrigation protocols on root canal wall after post preparation: a micro-CT and microhardness study.

The aim of this study was to investigate the effects of different post space irrigation protocols for removing residual filling material from dentin walls, by using microcomputed tomography (micro-CT), and the influence of these protocols on dentin microhardness. Bovine incisors (n = 35) were filled with the single-cone technique and MTA Fillapex (Angelus, Londrina, PR, Brazil). Post space preparation (PSP) was performed 7 days after filling, using the Odous Touch electrical system (Odous De Deus Ind. e Com., Belo Horizonte, MG, Brazil), followed by post space irrigation using manual irrigation, passive ultrasonic irrigation, or Easy Clean, together with 2.5% sodium hypochlorite (NaOCl), or with 2.5% NaOCl and 17% EDTA (NaOCl/EDTA). Micro-CT scans were performed at three time points. The residual filling material was evaluated at three levels: cervical, middle and apical. The Knoop test was measured with four indentations around the canal lumen at three dentin depths: X (100 µm), Y (200 µm) and Z (400 µm). Statistical analysis was performed using ANOVA (p < 0.05). The effects of the activation method (p < 0.001), and the root level (p = 0.013), as well as the interaction between the irrigant and the activation method (p = 0.041), led to different percentages of residual filling material. Lower amounts of residual filling material were observed at the cervical versus the middle and apical levels (p < 0.05). No significant differences were observed in dentin microhardness (p > 0.05). The best removal of the residual filling material was performed using the Easy Clean tip and NaOCl/EDTA, regardless of the activation methods.

Influence of chelating solutions on tubular dentin sealer penetration: A systematic review with network meta-analysis.

This systematic review assessed the influence of conventional final irrigation with chelating solutions (CS) on tubular dentin sealer penetration (TDSP). The literature search was conducted in eight electronic databases using MeSH, DeCS, EMTREE and free terms. The study protocol followed the PRISMA guidelines and was registered on the PROSPERO database (CRD42020203080). Twelve studies were included, and a qualitative synthesis and network meta-analysis of the data were performed. The risk of bias of the studies was assessed using an adaptation of the JBI Critical Appraisal tool. QMix was the solution with the highest probability of having the highest percentage of TDSP in the apical (34.1%), middle (86.5%) and coronal (97.7%) thirds. Eleven studies presented a moderate risk of bias, whereas one study presented a high risk of bias. In conclusion, CS improves sealer penetration into the dentinal tubules with QMix demonstrating superior results.

Effect of irrigation protocols on root canal wall after post preparation: a micro-CT and microhardness study

Abstract: The aim of this study was to investigate the effects of different post space irrigation protocols for removing residual filling material from dentin walls, by using microcomputed tomography (micro-CT), and the influence of these protocols on dentin microhardness. Bovine incisors (n = 35) were filled with the single-cone technique and MTA Fillapex (Angelus, Londrina, PR, Brazil). Post space preparation (PSP) was performed 7 days after filling, using the Odous Touch electrical system (Odous De Deus Ind. e Com., Belo Horizonte, MG, Brazil), followed by post space irrigation using manual irrigation, passive ultrasonic irrigation, or Easy Clean, together with 2.5% sodium hypochlorite (NaOCl), or with 2.5% NaOCl and 17% EDTA (NaOCl/EDTA). Micro-CT scans were performed at three time points. The residual filling material was evaluated at three levels: cervical, middle and apical. The Knoop test was measured with four indentations around the canal lumen at three dentin depths: X (100 μm), Y (200 μm) and Z (400 μm). Statistical analysis was performed using ANOVA (p < 0.05). The effects of the activation method (p < 0.001), and the root level (p = 0.013), as well as the interaction between the irrigant and the activation method (p = 0.041), led to different percentages of residual filling material. Lower amounts of residual filling material were observed at the cervical versus the middle and apical levels (p < 0.05). No significant differences were observed in dentin microhardness (p > 0.05). The best removal of the residual filling material was performed using the Easy Clean tip and NaOCl/EDTA, regardless of the activation methods.

Effect of Endodontic Sealer in Young Molars Treated by Undergraduate Students - A Randomized Clinical Trial.

The progression of caries in permanent molar teeth of young patients, frequently result in endodontic treatment. This randomized blinded clinical trial assessed the effect of two endodontic sealers (Sealer 26 and AH Plus) on the incidence of pain and apical repair after endodontic treatment of young molar teeth, and secondly identify factors associated with the outcomes. Endodontic treatment was performed by undergraduate students in molar teeth (n=69) of young patients (n=54) at the Endodontic and Restorative Public Extension Clinic Service. Protaper Next was used and the endodontic sealers were allocated which were restored with direct composite resin. Two primary clinical outcomes - apical repair and postoperative pain, were assessed after 12 and 24 months for blinded operators. Description of incidence rates and mixed-model regression using Generalized Estimation Equations (GEE). After 2 years 69 molar teeth of 54 patients were evaluated. No effect of the endodontic sealer was observed irrespective of period of evaluation. Apical repair incidences and asymptomatic teeth were, respectively, 90.5 and 89.3, 96.8 and 90.0% during 1 and 2 years of follow-up. Failed apical repair was associated with unsatisfactory pulpectomy (p=0.003) and periapical conditions (p=0.007) as well as their interaction (p=0.016). None of these independent variables was able to predict the occurrence of pain in both periods. Prognosis of apical repair is dependent on the initial conditions. Endodontic treatment of young molars associated with composite resin restorations performed by undergraduate students have satisfactory results after 2 years and was effective to prevent the risk of permanent teeth loss.

Apical Displacement and Residual Root Canal Filling with Single-Cone After Post Space Preparation: A Micro-CT Analysis.

The purpose of this study was to evaluate the presence of residues after post space preparation (PSP) and establish whether the apical displacement of the gutta-percha was affected by the moments and methods of PSP in teeth filled by the single-cone technique. The root canals of 20 bovine incisor teeth were instrumented with Reciproc and filled with single-cone and AH Plus. The specimens were divided into 4 groups according to the moment and method of PSP (n=5): immediate with drill, immediate with thermoplasticizer, delayed with drill and delayed with thermoplasticizer. Micro-CT scans were performed before and after the PSP for residues of the root canal filling (1) and analysis of apical displacement (2). Data were analyzed by using 2-way repeated measurement ANOVA (1) and 2-way ANOVA (2) followed by the Tukey's test (a=0.05). Significance effect on the residues percentage remaining for methods (p=0.044), for moments (p=0.006), for thirds repetition (p<0.001), and for interaction between methods and thirds (p<0.001), and moments and thirds (p=0.044). Significance effect on the apical displacement of root canal filing was detected for methods (p=0.008), however no difference was found between moments (p=0.617). In general, PSP using drill resulted in more homogeneous root canal preparation, mainly when made immediately. For all other combinations between methods and moments for PSP, the middle and apical thirds presented significant higher residues remaining. Thermo method performed in both moments and the drill method performed immediately had displacement in the apical direction, representing extrusion of the root filling material.

Effect of temperature and humidity on post-gel shrinkage, cusp deformation, bond strength and shrinkage stress - Construction of a chamber to simulate the oral environment.

OBJECTIVES: Evaluate the effect of environment on post-gel shrinkage (Shr), cuspal strains (CS), microtensile bond strength (µTBS), elastic modulus (E) and shrinkage stress in molars with large class II restorations. METHODS: Sixty human molars received standardized Class II mesio-oclusal-distal cavity preparations. Restorations were made with two composites (CHA, Charisma Diamond, Heraus Kulzer and IPS Empress Direct, Ivoclar-Vivadent) using three environment conditions (22°C/50% humidity, 37°C/50% humidity and 37°C/90% humidity) simulated in custom developed chamber. Shr was measured using the strain gauge technique (n=10). CS was measured using strain gauges. Half of the teeth (n=5) were used to assess the elastic modulus (E) and Knoop hardness (KHN) at different depths using microhardness indentation. The other half (n=5) was used to measure the µTBS. The composites and environment conditions were simulated in a two-dimensional finite element analysis of a tooth restoration. Polymerization shrinkage was modeled using Shr data. The Shr, CS, µTBS, KHN and E data were statistically analyzed using two-way ANOVA and Tukey test (significance level: 0.05). RESULTS: Both composites had similar Shr, CS, µTBS and shrinkage stress. CHA had higher elastic modulus than IPS. Increasing temperature and humidity significantly increased Shr, CS and shrinkage stress. µTBS were similar for groups with lower humidity, irrespective of temperature, and higher with higher humidity. E and KHN were constant through the depth for CHA. E and KHN values were affected by environment only for IPS, mainly deeper in the cavity. Shrinkage stress at dentin/composite interface had high inverse correlation with µTBS. Shrinkage stress in enamel had high correlation with CS. CONCLUSIONS: Increasing temperature and humidity caused higher post-gel shrinkage and cusp deformation with higher shrinkage stresses in the tooth structure and tooth/restoration interface for both composites tested. The chamber developed for simulating the oral environment conditions will improve the realism of in vitro studies. Clinical significance Simulating oral temperature and humidity is important to better determine the biomechanical behavior of composite resin restoration. Avoiding high humidity during restorative procedures using rubber dam isolation may reduce cuspal deformation and shrinkage stress and improve the bonding strength of posterior composite restorations.

Effect of silane type and air-drying temperature on bonding fiber post to composite core and resin cement.

This study evaluated the influence of silane type and temperature of silane application on push-out bond strength between fiberglass posts with composite resin core and resin cement. One hundred and sixty fiberglass posts (Exacto, Angelus) had the surface treated with hydrogen peroxide 24%. Posts were divided in 8 groups according to two study factors: air-drying temperature after silane application (room temperature and 60 ºC) and silane type: three pre-hydrolyzed--Silano (Angelus), Prosil (FGM), RelyX Ceramic Primer (3M ESPE) and one two-component silane--Silane Coupling Agent (Dentsply). The posts (n=10) for testing the bond strength between post and composite core were centered on a cylindrical plastic matrix and composite resin (Filtek Z250 XT, 3M ESPE) that was incrementally inserted and photoactivated. Eighty bovine incisor roots (n=10) were prepared for testing the bond strength between post and resin cement (RelyX U100, 3M ESPE) and received the fiberglass posts. Push-out test was used to measure the bond strength. Data were analyzed by two-way ANOVA followed by Tukey's test (α=0.05). ANOVA revealed that temperature and silane had no influence on bond strength between composite core and post. However, for bond strength between post and resin cement, the temperature increase resulted in a better performance for Silane Coupling Agent, Silano and RelyX Ceramic Primer. At room temperature Silane Coupling Agent showed the lowest bond strength. Effect of the warm air-drying is dependent on the silane composition. In conclusion, the use of silane is influenced by wettability of resinous materials and pre-hydrolyzed silanes are more stable compared with the two-bottle silane.

Effect of Silane Type and Air-Drying Temperature on Bonding Fiber Post to Composite Core and Resin Cement

This study evaluated the influence of silane type and temperature of silane application on push-out bond strength between fiberglass posts with composite resin core and resin cement. One hundred and sixty fiberglass posts (Exacto, Angelus) had the surface treated with hydrogen peroxide 24%. Posts were divided in 8 groups according to two study factors: air-drying temperature after silane application (room temperature and 60 ºC) and silane type: three pre-hydrolyzed - Silano (Angelus), Prosil (FGM), RelyX Ceramic Primer (3M ESPE) and one two-component silane - Silane Coupling Agent (Dentsply). The posts (n=10) for testing the bond strength between post and composite core were centered on a cylindrical plastic matrix and composite resin (Filtek Z250 XT, 3M ESPE) that was incrementally inserted and photoactivated. Eighty bovine incisor roots (n=10) were prepared for testing the bond strength between post and resin cement (RelyX U100, 3M ESPE) and received the fiberglass posts. Push-out test was used to measure the bond strength. Data were analyzed by two-way ANOVA followed by Tukey's test (a=0.05). ANOVA revealed that temperature and silane had no influence on bond strength between composite core and post. However, for bond strength between post and resin cement, the temperature increase resulted in a better performance for Silane Coupling Agent, Silano and RelyX Ceramic Primer. At room temperature Silane Coupling Agent showed the lowest bond strength. Effect of the warm air-drying is dependent on the silane composition. In conclusion, the use of silane is influenced by wettability of resinous materials and pre-hydrolyzed silanes are more stable compared with the two-bottle silane.

Este estudo avaliou a influência do tipo de silano e a aplicação de temperatura no silano na resistência de união por push-out entre pinos de fibra de vidro com núcleo de preenchimento em resina composta e cimento resinoso. Cento e sessenta pinos de fibra de vidro (Exacto, Angelus, Londrina, PR, Brasil) receberam tratamento de superfície com peróxido de hidrogênio a 24%. Os pinos foram divididos em 8 grupos com dois fatores em estudo: temperatura de secagem de ar após a aplicação do silano (temperatura ambiente e 60 ºC) e o tipo de silano: três pré-hidrolisados - Silano (Angelus), Prosil (FGM), RelyX Ceramic Primer (3M ESPE) e um silano de dois frascos - Silane Coupling Agent (Dentsply). Para o teste de resistência de união entre pino e núcleo de preenchimento, os pinos (n=10) foram centralizados em uma matriz plástica cilíndrica e a resina composta (Filtek Z250 XT, 3M ESPE) foi incrementalmente inserida e fotopolimerizada. Para o teste de resistência de união entre pino e cimento resinoso (RelyX U100, 3M ESPE) 80 raízes de incisivos bovinos (n=10) foram preparadas e receberam os pinos de fibra de vidro. Teste de push-out foi usado para mensurar a resistência de união. Os dados foram analisados por ANOVA fatorial seguido do teste de Tukey (a=0,05). Temperatura e silano não tiveram influência na resistência de união entre núcleo de preenchimento e pino. Entretanto, para a resistência de união entre pino e cimento resinoso, o aumento da temperatura resultou em um melhor desempenho para Silane Coupling Agent, Silano e RelyX Ceramic Primer. Além disso, na temperatura ambiente Silane Coupling Agent teve a menor resistência de união. O efeito da secagem de ar quente é dependente da composição do silano. Concluindo, o uso do silano é influenciado pela molhabilidade dos materiais resinosos e os silanos pré-hidrolisados são mais estáveis comparados ao silano de dois frascos.