Evaluation of Microleakage of Nanoparticle-incorporated Cyanoacrylate Root Canal Sealer Using the Radioisotopic Method: An In Vitro Study.

AIM OF THE STUDY: The study aimed to assess the microleakage of nanoparticle-based (NPB) cyanoacrylate sealer and epoxy resin-based (ERB) sealer using radioisotope method and confocal laser scanning microscopy (CLSM). MATERIALS AND METHODS: A total of 100 single-rooted teeth were collected; specimens were accessed, instrumented, and irrigated, and randomly distributed into 4 groups of 25 samples each: Group I: Positive control, group II: Negative control, group III: Obturated with NPB sealer, and group IV: Obturated with ERB sealer. All samples were immersed in 99mTc pertechnetate solution, for 3 hours after which radioactivity was estimated under a Gamma camera. The radioactivity released by specimens before and after nail varnish removal was statistically analyzed. After 2 weeks, the same samples were used for CLSM analysis. The sealer tubular penetration depth was measured at the deepest level for each group using ZEN lite 2012. Data collected was statistically evaluated. RESULTS: The amount of radioactivity observed at first in group III and group IV was 194.76 and 599.12 units, respectively, with p-value < 0.001, indicating significant interaction, and after nail varnish removal, it was 89.68 and 468.44 units, respectively, with a p-value < 0.001; again, indicating statistical significance. Hence, the radioactivity of NPB sealer was found to be lower than ERB sealer in both cases, indicating better sealing of the former. The photomicrographs show that mean value of dye penetration in NPB sealer in first, second, and third segment from apex was 85.06, 75.73, and 66.09, respectively; while in the case of ERB sealer, those were 597.28, 461.17, and 195.68, respectively; with p-value < 0.001; signifying that NPB sealer exhibited higher resistance to microleakage than ERB sealer. CONCLUSION: The NPB sealer can become a potential root canal sealer in future endodontics due to superior physiochemical properties attributed to the cyanoacrylate and incorporated nanoparticles. CLINICAL SIGNIFICANCE: The study clinically signifies that we can equally use the radioisotopic method along with confocal method while conducting the microleakage studies. In addition, NPB sealer can be an emerging replacement with better properties than gold standard root canal sealers for clinical use. How to cite this article: Shetty C, Qaiser S, Shetty A, et al. Evaluation of Microleakage of Nanoparticle-incorporated Cyanoacrylate Root Canal Sealer Using the Radioisotopic Method: An In Vitro Study. J Contemp Dent Pract 2024;25(4):335-341.

An in vitro evaluation of endodontic sealers and an antibiotic to assess their antimicrobial effect against Enterococcus faecalis.

Objective: This study aimed to compare the antimicrobial effect of three endodontic sealers (AH Plus, Mineral trioxide aggregate [MTA] Fillapex, and BioRoot RCS) with and without amoxicillin against E. faecalis. Methodology: Amoxicillin, equivalent to 10% of the sealers' total weight, was mixed with the sealers. Another batch was prepared without amoxicillin. The direct contact test (DCT) and the agar diffusion test were used to assess the antibacterial effect. Results were analysed using one-way analysis of variance (ANOVA), the F-test, and the Kruskal-Wallis test. Results: AH Plus significantly suppressed E. faecalis without the addition of amoxicillin in the DCT (p = 0.011), while in the agar diffusion test, BioRoot RCS had a larger inhibition zone than the control (p < 0.001). When amoxicillin was added to the sealers, AH Plus (p = 0.003) and MTA Fillapex (p = 0.042) reduced E. faecalis growth. In contrast, all three sealers showed larger inhibition zones than the control (p = 0.001), with AH Plus displaying a larger inhibition zone than MTA Fillapex (p = 0.042) and BioRoot RCS (p = 0.032). Conclusions: It was thus concluded that the addition of amoxicillin to endodontic sealers enhances their antimicrobial activity against E. faecalis.

To check the antibacterial efficacy against Enterococcus faecalis by various ayurvedic oils used as a solvent in endodontic sealers - An in vitro study.

Aim: The aim of the study is to check the antibacterial efficacy of various ayurvedic oils used as a solvent with zinc oxide for preparing endodontic sealers. Materials and Methods: Forty-five extracted premolars were taken and were cut coronally and apically such that 7 mm of tooth specimen was prepared. Teeth were sterilized by autoclaving inoculated with Enterococcus faecalis and incubated for 24 h. The specimens were divided into three groups of 15 each. Group 1 - ZnO powder + Eugenol, Group 2 - ZnO powder + Aremidadi Oil, and Group 3 - ZnO powder + Dashmool oil. Bacterial growth in each specimen was calculated before and after sealer application and noted as the initial and final colony count. The antimicrobial effect of each sealer was measured by calculating the percentage reduction in colony count (%). One-way analysis of variance and post hoc tests will be used for statistical analysis. Results: The Zn + Arimedadi oil group showed the maximum antibacterial effect among the sealers tested and the Zn + eugenol sealer showed the least antimicrobial effect In comparison, there was a statistically significant difference between all the groups. Conclusion: Ayurvedic oil-based root canal sealers showed better antibacterial efficacy than eugenol-based sealers. Arimedadi oil showed the highest antibacterial activity against E. faecalis and Eugenol showed the least when used as a solvent.

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.

Comparative evaluation of resin-based sealers and bioceramic sealers for postoperative pain after endodontic treatment: A systematic review.

The systematic review aimed to compare and evaluate the effect of resin-based sealers and bioceramic sealers on postoperative pain after endodontic treatment. Two reviewers independently conducted electronic search in PubMed, the Web of Science, ScienceDirect, the Wiley Online Library, SpringerLink, Google Scholar, and the Cochrane Library, employing a complete dual-review process to ensure the inclusion of all relevant studies in the review. The search was carried out until November 2021. After selecting eligible studies, the risk of bias assessment was carried out using the revised Cochrane risk-ofbias tool for randomized trials (RoB 2). A total of 1,931 studies were identified from the electronic search, and finally 10 studies were included after full-text assessment. In all our included studies, the visual analog scale (VAS) was used for recording pain scores. Most of the studies recorded pain intensity starting from 6 h to 7 days. The results showed that there was no significant difference between resin-based sealers and bioceramic sealers in terms of incidence or intensity of postoperative pain at any point in time.

Characterisation and evaluation of physical properties of AH-Plus sealer with and without the incorporation of petasin, pachymic acid, curcumin and shilajit-an invitro study.

BACKGROUND: AH Plus, an epoxy resin-based sealer, is widely used in endodontic practice, owing to its good physical properties that confers longstanding dimensional stability and good adhesion to dentin. Nevertheless, its propensity to trigger inflammation, especially in its freshly mixed state, has been extensively documented. Phytochemicals such as Petasin, Pachymic acid, Curcumin, and Shilajit are known for their anti-inflammatory and analgesic effects. This study aimed to analyze and determine the effect of these natural products on the physical properties of AH Plus sealer when incorporated with the sealer. METHODS: AH Plus (AHR) sealer was mixed with 10% petasin, 0.75% pachymic, 0.5% and 6%shilajit to obtain AHP, AHA, AHC and AHS in the ratio of 10:1 and 5:1 respectively. Five samples of each material were assessed for setting time, solubility, flow, and dimensional stability in accordance with the ISO 6876:2012 standardization. Sealers were characterized through scanning electron microscopy (SEM), X-ray energy dispersive spectroscopy, X-ray diffraction (XRD), and Fourier transform infrared (FTIR) spectroscopy. Statistical evaluation involved the Kolmogorov-Smirnov and Shapiro-Wilks tests for normality and the one-way ANOVA test for analysis. RESULTS: In this investigation, the characterisation analysis revealed a relatively similar microstructure in all the experimental root canal sealers. All experimental groups, excluding the control group, exhibited an increase in flow ranging from 11.9 to 31.4% at a 10:1 ratio. Similarly, for the 5:1 ratio, the increase ranged from 12.02 to 31.83%. In terms of dimensional stability, all groups at the 10:1 ratio showed a decrease compared to the control group. The addition of natural agents to AHR in 10:1 ratio led to a reduction in setting time by 8.9-31.6%, and at a 5:1 ratio, the reduction ranged from 8.1 to 31.5%. However, regarding solubility, the addition of natural agents did not induce any significant alterations. CONCLUSION: Based on the results of this study, it can be concluded that all tested root canal sealers exhibited properties that met the acceptable criteria outlined in the ISO 6876:2012 standardization.

Comparative Evaluation of the Sealing Ability of Mineral Trioxide Aggregate (MTA)-Based, Resin-Based, and Zinc Oxide Eugenol Root Canal Sealers: An In Vitro Study.

Root canal therapy is a crucial procedure in endodontics that is done to achieve complete obliteration of the root canal space. The success of this therapy depends on achieving a proper seal, which is facilitated using root canal sealers. This study aimed to compare the apical sealing ability of three different root canal sealers: MTA Fillapex, AH Plus, and zinc oxide eugenol (ZOE), using the dye penetration method. Forty freshly extracted single-rooted human maxillary incisors were collected and prepared for the study. The root canals were instrumented using the ProTaper system, and the canals were then obturated using the lateral condensation technique with the respective sealers. After one week of storage, the samples were coated with nail varnish, immersed in a rhodamine B dye solution, and then sectioned longitudinally. The depth of dye penetration was measured, and the results were analyzed statistically. The results revealed significant differences in apical leakage among the three experimental groups. Group 2 (AH Plus) showed the minimum leakage with a mean of 0.13 mm, while Group 4 (no sealer) exhibited the maximum leakage with a mean of 4.49 mm. Group 3 (ZOE) showed an intermediate level of leakage with a mean of 2.37 mm. The statistical analysis confirmed the significant difference in mean leakage among the groups. The findings of this study indicate that AH Plus exhibited superior apical sealing ability compared to MTA Fillapex and ZOE. AH Plus is a resin-based sealer known for its dimensional stability. On the other hand, MTA Fillapex, a newly introduced sealer containing mineral trioxide aggregate, resin, and silica, showed promising sealing properties but had slightly higher leakage compared to AH Plus. ZOE, a traditional sealer, demonstrated relatively higher leakage than the other sealers. In conclusion, choosing a root canal sealer is crucial in achieving a successful endodontic treatment outcome. AH Plus demonstrated superior apical sealing ability among the three sealers tested. Further research and long-term clinical studies are warranted to validate these findings and assess the impact of sealer choice on treatment outcomes and post-endodontic healing.

Stereomicroscopic evaluation of sealing ability of four different root canal sealers: an in-vitro study.

AIM: To compare and evaluate the sealing ability of four different commercially available sealers to provide seal against the dye penetration test using a stereomicroscope-an in-vitro study. MATERIAL/METHOD: 80 extracted single rooted mandibular premolar with single canal were used in this study. The samples were divided in 4 groups (20 in each) based on sealer. Group I (Diaproseal), Group II (apexit Plus), Group III (MTA Fillapex) and Group IV (Bio-C). The samples were analyzed using a stereomicroscope and data analysis was done with one-way Anova And post hoc Tukey's test. RESULT: The mean dye penetration score was 1.2400 ± 0.778 mm for Group I. 2.6000 ± 0.897 mm for Group II, 4.2000 ± 0.923 mm for Group III and 4.225 ± 2.055 mm for Group IV. One-way Anova analysis shows that intergroup comparison was statistically significant between the four groups. The post hoc Tukey's test reveals that the difference was statistically non-significant between group III and group IV. CONCLUSION: It was concluded that between the four groups the Group I (Diaproseal) showed the least dye penetration followed by Group II (Apexit Pus), Group III (MTA Fillapex) and then Group IV (Bio-C), where there was no significant difference between the Group III (MTA Fillapex) and Group IV (Bio-C).

Comparative evaluation of dentinal tubule penetration and push-out bond strength of new injectable hydraulic calcium disilicate based root canal sealer: A single blinded in vitro study.

Objective: To evaluate and compare dentinal tubule penetration and push-out bond strength of BIO-C ION+, AH Plus and NanoSeal-S using Confocal Laser Scanning Microscopy (CLSM) and Universal Testing Machine (UTM). Materials & method: Sixty human mandibular premolars were prepared using ProTaper Gold till F3. Samples were then divided into 3 groups: Group I (n = 20) BIO-C ION + sealer, Group II (n = 20) AH Plus and Group III (n = 20) NanoSeal-S sealer. Groups were then sub-divided into two sub groups: In Subgroup A (n = 10) samples were obturated using single-cone with 0.1 % Rhodamine B dye and in Subgroup B (n = 10) samples were obturated using single cone. The samples were then transversely sectioned into coronal, middle and apical segments, samples in subgroup A & B were then submitted to CLSM analysis and UTM respectively. Results: The Bond Strength data showed following means (MPa): Group I Subgroup B: (BIO-C ION+) coronal (1.64), middle (1.25), apical (0.93); Group II Subgroup B: (AH Plus) coronal (2.20), middle (1.85) apical (1.38) and Group III Subgroup B: (NanoSeal-S) coronal (1.26), middle (0.94), apical (0.58). The dentinal tubule penetration data showed following means: (µm) Group I Subgroup A (BIO-C ION+) coronal (1184.69), middle (997.03), apical (637.26); Group II Subgroup-A AH Plus (864.14) and NanoSeal-S (495.64). Statistical analysis (two-way ANOVA, Tukey's Post Hoc Test) showed significant difference among sealers (p < 0.001) and root canal thirds (p < 0.001). Conclusion: The results of the study concluded that BIO-C ION + sealer showed maximum dentinal tubule penetration and AH Plus demonstrated maximum push-out bond strength.

Investigating best practice for specimen preparation for biological testing of root canal sealers.

INTRODUCTION: Biological characterization of root canal sealers is important as it assesses the ability of the root canal sealer to exert antimicrobial properties thus avoiding treatment failures caused by microbial challenge and also assess the cytotoxic effect on the periapical tissues. Assessment of the biological testing of root canal sealers necessitates the sterilisation of the materials prior to evaluation. This study aims to analyse the influence of various sterilisation techniques conducted prior to biological testing on the microstructure and surface properties of endodontic sealers. Assessment of the initial microbial contamination on the material was also undertaken. METHODS: Four commercial sealers were investigated. The sealers were either prepared in a laminar flow cabinet or on a laboratory bench top under ambient conditions. Each group was further divided into 5 groups (n = 3) based on the sterilization technique:1) ethanol-10 mins, 2) ultraviolet-1 h, 3) ethanol-10 mins + ultraviolet-1 h, 4) autoclave, and 5) no sterilisation (control). Microbial levels in the materials were assessed by plate streaking technique. The materials were characterized by scanning electron microscopy and energy dispersive spectroscopy, and Fourier transform infrared spectroscopy, before and after sterilisation, to assess any changes in microstructure and chemical composition. RESULTS: All the materials did not exhibit contamination when prepared in laminar flow chamber in sterile conditions compared with sealers prepared on the bench top. Three of the commercial materials showed changes in microstructure while one (TotalFill) was not affected by the sterilisation. AH Plus and BioRoot RCS exhibited alterations in water and alcohol peaks in FT-IR while the single syringe sealers (TotalFill and BioRoot Flow) showed no changes. CONCLUSIONS: Sterilisation methods cause physical and chemical alterations to sealers. Material preparation should be performed in a laminar flow cabinet and a test for sterility should be performed prior to any biological testing being undertaken. If the materials are not sterile, assessment of the effects of the sterilization methods is recommended.

Antimicrobial Activity of Five Calcium Silicate Based Root Canal Sealers against a Multispecies Engineered Biofilm: An In Vitro Study.

AIM: The present study's objective was to compare the impact of CerasealR, total fill BC SealerR, Bio-C SealerR, AH Plus BioceramicR, and K-BiocerR on the elimination of a multispecies' endodontic biofilm at 3, 7 and 14 days. MATERIALS AND METHODS: A total of 20 freshly extracted, caries-free premolars were prepared for the study to create dentinal disks. For the multispecies biofilm formation, Enterococcus faecalis, Proteus mirabilis, Pseudomonas aeruginosa, and Candida albicans were cultured and used to inoculate hydroxyapatite discs. After incubation, the biofilms were placed on blotting papers in petri dishes with an orthodontic bend. Different root canal sealers, including CeraSeal, total Fill BC Sealer, Bio-C Sealer, AH Plus Bioceramic, K-Biocer, and Sealite, were injected into the bend, facilitating contact with the biofilms. The samples were divided into seven groups, including a negative control. At specific intervals, 3, 7, and 14 days, 3 biofilm samples from each group were collected, diluted, and plated on Agar media for colony counting and analysis. RESULTS: In all tested groups, the total bacterial count significantly decreased between day 3 and 14 (p < 0.05) with no statistically significant differences among the different sealers' groups at all-time points for the total bacterial count, E. faecalis count, and P. mirabilis count. However, Sealite demonstrated the most consistent effectiveness in reducing bacterial counts across multiple categories. The sealite group was capable of decreasing the C. albicans count significantly between day 3 and day 14 (p < 0.05) in comparison with the bioceramic groups. CONCLUSION: All sealers had antibacterial activity against the multispecies biofilm between day 3 and day 14. The ascending order of sealers in terms of their effectiveness in killing bacteria, based on the provided results, is as follows: Sealite, Bio-C Sealer, AH Plus, CeraSeal, TotalFill, and K-Biocer. However, there were no statistically significant differences in the bacterial counts among the different sealer groups at any time point. CLINICAL SIGNIFICANCE: The role of sealers in combating biofilm-associated infections highlights their potential clinical utility in preserving root canal health. Understanding the antimicrobial properties of these sealers is vital for informed decision-making in selecting the most effective materials for improved treatment outcomes and long-term success in endodontic procedures.

In vitro evaluation of temperature change on the root surface after the removal of root canal filling.

This study aimed to compare the temperature changes occurring on the root surfaces after the removal of root canal filling with two different root canal sealers by two different reciprocating files. Sixty extracted teeth with a single root and canal were used in this study. After chemomechanical preparation, the root canals in the experimental groups were filled with gutta-percha and AH Plus or CeraSeal, while those of the control groups were filled with gutta-percha only. Resiproc or WaveOne Gold were used for the removal of the root canal filling. Temperature changes in the middle and apical third of the root surface were recorded by a thermal camera at different time intervals. Among the groups using the same sealer, the temperature rise observed on the root surface at the end of 90 s in the Resiproc groups was found to be significantly higher than that of the WaveOne Gold groups.

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.

A critical review of the material properties guiding the clinician's choice of root canal sealers.

OBJECTIVES: The introduction of hydraulic cement sealers has increased the popularity of single cone obturation where the chemistry and properties of hydraulic cement sealers are crucial. This article has investigated the materials present on the market by reviewing the chemistry aiming at understanding whether these materials are optimized or have been tested appropriately. METHODOLOGY: A market search on materials called bioceramic and hydraulic sealers was undertaken. The safety data sheet and manufacturer details for every material were searched and the components were checked. The literature was searched for information about the properties of these materials based on their composition. RESULTS: The safety data sheets and manufacturer details were imprecise with some manufacturers providing little detail on composition. From the publications reviewed, it is apparent that the materials used clinically are not optimized, and there is little evidence that the material chemistry and presentation aid the clinical technique in any way. CONCLUSIONS: There has been a rapid increase in materials identifying as bioceramics on the market. These materials have diverse chemistries, and some of the constituents are not declared. This may affect the clinical performance of these materials. CLINICAL SIGNIFICANCE: Smart materials developed on the clinical need which are appropriately tested are necessary for a paradigm shift in root canal obturation. It is important to use reputable materials that have been adequately researched in clinical practice.

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.

Effectiveness of root canal filling materials and techniques for treatment of apical periodontitis: A systematic review.

BACKGROUND: Apical periodontitis (AP) is an inflammatory disease of the apical periodontium as sequelae of pulp death. It is managed by disinfection and filling of the root canal space. OBJECTIVES: The aim of this systematic review was to investigate whether obturation techniques and materials used for root canal filling led to the management of AP. METHODS: A systematic review protocol was written following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist and registered on the international prospective register of systematic reviews (PROSPERO; CRD42021260275) including two populations, interventions, comparisons, outcomes and time (PICOT) for the research questions querying the effectiveness of obturation techniques (PICOT 1) and materials (PICOT 2) for the management of AP. Electronic searches were conducted on PubMed, ScienceDirect, Scopus and Embase search engines. Searches on International Endodontic Journal, Journal of Endodontics, Clinical Oral Investigations, Journal of Dental Research and Journal of Dentistry websites were also conducted, until May 2021. Both primary (tooth survival) and secondary outcomes were evaluated. The risk of bias was assessed by Cochrane RoB2 for the randomized and ROBINS-I for the nonrandomized trials. RESULTS: The search strategy identified 1652 studies, with 1600 excluded on the title and abstract screening, leaving 52 studies for full-text screening. In total, 10 studies met the inclusion criteria. The obturation technique and materials used did not affect the outcome of AP. Vertical compaction resulted in faster resolution of periapical lesions. The oral health-related quality of life of patients treated with lateral condensation exhibited poorer outcomes compared with single matched cone after 6 months of recall. DISCUSSION: The inclusion and exclusion criteria used for this systematic review enabled the capture of all the literature available on the effect of obturation techniques and materials on the outcome of AP. The data were heterogenous, and a number of articles investigating obturation techniques had no information on the materials and techniques used as they looked at the quality of fill. CONCLUSIONS: Included studies did not find any difference between different procedures (PICOT 1) and materials (PICOT 2). The risk of bias was high, thus the findings should be interpreted with caution. REGISTRATION: PROSPERO registration number: CRD42021260275.

Effect of three different photosensitizers in photodynamic therapy on bond strength of a calcium silicate-based sealer to radicular dentin.

To evaluate the effect of the photodynamic therapy (PDT) using with different photosensitizers on the bond strength of BioRoot RCS (BR) to radicular dentin by comparing with AH Plus (AH). The shaped root canals of 80 human mandibular premolars were divided into four groups based on the final disinfection protocol: NaOCl/EDTA, PDT with methylene Blue (MB), PDT with curcumin (CUR) and PDT with toluidine blue O (TBO) (n = 20). Each group was randomly divided into two subgroups (n = 10), according to the endodontic sealer used for obturation (n = 10). The test of push-out bond strength (PBS) was performed using an universal test machine. The data were analysed using ANOVA, Tukey post-hoc, and independent sample t-test (α = 0.05). MB-BR group showed the highest PBS at the cervical level (p < 0.05). The selection of the photosensitizer in PDT influenced adhesion of root canal sealers to radicular dentin.

Evaluation of Cytotoxicity of Calcium Silicate-based Mineral Trioxide Aggregate Sealers: A Systematic Review of In Vitro Studies.

AIM: This review aimed to evaluate the in vitro studies done with regard to the cytotoxicity associated with mineral trioxide aggregate (MTA)-based root canal sealers. BACKGROUND: Root canal sealers are used during endodontic treatment as fillers to seal the gaps between the canal gutta-percha cone and canal walls. It is necessary to understand the cytotoxicity of these materials on human-derived cells as these materials interact with human cells periapically. REVIEW RESULTS: Six in vitro studies were chosen for review. In these selected studies, along with MTA-based root canal sealers, other sealers were tested for cytotoxicity on human periodontal ligament (PDL) stem cells, human PDL fibroblasts, and human osteoblast cells. Regarding cytotoxicity, the studies were diverse, and most were based on 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl-2H-tetrazolium bromide) (MTT) assay. In general, the studies suggested that root canal sealers cause mild to severe cytotoxic effects and that several factors influence this effect, such as material setting time, concentration, and duration of exposure. CONCLUSION: All studies in the review indicated that MTA. Fillapex must be used cautiously as it exhibited the highest cytotoxic effect compared to other MTA-based and non-MTA-based sealers. CLINICAL SIGNIFICANCE: Endodontic sealers do serve the purpose of bridging the gaps between the gutta-percha cone and the canal wall but knowing its biocompatibility becomes important as the material is extruded beyond the apical foramen where it comes in contact with the surrounding tissues. The effect of sealers on the surrounding tissues affects the healing and prognosis of the treatment.

In vivo cytotoxicity analysis of bioceramic root canal sealers on zebrafish embryo.

Background: This study evaluated the cytotoxicity of four bioceramic root canal sealers (RCSs) in vivo. The embryonic zebrafish characteristics, such as mortality, survival, hatching, and general morphology, served as the parameters for assessing cytotoxicity. Methods: The RCSs, namely GuttaFlow Bioseal, MTA Fillapex, CeraSeal Bioceramic, and iRoot SP, were mixed according to the manufacturer's guidelines. The extract solution was prepared by immersing the set RCS into 1X dilution of E3 solution. Then, the extract solution was delivered into a Petri dish where zebrafish embryos were allowed to develop. Cytotoxicity was evaluated 24, 48, 72, and 96 hours after fertilization. Results: The Kruskal-Wallis test showed that except for GuttaFlow Bioseal, the mortality, survival, and hatching of zebrafish embryos for the remaining three bioceramic RCSs were significantly different from the negative controls (P<0.05). Significant differences were also evident in the mortality, survival, and hatching of zebrafish embryos between GuttaFlow Bioseal and three other RCSs (P<0.05). Conclusion: GuttaFlow Bioseal was less cytotoxic than other bioceramics RCSs; MTA Fillapex, CeraSeal Bioceramic root canal sealer, and iRoot SP root canal sealer exhibited comparable cytotoxicity.

Evaluation of the Sealing Ability and Bond Strength of Two Endodontic Root Canal Sealers: An In Vitro Study.

BACKGROUND: Obturation represents a critical step in endodontic treatment, which relies on a core material and a sealer. This study aims to evaluate the sealing ability and bond strength to the root canal walls of an epoxy resin-based sealer (AH-Plus®, Dentsply Sirona, Johnson City, TN, USA) and a bioceramic sealer (GuttaFlow Bioseal®, Coltène/Whaledent, GmbH + Co. KG, Langenau, Germany). METHODS: Thirty-eight maxillary anterior teeth with single roots and identical round sections were separated into two experimental groups according to the root canal sealers used, namely, G1 = AH-Plus® and G2 = GuttaFlow Bioseal®, and two control groups, specifically, G3 = the negative control and G4 = the positive control. The sealing capacity was measured by the penetration of the radioactive isotope 99mTc. For the push-out test, the compressive force test was performed in a universal machine and the force was applied by exerting pressure on the surface of the material to be tested in the apical to the coronal direction and using three test points with different diameters. RESULTS: GuttaFlow Bioseal® exhibited superior sealing ability compared to AH-Plus® (p = 0.003). Regarding the bond strength, AH-Plus® provided higher adhesion values than GuttaFlow Bioseal® in the three sections of the tooth root (p = 0.001). CONCLUSIONS: GuttaFlow Bioseal® had significantly better sealing ability than AH-Plus® but lower adhesion values in the three zones of the root canal, with statistically significant differences between the groups. However, it is important to note that for the action of endodontic sealers to be maximized, the root-filling technique must be most appropriate.