Evaluation of dimensional changes in EndoSeal mineral trioxide aggregate and AH Plus sealers using micro-computed tomography imaging.

Background: Optimal dimensional stability is required for successful root canal treatment. A sealant called EndoSeal mineral trioxide aggregate (MTA) was recently introduced to the market due to its favorable physical and chemical properties. On the other hand, AH Plus (AHP) is considered the gold-standard seal. Materials and Methods: In this ex vivo quasi-experimental study, 24 single-canal premolars extracted from humans were cleaned and shaped with a motorized and rotary file, then that is divided into two groups. The teeth of each group were filled with gutta F3 and each type of sealant. The teeth were scanned by a micro-computed tomography device after 24 h. After 7 days of storage in phosphate-buffered saline solution, the samples were re-scanned. Data were analyzed using SPSS software (version 21). Descriptive data were presented as frequency, percentage, mean, and standard deviation. The Shapiro-Wilk and Kolmogorov-Smirnov tests were used to investigate the normality of the data. The Mann-Whitney test was used to compare the two groups, and the differences were ultimately not significant. The level of significance was set at 0.05 (P < 0.05). Results: The mean differences between sealer volumes before and after the intervention were not significantly different between the two groups indicating that the EndoSeal MTA sealer is not inferior to the gold-standard root canal sealer, AHP. Conclusion: EndoSeal MTA can be considered a reliable sealer in endodontic treatments and be subjected to further investigation.

Comparative study of the pure AH Plus sealer and its combination with triple antibiotic paste at different concentrations on Enterococcus faecalis bacteria.

Background: In this study, the effects of pure AH Plus sealer and its combination with triple antibiotic paste at different concentrations on Enterococcus faecalis bacteria have been investigated. Materials and Methods: This in vitro study was accomplished by the means of a triple antibiotic paste combination (minocycline, metronidazole, and ciprofloxacin) at different concentrations (0%, 1%, 5%, 10%, and 25%) with AH Plus sealer on E. faecalis bacteria. Sealers were set in an incubator for 1 h, 1 day, 3 days, and 7 days, and then 10 µL of bacteria solution was placed on all samples except the negative control group. After drying for 1 h, 250 µL brain-heart infusion broth culture medium was added, and it was cultured in solid media. Direct contact test technique was performed, and the obtained data were analyzed by 1-way ANOVA, 2-way ANOVA, 3-way ANOVA, and post hoc test least significant difference. It should be noted that the data were evaluated at the significance level of P < 0.05. Results: The average of colony-forming unit (CFU)/mL illustrated that there were no significant differences between fresh antibiotic-sealer combination, 1-day set, and 3-day set (P = 0.525), while in sealer with 7-day set, the average of CFU/mL was notably lower than other sets (P < 0.001). The outcomes revealed a considerable variation by passing time and the number of CFU/mL was remarkably reduced (P < 0.05). The data suggested that, by increasing the concentration, the average of CFU/mL was decreased, whereas the average of CFU/mL did not have significant differences in all concentrations of the antibiotic-sealer combination compared to pure sealer (P < 0.05). Conclusion: The concentration of 1% triple antibiotic in combination with root canal sealer may become a crucial factor for inhibiting the growth of remaining bacteria.

Nanostructured ZnO thin film to enhance gutta-percha's adhesion to endodontic sealers.

BACKGROUND: Gutta-percha (GP) combined with an endodontic sealer is still the core material most widely used for tridimensional obturation. The sealer acts as a bonding agent between the GP and the root dentinal walls. However, one of the main drawbacks of GP core material is the lack of adhesiveness to the sealer. ZnO thin films have many remarkable features due to their considerable bond strength, good optical quality, and excellent piezoelectric, antibacterial, and antifungal properties, offering many potential applications in various fields. This study aimed to explore the influence of GP surface's functionalization with a nanostructured ZnO thin film on its adhesiveness to endodontic sealers. METHODS: Conventional GP samples were divided randomly into three groups: (a) Untreated GP (control); (b) GP treated with argon plasma (PT); (c) Functionalized GP (PT followed by ZnO thin film deposition). GP's surface functionalization encompassed a multi-step process. First, a low-pressure argon PT was applied to modify the GP surface, followed by a ZnO thin film deposition via magnetron sputtering. The surface morphology was assessed using SEM and water contact angle analysis. Further comprehensive testing included tensile bond strength assessment evaluating Endoresin and AH Plus Bioceramic sealers' adhesion to GP. ANOVA procedures were used for data statistical analysis. RESULTS: The ZnO thin film reproduced the underlying surface topography produced by PT. ZnO thin film deposition decreased the water contact angle compared to the control (p < 0.001). Endoresin showed a statistically higher mean bond strength value than AH Plus Bioceramic (p < 0.001). There was a statistically significant difference between the control and the ZnO-functionalized GP (p = 0.006), with the latter presenting the highest mean bond strength value. CONCLUSIONS: The deposition of a nanostructured ZnO thin film on GP surface induced a shift towards hydrophilicity and an increased GP's adhesion to Endoresin and AH Bioceramic sealers.

Effect of the filling technique on the filling removal from oval-shaped canals.

OBJECTIVES: This ex vivo study aimed to evaluate the influence of different filling techniques on the filling removal from oval root canals filled with bioceramic sealer. METHODS: Thirty-six mandibular incisors with single oval canals were filled with bioceramic sealer following the techniques (n = 12): single-cone, modified McSpadden, or continuous wave of condensation, and scanned by micro-computed tomography (micro-CT). The filling was removed using the Clearsonic ultrasound tip and Reciproc system up to the R40 instrument, and the working time was recorded. The teeth were scanned again by micro-CT. Percentage of remnant volume (mm³) of the filling material, dentin thickness, and root canal transportation were measured. The data was analyzed using parametric and non-parametric tests with a significance level of 5%. RESULTS: It took more time to remove the filling material using the continuous wave of condensation technique (p < 0.05), followed by the modified McSpadden and single-cone techniques. There was no difference (p > 0.05) when comparing the percentage of remaining filling material among the three groups, nor did it among the segments of each tooth. There was also no difference in the analysis of dentin thickness and transportation when comparing the groups (p > 0.05). CONCLUSIONS: The filling technique did not influence the amount of remaining filling material, dentin thickness, and transportation. The working time was longer with thermoplastic filling techniques. CLINICAL RELEVANCE: Endodontic retreatment in teeth filled with bioceramic sealers increases with their use. Several techniques are used to fill the root canals, thus, it is important to know whether the filling technique influences the non-surgical endodontic retreatment.

Does the Mixing Method of AH Plus Jet Affect its Physicochemical and Mechanical Properties?

INTRODUCTION: The purpose of this study was to evaluate whether the mixing method of AH Plus Jet sealer affects its physicochemical and mechanical properties. METHODS: The properties of AH Plus Jet sealer were analyzed when mixed using either the Auto Mix Tip or manual mixing. The evaluated properties included radiopacity (n = 5), initial and final setting times (n = 5), flow (n = 5), and solubility (n = 3), following specifications outlined in ISO 6876/2012 and ADA Nº 57/2000. pH levels were measured at intervals of 3, 24, 72, and 168 hours (n = 10). The push-out bond strength test was conducted using a universal testing machine and using bovine teeth (n = 30). Failure modes were analyzed with stereomicroscopy. Porosity was evaluated under micro-CT (n = 5), and scanning electron microscopy was also performed (n = 5). One-way analysis of variance and Tukey, unpaired t-tests, or Mann-Whitney tests were used with a significance level of 5%. RESULTS: The Auto Mix exhibited a radiopacity value of 12.11 mmAl, whereas manual mixing resulted in 12.55 mmAl (P > .05). For initial and final setting times, Auto Mix showed 901 minutes and 1779 minutes, respectively, while manual mixing recorded values of 631 minutes and 1504 minutes (P < .05). In terms of flow, Auto Mix demonstrated higher values (25.26 mm) than manual mixing (21.71 mm) (P < .05). No statistical differences were observed between the two methods for solubility and pH (P > .05). Manual mixing presented a higher bond strength value (14.52 MPa) than Auto Mix (9.81 MPa) (P < .05). The mixed failure mode was the most frequent outcome for both methods. The highest porosity was observed for Auto Mix (P < .05). Scanning electron microscopy analysis revealed that manual mixing resulted in a smoother surface with fewer pores and smaller, more evenly distributed agglomerates compared to automatic mixing. CONCLUSION: The mixing method employed for AH Plus Jet sealer influences some physicochemical and mechanical properties of the material.

Comparison of the Antibacterial Effect of AH26, Adseal and Beta RCS Root Canal Sealers against Enterococcus Faecalis, an in Vitro Study.

Objectives: Antibacterial activity against endodontic pathogens is a desirable feature for root canal sealers. The objective of this study was to compare the antibacterial effect of three resin-based endodontic sealers (AH26, Adseal, and Beta RCS) against Enterococcus faecalis in vitro. Materials and Methods: The antibacterial properties of the sealers were assessed against E. faecalis using agar diffusion test (ADT) for fresh state (N=10) and direct contact test (DCT) for freshly-mixed and set states of the materials (N=10). In ADT, the diameter of the zones of inhibition was measured after 24h of contact. In DCT, the colony-forming units of the bacteria were counted after 30 minutes and 180 minutes of exposure. The results were analyzed with two-way ANOVA and independent sample t-test. P<0.05 was considered significant. Results: Regarding DCT results, all test materials indicated an antibacterial effect, both in freshly-mixed and set states. The highest antibacterial effect was related to Adseal, whereas the lowest was observed in Beta RCS. There was a significant difference between all study groups (different sealers, setting states, and contact times; P<0.001), except for freshly-mixed AH26 and Adseal at 180 minutes (P>0.05). According to ADT, AH26 and Adseal represented the widest and the smallest inhibition zones, respectively (P<0.001). Conclusion: Within the limitations of this in vitro study, AH26, Adseal, and Beta RCS showed antibacterial effects against E. faecalis in both freshly-mixed and set states. The antibacterial effect increased over time in all of the studied sealers.

Sealing Ability Comparison of Three Different Obturating Systems to Intraradicular Dentin-An In Vitro Stereomicroscopic Study.

Background: Different obturation techniques are being used to improve canal sealing, thereby minimizing marginal leakage. Aims and Objectives: To evaluate the marginal leakage of three different obturating materials and techniques using stereomicroscope. Materials and Methods: Thirty freshly extracted maxillary anterior teeth were collected and were divided into three groups of 10 each for which the biomechanical preparation was done. The teeth were divided into three experimental groups according to the obturation material and technique used, Group I: gutta-percha with AH Plus root canal sealer (lateral condensation): Group II: thermoplasticized gutta-percha technique-non-carrier-based (calamus) with AH Plus sealer (backfill): Group III: C point (self-sealing root canal obturating system) with bioceramic sealer (single cone). Each specimen was subjected for testing apical sealing ability. The values of microleakage associated with different root canal sealers were evaluated using a stereomicroscope. Results: There was no statistically significant difference in the mean scores of apical dye penetration/leakage among all the three groups (P = 0.091), whereas Group I showed a higher degree of apical leakage than the other techniques tested. Conclusion: None of the tested filling materials provided a gap-free or void-free root canal filling; however, thermoplasticized gutta-percha is used with AH Plus sealer exhibited less voids and gaps when compared to other tested materials.

Epoxy resin-based root canal sealers: An integrative literature review.

The correct obturation of the root canal system achieved by means of a core and a cement is essential for the success of endodontic treatment. There are several root canal cements (RCCs) on the market; however, because of their excellent characteristics, epoxy resin-based sealers (ERBSs) have been widely used. The main aim of this review was to analyze and integrate the available information on different ERBSs. An electronic search was performed in the PubMed and Scopus databases, using "epoxy resin" AND "root canal treatment", and "epoxy resin" AND "endodontics" as search terms. In general, ERBSs have good flow properties, film thickness, solubility, dimensional stability, sealing capacity, and radiopacity. They are also able to adhere to dentin while exhibiting low toxicity and some antibacterial effects. However, their main disadvantage is the lack of bioactivity and biomineralization capability. A large number of ERBSs are available on the market, and AH Plus keeps being the gold standard RCC. Yet, information on many of them is limited or non-existent, which could be due to the fact that some of them are relatively new. The latter emphasizes the need for relevant research on the physicochemical and biological properties of some ERBSs, with the aim of supporting their clinical use with sufficient evidence via prospective and long-term studies.

A Comparative Evaluation of Push-Out Bond Strength of Six Different Root Canal Sealers: An In-Vitro Study.

BACKGROUND: Adhesiveness with radicular dentin is absent with gutta-percha, leading to microleakage and hence re-infection. Root canal sealer helps to achieve an adhesive interface between gutta-percha and root dentin thereby resisting the displacement forces during the functioning of teeth which is evaluated by the push-out test. The aim of this study is to compare the push-out bond strength and to assess the relative bond failure between dentin-sealer, sealer-main cone of (1) epoxy resin, (2) silicon, (3) mineral trioxide aggregate (MTA), (4) calcium hydroxide, (5) bioceramic, (6) zinc oxide eugenol containing root canal sealers. METHODOLOGY: Sixty human permanent lower premolars with one root were collected, disinfected, and decoronated at cemento-enamel junction. Instrumentation was done with a K3 40,0.06 Ni-Ti rotary file and obturated using the main cone and sealer. Based on the sealer utilized, six groups were created: Group 1: AH-Plus, Group 2: RoekoSeal, Group 3: MTA Fillapex, Group 4: Apexit, Group 5: Smart Paste Bio, and Group 6: Procosol. One slice each was obtained from the coronal, middle, and apicalsections of all the obturated canals. Push-out bond strength and failure modes were studied. Statistics involved analysis of variance (ANOVA) followed by the post hoc Tukey test. RESULTS: All three sections exhibited the highest strength for Smart Paste Bio sealer and the least was for RoekoSeal. With all the sealers, the apical section had the highest strength followed by the middle and coronal. CONCLUSION: The smart seal system was superior to all other sealers and displayed a good bond to dentin.

Comparative Analysis of AH Plus Bond Strength to Root Canal Dentin and Adhesive Interface Quality after Calcium Hydroxide Removal using Different Irrigation Protocols.

INTRODUCTION: To evaluate the push-out bond strength (POBS) of AH Plus sealer to root dentin and the adhesive interface quality after calcium hydroxide (Ca(OH)2) intracanal dressing removal with different final irrigation protocols. METHOD: After root canal instrumentation and irrigation, 40 root canals were filled with Ca(OH)2 and sealed. After 14 days, the specimens were randomly distributed according to the irrigation protocols for Ca(OH)2 removal (n = 10): GH2O (control) - distilled water; GNaOCl - 1% NaOCl; GEDTA - 17% EDTA; GEDTA + NaOCl - 17% EDTA + 1% NaOCl. The root canals were filled with AH Plus sealer and gutta-percha. After 7 days, the roots were sectioned into dentin slices and submitted to POBS test and analysis of the adhesive interface under scanning electron microscope. The POBS data were statistically evaluated (analysis of variance and Tukey test). The Kruskal-Wallis and Mann-Whitney tests were used to analyze the adhesive interface (α = 0.05). RESULTS: GH2O, GNaOCl, and GEDTA + NaOCl had similar POBS values, with higher values on the apical third, in comparison with other thirds (P < .05). A homogeneous and free-of-gaps adhesive interface was observed for GH2O, GNaOCl, and GEDTA + NaOCl, with difference between GH2O and GEDTA (P < .05). GH2O and GEDTA + NaOCl presented higher sealer tags formation (P < .05). CONCLUSION: The final rinse with EDTA for Ca(OH)2 dressing removal had a negative effect on the POBS of the filling material to root dentin. The use of EDTA followed by NaOCl had results similar to the distilled water, providing uniform and free-of-gaps adhesive interface, and a higher number of sealer tags.

The status of clinical trials regarding root canal sealers.

Objectives: This study aimed to present the results and analyses of clinical trials, including updates on the different functions of root canal sealers. Materials and Methods: In June 2023, we performed a comprehensive search of ClinicalTrials.gov to identify interventional clinical trials pertaining to root canal sealers. In total, 23 clinical trials conducted up to June 2023 were included in this study. Results: Approximately half of the trials (11 out of 23) were completed, while none were terminated or withdrawn. Each included trial had a minimum of 10 participants, with 11 trials having more than 100 participants. None of the assessed trials provided outcomes, and the majority (17 out of 23) lacked associated publications. In terms of geographic distribution, the USA and Canada did not contribute to any root canal sealer trials. Conclusions: This study highlights the lack of diversity in trial locations, the absence of reported results, and a scarcity of clinical trials examining the physicochemical properties of different sealers. Most published trials primarily focused on assessing the post-operative pain effect of these sealers, but no significant difference was found regarding post-operative pain control.

Influence of bioceramic sealers on dentinal tubule penetration and antimicrobial effectiveness: a systematic review and meta-analysis of in vitro studies.

The aim of this systematic review and meta-analysis (SRM) was to evaluate whether bioceramic sealers have better penetration capacity in dentinal tubules and antimicrobial activity when compared to AH Plus® sealer. This SRM was recorded in the Open Science Framework database and followed the guidelines of the PRISMA 2020. Five databases were searched by two independent reviewers. Only in vitro studies that evaluated the effects of bioceramic sealers on dentinal tubule penetration and antimicrobial activity outcomes compared to AH Plus® sealer were included. Meta-analysis was conducted using R software, using the effect measure of the standardized mean difference (SMD) and inverse variance method. A modified Joanna Briggs Institute's Checklist was used for the risk of bias assessment. A total of 1486 studies were identified, and only 54 studies that fulfilled our eligibility criteria were included in this review. There was no statistical difference between the sealers evaluated for dentinal tubule penetration, in the thirds evaluated: coronal SMD 0.58 [0.14; 1.31], p = 0.12; middle SMD 0.07 [0.54; 0.39], p = 0.75; and apical SMD 0.08 [0.73; 0.56], p = 0.80. Both sealers demonstrated similar antimicrobial action (SMD [3.42; 5.32], p = 0.67 and SMD 0.67 [1.89; 0.55], p = 0.28). The studies presented a low risk of bias. Based on the in vitro studies included and according to the limitations of the present review, the data suggest that bioceramic and AH Plus® sealers present similar penetration capacity in dentinal tubules and antimicrobial effect, making them suitable materials to be considered in clinical practice.

Assessment of the impact of XP-Endo Finisher file on push-out bond strength of various endodontic sealers.

Background: An endodontic treatment is considered a success after thorough chemomechanical debridement coupled with obturating root canals in a concrete way thereby providing hermetic seal. Gutta-percha being nonadherent necessitates use of a sealer to achieve hermetic seal. Adequate adhesion of root canal sealer with gutta-percha core and radicular dentin ensures lack of apical leakage. Materials and Methods: Sixty extracted mandibular premolars with single root canal decoronated at cementoenamel junction were selected and randomly allocated to two groups (n = 30). Samples in Group 1 were prepared with BT Race file, while Group 2 samples were prepared with BT Race alongwith XP Endo file. Absorbent paper points were used for canal drying and samples were randomly divided into six subgroups. In Subgroup I, obturation was done with bio-ceramic (BC) sealer (Endosequence BC) and BC gutta-percha. In Subgroup II, resin-based (AH plus) sealer and gutta-percha were used. In Subgroup III, calcium hydroxide-based (Sealapex) sealer and gutta-percha were used. Sectioning of root samples was done perpendicularly into coronal, middle, and apical segments of 3 mm each. A universal testing machine was used for sample testing, in which push-out bond strength corresponded to the highest value obtained. Stereomicroscopic (×20) study of the samples determined the failure mode at dentin/sealer/main cone interface. Statistical Analysis: Analysis of variance and post hoc Tukey's tests were used for data analysis. Results: Endosequence BC with XP-Endo files showed the highest mean push-out bond strength (16.31 MPa), whereas Sealapex without XP-Endo file had the lowest values (12.76 MPa). Mixed failure of adhesive and cohesive mode was observed for most samples. Conclusion: Adjunctive irrigation agitation technique utilizing XP-Endo Finisher facilitates biofilm eradication from difficult niches in root canals, thereby improving adhesion of sealer and subsequently the sealer bond strength.

Retreatment Strategies for Cases Containing Calcium Silicate-Based Root Canal Sealers: A Comprehensive Review.

This review explores the field of retreatment strategies for cases filled with calcium silicate-based root canal sealers. Since the introduction of calcium silicate-based materials in dentistry, calcium silicate-based root canal sealers have become popular among dentists because of their biocompatibility, bioactivity, and sealing ability. Therefore, effective retreatment strategies are indispensable. This article aims to identify the challenges associated with the removal of calcium silicate-based sealers themselves and removal of gutta-percha with the sealers during retreatment, evaluate current techniques and materials, and provide future directions for research in this field. Regarding the strategies of removal of root canal sealers, calcium silicate-based sealers are still relatively new materials for clinicians compared with traditional sealers such as epoxy- or eugenol-based sealers. First, no clinically established solvents have been reported. Second, calcium silicate-based sealers are currently utilized by clinicians in either the cold sealer-based technique or the warm vertical condensation technique. Third, the setting process of calcium silicate-based sealers generates byproducts, primarily calcium hydroxide and secondarily hydroxyapatite, that could interact with dentine. Lastly, there is a lack of clinical studies evaluating the efficacy of retreatment protocols for teeth filled with calcium silicate-based sealers. Therefore, it is important to investigate the chemo-mechanical properties of calcium silicate-based sealers themselves and their reactions to solvents and/or mechanical instruments and identify the interfacial properties of calcium silicate-based sealers with respect to dentine and gutta-percha. In addition, researchers in the clinical field need to actively gather and report data on retreatments of teeth filled with calcium silicate-based sealers.

Ultrasonic activation of the endodontic sealer enhances its intratubular penetration and bond strength to irradiated root dentin.

To evaluate the effect of ultrasonic activation of the endodontic sealer on its intratubular penetration and bond strength to irradiated root dentin. Forty human teeth were distributed into 4 groups (n = 10), according to the radiation therapy (RT) exposure-70 Gy-and ultrasonic activation (UA) of the endodontic sealer: RT/UA-irradiated teeth and sealer UA; RT/no-UA-irradiated teeth and no sealer UA; no-RT/UA-non-irradiated teeth and sealer UA and no-RT/no-UA-non-irradiated teeth and no sealer UA. Push-out bond strength test was performed in a Universal Testing Machine. Failure modes and adhesive interface were analyzed under Scanning Electron Microscopy. The data were statistically compared (two-way-ANOVA and posthoc Games-Howell test; Fisher's exact test - α = 5%). The different experimental conditions (radiation and UA) and the root third had a significant effect on push-out bond strength, and the interaction of these factors was significant (p < 0.05). UA of the sealer significantly increased its bond strength to both irradiated and non-irradiated dentin (p < 0.05). The irradiated groups mostly presented adhesive-type failure of the sealer (p < 0.01). Regardless of the irradiation, the ultrasonically activated groups showed a more homogeneous adhesive interface, with the presence of sealer tags in greater density and depth. Ultrasonic activation enhanced the intratubular penetration and the bond strength of the endodontic sealer to irradiated dentin. The impact of ultrasonic activation of the endodontic sealer on teeth undergoing radiotherapy is a gap in the scientific literature that needs to be bridged.

An automated method to analyze root filling voids and gaps using confocal microscopy images.

This study evaluated the feasibility of an automated method to delimit the required area to quantitatively analyze root filling voids and gaps from cross-sectional confocal laser scanning microscopy (CLSM) images. Root canals of maxillary canines were prepared with rotary instruments and filled by lateral compaction technique using gutta-percha and AH Plus sealer. The roots were stored (100% humidity, 37 °C) for a period of 24 h and then transversally sectioned to obtain 2-mm-thick slices from the apical and middle thirds. The areas corresponding to filling materials, gaps, and voids were manually delimited or automatically demarked by ImageJ software after converting the images to the RGB color system. Based on manual and automatic delimitations, the percentages of voids and gaps were calculated. Data of voids and gaps between middle and apical thirds were individually compared by paired t-test. Pearson`s correlation test was used to assess the correlation of data between the methods. Irrespective of the method of area delimitation, no difference was observed between the root thirds for both voids and gaps, while the p-values calculated for each method were similar. Almost perfect correlations between the methods were observed for both outcomes. The proposed method to automatically delimit the areas corresponding to filling material, voids, and gaps appears to be a valid method to facilitate the quantitative analysis of defects in root canal fillings using topographic CSLM images.

Evaluation of Postoperative Pain in Response to Polydimethylsiloxane and Calcium Silicate-Based Endodontic Sealers Using the Visual Analog Scale (VAS).

BACKGROUND: The main purpose of obturation is to achieve a complete three-dimensional sealing of the pulp space to create a tight seal and prevent bacterial movement and its toxins to the periapical tissues. Different approaches and sealants have been developed due to the root canal system's intricacy for ensuring tight adherence. The root canal sealants need to establish a bond between the material and root dentine in order to prevent leakage. Even though the biocompatibility and sealing abilities of the materials are prioritized in modern endodontics, some sealers incorporate therapeutic or antibacterial drugs like corticosteroids or calcium hydroxide. An endodontic sealer's cytotoxicity and antibacterial capabilities must be perfectly balanced. Due to the limited evidence in endodontic literature regarding the relationship between postoperative pain and the sealers that are used in this study, we conducted the research to explore the same. AIM: This study aimed to evaluate and compare pain in responses to polydimethylsiloxane and calcium silicate-based endodontic sealers (CS-BG). METHODOLOGY: The participants were divided into two groups, Nanoseal (Nanoseal-S™; Prevest, DenPro, USA) and Bioceramic (CeraSeal™; Mera Biomed Co., Cheongju, Korea) with 20 patients in each group. After caries excavation and access opening, the biomechanical preparations were performed in each tooth. To avoid over-instrumentation, the working length was verified after each instrument use. The standard irrigation protocol was performed. Sealers were mixed according to the manufacturer's instructions followed by obturation. The patients were asked to take medicines only if they had pain. The pain was evaluated using the visual analog scale (VAS) postoperatively at 24 hours, 48 hours, and a week after the root canal obturation. RESULTS: Pain perception using Nanoseal-S™ and CeraSeal™ materials were compared at 24 hrs, 72 hrs, and seven days. Nanoseal showed statistically significant repletion at 24 hrs and seven days. CONCLUSION: The decreased irritation character of CS-BG for the periapical tissues explains the lesser percentage of pain during and pain immediately after root canal obturation observed in this investigation, which proves CS-BG is highly biocompatible with periapical tissue and further reduces patient anxiety during root canal obturation.

A comparative study of biological properties of three root canal sealers.

OBJECTIVES: The aim of this study was to evaluate the effects of Hiflow with other two kinds of root canal sealers on the biological behavior of stem cells from the apical papilla (SCAP), the influence on inflammatory cytokines release and its antibacterial effects. MATERIALS AND METHODS: Material extracts of Hiflow, iRoot SP, and AH Plus were prepared. Then, SCAP was incubated with extracts. The effects were evaluated by CCK-8, wound healing assay, ALP staining, alizarin red staining, and qRT-PCR. Meanwhile, polymorphonuclears (PMNs) and monocytes were isolated and treated with extracts for 4 h and 24 h respectively. Cell viability was analyzed by Annexin-V/PI double staining flow cytometry. The effects on the release of cytokines were observed by ELISA. The antibacterial effects of different sealers were tested against three kinds of bacteria found in chronic apical periodontitis. RESULTS: A series of results of SCAP showed that Hiflow and iRoot SP could promote cell proliferation, migration, and osteogenesis (p < 0.05). Although Hiflow was associated with greater cell apoptosis and necrosis when incubated with PMNs and monocytes (p < 0.05), it had an approximate release of anti-inflammatory cytokines with iRoot SP, which was higher than AH plus (p < 0.05). The co-culture showed that Hiflow and iRoot SP inhibited the colony formation of F. nucleatum (p < 0.05). However, both sealers had no obvious antibacterial effect on E. faecalis and P. gingivalis (p > 0.05). CONCLUSIONS: In summary, Hiflow and iRoot SP both had positive biological stimulus on SCAP. Meanwhile, Hiflow showed a better induction on anti-inflammatory cytokines over the others. All the properties mentioned above and its antibacterial effect of F. nucleatum promise Hiflow a bright application prospect in endodontic uses. CLINICAL RELEVANCE: References for clinical work to use BC Sealer Hiflow as a good biological root canal sealer.

A comparison of osteogenic effect of newly manufactured calcium silicate-based sealers in vitro.

This study aimed to assess the effect of different calcium silicate-based root canal sealers (CSRS) on osteogenic effect in human periodontal ligament cells (hPDLCs). hPDLCs were cultured in a medium containing extract of 5 types of CSRS. The specimens were assessed by the cell cytotoxicity test, alkaline phosphatase staining, alizarin red S staining, quantitative real-time PCR, Western blot analysis, and enzyme-linked immunosorbent assay. The diluted concentrations of extracted solutions had no significant effect on the viability of hPDLCs. There was a statistically significant difference in the mRNA expression level of bone sialoprotein (BSP), osteocalcin (OCN), and runt-related transcription factor 2 (RUNX2) among some groups. The protein expressions of BSP, OCN, and RUNX2 were significantly higher in some groups compared to the control group. The CSRS did not interfere with the osteogenic differentiation of hPDLCs, compared to the control group. CSRS are shown to have biocompatibility and osteogenic differentiation effect on hPDLCs.

Effect of Photodynamic Therapy on the Pushout Bond Strength of Resin-Based and Calcium Silicate-Based Endodontic Sealers.

Introduction: This study aimed to assess the effect of photodynamic therapy (PDT) on the pushout bond strength (PBS) of resin-based and calcium silicate-based endodontic sealers. Methods: Forty single-canal teeth were assigned to four groups. After root canal preparation by the crown-down technique and smear layer removal, groups 1 and 2 served as the control group, and groups 3 and 4 underwent PDT by using a low-level diode laser as the light source and methylene blue as the photosensitizer (MB). The root canals in groups 1 and 3 were filled with AH26 sealer while the root canals in groups 2 and 4 were filled with Endoseal TCS. The samples were sectioned at 4, 8, and 12 mm from the apex tip (1mm thick slices). The PBS test was performed, and the mode of failure was determined in the coronal, middle, and apical thirds. The data were analyzed by the Kruskal-Wallis, Friedman, and Dunn tests. Results: No significant difference was noted in the PBS of resin-based and calcium silicate-based sealers in the apical, middle, or coronal thirds in the application of PDT (P>0.05). The PBS of AH26 was significantly higher than that of Endoseal TCS (P<0.05). Cohesive failure was the dominant mode of failure in the AH26 groups, while mixed failure was the dominant failure mode in the Endoseal TCS groups. Conclusion: PDT had no significant effect on the PBS of resin-based and calcium silicate-based sealers.