Effect of the timing of primary endodontic treatment and dosage of radiation therapy on the filling material removal.

This study investigated the effect of the timing of primary endodontic treatment and dosage of radiotherapy on the remaining filling material (RFM) during endodontic reintervention. 60 single-rooted human mandibular premolars were distributed into five groups (n = 12), according to the timing and dosage of radiation (55Gy or 70Gy): NegativeCG-non-irradiated teeth; Endo-pre-RT55/70-obturation before irradiation (55Gy or 70Gy); Endo-post-RT55/70-obturation and reintervention after irradiation (55Gy or 70Gy). Roots were cleaved and analysed under stereomicroscope and Scanning Electron Microscope to quantify (%) the RFM. Experimental groups had a significantly greater amount (p < 0.05) of RFM in the middle and apical thirds than the control group, except for Endo-pre-RT55 in the middle third (p < 0.0001). The apical third had greater amount of RFM (p < 0.05). Radiation therapy, before and after primary endodontic treatment, increased the amount of RFM, regardless of the dose delivered. When necessary, reintervention preferably must be performed before radiation therapy.

Volumetric changes in root canal sealers in ex vivo and a novel animal model approach.

AIM: This study aimed to evaluate the volumetric change of root canal sealers through micro-computed tomographic analysis using a novel in vivo model and to compare the results with those obtained using an ex vivo test. METHODOLOGY: Eighteen single-rooted teeth were cut to 5 mm length from the root apex. The root canals were uniformly enlarged and filled with EndoSequence BC Sealer or AH Plus Jet root canal sealers. Samples were stored at 37°C and 95% relative humidity for 24 h and then scanned with a micro-CT device. Twelve samples (n = 6 for each sealer) were implanted in the subcutaneous tissue of Wistar rats, while six samples (n = 3 for each sealer) were immersed in 20 mL of phosphate-buffered saline (PBS) at 37°C at neutral pH. After 7 and 30 days, teeth were removed from subcutaneous tissue or PBS and rescanned. Statistical analysis of volume changes was performed using Shapiro-Wilk's test and independent t-test (p < .05). RESULTS: AH Plus Jet had smaller volume changes (-2.2 to +0.77%) than EndoSequence BC Sealer (-2.0 to +4.0%) (p < .05), in the two tested models. The volume of the root canal sealers decreased over time (p < .05), in vivo. AH Plus Jet results varied between the in vivo and ex vivo results (p < .05), while EndoSequence BC Sealer presented similar volume losses for both experimental models (p > .05). CONCLUSION: EndoSequence BC Sealer lost more volume than AH Plus Jet. The experimental conditions influenced the volumetric change of AH Plus Jet but not the EndoSequence BC Sealer. The ex vivo model should be further explored as a methodological alternative to assess the volumetric changes of root canal sealers without causing harm to animals.

Root canal filling materials for endodontic treatment of necrotic primary teeth: a network meta-analysis.

PURPOSE: To investigate the effect of different root canal filling materials on the change of failure of the endodontic treatment of necrotic primary teeth. METHODS: A literature search was carried out in PubMed/MEDLINE, CENTRAL, Scopus databases, and grey literature up to July 2022 selecting randomised clinical trials related to research question. Two reviewers independently selected the studies, extracted the data, and assessed the bias risk. Root canal filling materials were grouped according to the main component [iodoform (IOD), calcium hydroxide (CAOH), zinc oxide (ZO) or mix (IOD plus CAOH plus ZO) pastes]. Pairwise and network meta-analyses using the mixed treatment comparisons method were performed to compare the number of events (failure) among treatments. Odds ratio and 95% confidence intervals (CI) for calculated. Post-probabilities among treatments were also calculated and interpreted. RESULTS: From 1186 potentially relevant studies, 17 were selected for full-text analysis, and 7 were included in the meta-analysis, totalizing 263 teeth. In the direct evidence, ZO pastes resulted in a higher chance of failure than IOD pastes (OR 7.07 95% CI 1.02, 62.59). In the indirect evidence, there was no difference between the materials. The IOD pastes presented a high probability (81%) of being the treatment associated to lowest number of failures among all treatments. The CAOH pastes presented the highest probability of being the worst option. Studies showed high bias risk. CONCLUSION: There is currently no scientific evidence of the superiority of any one root canal filling material for endodontic treatment of necrotic primary teeth.

Influence of supplement administration of omega-3 on the subcutaneous tissue response of endodontic sealers in Wistar rats.

AIM: Natural substances such as omega-3 have been used in the medical field due to their numerous properties and, in particular, modulating effect on the systemic and local inflammatory processes. Thus, this study evaluated the influence of omega-3 supplementation on the subcutaneous tissue response of endodontic sealers in Wistar Rats. METHODOLOGY: Polyethylene tubes were implanted in the subcutaneous tissue of 48 animals (one empty for control and three filled with Sealapex, AH Plus or Endofill). The animals were treated with omega-3 (TO) or water (TW). Treatments started 15 days before implantation until euthanasia. After 5, 15 and 30 days (n = 8), animals were euthanized and polyethylene tubes and surrounding tissue were removed and processed for histological analysis. The inflammatory reaction was analysed by Haematoxylin and Eosin stain and immunolabelling for IL-6 and TNF-α. The collagen maturity was analysed by picrosirius red stain and calcium deposition by von Kossa stain and polarized light. Results were statistically analysed (p < .05). RESULTS: Amongst TW sealer groups, Endofill evoked a more intense inflammatory infiltrate compared with AH Plus and control in the 30-day period (p = .009). However, in TO sealer groups, there was no difference amongst the sealers and control in all periods (p > .05). Comparing each sealer as a function of the supplementation with water or omega-3, there are differences for Endofill (p = .001) and Sealapex (p = .005) in the 30-day period, presenting lower inflammatory infiltrate in the animals treated with omega-3. A higher percentage of immature fibres was observed at 15 and 30 days in the TO group, compared with the TW group (p < .05). The deposition of calcium particles was observed only by Sealapex in all periods, despite the supplementation procedure. CONCLUSIONS: Omega-3 supplementation influence the tissue reactions of endodontic sealers, modulating inflammation, the immunolabelling of IL-6 and TNF-α, the repair process and it does not interfere with calcium deposition.

Cimento biocerâmico no tratamento conservador de perfuração radicular em molar inferior / Bioceramic sealer in conservative treatment of mandibular molar root perforation

Introdução: A perfuração radicular é um acidente técnico-operatório que resulta em comunicação da cavidade pulpar com os tecidos periodontais. Esse tipo de acidente pode apresentar prognóstico desfavorável, por afetar significativamente o soalho da câmara coronária ou os terços cervical, médio e apical do canal radicular. Entre os fatores que interferem no prognóstico das perfurações radiculares, destacam-se: localização, extensão, presença ou ausência de bolsa periodontal; tempo decorrido entre a perfuração e o tratamento; e tipo de material obturador. Nesse contexto, os cimentos obturadores de canais denominados biocerâmicos surgiram como uma proposta inovadora para tratamento de perfurações antes consideradas de prognóstico desfavorável. Objetivo: O presente trabalho teve por objetivo relatar o tratamento de uma perfuração radicular em molar inferior com o cimento biocerâmico EndoSequence BC Sealer, com três anos de acompanhamento. Resultados: As imagens radiográficas e os dados clínicos do paciente evidenciaram o sucesso no tratamento da perfuração, com reparo da lesão perirradicular. Conclusão: O cimento endodôntico biocerâmico EndoSequence BC Sealer associado com a retomada do trajeto original do conduto e sua instrumentação favoreceram o reparo dos tecidos perirradiculares, sugerindo propriedades biológicas promissoras de compatibilidade e bioativida (AU).

Introduction: Root perforation is a technical-surgical accident that results in communication of the pulp cavity with periodontal tissues. This type of accident may have an unfavorable prognosis because it significantly affects the floor of the coronary chamber or the cervical, middle and apical thirds of the root canal. Factors that interfere with the prognosis of root perforations include location, extension, presence or absence of periodontal pocket, time elapsed between perforation and treatment, and type of obturator material. In this context, bioceramic canal sealers have emerged as an innovative proposal for treatment of perforations previously considered to have an unfavorable prognosis. Objective: The aim of this study was to report the treatment of a lower molar root perforation with the EndoSequence BC Sealer bioceramic sealer after a 3-year follow up. Results: Radiographic images and patient clinical data showed success in the treatment of perforation with repair of the periradicular lesion. Conclusion: Endo-Sequence BC Sealer bioceramic endodontic sealer associated with the resumption of the original conduit path and its instrumentation favored the repair of periradicular tissues, suggesting promising biological properties of compatibility and bioactivity (AU).

Influence of variations in the environmental pH on the solubility and water sorption of a calcium silicate-based root canal sealer.

AIM: To evaluate the influence of pH variation on the solubility and water sorption of a premixed calcium silicate-based root canal sealer (EndoSequence BC Sealer) compared to the gold standard based on epoxy resin (AH Plus Jet) after immersion in distilled water and phosphate-buffered saline (PBS). METHODOLOGY: Solubility and water sorption were evaluated after immersion in distilled water or PBS at several pHs (5, 7 and 12) and the values were calculated as percentages of the original mass after 24 h, 7 and 30 days of immersion. The crystalline structures present in the sealers and surface precipitates were assessed by X-ray diffraction. The Shapiro-Wilk's test revealed that data were normally distributed; thus, statistical analysis was performed using one-way anova and Tukey's tests or independent t-test, assuming a 5% α-error. RESULTS: EndoSequence BC Sealer was associated with significantly greater water sorption and solubility compared to AH Plus Jet in all tested conditions (P < 0.05). The acid environment increased the 24 h solubility of EndoSequence BC Sealer immersed in PBS (P < 0.05) and did not induce significative changes in the water sorption (P > 0.05). Alkaline pH reduced the solubility of EndoSequence BC Sealer and increased that of AH Plus Jet at all experimental times and soaking media (P < 0.05). Alkaline environment also significantly increased the water sorption of AH Plus Jet immersed in PBS (P < 0.05). Immersion in PBS significantly reduced the solubility of EndoSequence BC Sealer and significantly increased that of AH Plus Jet (P < 0.05). Precipitates on the surface of EndoSequence BC Sealer corresponding to hydroxyapatite and calcium carbonate were detected after immersion in PBS at pH 5 and 7 for 30 days. CONCLUSIONS: EndoSequence BC Sealer had significantly greater solubility and water sorption than AH Plus Jet. Although the alkaline pH and soaking media directly influenced the solubility and water sorption of the sealers, the solubility of AH Plus Jet remained within the limits recommended by ISO 6876, whilst the solubility of the EndoSequence BC Sealer did not comply with ISO recommendations in all the conditions tested.

Evaluation of the biological properties of two experimental calcium silicate sealers: an in vivo study in rats.

AIM: To evaluate the biological properties of experimental sealers based on tricalcium silicate and dicalcium silicate, manipulated with polyethylene glycol (CE-1) and with the addition of calcium hypochlorite (CE-2) compared to AH Plus (AHP) and TotalFill BC Sealer (TBC). METHODOLOGY: The tissue reaction caused by the materials in the subcutaneous tissue of rats was evaluated after implantation of polyethylene tubes filled with the materials at 7, 15, 30 and 60 days. Sections were stained with haematoxylin and eosin (HE) for morphological analysis and to evaluated number of inflammatory cells/mm2 (ICs). Sections were used for immunohistochemical detection of interleukin-6 (IL-6) and osteocalcin (OC). The von Kossa method was used to identify calcium precipitation in the capsules. The data were submitted to anova and Tukey's tests, with 5% significance level. RESULTS: At 7 days, CE-1, CE-2 and AHP had higher numbers of ICs. AHP presented higher immunolabelling for IL-6. After 15 days, regarding IL-6, there was no difference between CE-2 and the control group. At 30 days, AHP exhibited the highest number of IC (P < 0.05) and CE-2 and the control group presented the lowest ICs and IL-6-positive cells. After 60 days, all materials exhibited decreases in ICs. CE-2, TBC and the control had the lowest values (P < 0.05). No significant difference was detected between CE-1 and TBC, and between CE-2 and control considering the immunoexpression of IL-6. In this period, AHP had the greatest number of IC and IL-6 (P < 0.05). In all periods, CE-1, CE-2 and TBC sealers had von Kossa-positive structures and OC-immunolabelled cells. CE-2 had higher number of OC-positive cells than the CE-1 and TBC sealers (P < 0.05), in all periods. OC immunolabelling was not observed in the capsules of AH Plus and the control groups. CONCLUSIONS: The experimental sealer and its association with calcium hypochlorite, in addition to TotalFill BC Sealer, were biocompatible and had bioactive potential.

Biocompatibility and Bioactive Potential of New Calcium Silicate-based Endodontic Sealers: Bio-C Sealer and Sealer Plus BC.

INTRODUCTION: Bio-C Sealer (BC; Angelus, Londrina, PR, Brazil) and Sealer Plus BC (SPBC; MK Life, Porto Alegre, Brazil) are new ready-to-use bioceramic endodontic sealers. The aim of this study was to evaluate the biocompatibility and bioactive potential of BC and SPBC sealers in comparison with AH Plus (AHP; Dentsply DeTrey Gmbh, Konstanz, Germany) in subcutaneous tissue of rats. METHODS: Polyethylene tubes filled with materials and empty tubes, serving as the control group, were implanted in the subcutaneous tissues of rats. After 7, 15, 30, and 60 days, the tubes with connective tissue were removed, and inflammatory cells (ICs)/mm2 and immunolabeled cells for interleukin (IL)-6 were evaluated. Osteocalcin and von Kossa analysis were also performed. Data were submitted to analysis of variance and Tukey tests, with a significance level of 5%. RESULTS: At 7 days, SPBC showed lower ICs than BC (P < .05). AHP exhibited greater immunolabeled cells for IL-6 (P < .05). After 15 days, BC showed lower ICs and IL-6 compared with other materials. At 30 days, SPBC and AHP showed higher values for ICs (P < .05). After 60 days, calcium silicate sealers did not show statistical difference (P > .05) for ICs and IL-6, with values lower than AHP (P < .05). The materials showed positive structures to von Kossa staining. BC exhibited osteocalcin labeling in all periods. SPBC showed osteocalcin labeling from 15-60 days. AHP and the control group did not exhibit osteocalcin labeling. CONCLUSIONS: BC and SPBC sealers are biocompatible and present bioactive potential.

Cytokine Production and Cytotoxicity of Calcium Silicate-based Sealers in 2- and 3-dimensional Cell Culture Models.

INTRODUCTION: The aim of the present study was to assess the effects of different silicate-based sealers (ie, BioRoot RCS [Septodont, Saint Maur des Fosses, France], ProRoot ES [Dentsply Sirona, York, PA], and MTA Fillapex [Angelus, Londrina, PR, Brazil]) on cytokine production and viability of human periodontal ligament stem cells (PDLSCs). AH Plus (Dentsply DeTrey GmbH, Konstanz, Germany) was used as a reference material. METHODS: PDLSCs were cultured either in 2-dimensional or 3-dimensional conditions (in 0.15%-0.5% PuraMatrix [BD Biosciences, Bedford, MA]) for 24 hours with eluates from set endodontic sealers. Additionally, the toxicity of eluates from endodontic sealers was evaluated using an in vitro root model experimental procedure. PDLSC viability was determined using the 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide assay. PDLSC culture medium was used for cytokine quantification (interleukin [IL]-6, IL-8, growth-regulated oncogene, IL,-4 and IL-10) using the HCYTMAG-60K-PX41 Milliplex kit (EMD Millipore, Burlington, MA). RESULTS: In 2-dimensional culture conditions, BioRoot RCS revealed a good PDLSC viability rate. ProRoot ES had no effect on PDLSC viability regardless of the dilution. MTA Fillapex was strongly cytotoxic even at the lowest extract dilutions (1:1, 1:2, and 1:4). Encapsulation of PDLSCs in PuraMatrix tended to decrease the cytotoxic effect of the sealers. In the 3-dimensional in vitro root model experimental procedure, BioRoot RCS, ProRoot ES, and MTA Fillapex revealed a cytocompatibility pattern. Different calcium silicate-based sealers exhibited different proinflammatory cytokine production. BioRoot RCS greatly stimulated the release of IL-10 and, to a lesser degree, IL-4 by PDLSCs (P < .05). CONCLUSIONS: BioRoot RCS and ProRoot ES did not induce proinflammatory cytokines and promoted anti-inflammatory cytokine secretion by PDLSCs that may have a positive local impact by attenuating an initial inflammatory response.

Effect of immersion in distilled water or phosphate-buffered saline on the solubility, volumetric change and presence of voids within new calcium silicate-based root canal sealers.

AIM: To assess the effect of immersion in distilled water or phosphate-buffered saline (PBS) on the solubility, volumetric change and presence of voids of calcium silicate-based root canal sealers (TotalFill BC, Sealer Plus BC and Bio-C), in comparison with the gold standard epoxy resin-based sealer (AH Plus). METHODOLOGY: All properties were evaluated after immersion in distilled water or PBS. Solubility was determined by the percentage of mass loss, whereas volumetric change and presence of voids were evaluated by micro-computed tomography, after 7 days of immersion. The volumetric change and percentage of voids between the baseline (after setting) and the experimental period were calculated. Statistical analysis was performed using one-way anova and Tukey's or Student's t-tests (α = 0.05). RESULTS: The calcium silicate-based sealers had significantly greater solubility and volumetric loss than AH Plus, after immersion in distilled water or PBS (P < 0.05). Bio-C had the greatest solubility (P < 0.05), followed by TotalFill BC and Sealer Plus BC, which were similar (P > 0.05). Regarding the volumetric change, AH Plus had a volume increase, with similar values in distilled water and PBS (P > 0.05). TotalFill BC, Sealer Plus BC and Bio-C had a similar volumetric change (P > 0.05). The calcium silicate-based materials had the greatest solubility and volume loss after immersion in distilled water (P < 0.05). There was no difference in the percentage of voids amongst the sealers, before and after immersion in distilled water or PBS (P > 0.05). CONCLUSIONS: TotalFill BC, Sealer Plus BC and Bio-C had significantly greater solubility and volumetric loss than AH Plus. Although storage in PBS significantly reduced the solubility and volumetric change of calcium silicate-based sealers, their solubility remained above that recommend by ISO 6876. All the sealers evaluated had low and similar voids, even after immersion in distilled water or PBS.

Qualidade de três técnicas para preenchimento do canal radicular: análise in vitro de cortes transversais em molares inferiores / Quality of three techniques for root canal filling: an in vitro cross-sectional analysis in mandibular molars

Introdução: o sistema reciprocante pode preparar o canal radicular usando um único instrumento; entretanto, para garantir o sucesso endodôntico, a obturação radicular deve ser de alta qualidade. Para isso, várias técnicas podem ser usadas, e é importante que sua eficiência seja determinada. Assim, o presente estudo analisou três técnicas diferentes, considerando a capacidade de preenchimento da obturação do canal radicular. Métodos: o estudo envolveu 30 molares inferiores humanos extraídos; os canais mesiais desses dentes foram instrumentados com o sistema WaveOne e, então, divididos em três grupos, de acordo com a técnica utilizada para o preenchimento do canal radicular. A técnica de cone único, técnica híbrida de Tagger e uma técnica experimental (cone único mais o uso do condensador guta-percha) foram utilizadas para os Grupos I, II e II, respectivamente. Os dentes obturados foram cortados transversalmente em seções de 0,3 mm a 2, 4 e 6 mm do ápice do canal radicular. As seções foram, então, digitalizadas e analisadas. Os dados foram comparados estatisticamente pelos testes de Kruskal-Wallis e Dunn, com valores de p < 0,05 indicando significância. Resultados: não houve diferença significativa entre os grupos experimentais em relação às quantidades de guta-percha ou cimento utilizado. No entanto, nos Grupos II e III, houve menor ocorrência de espaços vazios no preenchimento do canal radicular do que no Grupo I (p < 0,05). Conclusão: conclui-se que as técnicas de preenchimento do canal radicular apresentadas no presente estudo geraram um baixo número de espaços vazios e que as técnicas termoplastificadoras conferem menos espaços vazios (AU).

ntroduction: Reciprocating system can prepare the root canal using only one instrument. However, to ensure successful endodontic treatment, it must result in high-quality root canal filling. In this regard, several techniques can be used, and it is important that their efficiency is determined. This study analyzed three different techniques in terms of their ability to fill root canal. Material and Methods: The study involved 30 extracted human mandibular molars. Mesial canals of these teeth were instrumented using WaveOne system and then divided into three groups according to the technique used for root canal filling. The single-cone technique, Tagger's hybrid technique, and an experimental technique (single-cone plus gutta-percha condenser) were used for Groups I, II, and II, respectively. Filled teeth were sectioned transversely into 0.3-mm sections 2, 4, and 6 mm from the root canal apex. The sections were then digitized and analyzed. Data were statistically compared using Kruskal-Wallis and Dunn tests, with p-values <0.05 indicating significance. Results: There was no significant difference among experimental groups in terms of the amount of gutta-percha or sealer used. However, in Groups II and III, there were fewer voids in root canal filling than in Group I (p < 0.05). Conclusion: The techniques for root canal filling presented in the current study yielded a low number of empty spaces, and thermoplastification techniques result infewer voids (AU).

Physicochemical properties and bioactive potential of a new epoxy resin-based root canal sealer

Abstract The aim of this study was to evaluate physicochemical properties and bioactive potential of Sealer Plus, in comparison with MTA Fillapex, Sealapex and AH Plus. Setting time, flow, and radiopacity were evaluated based on ISO 6876 Standard. Flow was also assessed in area (mm²). The solubility and volumetric change of the sealers were evaluated after 7 and 30 days of immersion in distilled water. Solubility was evaluated by the difference in mass of materials before and after immersion. Volumetric change was evaluated by using microcomputed tomography (micro-CT). The bioactive potential was observed by Scanning Electron Microscopy (SEM) after immersion in PBS. Data were compared using ANOVA and Tukey tests (α=0.05). Sealer Plus presented the shortest setting time (196 min.) and Sealapex the longest (912 min.) (p<0.05). AH Plus showed the highest radiopacity (9.5 mm Al) and MTA Fillapex the lowest (2.7 mm Al) (p<0.05). All the sealers presented flow in accordance with ISO 6876/2012 (>17 mm). Sealer Plus showed low solubility and volumetric change (<1%), and MTA Fillapex showed the highest solubility (>25%), and volumetric change (>4%) after all time intervals (p<0.05). MTA Fillapex was the only sealer that showed bioactive potential. In conclusion, Sealer Plus presented proper physicochemical properties. However, this sealer did not present a bioactive potential.

Resumo O objetivo deste estudo foi avaliar as propriedades físico-químicas e o potencial bioativo de Sealer Plus, em comparação com MTA Fillapex, Sealapex e AH Plus. Tempo de presa, escoamento e radiopacidade foram avaliados com base nas normas ISO 6876. O escoamento foi também avaliado em área (mm²). A solubilidade e a alteração volumétrica dos cimentos foram avaliadas após 7 e 30 dias de imersão em água destilada. A solubilidade foi analisada pela diferença entre as massas dos cimentos antes e após imersão. A alteração volumétrica foi avaliada por meio de microtomografia computadorizada (micro-CT). O potencial bioativo dos cimentos foi observado por Microscopia Eletrônica de Varredura (MEV) após imersão em PBS. Os dados foram comparados usando os testes ANOVA e Tukey (α=0.05). Sealer Plus apresentou o tempo de presa mais curto (196 min.) e Sealapex o mais longo (912 min.) (p<0.05). AH Plus mostrou a radiopacidade mais alta (9.5 mm Al) e MTA Fillapex a mais baixa (2.7 mm Al) (p<0.05). Todos os cimentos tiveram escoamento de acordo com as normas ISO 6876/2012 (>17 mm). Sealer Plus mostrou baixos valores de solubilidade e alteração volumétrica (<1%) e MTA Fillapex teve os valores mais altos de solubilidade (>25%) e alteração volumétrica (>4%) em todos os períodos avaliados (p<0.05). MTA Fillapex foi o único cimento que mostrou potencial bioativo. Como conclusão, Sealer Plus apresentou propriedades físico-químicas adequadas, entretanto, não apresentou potencial bioativo.

CBCT Performance and Endodontic Sealer Influence in the Diagnosis of Vertical Root Fractures.

AIM: To evaluate the performance of three cone beam computed tomography (CBCT) machines in detecting vertical root fractures (VRFs) in teeth filled with different sealers. MATERIALS AND METHODS: A total of 80 single-rooted premolars were subjected to instrumentation and restoration with gutta-percha + AH Plus sealer, gutta-percha + sealer 26, gutta-percha + fill canal, and gutta-percha without sealer as the control. Half of the samples were randomly subjected to root fracture and all the teeth were scanned by i-CAT (Imaging Sciences International, Hatfield, USA), PreXion (PreXion Inc., San Mateo, USA), and OrthoPhos XG (Sirona Dental System, Bensheim, Germany). Three examiners analyzed the images for the presence of fractures. RESULTS: The highest accuracy was obtained with the PreXion device, with Az = 0.85, while the i-CAT device provided higher sensitivity (0.93). The specificity values observed ranged between 0.75 and 0.70. Chi-squared tests (p > 0.05) demonstrated that the sealers did not exert a significant influence on the diagnosis of VRF. CONCLUSION: It may be concluded that endodontic sealers do not influence the detection of VRF. The PreXion device was the most accurate, having the highest specificity value. CLINICAL SIGNIFICANCE: Radiopaque materials might affect the diagnosis of VRFs because they can simulate fracture lines, leading to false-positive results. Moreover, CBCT machines present different specificities that could exert some influence on that.

Bone tissue response to an MTA-based endodontic sealer, and the effect of the addition of calcium aluminate and silver particles.

AIM: To evaluate bone tissue reactions in rats to an MTA-based endodontic sealer with and without the addition of various concentrations of C3A or C3A + Ag. METHODOLOGY: Bone tissue reactions were evaluated in 45 Wistar rats after 7, 30 and 90 days (n = 5 per period). Three surgical cavities were prepared on the right femur and filled with 0.2 mL MTA Fillapex, MTA Fillapex + C3A and C3A + Ag at various concentrations: AH Plus (Dentsply DeTrey GmbH, Konstanz, Germany), EndoSequence BC (Brasseler USA, Savannah, GA, USA) or no sealer (negative control). By the end of each experimental period, animals were randomly euthanized. The samples were histologically processed and analysed using a light microscope. The presence of inflammatory cells, fibres and hard tissue barrier formation was evaluated. Data were analysed statistically using nonparametric tests to compare the differences between groups. Multiple groups were compared using the Kruskal-Wallis and Mann-Whitney U-tests with a Bonferroni correction at P = 0.05. RESULTS: The inflammatory response significantly decreased from 30 to 90 days (P < 0.05). Fibre condensation was similar amongst the groups at 07 and 30 days after intervention (P > 0.05). At 90 days, however, fibres were absent in most specimens of EndoSequence BC Sealer, AH Plus, MTA Fillapex and the control group, whilst they were still observed in samples of the modified sealers (P < 0.05). At 90 days, all specimens of AH Plus, EndoSequence BC Sealer and control group had complete formation of hard tissue barrier. In the MTA Fillapex group, as well as in the modified sealers groups, partial deposition of mineralized tissue was noticed. CONCLUSION: The hypothesis tested that the incorporation of C3A and C3A + Ag particles to MTA Fillapex would improve bone tissue repair was partially accepted, since modified MTA Fillapex did not have the same repair potential as the commercial bioceramic material.

Cytocompatibility, bioactive potential and antimicrobial activity of an experimental calcium silicate-based endodontic sealer.

AIM: To evaluate the cytocompatibility, bioactive potential, antimicrobial and antibiofilm activities of an experimental calcium silicate-based endodontic sealer, in comparison with TotalFill BC Sealer and AH Plus. METHODOLOGY: Cytocompatibility was assessed by methyltetrazolium (MTT) and neutral red (NR) assays, after exposure of the Saos-2 cells to the sealer extracts (1 : 2, 1 : 4, 1 : 8, 1 : 16 and 1 : 32 dilutions) for 24 h. The sealers were manipulated and placed in 12-well culture plates and exposed to ultraviolet light; then, 5 mL of DMEM without serum was added. Cell bioactivity was evaluated by alkaline phosphatase activity (ALP) and Alizarin red staining (ARS). Antimicrobial and antibiofilm activities were evaluated by direct contact test (DCT) on planktonic cells (DCTPC) and modified DCT on biofilm formed in bovine dentine blocks (MDCT). MTT, NR and ALP data were analysed by two-way anova and Bonferroni tests; ARS data by anova and Tukey's tests; and the microbiological data by Kruskal-Wallis and Dunn tests (α = 0.05). RESULTS: The experimental sealer, TotalFill BC and AH Plus were not cytotoxic to Saos-2, in comparison with the negative control (P > 0.05). Greater ALP was observed after 7 days of exposure of Saos-2 to AH Plus and the experimental sealer (P < 0.05) when compared to the control. Significantly greater mineralized nodule production was observed for TotalFill BC and the experimental sealer (P < 0.05). In DCTPC, the experimental sealer and TotalFill BC were associated with a significantly greater reduction of E. faecalis (P < 0.05) and eliminated C. albicans. In MDCT, the experimental sealer and TotalFill BC had significantly greater antibiofilm efficacy (P < 0.05). CONCLUSIONS: The experimental calcium silicate-based sealer was cytocompatible, bioactive, antimicrobial against E. faecalis and C. albicans and effective against E. faecalis biofilms, with potential for use in root canal treatment.

Are Premixed Calcium Silicate-based Endodontic Sealers Comparable to Conventional Materials? A Systematic Review of In Vitro Studies.

INTRODUCTION: This study aimed to compare the physicochemical and biological properties of premixed calcium silicate-based endodontic sealers with other conventional root canal filling materials by systematically reviewing laboratory studies. METHODS: The search was conducted in 3 databases (Medline via PubMed, Scopus, and Web of Science) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two reviewers independently selected the studies and extracted the data. The properties of interest were bond strength, radiopacity, pH, solubility, setting and working time, dimensional change, flow, calcium ion release, antimicrobial activity, biocompatibility, and cytotoxicity. RESULTS: From 2636 potentially eligible studies, 31 were selected for full-text analysis, and 27 were included in the review. Premixed calcium silicate-based endodontic sealers followed the ISO 6876:2012 requirements for most physicochemical properties except for solubility. The target sealers also presented favorable biological findings when compared with conventional sealers. CONCLUSIONS: Despite the lack of well-designed long-term clinical trials, the target premixed calcium silicate-based sealers show good physicochemical and biological properties in vitro. In general, the results were similar or better than conventional endodontic sealers as observed in in vitro and in vivo animal studies.

The effects of endodontic substances and naturally reducing agents on the bond strength of epoxy resin-based sealer to root dentin.

AIM: To evaluate the effects of sodium hypochlorite (NaOCl), chlorhexidine (CHX), and two naturally derived reducing agents on the bond strength of epoxy resin-based sealer to root dentin. MATERIALS AND METHODS: A total of 60 single-rooted human teeth were prepared using ProTaper (Dentsply Tulsa Dental Specialties, Johnson City, TN, USA) and an irrigation protocol including 5% NaOCl or 2% CHX gel, and ethylenediaminetetraacetic acid (EDTA), for smear layer removal. The following subgroups (n = 10) were also assessed according to the naturally derived reducing agent used: no agent (control group); grape seed extract (GSE); and green tea. Root canals were filled with gutta-percha and AH Plus (Dentsply DeTrey, Konstanz, Germany). Bond strength was measured using the push-out test, and statistical analyses were performed using ANOVA; failure patterns (modes) were classified as adhesive, cohesive, or mixed. The types of failure modes were evaluated using the Chi-squared test at α =0.05. RESULTS: The irrigation protocols demonstrated similar bond strength values (P > 0.05). However, the Chi-squared test revealed significant differences in failure mode among the groups (P < 0.05). An increase in the incidence of adhesive failures was observed for the NaOCl and EDTA groups. The other groups demonstrated a prevalence of mixed and cohesive failures. CONCLUSION: The irrigation protocols and use of naturally derived reducing agents had no effect on the bond strength of the resin-based sealer to dentin; however, improvement was evident in the adhesion quality of AH Plus to NaOCl-treated root dentin, due to the prevalence of cohesive failure.

Bond strength to root dentin and fluid filtration test of AH Plus/gutta-percha, EndoREZ and RealSeal systems

OBJECTIVES: To investigate the bond strength and seal ability produced by AH Plus/gutta-percha, EndoREZ and RealSeal systems to root canal dentin. MATERIAL AND METHODS: Sixty extracted single-root human teeth, instrumented manually to size 40, were divided into three groups (n=20) according to the sealer used; G1: AH Plus, G2: EndoREZ, and G3: RealSeal sealers. After filling using the lateral condensation technique, each sealer group was randomly divided into two subgroups according to the tests applied (n=10 for µPush-out test and n=10 for fluid filtration test). A fluid filtration method was used for quantitative evaluation of apical leakage. Four 1-mm-thick slices (cervical and medium level) were obtained from each root sample and a µPush-out test was performed. Failure modes were examined under microscopy at 40x, and a one-way ANOVA was applied to analyze the permeability. Non-parametrical statistics for related (Friedman's and Wilcoxon's rank tests) or unrelated samples (Kruskal-Wallis' and Mann-Whitney's tests) allowed for comparisons of µPush-out strength values among materials at the different levels. Statistical significance was accepted for p values <.05. RESULTS: There are no significant differences among fluid filtration of the three sealers. The sealer/core material does not significantly influence the µPush-out bond strength values (F=2.49; p=0.10), although statistically significant differences were detected with regard to root level (Chi2=23.93; p<0.001). AH Plus and RealSeal obtained higher bond strength to intraradicular dentin in the ...

Sealability of MTA and calcium hydroxidecontaining sealers

OBJECTIVES: The aim of this study was to evaluate the apical sealability of Fillapex®, endo-CPM-Sealer® and Sealapex®. Material and Methods: Ninety-four freshly extracted single-rooted teeth were selected and decoronated. All teeth were radiographed to confirm the existence of a single and straight root canal, which was prepared using Protaper Universal and 2.5% sodium hypochlorite. The teeth were randomly divided in groups of 10 specimens each according to the sealer, and the canals were filled using the single cone technique and one of the sealers. Four additional teeth were used as controls. The teeth were submitted to dye leakage with Rhodamine B for 24 h but using vacuum on the initial 15 min. Thereafter, they were cut longitudinally and the leakage was measured in a linear fashion from apex to crown. Data were analyzed by ANOVA and Tukey's tests at 5% significance level. Results: Fillapex® and Sealapex® showed significantly less dye leakage than endo-CPM-Sealer® (p<0.05). Conclusions: It was concluded that Fillapex® and Sealapex® were able to prevent apical dye leakage differently from endo-CPM-Sealer®.

Bond strength of different endodontic sealers to dentin: push-out test

OBJECTIVE: The aim of this in vitro study was to evaluate the bond strength of different root canal sealers to dentin. MATERIAL AND METHODS: Forty extracted single-rooted human teeth were examined and the coronal and middle thirds of the canals were prepared with a 1.50 mm post drill (FibreKor Post System, Pentron). The teeth were allocated in two experimental groups, irrigated with 2.5 percent NaOCl+17 percent EDTA or saline solution (control group) and instrumented using Race rotary files (FKG) to a size #40 at the working length. Then, the groups were divided into four subgroups and filled with Epiphany sealer (Group 1), EndoREZ (Group 2), AH26 (Group 3) and Grossman's Sealer (Group 4). After 2 weeks of storage in 100 percent humidity at 37ºC, all teeth were sectioned transversally into 2-mm-thick discs. Push-out tests were performed at a cross-head speed of 1 mm/min using a universal testing machine. The maximum load at failure was recorded and expressed in MPa. RESULTS: Means (±SD) in root canals irrigated with 2.5 percent NaOCl and 17 percent EDTA were: G1 (21.6±6.0), G2 (15.2±3.7), G3 (14.6±4.5) and G4 (11.7±4.1).Two-way ANOVA and Tukey's test showed the highest bond strength for the Epiphany's group (p< 0.01) when compared to the other tested sealers. Saline solution decreased the values of bond-strength (p<0.05) for all sealers. CONCLUSION: Epiphany sealer presented higher bond strength values to dentin in both irrigating protocols, and the use of 2.5 percent NaOCl and 17 percent EDTA increased the bond strength values for all sealers.