Rectal Sedation With Ketamine and Midazolam in the Management of Uncooperative Children During Dental Treatment: A Case Series and Method Description.

Background In pediatric dentistry, sedation aims to eliminate anxiety to facilitate the completion of dental procedures. Sedation in children is a multidimensional field that includes the child, parents/guardians, and the health care team. The rectal route is generally painless, making it suitable for children who are afraid of needles. This route has several advantages over the oral route, including reduced patient cooperation requirements, a faster and more predictable onset, and less physical trauma than the intravenous and intramuscular routes. This case series aimed to evaluate the effectiveness and success rate of rectal sedation with ketamine and midazolam in the management of uncooperative children during dental treatment. Case presentation Ten healthy children with definitely negative behavior were enrolled in this study. Each child was given 7 mg/kg of ketamine in combination with midazolam 0.1 mg/kg by the rectal route. The mean onset sedation time was 9.5 minutes, and pulpotomy procedures were done. Behavioral response was monitored throughout treatment using the Ohio State University Behavioral Rating Scale (OSUBRS), and the depth of sedation was measured using the University of Michigan Sedation Scale (UMSS). The Houpt General Behavior Scale was used to estimate the treatment success rate based on the overall behavior rating. All 10 cases showed good anxiolysis and cooperation following rectal administration, with no side effects observed. Conclusions Rectal administration of ketamine in combination with midazolam may be considered a reliable method in the management of uncooperative children during dental treatment. No adverse effects were observed during or after the sedation procedure.

Association of Dental Caries in Primary Teeth With HLA Class II Gene Among Syrian Children.

Background and objectives Numerous studies have shown that there is evidence that genetic factors contribute in different ways to the occurrence of caries lesions, and the multiple differences in the human leucocytes antigen (HLA) gene patterns play an important role in the body's immune response. Therefore, this study aimed to evaluate the association between some HLA class II alleles (HLA-DR4, HLA-DQ2, HLA-DQ4) and early childhood caries (ECC) occurrence in Syrian children. Materials and methods The study included 80 children aged three to six, divided into two groups: Group 1 (n = 40) being severe early childhood caries (S-ECC) children (deft ≥ 10) and Group 2 (n = 40) being free caries children (deft = 0). The genomic DNAs were extracted and collected by taking a buccal swab using a sterile metal strip and were amplified by polymerase chain reaction-single specific primer (PCR-SSP) and then HLA-typing was performed for all alleles. Results There were no statistically significant differences in the frequency of occurrence of S-ECC, HLA-DR4, and HLA-DQ2 alleles (p = 0.626, 0.256 respectively), while the incidence of S-ECC was associated with the DQ4 allele (p = 0.012). Conclusion HLA class II molecules may play a crucial role in predisposing to ECC, since positive HLA-DQ4 may enhance the chance of developing ECC. However, no association were found between (HLA-DR4 and HLA-DQ2) and ECC.

Evaluation of the effect of high-intensity light-curing device on micro-leakage of pits and fissure sealants.

Reducing treatment time is one of the most important trends in modern dentistry. This study aimed to compare the micro-leakage around the resin sealants when using both high and conventional intensity light-curing systems. The study sample consisted of 30 extracted human maxillary premolar teeth that were divided into two equal groups according to the light-curing system used: Group 1, High-Intensity Light-Curing System and Group 2, Conventional Light-Curing System. Light-curing by Woodpecker I-LED device with two intensities (high and conventional) has been used. All teeth were subjected to 500 cycles of thermocycling. Then, a methylene blue dye microleakage test was performed, and the teeth were sectioned longitudinally and studied under a stereo microscope. The mean of micro-leakage in the high-intensity group (1.33 ± 1.29) was less than in the conventional intensity group (1.63 ± 1.29) without any statistically significant differences (p = 0.320). The high-intensity light-curing system mode may be a good and acceptable alternative to conventional intensity light-curing system mode in polymerization of pits and fissure sealants.

Partial Pulpotomy in Mature Permanent Molars with Symptoms Indicated Irreversible Pulpitis Using MTA: A Study of Three Case Reports over Four-Year Follow-Up.

VPT is vital pulp therapy, a biologically based procedure that combines several therapeutic techniques to maintain the entire or a portion of the dental pulp. Interest in VPT has grown due to recent developments in bioactive materials and an understanding of biological pulp reparative responses. This case report is aimed at evaluating the success rate of partial pulpotomy in permanent molars with symptoms indicating irreversible pulpitis using MTA and presenting with extremely deep carious lesions over four years of follow-up. All patients came with spontaneous and severe pain. Each tooth was isolated with a rubber dam and disinfected with 5.25% NaOCl before caries excavation. After caries removal, a partial pulpotomy was performed on 2-3 mm of the exposed pulp. Bleeding time was recorded after hemostasis was achieved, and then MTA was placed over the exposed pulp. The permanent restoration was placed after pulp capping, and postoperative periapical radiographs were taken. Patients were scheduled for clinical and radiological examinations for four years based on 6-month intervals. All teeth revealed a successful outcome throughout the follow-up periods (clinically and radiographically) with complete resolution of clinical signs and symptoms. Partial pulpotomy using MTA might be an effective long-term management strategy for permanent molars clinically diagnosed with irreversible pulpitis.

Comparing the Fracture Resistance of Dentine Posts and Glass Fiber Posts in Primary Maxillary Incisors: An In Vitro Study.

Background/purpose An ideal post material should have physical and mechanical properties similar to dentin. Another problem when restoring primary teeth that have undergone root canal treatment is the availability of materials that are resorbed in the exfoliation process in a manner similar to the structure of the natural tooth, allowing the normal eruption of a permanent tooth. This study aimed to evaluate the effect of using dentine posts on the fracture resistance of endodontically treated primary incisors in comparison to glass fiber posts. Materials and methods The study sample consisted of 30 extracted primary maxillary incisors that were randomly distributed into the following two groups: group I (experimental, n=15), which was restored with dentine posts; and group II (control, n=15), which was restored with glass fiber posts. Initially, 10 extracted single-root permanent teeth were collected to prepare 20 dentine posts using a computer-aided design-computer-aided manufacturing (CAD-CAM) machine. Then, the crowns of maxillary primary incisors were cut and the canals were prepared and filled. Then the preparation for a post was made using Gates Glidden drills, and the posts were placed with an extension of 3 mm within the canal in both groups, then the crown was built and the teeth were placed within acrylic cubes and subjected to 500 thermocycling. Fracture resistance was recorded using a Testometric machine (Rochdale, England: Testometric Co. Ltd.). Data were analyzed using an independent Student's t-test. Results The dentine posts group showed greater fracture resistance (246.3 N) than the glass fiber posts group (206.3 N). A statistically significant difference (p=0.004) was found between the two groups in favor of the dentine posts group. Conclusion Based on this in vitro study, the dentin posts used in restoring severely decayed primary maxillary incisors showed greater fracture resistance than glass fiber posts. Therefore, the use of dentin posts as intra-canal stabilizers in maxillary primary incisors is a good alternative for glass fiber posts.

Evaluation of Self-Adhesive Composite Restorations Bond on Primary Canines: An In Vitro Study.

Background and purpose The aesthetic requirements for the restoration of the primary anterior teeth of both the child and his parents increased recently, especially with the presence of materials with good mechanical properties capable of giving a good aesthetic shape. However, the challenge remains in the possibility of applying these materials to primary teeth, where the child's cooperation and ability to keep their mouth open during the completion of the restoration is an important challenge for the dentist. Therefore, this study aimed to evaluate the bonding of self-adhesive composite by studying the microleakage in primary canines. Materials and methods The studied sample consisted of 60 extracted primary canines that were divided into three equal groups (n=20) according to the type of restoration: group 1 (experimental) - self-adhesive composite alone, group 2 (experimental) - self-adhesive composite with selective enamel etching, and group 3 (control) - conventional composite with the self-etching bond and selective enamel etching. A Class V cavity was prepared at the cementoenamel junction, 2 mm deep and 1 mm in diameter. In this way, the gingival wall is dentine, while the incisal wall is enamel-dentine. Restorations were placed according to the group to which the tooth belongs. After that, all teeth were subjected to 500 cycles of thermocycling. Then, a methylene blue dye microleakage test was performed, and longitudinal sections of the teeth were made and studied under x20 magnification using a stereo microscope. Results In the gingival wall, the scores of microleakage in the conventional composite group after selective etching were lower than those of the self-adhesive composite groups, with a statistically significant difference. While in the incisal wall, there were no statistically significant differences in the frequencies of the scores of microleakage between the three groups. Conclusions Within the limitations of this study, the conventional composite bonded better to enamel and dentine than self-adhesive composite resin applied alone or after selective enamel etching. The bonding of the self-adhesive composite was lower than that of the conventional composite, and it is not recommended to use it in Class V restorations of primary anterior teeth.

Evaluating the Effectiveness of Different Irrigant Activation Techniques in Removing the Smear Layer and Opening the Dentinal Canals: A Scanning Electron Microscopic Study.

Background Although irrigation is one of the most important stages during root canal treatment, it is not possible to guarantee the entry of irrigants to all the areas in the root canal, especially in the apical third. Therefore, the activation of irrigants can stimulate and help the irrigants to access hard-to-reach places within the root canal system. Therefore, this study aimed to evaluate the opening of the dentinal canals with scanning electron microscopy (SEM) using different irrigant activation techniques, such as intracanal heating activation, sonic activation, and ultrasonic activation, along the walls of the root canals in the coronal, middle, and apical thirds. Methodology The study sample consisted of 36 single-canal premolars, which were randomly divided into the following three equal groups according to the method of activation used: group 1 (n = 12), which involved heating activation inside the root canals, group 2 (n = 12), which involved sonic activation, and group 3 (control; n = 12), which involved ultrasonic activation. Afterward, dental crowns were cut to standardize the working length by 18 mm and were then prepared using the ProTaper Next system up to size X2. Moreover, the irrigant was activated for each group separately, and the teeth were extracted and prepared for SEM. Three images were taken for each sample (i.e., coronal third, middle third, and apical third) at ×2,000 magnification. Data were analyzed using the Mann-Whitney U test. Results When studying the removal of the smear layer and the opening of the dentinal canal under ×2,000 magnification, there were no statistically significant differences in the coronal and middle third between the three studied groups. However, statistically significant differences were found in the apical third, where the ultrasonic activation group was the best, followed by the sonic activation group, and the heating activation group. Conclusions All methods of activation were effective in removing the smear layer and opening the dentinal canals with the advantage of ultrasonic activation in the rest of the groups. The intracanal heating irrigant activation proved to be similar to the effectiveness of sonic activation and close to ultrasonic activation.

Evaluation of the Effect of Antihypertensive Drugs on the Values of Dental Pulp Oxygen Saturation in Hypertension Patients: A Case-Control Study.

Purpose This study aimed to know about the positive or negative effect of antihypertensive drugs of different groups on the values of dental pulp oxygen saturation in hypertension patients. Materials and Methods A case-control study to evaluate the impact of the antihypertensive drugs on the values of dental pulp oxygen saturation in hypertension patients. The studied sample consisted of 40 participants, and they were distributed into two groups: Group I (n=20): Hypertension patients treated with antihypertensive drugs, and Group II (n=20): Healthy participants. A finger pulse oximeter was recorded after a rest period of 15 minutes by BCI® Advisor® vital signs monitor. The patient was then asked to use a chlorhexidine digluconate mouth rinse for five minutes, and the two dental pulp pulse oximeters for the central upper incisors were also recorded for all participants. Data were analyzed using the Mann-Whitney U test. Results ​​​​​​The results showed that there was no significant difference between the finger pulse oximeters of the two studied groups (P-value = 0.421). The two dental pulp oxygen saturation was higher than the control group with statistically significant (P-value = 0.043, P-value = 0.002). Conclusions Within the limitation of this study, it can be concluded that antihypertensive drugs increase the dental pulp oxygen saturation in patients with hypertension who are treated with antihypertensive drugs, and thus there is a positive effect of these drugs in stimulating the dental pulp.

Assessing an active distracting technique during primary mandibular molar pulpotomy (randomized controlled trial).

OBJECTIVES: This study aims to evaluate the effectiveness of two different distraction techniques (Audio Video Distraction/Video Game Distraction) in the management of anxious pediatric patients during dental treatment. MATERIALS AND METHODS: One hundred and five children were randomly divided into three groups; Group A: active distraction using video games on a tablet device and wireless joystick (VG). Group B: passive distraction using video on tablet, and wireless headphones (AV). Group C (Control group): basic behavior guidance technique Tell Show Do was used (C). The children were selected from the department of pediatric dentistry at the Faculty of Dentistry, Damascus University, who required pulpotomy in primary mandibular molars. All children were assessed by: Simplified Wong-Baker FACES for pain scale (self-report), and "HOUPT" Behavior Rating Scale for Overall Behavior (non-self-report), at the end of treatment. RESULTS: One hundred and five children completed the study (57 boys and 48 girls) aged between 6 and 10 years (mean age of 7.4 years). The active distraction (VG) group was superior to the passive distraction (AV) group and the control group (C) on the pain scale with statistically significant differences as appeared in Simplified Wong-Baker Scale (p = .000), The active distraction (VG) group was superior to the control group (C) in overall behavior as appeared in HOUPT scale (p = .041), but it was no statistically significant differences between (VG) group and (AV) group in overall behavior (p = .605). With the use of Bluetooth technology and wireless devices, the workspace was comfortable for the dentist and did not interfere with the movement of his hands. CONCLUSION: Positive distraction with video games by wireless joystick displayed on the portable tablet on the dental chair was the best technique for reducing dental anxiety and reported pain in school children (6-10 years) and was better than negative distraction by video cartoons on the tablet device.

Evaluation of the efficacy of mineral trioxide aggregate and bioceramic putty in primary molar pulpotomy with symptoms of irreversible pulpitis (a randomized-controlled trial).

OBJECTIVES: Preserving the primary teeth is important, as they play an important role in the integrity of the dental arch, the development of the craniofacial complex, speech, and chewing. This study aimed to evaluate the effectiveness of both Mineral Trioxide Aggregate (MTA) and Bioceramic putty in primary molar pulpotomy with symptoms of irreversible pulpitis. MATERIALS AND METHODS: In this study, 40 s primary mandibular molars in 40 healthy children aged 6-8 years were examined and classified into 2 groups according to the material: group A, with 20 primary molars capped by MTA, and group B, with 20 teeth capped by Bioceramic putty. Clinical and radiographic evaluation of the treatment results was carried out after 1 week, 3 months, 6 months, 9 months, and 1 year. RESULTS: Clinical and radiological success rates in the MTA group reached 95%, where a case of failure was observed after a year of follow-up. In the Bioceramic group, the success rate reached 100% after a year of follow-up, without any statistically significant differences between groups (p = .311). CONCLUSIONS: Pulpotomy using biocompatibility materials (MTA-Bioceramic) in primary molars with symptoms of irreversible pulpitis is considered effective due to the better advantages of the use of Bioceramic over MTA. This clinical trial was approved by Australian New Zealand Clinical Trials (12621001631897).

Evaluation of Bioceramic Putty in Pulpotomy of Immature Permanent Molars With Symptoms of Irreversible Pulpitis.

Purpose This study aimed to evaluate the effectiveness of both mineral trioxide aggregate (MTA) and bioceramic putty (Well-Root PT) in the pulpotomy of immature permanent molars diagnosed with symptoms of irreversible pulpitis. Materials and methods The study included 30 immature permanent molars with symptoms of irreversible pulpitis in 30 healthy children aged six to eight years. They were randomly distributed into the following two groups according to the material used: group 1 included 15 first permanent molars capped by MTA and group 2 included 15 first permanent molars capped by bioceramic putty. Clinical and radiographical evaluations of the treatment results were made after one week, three months, six months, nine months, and 12 months. Results The success rate in the bioceramic putty group was 93.3% clinically and radiographically after a 12 months follow-up, whereas in the group that underwent MTA treatment no cases of failure were registered with a 100% success rate. No statistical differences were observed between groups (p=0.309). The dentin bridge was formed in 60% of the MTA group and 33.3% of the bioceramic group without any statistically significant differences (p=0.272) after a 12 months follow-up. Conclusion Pulpotomy using biocompatible materials (MTA and bioceramic putty) on immature permanent molars with symptoms of irreversible pulpitis is considered acceptable and effective.

Three-Dimensional Finite Element Analysis of Worn Molars With Prosthetic Crowns and Onlays Made of Various Materials.

Background/Purpose Restoration of worn teeth represents a challenge for practitioners in terms of preserving dental tissues, achieving restoration requirements, and choosing the most appropriate material. This study aimed to evaluate the effect of both preparation and restoration type on stress distribution in modeled first mandibular molars when functional and parafunctional occlusal forces were applied. Materials and methods The study sample consisted of 40 three-dimensional computer models of restored lower first molars with full crowns (gold, nickel-chrome, lithium disilicate, BruxZir® zirconia, and porcelain fused to metal) and onlays (gold, nickel, chrome, lithium disilicate, and direct and indirect composites). Forces of different intensities and directions were applied, and then finite element analysis was carried out based on the von Mises equivalent stress theory to predict the failure that could occur in the restoring materials and luting cement or bonding agent. Results In functional forces groups, zirconia crowns showed the lowest value of the failure risk, while the highest value was in veneering porcelain with values close to the rest of the models. For onlays, gold onlays represented the best stress distribution with the lowest value of the failure risk, in contrast to the composite onlays that had the highest failure risk. In parafunctional forces groups, the preference remained for zirconia and gold crowns, as well as for metal onlays, with greater differences in the values of the failure risk. Conclusion Gold alloy exhibited better behavior in the stress distribution. All restorations showed similar behavior when applying functional forces; however, when applying parafunctional forces, both gold and zirconia crowns have shown the best results.

The Efficacy of Three Rotary Systems (Reciproc Blue, WaveOne Gold, and AF Blue R3) in Preparing Simulated, Highly Curved Root Canals: An In Vitro Study.

Purpose This study aimed to evaluate the effectiveness of three rotary, single-file, and reciprocating systems in terms of preparation time and canal centralization in simulated highly curved root canal preparation. Materials and methods The study sample consisted of 45 simulated canals with a curvature of 40°. They were randomly distributed into three experimental groups: Group 1-Reciproc Blue; Group 2-WaveOne Gold; and Group 3-AF Blue R3. A glide path was established by #10 hand K-file, then red dye was colored on the simulated canals, and photographs of the sample were taken before preparation. Then, the canals of each group were prepared, and other photographs were taken after preparation. The images of the two phases were combined using AutoCAD, where the canal was divided into three parts and the preparation area was measured from the right and left sides of each part of the canal. The preparation time for each system was also measured. Results While there were no statistically significant differences in the rate of preserving canal centralization in the middle and apical thirds between preparation groups, a statistically significant difference was found in the coronal third, as the Reciproc Blue and WaveOne Gold systems have a greater ability to maintain the centrality of the canal compared to the AF Blue R3 system. While there were no statistically significant differences between the Reciproc Blue and WaveOne Gold systems in the coronal third, as for the preparation time, it was found that there were statistically significant differences in the preparation time between the groups in favor of the WaveOne Gold system. Conclusion Both preparation systems (Reciproc Blue and WaveOne Gold) maintained the anatomical shape and canal centrality, with more cons for WaveOne Gold compared to the Reciproc Blue system. Regarding the volumetric changes, AF Blue R3 had the greatest changes compared to the Reciproc Blue and WaveOne Gold systems. WaveOne Gold Group, in terms of canal preparation time, showed the least time among the investigated groups.

Evaluation of the Antibacterial Efficacy of QMix and AgNP Solutions in Root Canals of Primary Molars: An In-Vitro Study.

Purpose The study aimed to evaluate QMix2in1 and silver nanoparticles (AgNPs) solution in eliminating Enterococcus faecalis (E. faecalis) bacteria within root canals of primary molars. Materials and methods The study sample consisted of 45 extracted primary molars, which were divided into three groups: Group 1 (control) NaOCl 5.25%, Group 2 (experimental) QMix2 in 1, and Group 3 (experimental) AgNPs 4000 ppm. The root canals were sterilized within an autoclave and then contaminated with E. faecalis bacteria. The root canals were irrigated for five minutes in a quantity of 3 ml using a 31-gauge irrigation needle, and then bacterial smears were taken. Results Sodium hypochlorite, AgNPs, and QMix2in1 effectively reduced the bacterial count of Enterococcus within root canals of primary molars. There were statistical differences between all groups. QMix2in1 solution showed the greatest antibacterial efficacy, then NaOCl solution and AgNPs solution.  Conclusion All irrigation solutions used are effective in eliminating E. faecalis. QMix2in1 can be considered a good alternative to sodium hypochlorite in irrigation root canals of primary teeth.

Histopathological evaluation of pulp response to portland cement compared to MTA after primary canines pulpotomy (in vivo study).

INTRODUCTION: ECC (Early childhood caries) is very common in children. Because of the small size of primary anterior teeth, endodontic exposures occur early. Pulp tissue response after pulpotomy of primary anterior teeth by both MTA and Portland Cement is very important when pulp exposures occur in these teeth. AIM: This study aimed to evaluate in vivo pulp tissue responses after the primary canines pulpotomy with either White Portland Cement (WPC) or White Mineral Trioxide Aggregate (WMTA), by histopathological analysis. MATERIALS AND METHODS: The study included 30 primary canines in 21 healthy children aged 6-9 years old and it was classified into 2 groups according to the material. Group 1: included 15 teeth capped by White Portland Cement, and Group 2: included 15 teeth capped by white MTA. The dentine bridge formation, soft Tissue Organization, tissue fibrosis, formed dentin bridge thickness, pulp calcifications, hemorrhage in the pulp tissue, and deposition of new dentin on the inner surface of the dentin at 3 months periods were recorded. RESULTS: Data were analyzed statistically; the Mann-Whitney U test was performed for the assessment of histopathological criteria. Descriptive statistics were performed for the analysis of participant properties. Histopathological analysis showed complete dentin bridge formation and normal soft tissue organization for both materials. Statistical analysis showed no significant differences in dentine bridge formation (P value = 0.213), soft Tissue Organization (P value = 0.339), tissue fibrosis (P value = 0.079), formed dentin bridge thickness (P value = 0.139), pulp calcifications (P value = 0.581), hemorrhage in the pulp tissue (P value = 0.117), and deposition of new dentin (P value = 0.097), during the observation period. CONCLUSIONS: Within the limitation of the current study WPC was similar to WMTA in terms of histological criteria so PC may serve as a good alternative to MTA in primary teeth pulpotomy.

Evaluation of the Efficacy of Nasal Sedation Midazolam Compared with Dexmedetomidine in the Management of Uncooperative Children with Down Syndrome during Dental Treatment.

Objective: This study aimed to compare the intranasal administration of midazolam and dexmedetomidine in uncooperative children with Down syndrome. Materials and Methods: The sample consisted of 20 children with Down syndrome aged 5 to 11 years who were divided equally into two groups: Group 1 (experimental) nasal dexmedetomidine and Group 2 (control) nasal midazolam. The efficacy of both the drugs was evaluated according to Ohio State University Behavioral Rating Scale (OSUBRS), University of Michigan scale (UMSS), and Houpt general behavior scale. Results: Both substances have been effective in the management of children with Down syndrome. There were no statistically significant differences for Ohio State University Behavioral Rating Scale (OSUBRS) (P value = 0.631), University of Michigan scale (UMSS) (P value = 0.739), and Houpt general behavior scale (P value = 0.481). Conclusion: Both midazolam and dexmedetomidine nasal can be used to sedate children with Down syndrome.

Evaluation Time and Efficacy of Root Canal Rotary Preparation in Primary Teeth: An In-Vitro Study.

Purpose The objective of this study was to evaluate the efficacy, apical debris extrusion, and time of rotary preparation of Baby Fanta files (Fanta Dental, (Shanghai, China) in root canals of primary molars. Materials and methods The study sample consisted of 30 upper secondary molars that were randomly divided into two groups (Baby Fanta - K file, Shanghai, China), each group comprising 15 palatal roots that were prepared, the necessary preparation time was calculated, the apical debris was collected, and they underwent a clearing technique to evaluate the cleaning effectiveness of the files used in this study. Results The results showed that Baby Fanta files were superior to K-file in time of preparation (P-value=0.000) while there were no statistical differences in the effectiveness of cleaning (P-value=0.188) or apical debris extrusion (P-value=0.451). Conclusion Baby Fanta files can be used effectively for the rotary preparation of root canals in primary teeth.

The Effect of Bioceramic HiFlow and EndoSequence Bioceramic Sealers on Increasing the Fracture Resistance of Endodontically Treated Teeth: An In Vitro Study.

Background/purpose Root fractures after endodontic treatment are a serious complication, and it often causes tooth loss, several studies have found a correlation between root canal preparation and filling, and the possibility of root fracture. Therefore, this study aimed to evaluate the root fracture resistance of the endodontically treated mandibular premolars after preparing and filling by EndoSequence Bioceramic (BC), EndoSequence BC HiFlow, and AH Plus (AHP). Materials and methods The study sample consisted of 75 single-rooted and single-canal mandibular premolars, they were randomly distributed into five groups: Group I: root canals preparation and fillings with AHP sealer; Group II: root canals preparation and fillings with EndoSequence BC sealer; Group III: root canals preparation and fillings with BC HiFlow sealer; Group IV (Negative Control): without root canals preparation; and Group V (Positive Control): canals preparation without root canals filling. A glide path was established by #10 hand K-file, then the crowns were cut, and the canals were prepared and filled. All teeth were restored with glass ionomer cement and kept in an incubator at 37°C for a week. All samples were placed within acrylic bases and a vertical force was applied using a Testometric machine and the fracture resistance force was recorded. Results EndoSequence BC and BC HiFlow groups showed slightly better fracture resistance (494.440, 496.960 N respectively) than AHP group (492.680 N). However, no statistically significant difference was found between the two groups (P-value >0.05). The greatest mean fracture force was observed in the positive control group (736.040 N) with statistically significant difference between the other groups (P-value <0.01) and the least mean fracture force was shown in the negative control group (318.040 N) with statistically significant difference between the other groups (P-value <0.01). Conclusion Based on this in vitro study, the use of EndoSequence BC, BC HiFlow, and AHP enhanced the fracture resistance in root-filled single-rooted premolar teeth. While, the application of EndoSequence BC, BC HiFlow, and AHP did not increase the fracture resistance of roots compared to that of unprepared root canals.