Effect of novel chelating agents on the push-out bond strength of calcium silicate cements to the simulated root-end cavities

Effect of different chelators on the push-out bond strength of hydraulic cements in retrograde obturation

Background

This study examined the effect of ethylenediaminetetraacetic acid (EDTA) and etidronic acid (HEDP) in retrograde cavities on the bond strength of MTA Angelus and NeoPutty.

Methods

Sixty-six teeth with single roots and canals were decoronated and enlarged up to F3 using the ProTaper Universal file system. After removing the apical 3 mm within the scope of endodontic surgery procedures, retrograde cavities were prepared with ultrasonic tips. The teeth were divided into three main groups according to the irrigation solution used: saline, 17% EDTA, and 9% HEDP. Following the irrigation of retrograde cavities, each main group was further divided into two subgroups in terms of using MTA Angelus and NeoPutty as retrograde filling materials. Bond strength values of hydraulic cements were measured by the push-out test. Fracture modes were examined under a stereo microscope. Two dentin sections from each group were examined under scanning electron microscopy (SEM) to observe dentinal tubules. Two-way ANOVA and post hoc Tukey tests were used to analyze the data.

Results

Irrigation solutions similarly affected the bond strength values of hydraulic cements (P=0.115). MTA Angelus showed significantly higher values than NeoPutty in all the solution groups (P=0.34). Adhesive and cohesive fracture modes were mostly observed in the MTA Angelus and NeoPutty groups, respectively.

Conclusion

EDTA, HEDP, and saline had a similar effect on the bond strength of hydraulic cements. The higher bond values of MTA Angelus compared to NeoPutty could support its safe use in endodontic surgery procedures.

Effects of blood and root-dentin cleaning on the porosity and bond strength of a collagen bioceramic material

To assess the effect of cleaning protocols on dentin contaminated with blood in reparative endodontic materials, bovine root samples were divided: no contamination (N); contamination (P); contamination and cleaning with saline (S), 2.5% NaOCl+saline (Na) or 2.5% NaOCl+17% EDTA+saline (NaE) and filled with: mineral trioxide aggregate (MTA), calcium-aluminate-cement (C), or C+collagen (Ccol) (n=13). The samples were evaluated for porosity, chemical composition, and bond strength. MTA porosity was lower than C (p=0.02) and higher than Ccol (p<0.001). P and NaE were similar (p=1.00), but higher than the other groups (p<0.001). MTA bond strength was similar to Ccol (p=0.777) and lower than C (p=0.028). P presented lower bond strength than the N (p<0.001); S and Na were similar to each other (p=0.969), but higher than P and lower than N (p<0.001). It was observed a predominance of mixed and cohesive failures. None of the samples showed Ca/P ratio values similar to human hydroxyapatite. This study showed that contamination with blood increased the materials porosity, but dentin cleaning with 2.5% NaOCl reduced this effect, and the collagen additive reduced the material porosity. Furthermore, blood contamination reduced the materials bond strength, and cleaning with saline or 2.5% NaOCl diminished this effect.

Effects of ethylenediaminetetraacetic acid, citric acid, and etidronic acid on root dentin mineral content and bond strength of a bioceramic-based sealer: A scanning electron microscopy-energy dispersive spectroscopy study

Background

This study assessed the impact of chelating agents, 17% ethylenediaminetetraacetic acid (EDTA), 10% citric acid (CA), and 18% etidronic acid (HEDP), on root dentin mineral content. Scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS) was applied to analyze changes, and the push-out bond strength test was used to measure dentin adhesion of Well-Root ST, a bioceramic root canal sealer.

Methods

A total of 80 extracted single-rooted lower premolar teeth were included in this study and randomly divided into four groups (n=20): group 1 (17% EDTA), group 2 (10% CA), group 3 (18% HEDP), and group 4 (distilled water, control). After irrigation and drying, SEM-EDS was applied to analyze eight samples from each group at coronal, middle, and apical root regions for mineral content and SEM images. The remaining 12 samples underwent a push-out bond strength test using Well-Root ST sealer and gutta-percha. Kruskal-Wallis and Dunn's tests were used for statistical analyses.

Results

Statistically significant differences were found between groups (P<0.05). SEM-EDS showed significant differences in C, O, Ca, P, and Ca/P content, with no significant differences in Na and Mg. Push-out bond strength was significantly higher in the 17% EDTA, 10% CA, and 18% HEDP groups compared to the control group, with no significant differences between chelating agents.

Conclusion

Chelating agents altered root dentin mineral content and improved the adhesive properties of the bioceramic sealer. These findings highlight the importance of considering the selection and use of chelating agents in the clinical practice for root canal treatment.

Comparative Evaluation of Push-out Bond Strength of Three Different Root Canal Sealers: An In Vitro Study

AIM

The aim of this present study was to compare the dislodgement resistance of calcium silicate-based sealer, zinc oxide sealer, and a new sealer combining both zinc oxide and calcium silicate-based sealer in vitro.

MATERIALS AND METHODS

60 single-rooted human teeth were instrumented with F3 Protaper Gold. All endodontic canals were filled using gutta percha cones using the cold lateral condensation technique in combination using one of the mentioned sealers (n = 20 per group). The teeth were divided into three groups: group A consisted of Sealite® Ultra, group B consisted of K-Sealer®, and group C consisted of BioRoot® RC. After 2 months of incubation (37°C, 100% humidity) and after cutting out 2 mm from the most apical portion of the root apex, six slices of 1 mm thickness were generated. Mechanical dislodgement resistance was examined using a universal pressure-testing machine and the push-out bond strength (POBS) was calculated. Specimens were examined under 20× magnification to define the bond failure mode. Statistical analysis was executed using ANOVA, post hoc Turkey test for pairwise comparisons and Kruskal-Wallis tests.

RESULTS

The POBS of BioRoot® was significantly higher than the POBS of the two other sealers with a mean of 10.54 MPa ± 2.10 and 5.73 MPa ± 2.34, respectively (p < 0.001). Sealite® and K-Sealer® showed similar results in the median and coronal part. K-Sealer® revealed highest POBS compared with Sealite® in the apical part (p < 0.05).

CONCLUSION

The POBS of the zinc oxide and calcium silicate-based sealer was significantly lower compared with calcium silicate. Sealite® and K-Sealer® exhibited almost same results. BioRoot showed the highest POBS of all sealers.

CLINICAL SIGNIFICANCE

The current study was needed to evaluate the bond strength of three different cements to dentinal walls, by evaluating their respective POBS in vitro. The findings of this study may provide guidance for the clinician in the selection of an adequate endodontic sealer that guarantees an enhanced adhesive seal between the Gutta-percha and the dentinal canal walls. How to cite this article: Makhlouf MP, El Helou JD, Zogheib CE, et al. Comparative Evaluation of Push-out Bond Strength of Three Different Root Canal Sealers: An In Vitro Study. J Contemp Dent Pract 2024;25(1):15-19.

Dislodgement pushout resistance of five bioceramic root-end filling materials

This study evaluated the dislodgement push-out resistance of five bioceramic materials. One hundred single-rooted teeth with one canal had the apical 3 mm and crown resected to create a 14 mm standardized length. The canals were instrumented to an apical size 80 with a 3 mm root-end preparation made with ultrasonic diamonds. The prepared roots were randomly divided into 5 root-end restorative groups (n=20). ProRoot MTA, Biodentine, EndoSequence Root Repair Material, EndoSequence Fast Set Putty, and EndoSequence BC Sealer with each material placed following manufacturer's instructions and stored at 100% humidity for 2 weeks. An apical-to-coronal static testing load with the identified dislodgement force converted into MPa with mean results analyzed with Kruskal-Wallis and Dunn's post hoc tests (α=0.05). ProRoot MTA and Biodentine displayed similar push-out stress resistance and exhibited significantly greater stress resistance than the similar Endosequence materials. However, all materials failed cohesively and were not dislodged from the root canal surface.

Efficacy of Photoinduced Photoacoustic Streaming and Diode Laser Irrigation Techniques on Smear Layer Removal, Sealer Penetration and Push-out Bond Strength

Introduction: The present study aimed to test the efficiency of photoinduced photoacoustic streaming using 2940 nm Er: YAG laser and 980 nm diode laser agitation on smear layer removal, sealer penetration and push-out bond strength. Methods: Sixty single canaled human permanent teeth were collected for this study. Specimens were grouped into three experimental groups (20 teeth in each group), depending on the activation protocol used for final irrigation: Group I (needle agitation), group II (980nm diode laser agitation) and group III (photon induced photoacoustic streaming (PIPS) using 2940 nm Er: YAG laser. The quantity of irrigant was standardized in all groups to 4 ml. The irrigant was activated for 40 seconds in different groups under continuous flow. Two teeth from each group were used to check the smear layer removal, and then the remaining teeth in each group were randomly divided into three equal experimental subgroups according to methods of evaluation used: subgroup A: Sealing ability evaluated by dye penetration method; subgroup B: SEM for sealer penetration; and subgroup C: Push-out bond strength assessed by the universal test machine. Results: As regards smear layer removal, results showed that the PIPS group had opened dentinal tubules, followed by the diode laser group, while the least cleaning effect was found in the Side-vented needle group. As for Sealing ability and dye penetration, a statistically significant difference was found between all of the three groups, with the Er:YAG laser (PIPS) having the best sealing ability and sealer penetration. Push-out bond strength results showed no statistically significant difference between diode and Er:YAG groups, with a significant difference between each of them and the Side-vented needle group. Conclusion: Using the diode or Er:YAG laser (PIPS) for irrigant activation led to better irrigant penetration and smear layer removal which subsequently led to obvious sealer penetration, better sealing, and strength properties of endodontic treated teeth.

The effect of different chelators on the dislodgement resistance of MTA Repair HP, MTA Angelus, and MTA Flow

The aim of this study was to investigate the influence of various irrigants on the dislodgement resistance of MTA Repair HP, MTA Angelus, and MTA Flow to root dentin. Three slices (1.0 ± 0.1 mm) were prepared from the middle third of 20 human maxillary anterior teeth. On each dentin disc, three perpendicular simulated perforation holes with a standardized 0.8 mm diameter were created. The sections from the same root were distributed arbitrarily into three groups (n = 20) for smear layer removal procedure: ethylenediaminetetraacetic acid (EDTA), chitosan-based silver nanoparticles (AgNPs-chitosan), and maleic acid (MA). Afterwards, the holes were randomly filled with one of the three investigated cements. The samples were submitted to the push-out test using a universal measuring system. Kruskal-Wallis and Mann-Whitney U tests were used to assess statistical differences among the groups. When the results were evaluated, it was found that the types of cement and chelating agents significantly affected the dislocation resistance (P < 0.05). EDTA provided a higher dislocation resistance with the investigated cements in comparison to MA and AgNPs-chitosan (P < 0.05). Furthermore, it was observed that MTA Flow and MTA Angelus presented improved dislocation resistance values than the MTA Repair HP when used with EDTA (P < 0.05). The findings indicated that EDTA increased the dislodgement resistance of the investigated cements. In conclusion, when EDTA used, MTA Flow, and MTA Angelus showed higher dislocation resistance values.

Effect of various calcium hydroxide removal protocols on the dislodgement resistance of biodentine in an experimental apexification model

Background/purpose

Residual calcium hydroxide (CH) in the root canal dentine walls may influence the adhesion of tricalcium silicate-based materials. The aim of this study is to evaluate the effect of various CH removal protocols on the dislodgement resistance of biodentine from simulated immature root canals in an experimental apexification model.

Materials and methods

CH was applied to 120 simulated immature root canals. The samples were divided into 12 experimental groups (n = 10) according to the applied irrigation protocols used for the removal of CH: Group 1: Sodium hypochlorite (NaOCl), Conventional needle irrigation (CNI); Group 2: NaOCl, EndoActivator; Group 3: NaOCl, XP-endo Finisher; Group 4: NaOCl- Ethylenediaminetetraacetic acid (EDTA), CNI; Group 5: NaOCl-EDTA, EndoActivator; Group 6: NaOCl-EDTA, XP-Endo Finisher; Group 7: NaOCl+etidronic acid (HEBP), CNI; Group 8: NaOCl+HEBP, EndoActivator; Group 9: NaOCl+HEBP, XP-endo Finisher; Group 10: NaOCl- Peracetic acid (PAA), CNI; Group 11: NaOCl-PAA, EndoActivator; Group 12: NaOCl-PAA, XP-endo Finisher; Control Group: CH was not applied. Biodentine was placed at the apical thirds of 130 immature root canals. Vertical loading was applied to biodentine fillings inside the dentin discs. Maximum force to dislodge the material was statistically analyzed with ANOVA.

Results

The control, NaOCl+HEBP (CNI, EndoActivator, XP-endo Finisher) and NaOCl-PAA (EndoActivator, XP-endo Finisher) groups exhibited the lowest dislodgement resistance values (p < 0.001). When used CNI, irrigation with NaOCl+HEBP resulted in lower resistance to dislodgement of biodentine compared to NaOCl, and NaOCl-EDTA (p < 0.001).

Conclusion

Adhesion of apical barrier materials to root canal dentine can be influenced by the irrigation protocols used for CH removal.

Effect of exposure to root canal irrigants on the push-out bond strength of calcium silicate-based cements

OBJECTIVES

The aim of this study was to compare the push-out bond strength (POBS) of three calcium silicate-based cements (CSBC) after exposure to saline, sodium hypochlorite (NaOCl), ethylenediaminetetraacetic acid (EDTA), and a mixture of NaOCl and etidronic acid (NaOCl+HEBP) in simulated perforation.

MATERIALS AND METHODS

A total of 180 dentin slices were perforated and then filled with either Biodentine (BD), ProRoot MTA (PMTA), or Total Fill (TF). After 1 week, specimens in each group were divided into 4 subgroups (n = 15) according to the root canal irrigant (RCI) that their coronal surface was exposed to: saline, 5.25% NaOCl, 17% EDTA, or a mixture of 5.25% NaOCl and 9% HEBP (NaOCl+HEBP). A push-out test was performed, and the failure pattern was assessed. POBS data were analyzed with ANOVA and Tukey post hoc tests and the failure patterns with chi-square test.

RESULTS

No differences were found when comparing the effect of RCI on the POBS of PMTA. BD showed significantly higher POBS values after exposure to NaOCl+HEBP (p < .05), and those of TF were significantly lower after exposure to EDTA (p < .05). No differences in the failure patterns were found among groups.

CONCLUSION

NaOCl+HEBP had no detrimental effect on the POBS of CSBC.

CLINICAL RELEVANCE

The mixture of sodium hypochlorite and etidronic acid may be considered as an alternative irrigant when treating root perforations.

Comparative evaluation of push-out bond strength of root-end filling materials in root-end cavities prepared by laser or ultrasonic technique: An in vitro study

Context:

The use of mineral trioxide aggregate (MTA) and Biodentine as a root-end filling materials used in the root-end cavities prepared by laser or ultrasonic technique is a current topic in the branch of dentistry and push-out bond strength is used to measure the adhesiveness provided by the root-end filling materials.

Aim:

The aim of this study is to evaluate the push-out bond strength of MTA and Biodentine in root-end cavities prepared by erbium:yttrium-aluminium-garne (Er:YAG) laser and ultrasonic retrotip.

Materials and Methods:

A total of 40 extracted maxillary central incisors and canines were selected. Chemomechanical preparation and obturation were done. Root-end resections were performed followed by the root-end cavity preparation and root-end filling. Specimens were divided into four groups. Root-end cavities prepared by Er:YAG laser and filled with MTA, root-end cavities prepared by Er:YAG laser and filled with Biodentine, root-end cavities prepared by ultrasonic retrotip and filled with MTA and root-end cavities prepared by ultrasonic retrotip and filled with Biodentine, respectively. The apical end was again sectioned perpendicular to the long axis. The push-out bond strength was evaluated using a universal testing machine.

Statistical Analysis Used:

The data were analyzed using the analysis of variance and post hoc Tukey test.

Results:

Difference between push-out bond strength of root-end filling materials to root-end cavity walls prepared by laser and ultrasonic retrotips was statistically nonsignificant. Push-out bond strength of MTA and Biodentine did not differ significantly.

Conclusion:

Difference between push-out bond strength of MTA and Biodentine to root-end cavity walls prepared by Er:YAG Laser or ultrasonic retrotip were statistically nonsignificant.

An in vitro comparative evaluation of the effect of three endodontic chelating agents (17% ethylenediamine tetraacetic acid, 1% peracetic acid, 0.2% chitosan) on the push out bond strength of gutta percha with a new bioceramic sealer (BioRoot RCS)

Aim:

This study aims to evaluate the effect of three endodontic chelating agents (17% ethylenediamine tetra-acetic acid [EDTA], 1% peracetic acid [PAA], 0.2% Chitosan) on the push out bond strength of gutta percha with a new bioceramic sealer (BioRoot RCS).

Materials and Methods:

Forty-eight single-rooted mandibular premolars were selected and decoronated to obtain standardized root length of 15 mm. The root canals were prepared up to #30 files (Hyflex CM) and copious irrigation was done with 3 ml of 5.25% of NaOCl. According to the final irrigation, specimens were divided into three groups: Group 1 (n = 16) 0.2% chitosan, Group 2 (n = 16) 17% EDTA, and Group 3 (n = 16) 1% PAA for 1 min. Samples from each group were obturated with bioceramic sealer and gutta percha and sealed with temporary filling material. Two horizontal slices of 2 mm was obtained from the middle third of each sample (n = 32). Push out bond strength and failure modes were assessed. Kruskal–Wallis test followed by Mann–Whitney post hoc analysis was used for push out analysis. Chi square test was used to compare the modes of failure. The statistical significance level was set at P = 0.05.

Results:

The highest push out bond strength was obtained with Group 1 (0.2% chitosan) followed by Group 3 (1% PAA). Group 2 (17% EDTA) showed least push out bond strength when compared to Group 1 (0.2% chitosan) and Group 3 (1% PAA). The mode of failure was mainly cohesive for all groups.

Conclusions:

The highest push-out bond strength of BioRoot RCS was seen after treatment with 0.2% chitosan while the least was after EDTA treatment. 1% PAA treatment also favorably affected push-out bond strength of BioRoot RCS.

Design Variability of the Push-out Bond Test in Endodontic Research: A Systematic Review

INTRODUCTION

There is limited literature on the impact of testing variables on the push-out bond test (POBT). This review identified designs of the POBT used in the endodontic literature and aimed to determine which experimental variables may influence the push-out bond strength (POBS).

METHODS

A systematic review based on PRISMA guidelines was performed by searching the PubMed, SCOPUS, and Cochrane library databases using terms including push-out and dislocation resistance and descriptions of endodontic materials. Test variables assessed included method of root preparation, timing of sectioning compared with filling, thickness, diameter and taper of sections, and plunger size and velocity. The POBS of 3 common materials (gutta-percha and AH Plus, mineral trioxide aggregate, and Biodentine) were collected from investigations, and a comparison was attempted.

RESULTS

One hundred thirty-three studies assessed the POBS of root-filling materials, 68 assessed root repair cements/root-end filling materials, and 16 assessed orifice barrier materials other than mineral trioxide aggregate. There was significant variation in all of the assessed variables, resulting in a large range of reported values for the POBS of the various materials. Because of this heterogeneity in study design, no further statistical analysis of the impact of the test variables on POBS was possible.

CONCLUSIONS

There was considerable variation in the POBT design used in endodontic research. Greater standardization is required for future research as well as accurate reporting for all test variables to assess the impact of specific design variables on POBS.