Dentinal tubule penetration of AH Plus, iRoot SP, MTA fillapex, and guttaflow bioseal root canal sealers after different final irrigation procedures: A confocal microscopic study

Reliability of sealer penetration measurement methods and assessment of dentine penetrability after endodontic retreatment: A correlation in vitro study

This study evaluated the reliability of sealer penetration measurement methods used with confocal laser scanning microscopy in correlation with the percentage of residual root filling and examined the effect of residual root-filling material on dentine penetrability after retreatment. Extracted teeth were randomly divided into different groups according to the obturation sealer used (n = 6); BioRoot RCS; MTA Fillapex; Bio-C and AH Plus. Root-filling material was removed before the secondary chemo-mechanical preparation and obturation using fluorescein labelled AH Plus. Multiple micro-computed tomography scans were obtained followed by confocal laser scanning microscopy to measure the penetration of the labelled sealer into the dentinal tubules using four different methods. Measuring sealer penetration into radicular dentine using the penetration percentage method was found to be the most reliable. Dentine penetrability during retreatment did not seem to be affected by the type of residual root-filling material.

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

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

Comparative Effectiveness of Different Er:YAG Laser-Activated Irrigation Systems on Removing Calcium Hydroxide from Simulated Internal Root Resorption Cavities at Different Root Levels

Objective: To investigate the effectiveness of Er:YAG laser-activated irrigation (LAI) with a short pulse duration for removing calcium hydroxide (CH) from simulated internal root resorption (IRR) cavities at three root levels. Background: Pulse duration is an important parameter during LAI, which ensures the efficiency of irradiation and the corresponding activation process. Short pulses in the range of a few microseconds enable rapid expansion and successive implosion of irrigants, resulting in distinct fluid movement. There have been few reports on CH removal efficacy from IRR cavities of different LAI systems, including those using short pulse duration. Methods: IRR cavities (1.6 mm diameter) were created at the apical, middle, and coronal root levels in 60 mandibular premolars and filled with a radiopaque CH paste. Samples were assigned to the following irrigation groups (n = 12, each): (1) LAI(P)-F, a prototype laser device that operates with short pulse duration (Morita Manufacturing) with a flat tip; (2) LAI(EA)-F, the ErwinAdverl laser device (Morita Manufacturing) with a flat tip; (3) LAI(EA)-T, the ErwinAdverl laser device with a tapered tip; (4) PIPS-T, the Lightwalker laser device (Fotona) with a tapered tip; and (5) SI, the syringe irrigation group. The laser tips were fixed at the canal entrance. The remaining CH volume and surface area were assessed in IRR cavities using micro-computed tomography and scanning electron microscopy, respectively. Data were statistically analyzed utilizing one-way analysis of variance and Tukey's test at 5% significance level. Results: The LAI(P)-F and PIPS-T groups exhibited the highest CH removal rates at three different levels (p < 0.05). The LAI(EA)-F group had a significantly better efficacy of CH removal compared with the LAI(EA)-T group at the middle level (p < 0.05). Conclusion: The LAI(P)-F and PIPS-T groups demonstrated superior efficiency in removing CH from simulated IRR cavities.

Coaggregated E. faecalis with F. nucleatum regulated environmental stress responses and inflammatory effects

To investigate the cell-cell interactions of intergeneric bacterial species, the study detected the survival of Enterococcus faecalis (Ef) under monospecies or coaggregation state with Fusobacterium nucleatum subsp. polymorphum (Fnp) in environmental stress. Ef and Fnp infected the human macrophages with different forms (Ef and Fnp monospecies, Ef-Fnp coaggregates, Ef + Fnp cocultures) for exploring the immunoregulatory effects and the relevant molecular mechanisms. Meanwhile, the transcriptomic profiles of coaggregated Ef and Fnp were analyzed. Ef was shown to coaggregate with Fnp strongly in CAB within 90 min by forming multiplexes clumps. Coaggregation with Fnp reinforced Ef resistance against unfavorable conditions including alkaline, hypertonic, nutrient-starvation, and antibiotic challenges. Compared with monospecies and coculture species, the coaggregation of Ef and Fnp significantly facilitates both species to invade dTHP-1 cells and aid Ef to survive within the cells. Compared with coculture species, dual-species interaction of Ef and Fnp significantly decreased the levels of pro-inflammatory cytokines IL-6, TNF-α, and chemokines MCP-1 secreted by dTHP-1 cells and lessened the phosphorylation of p38, JNK, and p65 signaling pathways. The transcriptome sequencing results showed that 111 genes were differentially expressed or Ef-Fnp coaggregated species compared to Ef monospecies; 651 genes were differentially expressed for Fnp when coaggregation with Ef. The analysis of KEGG pathway showed that Ef differentially expressed genes (DEGs) were enriched in quorum sensing and arginine biosynthesis pathway; Fnp DEGs were differentially concentrated in lipopolysaccharide (LPS) biosynthesis, biofilm formation, and lysine degradation pathway compared to monospecies. KEY POINTS: • Coaggregated with Fnp aids Ef's survival in environmental stress, especially in root canals after endodontic treatment. • The coaggregation of Ef and Fnp may weaken the pro-inflammatory response and facilitate Ef to evade killed by macrophages. • The coaggregation between Ef and Fnp altered interspecies transcriptional profiles.

Assessment of different irrigation techniques on the penetration depth of different sealers into dentinal tubules by confocal laser scanning microscope: An in vitro comparative study

Background

The effective disinfection of the entire root canal system aids in the penetration of irrigants into the dentinal tubules further improving sealer penetration and achieving a three-dimensional seal in endodontically treated teeth. Various final irrigation techniques can be employed to achieve this goal. Therefore, this study intended to assess and compare the efficacy of three final irrigation techniques on the depth of penetration of two root canal sealers into dentinal tubules using confocal laser scanning microscope (CLSM).

Methods

Forty-eight single-rooted mandibular premolars were selected and decoronated to a length of 12 mm. All the samples were prepared using ProTaper Gold rotary files and divided into three groups: Group 1 - Conventional syringe irrigation (CSI), Group 2 - passive ultrasonic irrigation (PUI), and Group 3 - Pro-agitator tip system (PATS). Each group was divided into two subgroups: Subgroup A - AH Plus and Subgroup B - GuttaFlow Bioseal (GFB). Then, sealers were mixed with 0.1% rhodamine B dye and the samples were obturated. All the samples were sectioned at 2 mm and 5 mm from the apex and visualized under confocal laser scanning microscope (CLSM) (10×) for maximum mean penetration depth and percentage of sealer penetration. Statistical analysis was done using the independent t-test and one-way analysis of variance test, followed by Tukey's Post hoc analysis.

Results

PUI performed better in the apical third, whereas PUI and PATS showed comparable results in the middle third for both depth and percentage of sealer penetration. Among the two sealers, GFB performed better than AH Plus in both the apical and middle third. These values were statistically significant. (P < 0.05).

Conclusion

Final irrigation activation with PUI or PATS can significantly improve sealer penetration. The average depth of penetration of GFB both at the middle and apical third of the root was significantly superior to AH Plus.

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

Objective

To evaluate and compare dentinal tubule penetration and push-out bond strength of BIO-C ION+, AH Plus and NanoSeal-S using Confocal Laser Scanning Microscopy (CLSM) and Universal Testing Machine (UTM).

Materials & method

Sixty human mandibular premolars were prepared using ProTaper Gold till F3. Samples were then divided into 3 groups: Group I (n = 20) BIO-C ION + sealer, Group II (n = 20) AH Plus and Group III (n = 20) NanoSeal-S sealer. Groups were then sub-divided into two sub groups: In Subgroup A (n = 10) samples were obturated using single-cone with 0.1 % Rhodamine B dye and in Subgroup B (n = 10) samples were obturated using single cone. The samples were then transversely sectioned into coronal, middle and apical segments, samples in subgroup A & B were then submitted to CLSM analysis and UTM respectively.

Results

The Bond Strength data showed following means (MPa): Group I Subgroup B: (BIO-C ION+) coronal (1.64), middle (1.25), apical (0.93); Group II Subgroup B: (AH Plus) coronal (2.20), middle (1.85) apical (1.38) and Group III Subgroup B: (NanoSeal-S) coronal (1.26), middle (0.94), apical (0.58). The dentinal tubule penetration data showed following means: (μm) Group I Subgroup A (BIO-C ION+) coronal (1184.69), middle (997.03), apical (637.26); Group II Subgroup-A AH Plus (864.14) and NanoSeal-S (495.64). Statistical analysis (two-way ANOVA, Tukey's Post Hoc Test) showed significant difference among sealers (p < 0.001) and root canal thirds (p < 0.001).

Conclusion

The results of the study concluded that BIO-C ION + sealer showed maximum dentinal tubule penetration and AH Plus demonstrated maximum push-out bond strength.

Expert consensus on irrigation and intracanal medication in root canal therapy

Chemical cleaning and disinfection are crucial steps for eliminating infection in root canal treatment. However, irrigant selection or irrigation procedures are far from clear. The vapor lock effect in the apical region has yet to be solved, impeding irrigation efficacy and resulting in residual infections and compromised treatment outcomes. Additionally, ambiguous clinical indications for root canal medication and non-standardized dressing protocols must be clarified. Inappropriate intracanal medication may present side effects and jeopardize the therapeutic outcomes. Indeed, clinicians have been aware of these concerns for years. Based on the current evidence of studies, this article reviews the properties of various irrigants and intracanal medicaments and elucidates their effectiveness and interactions. The evolution of different kinetic irrigation methods, their effects, limitations, the paradigm shift, current indications, and effective operational procedures regarding intracanal medication are also discussed. This expert consensus aims to establish the clinical operation guidelines for root canal irrigation and a position statement on intracanal medication, thus facilitating a better understanding of infection control, standardizing clinical practice, and ultimately improving the success of endodontic therapy.

Evaluation of cytotoxicity and adaptability of a novel bioceramic root canal sealer: An in vitro and scanning electron microscope study

Context

Cytotoxicity and adaptability are among the highly imperative tests that should be performed on a novel endodontic material to ensure its successful implementation in endodontic treatment.

Aims

Assess a recently introduced bioceramic root canal sealer CeramoSeal with TotalFill BC and AH plus sealers regarding the cytotoxicity and adaptability.

Materials and Methods

Five sealer discs were prepared for each sealer and their extracts were cultured in 96-well plates containing human fibroblasts for 24 h. After their incubation, MTT solution was added to each well plate using an enzyme-linked immunosorbent assay plate reader was implemented to calculate the percentage of viable cells. Thirty mandibular single-rooted premolars were prepared using the Edge Endo rotary system, teeth were divided into three groups (n = 10) based on the sealer type: Group 1 CeramoSeal, Group 2 Totalfill, and Group 3 AH plus sealer. Teeth were sectioned longitudinally and viewed under a scanning electron microscope where the region with the gaps was identified and quantified as a percentage of the root canal's overall area.

Statistical Analysis

One-way ANOVA test was used for cytotoxicity, while Kruskal-Wallis and Friedman's tests were used for adaptability.

Results

Ceramoseal statistically significantly showed the lowest viability, at high concentrations AH plus showed the highest cell viability, while at lower concentration Totalfill BC sealer showed the highest cell viability percentage. The gap percentages were statistically significantly higher in Ceramoseal group, there was no statistically significant difference between AH Plus and Totalfill groups.

Conclusions

Ceramoseal sealer exhibited the lowest viability and highest gap percentage compared to the other sealers.

Comparison of Easydo Activator, ultrasonic and needle irrigation techniques on sealer penetration and smear layer removal in vitro

The effects of Easydo Activator (EA), a new sonic irrigation system, on sealer penetration at the root apex were compared to needle irrigation (NI) and passive ultrasonic irrigation (PUI) in this study. Forty-two single-rooted teeth were prepared and randomly divided into three groups (n = 14): group 1: NI; group 2: PUI; and group 3: EA. A solution of 3% sodium hypochlorite (NaOCl) was used for irrigation. Nine teeth in each group were filled with AH Plus sealer mixed with CY5 fluorescent dye and a single gutta-percha cone. The sealer penetration area, maximum penetration depth and percentage of sealer penetration at 5 mm and 1 mm from the apex were analyzed by confocal laser scanning microscopy (CLSM). The remaining 5 teeth in each group were subjected to test smear layer scores by scanning electron microscopy (SEM). The CLSM evaluation showed that increases in the area, depth and percentage of sealer penetration were detected at 1 and 5 mm from the root apex in the PUI group compared with the NI group, and greater increases were observed in the EA group (P < 0.05). The SEM experiment showed that the lowest scores for the smear layer and debris removal were achieved by the EA group when compared with the PUI and NI groups (P < 0.05). In conclusion, EA was superior to PUI and NI regarding sealer penetration at the root apex during endodontic treatment, and it could provide a new technical idea for clinical root canal therapy.

The effects of chelation on the intratubular penetration depth of mineral trioxide aggregate

The penetration depth and extent of mineral trioxide aggregate (MTA) crystallisation into dentinal tubules at 2, 4 and 6 weeks after chelation and MTA obturation were investigated. Standardised 12 mm human root specimens (45) were prepared with NiTi rotary files using 4% NaOCl irrigation. They were randomly allocated to three irrigants (n = 15: 4% NaOCl, 15% ethylenediaminetetraacetic acid or Edgemix) and obturated with sodium fluorescein tagged ProRoot MTA. One millimetre thick apical, middle and coronal sections were examined using confocal laser scanning microscopy to determine MTA penetration depth and area. Depths varied from 352 to 1821 μm at 6 weeks depending on section level and were unaffected by chelation. No differences (p > 0.05) were found in mean maximum penetration depth or dentine area (%) between the 3 irrigants at all time intervals. MTA mineralisation penetrated up to 90% of dentinal tubules and can extend to the cementum in roots with patent, non-infected tubules.

Influence of bioceramic cones on the quality of root canal filling relative to bond strength and adaptation of the adhesive interface

AIM

To evaluate the bond strength (BS) and analysis of the adhesive interface in root canals filled with bioceramic gutta percha sealers and cones.

MATERIAL AND METHODS

Ninety-six maxillary canines were divided into eight groups according to the endodontic sealer (AH Plus, AH Plus Bioceramic, Bio-C Sealer or Bio-C Sealer Ion+ and gutta percha cones (conventional or bioceramic) tested. They were analyzed using the BS test, failure pattern, analysis of the adhesive interface by scanning electron microscopy and confocal laser scanning microscopy. The BS data were compared between groups using the analysis of variance test with the Turkey post-test. The chi-square test was used to assess the type of failure and the non-parametric Mann-Whitney and Kruse-Wallis tests (P < 0.05).

RESULTS

Analysis of variance showed higher BS values for the groups of bioceramic gutta percha cones in Bio-C Sealer Ion+ (8.38 ± 4.27), AH Plus Bioceramic (6.19 ± 3.28), Bio-C Sealer (5.70 ± 3.18), AH Plus (4.61 ± 2.11) and for conventional gutta percha cones in AH Plus sealers (4.26 ± 2.35), Bio-C Sealer Ion + (3.63 ± 2.29), Bio-C Sealer (2.94 ± 2.32) and AH Plus Bioceramic (1.19 ± 0.89) (P < 0.05). Relative to the type of failure and adaptation of the types of filling material, a higher percentage of mixed failures was observed (gaps between 1 µm-10 µm) for the group with bioceramic gutta percha cones (P < 0.001).

CONCLUSION

The bond between sealers and bioceramic gutta percha cones showed higher bond strength values and greater penetration into the dentin tubules.

CLINICAL RELEVANCE

The filling the root canal system with bioceramic sealers should be associated with bioceramic gutta percha cones.

The effect of sealer type and obturation technique on the fracture resistance of endodontically treated roots

OBJECTIVE

This study evaluated the effect of sealer type with various obturation techniques on the fracture resistance of root filled teeth.

MATERIALS AND METHODS

Eighty mandibular premolars were collected, and root canals of 70 of them were prepared by Mtwo system up to 40/04. Thirty teeth were obturated using TotalFill BC sealer, and 30 using AH Plus sealer, with one of the obturation techniques (N = 10), namely cold lateral compaction (CLC), warm vertical compaction (WVC), and single cone (SC). Ten teeth were left without obturation as a positive control, and the other 10 teeth were not prepared serving as a negative control. Teeth were stored for 3 weeks, and the crowns were separated and the roots were subjected to fracture test using a universal testing machine.

RESULTS

Data was analyzed by ANOVA followed by Tukey's test. Fracture resistance of the TotalFill groups was significantly higher than the AH Plus groups in each obturation technique, and SC had the highest fracture resistance regardless of sealer used (P < 0.05). Obturation of the root canal by TotaFill BC sealer increased the calcium/phosphorous ratio in the dentin of the root.

CONCLUSIONS

Obturation with TotalFill BC sealer improved the fracture resistance of the roots more than AH Plus sealer, and obturation with SC resulted in higher fracture resistance than CLC and WVC.

CLINICAL RELEVANCE

Obturation of the root canal with Bioceramic sealer with single cone obturation technique could reduce the incidence of vertical root fracture.

Evaluation of push-out bond strength, dentinal tubule penetration and adhesive pattern of bio-ceramic and epoxy resin-based root canal sealers

INTRODUCTION

Root canal sealing materials play a crucial role in an endodontic procedure by forming a bond between the dentinal walls and the gutta-percha. The current study aims to analyse the dentinal tubule penetration and adhesive pattern, including the push-out bond strength of six commercially available root canal sealers.

METHODOLOGY

Eighty-four mandibular first premolars were split into seven groups (and n = 12), Group 1: Dia-Root, Group 2: One-Fil, Group 3: BioRoot RCS, Group 4: AH Plus, Group 5: CeraSeal, Group 6: iRoot SP, Group 7: GP without sealer (control). Two groups were made, one for dentinal tubule penetration and the other for push-out bond strength; the total sample size was one hundred sixty-eight. Root canal treatment was performed using a method called the crown down technique, and for obturation, the single cone technique was used. A confocal laser scanning microscope (Leica, Microsystem Heidel GmbH, Version 2.00 build 0585, Germany) was used to evaluate dentinal tubule penetration, and Universal Testing Machine was utilised to measure the push-out bond strength (Shimadzu, Japan) using a plunger size of 0.4 mm and speed of 1mm/min. Finally, the adhesive pattern of the sealers was analysed by HIROX digital microscope (KH-7700). Statistical analysis was carried out by a one-way Anova test, Dunnet's T3 test, and Chi-square test.

RESULTS

Highest dentinal tubule penetration was noticed with One-Fil (p<0.05), followed by iRoot SP, CeraSeal, AH Plus, Dia-Root also, the most negligible value was recorded for BioRoot RCS. Meanwhile, BioRoot RCS (p<0.05) demonstrated the greater value of mean push-out bond strength, followed by One-fil, iRoot SP, CeraSeal, AH Plus and Dia-Root. Regarding adhesive pattern, most of the samples were classified as type 3 and type 4 which implies greater sealing ability and better adherence to the dentinal wall. However, BioRoot RCS revealed the most type 4 (p<0.05), followed by AH Plus, One-Fil, CeraSeal and Dia-Root.

CONCLUSION

The highest dentinal tubule penetration was shown by One-Fil compared to other groups. Meanwhile, BioRoot RCS had greater push-out bond strength and more adhesive pattern than other tested materials.

Assessment of the Penetration of an Endodontic Sealer into Dentinal Tubules with Three Different Compaction Techniques Using Confocal Laser Scanning Microscopy

Adequate root canal sealing is essential for the success of endodontic treatment. There are numerous techniques available; identifying simple and efficient techniques is important to provide good patient care. The purpose of the study was to compare the maximum penetration depth and the percentage of sealant penetration of an endodontic sealer into dentine tubules using cold lateral condensation, continuous wave, and hybrid techniques, and to contrast the effectiveness of two different tapered gutta-percha master cones (0.02 and 0.04). A sample of sixty single root teeth was used. Six experimental groups were formed from the three filling techniques and the two tapered master cones. Images were acquired using a confocal laser scanning microscope. In the apical root third, the penetration percentage was higher in the hybrid compared with the continuous wave technique. The results indicated a higher penetration depth of hybrid compared with cold lateral condensation in the middle and coronal thirds, and in the apical third, a higher penetration was identified in the hybrid group compared with the continuous wave group. No significant differences in penetration were found comparing 0.02 with 0.04 taper gutta-percha groups. The coronal cross-sections presented a higher penetration than the apical third sections. In conclusion, the hybrid technique a had higher maximum sealer penetration than the continuous wave in the apical third, and the coronal third hybrid and continuous wave had a higher penetration than cold lateral condensation.

The effect of an additional application of sealer prior to backfilling in the Continuous Wave of Condensation technique

An additional sealer application was investigated prior to backfilling with the Continuous Wave of Condensation (CWC). 105 Palatal roots were sectioned and prepared to a file size 40, 0.06 taper with Vortex Blue® files. Groups A, B and C had a single sealer application before while groups D, E and F, received a second application of dyed sealer prior to backfilling. Roots were sectioned at 2,3,4,6,7 and 8 mm from the root apex. The percentage of sealer and dentinal tubular penetration depth was calculated at each level. At each ascending level, the sealer percentage decreased for each experimental group while the number of outer third penetration depths increased when all groups were combined. An additional sealer application prior to backfilling had minimal effect on the percentage of sealer or outer third penetration depths and can be considered a clinical preference rather than an imperative step with the CWC technique.

Analysis of physicochemical properties of endodontic sealers containing rhodamine B

The use of fluorescent dyes in microscopy studies is frequent. Therefore, it is important to investigate whether these compounds may alter the physicochemical properties of materials in which they are incorporated to avoid methodological biases. This study evaluated the physicochemical properties of two endodontic sealers containing dry or diluted rhodamine B. Six groups were evaluated: AH Plus and MTA Fillapex in their original composition and mixed with 0.1% dry or diluted rhodamine. Push-out test was applied to assess the bond strength to root dentin. ANSI-ADA No. 57 and ISO No. 6876:2012 specifications were followed to evaluate flowability, setting time, and solubility of the sealers. pH changes were assessed after 24 h, 7, and 30 days. Intergroup comparisons were analyzed by ANOVA complemented by Tukey's post-hoc test; comparisons among periods were analyzed by Wilcoxon and Friedman tests. The incorporation of dry rhodamine decreased the bond strength and prolonged the setting time of AH Plus. The incorporation of diluted rhodamine decreased the setting time and increased the flowability of MTA Fillapex. Diluted rhodamine promoted pH reduction of AH Plus after 24 h and dry rhodamine after 7 days. Rhodamine incorporation promoted pH reduction after 30 days for MTA Fillapex. Solubility was not affected. In conclusion, the incorporation of diluted rhodamine changed the properties of MTA Fillapex, and the incorporation of dry rhodamine changed the properties of AH Plus. Previous dilution of rhodamine did not severely compromise the physicochemical properties of AH Plus and may be suggested to assess its penetrability.

Calcium Silicate-Based Sealer Dentinal Tubule Penetration-A Systematic Review of In Vitro Studies

The aim of this systematic review was to perform a qualitative synthesis of in vitro studies which evaluate and compare the penetration of calcium silicate-based sealers into dentinal tubules. A systematic advanced search was performed in Scopus, Embase, Medline (via PubMed), Web of Science, and Cochrane databases on the 1 December 2022. In vitro studies that compared the tubular penetration of at least two calcium silicate-based sealers in extracted human teeth were eligible. PRILE 2021 guidelines were used for the assessment of the risk of bias included studies. The search identified a total of 680 preliminary records, among which 12 studies were eligible for review. The most used methodology to evaluate sealer penetration was the use of a fluorochrome together with the tested sealers and the analysis of their penetration under confocal laser microscopy. Regarding the results of the included studies, calcium silicate-based sealers exhibit a favorable dentinal tubule penetration. Tubular penetration, however, can be affected by factors such as the irrigation protocol, sealer activation, the filling method used, and root canal morphology. EndoSequence BC Sealer showed the highest sealer penetration among the tested sealers. The influence of different fluorochromes on the results of dentinal tubule penetration studies should also be further explored. The in vitro nature of the included studies limits the applicability of the results into the clinical setting. Prospero registration: CRD42022383896.

Dislodgment Resistance, Adhesive Pattern, and Dentinal Tubule Penetration of a Novel Experimental Algin Biopolymer-Incorporated Bioceramic-Based Root Canal Sealer

The currently available bioceramic-based sealers still demonstrate low bond strength with a poor seal in root canal despite desirable biological properties. Hence, the present study aimed to determine the dislodgment resistance, adhesive pattern, and dentinal tubule penetration of a novel experimental algin-incorporated bioactive glass 58S calcium silicate-based (Bio-G) sealer and compared it with commercialised bioceramic-based sealers. A total of 112 lower premolars were instrumented to size 30. Four groups (n = 16) were assigned for the dislodgment resistance test: control, gutta-percha + Bio-G, gutta-percha + BioRoot RCS, and gutta-percha + iRoot SP, with exclusion of the control group in adhesive pattern and dentinal tubule penetration tests. Obturation was done, and teeth were placed in an incubator to allow sealer setting. For the dentinal tubule penetration test, sealers were mixed with 0.1% of rhodamine B dye. Subsequently, teeth were cut into a 1 mm-thick cross section at 5 mm and 10 mm levels from the root apex, respectively. Push-out bond strength, adhesive pattern, and dentinal tubule penetration tests were performed. Bio-G showed the highest mean push-out bond strength (p < 0.05), while iRoot SP showed the greatest sealer penetration (p < 0.05). Bio-G demonstrated more favourable adhesive patterns. No significant association was noted between dislodgment resistance and dentinal tubule penetration (p > 0.05).

Effect of using calcium-silicate and silicone based root canal sealers in bulk or with main core material on bond strength

Background

The purpose of this study was to assess the push-out bond strength of calcium-silicate and silicone based root canal sealers in bulk and with main cone.

Methods

Roots (n=48) randomly divided into 4 groups (n=12) according to the obturation protocol; (1) iRoot SP in bulk; (2) iRoot SP with gutta-percha; (3) GuttaFlow Bioseal in bulk; (4) GuttaFlow Bioseal with gutta-percha. Six horizontal sections were obtained from each root (n=72). Effect of sealers on bond strength was statistically significant (P<0.05).

Results

Highest mean value was obtained in iRoot-Bulk group and lowest in GuttaFlow Bioseal-GP group. Both iRoot SP groups had significantly higher bond strength values than both GuttaFlow Bioseal groups (P<0.05). There was no significant difference between iRoot-GP and iRoot-Bulk groups (P=0.603) also GuttaFlow Bioseal-GP and GuttaFlow Bioseal-Bulk groups (P=0.684).

Conclusion

Based on findings, using calcium silicate-based sealer in bulk can be also suitable in clinical practice.

Evaluation of the root filling quality with experimental carrier-based obturators: a CLSM and FEG-SEM analysis

This study evaluated tubule penetration of GuttaFlow Bioseal with cold single cone or carrier-based technique, under confocal laser scanning microscopy (CLSM). Twenty straight single-rooted teeth were instrumented with Hyflex CM and divided in two groups (n = 10) according to the obturation method: single cold gutta-percha cones; experimental carrier-based obturators. GuttaFlow Bioseal, labelled with Rhodamine B dye, was used as sealer in both groups. Teeth transversally sectioned were observed under CLSM. Percentage of sealer penetration and integrity of sealer layer perimeter were measured. Surface and microstructural characteristics of obturators and gutta-percha cones were compared by FEG-SEM and EDX analysis. No significant differences were found between groups for each examined parameter. Significant differences (P < 0.05) were reported mainly within groups. Integrity was similar among and within groups. FEG-SEM/EDX analysis of obturators revealed the presence of Ba and Zn. Carrier-based obturation technique associated with GuttaFlow Bioseal does not seem to affect sealer penetration into dentinal tubules.

Premixed Calcium Silicate-Based Root Canal Sealer Reinforced with Bioactive Glass Nanoparticles to Improve Biological Properties

Recently, bioactive glass nanoparticles (BGns) have been acknowledged for their ability to promote interactions with the periapical tissue and enhance tissue regeneration by releasing therapeutic ions. However, there have been no studies on calcium silicate sealers with bioactive glass nanoparticle (BGn) additives. In the present study, a premixed calcium silicate root canal sealer reinforced with BGn (pre-mixed-RCS@BGn) was developed and its physicochemical features and biological effects were analyzed. Three specimens were in the trial: 0%, 0.5%, and 1% bioactive glass nanoparticles (BGns) were gradually added to the premixed type of calcium silicate-based sealer (pre-mixed-RCS). To elucidate the surface properties, scanning electron microscopy, X-ray diffraction, and energy-dispersive spectroscopy were used and flowability, setting time, solubility, and radiopacity were analyzed to evaluate the physical properties. Chemical properties were investigated by water contact angle, pH change, and ion release measurements. The antibacterial effects of the bioactive set sealers were tested with Enterococcus faecalis and the viability of human bone marrow-derived mesenchymal stem cells (hMSCs) with this biomaterial was examined. In addition, osteogenic differentiation was highly stimulated, which was confirmed by ALP (Alkaline phosphatase) activity and the ARS (Alizarin red S) staining of hMSCs. The pre-mixed-RCS@BGn satisfied the ISO standards for root canal sealers and maintained antimicrobial activity. Moreover, pre-mixed-RCS@BGn with more BGns turned out to have less cytotoxicity than pre-mixed-RCS without BGns while promoting osteogenic differentiation, mainly due to calcium and silicon ion release. Our results suggest that BGns enhance the biological properties of this calcium silicate-based sealer and that the newly introduced pre-mixed-RCS@BGn has the capability to be applied in dental procedures as a root canal sealer. Further studies focusing more on the biocompatibility of pre-mixed-RCS@BGn should be performed to investigate in vivo systems, including pulp tissue.

Intratubular penetration capacity of HiFlow bioceramic sealer used with warm obturation techniques and single cone: A confocal laser scanning microscopic study

Objective

The aim of this paper was to evaluate the intratubular penetration area of a bioceramic sealer, using continuous wave (CW), vertical condensation (VC) with two different types of gutta-percha (conventional (NG) and bioceramic-coated (BG)) and single cone (SC) technique with BG gutta-percha, in different root thirds.

Methods

A total of 150 mature single-root human teeth (including incisors, canines and premolars) were prepared and randomly divided into five groups (n = 30). Teeth were filled using a bioceramic sealer (TotalFill BC Sealer HiFlow ®) and two different types of gutta-percha, with CW and VC techniques, the teeth in the control group were filled with SC technique and BG gutta-percha. The teeth were sectioned and evaluated as one-third portions in each case under a confocal laser microscope. The penetration area measurements were carried out with the Autocad ® programme. Data was analyzed using the one-factor ANOVA test (p < 0.05) and Post Hoc Test (p < 0.05).

Results

The ANOVA Test showed significant differences in the penetration areas of the five obturation techniques (P < 0.05). The Post Hoc Test exhibited significant differences in multiple comparisons (P < 0.05). There was more dentinal tubule penetration in the coronal third than in the apical third in all techniques.

Conclusions

The intratubular penetration of the bioceramic sealer was influenced by the obturation techniques tested, but not by the different gutta-percha tested. There was more penetration of sealer in the warm obturation techniques than the SC, regardless of the type of gutta-percha used.

Clinical outcome of bioceramic sealer iRoot SP extrusion in root canal treatment: a retrospective analysis

Background

During the obturation procedure, sealer extrusion occurs in some cases. iRoot SP is a kind of bioceramic sealer with superior physicochemical and biological properties. This article reports the outcome of iRoot SP extrusion in root canal treatment and the potential factors associated with the outcome.

Methods

Ninety-nine patients and one hundred and eighty-five teeth treated between 2014 and 2020 were included in this retrospective study. All of the cases were filled with a single-cone technique and the iRoot SP sealer. The minimum follow-up visit period was 1 year. The outcome was evaluated by clinical examination and radiographic examination at recall and was classified as healed, healing (success), or not healed (failure).

Results

The overall success rate of all teeth was 96.8%. The success rate of adequately filled teeth was 97.3%, while that of iRoot SP extrusion was 95.8%; the difference was not statistically significant. Factors such as gender, age, tooth position, follow-up visit period, size of periapical lesion, treatment type and extruding sealer amount had no influence on the outcome of iRoot SP extruded teeth.

Conclusions

The results suggested that iRoot SP extrusion has no adverse effect on the outcome of root canal treatment, which may contribute to the endodontic treatment.

Assessment of the Dentinal Surface Adaptation Efficacy of Different Obturation Systems with Bioceramic Sealer: A Scanning Electron Microscope Study

AIM

Aim of this study was to evaluate the dentinal surface adaptation effectiveness of different obturation methods with bioceramic sealer.

MATERIALS AND METHODS

Sixty recently removed human permanent premolars of the mandible having a solitary, straight as well as completely produced root were chosen on the basis of clinical/radiographic evaluation. The coronal parts of the premolars were subjected to sectioning at the cementoenamel junction (CEJ) with the aid of a water-cooled diamond disk. The regular access opening was done, following which the working length was visually estimated by deducting 1 mm from the length of a 10 size K-file (Dentsply, OK, USA) at the apex. Subsequent to preparing the radicular canal, the premolar specimens were randomly allocated to one of the following three groups. Group I: Lateral compaction (LC) technique; group II: Warm vertical compaction (WVC) technique; and group III: Thermafil obturation technique. Following obturation, the samples were subjected to sectioning in the horizontal direction at three dissimilar points as follows: First at the cervical third, then at the middle, and at the apical third employing a minitom under water irrigation to put off overheating. Internal spaces amid the radicular dentin as well as the obturating agents were appraised with the use of a scanning electron microscope (SEM).

RESULTS

Intragroup analysis showed that higher gaps were noted at the coronal level (2.30 ± 0.04), in pursuit by middle part (1.12 ± 0.02) and apical third (0.70 ± 0.02) for the LC method. With the WVC procedure, higher gaps were situated in the coronal level (1.96 ± 0.07), again in pursuit by middle part (1.02 ± 0.02) and apical third (0.86 ± 0.04). Even with the Thermafil obturation method, higher gaps were noted at the coronal level (0.92 ± 0.10), in pursuit by middle part (0.67 ± 0.05) and apical third (0.57 ± 0.01). No statistically significant difference was noted within the group. Upon intergroup comparative assessment of dentinal surface adaptation with dissimilar obturation systems at coronal, middle and apical thirds, there was a statistically noteworthy disparity amid the groups (p <0.001).

CONCLUSION

This research arrived at a conclusion that the most superior dentinal adaptation of bioceramic sealer was procured when the Thermafil obturation method was employed for obturating the root canals compared to the WVC technique as well as the LC technique.

CLINICAL SIGNIFICANCE

Numerous endodontic substances have been promoted for obturating the root canal areas. Majority of the methods use a core substance, in addition to a sealer. Despite the type of core agent, a sealer indispensable to each technique offers a fluid-tight sealing. The oral physicians' comprehension of the characteristics of the endodontic sealer plus method used, enhances the therapeutic effect.

Effect of activated chlorhexidine and irritrol with photon-induced-photoacoustic-streaming and EDDY® on the dislocation resistance of biodentine

Background

Irrigant activation techniques, which are more effective in anatomically complex areas, can be used to maximize irrigant efficacy.

Aim

This in vitro study aimed to evaluate the efficacy of different agitation techniques on the dislocation resistance of Biodentine to the root canal dentin.

Materials and Methods

Seventy single-rooted teeth divided into seven experimental groups (n = 10); Group I-Irritrol/Photon-induced-photoacoustic-streaming (PIPS), Group II-Irritrol/EDDY^®, Group III- Irritrol/Syringe-needle-irrigation (SNI), Group IV-Chlorhexidine-gluconate (CHX)/PIPS, Group V-CHX/EDDY^®, Group VI-CHX/SNI, Group VII-Saline. The midroot dentin slice was obtained from each tooth, and Biodentine was condensed with hand pluggers into the root canal lumen. The push-out bond strength values were measured using a universal testing machine. Each sample was categorized into one of the three failure modes: adhesive/cohesive/mixed. Scanning-Electron-Microscopy (SEM) was used to conduct the analyses, and the composition of Biodentine was analyzed using Energy-Dispersive Spectroscopy. The One-way ANOVA, post-hoc Tukey's test, and the Chi-square test were used for statistical analysis.

Results

The push-out bond strength values of Biodentine showed that Group VII-Saline had a statistically significant difference (P = 0.002), however, the differences between the other groups were not statistically significant (P = 0.922). The percentages of the failure modes of the samples showed that there was a higher rate of mixed failure except for Group VII-Saline. SEM examination showed that Group VII-Saline had no open dentinal tubules, whereas the other groups, particularly the Irritrol groups, had open dentinal tubule areas.

Conclusions

Within the scope of the study, using Irritrol or CHX as the final irrigation in the root canal treatment did not result in differences in the dislocation resistance of Biodentine to root canal dentin when PIPS and EDDY^® were used.

Present status and future directions: Hydraulic materials for endodontic use

BACKGROUND

Hydraulic materials are used in Endodontics due to their hydration characteristics namely the formation of calcium hydroxide when mixing with water and also because of their hydraulic properties. These materials are presented in various consistencies and delivery methods. They are composed primarily of tricalcium and dicalcium silicate, and also include a radiopacifier, additives and an aqueous or a non-aqueous vehicle. Only materials whose primary reaction is with water can be classified as hydraulic.

OBJECTIVES

Review of the classification of hydraulic materials by Camilleri and the literature pertaining to specific uses of hydraulic cements in endodontics namely intra-coronal, intra-radicular and extra-radicular. Review of the literature on the material properties linked to specific uses providing the current status of these materials after which future trends and gaps in knowledge could be identified.

METHODS

The literature was reviewed using PUBMED, and for each clinical use, the in vitro properties such as physical, chemical, biological and antimicrobial characteristics and clinical data were extracted and evaluated.

RESULTS

A large number of publications were retrieved for each clinical use and these were grouped depending on the property type being investigated.

CONCLUSIONS

The hydraulic cements have made a difference in clinical outcomes. The main shortcoming is the poor testing methodologies employed which provide very limited information and also inhibits adequate clinical translation. Furthermore, the clinical protocols need to be updated to enable the materials to be employed effectively.

Comparison of the efficacy of three different supplementary cleaning protocols in root-filled teeth with a bioceramic sealer after retreatment-a micro-computed tomographic study

OBJECTIVE

The present study evaluated the efficacy of three different supplementary cleaning protocols on the removal of bioceramic-based root canal filling materials from oval-shaped canals.

MATERIALS AND METHODS

A total of 36 human mandibular premolars were instrumented and obturated with gutta-percha and iRoot SP using the single-cone technique. Retreatment was performed with ProTaper Universal retreatment files. The samples were randomly divided into the following supplementary cleaning protocols: conventional syringe irrigation (CSI), passive ultrasonic irrigation (PUI), and XP-endo Finisher R (XPR). The samples underwent micro-CT scanning to quantify the amount of residual filling materials after retreatment and after performing the cleaning protocols. The volume of filling material removal was analyzed by one-way analysis of variance and post hoc Bonferroni and Games-Howell tests (P < 0.05).

RESULTS

There were significant differences in the amount of root canal filling material removal in every comparison group (P < 0.05). The XPR removed significantly more residual filling materials (P < 0.01) followed by PUI and CSI (P < 0.05). Similar efficacy was found in the total root canal and all root thirds.

CONCLUSIONS

The additional use of XP-endo Finisher R and passive ultrasonic irrigation effectively removed the bioceramic-obturated root filling materials from the oval-shaped canals. However, none of the techniques completely removed the filling materials.

CLINICAL RELEVANCE

The XP-endo Finisher R and passive ultrasonic irrigation exhibited greater efficacy compared with syringe irrigation in the reduction of residual filling materials after retreatment in root-filled teeth with a bioceramic sealer.

Efficacy of antimicrobial photodynamic therapy and Er,Cr:YSGG laser-activated irrigation on dentinal tubule penetration of MTA-based root canal sealer: a confocal microscopy study

BACKGROUND

Antimicrobial photodynamic therapy (aPDT) and laser-activated irrigation (LAI) are adjunctive therapies developed to enhance the effectiveness of root canal disinfection. Sealer penetration into dentinal tubules is significant for preventing re-infection, and the sealer's penetration ability is affected by the chemo-mechanical preparation of the root canal. This study aimed to evaluate the efficacy of aPDT and LAI on dentinal tubule penetration of MTA-based root canal sealer.

METHODS

Forty single-rooted mandibular premolars were divided into four groups (n = 10): control, methylene blue 50 mg/L (MB50), curcumin 500 mg/L (C500), and Er,Cr:YSGG and sodium hypochlorite (LAI). The smear removal efficiency of the groups on intraradicular dentin was evaluated with a scanning electron microscope (SEM). Confocal laser scanning microscopy (CLSM) was performed to determine the depth of penetration of MTA Fillapex into dentinal tubules. Data were analyzed statistically.

RESULTS

The maximum penetration depth of the C500 group was significantly higher than that of the other groups in all three levels of root sections (p<0.05). Regarding mean penetration depth, the highest values were obtained from the C500 group. However, there was no statistically significant difference between the C500 and MB50 groups in the middle and coronal thirds of the root (p>0.05). The LAI group showed the lowest penetrated area percentage in the middle and coronal third of the root (p<0.05). The C500 and LAI groups were more effective in removing the smear layer than the control and MB50 groups.

CONCLUSION

aPDT could enhance the penetration of MTA-based root canal sealer into dentin tubules.

Evaluation of the effect of calcium hydroxide paste on sealer penetration into dentinal tubules by confocal laser scanning microscopy

The study evaluated sealer penetration after calcium hydroxide (Ca(OH)₂ ) removal from the root canals. Sixty single-rooted mandibular premolars were divided into six groups. Ca(OH)₂ paste placed into the root canals except for the control group (CG) was removed using the following irrigation techniques: conventional needle irrigation (CNI), EndoActivator (EA), EndoVac (EV), passive ultrasonic irrigation (PUI) and photon-induced photoacoustic streaming (PIPS) technique. After canal filling, the penetration depth, penetration area and penetration percentage of the sealer were determined using confocal microscopy. The CG and EA had a greater penetration depth than CNI in the middle section. The CG exhibited a higher dentinal tubule penetration area than CNI, EV and PUI in the middle section. EA was significantly more effective than PUI in the coronal section for the percentage of sealer penetration. EA and PIPS removed Ca(OH)₂ from root canals effectively because they presented similar penetration to the CG in all sections.

The impact of irrigation protocols on epoxy sealer penetration depth in dentinal tubules. Study involving laser confocal microscopy

The aim was to assess the impact of irrigation protocols ended with ethanol or chlorhexidine on AH Plus penetration into dentinal tubules. 45 root canals were prepared to ISO 40/04, divided into three groups and irrigated with three protocols: Group 1 (control): 5.25% NaOCl; Group 2: 40% CA (citric acid), 5.25% NaOCl, 40% CA, water, ethanol; Group 3: 40% CA, 5.25% NaOCl, 40% CA, water, 2% chlorhexidine. Canals were filled using vertical condensation technique with gutta-percha and fluorescein-stained AH Plus sealer. After 72 h, 1 mm thick cross-sections were cut at 2, 5, 8 mm from the apex. Confocal laser microscope was used to measure the sealer penetration into dentinal tubules. Mean depth of sealer penetration (in micrometres) was 107, 131, 170 (Group 1); 146, 233, 317 (Group 2); 185, 301, 542 (Group 3); in apical, middle and coronal parts, respectively. Irrigation protocol ended with chlorhexidine resulted in the deeper sealer penetration compared with alcohol.

Effect of Various Laser-Activated Irrigation Protocols on Endodontic Sealer Penetration into the Dentinal Tubules: A Confocal Laser Scanning Microscopy Study

Objective: To study the effect of various laser-activated irrigation protocols on endodontic sealer penetration into the dentinal tubules. Background data: Laser-activated irrigation is helpful for smear layer removal and thus might increase the penetration of endodontic sealer into the dentinal tubules. Methods: Forty-eight mandibular premolars with straight canals were instrumented and divided into four groups: C-I group, conventional needle irrigation with sodium hypochlorite (NaOCl) followed by ethylenediaminetetraacetic acid (EDTA); Er:YAG-I, Er,Cr:YSGG-I, and Nd:YAP-I groups, NaOCl and EDTA irrigations activated by erbium:yttrium-aluminum-garnet (Er:YAG), erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG), and neodymium:yttrium-aluminum-perovskite (Nd:YAP) lasers, respectively. The cleanness of the treated canals was evaluated by scanning electron microscopy (SEM). Then, canals were obturated with AH-Plus sealer labeled with rhodamine B (0.1%) and combined with gutta-percha. After setting, canals were sectioned at 2, 5, and 8 mm short from the root apex, and the penetration area of the AH-Plus into the dentinal tubules was observed using confocal laser scanning microscopy (CLSM). Results: SEM results indicated that the Er:YAG-I and Er,Cr:YSGG-I lasers were more effective than the Nd:YAP-I and C-I in removing the smear layer. CLSM results indicated that the average AH-Plus penetration areas among the tested groups were in ascending order: C-I < Nd:YAP-I < Er:YAG-I, Er,Cr:YSGG-I (p < 0.05). Conclusions: Laser-activated irrigations significantly increased the penetration of the endodontic sealer into the dentinal tubules, among which Er:YAG-I and Er,Cr:YSGG-I lasers were the most effective and may be considered routine protocols for endodontic treatment.

Influence of different irrigation regimens on the dentinal tubule penetration of a bioceramic-based root canal sealer: a confocal analysis study

This study aims to assess the efficacy of various irrigation protocols on the dentinal tubule penetration of a bioceramic-based endodontic sealer. Sixty-four single-rooted extracted human mandibular incisors were used. After instrumentation, teeth were randomly divided into the following four groups (n = 16 each) according to the final irrigation technique: group 1, conventional endodontic needle (CEN); group 2, EndoActivator (EA); group 3, Er,Cr: YSGG laser; group 4, XP-endo Finisher (XPF). The root canals were finally irrigated with 17% EDTA and 5.25% NaOCl for 1 min (min) respectively. The teeth were then obturated with Endosequence BC Points and rhodamine B dye-labeled BC Sealer. After 2 weeks, 1-mm-thick transverse sections were cut 2 and 5 mm from the apex, and examined by confocal laser scanning microscopy at 5 × magnification. The total percentage of sealer penetration (TPSP), sealer penetration area (SPA), and maximum sealer penetration depth (MSPD) was measured. Data were analyzed by Kruskal-Wallis, Dunn's multiple comparison, and Wilcoxon tests, with significance set at P < 0.05. At 2 mm level, no significant differences were detected among the groups (P > 0.05). At the 5 mm level, the XPF group showed significantly higher values for both TPSP and SPA in comparison with the Er,Cr: YSGG laser and CEN groups (P < 0.05), but no significant difference was observed with the EA group. The choice of different final irrigation techniques can affect dentinal tubule penetration.

Photon-Induced Photoacoustic Streaming Activation of the Postbleaching Antioxidant Application Rapidly Improves Bonding to Pulp Chamber Dentin

Objective: This study explored whether the erbium/yttrium/aluminum/garnet (Er:YAG) laser irradiated through the photon-induced photoacoustic streaming (PIPS) method would impact on the resin bonding to pulp chamber dentin when used to activate bleaching and/or postbleaching antioxidant treatment. Materials and methods: One hundred five dentin samples prepared from freshly extracted human incisors were randomly assigned to seven groups (n = 15): control (no bleaching/antioxidant); CB (conventional bleaching only); MB (modified bleaching only); CB-NI (conventional bleaching+antioxidant with needle irrigation); MB-NI (modified bleaching+antioxidant with needle irrigation); CB-PIPSI (conventional bleaching+antioxidant with PIPS-activated irrigation); and MB-PIPSI (modified bleaching+antioxidant with PIPS-activated irrigation). Bleaching (40% hydrogen peroxide) lasted for 20 min. Modified bleaching groups were irradiated with Er:YAG laser using the PIPS tip (2940 nm, 0.90 W, 30 Hz, 30 mJ/pulse, 50-μsec pulse duration) during the first 60 sec of the procedure. The antioxidant treatment with 10% sodium ascorbate lasted for 60 sec. PIPS-activated antioxidant groups were irradiated with Er:YAG laser using the PIPS tip (2940 nm, 0.30 W, 15 Hz, 20 mJ per pulse, 50-μsec pulse duration) throughout the procedure. After completing the composite restorations, all samples were subjected to 5000 thermocycling and the shear bond strength (SBS) test at a crosshead speed of 1 mm/min. SBS data were analyzed using the Kruskal-Wallis test with Bonferroni correction (α& 0.05). Results: No significant difference was detected among the control, CB-PIPSI, and MB-PIPSI (p > 0.05), which presented a significantly higher SBS compared with the other groups (p < 0.05). Conclusions: Irrespective of the application mode of the initial bleaching, PIPS-activated irrigation of the antioxidant improved SBS to bleached dentin to the level of the control in 1 min. Postbleaching antioxidant treatment combined with the PIPS method might be a promising approach to enable immediate resin restoration of bleached dentin.

Influence of obturation technique on penetration depth and adaptation of a bioceramic root canal sealer

Aim:

Evaluation of the impact of three different obturation techniques on the penetration depth and adaptation of a bioceramic root canal sealer(BioRoot RCS) to root dentin using scanning electron microscope and confocal laser scanning microscope.

Materials and Methods:

Recently extracted ninety mandibular premolar teeth of similar dimensions (±0.2 mm) with single canals and straight roots were segregated into three experimental groups (n = 30 each) based on the method of obturation used, i.e., lateral compaction technique, warm vertical compaction technique, and injectable thermoplasticized technique. After obturation, half of the root samples (n = 15) in each group were sectioned horizontally by hard tissue microtome at 3, 6, and 9 mm, respectively, from root apex for measuring sealer penetration depth with a confocal laser scanning microscope. Longitudinal sections of the samples (n = 15) were used for measuring the adaptation of sealers to radicular dentin using a scanning electron microscope.

Statistical Analysis:

Intergroup comparison of sealer penetration depth and adaptation to root dentin was analyzed using one-way ANOVA, and pairwise comparisons were made using Tukey's post hoc test.

Results:

Warm vertical condensation technique showed deeper root dentin penetration of the sealer. Better adaptation of the sealer to apical root dentin with minimal voids (P ≤ 0.05) was achieved with warm vertical condensation in comparison to the injectable gutta-percha method and lateral condensation obturating techniques.

Conclusion:

At all three root levels (coronal, middle, and apical), warm vertical condensation technique exhibited more sealer penetration with minimum gaps, whereas lateral condensation technique exhibited more gaps and less sealer penetration.

Could the Calcium Silicate-Based Sealer Presentation Form Influence Dentinal Sealing? An In Vitro Confocal Laser Study on Tubular Penetration

Dentinal tubule penetration influences root canal treatment sealing. The aim of this study was to compare dentinal penetration of two clinical presentations of silicate-based sealers using confocal laser. Sixty single-rooted human teeth from 50-70 year-old patients extracted for orthodontic/periodontal reasons were used. Canals were prepared using Mtwo system up to 35/0.04, with 5.25% NaOCl irrigation and final irrigation using 17% EDTA. Teeth were randomly assigned into study groups (n_i = 20): EndoSequence BC sealer (ES, group 1), BioRoot RCS (BR, group 2); and a control group (n_c = 20) with AH Plus (AHP). Root canals were obturated with 35/0.04 gutta-percha (single-cone technique). The samples were obtained from apical, middle, and coronal thirds. Dentinal tubule penetration depth and percentage of penetration around the canal perimeter were measured. The statistical analysis was performed using Mann Whitney U test and Wilcoxon t-test (95% confidence interval). ES exhibited a significantly higher penetration than AHP in apical and middle thirds (p < 0.05), and in middle and coronal thirds relative to BR (p < 0.05). The percentage of penetration around the canal perimeter was significantly higher for ES compared to BR in all thirds, but only in the apical third for AHP (p < 0.05). The pre-mixed silicate-based sealer exhibited better penetration than the powder/liquid one.

Investigation of the effect of different chelation solutions on penetration of resin-based and bioceramic sealers with a novel method

This study aimed to investigate the effects of different chelation solutions on the penetration of resin-based and bioceramic root canal sealers into dentinal tubules using a device that assembles conventional microplate detection with automated digital microscopy. Eighty-four single-rooted teeth were prepared with 30.07 nickel-titanium instruments and divided into four groups of 21 according to the final irrigation solutions used: saline (control), ethylenediaminetetraacetic acid (EDTA), maleic acid (MA), and etidronic acid (HEBP). The samples were obturated with AH Plus, MTA Fillapex, or EndoSequence BC Sealer using the single-cone technique. The roots were then sectioned horizontally at 2, 6, and 10 mm and examined using a Cytation 5 reader and Gen5 software. Data were compared using two-way analysis of variance followed by univariate analyses and Tukey's multiple comparison test (p < .05). The mean penetration depth in the apical thirds was higher in the MA group than in the other groups (p = .013). The mean depth in the middle and coronal thirds was almost equal in the EDTA and HEBP groups. The mean depth was significantly higher in the coronal thirds of the root canals than in any other section in all final irrigation solution groups (p < .001). EndoSequence BC Sealer displayed higher penetration depth than AH Plus and MTA Fillapex, although the differences between the examined sealers were not statistically significant. The chelation solutions increased root canal sealer penetration into the dentinal tubule.

Impact of Warm Vertical Compaction on the Sealing Ability of Calcium Silicate-Based Sealers: A Confocal Microscopic Evaluation

The aim of this in vitro study was to evaluate the dentinal tubule penetration of two calcium silicate-based sealers used in warm vertical compaction (WVC) obturation technique in comparison with the single cone (SC) technique by confocal laser scanning microscopy (CLSM). The null hypothesis was that both obturation techniques produced similar sealer penetration depths at 1 and 5 mm from the apex. Forty-four mandibular single-rooted premolars were randomly divided into four equally experimental groups (n = 10) and two control groups (n = 2) according to the type of sealer (Bio-C Angelus, Londrína, PR, Brazil or HiFlow Brasseler, Savannah, GA, USA) with either SC or WVC. The sealers were mixed with a fluorescent dye Rhodamine B (0.1%) to enable the assessment under the CLSM. All the specimens were sectioned horizontally at 1 and 5 mm from the apex. The maximum penetration depth was calculated using the ImageJ Software (ImageJ, NIH). Data were analyzed by Mann-Whitney U and Kruskal-Wallis tests (p < 0.05). A significant difference was shown between the four groups at 1 mm (p = 0.0116), whereas similar results were observed at 5 mm (p = 0.20). WVC allowed better diffusion for both sealers at 1 mm (p = 0.01) and 5 mm (p = 0.034). The maximum penetration of the Bio-C and HiFlow sealers was more important at 5 mm with the two obturation techniques. Within the limitations of this study, WVC enhanced the penetration of calcium silicate-based sealers into the dentinal tubules in comparison with the SC technique at both levels.

Microscopic evaluation of sealer penetration and interfacial adaptation of three different endodontic sealers: An in vitro study

Background:

The dentinal tubular penetration depth and interfacial adaptation of sealer are important factors for successful root canal treatment.

Aims:

This study aims to assess and evaluate the sealer penetration depth and interfacial adaptation of AH Plus, Apexit Plus, and GuttaFlow Bioseal sealer to root dentin.

Materials and Methods:

After decoronating sixty extracted single-rooted premolar teeth, preparation was done using ProTaper Gold rotary files until F3. The samples were randomly divided into three groups (n = 20 each) consistent with the sort of sealer used for obturation. After obturation with lateral compaction technique, half of the samples (n = 10 each) were sectioned transversely for measuring tubular depth penetration under a confocal laser scanning microscope. Longitudinal sections were obtained for the rest half the samples to gauge the difference of sealer using the scanning electron microscope.

Statistical Analysis Used:

Data were analyzed using one-way analysis of variance and Tukey's post hoc tests.

Results:

GuttaFlow Bioseal has shown a significantly higher depth of sealer penetration and minimum interfacial adaptation than resin-based sealer and calcium hydroxide-based sealer (P < 0.05).

Conclusion:

At all root regions, the GuttaFlow Bioseal sealer exhibited more sealer penetration and minimum interfacial adaptation whereas the Apexit Plus sealer exhibited less sealer penetration and maximum interfacial adaptation.

In vivo Biocompatibility and Bioactivity of Calcium Silicate-Based Bioceramics in Endodontics

Endodontic therapy aims to preserve or repair the activity and function of pulp and periapical tissues. Due to their excellent biological features, a substantial number of calcium silicate-based bioceramics have been introduced into endodontics and simultaneously increased the success rate of endodontic treatment. The present manuscript describes the in vivo biocompatibility and bioactivity of four types of calcium silicate-based bioceramics in endodontics.

Sealing Ability of AH Plus and GuttaFlow Bioseal

The objective of root canal obturation is to achieve a fluid-tight seal. Recently, GuttaFlow bioseal (GB), a root canal sealer composed of polydimethylsiloxane, gutta-percha particles, and bioactive glass ceramics, has been developed, to enhance the sealing ability of root canal filling material. The objective of this study was to assess the sealing ability of GB using a subnanoliter-scaled fluid-flow measuring device and to compare with that of AH Plus (AH). The fluid flow in root canal-filled teeth using either gutta-percha cone (GP) with AH (GAR; n = 10) or GP with GB (GBR; n = 10) and in GP inserted in AH blocks (GA; n = 10) or GP inserted in GB blocks (GB; n = 10) was measured. In addition, fluid flow in sealer blocks of AH (A; n = 10) and GB (B; n = 10), which served as negative controls, was measured. Root canal-filled teeth using GP without any sealer (GR) acted as positive controls (n = 10). The leakage was obtained by calculating the volume of moved water by time (s), after stabilization of the fluid flow was achieved. Statistical analysis was performed using the Kruskal–Wallis test and Mann–Whitney U-test with Bonferroni correction. A p value less than 0.00238 (0.05/21) was considered significantly different. The mean leakages (nL/s) in the groups are as follows: GAR, 0.0958 ± 0.0543; GBR, 0.0223 ± 0.0246; GA, 0.0644 ± 0.0803; GB, 0.0267 ± 0.0182; A, 0.0055 ± 0.0057; B, 0.0052 ± 0.005; and GR, 0.2892 ± 0.3018. The mean leakage in the GBR group was lower than that in the GAR group (p = 0.001), while the mean leakages in the GA and GB groups were not significantly different. GuttaFlow bioseal can be useful in single-cone obturation technique.

The Efficiency of the Er: YAG Laser and PhotonInduced Photoacoustic Streaming (PIPS) as an Activation Method in Endodontic Irrigation: A Literature Review

In the field of endodontics, lasers have been used for a long time for the optimization of Endodontic irrigation in particular. The laser-activated irrigation (LAI) technique is based on the photomechanical effects of the lasers at low settings. They create specific cavitation phenomena and acoustic streaming in intracanal fluids. More recently, a new technique with a Er:YAG laser has been used with sub-ablative energy (20 mJ, 15 Hz) and ultra-short pulses (50 µs). This leads to intracanal cavitation and shockwaves as a result of photoacoustic and photomechanical effects. This phenomenon is called photon-induced photoacoustic streaming (PIPS). PIPS and Laser activated irrigation are described in the literature as a revolutionary and powerful method to activate the irrigant; however, systematic literature on this topic is missing. This review compares the literature on Er:YAG LAI and PIPS on endodontic irrigation with other irrigation methods. An article search was performed on the PubMed database using a series of keywords related to endodontic irrigation, including Er:YAG LAI and PIPS; 59 articles were selected for the review according to the inclusion and exclusion criteria. No in vivo study was found. The Er:YAG LAI and PIPS outperformed other methods in 33 of the 59 articles. There was a great variety in the study designs including bacterial incubation time, laser parameters, irrigation protocols, and irrigating solution used. The evidence suggests that the Er:YAG LAI and PIPS are promising in canal disinfection as well as debris and smear layer removal. However, the large variety in the study methods makes the results less significant. Further studies are needed to better evaluate the efficiency of these techniques, especially in vivo studies.

Comparing dentinal tubule penetration of conventional and 'HiFlow' bioceramic sealers with resin-based sealer: An in vitro study

This study compared the depth and percentage of dentinal tubule penetration for single-cone (SC) and warm vertical (WV) obturation techniques with two different bioceramic sealers (BC Sealer [BCS], BC Sealer HiFlow [BCSHF]) and an epoxy resin-based sealer (2Seal easymiX). Fifty canals were filled with BCS, BCSHF or resin-based sealer (RBS). Teeth in BCS and BCSHF groups were filled with SC or WV techniques, and teeth in the control group (RBS) filled with WV technique only. The roots were sectioned at 3 mm and 6 mm levels from the apex and evaluated with a confocal laser microscope. There was significantly greater depth and percentage of sealer penetration at the 6 mm section compared to 3 mm (P < 0.05). No statistically significant difference was found in sealer type or obturation technique at the examined levels (P > 0.05). In conclusion, dentinal tubule penetration was similar comparing BC Sealer, BC Sealer HiFlow and RBS using SC and WV techniques.

Effect of different laser-assisted irrigation activation techniques on apical debris extrusion

Objective: The aim of this study was to compare apical debris extrusion when neodymium-doped yttrium aluminium garnet (Nd:YAG) lasers, erbium-doped yttrium aluminium garnet (Er:YAG) or photon-induced photoacoustic streaming (PIPS) are used for irrigation activation.Materials and methods: A total of 60 extracted human mandibular premolar teeth have similar dimensions were included and the samples were split into four groups according to the irrigation technique (n = 15): conventional needle irrigation, PIPS, Er:YAG and Nd:YAG. ProTaper Universal system up to F4 was used for root canal instrumentation. Bidistilled water was used as an irrigation solution during instrumentation and irrigation activation. Apically extruded debris was collected into preweighed Eppendorf tubes during instrumentation and irrigation activation procedures. The tubes were then kept in an incubator at 70 °C for 5 days. The initial weight of the tube was subtracted from the final weight and the result was recorded as the weight of dry extruded debris. The data were evaluated statistically using a one-way ANOVA test followed by least significant difference post hoc test (p < .05).Results: Conventional needle irrigation caused significantly less debris extrusion than laser-assisted irrigation activation groups (p < .05). Laser-assisted irrigation activation groups caused statistically similar debris extrusion (p > .05).Conclusion: Laser-assisted irrigation activation techniques caused more debris extrusion when compared to conventional needle irrigation.

The effect of 17% EDTA and QMiX ultrasonic activation on smear layer removal and sealer penetration: ex vivo study

This study aimed to compare the effect of conventional irrigation (CI) and passive ultrasonic irrigation (PUI) with 17% EDTA and QMiX on the maximum depth and percentage of sealer penetration into the dentinal tubules by confocal laser scanning microscopy (CLSM) and to describe the cleaning of root canal walls by scanning electron microscopy (SEM). Eighty single-rooted human mandibular premolars were instrumented and randomly assigned to four groups (n = 20): EDTA + CI, QMiX + CI, EDTA + PUI, and QMiX + PUI. Ten samples from each group were examined by SEM (2,000×) and the remaining 40 roots were filled with a single gutta-percha cone and AH Plus sealer mixed with 0.1% rhodamine B for analysis by CLSM (10×). Images were assessed at distances of 2 mm (apical), 5 mm (middle), and 8 mm (coronal) from the apex with the Leica Application Suite V4.10 software. The EDTA + PUI and QMiX + PUI protocols presented higher rates of debris/smear layer removal in the apical and middle thirds. The PUI was superior to CI in the maximum depth of sealer penetration at the middle third. The QMiX + PUI group had a higher percentage of sealer penetration at the apical third. The PUI and QMiX protocol improved debris/smear layer removal and tubular dentin sealer penetration.

Dentin moisture conditions strongly influence its interactions with bioactive root canal sealers

Objectives

It is known that bioactive materials interact with the dentin to undergo biomineralization. The exact role of moisture in this interaction is unknown. Here, we investigate the effects of dentin moisture conditions on the dislocation resistance of two bioactive root canal sealers (MTA Fillapex [Angelus Solucoes Odontologicas] and GuttaFlow BioSeal [Colténe/Whaledent AG]) at 3 weeks and 3 months after obturation.

Materials and Methods

Mandibular premolars (n = 120) were prepared and randomly divided into 3 groups based on the dentin condition: group 1, dry dentin; group 2, moist dentin; group 3, wet dentin. Each group was divided into 2 subgroups for root canal filling: MTA Fillapex and GuttaFlow BioSeal. Dislocation resistance was evaluated by measuring the push-out bond strength at 3 weeks and 3 months. Failure modes were examined under a stereomicroscope. Data were statistically analyzed by Kruskal-Wallis test with a significance level of 5%.

Results

Moist dentin resulted in higher bond strength values for both materials at both time points. This was significantly higher than wet and dry dentin for both the sealers at the 3 months (p < 0.05), while at 3 weeks it was significant only for GuttaFlow Bioseal. The different moisture conditions demonstrated similar trends in their effects on the dislocation resistance of the 2 root canal sealers.

Conclusions

The dentin moisture conditions had a significant impact on its interaction with the bioactive materials tested. Maintaining moist dentin, but not dry or wet dentin, may be advantageous before the filling root canals with bioactive sealers.

Bioactive Glass-Based Endodontic Sealer as a Promising Root Canal Filling Material without Semisolid Core Materials

Endodontic treatment for a tooth with damaged dental pulp aims to both prevent and cure apical periodontitis. If the tooth is re-infected as a result of a poorly obturated root canal, periapical periodontitis may set-in due to invading bacteria. To both avoid any re-infection and improve the success rate of endodontic retreatment, a treated root canal should be three-dimensionally obturated with a biocompatible filling material. Recently, bioactive glass, one of the bioceramics, is focused on the research area of biocompatible biomaterials for endodontics. Root canal sealers derived from bioactive glass-based have been developed and applied in clinical endodontic treatments. However, at present, there is little evidence about the patient outcomes, sealing mechanism, sealing ability, and removability of the sealers. Herein, we have developed a bioactive glass-based root canal sealer and provided evidence concerning its physicochemical properties, biocompatibility, sealing ability, and removability. We also review the classification of bioceramics and characteristics of bioactive glass. Additionally, we describe the application of bioactive glass to facilitate the development of a new root canal sealer. Furthermore, this review shows the potential application of bioactive glass-based cement as a root canal filling material in the absence of semisolid core material.