An In Vitro Comparison of Microleakage between Resilon and Gutta-Percha with a Fluid Filtration Model

Comparative Evaluation of the Apical Sealability of AH Plus and RealSeal SE Using 5.25% Sodium Hypochlorite with 17% EDTA and 10% Citric Acid as Irrigants-An In Vitro Study

Background

Apical microleakage is considered to be a common reason for the clinical failure of endodontic therapy. Three dimensional sealing of the root canal is one of the main goals of endodontic treatment and is essential for preventing reinfection of the canal and for preserving the health of the periapical tissues, Recently Epoxy resin sealers have been used because of their reduced solubility apical seal and micro-retention to root dentine.

Aim and Objective

This in vitro study was done to evaluate and compare the apical sealability of AH Plus and RealSeal SE using 5.25% sodium hypochlorite with 17% EDTA and 10% citric acid as irrigants. Materials and methods: 44 single-rooted premolars were selected and the teeth are randomly divided into 4 groups (n=10) and 2 control groups (n=2). The extent of dye penetration, from the apical to the coronal part of the root canal, was assessed using a stereomicroscope at 10x magnification for all groups.One-way ANOVA and Kruskal-Wallis tests were performed to compare statistically significant differences among the groups, using SPSS software version 10.0.

Results

Group IV (Citric acid + RealSeal SE) showed a statistically lower mean microleakage when compared to all other groups.

Conclusion

From, the present study, it was concluded that, RealSeal SE sealer with 10% citric acid as irrigant (group IV) showed better apical sealability followed by RealSeal SE sealer with 17% EDTA as irrigant (group III), when compared to AH Plus groups which showed least sealability.

What Are the Chances of Resilon to Dominate the Market Filling Materials for Endodontics?

This paper is a literature review with additional virtual analyses of the authors’ own experimental research results. Knowledge from various areas was synergistically combined, appropriately for concurrent engineering, presenting several possible methodological approaches used in research, optimizing the selection of engineering materials and the conditions of their application with particular application in endodontics. Particular attention was paid to the theoretical aspects of filling material strengths, weaknesses, opportunities, and threats SWOT analysis. Attention was paid to the original concepts of Sustainable Dentistry Development in conjunction with Dentistry 4.0, which includes endodontics as an important element. The dentists’ actions, among others, in conservative dentistry, along with endodontics, requires close cooperation with engineers and the enginering sciences. Methods of root canal preparation were described, together with selected tools, including those made of nitinol. Principles concerning the process of cleaning and shaping the pulp complex are presented. The importance of obturation methods, including the Thermo-Hydraulic-Condensation THC technique, and the selection of filling materials with the necessary sealants for the success of endodontic treatment are discussed. The experimental studies were carried out in vitro on human teeth removed for medical reasons, except for caries, for which two groups of 16 teeth were separated. After the root canal was prepared, it was filled with studs and pellets of a filling material based on polyester materials, which has gained the common trade name of resilon or, less frequently, RealSeal (SybronEndo) with an epiphany sealant. The teeth for the first group were obturated by cold lateral condensation. In the second case the obturation was performed using the Thermo-Hydraulic-Condensation technique using System B and Obtura III. The experimental leakage testing was done using a scanning electron microscope SEM and a light stereoscopic microscope LSM, as typical research tools used in materialography. The research results, in a confrontation with the data taken from the literature studies, do not indicate the domination of resilon in endodontics.

Is Gutta-Percha Still the “Gold Standard” among Filling Materials in Endodontic Treatment?

The paper is an extensive monographic review of the literature, and also uses the results of the authors’ own experimental research illustrating the noticed developmental tendencies of the filling material based on gutta-percha. The whole body of literature proves the correctness of the research thesis that this material is the best currently that can be used in endodontics. Caries is one of the most common global infectious diseases. Since the dawn of humankind, the consequence of the disease has been the loss of dentition over time through dental extractions. Both tooth caries and tooth loss cause numerous complications and systemic diseases, which have a serious impact on insurance systems and on the well-being, quality, and length of human life. Endodontic treatment, which has been developing since 1836, is an alternative to tooth extraction. Based on an extensive literature review, the methodology of qualifying patients for endodontic treatment was analyzed. The importance of selecting filling material and techniques for the development and obturation of the root canal during endodontic treatment was described. Particular attention was paid to the materials science aspects and the sequence of phase transformations and precipitation processes, as well as the need to ensure the stoichiometric chemical composition of Ni–Ti alloys, and the vacuum metallurgical processes and material processing technologies for the effects of shape memory and superelasticity, which determine the suitability of tools made of this alloy for endodontic purposes. The phenomena accompanying the sterilization of such tools, limiting the relatively small number of times of their use, play an important role. The methods of root canal preparation and obturation methods through cold side condensation and thermoplastic methods, including the most modern of them, the thermo-hydraulic condensation (THC) technique, were analyzed. An important element of the research hypothesis was to prove the assumption that to optimize the technology of development and obturation of root canals, tests of filling effectiveness are identified by the density and size of the gaps between the root canal wall, and the filling methods used and devices appropriate for material research, using mainly microscopy such as light stereoscopic (LSM) and scanning electron (SEM). The most beneficial preparations were obtained by making a longitudinal breakthrough of 48 natural human teeth, extracted for medical reasons, different from caries, with compliance with all ethical principles in this field. The teeth were prepared using various methods and filled with multiple obturation techniques, using a virtual selection of experimental variants. The breakthroughs were made in liquid nitrogen after a one-sided incision with a narrow gap created by a diamond disc using a materialographic cutter. The best effectiveness of the root canal filling was ensured by the technology of preparing the root canals with K3 rotary nitinol tools and filling the teeth with the THC thermoplastic method using the System B and Obtura III devices with studs and pellets of filling material based on gutta-percha after covering the root canal walls with a thin layer of AH Plus sealant. In this way, the research thesis was confirmed.

Virtual Approach to the Comparative Analysis of Biomaterials Used in Endodontic Treatment

The importance of endodontics is presented within our own concept of Dentistry Sustainable Development (DSD) consisting of three inseparable elements; i.e., Advanced Interventionist Dentistry 4.0 (AID 4.0), Global Dental Prevention (GDP), and the Dentistry Safety System (DSS) as a polemic, with the hypothesis of the need to abandon interventionist dentistry in favour of the domination of dental prevention. In view of the numerous systemic complications of caries that affect 3−5 billion people globally, endodontic treatment effectively counteracts them. Regardless of this, the prevention of oral diseases should be developed very widely, and in many countries dental care should reach the poorest sections of society. The materials and methods of clinical management in endodontic procedures are characterized. The progress in the field of filling materials and techniques for the development and obturation of root canals is presented. The endodontics market is forecast to reach USD 2.1 billion in 2026, with a CAGR of 4.1%. The most widely used and recognized material for filling root canals is gutta-percha, recognized as the “gold standard”. An alternative is a synthetic thermoplastic filler material based on polyester materials, known mainly under the trade name Resilon. There are still sceptical opinions about the need to replace gutta-percha with this synthetic material, and many dentists still believe that this material cannot compete with gutta-percha. The results of studies carried out so far do not allow for the formulation of a substantively and ethically unambiguous view that gutta-percha should be replaced with another material. There is still insufficient clinical evidence to formulate firm opinions in this regard. In essence, materials and technologies used in endodontics do not differ from other groups of materials, which justifies using material engineering methodology for their research. Therefore, a detailed methodological approach is presented to objectify the assessment of endodontic treatment. Theoretical analysis was carried out using the methods of procedural benchmarking and comparative analysis with the use of contextual matrices to virtually optimize the selection of materials, techniques for the development and obturation of root canals, and methods for assessing the effectiveness of filling, which methods are usually used, e.g., in management science, and especially in foresight research as part of knowledge management. The results of these analyses are presented in the form of appropriate context matrices. The full usefulness of the research on the effectiveness and tightness of root canal filling using scanning electron microscopy is indicated. The analysis results are a practical application of the so-called “digital twins” approach concerning the virtual comparative analysis of biomaterials used in endodontic treatment.

The effect of chlorhexidine and dimethyl sulfoxide on long-term sealing ability of two calcium silicate cements in root canal

OBJECTIVES

To evaluate the long-term effect of chlorhexidine (CHX) and dimethyl sulfoxide (DMSO) on the sealing ability and biomineralization of two different calcium silicate cements (CSC) in root canal.

METHODS

Sixty human third molar root canals were obturated with ProRoot MTA or Biodentine. Before obturation the canals were irrigated with saline (control), 2% CHX or 5% DMSO. Microleakage was tested after three days and after six months. After additional six months (12 months after root filling) the roots were cut into 2 mm thick dentine discs. The discs were stored in artificial saliva for one year. The bond strength was measured with the push-out method, and the failure mode was evaluated with a stereomicroscope. The most apical disc of each tooth was used for Vickers hardness test.

RESULTS

No significant differences between the groups was found in initial microleakage. The leakage increased significantly during the 6-month storage in all groups except in Biodentine-CHX group and Biodentine-DMSO group. CHX and DMSO irrigation significantly increased the leakage with ProRoot MTA with time, but there was no statistically significant difference compared to the ProRoot MTA-control group at six months' time point. CHX significantly reduced the push-out bond strength of ProRoot MTA. With Biodentine irrigation with CHX or DMSO resulted with significantly higher push-out strength compared to the Biodentine control group. Fracture analysis showed statistically significant difference in the distribution of the fractures between the groups, but neither CHX nor DMSO change the fracture pattern statistically significantly. With Vickers hardness test ProRoot MTA with and without DMSO as the final irrigant showed significantly higher dentin hardness than any Biodentine-group.

SIGNIFICANCE

Considering that aging increased the leakage in all groups except with Biodentine-DMSO and the differences in the push-out strength and surface microhardness data, it appears that the time-related biomineralizing effect of MTA and Biodentine does not improve sealing to dentin. CHX significantly reduced ProRoot MTA bond strength and increased pure adhesive failures with both cements.

Comparative evaluation of sealing ability of gutta percha and resilon as root canal filling materials- a systematic review

This systematic review aims to comparatively evaluate the sealing ability gutta-percha and resilon as root canal filling materials. A Medline search was conducted to identify in-vitro studies published between October 01, 2004 and October 01, 2019, conducted on human extracted teeth, published in English and testing the sealing ability of gutta-percha and resilon as root canal filling materials using fluid filtration method. The search identified fifty-five published articles. After a thorough screening, five articles meeting the selection, and validity assessment criteria were critically appraised. The results indicated that during the initial time-period, resilon/epiphany sealer has better sealing ability than gutta-percha. However, over a period of time the resilon system demonstrated increased fluid flow. Gutta-percha with AH plus sealer showed the best long term sealing ability.

Physical Properties, Cytocompatibility and Sealability of HealApex (a Novel Premixed Biosealer)

Introduction:

The objective of this study was to evaluate the physical properties, cytotoxicity and sealing ability of HealApex _a new premixed calcium-silicate-phosphate-based biosealer_ in comparison with AH-26.

Methods and Materials:

Setting time, working time, film thickness, flow and radiopacity evaluation were performed according to ISO 6876 specification. L929 fibroblasts were incubated with the extracts of sealers and cytotoxicity was then evaluated using MTT assay. Thirty intact extracted human premolars were instrumented using step-back technique. The specimens were obturated with gutta-percha and experimental sealers employing lateral condensation technique. Sealing ability of sealers was investigated for up to one month using fluid filtration method. Data were statistically analyzed by t-test and ANOVA.

Results:

Physical properties of both sealers conformed to ISO specification. AH-26 exhibited significantly higher flow, higher radiopacity and lower film thickness; whereas HealApex showed lower setting time (P<0.05). HealApex represented high cell viability (P<0.05); however, AH-26 demonstrated significantly lower cell viability compared with the negative control group (P<0.05). There was no significant difference in microleakage between the sealers after 1 and 7 days; however, after 30 days, HealApex displayed better sealing ability (P<0.05).

Conclusions:

In this in vitro study, HealApex revealed acceptable physical properties, biocompatibility and good sealing ability as an endodontic sealer. Obtained results showed the new sealer had acceptable physical properties and good biocompatibility. In short term, the sealing ability of HealApex was comparable with AH-26 whilst in long term, HealApex’s sealing ability was better than the epoxy resin-based sealer.

Quantitative microleakage analysis of root canal filling materials in single-rooted canals

The purpose of this study was to analyze the sealing ability of different root canal filling materials over a 6-week period using a glucose penetration model. Forty-six recently extracted human premolars were used in this study. The root canals were enlarged to 40/0.06. Prepared canals were randomly assigned into four groups (n = 10) as follows: Group 1, Gutta-Percha (GP)/AH Plus with cold lateral compaction; Group 2, GP/AH Plus with continuous wave compaction; Group 3, RealSeal SE obturation system; and Group 4, OrthoMTA. The remaining specimens were used as positive and negative controls, and all specimens underwent thermocycling (10,000; 5-55 °C). The sealing ability of all samples was evaluated at 24 h, 1, 2, 4, and 6 weeks using a quantitative glucose leakage model, and scanning electron microscope (SEM) images were taken. A mixed effect analysis using R statistical language was performed. Groups 1, 2, and 4 showed low leakage levels during experimental periods. Group 3 showed low leakage levels for the first 2 weeks; however, the leakage level was significantly increased after 2 weeks compared to negative control group (p < 0.05). In the SEM results, Group 3 showed imperfect dentin bonding, whereas Group 4 showed calcium silicate hydrate short tags, which are formed at the access of the dentin tubules. GP/AH Plus and OrthoMTA showed less microleakage than RealSeal SE obturation system when used as root canal filling materials. Traditional GP/AH Plus sealer and the newly developed OrthoMTA are more appropriate for ideal sealing of the root canals.

Resilon: Review of a New Material for Obturation of the Canal

Resilon is a thermoplastic synthetic polymer-based endodontic material alternative to gutta-percha. It contains bioactive glass and also radiopaque fillers. It has the same handling properties as gutta-percha. For endodontic retreatment, it may be dissolved with some solvents, such as chloroform or softened with heat. The composition of Resilon and its sealer (Epiphany) bond to dentin and form a monoblock. A review of the literature and a discussion of its properties comparing to other root canal filling materials are presented.

A microleakage study of gutta-percha/AH Plus and Resilon/Real self-etch systems after different irrigation protocols

The development and maintenance of the sealing of the root canal system is the key to the success of root canal treatment. The resin-based adhesive material has the potential to reduce the microleakage of the root canal because of its adhesive properties and penetration into dentinal walls. Moreover, the irrigation protocols may have an influence on the adhesiveness of resin-based sealers to root dentin.

Lack of correlation between obturation limits and apical leakage

The aim of this paper was to evaluate a possible correlation between obturation limits and leakage. Thirty-six extracted human mandibular incisors were used, characterized by straight and single canals, non-anatomical complexities, absence of previous endodontic treatment, complete root formation and patent foramen. For standardization of the specimens for the leakage analysis, foraminal instrumentation was performed up to a Flexofile #25 (Dentsply-Maillefer, Ballaigues, Switzerland). All specimens were instrumented and filled following the same protocol, and the obturation limits were measured using Axiovision 4.5 Software (Carl Zeiss Vision, Hallbergmoos, Germany). The specimens were then separated into three groups (n=12) according to the following variables: Group I--obturation limits ranging from 0 mm to 0.76 mm of the main apical foramen. Group II--obturation limits ranging from 0.77 mm to 0.98 mm of the main apical foramen. Group III--obturation limits ranging from 0.99 mm to 1.68 mm of the main apical foramen. Apical leakage was quantified by fluid filtration. The analyses were confronted using Pearson's test (p>0.05). Groups I, II and III showed Pearson correlation values (r2) of -0.152, -0.186 and 0.058, respectively. No correlation was found between the obturation limits and apical leakage.

Carrier-based root canal filling materials: a literature review

A review of the literature on the use of carrier based obturation materials focusing on Thermafil and Resilon based obturator (RealSeal 1) are presented in this article. The review addressed the history, apical leakage, coronal leakage, biocompatibility, sealing ability and clinical success of Thermafil and RealSeal 1. Based on the studies gathered, this review concluded that both treatment techniques (Thermafil and RealSeal 1) did not provide excellent apical sealing ability. More research should be done to try to overcome their main drawback, its sealing ability.

Comparative analysis of leakage in root canal fillings performed with gutta-percha and Resilon cones with AH Plus and Epiphany sealers

OBJECTIVE

The aim of this study was to compare the leakage of root canal fillings of gutta-percha or Resilon cones in association with AH Plus or Epiphany sealer.

STUDY DESIGN

Four groups of premolars (n = 64) were instrumented to size 45/.04 ProFile and filled with laterally compacted gutta-percha cones or Resilon cones in association with AH Plus or Epiphany sealer. The specimens were stored for 2 weeks at 37 degrees C and 100% humidity. After that, leakage was measured using the fluid filtration method and determined as microL/min.10 psi.

RESULTS

Homogeneity of variance and multiple comparisons tests were performed and indicated that root fillings with the combination of gutta-percha cones and AH Plus sealer showed lower leakage values (P < .05) than the other groups.

CONCLUSION

Considering the experimental conditions and the results obtained, it was concluded that fillings made with gutta-percha cones in combination with AH Plus sealer had the best performance.

Microleakage of various root filling systems by glucose filtration analysis

OBJECTIVE

The aim of this study was to evaluate the microleakage of Resilon + Epiphany, EndoRez, Activ GP, and conventional AH Plus + gutta-percha technique using the glucose filtration model.

STUDY DESIGN

One hundred twenty maxillary incisors were divided into 5 experimental and 2 control groups. After root canal shaping, the experimental groups were filled with AH Plus + gutta-percha (lateral compaction), Resilon + Epiphany (lateral compaction), AH Plus + Protaper's proprietory cone, EndoRez + sealer, or Activ GP + sealer). The specimens were mounted on a glucose model and samples were taken for 3 weeks for leakage measurement.

RESULTS

No statistically significant difference was observed between the leakage of all groups at the 3 testing periods (P > .05).

CONCLUSION

The filling materials with the monoblock concept do not seem to be superior to the conventional AH Plus + gutta-percha system regarding microleakage.