In Vitro Comparison of Coronal Microleakage between Resilon Alone and Gutta-Percha with a Glass-ionomer Intraorifice Barrier Using a Fluid Filtration Model

Biological considerations of dental materials as orifice barriers for restoring root-filled teeth

There is ample published literature regarding the technical aspects of restoring root-filled teeth, but little concerning the biological impacts, consequences, and criteria for the selection of direct restorative materials following endodontic treatment. The provision of an effective coronal seal in addition to a sound root filling is known to be important in the prevention of root canal infection. This review seeks to explore the evidence concerning the selection of dental materials in the restoration of root-filled teeth, specifically with a close examination of the properties of commonly used materials as orifice barriers. © 2023 Australian Dental Association.

Effect of an Intraorifice Barrier on Endodontically Treated Teeth: A Systematic Review and Meta-Analysis of In Vitro Studies

The main cause of unsuccess in endodontically treated teeth (ETT) is due to bacterial recontamination. The placement of an intraorifice barrier (IOB) has been proposed for preventing this event in cases that the restoration is in an inadequate condition, enhancing the possibilities for predictable long-term success in endodontic therapy. Objectives. To evaluate through a systematic review and meta-analysis if it would be necessary to place an IOB in ETT. Materials and Methods. The present review is in accordance with the PRISMA 2020 Statement and is registered in the Open Science Framework. Two blinded reviewers carried out a comprehensive search in four databases up to July 10^th, 2021: MEDLINE, Scopus, Embase, and Web of Science. Eligible studies were the ones which evaluated the use of an IOB in ETT in reducing microleakage with any material of choice and with any methods employed. Only in vitro studies published in English were included. Results. A total of thirty in vitro studies were included in the qualitative synthesis, and seven of those were included in the quantitative analyses evaluating the following materials: bioceramic cement, glass-ionomer cement (GIC), and resin-based composite (RBC). Most of the included studies placed an IOB at a 3 mm depth. Reduction in microleakage was observed when an IOB was placed, regardless of the material employed (p ≤ 0.01). Among the materials, GIC and RBC performed similarly (p > 0.05), with the bioceramic subgroup being statistically superior to the GIC subgroup (p ≤ 0.05). Conclusions. Although well-designed randomized clinical trials are required, the placement of an intraorifice barrier can significantly reduce microleakage in endodontically treated teeth, and the use of bioceramics as IOB seems to be the best available material for this purpose.

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 Microleakage of Two Different Sealers in Root Canals

Objective

The aim of root canal obturation is to prevent leakage and inhibit microbial invasion. This study aimed to determine the effect of chlorhexidine (CHX) and dimethyl sulfoxide (DMSO) as final irrigants on microleakage of root filling immediately and after 18 months. The hypothesis was that either CHX or DMSO would not affect the immediate or long-term microleakage.

Methods

A total of 120 human third molar root canals were obturated with RealSeal SE or Topseal and gutta percha. Before obturation, the canals were irrigated with saline (control), 2% CHX or 5% DMSO. Microleakage of half of each groups (n=10) was measured after 3 days, and of the other half was measured after 18 months with fluid filtration method.

Results

In immediate measurements, RealSeal SE performed significantly better in CHX-irrigated group (p=0.035; Mann-Whitney test). For both sealers, DMSO had the lowest mean microleakage values, which were also statistically significantly lower than with CHX irrigation within sealers (p<0.009 for Topseal and p=0.04 for RealSeal SE; Mann-Whitney test). With RealSeal SE, the microleakage with CHX was significantly higher than that in controls (p=0.022; Mann-Whitney test).

Conclusion

Neither final irrigant showed statistically significant differences in the immediate microleakage within the two sealers. Irrigation with DMSO caused significantly less microleakage than CHX for both sealers after 18 months.

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.

Fluid flow evaluation of coronal microleakage intraorifice barrier materials in endodontically treated teeth

Objective:

The objective of this study was to compare the coronal microleakage intraorifice barrier materials, called CoroSeal (CS), fissur sealant (FS), flowable composite FC, and policarboksilate cement (PC), by using the computerized fluid filtration method.

Materials and Methods:

Fifty freshly extracted, single-canal human maxillary central teeth were used in this study. The teeth were decoronated to a standardized root length of 15 mm. After preparation and irrigation, all the teeth were obturated with gutta-percha and AH-Plus. In all teeth, the coronal 2 mm of root filling was removed and replaced with one of the intraorifice barriers. According to intraorifice barriers, teeth were divided randomly into 4 experimental groups (n = 10) and 2 control groups (n = 5). Group 1: CS; Group 2: FS; Group 3: FC; and Group 4: PC.

Positive Control Group:

No barrier material was used.

Negative Control Group:

Roots were completely coated with the nail polish, including the orifice. Leakage was evaluated by using a computerized fluid filtration model. Differences in fluid filtration among groups were subjected to statistical analysis using the Kruskal-Wallis Test and multiple comparisons test.

Results:

A value of P < 0.05 was statistically significant. Statistical analysis has indicated that the CS leaked significantly less than other groups (P < 0.05). There was a significant difference between FS and PC (P < 0.05), in contrast there was no significant difference between FS and FC (P > 0.05).

Conclusions:

Using the CS material as an intraorrifice barrier material reduced amount of microleakage as compared with FS, FC, and PC.

Bond strength to radicular dentin and sealing ability of AH Plus in combination with a bonding agent

OBJECTIVE

To evaluate the sealing ability and bond strength of AH Plus sealer associated with the hybridization protocol of radicular dentin with Scotchbond Multi Purpose (SB).

MATERIALS AND METHODS

Ninety palatal roots of maxillary molars were selected and divided into three groups (n = 30) according to filling protocol (G1, AH Plus/Resilon; G2, SB/AH Plus/Resilon; and G3, AH Plus/Gutta-Percha). In groups in which AH Plus + resin cones were used, dentin was hybridized before applying sealing material. For the bond strength test, 60 roots of bovine teeth were selected. Six holes were made in each root, two in the cervical, middle and apical third of the root. The roles were filled with AH Plus sealer with or without an adhesive system and submitted to push out test and the fracture mode was examined using a stereomicroscope (×32).

RESULTS

Statistical analysis showed that ScotchBond Multi Purpose (SB) + Resilon cone + AH Plus group promoted higher sealing ability than the gutta-percha + AH Plus group (p < 0.05). Bond strength was lower with SB application than without it (p < 0.05). A reverse correlation was found between bond strength and sealing ability. The fracture mode methodology revealed 22.77% of adhesive, 11.67% of cohesive and 65.55% of mixture fractures for SBMP/AH Plus protocol, whereas the AH Plus protocol indicated 86.11% of cohesive and 13.89% of mixed fractures.

CONCLUSION

It was concluded that the use of the adhesive system Scotchbond Multi Purpose improved coronal sealing ability of AH Plus, but bond strength of sealer was reduced when adhesive was applied.

Resilon: a comprehensive literature review

Background and aims. An ideal root canal filling material should completely seal the entire root canal space and block communication between the root canal system and its surrounding tissues; it should also be nontoxic, noncarcinogenic, non-genotoxic, biocompatible, insoluble in tissue fluids and dimensionally stable. Bonding to dentin is a promising property, which can prevent leakage and improve the sealing ability of root canal filling materials. Resilon was developed and rec-ommended initially because the existing rootcanal filling materials did not bond to root canal dentin. Since its introduction in 2004, numerous reports have been published regarding various aspects of this material. The aim of this literature review is to present investigations regarding Resilon's physical and chemical properties and leakage studies. Materials and methods. A review of the literature was performed by using electronic and hand searching methods for Resilon from May 2004 to April 2012. Results. There are many published reports regarding Resilon. The searchshowed that Resilon is composed of a parent polymer, polycaprolactone or Tone, which is a biodegradable aliphatic polyester, with filler particles consisting of bioactive glass, bismuth oxychloride and barium sulfate. It possesses some antibacterial and antifungal properties. It is a promising material for root canal filling. Despite the presence of numerous case reports and case series regarding these applications, there are few designed research studies on clinical applications of this material. Resilon has some drawbacks such as high cost. Conclusion. Resilon seals well and is a biocompatible material. However, more clinical studies are needed to confirm its efficacy compared with other materials.

Clinical applications of glass ionomers in endodontics: a review

Glass ionomer cements (GICs) are biocompatible and have capacities to release fluoride and to bond to dentine, and thus are appropriate for use in endodontics. This paper reviews the composition and properties of different GICs, including their biocompatibility and antibacterial activity, their applications as intraorifice barriers and root canal sealers, and their use in the repair of root perforations, root-end fillings and temporary coronal restorations.

Effect of bleaching agents on sealing properties of different intraorifice barriers and root filling materials

Objective: To evaluate the effect of intracoronal bleaching agents on the sealing properties of different intraorifice barriers and root filling materials. Study Design: The root canals of extracted human premolars (n=180) were prepared by using System GT rotary files and filled with either gutta-percha+AH Plus or Resilon+Epiphany sealer. In both groups, the coronal 3mm of root filling was removed and replaced with one of the following materials applied as intraorifice barriers (n=30/group): 1. ProProot-MTA; 2. Conventional Glass ionomer cement; and 3. Hybrid resin composite. In each subgroup, intracoronal bleaching was performed using either sodium perborate with distilled water or 35% hydrogen peroxide gel for 3 weeks. The leakage of specimens was measured using fluid-filtration and dye penetration tests. The data were analyzed statistically with One-way ANOVA, Repeated Measures t-test and Independent Samples t-test (p=0.05). Results: The fluid conductance values of the test groups were not influenced by the type of the bleaching agent, the intraorifice barrier, or the root filling material (all p>0.05). However, the extent of dye leakage was significantly affected by the type of intraorifice barrier material (p<0.05), which showed the following statistical ranking: glass ionomer cement > resin composite > ProRoot-MTA (p<0.05). Conclusions: The effect of 35% hydrogen peroxide gel or sodium perborate/distilled water on the sealing properties of tested intraorifice barriers and root filling materials varied conforming leakage assessment. These properties were not affected by using fluid filtration test, while the glass ionomer barrier showed the greatest amount of dye leakage in both gutta-percha and Resilon root-filled teeth.

Key words:Tooth Bleaching, root canal filling materials, glass ionomer cement, mineral trioxide aggregate, micro leakage

Effect of intra-orifice depth on sealing ability of four materials in the orifices of root-filled teeth: an ex-vivo study

Aim. To investigate the effect of orifice cavity depth on the sealing ability of Fusio, Fuji II, Fuji IX, and MTA“G”. Materials and Methods. Ninety-two canals in extracted mandibular premolars were prepared, obturated, and randomly grouped into 4 groups. Each group was subgrouped for a 2 mm and 3 mm orifice cavity depth (n = 10). The remaining roots were divided to serve as positive and negative controls (n = 6). Cavities of the 4 experimental groups were filled with the respective materials and subjected to methylene blue dye leakage. Linear leakage was measured in mm using a stereomicroscope. Statistical Analysis. Kruskall-Wallis test was used at P < 0.05, and t-test was done to compare 2 mm and 3 mm. Results. All tested materials leaked to various degrees. Significantly higher leakage score was found for Fuji IX, Fusio, Fuji II, and MTA “G” in a descending order, when the materials were placed at 3 mm depths. A significant difference was found in the leakage score between the 2 mm and 3 mm depths in all tested materials with the 3 mm depth showing a greater leakage score in all tested materials. Exception was in MTA “G” at 2 mm and 3 mm depths (0.551 mm ± 0.004 mm and 0.308 mm ± 0.08 mm, resp.). Conclusion. The null hypothesis should be partially rejected. Fusio and MTA “G” were affected by orifice cavity depth with regard to their sealing ability. MTA “G” had the least leakage when placed at 2 or 3 mm depths, and Fusio is the next when placed at 2 mm depth. Two millimeters orifice cavity depth is suitable for most adhesive orifice barrier materials.

Restoration of endodontically treated teeth review and treatment recommendations

Coronal restorations and posts can positively influence the long-term prognosis of teeth following root canal therapy. Final sealing the canal by placing an appropriate post and core will minimize leakage of oral fluids and bacteria into the periradicular area and is recommended as soon as possible after completion of root canal filling. Glass ionomer or MTA placed over the residual root canal filling after post space preparation may be effective to prevent bacterial leakage. A ferrule of 1-2 mm of tooth tissue coronal to the finish line of the crown significantly improves the fracture resistance of the tooth and is more important than the type of the material the core and post are made of.