The Effect of Different Irrigating Solutions on Bond Strength of Two Root Canal–filling Systems

Dentinal tubule penetration following ultrasonic, sonic, and single-cone technique of a biosealer: An ex vivo study

Background

The endodontic space is complex, and using a single-cone obturation technique fails to ensure a complete filling.

Introduction

This study aimed to investigate the effect of ultrasonic activation, sonic activation, and single-cone technique of a biosealer on its dentinal tubular penetration.

Materials and Methods

In the experiment, single-root mandibular premolars were randomly assigned to three groups (n = 20): group A, ultrasonic activation; Group B, sonic activation; and Group C, single-cone technique. Penetration of the fluorescently labeled biosealer was investigated using a confocal laser scanning microscope.

Results

The data were statistically analyzed using Kruskal-Wallis and Mann-Whitney tests (P = 0.05). The highest penetration of biosealer was observed in Group A, followed by Group B (P < 0.05).

Conclusions

Dentinal tubule penetration of biosealer was significantly improved by ultrasonic and sonic activation techniques.

Canal disinfection using photo-chemically activated micro-bubble emulsion, Emblica officinalis, and Nd: YAP laser on smear layer and push-out bond strength of resin-based root canal sealer to the radicular dentin

AIMS

Evaluation of the effects of the latest root canal disinfectants i.e., Micro-bubble emulsion (MBE), Neodymium-doped yttrium aluminum perovskite (Nd: YAP), Emblica officinalis (E. officinalis) on the removal of smear layer (SL) and push out bond strength (PBS) of resin-based root canal sealer to the radicular dentin.

METHODS

The coronal portion of sixty single-rooted human mandibular premolar teeth was precisely sectioned at the cementoenamel junction. The canals were prepared to utilize ProTaper universal rotary files till F3. All the study specimens were divided into four groups based on the disinfection regime (n = 15) Group 1: 5.25% NaOCl, Group 2: MBE, Group 3: Nd: YAP laser and Group 4: E. officinalis extract. All the canals were then finally irrigated using 17% EDTA solution as a final disinfecting agent. SL removal assessment was performed on five samples from each group using a scanning electron microscope (SEM). Ten samples from each group were then filled with root canal filling material and the roots were sectioned. Push-out test and failure mode analysis were performed using the universal testing machine (UTM) and stereomicroscope respectively. The mean scores of PBS and SL removal were compared using a one-way analysis of variance (ANOVA) and Post Hoc Tukey's HSD test p = 0.05.

RESULTS

Group-2 (MBE + EDTA) coronal section (1.50 ± 0.23) exhibited the most effective eradication of SL from the canal space. The apical third of Group-1 (NaOCl+EDTA) (2.68 ± 0.82) samples demonstrated the least effective removal of SL from the radicular canal. The maximum score of PBS of AH plus sealer to the canal dentin was exhibited by the coronal section of Group-2 (MBE + EDTA) (9.55 ± 0.45 MPa) samples. However, the apical third of Group-1 (NaOCl+ EDTA) specimens (5.16 ± 0.32 MPa) demonstrated the minimum EBS.

CONCLUSION

MBE+ EDTA displayed better smear layer removal and bond integrity of AH plus sealer to the root canal dentin. Nd: YAP+ EDTA laser and E.officinalis displayed comparable outcomes to that of control NaOCl+ EDTA.

Effect of different irrigants on the push-out bond strength of biodentine and TheraCal LC when used for perforation repair in simulated condition

Background

Perforation repair materials should have excellent sealing ability and dislodgement resistance. While several materials have been employed for perforation repair, newer calcium-silicate materials, such as Biodentine and TheraCal LC, have shown promising outcomes.

Aims

This study aimed to evaluate the effect of different irrigants on the dislodgement resistance of Biodentine and TheraCal LC when used for perforation repair in simulated conditions.

Methods and Material

3% sodium hypochlorite, 2% chlorhexidine gluconate, and 17% EDTA were evaluated for their effect on the dislodgement resistance of Biodentine and TheraCal LC. 48 permanent mandibular molars were selected for the study. The samples were divided into two groups: Group I - Biodentine and Group II - TheraCal LC, with 24 samples each.

Statistical Analysis

The mean dislodgement resistance and standard deviation of Group I (Biodentine) and Group II (TheraCal LC) were compared and Failure pattern analysis was done.

Results

Biodentine showed a significant decrease in push-out bond strength after contact with 3% NaOCl, 2% CHX, and 17% EDTA whereas, TheraCal LC showed no significant decrease in push-out bond strength after exposure to 3% NaOCl, 2% CHX, and 17% EDTA.

Conclusions

Overall, TheraCal LC can be considered good perforation repair material with excellent physical and biological properties.

The effect of different acidic irrigation solutions on the pushout bond strength of root canal filling

Background

This study investigated the effects of different acidic solutions used as the final irrigation on the push-out bond strength (PBS) of resin-based and bioceramic-based root canal sealers.

Methods

100 single root and canal human incisors were selected and decorated. Root canal shaping was done with ProTaper Next rotary files up to X4 and rinsed with 5 mL of 5.25% NaOCl between each file. Then, teeth were divided into five main groups according to the final irrigation (n=20). Group 1: glycolic acid; Group 2: phosphoric acid; Group 3: citric acid; Group 4: EDTA and group 5: saline. Then, each group was divided into two subgroups according to the canal sealer used (n=10). The groups filled with bioceramic-based sealer (bioserra) were named A, and the groups filled with resin-based sealer (AH Plus) were called B. PBS test was applied to one of the two samples obtained from the coronal third of each root. The data were statistically analyzed using a two-way analysis of variance and Tukey's HSD test (α=0.05).

Results

Statistically, the highest PBS value was obtained in group 2A (4.81±0.03 MPa), which was irrigated with phosphoric acid and filled with bioserra, and the lowest PBS value was obtained in group 5B (1.10±0,03), which was irrigated with saline and filled with AH Plus (P<0.05). There was a statistical difference between all groups except group 1A and group 3A (P<0.05).

Conclusion

The bioceramic-based root canal sealer (bioserra) bond strength is superior to resin-based (AH Plus). Phosphoric acid, glycolic acid, and citric acid can be an alternative to EDTA.

Comparison of the push-out bond strength of AH Plus sealer to dentin after using different herbal irrigation solutions as the final rinse

The aim of the present study was to evaluate the push-out bond strength of AH Plus sealer to dentin treated with the essential oils of Cumimum cyminum and Cinnamomum zeylanicum as herbal final irrigants. Forty human mandibular first premolars were selected. After smear layer removal, the samples were divided into 4 groups and irrigated with experimental solutions for 1 min and later with distilled water. G1: Cinnamomum zeylanicum (CZ) in minimum inhibitory concentration (MIC); G2: Sodium hypochlorite 2.5%; G3: Sodium hypochlorite in MIC; G4: Cuminum cyminum (CC) in MIC. After obturation, the roots were sectioned in order to obtain 1-mm discs for push-out assessment. The push-out test was performed using a universal testing machine. The slices were examined using a stereomicroscope at 30× to determine the mode of failure. The data were analyzed using one-way analysis of variance and Tukey's post-hoc test. The teeth irrigated with CZ showed significantly lower push-out resistance than those irrigated with NaOCl 2.5% and NaOCl at MIC. The other groups had no significant difference. The modes of failure were predominantly mixed. Under the limitations of the present study, CC does not have adverse effects on the bond strength of AH Plus and can be used as a good alternative for currently used final irrigants.

Extrusion bond strength of glass fiber post to radicular dentin after final irrigation using MTAD, EDTA, Pineapple peel extract, and riboflavin

INTRODUCTION

The present study aims to determine the effect of different post-space final irrigants ethylenediaminetetraacetic acid (EDTA), a mixture of Doxycycline citric acid and detergent (MTAD), Riboflavin (RF) and Pineapple peel extract (PPE) on the bond integrity of GFPs bonded to radicular dentin.

MATERIALS AND METHODS

Crowns of forty human mandibular premolars teeth were sectioned up to cementoenamel junction CEJ. Root canal treatment was performed. Gates Glidden drills were used to retrieve gutta-percha from the canal. All the specimens were randomly divided into four groups based on the final irrigant used. Group 1 (NaOCl with EDTA), group 2 NaOCl+ MTAD, group 3 NaOCl+RF and group 4 NaOCl+PPE. Cementation of glass fiber posts (GFPs) was performed using self-etch dual-cure resin cement. Sectioning was performed using a slow-speed saw from the coronal, middle, and apical third under constant water irrigation. A universal testing machine was used to assess push-out bond strength (PBS) and failure mode was evaluated using a Stereomicroscope at 40x magnification. One-way analysis of variance (ANOVA) and Tukey multiple comparison tests were used for statistical analysis (p=0.05).

RESULTS

Group 4 (2.5% NaOCl+ PPE) displayed the highest PBS at all three root levels (Cervical: 11.22±0.74 MPa, Middle: 8.99±0.97MPa, and Apical: 6.00±0.88 MPa). However, Group 1 (2.5% NaOCl+17% EDTA) demonstrated the lowest EBS (Cervical: 9.25±0.17 MPa, Middle: 7.01±1.84 MPa, and Apical: 4.41±0.17 MPa). Inter-group comparison displayed that PBS to be comparable between group 1 and group 3 (2.5% NaOCl+ Riboflavin) (Cervical: 9.74±0.41 MPa, Middle: 7.44±1.18 MPa, and Apical: 4.21±0.05 MPa) (p > 0.05). Whereas, group 2 (1.3% NaOCl+ MTAD) (Cervical: 9.32±1.36 MPa, Middle: 7.17±1.75 MPa, and Apical: 4.85±0.19 MPa) and group 4 demonstrated comparable values of PBS (p >0.05).

CONCLUSION

Pineapple peel extract and a mixture of Doxycycline citric acid and a detergent when used as a final irrigant demonstrated better bond integrity of GFPs to radicular dentin at all three levels coronal, middle and apical.

In Vitro Comparison of the Wettability of a Bioceramic Root Canal Sealer on Dentin With and Without Erbium-Doped Yttrium Aluminum Garnet (Er:YAG) Laser Irradiation

Introduction: To evaluate and compare the wettability of bioceramic root canal sealer (BioRoot™ RCS, Septodont, Saint-Maur-des-Fossés, France) on dentin with and without erbium-doped yttrium aluminum garnet (Er:YAG) laser irradiation using different frequencies and energies.

Methods: A hundred single-rooted tooth samples were divided into five groups of 20 samples each. Each group was treated with different methods before sealer application as follows: Group 1: Treated with 2 ml 17% ethylenediaminetetraacetic acid (EDTA) irrigant for one minute (control group); group 2: Irradiated with Er:YAG laser for one minute (8 Hz frequency and 200mJ energy); group 3: Irradiated with Er:YAG laser for one minute (8 Hz frequency and 400mJ energy); group 4: Irradiated with Er:YAG laser for one minute (16 Hz frequency and 200mJ energy); group 5: (n=20) samples irradiated with Er:YAG laser for one minute (16 Hz frequency and 400mJ energy). Bioceramic root canal sealer application was done onto the treated dentin specimen using a micropipette. The contact angle of the drop of the sealer with the dentin surface was measured after five minutes using a contact angle analyzer.

Results: There was no significant difference in wettability between Er:YAG laser using 8Hz frequency and 200mJ energy and Er:YAG laser using 8Hz frequency and 400mJ energy. However, there was a significant difference between the other two groups of Er:YAG laser using 16Hz frequency and 400mJ energy and Er: YAG laser using 16Hz frequency and 200mJ energy.

Conclusion: Contact angle was found to be lowest in the group that was irradiated with Er:YAG laser for one minute (16 Hz frequency and 400mJ energy) before the sealer application. The test findings demonstrated that the control group had the highest contact angle (low wettability) and it was statistically significant with all other groups.

Comparison of the effect of QMix and conventional root canal irrigants on push-out bond strength of fiber post to root dentin

Objectives

This study aimed to assess the effect of application of QMix and common root canal irrigating solutions on the bond strength of fiber post to root dentin.

Material and Methods

In this in‐vitro study, 60 extracted incisor teeth were decoronated such that 15 mm of root length remained. The canals were prepared with ProTaper rotary system to F5 and filled with gutta‐percha and AH26 sealer. Prior to post placement, the teeth were divided into four groups based on the type of final irrigating solution namely saline, 5.25% NaOCl, 2% chlorhexidine, and QMix. The fiber posts were then cemented with Panavia F2 resin cement. The roots were sectioned perpendicular to their longitudinal axis, and four sections with 1 mm thickness were made at the middle and coronal thirds of the roots. The push‐out bond strength of fiber posts was measured by a universal testing machine in megapascals. Data were analyzed by two‐way ANOVA and Tukey's test.

Results

The maximum and minimum bond strength values were noted in QMix and NaOCl groups in both the middle and coronal third of the root, respectively. But, there was no significant difference between the push‐out bond strength in the middle or coronal third of the root (p = 0.054). Adhesive failure was the most common mode of failure in all groups.

Conclusion

Use of QMix for post space irrigation does not compromise the bond strength of fiber post to root dentin, and can be used for final rinsing of the post space.

Influence of the use of chelating agents as final irrigant on the push-out bond strength of epoxy resin-based root canal sealers: A systematic review

This systematic review (PROSPERO - CRD42020150722) was performed to answer the following question: Does the use of chelating agents affect the dislodgment resistance of epoxy resin-based root canal sealers? A search was conducted in PubMed, EMBASE, Scopus, LILACS and Web of Science, hand searching of two endodontic journals and grey literature until September 2020. Extracted data included: teeth used, sample size, root canal preparation, irrigant, chelating solution, neutralisation solution, type of resin-based sealer and obturation approach, storage method and duration, root third and slice thickness, plunger dimension and loading direction and the push-out testing parameters and values. The search retrieved a total of 2.389 studies. After analysis, 12 studies fulfilled the eligibility criteria and were included. Most of the final irrigation protocols with chelating agents had a positive impact and promoted an improvement in the dislodgment resistance of epoxy resin-based sealers to the root dentin.

The effects of final irrigants on the push-out bond strength of two calcium silicate-based root canal sealers: an in vitro study

Purpose:

The purpose of the present study was to investigate the effect of the different irrigant combinations used in final irrigation on the push-out bond strength of root canal sealers that have different compositions.

Materials and methods:

In total 60 dentinal slices in 1 mm thickness were collected from 15 extracted mandibular premolar teeth; 4 slices from each tooth. 3 canal-like artificial cavities were opened on each dentinal slice. Samples were divided into 4 experimental groups, each of which consisted of 15 samples. In group 1, samples were immersed in 5.25% NaOCl and 17% EDTA solutions respectively; in group 2, immersed in 5.25% NaOCl and 2% CHX solutions respectively; in group 3, immersed in 5.25% NaOCl, 17% EDTA and 2% CHX solutions respectively; and in group 4 immersed in distilled water. After drying with absorbent papers, each cavity in dentinal slice sample was filled with different sealer (Endoseal MTA, Tech Biosealer Endo or AH Plus). Two days later, the push-out bond examination was performed.

Results:

AH Plus showed higher push-out bond strength value in two combinations (group 2 and 3) in which final irrigants contained CHX (p<0.001). Dentinal push-out bond strengths of root canal sealers from Endoseal MTA and Tech BioSealer Endo were not affected by final irrigant (p=0.965).

Conclusion:

Using CHX after NaOCl in final irrigant increases push-out strength of epoxy resinbased sealer but, did not create any difference in dentinal push-out bond strength of calcium silicate-based sealers.

Push out bond strength of glass fiber post to radicular dentin irrigated with Nisin and MTAD compared to methylene blue photodynamic therapy

AIM

Present lab-based study intended to appraise the effect of nisin, Mixture of Tetracycline, Acid and Detergent (MTAD), and photodynamic therapy (PDT) when used as a canal disinfectant on push-out bond strength (PBS) of fiber post to radicular dentin MATERIALS AND METHODS: Forty uni-radicular premolar teeth were extracted and disinfected in 0.5 % thymol solution. All specimens were decoronated to achieve standardize root length of 14 mm. Cleaning and shaping of the canal were done using protaper NiTi system. The canal space was dried and obturated. Post space was prepared using peso reamers up to 10 mm length and samples were randomly divided into 4 groups (n = 10). Group 1 irrigated with 10 % Nisin with MTAD, group 2: 1.3 % NaOCl and MTAD, Group 3 irrigated with 2.5 % NaOCl and 17 % EDTA and post space of samples in group 4 with PDT with MTAD. Fiber-reinforced composite post (FRCP) was fitted in canal space using self-etch resin cement. Each sample was cut into 1 mm from coronal, middle, and apical and subjected to PBS via a universal testing machine. For comparison of means, Analysis of variance (ANOVA) and Tukey multiple comparison test was used maintaining the level of significance at p < 0.05.

RESULT

Samples in group 3 post space irrigated with 2.5 % NaOCl and 17 % EDTA demonstrated the highest PBS at all root levels (cervical: 8.83 ± 0.14 MPa, middle: 7.63 ± 0.82 MPa and apical: 5.82 ± 0.32 MPa) in comparison to other tested groups. Whereas, group 1 in which Nisin 10 % with MTAD was used as a canal disinfectant displayed the lowest PBS at all levels (cervical: 6.91 ± 0.54 MPa, middle: 6.15 ± 0.31 MPa, and apical: 3.62 ± 0.68 MPa).

CONCLUSION

Post space irrigated with 1.3 % NaOCl and MTAD shows PBS similar to control group 2.5 % NaOCl and 17 % EDTA. Both types of irrigation methods have potential and can be recommended in clinical scenarios. Whereas, 10 % Nisin and PDT with MTAD as chelator needs further inquiry.

Evaluation and comparison on the wettability of three root canal sealers after three different irrigant activation techniques: An in vitro study

Background

Wettability of root canal sealers to the root canal wall plays a significant role in the attainment of a fluid-tight seal.

Aims

This study aimed to evaluate and compare the wettability of three different root canal sealers on the root canal walls after three different irrigant activation techniques using the contact angle meter.

Subjects and Methods

Thirty-six single-rooted mandibular premolars after decoronation and cleaning and shaping up to size #35 were randomly divided into three groups with 12 samples in each group (n = 12) based on the different activation techniques: Group I (passive irrigation with side-vented needle), Group II (manual dynamic agitation), and Group III (passive ultrasonic irrigation). Root segments were split longitudinally and were subdivided into three subgroups based on the root canal sealers tested with four samples in each subgroup (n = 4): Subgroup A (Tubliseal EWT), Subgroup B (AH Plus), and Subgroup C (Endosequence BC sealer). A controlled volume droplet of sealer was placed on each specimen and was subjected to the contact angle meter.

Statistical Analysis

Data were statistically analyzed using the one-way ANOVA and Tukey's post hoc test at a significance level of 0.05 (P < 0.05).

Results

A statistically significant difference was seen among all the groups and subgroups with the highest contact angle value for Group III and Subgroup C and the least value for Group I and Subgroup A.

Conclusions

Passive irrigation with side-vented needle and Tubli-Seal EWT showed better wettability on dentin.

Does Caffeic Acid Phenethyl Ester as an Irrigation Solution Increase the Adhesive Quality of Root Canal Sealer?

Aim:

To evaluate the effect of the caffeic acid phenethyl ester (CAPE) as a root canal irrigation agent on the push-out bond strength of the AH-Plus sealer.

Materials and Methods:

A total of 75 single-rooted teeth were decoronated and were randomly divided into 5 groups of 15 roots for irrigation protocols: Group NaOCl: 5.25 percent NaOCl; Group CAPE: 0.5 percent CAPE; Group NaOCl + ethylenediaminetetraacetic acid (EDTA): 5.25 percent NaOCl-17 percent EDTA; Group NaOCl + CAPE: 5.25 percent NaOCl-0.5 percent CAPE; and Group CAPE + EDTA: 0.5 percent CAPE-17 percent EDTA (for 3 min each group). All root canals were then obturated and 1-mm-thick horizontal slices were obtained from different root thirds of the root canal (coronal, middle, and apical, respectively). The groups were challenged with push-out tests. Modes of failure were determined under a stereomicroscope.

Results:

The CAPE-EDTA-treated group presented the highest mean bond strength in the coronal region of root dentin ( P < .05). The CAPE-treated group had a higher mean bond strength than the NaOCl-treated group ( P < .05). The mixed mode of failure was most predominant in all groups.

Conclusion:

Under the presented in vitro conditions, CAPE alone or in combination with EDTA or NaOCl demonstrated a positive effect that increased the push-out bond strength of the AH-Plus sealer to root dentin.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effect of intracanal medicaments used in endodontic regeneration on the push-out bond strength of a calcium-phosphate-silicate-based cement to dentin

Objective:

To evaluate the effects of various endodontic regeneration agents on the push-out bond strength of Endosequence Root Repair Material (ERRM) to root-canal dentin.

Methods:

Fifty single-rooted human teeth were selected and instrumented to obtain a standard internal diameter of 1.5 mm. Specimens were randomly divided into four experimental groups and treated with an intracanal medicament [calcium hydroxide (CH), double antibiotic paste (DAP), triple antibiotic paste (TAP), TAP with amoxicillin (mTAP)] and a non-treated control group. Medicaments were removed after three weeks, and ERRM was applied to all specimens. The coronal portion of each root was then sliced into 2-mm-thick parallel transverse sections (2 slices per tooth, n=20 slices per group), and a push-out test was used to measure the bond strength of ERRM to dentin. Data were analyzed using Bonferroni-corrected Mann-Whitney tests, with the level of significance set at p<0.05.

Results:

The push-out bond strength of the CH group was significantly higher than that of the TAP, DAP and mTAP groups (p< 0.005). Furthermore, the bond strength of the control group was higher than the bond strength of both the DAP and mTAP groups.

Conclusion:

The use of CH in clinical practice may help improve the adhesion of ERRM to dentin.

In vitro evaluation of the contact angle formed between AH Plus, Hybrid Root Seal and mineral trioxide aggregate Plus sealer with dentin and gutta-percha

Aim:

The purpose of this study was evaluation and comparison of the contact angle of new root canal sealers – Hybrid Root Seal, mineral trioxide aggregate (MTA) Plus, and the conventional AH Plus sealer with dentin and gutta-percha.

Materials and Methods:

Two groups (Group D – dentin and Group G – gutta-percha) of 18 samples each were further randomly divided into 3 subgroups based on the type of sealer used, that is, AH Plus, Hybrid Root Seal, and MTA Plus. Contact angle measurement device (Phoenix 300) was used to measure the contact angle of the sealers on both dentin and gutta-percha. The results thus obtained were analyzed using one-way analysis of variance and Student's t-test.

Results:

MTA Plus recorded significantly higher values of contact angle on both the substrates, that is, dentin and gutta-percha when compared to AH Plus and Hybrid root canal sealer. The lowest value of contact angle in gutta-percha and dentin was shown by Hybrid root canal sealer and AH Plus, respectively.

Conclusion:

Both AH Plus and Hybrid Root Seal exhibited lower contact angle values, and hence, better wettability on both dentin and gutta-percha as compared to MTA Plus.

Efficacy of different irrigation regimes on the push-out bond strength of various resin-based sealers at different root levels: An in vitro study

Aim:

This study aims to evaluate and compare the efficacy of various irrigation regimens on push-out bond strength of AH Plus/gutta-percha, Real Seal/Resilon, and MetaSeal/gutta-percha at three different root levels.

Materials and Methods:

Single-rooted mandibular premolars (n = 120) were prepared and divided into four groups (n = 30) based on irrigation regimen used: I: 5.25% sodium hypochlorite (NaOCl)-17% ethylenediaminetetraacetic acid (EDTA); II: 5.25% NaOCl-2.25% Peracetic acid (PAA); III: 5.25% NaOCl-18% 1-hydroxyethylidene-1, 1-bisphosphonate (HEBP) (Etidronic Acid); and IV: Distilled Water. Each group was further divided into three subgroups (n = 10); A: AH Plus/gutta-percha; B: MetaSEAL/gutta-percha; C: RealSeal/Resilon. After obturation, roots were sectioned at 3 levels and push-out tests were performed. One-way ANOVA with post hoc Tukey-honestly significant difference tests were applied to assess the significance among various groups.

Results:

Among irrigants, 2.25% PAA showed significantly lower values when compared with rest of the irrigants. There was no significant difference found among EDTA and HEBP. The push-out bond strength of AH Plus was significantly higher among all sealers. The bond strength values were significantly decreased in apico-coronal direction.

Conclusions:

There was superior efficacy of EDTA and HEBP on the bond strength of AH Plus at apical root level when compared with other irrigants and sealers at various root levels.

The effect of photodynamic therapy and polymer solution containing nano-particles of Ag /ZnO on push-out bond strength of the sealers AH-Plus and MTA Fillapex

Background

The aim of this in vitrostudy was to examine and compare the effect of photodynamic therapy and solution containing nano particles Ag/ZnO on adhesion of endodontic sealers to dentinal walls of human root canal.

Material and Methods

Ninty single-rooted human teeth were selected and their clinical crown was cut from the cemento-enamel junction zone. Canals were prepared by RaCe rotary system and the smear layer was removed using 17% EDTA and 5.25% NaOCl. Samples were randomly divided into two groups of AH Plus and MTA Fillapex based on the sealer type and each group based on antimicrobial method was divided into two sub-groups of photodynamic therapy and polymer containing nano particles of Ag / ZnO and a control sub-group (N = 15). After obturation of canals with gutta-percha and sealers mentioned, the samples were incubated for a week at a humidity of 95% and 37°C and then 2mm thick discs were prepared from the middle region of roots for Push-out test. The maximum failure force was recorded in newton and converted to MPa. Then, 3 random specimens of each subgroup were evaluated by scanning electron microscopy. Statistical analysis was performed by Two way ANOVA and (P<0.05) was considered significant.

Results

The highest (4.84 ± 1.63) and lowest (0.16 ± 0.075) push-out bond strength values were obtained in (AH Plus-PDT) and (MTA Fillapex-Ag/ZnO) respectively. Independent of antimicrobial method, AH Plus bond strength was significantly higher than the MTA Fillapex (p<0.001). For both sealers, PDT increased the bond strength significantly (p<0.001).

Conclusions

Photodynamic therapy has a positive effect on the bond strength of AH Plus and MTA Fillapex sealers.

Key words:AH Plus, MTA Fillapex, Nano particles, Photodynamic therapy, Push-out.

Effect of Intermediate Flush Using Different Devices to Prevent Chemical Smear Layer Formation

This study compared the effect of intermediate flush with distilled water delivered by conventional irrigation, EndoVac microcannula or Self-Adjusting File (SAF) system in the prevention of chemical smear layer (CSL) formation. Thirty human premolars were used. Canals were prepared with Reciproc system and 5.25% NaOCl. After chemomechanical preparation, samples were divided in 3 groups (n=10) according to the intermediate irrigation protocol with distilled water using: conventional irrigation, EndoVac microcannula or SAF. A final flush with 2% chlorhexidine solution was used and scanning electron microscopy was performed to assess protocol effectiveness. Two calibrated evaluators attributed scores according the presence or absence of CSL on the surface of the root canal walls at the coronal, middle and apical thirds, as follows: (1) no CSL; (2) small amounts of CSL; (3) moderate CSL; and (4) heavy CSL. Differences between protocols were analyzed with Kruskal-Wallis and Mann-Whitney U tests. Friedman and Wilcoxon signed rank tests were used for comparison between each root canal third. SAF resulted in less formation of CSL when compared with the conventional irrigation and EndoVac microcannula (p<0.05). When root canal thirds were analyzed, conventional irrigation and EndoVac groups showed less CSL formation at coronal and middle thirds in comparison to the apical third (p<0.05). In SAF group, there was no difference among the thirds (p>0.05). It may be concluded that an intermediate flush of distilled water, delivered by the SAF system resulted in a better reduction of CSL formation during chemomechanical preparation.

Marginal adaptation of newer root canal sealers to dentin: A SEM study

Aim:

This in vitro study evaluated and compared the marginal adaptation of three newer root canal sealers to root dentin.

Materials and Methods:

Thirty freshly extracted human single-rooted teeth with completely formed apices were taken. Teeth were decoronated, and root canals were instrumented. The specimens were randomly divided into three groups (n = 10) based upon the sealer used. Group 1 - teeth were obturated with epoxy resin sealer (MM-Seal). Group 2 - teeth were obturated with mineral trioxide aggregate (MTA) based sealer (MTA Fillapex), Group 3 - teeth were obturated with bioceramic sealer (EndoSequence BC sealer). Later samples were vertically sectioned using hard tissue microtome and marginal adaptation of sealers to root dentin was evaluated under coronal and apical halves using scanning electron microscopy (SEM) and marginal gap values were recorded.

Results:

The data were statistically analyzed by two-way ANOVA and Tukey's multiple post hoc test. The highest marginal gap was seen in Group 2 (apical-16680.00 nm, coronal-10796 nm) and the lowest marginal gap was observed in Group 1 (apical-599.42 nm, coronal-522.72 nm). Coronal halves showed superior adaptation compared to apical halves in all the groups under SEM.

Conclusion:

Within the limitations of this study epoxy resin-based MM-Seal showed good marginal adaptation than other materials tested.

Effect of different final irrigating solutions on smear layer removal in apical third of root canal: A scanning electron microscope study

AIM

The aim of this in vitro study is to compare the smear layer removal efficacy of different irrigating solutions at the apical third of the root canal.

MATERIALS AND METHODS

Forty human single-rooted mandibular premolar teeth were taken and decoronated to standardize the canal length to 14 mm. They were prepared by ProTaper rotary system to an apical preparation of file size F3. Prepared teeth were randomly divided into four groups (n = 10); saline (Group 1; negative control), ethylenediaminetetraacetic acid (Group 2), BioPure MTAD (Group 3), and QMix 2 in 1 (Group 4). After final irrigation with tested irrigants, the teeth were split into two halves longitudinally and observed under a scanning electron microscope (SEM) for the removal of smear layer. The SEM images were then analyzed for the amount of smear layer present using a three score system.

STATISTICAL ANALYSIS

Data are analyzed using the Kruskal-Wallis test and Mann-Whitney U-test.

RESULTS

Intergroup comparison of groups showed statistically significant difference in the smear layer removal efficacy of irrigants tested. QMix 2 in 1 is most effective in removal of smear layer when compared to other tested irrigants.

CONCLUSION

QMix 2 in 1 is the most effective final irrigating solution for smear layer removal.

Effect of Argon Plasma on Root Dentin after Use of 6% NaOCl

Abstract The aim of this study was to evaluate the effect of argon plasma on dentin surface after use of 6% NaOCl. Sixty bovine incisors had their crowns removed, the roots split, and the segments planed. One hundred twenty segments of the cervical third were used. The samples were divided in two groups (n=60): Control group: immersed in 6% NaOCl, washed, dried and then immersed in 17% EDTA, washed and dried and Argon group: after treatment described for the Control group, non-thermal argon plasma was applied for 30 s. Ten samples were evaluated by scanning electron microscopy in each group. Other ten samples were analyzed by Fourier transform infrared spectroscopy (FTIR). Thirty samples were analyzed with a goniometer to measure the contact angle between the dentin surfaces and solutions, to determine the surface free energy. The last ten samples were used to evaluate the wettability of AH Plus sealer. Data were statistically analyzed using Kruskal Wallis and Mann-Whitney tests (p<0.05). The results of this study showed that argon plasma did not modify the surface topography. FTIR analysis showed chemical modifications after plasma treatment. Argon plasma increased the surface free energy of dentin and AH Plus wettability. In conclusion, argon plasma treatment modified chemically the dentin surface. This treatment increased the surface free energy and wettability of an epoxy resin root canal sealer, favoring its bonding to dentin surfaces.

Bonding values of two contemporary ceramic inlay materials to dentin following simulated aging

PURPOSE

To compare the push-out bond strength of feldspar and zirconia-based ceramic inlays bonded to dentin with different resin cements following simulated aging.

MATERIALS AND METHODS

Occlusal cavities in 80 extracted molars were restored in 2 groups (n=40) with CAD/CAM feldspar (Vitablocs Trilux forte) (FP) and zirconia-based (Ceramill Zi) (ZR) ceramic inlays. The fabricated inlays were luted in 2 subgroups (n=20) with either etch-and-bond (RelyX Ultimate Clicker) (EB) or self-adhesive (RelyX Unicem Aplicap) (SA) resin cement. Ten inlays in each subgroup were subjected to 3,500 thermal cycles and 24,000 loading cycles, while the other 10 served as control. Horizontal 3 mm thick specimens were cut out of the restored teeth for push out bond strength testing. Bond strength data were statistically analyzed using 1-way ANOVA and Tukey's comparisons at α=.05. The mode of ceramic-cement-dentin bond failure for each specimen was also assessed.

RESULTS

No statistically significant differences were noticed between FP and ZR bond strength to dentin in all subgroups (ANOVA, P=.05113). No differences were noticed between EB and SA (Tukey's, P>.05) bonded to either type of ceramics. Both adhesive and mixed modes of bond failure were dominant for non-aged inlays. Simulated aging had no significant effect on bond strength values (Tukey's, P>.05) of all ceramic-cement combinations although the adhesive mode of bond failure became more common (60-80%) in aged inlays.

CONCLUSION

The suggested cement-ceramic combinations offer comparable bonding performance to dentin substrate either before or after simulated aging that seems to have no adverse effect on the achieved bond.

Comparison of the effect of MTAD and conventional irrigation agents on apical leakage and push-out bond strength of root canal filling

The aim of this study was to evaluate the effect of MTAD (a mixture of tetracycline isomer, an acid, and a detergent) and conventional irrigation agents on the apical leakage and push-out bond strength of root canal filling and to correlate the apical leakage and push-out bond strength. Root canals of 120 maxillary central incisors were prepared with a ProTaper file up to F3 and distributed to six groups. Saline, 1% NaOCl, 17% EDTA, 17% EDTA/1% NaOCl, and 2% chlorhexidine (CHX) solutions were used between each file change, and 5 mL of the same irrigating solution was used for the final flush. In the MTAD group, the root canals were irrigated with 1.3% NaOCl between each file and 5 mL of MTAD for the final flush. All the root canals were filled with AH Plus sealer and gutta-percha cones. Apical leakage was evaluated using a fluid transport system. After the apical leakage test, each tooth was prepared for the push-out assessment. The statistical analysis revealed that the irrigation solutions had no effect on the apical leakage of the root canal fillings (p = 0.258). The root fillings of the groups irrigated with MTAD showed significantly lower push-out bond strength values than the other groups (p < 0.001). These commonly used irrigating solutions did not affect the apical leakage of the root canal sealer. MTAD reduced the bond strength of the root canal sealer to the root canal dentin.

The Effect of Increased Temperatures of QMix and EDTA on the Push-out Bond Strength of an Epoxy-resin Based Sealer

BACKGROUND

Bond strength of root canal sealers is mainly influenced by the surface tension of the root canal wall. Heat, or the use of a surfactant might reduce surface tension and it is known that surface tension of an EDTA solution significantly affected from temperature rise. QMix is a novel endodontic irrigant for smear layer removal containing EDTA, chlorhexidine and a detergent. There is no data regarding the influence of the temperature of the EDTA and QMix on the push-out bond strength of root canal sealers.

AIM

To evaluate effect of temperatures of QMix and EDTA on the bond-strength of AH Plus.

MATERIALS AND METHODS

Sixty premolars were prepared with ProTaper F4. During preparation 3% NaOCl was performed. Specimens were divided into 4 groups as follows: 5-mL 17% EDTA at 22°C and 37°C; 5-mL QMix at 22°C and 37°C. Three specimens from each group were prepared for observation using SEM. Remaining roots were obturated and prepared for a push-out test. Data was analysed using Anova and Bonferroni tests (p<0.05).

RESULTS

Samples irrigated with QMix had higher push-out bond strength values than those irrigated with EDTA (p=0.01), regardless of temperature. Samples irrigated with 37°C EDTA resulted in higher bond-strength values than those irrigated with 22°C EDTA (p<0.001).

CONCLUSION

Temperature of the final irrigant does affect the bond strength values of AH plus to root dentin irrigated with EDTA. Bond strength of AH Plus sealer to root canal dentin may improve with QMix.

The comparison between two irrigation regimens on the dentine wettability for an epoxy resin based sealer by measuring its contact angle formed to the irrigated dentine

AIM

The aim was to assess the influence of two irrigation regimens having ethylenediaminetetraacetic acid (EDTA) and ethylenediaminetetraacetic acid with cetrimide (EDTAC) as final irrigants, respectively, on the dentine wettability for AH Plus sealer by comparing its contact angle formed to the irrigated dentine.

MATERIALS AND METHODS

Study samples were divided into two groups (n = 10). The groups were irrigated with 3% sodium hypochlorite (NaOCl) solution followed by either 17% EDTA or 17% EDTAC solution. AH Plus was mixed, and controlled volume droplet (0.1 mL) of the sealer was placed on the dried samples. The contact angle was measured using a Dynamic Contact Angle Analyzer and results were analyzed using SPSS 21.0 and 2 sample t-test.

RESULTS

There was a significant difference in the contact angle of AH Plus formed to the dentine irrigated with the above two regimens. AH Plus showed significantly lower contact angle with the regimen having EDTAC as a final irrigant than the one with EDTA (P < 0.05).

CONCLUSION

An irrigation regimen consisting of NaOCl with either EDTA or EDTAC solution as a final irrigant influences the dentine wettability and contact angle of a sealer. EDTAC as a final irrigant facilitates better dentin wettability than EDTA for AH Plus to promote its better flow and adhesion.

Dentin wettability enhancement for three irrigating solutions and their effect on push out bond strength of gutta percha / AH Plus

Background

The aim of this study was to investigate the effect of wettability enhancement for 17% EDTA, 2.5% sodium hypochlorite and 7% maleic acid solutions on push out bond strength of gutta percha /AH Plus to root dentin.

Material and Methods

One hundred and eight extracted single rooted human lower premolars were instrumented up to Protaper Universal F5 then irrigated with 3ml of 2.5% NaOCl after each file. Irrigants were prepared and a pilot study for determination of Tween 80 concentration yielding the lowest surface tension value in every solution was conducted. Samples were randomly divided into a control group and two experimental groups (17% EDTA and 7% Maleate), further split into eight subgroups (n=12), according to Tween 80 implementation sequence. Roots were obturated using gutta percha and AH plus by lateral condensation. Bond strength was measured by push out test. Mode of failure was then evaluated quantitatively by stereomicroscopy. Data were statistically analyzed using one way ANOVA followed by Tukey-Kramer for multiple comparisons.

Results

Control group showed the lowest values. Maleic acid subgroups showed significantly higher overall values than EDTA subgroups (P<0.05). Protocols implementing surfactant containing NaOCl showed significantly lower values than plain counterparts. Failure pattern was predominantly cohesive for plain regimens and the ones implementing Tween 80 in maleic acid solutions with plain NaOCl.

Conclusions

Tween 80 addition to demineralizing irrigants increased the bond strength values. Surfactant containing NaOCl solutions yielded lower bond strength than plain ones.

Key words:Wettability enhancement for three irrigants vs. corresponding gutta percha/AH Plus bonding.

Resistance to fracture of dental roots obturated with different materials

The aim of this study was to compare the vertical fracture resistance of roots obturated with different root canal filling materials and sealers. Crowns of 55 extracted mandibular premolar teeth were removed to provide root lengths of 13 mm. Five roots were saved as negative control group (canals unprepared and unfilled). Fifty root canals were instrumented and then five roots were saved as positive control group (canals prepared but unfilled). The remaining 45 roots were randomly divided into three experimental groups (n = 15 root/group) and obturated with the following procedures: in group 1, glass ionomer-based sealer and cone (ActiV GP obturation system); in group 2, bioceramic sealer and cone (EndoSequence BC obturation system); and in group 3, roots were filled with bioceramic sealer and cone (Smartpaste bio obturation system). All specimens were tested in a universal testing machine for measuring fracture resistance. For each root, the force at the time of fracture was recorded in Newtons. The statistical analysis was performed by using Kruskal-Wallis and post hoc test. There were no significant differences between the three experimental groups. The fracture values of three experimental and negative control groups were significantly higher than the positive control group. Within the limitations of this study, all materials increased the fracture resistance of instrumented roots.

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.

Push-out bond strength of a self-adhesive resin cement used as endodontic sealer

OBJECTIVES

The aim of the present study was to investigate the bond strength of RelyX Unicem (3M) to root canal dentin when used as an endodontic sealer.

MATERIALS AND METHODS

Samples of 24 single-rooted teeth were prepared with Gates Glidden drills and K3 files. After that, the roots were randomly assigned to three experimental groups (n = 8) according to the filling material, (1) AH Plus (Dentsply De Trey GmbH)/Gutta-Percha cone; (2) Epiphany SE (Pentron)/Resilon cone; (3) RelyX Unicem/Gutta-Percha cone. All roots were filled using a single cone technique associated to vertical condensation. After the filling procedures, each tooth was prepared for a push-out bond strenght test by cutting 1 mm-thick root slices. Loading was performed on a universal testing machine at a speed of 0.5 mm/min. One-way analysis of variance and Tukey test for multiple comparisons were used to compare the results among the experimental groups.

RESULTS

Epiphany SE/Resilon showed significantly lower push-out bond strength than both AH Plus/Gutta-Percha and RelyX Unicem/Gutta-Percha (p < 0.05). There was no significant difference in bond strength between AH Plus/Gutta-Percha and RelyX Unicem/Gutta-Percha (p > 0.05).

CONCLUSIONS

Under the present in vitro conditions, bond strength to root dentin promoted by RelyX Unicem was similar to AH Plus. Epiphany SE/Resilon resulted in lower bond strength values when compared to both materials.

The effect of 2% chlorhexidine on the bond strength of two different obturating materials

The bond strength of ActiV GP and gutta-percha/AH Plus after using 2% CHX as final rinse was evaluated in this study. According to the final irrigation regimen forty roots were divided into two groups (n = 20) randomly: Group 1-5 ml of 17% EDTA; Group 2-5 ml of 17% EDTA followed by 5 ml of 2% chlorhexidine gluconate (CHX). Based on the obturation system the two groups were further subdivided into two subgroups (n = 10). The roots were horizontally sectioned from the coronal and midthird sections for measuring the push-out bond strength. CHX/AH Plus (2.795 ± 0.42 MPa) and EDTA/ActiV GP (1.489 ± 0.117 MPa) recorded the highest and lowest mean bond strength values respectively. It was concluded that when 2% CHX was used as a final irrigation rinse the bond strength of both gutta-percha/AH Plus and ActiV GP obturation system improved significantly.

Critical evaluation of the push-out test for root canal filling materials

INTRODUCTION

The push-out test has been widely used in experimental endodontics but has been criticized on technical grounds particularly because the soft-core material undergoes plastic deformation under load. This study systematically evaluated the technique by comparing push-out strength and load profiles in relation to core material stiffness, canal diameter, punch diameter, sample orientation, and mode of failure.

METHODS

Straight palatal roots of 90 maxillary molars were obturated with an epoxy resin-based sealer alone (10 roots) or gutta-percha (70) or epoxy resin (10) cores with a thin layer of sealer cement. Roots were embedded in mounting resin vertically or at an angle of 5° or 10° to the long axis of the root. One-millimeter sections were tested using a universal testing machine with a punch diameter corresponding to 50%, 75%, or 90% of the canal diameter. Bond strengths (MPa) were calculated, and data were analyzed using analysis of variance with post hoc Tukey multiple comparisons (P < .05). After push out, core materials and canal walls were examined using scanning electron microscopy.

RESULTS

Push-out strength was affected by core material stiffness. Angulation up to 10° from vertical had little effect on push-out strength, but load profiles were strongly influenced by orientation. No effect of the punch diameter was observed when the diameter was 90% of the canal diameter, but push-out strength was lower when the punch diameter was 50%-60% of the canal size.

CONCLUSIONS

Despite limitations, the push-out test may still be suitable for ranking the bonding of root filling materials.

Chlorhexidine in Endodontics

Chemical auxiliary substances (CAS) are essential for a successful disinfection and cleanness of the root canals, being used during the instrumentation and if necessary, as antimicrobial intracanal medicaments. Different CAS have been proposed and used, among which sodium hypochlorite (NaOCl), chlorhexidine (CHX), 17% EDTA, citric acid, MTAD and 37% phosphoric acid solution. CHX has been used in Endodontics as an irrigating substance or intracanal medicament, as it possesses a wide range of antimicrobial activity, substantivity (residual antimicrobial activity), lower cytotoxicity than NaOCl whilst demonstrating efficient clinical performance, lubricating properties, rheological action (present in the gel presentation, keeping the debris in suspension); it inhibits metalloproteinase, is chemically stable, does not stain cloths, it is odorless, water soluble, among other properties. CHX has been recommended as an alternative to NaOCl, especially in cases of open apex, root resorption, foramen enlargement and root perforation, due to its biocompatibility, or in cases of allergy related to bleaching solutions. The aim of this paper is to review CHX's general use in the medical field and in dentistry; its chemical structure, presentation form and storage; mechanism of action; antimicrobial activity including substantivity, effects on biofilms and endotoxins, effects on coronal and apical microbial microleakage; tissue dissolution ability; interaction with endodontic irrigants; effects on dentin bonding, metalloproteinases and collagen fibrils; its use as intracanal medicament and diffusion into the dentinal tubules; its use as disinfectant agent of obturation cones; other uses in the endodontic therapy; and possible adverse effects, cytotoxicity and genotoxicity.

The effect of different irrigation protocols for smear layer removal on bond strength of a new bioceramic sealer

INTRODUCTION

The purpose of this study was to assess the effect of different irrigation protocols for smear layer removal on the bond strength of EndoSequence BC Sealer, a new bioceramic sealer, to root canal dentin.

MATERIALS AND METHODS

The middle third of forty-four extracted human teeth were sectioned horizontally to obtain 128 dentin disks. After standardization of canal spaces, dentin disks were immersed in 5.25% NaOCl for 20 min. The specimens were then randomly assigned to four groups (n=32) according to dentin treatment procedure: group 1, 17% EDTA (1 min); group 2, 17% EDTA (1 min) + 5.25% NaOCl (5 min); group 3, 17% EDTA (1 min) + 2% chlorhexidine (CHX) (5 min); and group 4, 17% EDTA (1 min) + saline (5 min). After dentin treatment, two specimens of each group were prepared for investigation with scanning electron microscopy (SEM). Surface of root canal wall was assessed in each specimen. Then the canal spaces were filled with EndoSequence BC Sealer in the remaining specimens. Push-out bond-strength and failure modes were assessed. The data on push-out test were analyzed using one-way ANOVA test. The significance level was set at P=0.05.

RESULTS

There was no significant difference between the bond strengths of test groups (P=0.203). The bond failure was mainly cohesive for all groups.

CONCLUSION

Under the conditions of this ex vivo study, it could be concluded that the application of 17% EDTA alone or followed by 5.25% NaOCl, 2% CHX, or saline resulted in similar bond strength of EndoSequence BC Sealer to dentinal walls.