The effect of three different sealers on the radiopacity of root fillings in simulated canals

Radiopacity of premixed and two-component Calcium silicate-based Root Canal sealers

Background/Aim: Radiopacity enables radiographic visualization, which is significant in diagnostic procedures and assessment of the quality of endodontic filling. It is important to compare newly developed endodontic sealers with materials that are already in clinical use in order to promote evidence-based dentistry. The aim of our study was to evaluate radiopacity of different calcium silicate-based sealers in comparison with control, epoxy resin-based sealer. The null hypothesis was that there were no statistically significant differences in radiopacity of the tested sealers. Material and Methods: Premixed (TotalFill BC Sealer, EndoSequence BC Sealer, Ceraseal, Bio-C Sealer), two-component (BioRoot RCS, MTA Fillapex, Bioceramic Root Canal Sealer, GuttaFlow Bioseal) calcium silicate-based sealers and AH Plus, as a control, were used. Specimens were radiographed using a Radiovisiography (RVG-4) CCD (charge-coupled devices)-based digital sensor. Results: Ceraseal had the highest, while Bioceramic Root Canal Sealer had the lowest radiopacity. Bioceramic Root Canal Sealer and MTA Fillapex had radiopacity significantly lower than all other sealers. Radiopacity level of AH Plus, was similar to premixed and significantly higher than radiopacities of all two-component endodontic sealers. Conclusions: Calcium silicate-based sealers radiopacity ranged from slightly above minimal required value (3mm), to a value higher than control sealer. Premixed endodontic sealers showed similar radiopacity as AH Plus which suggests that their clinical performance, in terms of visibility on dental radiograms, should be similar

Antibacterial, biological, and physicochemical properties of root canal sealers containing chlorhexidine-hexametaphosphate nanoparticles

OBJECTIVE

The aim of this study was to evaluate the influence of the incorporation of chlorhexidine-hexametaphosphate nanoparticles (CHX-HMP NPs) on antibacterial, cytotoxic and physicochemical properties of AH Plus (AH), MTA Fillapex (MTA) and Pulp Canal Sealer (PCS).

METHODS

The NPs were synthesized and characterized by Scanning Electron Microscopy (SEM), Dynamic Light Scattering (DLS), zeta potential, Atomic Force Microscopy (AFM) and Energy-Dispersive X-ray Spectroscopy (EDS). The incorporation was made by weight, 2% and 5% of NPs. The antimicrobial activity, cytotoxicity, flow, radiopacity, setting time, solubility and pH were evaluated. The statistical analysis was performed by two-way analysis of variance test and Tukey post hoc test (P < 0.05).

RESULTS

SEM analysis showed the tendency for CHX-HMP NPs to cluster, the effective mean diameter measured by DLS: 169.39 nm and the zeta potential: -10.18 mV. The NPs were individually measured by AFM: 22.99-52.75 nm. EDS analysis identified the presence of C, N, O, Na, P, Cl. After incorporation: The Direct Contact Test showed an increase in the antimicrobial action of AH, PCS and MTA; the sealers showed a decrease in flow and at 24 h of immersion also an increase in solubility, but did not affect the radiopacity of the samples; AH setting time increased and MTA did not reach setting under any of the conditions tested. All samples showed a decrease in pH value as the immersion time progressed.

SIGNIFICANCE

The incorporation of NPs can improve the antimicrobial performance of endodontic sealers without impairing other biological and physicochemical properties.

Radiopacity of Premixed calcium silicate-based endodontic sealers

Background: Premixedcalcium silicate-based sealers are ready-to-use, injectable materials with advantageous biological properties that create environment favorable for periapical tissues repair and health. The aim of our study was to examine the radiopacities of premixed calcium silicate-based sealers:TotalFill BCSealer, EndoSequence BC Sealer, Ceraseal, Bio-C Sealer and to compare them with epoxy-basedsealer, AH Plus. Material and methods: Three specimens (2 mm thick and 5 mm in diameter) of each sealer were radiographed using charge-coupled device-baseddigital sensor (Trophy Radiology, Cedex, France) along with an aluminum stepwedge reference.For radiopacity determination, a graph of the logarithm of aluminum thickness versus radiographic density was plotted and a calibration curve was generated. Radiopacities were assessed from the graph and presented as millimeters of aluminum per millimeter of material (mmAl).ANOVA with a post hoc Tukey test was used for statistical analysis and significance was set at 0.05. Results: Radiopacity values of EndoSequence BC Sealer and Bio-C Sealerwere significantly lower than radiopacities of Ceraseal and AH Plus. Differences in values between EndoSequence BC Sealer and Bio-C Sealer as well as between Ceraseal and AH Plus were nonsignificant. TotalFill BC Sealer was nonsignificantly different from all other sealers. Conclusion: Premixed calcium silicate-based endodontic sealers evaluated in our study had radiopacity values higher than 9 mmAl, in ascending order,from Bio-C Sealer, EndoSequence BC Sealer, TotalFill BC Sealer to Ceraseal.

Comparison of two digital intraoral radiography imaging systems as a function of contrast resolution and exposure time

BACKGROUND

To compare the image quality of two different digital imaging systems; one photostimulable phosphor plate system (PSP) and a direct digital radiography system with CMOS imaging sensor; via evaluating contrast resolution among four different exposure times.

METHODS

Endodontically treated incisor teeth embedded in paraffin blocks are aligned next to a 99.5% Al wedge and exposed for 0.8, 0.1,0.125 and 0.16 seconds using both the CMOS and PSP systems. Using ImageJ software, 5 isometric and isogridded ROI from each root filling area and isometric ROI from the Al stepwedge were calculated.

RESULTS

Evaluation of the total of 120 images displayed that PSP system produced significantly higher contrast resolution (P<0.05) in regard to pixel values than the CMOS. The CMOS system was non- responsive to increasing dose (P=0.000). Regarding the EqAl values, no significant difference was determined between groups (P>0.05).

CONCLUSIONS

The contrast resolution was higher using the PSP system. It can be estimated that, filling material will be more obvious under lower doses using PSP.

Radiopacity Evaluation of Gutta-Percha Points in Thinner Samples than the ANSI/ADA Recommendation

The aim of this study was to evaluate the radiopacity of different gutta-percha points (Endo Points®, Dentsply®, Tanari®, Meta®, Roeko® and Odous®) in samples of 1 mm thick as established by ANSI/ADA Specification #57 and ISO 6876/2001, in comparison with thinner samples. Twelve test specimens for each material, four for each thickness (0.3, 0.6, and 1 mm and diameter of 8 mm), were laminated and compressed between two polished glass plates until the desirable thickness. Digital radiographs were obtained along with a graduated aluminum stepwedge varying from 1 to 10 mm in thickness. The X-ray unit was set at 70 kVp, 10 mA and 0.4 s exposure time, at a focal distance of 36 cm. One calibrated observer quantified the average values of pixels with Adobe Photoshop® software. Data were analyzed using ANOVA and Tukey tests, at 5% significance level. At 0.6 and 1 mm thickness, all the tested materials showed radiopacity higher than 3 mm of aluminum (reference value). At 0.3 mm thickness, Odous and Tanari presented significantly less radiopacity than the reference, and the other materials showed similar radiopacity to the reference. The study concluded that the materials demonstrated different radiopacities and all had values above the minimum recommended by ANSI/ADA specification #57, being Odous and Tanari less radiopaque than the reference value in thinner samples (0.3mm).

Comparative radiographic assessment of a new bioceramic-based root canal sealer

Background and aims

The aim of this study was to assess the radiopacity of two bioceramic-based root canal sealers, the conventional TotalFill BC sealer (FKG Dentaire Switzerland) and a new experimental filling material developed in collaboration with ‘Raluca Ripan’ Institute for Research in Chemistry, Cluj-Napoca.

Methods

Five disc samples were prepared using both materials (10 mm diameter × 1 mm thickness), being subjected to digital radiography together with aluminum step wedges (1 to 12 mm in thickness), in accordance with ISO 6876: 2012. Radiopacity was determined by the computer analysis of the images obtained. Four different areas were selected for each sample, corresponding to a disk-sample quadrant. Statistical analysis was performed using ANOVA.

Results

Both materials showed a radiopacity that was 3 mm greater than the equivalent thickness of aluminum. Total Fill BC showed greater radiopacity than the experimental material, but the differences were not statistically significant.

Conclusions

Both materials comply with ISO 6876: 2012 recommendations on minimum radiopacity.

Physical Properties and Chemical Characterization of Two Experimental Epoxy Resin Root Canal Sealers

Introduction:

The aim of this in vitro study was to evaluate the setting time, flow, film thickness, solubility, radiopacity and characterization analysis of three epoxy resin based sealers including two experimental sealers and AH-26.

Methods and Materials:

Five samples of each material were evaluated for setting time, flow, film thickness, solubility and radiopacity according to ISO 6876 Standard. Characterization of sealers was performed under the scanning electron microscopy (SEM), X-ray energy dispersive spectroscopy, X-ray diffraction (XRD) and Fourier transform infrared (FTIR) spectroscopy. Statistical evaluation was performed using the Kruskal-Wallis test.

Results:

In this study, AH-26 showed more radiopacity and flow compared to two other experimental sealers (P<0.05). However, both sealers had lower setting time than AH-26 (P<0.05). No statistical differences were found regarding film thickness, solubility and radiopacity (P>0.05). The characterization analysis exhibited relatively similar microstructure of AH-26 sealer to the experimental root canal sealers.

Conclusion:

According to the result of this study, all tested root canal sealers had acceptable properties based on ISO 6876 standard criteria.

Physicochemical Properties of Epoxy Resin-Based and Bioceramic-Based Root Canal Sealers

Three bioceramic sealers (EndoSequence BC sealer, EndoSeal MTA, and MTA Fillapex) and three epoxy resin-based sealers (AH-Plus, AD Seal, and Radic-Sealer) were tested to evaluate the physicochemical properties: flow, final setting time, radiopacity, dimensional stability, and pH change. The one-way ANOVA and Tukey's post hoc test were used to analyze the data (P = 0.05). The MTA Fillapex sealer had a highest flow and the BC Sealer presented a flow significantly lower than the others (P < 0.05). The BC Sealer and MTA Fillapex samples were not set in humid incubator condition even after one month. EndoSeal MTA had the longest setting time among the measurable materials and Radic-Sealer and AD Seal showed shorter setting time than the AH-Plus (P < 0.05). AH-Plus and EndoSeal MTA showed statistically higher values and MTA Fillapex showed statistically lower radiopacity (P < 0.05). BC Sealer showed the highest alkaline pH in all evaluation periods. Set samples of 3 epoxy resin-based sealers and EndoSeal MTA presented a significant increase of pH over experimental time for 4 weeks. In conclusion, the bioceramic sealer and epoxy resin-based sealers showed clinical acceptable physicochemical properties, but BC Sealer and MTA Fillapex were not set completely.

A new in vitro method to evaluate radio-opacity of endodontic sealers

OBJECTIVES

To evaluate a new method for assessing the radio-opacity of endodontic sealers and to compare radio-opacity values with a well-established standard method.

METHODS

The sealers evaluated in this study were AH Plus(®) (Dentsply DeTrey GmbH, Konstanz, Germany), Endo CPM Sealer (EGEO SRL, Buenos Aires, Argentina) and MTA Fillapex(®) (Angelus Dental Products Industry S/A, Londrina, Parana, Brazil). Two methods were used to evaluate radio-opacity: (D) standard discs and (S) a tissue simulator. For (D), ten standard discs were prepared for each sealer and were radiographed using Digora(®) phosphor storage plates (Soredex; Orion Corporation, Helsinki, Finland), alongside an aluminium stepwedge. For (S), polyethylene tubes filled with sealer (n = 10 for each) were radiographed inside the simulator as described. The digital images were analysed using Adobe Photoshop(®) software v. 10.0 (Adobe Systems, San Jose, CA). To compare the radio-opacity among the sealers, the data were analysed by ANOVA and Tukey's test, and to compare methods, they were analysed by the Mann-Whitney U test. To compare the data obtained from dentin and sealers in method (S), Student's paired t-test was used (=0.05).

RESULTS

In both methods, the sealers showed significant differences, according to the following decreasing order: AH Plus, MTA Fillapex and Endo CPM. In (D), MTA Fillapex and Endo CPM showed less radio-opacity than aluminium. For all of the materials, the radio-opacity was higher in (S) than in (D). Compared with dentin, all of the materials were more radio-opaque.

CONCLUSIONS

The comparison of the two assessment methods for sealer radio-opacity testing validated the use of a tissue simulator block.

Influence of root canal sealer on the radiographic appearance of filling voids in maxillary single-rooted teeth

OBJECTIVE

This study compared the influence of three epoxy resin-based sealers with distinct radiopacities on the observers' ability to detect root canal filling voids during radiographic analysis.

MATERIAL AND METHODS

The root canals of 48 extracted maxillary canines were prepared and divided into three groups. Each group was laterally condensed with one sealer (AH Plus®, Acroseal® or a non-radiopaque sealer), and a longitudinal void was simulated in half of the specimens from each group (n=8). Buccolingual radiographs were obtained and randomly interpreted for voids by a radiologist and an endodontist in a blinded fashion. Teeth were cut and inspected under a microscope to confirm the position of void. Differences in sensitivity and specificity between groups and examiners were compared using the Fisher's Exact and McNemar tests, respectively (α=0.05).

RESULTS

Significantly lower sensitivity levels (p<0.05) were observed in the coronal portion of fillings performed with both radiopaque sealers. Specificity values for Acroseal® were significantly higher (p<0.05) in the coronal and apical portions of fillings.

CONCLUSIONS

The type of root canal sealer can affect the observers' ability to detect root canal filling voids during radiographic analysis of upper single-rooted teeth.

Evaluation of cytotoxicity and physicochemical properties of calcium silicate-based endodontic sealer MTA Fillapex

INTRODUCTION

The aim of the study was to evaluate the cytotoxicity, radiopacity, pH, and flow of a calcium silicate-based and an epoxy resin-based endodontic sealer, MTA Fillapex (Angelus, Londrina, PR, Brazil) and AH Plus (Dentsply, Konstanz, Germany), respectively.

METHODS

Cytotoxicity, radiopacity, and flow evaluation were performed following ISO requirements. The pH level was measured at periods of 3, 24, 72, and 168 hours. Cytotoxicity was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay to check the Balb/c 3T3 cells viability at 1- to 4-week periods. Data were statistically analyzed by analysis of variance and the Tukey test with a significance level of 5%.

RESULTS

In all tested periods, MTA Fillapex was more cytotoxic than AH Plus (P < .05). Although AH Plus presented higher radiopacity than MTA Fillapex (P < .05), both sealers showed minimum required values. MTA Fillapex presented alkaline pH in all experimental times, whereas AH Plus cement showed a slightly neutral pH and a flow significantly lower than that of MTA Fillapex (P < .05).

CONCLUSIONS

Although MTA Fillapex was more cytotoxic than AH Plus, it showed suitable physicochemical properties for an endodontic sealer.

Gray Value Differences to Dentin of Root Posts Radiographed with Digital Intraoral Systems and Conventional X-ray Films

Digital radiographs often provide significantly higher gray value differences between root posts and root dentin than conventional x-ray films.

Radiographic analysis of root canal fillings: influence of two sealers on the perception of voids

The aim of this ex vivo was to investigate if two radiopaque root canal sealers with different formulations would influence the radiographic perception of root canal fillings. The root canals of 48 extracted maxillary canines were prepared and randomly assigned to 3 groups of 16 specimens each. In each group, the root canals were filled by lateral condensation of gutta-percha and one of the tested sealers: Endométhasone, Sealer 26, or a non-radiopaque sealer. A through-and-through void was simulated in half of the specimens from each group (n=8). The buccolingual radiographic images obtained were randomly interpreted for voids existence by a radiologist and an endodontist. The differences in sensitivity and specificity between groups and examiners were compared using, respectively, Fisher's Exact and McNemar tests at 5% significance level. Both radiopaque sealers caused a significant decrease in sensitivity at the coronal part of fillings. The use of Endométhasone increased specificity values for both coronal and apical portions of the root canal fillings. In conclusion, the tested sealers influenced the radiographic perceptions of laterally condensed root canal fillings in a different way.

Calcium hydroxide-based root canal sealers: a review

The aim of this review was to consider laboratory experiments and clinical studies of calcium hydroxide-based root canal sealers. An extensive search of the endodontic literature was made to identify publications related to calcium hydroxide-based root canal sealers. The articles were assessed for the outcome of laboratory and clinical studies on their biological properties and physical characteristics. Comparative studies with other sealers were also considered. Several studies were evaluated covering different properties of calcium hydroxide-based sealers including physical properties, biocompatibility, leakage, adhesion, solubility, antibacterial properties, and periapical healing effect. Calcium hydroxide-based root canal sealers have a variety of physical and biological properties. Comparative studies reveal their mild cytotoxicity, but their antibacterial effects are variable. Further research is required to establish the tissue healing properties of calcium hydroxide in root canal sealers.

Radiopacity of a new root canal sealer, Epiphany

OBJECTIVE

The purpose of this study was to evaluate the radiopacity of a new root canal sealer, Epiphany, relative to 3 other root canal sealing materials, AH 26, Sealapex, and Ketac-Endo.

STUDY DESIGN

Radiographs were taken of 1-mm-thick specimens of 4 root canal sealers and dentine slides, as well as a range of aluminum thicknesses, by using a step-wedge. The radiographic density of each specimen was measured and correlated with the equivalent thickness of aluminum.

RESULTS

All sealers were found to be more radiopaque than dentine (1.05 +/- 0.2-mm aluminum) and to possess radiopacity of greater than 3-mm aluminum. The radiopacity values reported in this study were 11.27 +/- 0.18-mm, 10.88 +/- 0.16-mm, 10.35 +/- 0.15-mm, and 9.78 +/- 0.21-mm aluminum for Sealapex, Ketac-Endo, Epiphany, and AH 26, respectively, which were significantly different from each other (P < .01).

CONCLUSION

Radiopacity measurements for Epiphany, Ketac-Endo, Sealapex, and AH 26 exceeded the minimum standard for root canal sealers. Epiphany has higher radiopacity than dentine. Therefore, this sealer is suitable for endodontic usage in terms of radiographic assessment.