Comparison of the rheological properties of four root canal sealers

Evaluation of rheological properties of soft lining materials with different composition under various temperatures

PURPOSE

The aim of this in vitro study was to evaluate the changes the rheological properties of some soft lining materials, to compare the rheological properties and viscoelastic behaviour at different temperatures.

MATERIALS AND METHODS

Five soft lining materials (acrylic and silicone based) were used. the storage modulus (G'), loss modulus (G"), tan delta (tan δ) and complex viscosity (η') were chosen and for each material, measurements were repeated at 23, 33 and 37  °C, using an oscillating rheometer. All data were statistically analyzed using the Mann Whitney U test, Kruskal Wallis test and Conover's Multiple Comparison test at the significance level of 0.05.

RESULTS

Soft lining materials had different viscoelastic properties and most of the materials showed different rheological behavior at 23, 33 and 37  °C. At the end of the test (t¹5), at all the temperatures, Sofreliner Tough M had the highest storage modulus values while Visco Gel had the highest loss Tan delta values.

CONCLUSIONS

There were significant changes in the rheological parameters of all the materials. Also temperature affected the initial rheological properties, and polymerization reaction of all the materials, depending on temperature increase.

CLINICAL IMPLICATIONS

Temperature affected the initial rheological properties, and polymerization reaction of soft denture liner materials, and clinical inferences should be drawn from such studies conducted. It can be recommended to utilize viscoelastic acrylic-based temporary soft lining materials with lower storage modulus, higher tan delta value, and high viscosity in situations where pain complaint persists and tissue stress is extremely significant, provided that they are replaced often.

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

AIM

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSION

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

CLINICAL RELEVANCE

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

Comparison of the Physical Properties of Three Resin-Based Root Canal Sealers: An In-Vitro Study

Objectives: This in-vitro study aimed to evaluate the physical properties of three resin-based root canal sealers, including BETA-RCS, AH26, and Adseal. Materials and Methods: Flowability, film-thickness, solubility, and radiopacity of BETA-RCS, AH26, and Adseal sealers were evaluated according to ISO 6876/2012 specifications. Three samples of each sealer were used to test each of the properties. Results: The results revealed that the flow rate (mm) of BETA-RCS, Adseal, and AH26 were 23.06±1.58, 22.5±4.23, and 21.85±1.71, respectively. Film-thickness values (µm) for BETA-RCS, Adseal, and AH26 sealers were 52.33±2.51, 18.66±0.57, and 52±2, respectively. No significant difference was observed regarding film-thickness between AH26 and BETA-RCS (P>0.05), while Adseal showed significantly lower film-thickness (P˂0.05). The highest and lowest solubility were related to BETA-RCS and Adseal, respectively. However, all sealers had acceptable solubility and radiopacity. Conclusion: The findings of the current study suggested that all three root canal sealers including BETA-RCS, AH26, and Adseal had similar properties based on ISO 6876 standard criteria. As such, they could be viable choices for facilitating effective root canal procedures. Further long-term clinical studies are warranted to assess their performance and success rates in actual endodontic cases.

Dentinal Tubule Penetrability and Bond Strength of Two Novel Calcium Silicate-Based Root Canal Sealers

BACKGROUND

Once the chemo-mechanical preparation of root canals is finished, achieving a complete seal of the root canal system becomes crucial in determining the long-term success of endodontic treatment. The important goals of root canal obturation are to minimize leakage and achieve an adequate seal. Thus, a material that possesses satisfactory mechanical characteristics, is biocompatible, and has the ability to penetrate the dentine tubules adequately is needed.

AIM

This study aimed to compare the penetrability and bond strength between two calcium silicate-based sealers and an epoxy resin-based sealer, as well as examine the relationship between penetrability and bond strength for the different sealers.

METHOD AND MATERIALS

Thirty-nine recently extracted single-rooted human premolar teeth were instrumented and divided evenly into three groups (n = 13), according to the sealer used for obturation: AH Plus Jet, EndoSequence, and AH Plus Bioceramic Sealer. Three teeth (30 slices) were randomly selected out of each for analysis using confocal laser scanning microscopy to assess penetrability. The remaining ten teeth (90 slices) in each group were subject to push-out tests using a universal testing machine. All teeth were sectioned into nine transverse slices of 0.9 mm thickness for their respective tests (apical, middle, coronal).

RESULTS

AH Plus Jet exhibited significantly lower penetrability and significantly higher bond strength compared to EndoSequence BC sealer (p = 0.002) and AH Plus Bioceramic Sealer (p = 0.006). There was no significant difference between EndoSequence BC sealer and AH Plus Bioceramic Sealer in terms of either penetrability or bond strength. No correlation was found between penetrability and bond strength.

CONCLUSIONS

Within the limitation of this study and regardless of the location in the canal, the bioceramic based root canal sealers appeared to perform better than the epoxy resin-based sealer in terms of dentinal penetration rate. Further studies are required to compare other biomechanical properties of bioceramic sealers including setting characteristics and bacterial leakage.

How Adding Chlorhexidine or Metallic Nanoparticles Affects the Antimicrobial Performance of Calcium Hydroxide Paste as an Intracanal Medication: An In Vitro Study

The aim of our study was to explore the potential value of metallic (Ag, Cu, and Zn) salts, polymer/metallic nanoparticles, and chlorhexidine (CHX) for improving the antimicrobial activity of calcium hydroxide (CH) against E. faecalis and C. albicans, associated with persistent endodontic infections. A first screening was performed by determining minimum inhibitory/bactericidal concentrations (MIC/MBC). Antimicrobial activity of the CH paste mixed with metallic salts, chitosan or cyclodextrin polymer metallic nanoparticles was compared to the antimicrobial activity of CH paste alone and CH + CHX using a time-kill kinetics assay. The effect of the antimicrobials on the rheological and the key mechanical properties were also examined. Copper and zinc were discarded because of their MIC/MBC values and silver because of its kill time curve profile. Except for a slower setting time after 24 h and a higher weight loss after 1 week of incubation, the mechanical behavior of the CH paste was unaffected by the addition of CHX. Polymeric/metallic nanoparticles failed to potentiate the antimicrobial effect of CH. By contrast, CHX increased this effect and thus could help eradicate E. faecalis associated with persistent root canal infections without altering the desired key physical properties of the CH paste.

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

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

Flow characteristics and alkalinity of novel bioceramic root canal sealers

Objective

This study aimed to examine the physical properties (pH and flow) of 2 novel bioceramic sealers.

Materials and Methods

The tested sealers were a calcium hydroxide sealer (Sealapex) and 2 bioceramic sealers (BioRoot RCS and TotalFill BC Sealer). Flow measurements were conducted according to ISO 6876/2012, with a press method of 0.05 mL of sealer. The pH of fresh samples was tested immediately after manipulation, while set samples were stored for 3 times the recommended setting time. The predetermined time intervals ranged from 3 minutes to 24 hours for fresh samples and from 10 minutes to 7 days and 4 weeks for the set samples. Analysis of variance was performed, with p = 0.05 considered indicating significance.

Results

The mean flow values were 26.99 mm for BioRoot, 28.19 for Sealapex, and 30.8 mm for TotalFill BC Sealer, satisfying the ISO standard. In the set samples, BioRoot RCS had higher pH values at 24 hours to 1 week after immersion in distilled water. At 2 weeks, both bioceramic sealers had similar pH values, greater than that of Sealapex. In the fresh samples, the bioceramic sealers had significantly higher initial pH values than Sealapex (p < 0.05). At 24 hours post-immersion, all sealers showed an alkaline pH, with the highest pH observed for TotalFill.

Conclusions

The TotalFill BC Sealer demonstrated the highest flow. The bioceramic sealers initially presented higher alkaline activity than the polymeric calcium hydroxide sealer. However, at 3 and 4 weeks post-immersion, all sealers had similar pH values.

Temperature changes affect the rheological properties of a silicone-based and an epoxy resin-based root canal sealers

To evaluate temperature changes on the rheological properties (setting time and complex viscosity (η*)) of GuttaFlow Bioseal (GFB) and AH Plus Jet (AHPJ). Rheological measurements were performed in oscillating mode at the strain amplitude and angular frequency of 0.01% and 10 rad s^-1 , respectively. Each sealer (n = 5) was tested running a temperature ramp (rapid increase to 80°C, 1 min constantly at 80°C, and slower decrease to 37°C). Control groups (n = 5) were tested at a constant temperature of 37°C. Kolmogorov-Smirnov and one-way ANOVA (P < 0.05) statistical tests were performed. The temperature ramp reduced setting time of GFB (24.85 to 4.45 min) (P < 0.05), but did not alter that of AHPJ (P > 0.05). GFB exhibited an increased η*, whereas the AHPJ η* was decreased when heated (P < 0.05). Rheological properties of sealers were negatively affected by temperature changes.

Do Contaminating Substances Influence the Rheological Properties of Root Canal Sealers?

INTRODUCTION

This study evaluated the effect of residual substances derived from irrigant solutions and intracanal medications on the rheological properties of a silicone, gutta-percha, and bioactive glass-based sealer in comparison with an epoxy resin-based sealer.

METHODS

Thin films of contaminants (0.5 μL) (3% sodium hypochlorite [NaOCl], chlorhexidine digluconate [CHX], 17% EDTA, calcium hydroxide, 40% citric acid, or distilled water [DW]) were applied along with freshly mixed GuttaFlow Bioseal (GFB; Coltene/Whaledent, Langenau, Germany) or AH Plus Jet (Dentsply DeTrey, Konstanz, Germany) on the lower plate of a dynamic rheometer. Rheological measurements were performed in oscillating mode at the strain amplitude, angular frequency, and constant temperature of 0.01%, 10 rad/s, and 37°C, respectively. Samples without contaminants served as controls. All measurements were performed 5 times. The Kolmogorov-Smirnov test and 1-way analysis of variance followed by the Student-Newman-Keuls test were performed to analyze the results (P < .05).

RESULTS

The contaminants did not alter the setting time of GFB compared with the controls; however, CHX and calcium hydroxide decreased its complex viscosity (ƞ*) (P < .05). The setting time of AH Plus Jet was increased by DW, CHX, citric acid, and EDTA (P < .05). All contaminants decreased its ƞ* at the setting point (P < .05). NaOCl led to the greatest alteration of its rheological parameters.

CONCLUSIONS

Irrigant solutions and intracanal medications adversely affected at least 1 of the tested rheological properties of both sealers, except for DW and 3% NaOCl, which did not alter any rheological property of GFB.

Evaluation of flow and filling of root canal sealers using different methodologies

Abstract Introduction Flow and filling ability of root canal sealers are indispensable for hermetic sealing of the root canal. Micro-computed tomography (micro-CT) can be used as a complementary methodology to evaluate such properties. Objective To evaluate the flow and filling ability of AH Plus, Endofill and Sealapex by conventional methodology and micro-CT. Material and method The flow of the sealers was analyzed according to ISO 6876/2012 and complemented by the area evaluation. Glass plates were manufactured with diameters of 1×1×2 mm and 1×1×1 mm (length, width and height), with a central cavity and four grooves in the horizontal and vertical directions. Each material was placed in the central cavity. Another glass plate and a metal weight were placed on the cement and kept for 10 minutes. The glass plate/sealer set was scanned using micro-CT. The flow was calculated by linear measurement of the material in the grooves. The central filling (mm3) was calculated in the central cavity and the lateral filling was measured up to 2 mm from the central cavity. Data were submitted to ANOVA/Tukey tests (α=0.05). Result All evaluated sealers presented flow according to ISO 6876 standards. The materials showed central cavity filling capacity higher than 80% and lateral filling greater than 75%. There was no difference in flow (mm and mm2) and in the filling ability (mm3) provided by the materials (p>0.05). Conclusion All evaluated root canal sealers showed adequate flow and filling capacity, suggesting their clinical application.

Rheological Characterization as an Alternative Method to Indentation for Determining the Setting Time of Restorative and Endodontic Cements

This study explored an alternative approach using rheology to assess setting time. The following cements were tested: ProRoot^® MTA (Dentsply, Tulsa, OK, USA), Biodentine^® (Septodont, Saint Maur des Fosses, France), Fuji VII^®, FujiVII^® EP, and Fuji IX^® (from GC Corporation, Tokyo, Japan), RealSeal SE™ Sealer (SybronEndo, Amersfoort, The Netherlands), AH 26^® and AH Plus (both from Dentsply DeTrey, Konstanz, Germany). Freshly mixed cements were placed into a strain-controlled rheometer (1 rad·s^-1 with an applied strain of 0.01%). From measurements of elastic modulus over time, the time taken to reach 90% of the plateau elastic modulus (designated as the setting time) was determined for each cement. In increasing order, the setting times were as follows: Fuji VII EP 3.3 min, Fuji VII 3.6 min, Fuji IX 3.7 min, ProRoot MTA 5.1 min, Biodentine 15.9 min, RealSeal 22.2 min, AH Plus 5933 min, and AH 26 5067 min. However, ProRoot MTA did not yield reliable results. The time to reach the 90% plateau elastic modulus correlates well with the setting time of glass ionomer cements and Biodentine. Using this approach gives much longer setting times for endodontic sealers than previously recognized.

Mineral Trioxide Aggregate-A Review of Properties and Testing Methodologies

Mineral trioxide aggregate (MTA) restoratives and MTA sealers are commonly used in endodontics. Commonly referenced standards for testing of MTA are ISO 6876, 9917-1 and 10993. A PubMed search was performed relating to the relevant tests within each ISO and "mineral trioxide aggregate". MTA restoratives are typically tested with a mixture of tests from multiple standards. As the setting of MTA is dependent upon hydration, the results of various MTA restoratives and sealers are dependent upon the curing methodology. This includes physical properties after mixing, physical properties after setting and biocompatibility. The tests of flow, film thickness, working time and setting time can be superseded by rheology as it details how MTA hydrates. Physical property tests should replicate physiological conditions, i.e. 37 °C and submerged in physiological solution. Biocompatibility tests should involve immediate placement of samples immediately after mixing rather than being cured prior to placement as this does not replicate clinical usage. Biocompatibility tests should seek to replicate physiological conditions with MTA tested immediately after mixing.

Wear profile of canal wall surfaces and bond strength of endodontic sealers after in situ acid challenge

AIM

To evaluate the wear of root wall surfaces, the bond strength of sealers to dentine and the demineralization around root filling materials after canals were exposed to acid challenge in situ.

METHODOLOGY

Eighty-seven roots of mandibular incisors were selected. Thirty-two were used in the laboratory bond strength study (n = 8), and 55 in the in situ study (n = 11). Root canals were prepared biomechanically and then filled with gutta-percha and AH Plus, MTA Fillapex, Sealapex or Endofill. For 14 days, 11 participants used intra-oral devices with five sterilized roots (four experimental and one control - only canal prepared). Drops of sucrose were dripped onto roots allowing the accumulation of biofilm on canal surfaces. Roots were removed, sectioned and analysed for the following: bond strength of filling material using a push-out test and also wear profile and dentine demineralization using confocal microscopy. Bond strength (MPa) was evaluated by two-way anova and Tukey test (α = 0.05), and wear profile was assessed by Kruskal-Wallis and t-tests (α = 0.05).

RESULTS

AH Plus had the highest bond strength values. Intermediate results were found in roots with MTA Fillapex and Endofill, whilst Sealapex had inferior results (P < 0.05). No significant differences were found amongst root thirds (P > 0.05). For wear profile, samples were associated with degradation of the filling materials after exposure to the oral environment (P < 0.05). Roots had signs of demineralization around the filling material when Sealapex and Endofill were used.

CONCLUSIONS

Sealers were not able to prevent degradation of the adhesive interface and dentine. AH Plus and MTA Fillapex had superior bond strength to dentine and less intense demineralization around the root filling.

In vitro evaluation of a newly produced resin-based endodontic sealer

OBJECTIVES

A variety of root canal sealers were recently launched to the market. This study evaluated physicochemical properties, biocompatibility, and sealing ability of a newly launched resin-based sealer (Dia-Proseal, Diadent) compared to the existing root canal sealers (AHplus, Dentsply DeTrey and ADseal, Metabiomed).

MATERIALS AND METHODS

The physicochemical properties of the tested sealers including pH, solubility, dimensional change, and radiopacity were evaluated. Biocompatibility was measured using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. For microleakage test, single-rooted teeth were instrumented, and obturated with gutta-percha and one of the sealers (n = 10). After immersion in 1% methylene blue solution for 2 weeks, the specimens were split longitudinally. Then, the maximum length of staining was measured. Statistical analysis was performed by one-way analysis of variance followed by Tukey test (p = 0.05).

RESULTS

Dia-Proseal showed the highest pH value among the tested sealers (p < 0.05). ADseal showed higher dimensional change compared to AHplus and Dia-Proseal (p < 0.05). The solubility values of AHplus and Dia-Proseal were similar, whereas ADseal had the lowest solubility value (p < 0.05). The flow values of sealer in increasing order were AHplus, DiaProseal, and ADseal (p < 0.05). The radiopacity of AHplus was higher than those of ADseal and Dia-Proseal (p < 0.05). The cell viability of the tested materials was statistically similar throughout the experimental period. There were no significant differences in microleakage values among the tested samples.

CONCLUSIONS

The present study indicates that Dia-Proseal has acceptable physicochemical properties, biocompatibility, and sealing ability.

Volume of sealer in the apical region of teeth filled by different techniques: a micro-CT analysis

The volume of sealer in the apical 1 mm of teeth filled using different techniques was evaluated by micro-commuted tomography (micro-CT). Sixty-four maxillary central incisors were prepared using NiTi rotary instruments. Teeth were randomly distributed into four groups according to root canal sealers (AH Plus, Endofill, Sealapex, and Sealer 26) and subdivided into two subgroups according to the filling techniques (active and passive lateral condensation; n = 8 each). Subsequently, teeth were examined using the 1174 SkyScan micro-CT device. Images were reconstructed using the NRecon software, and the sealer volume (mm3) in the apical region was analyzed using the two-way ANOVA and post-hoc Student-Newman-Keuls test (α = 0.05). The lowest volume of sealer was observed in teeth filled with Sealapex (0.100 ± 0.009) and Endofill (0.103 ± 0.010). The highest volume was observed in teeth filled with AH Plus (0.112 ± 0.008) and Sealer 26 (0.109 ± 0.018) (p > 0.05). Regarding the filling technique, a lower sealer volume was observed using the active lateral condensation technique compared with that using the passive lateral condensation technique (0.100 ± 0.010 vs. 0.111 ± 0.012) (p < 0.05). Therefore, the lowest volume of sealer was observed in teeth filled with Sealapex and Endofill using the active lateral condensation technique.