Endodontic leakage studies reconsidered. Part I. Methodology, application and relevance

Comparative Evaluation of the Sealing Ability of Mineral Trioxide Aggregate (MTA)-Based, Resin-Based, and Zinc Oxide Eugenol Root Canal Sealers: An In Vitro Study

Root canal therapy is a crucial procedure in endodontics that is done to achieve complete obliteration of the root canal space. The success of this therapy depends on achieving a proper seal, which is facilitated using root canal sealers. This study aimed to compare the apical sealing ability of three different root canal sealers: MTA Fillapex, AH Plus, and zinc oxide eugenol (ZOE), using the dye penetration method. Forty freshly extracted single-rooted human maxillary incisors were collected and prepared for the study. The root canals were instrumented using the ProTaper system, and the canals were then obturated using the lateral condensation technique with the respective sealers. After one week of storage, the samples were coated with nail varnish, immersed in a rhodamine B dye solution, and then sectioned longitudinally. The depth of dye penetration was measured, and the results were analyzed statistically. The results revealed significant differences in apical leakage among the three experimental groups. Group 2 (AH Plus) showed the minimum leakage with a mean of 0.13 mm, while Group 4 (no sealer) exhibited the maximum leakage with a mean of 4.49 mm. Group 3 (ZOE) showed an intermediate level of leakage with a mean of 2.37 mm. The statistical analysis confirmed the significant difference in mean leakage among the groups. The findings of this study indicate that AH Plus exhibited superior apical sealing ability compared to MTA Fillapex and ZOE. AH Plus is a resin-based sealer known for its dimensional stability. On the other hand, MTA Fillapex, a newly introduced sealer containing mineral trioxide aggregate, resin, and silica, showed promising sealing properties but had slightly higher leakage compared to AH Plus. ZOE, a traditional sealer, demonstrated relatively higher leakage than the other sealers. In conclusion, choosing a root canal sealer is crucial in achieving a successful endodontic treatment outcome. AH Plus demonstrated superior apical sealing ability among the three sealers tested. Further research and long-term clinical studies are warranted to validate these findings and assess the impact of sealer choice on treatment outcomes and post-endodontic healing.

Methodologies used for testing the sealability of endodontic temporary fillings in vitro: A narrative review

Introduction

The ability of the temporary filling to seal endodontic access cavities may be crucial for the success of endodontic treatment. Numerous in vitro studies have investigated the sealability of the temporary fillings used in endodontic treatments. However, in vitro sealability studies have been criticized for their inconsistent results and questionable clinical relevance. Some journals have imposed moratoriums on publishing such studies to encourage researchers to test their validity and clinical relevance. Since the implementation of this moratorium, little progress has been made in this field. To further encourage researchers to investigate the reliability of these studies, this review presents an overview of the methodologies of studies that examine the ability of temporary filling materials to seal the endodontic access cavity in vitro and discusses the criticisms of these studies in detail.

Materials and Methods

PubMed, Scopus, and Embase electronic databases were searched to identify studies that tested in vitro the ability of temporary filling materials to seal endodontic access cavities. Only original articles published in English between 01/01/1970 and 28/02/2022 were included.

Results

The search yielded 551 results. After removing duplicates and excluding studies that did not meet the inclusion criteria, 94 studies were included in this review.

Conclusion

Although clinical studies may be the best way to test the performance of temporary fillings, the ethical importance of conducting preliminary in vitro studies is undeniable. It seems that questioning the reliability of in vitro sealability studies is not based on sufficient scientific evidence and that the inconsistencies in the results of these studies may be due to differences in the methodological and clinically relevant variables between them, rather than due to their unreliability.

Lipopolysaccharide penetration analysis of two different resin cement systems to dentin and ceramic surface

Background/purpose

One of the challenges in adhesive ceramic restorations is deterioration of tooth-cement-ceramic interfaces. This study was to quantitatively investigate lipopolysaccharide (LPS) penetration through adhesive ceramic restorations.

Materials and methods

Standardized holes were formed on ceramic (IPS Empress CAD, Ivoclar Vivadent) and human dentin discs. Prepared discs were randomly assigned to experimental groups (n = 6/group): SC, self-adhesive resin cement (SmartCem 2, Dentsply Sirona) bonded to ceramic discs; ST, self-adhesive resin cement bonded to dentin discs; VC, etch-and-rinse resin cement (Variolink II, Ivoclar Vivadent AG) bonded to ceramic discs; VT, etch-and-rinse resin cement bonded to dentin discs. The specimens underwent thermocycling (10,000 cycles; 5-55 °C) then LPS penetration test until 5-weeks. A mixed effect analysis using R statistical language was performed for data analysis.

Results

Dentin and ceramic bonded with etch-and-rinse resin cements (groups VT and VC) showed significantly less penetration than those with self-adhesive resin cement (groups ST and SC) (P < 0.05). ST showed significantly lower penetration than SC (P < 0.05), that showed similar penetration with positive control (P > 0.05). VC showed minimal penetration during observed time of period (P < 0.05). Scanning electron microscope observations showed different interfacial characteristics among the groups.

Conclusion

Within the limitation of this study, etch-and-rinse resin cement showed less LPS penetration than self-adhesive resin cement on both ceramic and dentin surfaces.

Effect of blood contamination on marginal adaptation of cold ceramic and MTA angelus: a scanning electron microscopic study

BACKGROUND

This study aimed to assess the effect of blood contamination on marginal adaptation of cold ceramic (CC) and mineral trioxide aggregate (MTA) Angelus using scanning electron microscopy (SEM).

METHODS

This in vitro experimental study was conducted on 24 extracted single-rooted human teeth. After cleaning and shaping, the root canals were filled with lateral compaction technique. The apical 3 mm of the roots was cut, and cavities with 3 mm depth were created at the apex. The teeth were randomly assigned to two group (n = 12) for the application of CC and MTA Angelus as retrograde filling materials. CC and MTA Angelus were prepared by mixing the powder with blood, and applied in the cavities. After 24 h, their marginal adaptation to the canal walls was assessed by SEM. Data were statistically analyzed by t-test (alpha = 0.05).

RESULTS

The mean marginal gap was 8.98 μm in the CC, and 16.26 μm in the MTA Angelus group; this difference was statistically significant (P < 0.001).

CONCLUSIONS

The present in vitro study revealed that following complete blood contamination of powder, CC showed significantly superior marginal adaptation than MTA Angelus as shown by SEM assessment.

Comparison of obturation quality in natural and replica teeth root-filled using different sealers and techniques

OBJECTIVES

This study aims to assess the obturation efficacy of sealers placed with different techniques using microcomputed tomography (µCT) and assess the influence of µCT testing parameters on the obturation data obtained.

MATERIALS AND METHODS

Incisors and mesial roots of lower molars with standardized root length were scanned using µCT, and one tooth of each type was 3D printed in acrylic. Two obturation techniques (warm vertical and single cone) and 4 sealer types (AH Plus, BioRoot RCS, Totalfill BC, and Bio-C Sealers) were assessed following storage in Hank's balanced salt solution for 3 and 6 months by assessing gap and void volume percentages on both natural and replica incisor and molar roots. The storage solution was analysed to assess calcium ion leaching. The influence of temperature, tooth positioning, and moisture content of the teeth while µCT scanning was also investigated.

RESULTS

The obturation quality in the incisor group was the same using both natural teeth and replicas (p > 0.05). No changes in void volume were identified when comparing the same sealer using different obturation techniques. The premixed sealers used in single-cone obturation exhibited high void volume in the 3D printed replicas in the long term. The temperature, positioning, and moisture content of the teeth did not affect the outcome of µCT testing.

CONCLUSIONS

BioRoot RCS, Totalfill BC, and Bio-C Sealers are suitable for obturation of both complex and simple root canal systems using different obturation techniques with BioRoot RCS exhibiting the highest calcium ion release. 3D printed acrylic teeth can be used to assess the obturation quality in uncomplicated root canal systems. µCT parameters had no significant effect on the µCT measurement.

CLINICAL RELEVANCE

The single-cone obturation technique with hydraulic sealer is a simple technique that can be used for obturation of all root canal systems.

Apical Sealing and Bioactivity of an Experimental Gutta-Percha Containing Niobium Phosphate Bioglass

This study evaluated the apical sealing ability and bioactivity of an experimental gutta-percha containing niobium phosphate bioglass. Thirty-six human premolars were endodontically prepared and divided into three groups: GPC—filling with conventional gutta-percha; GBC—filling with bioceramic gutta-percha (EndoSequence BC); GNB—filling with experimental gutta-percha containing niobophosphate. Teeth were stored in tubes containing 2 mL of simulated body fluid (SBF) solution in an oven for 30 days. Then, the samples were immersed in lanthanum nitrate solution and analyzed for apical nanoleakage (NI) with a scanning electron microscope (SEM/EDS) and transmission electron microscope (TEM). Gutta-percha specimens were immersed for 28 days (SBF) and analyzed in SEM/EDS and X-ray diffraction (XRD) to assess bioactivity. NI data originated from the SEM/EDS were analyzed using the Kruskal–Wallis test (α = 5%). NI data originated from TEM and bioactivity were descriptively reported. Statistical analysis did not detect a significant difference between groups (p = 0.13) for NI. In the bioactivity analysis, an abundant layer of hydroxyapatite was identified only in the surface of the GNB group samples. The gutta-percha containing niobophosphate bioglass promoted an apical sealing similar to EndoSequence BC, in addition to demonstrating bioactivity through the deposition of hydroxyapatite on the surface of the material after immersion in SBF.

A New Mass Spectroscopy-Based Method for Assessing the Periodontal-Endodontic Interface after Intracanal Placement of Biomaterials In Vitro

Optimizing the interface between biomaterials and dental hard tissues can prevent leakage of bacteria or inflammatory mediators into periapical tissues and thus avoid alveolar bone inflammation. In this study, an analysis system for testing the periodontal-endodontic interface using gas leakage and subsequent mass spectrometry was developed and validated using the roots of 15 single-rooted teeth in four groups: (I) roots without root canal filling, (II) roots with an inserted gutta-percha post without sealer, (III) roots with gutta-percha post and sealer, (IV) roots filled with sealer only, and (V) adhesively covered roots. Helium was used as the test gas, and its leakage rate was found by measuring the rising ion current using mass spectrometry. This system made it possible to differentiate between the leakage rates of tooth specimens with different fillings. Roots without filling showed the highest leakage values (p < 0.05). Specimens with a gutta-percha post without sealer showed statistically significantly higher leakage values than groups with a filling of gutta-percha and sealer or sealer alone (p < 0.05). This study shows that a standardized analysis system can be developed for periodontal-endodontic interfaces to prevent biomaterials and tissue degradation products from affecting the surrounding alveolar bone tissue.

Orifice barriers to prevent coronal microleakage after root canal treatment: systematic review and meta-analysis

AIMS

This systematic review aimed to compare the efficiency of orifice barriers in preventing coronal microleakage in vitro.

METHODS

Articles published in English, German and Chinese were searched for studies describing microleakage assays for the bacterial penetration of root canal-treated teeth in vitro. The final sample included 18 articles for review and meta-analysis. Risk ratios and confidence intervals were determined for dichotomous variables. Ten publications using bacterial leakage models contributed to the meta-analysis.

RESULTS

The addition of orifice barriers to a root canal filling was overall effective, shown by risk ratios (RR) and 95% confidence intervals (CI) demonstrating reduced microleakage with glass ionomer cement (GIC) (RR 0.37, 95% CI 0.26-0.53, P < 0.001), resin-modified GIC (RR 0.32, 95% CI 0.15-0.67, P = 0.01), composite resin (RR 0.54, 95% CI 0.38-0.75, P < 0.001), mineral trioxide aggregate (MTA) (RR 0.25, 95% CI 0.12-0.52, P < 0.001) and Cavit (RR 0.23, 95% CI 0.14-0.39, P < 0.001). There were no significant differences between GIC, resin-modified GIC, composite resin and MTA orifice barriers.

CONCLUSIONS

Placement of an orifice barrier over the root canal filling is effective in the prevention of coronal microleakage in vitro. Other parameters may also affect the effectiveness of orifice barriers, including thickness and duration of exposure to the oral environment. © 2023 Australian Dental Association.

Sealing Ability of Bioactive Root-End Filling Materials in Retro Cavities Prepared with Er,Cr:YSGG Laser and Ultrasonic Techniques

The aim of this in vitro study was to compare the apical sealing ability of total fill bioceramic root repair material (BC-RRM) and mineral trioxide aggregate (MTA), regarding the retrograde preparation technique used: ultrasonic or erbium, chromium: yttrium, scandium, gallium, or garnet (Er,Cr:YSGG) laser. The study sample consisted of 48 human single-rooted teeth. After root-end resection, the samples were divided into two groups, according to the retrograde preparation technique used: Group 1: ultrasonic; Group 2: Er,Cr:YSGG laser. In each group, half of the retrograde cavities were filled with BC-RRM, and the other half were filled with MTA. The specimens were mounted in tubes and sterilized in plasma. The root canals were inoculated with Enterococcus faecalis, and the tubes were filled with fetal bovine serum, leaving the apical part of the root in the serum. After 30 days, the canals were sampled and cultured, and the colony forming units (CFUs) were counted with the additional polymerase chain reaction (PCR analysis). There was no significant difference between ultrasonic groups and the Er,Cr:YSGG-MTA group, regarding the number of CFUs (p > 0.05). The Er,Cr:YSGG-BC-RRM group showed the highest number of remaining viable bacteria (p < 0.001). Both filling materials filled in ultrasonic preparations presented similar sealing abilities. The BC-RRM showed more leakage when used in retro cavities prepared with the Er,Cr:YSGG laser.

A critical analysis of research methods and experimental models to study irrigants and irrigation systems

Irrigation plays an essential role in root canal treatment. The purpose of this narrative review was to critically appraise the experimental methods and models used to study irrigants and irrigation systems and to provide directions for future research. Studies on the antimicrobial effect of irrigants should use mature multispecies biofilms grown on dentine or inside root canals and should combine at least two complementary evaluation methods. Dissolution of pulp tissue remnants should be examined in the presence of dentine and, preferably, inside human root canals. Micro-computed tomography is currently the method of choice for the assessment of accumulated dentine debris and their removal. A combination of experiments in transparent root canals and numerical modeling is needed to address irrigant penetration. Finally, models to evaluate irrigant extrusion through the apical foramen should simulate the periapical tissues and provide quantitative data on the amount of extruded irrigant. Mimicking the in vivo conditions as close as possible and standardization of the specimens and experimental protocols are universal requirements irrespective of the surrogate endpoint studied. Obsolete and unrealistic models must be abandoned in favour of more appropriate and valid ones that have more direct application and translation to clinical Endodontics.

A critical analysis of research methods and experimental models to study root canal fillings

Canal filling materials and techniques have been one of the most studied topics in Endodontics. A simple search using the mesh term "root canal filling" in PubMed revealed more than 11,000 articles, an impressive number that is much higher than "root canal disinfection" (5,544 articles) or even the popular "root canal preparation" (8,527 articles). The overriding importance attributed to root filling procedures is not merely intuitive. It derived from the appealing relevance given by the appearance of the white lines in common radiographs grounded on retrospective clinical data that had identified the quality of a root filling as one of the major causes of treatment failure (lack of healing). Since the publication of the Washington study, impressive efforts have been made for the release of new materials and techniques, as well as, for the development of a plethora of laboratory methods to assess the quality of root filling procedures. This narrative review aims to address and discuss the most relevant laboratory methods to assess the root canal filling. Since filling quality improvements have not translated into higher success rates, as reported in longitudinal clinical studies, more than to deliver a simple methodology-based review, this paper aims to present an in-depth critical view on the assessment of laboratory methods used to study the filling materials and techniques. Recent data indicate that the long-term dimensional stability/degradation over time of endodontic sealers plays a central role in the treatment outcome. In this context, laboratory methods should be developed focusing on predicting, at least to some degree, the long-term clinical behaviour of root canal fillings, rather than simply ranking different materials or techniques.

Common Temporization Techniques Practiced in Saudi Arabia and Stability of Temporary Restoration

Introduction

Coronal leakage is detrimental to the long-term success of root canal treatment (RCT). While much emphasis is being placed on the quality of the final restoration, little attention is given to the temporary restoration placed in between root canal treatment appointments. The aim of this study was to survey temporization techniques practiced in Saudi Arabia and the frequency of observing temporary material breakdown or complete loss.

Materials and Methods

An online questionnaire was distributed among general dentists, dental specialists, and clinical trainees in undergraduate and postgraduate dental programs. The sample size was estimated at 370 participants. Data were analyzed using descriptive statistics and chi-square tests.

Results

The total number of participants who met the inclusion criteria was 525. The majority of them (94.6%) were practicing two-visit RCT. The most common temporization materials were Cavit (50.3%) followed by glass ionomer cement (32%). The majority (72.6%) of participants claimed they allow a thickness of 2-3 mm for temporary restorations. Many participants (60.4%) used a spacer material during temporization, and the cotton pellet was the most common spacer material. Temporary restoration breakdown or complete loss was a common observation. Although the duration between the two RCT visits was 2 weeks or less for 83.6% of participants, only 19.6% of participants claimed that they rarely observed temporization breakdown.

Conclusion

Two-visit RCT is commonly practiced in Saudi Arabia, and endodontists performed significantly more single-visit procedures. Temporization practices may lack uniformity; however, clinicians were more likely to use calcium sulfate-derived material for two weeks or less. They allow for 2-3 mm thickness restoration and use a cotton pellet as a spacer. According to their clinical observation, temporary material breakdown or complete loss was frequent. This mandates further attention in research and education.

Sealing ability of three different materials to repair furcation perforations using computerized fluid filtration method

Background. The present study aimed to evaluate the sealing ability of three different calcium silicate-based materials in furcation perforations.

Methods. Seventy-six human mandibular molar teeth were selected. Perforations were created in the center of the pulp chamber floor. The experimental teeth were randomly divided into three groups (n=22). Perforations were repaired with MTA Angelus, Endocem MTA, or EndoSequence BioCeramic Root Repair Material Fast Set Putty (BC-RRM Putty). Microleakage of the different repair materials to be tested was measured by computerized fluid filtration method at 24- and 72-hour intervals.

Results. For each time interval, no statistically significant difference was observed between the groups. For Endocem MTA and BC-RRM Putty groups, the difference between the leakage values measured at both periods was not statistically significant (P > 0.05). However, there was a significant difference for the MTA Angelus group (P < 0.05).

Conclusion. All the calcium silicate-based materials used in the present study showed similar performance in repairing furcation perforations at 24- and 72-hour intervals.

A Confocal Microscopic Study on Percentage Penetration of Different Sealers into Dentin

Context:

Three-dimensional seal of the root canal space has always been challenging. The incorporation of gutta-percha and sealer prevents microleakage by bacteria, ensuring a shielded root canal space. However, the penetration of sealer to various depths within the root canal has always been looked with curiosity.

Aims:

Thus, the present in vitro study was undertaken to evaluate the percentage and average depth of penetration of Endoflas F. S., AH Plus, and Epiphany sealers into dentinal tubules among the coronal, middle, and apical thirds of the roots following obturation with a lateral compaction technique using Confocal Laser Scanning Microscopy.

Settings and Design:

The study is an in vitro randomized control trial.

Subjects and Methods:

Thirty sound central incisors were decoronated at the level of the cementoenamel junction. Working length determination was done followed by a meticulous cleaning, shaping, and under copious irrigation. The teeth were then randomly divided into three groups: Endoflas FS sealer, AH Plus sealer, and Epiphany sealer. On fluorescence treatment, the teeth were sectioned at the midpoint of coronal, middle, and apical third of each root and viewed under confocal laser scanning microscope.

Statistical Analysis Used:

The results were analyzed using one-way ANOVA, and the significant difference between groups was analyzed with post hoc Tukey test.

Results:

Epiphany sealer provided with better percentage and depth penetration in comparison to Endoflas FS and AH Plus sealers. Furthermore, the coronal third of the root had better percentage and sealer penetration than the middle and apical thirds.

Conclusions:

Sealers tend to provide a firm bond between the tooth and the gutta-percha. They bind, lubricate, and seal the gutta-percha cones to fill the accessory canals. Within the limitations of this study, the superior flow and enhanced setting time Epihany sealers provide better percentage and depth of penetration than AH Plus and Endoflas FS.

Sealing ability and microbial leakage of root-end filling materials: MTA versus epoxy resin: A systematic review and meta-analysis

Objectives

The purpose of this systematic review of the literature is to investigate which of the epoxy-based cements and those based on Tricalciumsilicate (MTA, Bioceramic) have the best sealing capacity through the analysis of studies that have provided a survey model in vitro of bacteria leakage.

Source

The articles were identified using electronic databases such as PubMed, Scopus, the search was conducted between 8.12.2020 and 31.12.2020 and a last search was conducted on 2.12.2021.

Study selection

678 records were identified and after removing the duplicates we obtain 481 records, with the first phase of screening and selection of records we reached 204 and with the application of the inclusion and exclusion criteria we selected 31 articles, only 9 studies made a direct comparison between the two endodontic cement categories and presented data that could be included in the metaanalysis.

Data

The meta-analysis of first outcome shows an odds ratio of 2.70 C.I.(Confidence Interval) [1.54, 4.73], the test for overall effect has a p value = 0.0005 with a heterogeneity index of I 2 of 9%; The second outcome meta-analysis shows an Odds Ratio of 1.50 C.I. (Confidence Interval) [0.92, 2.46] with a p value of 0.10 with an I 2 of 79%.

Conclusion

the sealing ability is higher for epoxy resins than for tricalcium silicate-based cements, for observation periods longer than 90 days.

Clinical relevance

The knowledge of the cement that determines the best sealing ability and resistance to microbial leakage, can be of help for the dentist who has to face clinical situations such as endodontic retreatments whose failure is determined by the persistence of bacteria in the endodontic canals.

Comparison of bacterial microleakage of three bioactive endodontic sealers in simulated underwater diving and aviation conditions

BACKGROUND

Bacterial microleakage is an important cause of apical periodontitis and endodontic treatment failure. This study aimed to assess the bacterial microleakage of nano-mineral trioxide aggregate (nano-MTA) as a sealer, Endoseal MTA, and GuttaFlow Bioseal sealers in atmospheric pressure, and simulated underwater diving and aviation conditions.

METHODS

In this in vitro, experimental study, 180 extracted single-rooted teeth were cleaned and shaped, and were then randomly divided into three groups for single-cone obturation using Endoseal MTA, GuttaFlow Bioseal, or nano-MTA as a sealer. Each group was then randomly divided into three subgroups, and subjected to ambient atmospheric pressure, 2 atm pressure (to simulate underwater diving), and 0.5 atm pressure (to simulate aviation) using a custom-made pressure chamber. The teeth then underwent microbial leakage test using Streptococcus mutans (S. mutans), and the percentage of samples showing microleakage was recorded for up to 1 month, and analyzed using the Chi-square test.

RESULTS

The three sealer groups were significantly different regarding bacterial microleakage (P < 0.05). The nano-MTA group showed significantly higher microleakage after 15 days than the other two groups (P = 0.006). The effect of pressure on bacterial microleakage was not significant in any sealer group (P > 0.05).

CONCLUSION

Within the limitations of this in vitro study, it may be concluded that single-cone obturation technique using nano-MTA as a sealer results in lower resistance to bacterial microleakage compared with the use of GuttaFlow Bioseal, and Endoseal MTA. Pressure changes in simulated underwater diving and aviation conditions had no significant effect on bacterial microleakage. Trial Registration Number This is not a human subject research.

Five decades of the International Endodontic Journal: Bibliometric overview 1967-2020

AIM

The International Endodontic Journal (IEJ) has served as a platform for research and clinical practice in Endodontics since 1967. This study provides a bibliographic analysis and overview of the publications that have appeared in the IEJ from 1967 to 2020.

METHODOLOGY

A literature search was performed in Elsevier's Scopus database to locate all the publications of the International Endodontic Journal. Various bibliometric software packages including the open-source visualization software Gephi and Biblioshiny (version 2.0) were employed for data visualization and analysis.

RESULTS

A total of 3739 records with citation and bibliographic details were selected and retrieved to allow a bibliometric analysis to be performed. The bibliometric analysis indicates that the IEJ has grown both in terms of productivity and influence. Over time, the journal has been associated with an increase in the number of manuscripts published and the citations they have attracted, but with minor downward fluctuations in citations in the last few years. Bibliographic coupling of the IEJ articles revealed that the major research themes published in the journal include 'endodontics', 'root canal treatment', 'calcium hydroxide', 'apical periodontitis', 'mineral trioxide aggregate', 'microbiology', 'cyclic fatigue', 'cone-beam computed tomography' and 'micro-computed tomography'. Authors affiliated to institutions in the UK were the major contributors to the journal and were linked with other countries such as Brazil, USA and Malaysia. The largest number of publications were from the University of São Paulo, Brazil.

CONCLUSION

The IEJ is one of the leading journals in Endodontology and has been providing a platform for innovative research and clinical reports for more than 50 years. Publications have been associated with a wide range of authors, institutions and countries around the world.

Correlation among Root Canal Configuration, Quality of Filling, and Its Sealability

Objective  This study aimed to evaluate the existence of possible correlations among root canal configuration, quality of filling, and its sealability.

Materials and Methods  Sixty human mandibular central incisors were selected for this study. The teeth were prepared with the Profile 04 system up to instrument 35/0.04 and irrigated with 2.5 mL of 2.5% sodium hypochlorite at each instrument change. Root canal filling was performed by the lateral compaction technique, using gutta-percha and an epoxy resin-based sealer (AH Plus) labeled with 0.1% Rhodamine B dye. Afterward, the specimens were submitted to fluid filtration tests to assess the sealability of the filling. Cross-sections were obtained at −3, −6, and −8 mm from the root apex and submitted to a metallographic treatment to determine the root canal configuration and the percentage of gutta-percha filled areas. The data were statistically analyzed by the Grubbs test. Pairs of correlations were analyzed by applying the Spearman test at a level of significance of 5%.

Results  No correlation was observed among the analyzed variables as follows: root canal configuration versus filling quality (Spearman’s rho = 0.031); filling quality versus sealability (Spearman’s rho = 0.219); and root canal configuration versus sealability (Spearman’s rho = 0.184).

Conclusion  The root canal configuration did not affect the quality of the filling and its sealability.

Assessment of Quality of Root Canal Filling with C Point, Guttacore and Lateral Compaction Technique: A Confocal Laser Scanning Microscopy Study

Objective:

The purpose of this in vitro study was to compare the quality of root canal filling of C Point, GuttaCore and lateral compaction using confocal laser scanning microscopy.

Methods:

Ninety recently extracted human mandibular incisors with single canal were selected. Canals were prepared with ProTaper instruments to size F3 and obturated using C Point, GuttaCore or lateral compaction technique. Endosequence BC sealer was labeled with Rhodamine B dye to allow analysis under a confocal microscope. The percentages of gutta-percha filled area (PGFA), sealer filled area (PSFA), voids (POV) and interfacial adaptation (IA) was assessed at 2, 5 and 8 mm from the apex, using image analysis software. Kruskal–Wallis followed by Mann Whitney U tests were used for data analysis, and the P value was set at 0.05 (P=0.05).

Results:

No significant difference was seen among the three groups at 2 mm level for PGFA, PSFA and voids (P>0.05). At 5 and 8 mm levels, canals filled with GuttaCore had significantly higher PGFA and lower PSFA than lateral compaction and C Point. Highest POV was seen for lateral compaction group followed by C Point and GuttaCore.

Conclusion:

Out of the three techniques examined, best results in terms of quality of root canal filling were observed for GuttaCore. C Point system was found to be associated with internal defects such as tears and delamination which may adversely affect the long term performance of this system.

Filling ability of three variants of the single-cone technique with bioceramic sealer: a micro-computed tomography study

The present study evaluated the quality of single-cone root canal fillings with bioceramic (BC) sealer using three different techniques by means of micro-computed tomography (micro-CT). The canals of 30 extracted single-rooted permanent teeth were shaped with R40 Reciproc blue files and filled with the single-cone technique (SCT). BioRoot RCS BC sealer was placed inside the canals with one of the following master cones: R40 cone to working length (RWL, n = 10); R40 cone trimmed 1 mm short of working length (RWL-1, n = 10); non-standardized gutta-percha cone to working length (NSWL, n = 10). A quantitative and qualitative micro-CT analysis assessed the filling quality and internal/external voids formation. Collected data underwent statistical analysis by multivariate one-way analysis of variance (α = 0.05). In all groups, the voids were minimal and prevalently external. The NSWL and RWL-1 groups had increased sealer ratios in the whole canal and the apical canal portion, respectively. The lowest amounts of voids were found in the RWL group; the void volumes were slightly greater in the RWL-1 mm and NSWL groups, especially at the apical level. Two alternative SCTs showed satisfactory filling ability, uniform distribution of the BC sealer, and a minimally increased voids formation compared to the standard SCT with dedicated cone. The two tested alternative SCTs could take advantage of the beneficial characteristics of the BC sealer, which evenly filled the endodontic space, ideally sealing both the major and the accessory communications with the periodontium.

Sealing Ability of AH Plus and GuttaFlow Bioseal

The objective of root canal obturation is to achieve a fluid-tight seal. Recently, GuttaFlow bioseal (GB), a root canal sealer composed of polydimethylsiloxane, gutta-percha particles, and bioactive glass ceramics, has been developed, to enhance the sealing ability of root canal filling material. The objective of this study was to assess the sealing ability of GB using a subnanoliter-scaled fluid-flow measuring device and to compare with that of AH Plus (AH). The fluid flow in root canal-filled teeth using either gutta-percha cone (GP) with AH (GAR; n = 10) or GP with GB (GBR; n = 10) and in GP inserted in AH blocks (GA; n = 10) or GP inserted in GB blocks (GB; n = 10) was measured. In addition, fluid flow in sealer blocks of AH (A; n = 10) and GB (B; n = 10), which served as negative controls, was measured. Root canal-filled teeth using GP without any sealer (GR) acted as positive controls (n = 10). The leakage was obtained by calculating the volume of moved water by time (s), after stabilization of the fluid flow was achieved. Statistical analysis was performed using the Kruskal–Wallis test and Mann–Whitney U-test with Bonferroni correction. A p value less than 0.00238 (0.05/21) was considered significantly different. The mean leakages (nL/s) in the groups are as follows: GAR, 0.0958 ± 0.0543; GBR, 0.0223 ± 0.0246; GA, 0.0644 ± 0.0803; GB, 0.0267 ± 0.0182; A, 0.0055 ± 0.0057; B, 0.0052 ± 0.005; and GR, 0.2892 ± 0.3018. The mean leakage in the GBR group was lower than that in the GAR group (p = 0.001), while the mean leakages in the GA and GB groups were not significantly different. GuttaFlow bioseal can be useful in single-cone obturation technique.

Real-time nanoleakage and the flow characteristics of calcium silicate root canal filling materials

This study aimed to investigate the real-time nanoleakage and flow characteristics of calcium silicate-based (Ca-Si) root canal filling materials. Extracted human teeth (n = 30) were decoronated and standardized in their inner and outer dimensions. After root canal enlargement, the roots were filled with gutta-percha (GP) and AH26 sealer, GP and EndoSeal MTA sealer, or Biodentine. The roots were connected to a Nanoflow device (IB Systems) under hydrostatic pressure (40 cm∙H₂O) and fluid flow was traced through the filled roots. Data were detected at the nanoscale twice per second and automatically recorded in units of nL/s. Leakage was quantified as the mean slope until the curve plateaued over time, and all static flow intervals lasting longer than 1 s were analyzed to identify any increase in flow and duration. Data were statistically analyzed using the Kruskal-Wallis test. The calculated leakage values were 0.0670 ± 0.0516 nL/s for GP/AH26, 0.1397 ± 0.1579 nL/s for GP/EndoSeal MTA, and 0.0358 ± 0.0538 nL/s for Biodentine, with no statistically significant differences among the root filling materials (P > 0.05). An analysis of real-time flow data for 1000 s to identify spot trends and the overall tendency of flow until a plateau was reached revealed a stepwise increase in the roots filled with Ca-Si material, whereas the GP/AH26-filled roots showed a linear increase. Real-time measurements under hydrostatic pressure with the Nanoflow device enabled precise fluid flow tracing through the root canal filling material. In terms of nanoleakage, the tested root canal filling materials showed no significant differences, while the real-time flow patterns of roots filled with Ca-Si material showed different characteristics from those of GP/AH26-filled roots.

Comparison of apical sealing ability of bioceramic sealer and epoxy resin-based sealer using the fluid filtration technique and scanning electron microscopy

Background/purpose

A perfect sealing of root canal system is essential for preventing ingress of bacteria from the oral environment. The purpose of this study was to evaluate the apical sealing ability of bioceramic (EndoSequence BC Sealer®) and epoxy resin-based (AH Plus®) sealers at 24 h, 7 days and 4 weeks.

Materials and methods

Forty two extracted human upper anterior teeth were sectioned to leave the root 15-mm long, then all the roots were instrumented using a set of ProTaper® rotary instruments. Four roots were selected randomly as controls, and the remaining 38 roots were randomly divided into 2 groups of 19 roots each: group 1: EndoSequence BC Sealer® and gutta-percha, and group 2: AH Plus® and gutta-percha using a multiple wave condensation technique. The apical sealing ability of the filled root canal was measured using the fluid filtration method with 200 mmHg (26.67 KPa) above atmospheric pressure at 24 h, 7 days and 4 weeks. Scanning electron microscopy (SEM) was used to assess the adaptation and penetration of the sealers. The apical microleakage between 2 groups was compared using Student's t-test. P < 0.05 was considered statistically significant.

Results

EndoSequence BC Sealer® had significantly better sealing ability than AH Plus® at all test periods (P < 0.001). SEM showed EndoSequence BC Sealer® had better penetration into dentinal tubules.

Conclusion

Bioceramic sealer could promote proper sealing of root canals obturated with multiple wave condensation.

Outcome of Root Canal Treatments Using a New Calcium Silicate Root Canal Sealer: A Non-Randomized Clinical Trial

Background: The aim of this study was to compare the success rate of root canal treatments undertaken using a calcium silicate root canal sealer in combination with a single cone with non-calcium silicate cement and warm vertical condensation. Methods: 150 necrotic or pulpitic teeth were treated. (REC: 08/H0804/79). Following standardized root canal chemo-debridement. The canals were obturated using warm vertical condensation of gutta-percha and epoxy-based sealer (AH plus) or a calcium silicate sealer (BioRoot^TM RCS) with a single cone technique. Follow-up assessment was conducted at 12 months using Cone Beam Computed Tomography (CBCT). Results: At 1-year recall, 104 teeth were assessed (51 AH plus, 53 BioRoot^TM RCS). The success rate using loose criteria for the CBCT images and PA radiographs was respectively 80% and 89% in the AH plus/warm vertical condensation group, 84% and 90% in the BioRoot^TM RCS/single cone group. There was no statistically significant difference between the two groups (Fisher exact test p value 0.6099 for the CBCT images). Conclusion: Within the limitations of this non-randomized trial, a calcium silicate cement in combination with single cone resulted in a similar proportion of successful cases compared to warm vertical condensation and epoxy-based sealer.

The effect of smear layer removal on E. faecalis leakage and bond strength of four resin-based root canal sealers

BACKGROUND

The aim of the study was to assess bacterial sealability and bonding ability of methacrylate-based Resilon (RS, SybronEndo), Endo Rez (ER, Ultradent Products Inc), and epoxy-based AH Plus (AH, Dentsply/DeTrey), MTA Fill Apex (MTAF, Angelus Soluções Odontológicas) root canal sealers, and the effect of the smear layer removal on the sealability.

METHODS

One hundred thirty root segments were instrumented up to apical size #60 and rinsed with 2.5% NaOCl. Half of the roots were rinsed with 5ml 17% EDTA to remove the smear layer. All the roots were filled with AH, ER, MTAF sealers and gutta-percha, or RS with Resilon cones. After storage at 37°C for 7 days the samples were mounted into bacterial leakage assay for 50 days. Another 100 roots were instrumented and rinsed as described above, split longitudinally, cut into the cervical, middle and apical parts. The sealers were injected through the plastic mould on the dentin surface. After 7 days of incubation at 37°C, bond strength was tested using a notched-edge test fixture (Crosshead, Ultradent Products Inc.) and a universal testing machine (Lloyd Instruments).

RESULTS

AH revealed the longest mean time for bacterial resistance by 29.4 and 36.8 days (with and without smear layer, respectively) followed by RS (15.1 and 24.7 days, respectively). The difference between materials was significant (p<0.001). Bond strength values ranged from 0.2± 0.1 to 3.5± 0.7 MPa and increased from the apical to the cervical third. In the apical third, AH showed the highest mean (SD) bond values 1.4 (0.4) MPa and 1.7 (0.6) MPa (with and without smear, respectively, followed by RS, 0.5 (0.1) MPa and 0.8 (0.1) MPa, respectively. The difference between materials was significant (p=0.001).

CONCLUSION

The effect of the smear layer removal on the sealability was material-dependent.

Bacterial leakage and micro-computed tomography evaluation in round-shaped canals obturated with bioceramic cone and sealer using matched single cone technique

OBJECTIVES

To evaluate sealing ability of root canals obturated with bioceramic-impregnated gutta percha cone (BCC) or gutta percha (GP), with bioceramic sealer (BCS) or AH Plus (AH; Dentsply-Maillefer), in roundly-prepared canals using matched single-cone technique, based on bacterial leakage test, and to analyze obturation quality using micro-computed tomography (CT) analysis.

MATERIALS AND METHODS

Ninety-two distobuccal roots of maxillary molars were prepared using nickel-titanium files to apical size 40/0.06. The roots were divided into 4 groups (n = 20) that were obturated with a master cone and sealer: GP/AH, BCC/AH, GP/BCS, and BCC/BCS. Bacterial leakage model using Enterococcus faecalis was used to evaluate sealing ability for 60-day period. Obturated samples from each group (n = 4) were analyzed using micro-CT.

RESULTS

All groups showed bacterial leakage at 20%-45% of samples with mean leakage times of 42-52 days. There were no significant differences in bacterial leakage among the groups. Micro-CT showed minimal gaps and voids in all groups at less than 1%.

CONCLUSIONS

In roundly-prepared canals, the single cone obturation with BCC/BCS was comparable to GP/AH for bacterial leakage at 60 days.

Evaluation of bioceramics and zirconia-reinforced glass ionomer cement in repair of furcation perforations: An in vitro study

Aim:

The aim and objective of this study was to evaluate and compare the sealing ability of EndoSequence BC RRM-fast set putty, Proroot mineral trioxide aggregate (MTA), and Zirconomer in the repair of furcal perforation by measuring dye leakage under stereomicroscope.

Methodology:

A standard access cavity was made on forty-eight extracted mandibular and maxillary first molars followed by creating a furcal perforation in the center of the pulp chamber by using No. 4 round bur (creating a perforation of 2 mm diameter). Teeth were categorized into 4 groups containing 12 samples in each group based on material used for furcation repair. Group 1 – Endosequence BC RRM-fast set putty; Group 2 – Zirconomer; Group 3-MTA (positive control); Group 4 – negative control. All groups were covered with two layers of clear varnish except for 2 mm around the perforation region. All the teeth were immersed in 2% methylene blue dye for 48 h for dye penetration. Teeth were sectioned buccolingually using a diamond disk. The sectioned teeth were examined under stereomicroscope with ×10 magnification for dye penetration.

Results:

Endosequence showed less microleakage than MTA but not statistically significant. Zirconomer showed statistically significant higher microleakage.

Conclusion:

Endosequence and MTA showed less microleakage hence can be used as furcation repair materials. Due to higher microleakage, Zirconomer should be avoided as furcation repair material. Due to its favorable cost, ready availability, and almost similar outcome as bioceramics, MTA is considered as an alternative to Endosequence and is the gold standard in furcation repair.

Novel Calcium Zirconate Silicate Cement Biomineralize and Seal Root Canals

This study evaluated the sealing ability of gutta-percha (GP) with a calcium silicate-based sealer and a novel calcium zirconate containing calcium silicate cement (ZC). The root canals of the extracted premolars were prepared, which were then randomly allocated to three experimental groups (12 root canals per group) for obturation by continuous wave of condensation with the GP and AH 26 sealer (CW); obturation using a single GP with a calcium silicate-based EndoSequence BC sealer (SC); or obturation with ZC. The roots were inserted into sterile Eppendorf tubes, which were inoculated coronally with Porphyromonas gingivalis. The amount of endotoxin leakage into the apical reservoirs were measured using the Limulus Amebocyte Lysate (LAL) assay over 21 days, with comparisons made using one-way ANOVA and Scheffe’s tests (α = 0.05). After 21 days, 75% of the canals that had been obturated by SC, 50% of those obturated by CW and 42% of those obturated by ZC showed endotoxin leakage. The amount of leakage was higher in the SC canals than in the CW (p = 0.031) or ZC (p = 0.03) canals, although there was no significant difference in the amount of leakage for CW and ZC (p > 0.05). X-ray diffraction revealed the presence of tricalcium silicate (Ca₃SiO₅) and calcium zirconate (CaZrO₃) in the synthesized ZC. Scanning electron microscopy revealed mineralized precipitates on the dentin of canals obturated by ZC. The novel calcium zirconate silicate cement appears to promote biomineralization and seal root canals at least as effectively as the conventional sealer.

Adaptation of mineral trioxide aggregate to dentine walls compared with other root-end filling materials: A systematic review

This systematic review analysed the literature comparing marginal adaptation of mineral trioxide aggregate (MTA) with other filling materials in root-end cavities. The PubMed, Ovid, Web of Science, SCOPUS, and Cochrane library databases were searched using appropriate keywords related to root-end filling materials and adaptation. Of 38 articles assessed, 20 met the inclusion criteria. No in vivo study was identified. In 10 studies, MTA gave the best marginal adaptation results, but no significant differences were found between MTA and any of the tested filling materials in seven studies. There was great variability in the study designs including analysed surface, unit of gap measurement and magnification amount during analysis. On the basis of available evidence, MTA presented good marginal adaptation to dentine walls. This review identified the need for the development of standardised methods to evaluate the adaptation property of root-end filling materials in ex vivo studies as well as in clinical studies evaluating outcome.

Porosity analysis of mineral trioxide aggregate Fillapex and BioRoot cements for use in endodontics using microcomputed tomography

Aim:

The purpose of this study is to compare the porosity of two sealant cements, mineral trioxide aggregate (MTA) Fillapex^® and BioRoot^® root canal sealer (RCS). These samples were analyzed using microcomputed tomography.

Materials and Methods:

Sixteen samples were used in the study that were divided according to the composition of the materials used. MTA Fillapex^® (n = 8) and BioRoot^® RCS (n = 8) were the samples prepared according to the manufacturer's instructions. They were placed in silicone molds of 5 ± 0.1 mm in height and an internal diameter of 5 ± 0.1 mm; 24 h after its preparation, the samples were scanned through a microcomputed tomography, and the porosity results were analyzed statistically by independent t-tests.

Results:

It is evident that MTA Fillapex^® has better porosity properties than BioRoot^® RCS. The results of the study quantify a smaller number of pores per surface, a smaller volume in each pore per mm³, and a lower total porosity present in samples of MTA Fillapex^® unlike BioRoot^® RCS samples which is larger in both.

Conclusions:

The results obtained in computerized microtomography endodontic biomaterial samples concluded that MTA Fillapex^® has a lower porosity than BioRoot^® RCS.

Influence of the internal anatomy on the leakage of root canals filled with thermoplastic technique

OBJECTIVES

The aim of this paper is to evaluate the influence of the internal anatomy on the leakage of root canals filled with the thermoplastic technique.

MATERIALS AND METHODS

The upper central incisors (UCI) and mesial roots of the lower molars (MRLM) (n = 12 each) were tested regarding leakage using the gas-enhanced permeation test (GEPT) after root filling. The quality of the root fillings was assessed using micro-computed tomography (μCT) by superimposing scans before and after treatment to calculate unfilled volume. The calculated void volume was compared between the groups and correlated to the measured leakage values. Data were analyzed using t test and Pearson's correlation tests (p < 0.05).

RESULTS

The mean void volume did not differ between UCI and MRLM (13.7 ± 6.2% vs. 14.2 ± 6.8%, respectively). However, significantly more leakage was evident in the MRLM (p < 0.001). While the leakage correlated highly to the void volume in the MRLM group (R ² = 0.981, p < 0.001), no correlation was found in UCI (R ² = 0.467, p = 0.126).

CONCLUSION

MRLM showed higher leakage values, which correlated to the void volume in the root canal fillings.

CLINICAL RELEVANCE

Care should always be taken while doing root canal treatments, but attention to teeth with known/expected complex root canal anatomy should be considered.

Micro-CT assessment of the sealing ability of three root canal filling techniques

This study used micro-CT to compare three obturation techniques with respect to void occurrence in canals filled with bioceramic sealer. Thirty extracted first mandibular premolars were prepared with a ProTaper Universal system and randomly allocated to three groups. Canals were obturated with gutta-percha and bioceramic root canal sealer, using either single-cone, lateral compaction, or Thermafil filling technique. Each tooth was then scanned with micro-CT. Voids in 2D cross-sectional images and void volumes in 3D images of all root thirds were assessed in relation to obturation technique. There was no significant difference between obturation techniques in the proportion of sections with voids (P > 0.05). However, the results of the obturation techniques significantly differed in relation to root region (P < 0.05). In conclusion, no root filling technique resulted in void-free specimens. Void volumes were highest for the single-cone technique and lowest for Thermafil, in all regions (P < 0.05).

Sealing efficacy of mineral trioxide aggregate with and without nanosilver for root end filling: An in vitro bacterial leakage study

BACKGROUND

Various materials have been added to mineral trioxide aggregate to enhance its properties. This study was aimed to compare the sealing efficacy of MTA with and without nanosilver using bacterial leakage approach.

MATERIAL AND METHODS

Seventy canine teeth were prepared and obturated. Then, after apical resection, the root-end cavities were prepared by ultrasonic retrotips. Teeth were randomly divided into 4 groups containing two experimental groups (n=30) and two negative and positive controls (n=5). In group 1 and 2, root-end cavities were respectively filled with MTA and MTA with nanosilver (by 1% weight). Leakage assessment was carried out by bacterial leakage apparatus with Enterococcus faecalis species. Leakage comparison between experimental groups was done using Mann-Whitney test by Spss 16 software at significancy level of 0.05.

RESULTS

The median bacterial leakages for MTA and MTA with nanosilver were 19 and 2, respectively. The mean bacterial leakages for MTA and MTA with nanosilver were 30.06±28.67 and 9.66±14.25, respectively. Mann-Whitney test indicated that there was a significant difference in bacterial leakage day between two experimental groups (P=0.002).

CONCLUSIONS

Based on the findings of this in-vitro bacterial leakage study, adding nanosilver to MTA decreased its sealing ability. Key words:Root canal therapy, root canal obturation, root canal filling materials, nanosilver, MTA.

Solubility and bacterial sealing ability of MTA and root-end filling materials

Objective

To evaluate solubility and sealing ability of Mineral Trioxide Aggregate (MTA) and root-end filling materials.

Material and Methods

The materials evaluated were: MTA, Calcium Silicate Cement with zirconium oxide (CSC/ZrO₂), and zinc oxide/eugenol (ZOE). Solubility test was performed according to ANSI/ADA. The difference between initial and final mass of the materials was analyzed after immersion in distilled water for 7 and 30 days. Retrograde cavities in human teeth with single straight root canal were performed by using ultrasonic tip CVD 9.5107-8. The cavities were filled with the evaluated materials to evaluate sealing ability using the bacterial leakage test with Enterococcus faecalis. Bacterial leakage was evaluated every 24 hours for six weeks observing the turbidity of Brain Heart infusion (BHI) medium in contact with root apex. Data were submitted to ANOVA followed by Tukey tests (solubility), and Kruskal-Wallis and Dunn tests (sealing ability) at a 5% significance level.

Results

For the 7-day period, ZOE presented highest solubility when compared with the other groups (p<0.05). For the 30-day period, no difference was observed among the materials. Lower bacterial leakage was observed for MTA and CSC/ZrO₂, and both presented better results than ZOE (p<0.05).

Conclusion

MTA and CSC/ZrO₂ presented better bacterial sealing capacity, which may be related to lower initial solubility observed for these materials in relation to ZOE.