Presence of pores and vacuoles in set endodontic sealers

Analysis of porosity, sealer dissolution and apical extrusion of endodontic sealers: A micro computed tomography study

Aim

The aim of the study was to determine the porosity, dissolution and apical extrusion of AH Plus, MTA Fillapex and EndoSequence BC sealer after immersion in phosphate buffered saline (PBS) using microcomputed tomography (micro-CT).

Methodology

Forty-eight single-rooted teeth were selected. Gutta percha and one of the aforementioned root canal sealers was used for obturation using continuous wave technique. The specimens were scanned after obturation and after seven days of immersion in PBS, by using micro-computed tomography. Porosity, sealer dissolution and apical extrusion were calculated. Statistical analysis was done by using paired t-test, post hoc tukey test and Fischer exact test.

Results

Significantly higher percentage of porosity and dissolution of sealer in the apical 4 mm was found for MTA Fillapex and EndoSequence BC sealer than for AH Plus. The incidence of apical extrusion was significantly more in MTA Fillapex (56.25%), followed by EndoSequence BC (31.25%) and AH Plus (0%).

Conclusions

None of the three root canal sealers exhibited perfect three-dimensional obturation. The sealers manifested porosity, dissolution and apical extrusion to varying degrees both after obturation and after storage in PBS for 7 days.

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.

An Updated Review on Properties and Indications of Calcium Silicate-Based Cements in Endodontic Therapy

Regarding the common use of calcium silicate cements (CSCs) in root canal therapy, their position in the context of past and present dentistry agents can provide a better understanding of these materials for their further improvement. In this context, the present review article addresses a wide range of recent investigations in the field of CSC-based products and describes details of their composition, properties, and clinical applications. The need for maintaining or reconstructing tooth structure has increased in contemporary endodontic treatment approaches. This research thus discusses the attempts to create comprehensive data collection regarding calcium ion release, bond strength, alkalinizing activity and bioactivity, and the ability to stimulate the formation of hydroxyapatite as a bioactive feature of CSCs. Sealing ability is also highlighted as a predictor for apical and coronal microleakage which is crucial for the long-term prognosis of root canal treatment integrity. Other claimed properties such as radiopacity, porosity, and solubility are also investigated. Extended setting time is also mentioned as a well-known drawback of CSCs. Then, clinical applications of CSCs in vital pulp therapies such as pulpotomy, apexification, and direct pulp capping are reviewed. CSCs have shown their benefits in root perforation treatments and also as root canal sealers and end-filling materials. Nowadays, conventional endodontic treatments are replaced by regenerative therapies to save more dynamic and reliable hard and soft tissues. CSCs play a crucial role in this modern approach. This review article is an attempt to summarize the latest studies on the clinical properties of CSCs to shed light on the future generation of treatments.

Volumetric Evaluation of Voids and Gaps of Different Calcium-Silicate Based Materials Used in Furcal Perforations: A Micro-CT Study

This study aimed at evaluating volumetrically gaps and voids of calcium-silicate based materials of different generations and handling properties (BC—Endosequence BC RRM-Fast Set Condensable Putty, MTA—ProRoot MTA, and BIO—Biodentine) in simulated furcal perforations in an ex vivo setup by microcomputed tomography (Micro-CT) analysis. Thirty-six extracted human mandibular molars with sound furcation areas were selected. Standardized perforations were created in the furcation area of the pulp chamber using #4 diamond burs. The specimens were randomly assigned to three groups (BC, MTA and BIO; n = 12). Samples were then scanned (SkyScan 1172; Bruker-microCT, Kontich, Belgium), and three-dimensional (3D) images reconstructed. The relative volume of gaps (VG%) and voids (VV%) present on each material was calculated. Data were analyzed using one-way analysis of variance (ANOVA) and Tukey’s HSD test (p < 0.05). Mean VG% for BC, MTA, and BIO groups were, respectively, 0.513%, 1.128%, 1.460%, with BC presenting statistically (p < 0.05) fewer gaps formation than the other groups. Mean VV% were, respectively, 0.018%, 0.037%, and 0.065%. The was no statistical difference regarding VV%. There were no gap-free and void-free samples. BC group had the lowest VG% among the groups with a significant statistical difference (p < 0.05).

Tannic acid speeds up the setting of mineral trioxide aggregate cements and improves its surface and bulk properties

HYPOTHESIS

The setting time and mechanical properties of cements are a major technical concern for a long time in civil engineering. More recently those practical problems became a major concern for biomedical applications -in bone surgery and in dentistry- in particular concerning the setting time which should be minimized. The possibility to add organic additives to interact with the different constituting ions in cements constitutes a way to modify the setting kinetics. We made the assumption that a hydrolysable polyphenol like tannic acid could modify the setting time and the physical properties of Mineral Trioxide Aggregate (MTA).

EXPERIMENTS

Tannic acid is added in variable proportions to the water used to set MTA. The formation of the hybrid organic-mineral cements is investigated using a combination of structural, chemical and mechanical methods. X-ray tomography was also used to investigate the changes in porosity and pore size distribution upon incorporation of tannic acid in MTA based cements. The hydrophilicity of the cements was evaluated by measuring the permeation kinetics of small water droplets.

FINDINGS

We found that tannic acid allowed to reduce markedly the setting time of MTA based cements. The obtained cements have an increased hydrophilicity and display excellent resistance to compression. The number of pores but not the average pore size is also affected. The possible roles of tannic acid in modifying the cement properties are discussed.

Solubility, Porosity, Dimensional and Volumetric Change of Endodontic Sealers

The aim of this study was to evaluate physical properties of endodontic sealers (AH Plus, MTA Fillapex and Endofill), by conventional and micro-CT tests. Dimensional stability was evaluated after immersion of materials in distilled water for 30 days. Solubility and volumetric change were evaluated after 7 and 30 days of immersion in distilled water. Solubility was evaluated by means of mass loss and volumetric change was assessed by micro-CT. Porosity was evaluated under a microscope after 7 days of immersion in distilled water, and by using micro-CT after setting and immersion in distilled water for 7 and 30 days. Statistical analysis was performed by ANOVA and Tukey's test with 5% significance level. MTA Fillapex presented the highest solubility (p<0.05), showing values above the ISO/ADA recommendations. MTA Fillapex presented higher volumetric and dimensional changes, followed by Endofill and AH Plus (p<0.05). Dimensional stability of the MTA Fillapex and AH Plus did not follow ISO/ADA standards. The highest total porosity was observed for MTA Fillapex (p<0.05). Endofill had higher total porosity than AH Plus according to microscope evaluation (p<0,05), and both sealers were similar in micro-CT assessment (p>0,05). In conclusion, MTA Fillapex presented higher solubility, dimensional and volumetric change besides porosity compared to the other evaluated sealers. The assessed physical properties of sealers are related, and the different tests provided complementary data. Micro-CT is a valuable method for assessment of physical properties of endodontic materials.

Solubility, porosity and fluid uptake of calcium silicate-based cements

Objective:

To evaluate the absorption/fluid uptake, solubility and porosity of White mineral trioxide aggregate (MTA) Angelus, Biodentine (BIO), and zinc oxide-eugenol (ZOE).

Material and Methods:

Solubility was evaluated after immersion in distilled water for 7 and 30 days. Porosity was evaluated using digital inverted microscope, scanning electron microscope (SEM) and micro-computed tomography (micro-CT). For the fluid uptake test, specimens were immersed in Hank's balanced salt solution (HBSS) for 1, 7, 14 and 28 days. Fluid absorption, solubility and porosity of the materials were measured after each period. Statistical evaluation was performed using one-way analysis of variance (ANOVA) and Tukey tests, with a significance level at 5%.

Results:

After 7 and 30 days, BIO showed the highest solubility (p<0.05). All methods demonstrated that MTA had total porosity higher than BIO and ZOE (p<0.05). Micro-CT analysis showed that MTA had the highest porosity at the initial period, after its setting time (p<0.05). After 7 and 30 days, ZOE had porosity lower than MTA and BIO (p<0.05). Absorption was similar among the materials (p>0.05), and higher fluid uptake and solubility were observed for MTA in the fluid uptake test (p<0.05).

Conclusions:

BIO had the highest solubility in the conventional test and MTA had higher porosity and fluid uptake. ZOE had lower values of solubility, porosity and fluid uptake. Solubility, porosity and fluid uptake are related, and the tests used provided complementary data.

Porosity analysis of MTA and Biodentine cements for use in endodontics by using micro-computed tomography

Background

The purpose of this study is to compare the porosity of two repair cements, White ProRoot® MTA and Biodentine®. These samples were analyzed by using micro-computed microtomography.

Material and Methods

Sixteen samples were used in the study that were divided according to the composition of the materials used. White ProRoot® MTA (n = 8) and Biodentine® (n = 8) were the samples prepared according to the manufacturer’s instructions. They were placed in silicone molds of 5 ± 0.1mm in height and an internal diameter of 5 ± 0.1mm, 24 hours after its preparation, the samples were scanned through a micro-CT, the porosity results were analyzed statistically by independent “t” tests.

Results

It is evident that Biodentine® has better porosity properties than ProRoot® MTA. 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 Biodentine® unlike ProRoot® MTA samples which is larger in both.

Conclusions

The results obtained in computerized microtomography endodontic biomaterial samples concluded that Biodentine® has a lower porosity than ProRoot® MTA.

Key words:Porosity, microleakage, micro-CT, endodontic cements.

Analysis of the porosity of endodontic sealers through micro-computed tomography: A systematic review

Endodontic treatments have as their objective the appropriate sealing of the space caused by the root canal, providing a complete seal of the canal in all dimensions, creating an airtight seal against fluids. Thus, endodontic cements must possess physical properties such as solubility and long-term dimensional stability. An electronic search in the main endodontic magazines using appropriate keywords to identify studies that investigated the porosity of endodontic materials using micro-computed tomography. Of the 125 studies researched, 16 fulfilled the criteria for inclusion. Four studies analyzed the porosity of endodontic cements specifically. Twelve studies investigated and compared different techniques of root canal obturation and the repercussions from the lowering of porosity in the interior of the endodontic cement. The presence of porosity inside the endodontic cement is a constant in the treatments of root canals, even now when there is a great variety of endodontic cements.

Micro-CT analysis of filling ability and porosity of root-end filling materials

Abstract Introduction Filling ability of retrograde cavity and porosity are important properties for root-end filling materials and may be evaluated by using microcomputed tomography (micro-CT). Objective To evaluate filling ability and porosity of root-end filling materials using microcomputed tomography (micro-CT). Material and method Cavities with 1 mm internal diameter and 3 mm depth were prepared in bovine dentin sections by using ultrasonic tips (CVD No. 6.1107-6), and filled by Mineral Trioxide Aggregate (MTA); Sealer 26 (S26) and zinc oxide and eugenol cement (ZOE). Before and after filling, cavities were scanned by using micro-CT (SkyScan 1176). Filling and porosity were analyzed by using CTAn software. Filling ability was calculated based on volumetric percentage of the filled cavity. The number and percentage of closed pores were measured throughout entire extension of the filled cavity (total) and in each third (cervical, middle and apical), by using bi and tridimensional analyses. The filling data were submitted to ANOVA and Tukey statistical tests, and porosity data to Kruskall-Wallis and Dunn tests, at a 5% significance level. Result S26 and ZOE presented higher filling ability than MTA (p<0.05). S26 showed the highest total porosity (number and percentage) (p<0.05). In all thirds after 2D and 3D analyses, porosity was higher for S26 in comparison to MTA and ZOE (p<0.05). Conclusion Although Sealer 26 presented more porosity, the material was associated with a great filling ability. Micro-CT analysis showed no correlation between filling ability and porosity.

Sealer penetration and adaptation in root canals with the butterfly effect

The butterfly effect is a phenomenon seen in some roots and is related to density of dentinal tubules. The aim was to investigate penetration depth and adaptation quality of root canal sealers and ProRoot MTA into bucco-lingual and mesio-distal aspects of roots with and without the effect. One hundred and twenty teeth were decoronated at the cemento-enamel junction. Canals were prepared and assigned to obturation groups: gutta-percha with a sealer (AH Plus, EndoREZ, Kerr Pulp Canal Sealer, MTA Fillapex) or ProRoot MTA alone (each containing 10 butterfly and 10 non-butterfly roots). Root sectioning yielded coronal and middle samples. Confocal laser scanning and scanning electron microscopy were used to assess penetration and adaptation. Teeth with the effect had greater mean penetration bucco-lingually (766 μm) than mesio-distally (184 μm, P = 0.003). Coronal sections had greater penetration (430 μm) compared with middle (247 μm, P = 0.006). In conclusion, greater penetration in roots with the effect may improve treatment outcomes.

Three-dimensional Quantitative Porosity Characterization of Syringe- versus Hand-mixed Set Epoxy Resin Root Canal Sealer

The aim of the present study was to compare the porosity characteristics of AH Plus Jet(tm) syringe-mix and the conventional hand-mixed AH Plus root canal sealers by three-dimensional quantitative high-resolution micro-computed tomography (micro-CT). Seven test specimens were prepared from each tested sealer by a single operator following the manufacturer's instructions and poured into pre-lubricated plastic split-ring moulds. Set sealer test specimens were scanned using a micro-CT device and the shadow images were reconstructed into cross-sectional slices. The evaluated parameters were (i) total pore count, (ii) total pore volume and mean pore volume, (iii) total porosity (% of pore volume in relation to total sealer volume) and (iv) mean pore distance to the sealer lateral external surface. In both groups, most pores were localized within the external sealer perimeter (0.05 mm from the external surface). Hand-mixed AH Plus specimens showed statistically significant higher mean total pore count, total pore volume and total porosity (p=0.001) than the syringe-mixed specimens. However, mean pore sizes in AH Plus syringe-mixed specimens were significantly higher (p=0.046) than the AH Plus hand-mixed counterparts. Hand-mixed AH Plus was associated with higher total mean pore count, volume and total porosity compared to syringe mixed AH Plus.

Light transmittance of zirconia as a function of thickness and microhardness of resin cements under different thicknesses of zirconia

OBJECTIVE

The objective of this study was to compare microhardness of resin cements under different thicknesses of zirconia and the light transmittance of zirconia as a function of thickness.

STUDY DESIGN

A total of 126 disc-shaped specimens (2 mm in height and 5 mm in diameter) were prepared from dual-cured resin cements (RelyX Unicem, Panavia F and Clearfil SA cement). Photoactivation was performed by using quartz tungsten halogen and light emitting diode light curing units under different thicknesses of zirconia. Then the specimens (n=7/per group) were stored in dry conditions in total dark at 37°C for 24 h. The Vicker's hardness test was performed on the resin cement layer with a microhardness tester. Statistical significance was determined using multifactorial analysis of variance (ANOVA) (alpha=.05). Light transmittance of different thicknesses of zirconia (0.3, 0.5 and 0.8 mm) was measured using a hand-held radiometer (Demetron, Kerr). Data were analyzed using one-way ANOVA test (alpha=.05).

RESULTS

ANOVA revealed that resin cement and light curing unit had significant effects on microhardness (p < 0.001). Additionally, greater zirconia thickness resulted in lower transmittance. There was no correlation between the amount of light transmitted and microhardness of dual-cured resin cements (r = 0.073, p = 0.295).

CONCLUSION

Although different zirconia thicknesses might result in insufficient light transmission, dual-cured resin cements under zirconia restorations could have adequate microhardness.

Towards antibacterial endodontic sealers using quaternary ammonium nanoparticles

AIM

To change and characterize the antibacterial properties of endodontic sealers by incorporating low concentrations of insoluble antibacterial nanoparticles (IABN).

METHODOLOGY

The antibacterial effect against Enterococcus faecalis was evaluated by (i) agar diffusion test (ADT), (ii) direct contact test (DCT) and (iii) scanning electron microscopy (SEM). IABN were incorporated into AH Plus (Dentsply, DeTrey Konstanz, Germany) and GuttaFlow (Coltène Whaledent, Langenau, Germany) at concentrations of 0.5%, 1% or 2% weight/weight. Bacterial growth rates were analysed using ANOVA followed by Tukey's test.

RESULTS

The antibacterial tests demonstrated total bacterial growth inhibition using AH Plus samples incorporating 2% weight/weight IABN after 4 weeks (P < 0.005). DCT showed total growth inhibition of up to 6 logs in viable count in AH Plus samples incorporating IABN and up to 4 log in count in GuttaFlow incorporating IABN (P < 0.005). Significant differences were found between the unmodified sealers and the experimental groups. No antibacterial effect was observed in the ADT, indicating IABN were not diffusing into the agar. Furthermore, SEM indicated bacterial cell wall damage and lysis.

CONCLUSIONS

AH Plus and GuttaFlow incorporating low concentrations of IABN exhibited significant and stable antimicrobial properties.

Effect of different light curing methods on mechanical and physical properties of resin-cements polymerized through ceramic discs

OBJECTIVE

The aim of this study was to compare the polimerization ability of three different light-curing units (quartz tungsten halogen, light-emitting diodes and plasma arc) and their exposure modes (high-intensity and soft-start) by determination of microhardness, water sorption and solubility, and diametral tensile strength of 5 dual-curing resin cements.

MATERIAL AND METHODS

A total of 720 disc-shaped samples (1 mm height and 5 mm diameter) were prepared from different dual-curing resin cements (Duolink, Nexus, Bifix-QM, Panavia F and RelyX Unicem). Photoactivation was performed by using quartz tungsten halogen (high-power and soft-up modes), light-emitting diode (standard and exponential modes) and plasma arc (normal and ramp-curing modes) curing units through ceramic discs. Then the samples (n=8/per group) were stored dry in the dark at 37°C for 24 h. The Vickers hardness test was performed on the resin cement layer with a microhardness tester (Shimadzu HMV). For sorption and solubility tests; the samples were stored in a desiccator at 37°C and weighed to a constant mass. The samples were weighed both before and after being immersed in deionized water for different periods of time (24 h and 7 days) and being desiccated. The diametral tensile strength of the samples was tested in a universal testing machine at a crosshead speed of 0.5 mm/min. Data were analyzed statistically by nonparametric Kruskal Wallis and Mann-Whitney U tests at 5% significance level.

RESULTS

Resin cement and light-curing unit had significant effects (p<0.05) on microhardness, diametral tensile strength, water solubility and sorption. However, no significant differences (p>0.05) were obtained with different modes of LCUs.

CONCLUSION

The study indicates that polymerization of resin cements with different light-curing units may result in various polymer structures, and consequently different mechanical and physical properties.

A laboratory evaluation of the physical and mechanical properties of selected root canal sealers

AIM

To evaluate and compare the porosity, degree of conversion (DC) and hardness of two resin-based sealers; RealSeal and EndoRez, and a silicon-based sealer; GuttaFlow to that of a traditional zinc oxide-based sealer; TubliSeal.

METHODOLOGY

For porosity, four samples from each sealer were prepared and scanned using a SkyScan 1072 Micro-CT. Porosity was then calculated using specialized software. For DC, 10 samples from each sealer were prepared and placed onto a Fourier transform infrared spectroscopy spectrometer. Spectra readings were carried out before and after curing of the sealers, and the DC for each sealer was calculated. For hardness, 10 samples from each sealer were prepared and then tested using a Wallace hardness tester. SPSS software was used for statistical analysis of the data using one-way anova and independent t-tests.

RESULTS

TubliSeal had the highest percentage porosity (3.52%), whilst RealSeal had the lowest percentage porosity (0.41%). Statistically significant differences (P = 0.01) in porosity were present between all groups except between RealSeal and EndoRez groups. RealSeal exhibited a significantly higher DC% than EndoRez (P = 0.01), whereas EndoRez had the highest hardness number [28.54 Vickers hardness number (VHN)] whilst TubliSeal showed the lowest (13.57 VHN). Statistically significant differences in hardness were found between all groups (P = 0.01) except between RealSeal and EndoRez groups.

CONCLUSIONS

Resin-based sealers had less porosity, greater hardness and a high DC.

Initial In Vitro Biological Response to Contemporary Endodontic Sealers

The objective of this study was to evaluate the cytotoxicity of three endodontic sealers (AH Plus/Maillefer-Dentsply, Epiphany/Pentron, GuttaFlow, Coltene-Whaledent). Materials were mixed according to the manufacturer instructions and packed into Teflon molds (10 x 1 mm). For cytotoxicity testing (MTT method), the specimens were placed in contact with cultured cells, then evaluated at two subsequent time points (24 or 72 h). In addition to testing the mixed materials, 5 microl of primer liquid (GuttaFlow and Epiphany) and resin solvents (HEMA, ethanol, sterile water, or acetone) were added directly in culture for 24 and 72 h. The results showed that most materials pose significant cytotoxic risks and that cytotoxicity generally increased with time. At 72 h, GuttaFlow became significantly less toxic than AH Plus, Epiphany sealer, and Resilon. The current results support the need to continue to develop better endodontic sealers that combine the excellent sealing and bonding properties of resins with acceptable biological properties for endodontic applications.