Long-term sealing ability of Resilon apical root-end fillings

Application of Nanomaterials in Endodontics

Recent advancements in nanotechnology have introduced a myriad of potential applications in dentistry, with nanomaterials playing an increasing role in endodontics. These nanomaterials exhibit distinctive mechanical and chemical properties, rendering them suitable for various dental applications in endodontics, including obturating materials, sealers, retro-filling agents, and root-repair materials. Certain nanomaterials demonstrate versatile functionalities in endodontics, such as antimicrobial properties that bolster the eradication of bacteria within root canals during endodontic procedures. Moreover, they offer promise in drug delivery, facilitating targeted and controlled release of therapeutic agents to enhance tissue regeneration and repair, which can be used for endodontic tissue repair or regeneration. This review outlines the diverse applications of nanomaterials in endodontics, encompassing endodontic medicaments, irrigants, obturating materials, sealers, retro-filling agents, root-repair materials, as well as pulpal repair and regeneration. The integration of nanomaterials into endodontics stands poised to revolutionize treatment methodologies, presenting substantial potential advancements in the field. Our review aims to provide guidance for the effective translation of nanotechnologies into endodontic practice, serving as an invaluable resource for researchers, clinicians, and professionals in the fields of materials science and dentistry.

What Are the Chances of Resilon to Dominate the Market Filling Materials for Endodontics?

This paper is a literature review with additional virtual analyses of the authors’ own experimental research results. Knowledge from various areas was synergistically combined, appropriately for concurrent engineering, presenting several possible methodological approaches used in research, optimizing the selection of engineering materials and the conditions of their application with particular application in endodontics. Particular attention was paid to the theoretical aspects of filling material strengths, weaknesses, opportunities, and threats SWOT analysis. Attention was paid to the original concepts of Sustainable Dentistry Development in conjunction with Dentistry 4.0, which includes endodontics as an important element. The dentists’ actions, among others, in conservative dentistry, along with endodontics, requires close cooperation with engineers and the enginering sciences. Methods of root canal preparation were described, together with selected tools, including those made of nitinol. Principles concerning the process of cleaning and shaping the pulp complex are presented. The importance of obturation methods, including the Thermo-Hydraulic-Condensation THC technique, and the selection of filling materials with the necessary sealants for the success of endodontic treatment are discussed. The experimental studies were carried out in vitro on human teeth removed for medical reasons, except for caries, for which two groups of 16 teeth were separated. After the root canal was prepared, it was filled with studs and pellets of a filling material based on polyester materials, which has gained the common trade name of resilon or, less frequently, RealSeal (SybronEndo) with an epiphany sealant. The teeth for the first group were obturated by cold lateral condensation. In the second case the obturation was performed using the Thermo-Hydraulic-Condensation technique using System B and Obtura III. The experimental leakage testing was done using a scanning electron microscope SEM and a light stereoscopic microscope LSM, as typical research tools used in materialography. The research results, in a confrontation with the data taken from the literature studies, do not indicate the domination of resilon in endodontics.

Is Gutta-Percha Still the “Gold Standard” among Filling Materials in Endodontic Treatment?

The paper is an extensive monographic review of the literature, and also uses the results of the authors’ own experimental research illustrating the noticed developmental tendencies of the filling material based on gutta-percha. The whole body of literature proves the correctness of the research thesis that this material is the best currently that can be used in endodontics. Caries is one of the most common global infectious diseases. Since the dawn of humankind, the consequence of the disease has been the loss of dentition over time through dental extractions. Both tooth caries and tooth loss cause numerous complications and systemic diseases, which have a serious impact on insurance systems and on the well-being, quality, and length of human life. Endodontic treatment, which has been developing since 1836, is an alternative to tooth extraction. Based on an extensive literature review, the methodology of qualifying patients for endodontic treatment was analyzed. The importance of selecting filling material and techniques for the development and obturation of the root canal during endodontic treatment was described. Particular attention was paid to the materials science aspects and the sequence of phase transformations and precipitation processes, as well as the need to ensure the stoichiometric chemical composition of Ni–Ti alloys, and the vacuum metallurgical processes and material processing technologies for the effects of shape memory and superelasticity, which determine the suitability of tools made of this alloy for endodontic purposes. The phenomena accompanying the sterilization of such tools, limiting the relatively small number of times of their use, play an important role. The methods of root canal preparation and obturation methods through cold side condensation and thermoplastic methods, including the most modern of them, the thermo-hydraulic condensation (THC) technique, were analyzed. An important element of the research hypothesis was to prove the assumption that to optimize the technology of development and obturation of root canals, tests of filling effectiveness are identified by the density and size of the gaps between the root canal wall, and the filling methods used and devices appropriate for material research, using mainly microscopy such as light stereoscopic (LSM) and scanning electron (SEM). The most beneficial preparations were obtained by making a longitudinal breakthrough of 48 natural human teeth, extracted for medical reasons, different from caries, with compliance with all ethical principles in this field. The teeth were prepared using various methods and filled with multiple obturation techniques, using a virtual selection of experimental variants. The breakthroughs were made in liquid nitrogen after a one-sided incision with a narrow gap created by a diamond disc using a materialographic cutter. The best effectiveness of the root canal filling was ensured by the technology of preparing the root canals with K3 rotary nitinol tools and filling the teeth with the THC thermoplastic method using the System B and Obtura III devices with studs and pellets of filling material based on gutta-percha after covering the root canal walls with a thin layer of AH Plus sealant. In this way, the research thesis was confirmed.

Virtual Approach to the Comparative Analysis of Biomaterials Used in Endodontic Treatment

The importance of endodontics is presented within our own concept of Dentistry Sustainable Development (DSD) consisting of three inseparable elements; i.e., Advanced Interventionist Dentistry 4.0 (AID 4.0), Global Dental Prevention (GDP), and the Dentistry Safety System (DSS) as a polemic, with the hypothesis of the need to abandon interventionist dentistry in favour of the domination of dental prevention. In view of the numerous systemic complications of caries that affect 3−5 billion people globally, endodontic treatment effectively counteracts them. Regardless of this, the prevention of oral diseases should be developed very widely, and in many countries dental care should reach the poorest sections of society. The materials and methods of clinical management in endodontic procedures are characterized. The progress in the field of filling materials and techniques for the development and obturation of root canals is presented. The endodontics market is forecast to reach USD 2.1 billion in 2026, with a CAGR of 4.1%. The most widely used and recognized material for filling root canals is gutta-percha, recognized as the “gold standard”. An alternative is a synthetic thermoplastic filler material based on polyester materials, known mainly under the trade name Resilon. There are still sceptical opinions about the need to replace gutta-percha with this synthetic material, and many dentists still believe that this material cannot compete with gutta-percha. The results of studies carried out so far do not allow for the formulation of a substantively and ethically unambiguous view that gutta-percha should be replaced with another material. There is still insufficient clinical evidence to formulate firm opinions in this regard. In essence, materials and technologies used in endodontics do not differ from other groups of materials, which justifies using material engineering methodology for their research. Therefore, a detailed methodological approach is presented to objectify the assessment of endodontic treatment. Theoretical analysis was carried out using the methods of procedural benchmarking and comparative analysis with the use of contextual matrices to virtually optimize the selection of materials, techniques for the development and obturation of root canals, and methods for assessing the effectiveness of filling, which methods are usually used, e.g., in management science, and especially in foresight research as part of knowledge management. The results of these analyses are presented in the form of appropriate context matrices. The full usefulness of the research on the effectiveness and tightness of root canal filling using scanning electron microscopy is indicated. The analysis results are a practical application of the so-called “digital twins” approach concerning the virtual comparative analysis of biomaterials used in endodontic treatment.

Influence of a calcium hydroxide-based intracanal dressing on the quality of the root canal filling assessed by capillary flow porometry

OBJECTIVE

The objective of this study is to evaluate the influence of a calcium hydroxide intracanal dressing (CH) on the short- and long-term sealing ability of the root canal filling using capillary flow porometry (CFP).

MATERIALS AND METHODS

To verify the repeatability of the method, five obturated specimens were submitted to CFP. Measurements were repeated three times and compared with the non-parametric Friedman test. Forty-five instrumented palatal roots were randomly divided into three groups. Group 1: specimens were obturated in one step without placement of any dressing. Group 2: CH was placed and removed after 1 week with syringe irrigation before obturation. Group 3: CH was placed and removed after 1 week with ultrasonic activation before obturation. CFP measurements were conducted at 1 week and 6 months after obturation. The inter-group comparisons were performed using the Kruskal-Wallis test and the intra-group comparison over time using the Wilcoxon signed-rank test. Significance level was set at 0.05.

RESULTS

In the five specimens, no difference could be detected between the consecutive measurements for minimum, mean flow, and maximum pore diameter indicating repeatability of the method. No difference in sealing ability could be detected neither between the 3 groups at 1 week and at 6 months nor within each group between the 1 week and the 6 months measurements.

CONCLUSIONS

Placement of a CH did not affect significantly the short- and long-term sealing ability of the root canal filling.

CLINICAL RELEVANCE

The use of an intermediary CH does not negatively influence the quality of the root canal filling.

Influence of Post Space Preparation on the Apical Leakage of Calamus, Single-Cone and Cold Lateral Condensation Obturation Techniques: A Computerized Fluid Filtration Study

PURPOSE

Apical microleakage between the root canal and periapical tissues is considered a common cause of endodontic failure. The aim of this study was to evaluate the apical microleakage of various obturation techniques after immediate post space preparations with different drills.

MATERIALS AND METHODS

One hundred twenty human single-rooted teeth were selected for this study. The coronal portions were removed to achieve a uniform length of 15 mm. All root canals were instrumented with ProTaper Next rotary files using crown-down technique. The 120 roots were randomly assigned to 3 experimental groups according to obturation technique (n = 40). The root canals were obturated with lateral condensation in group 1, single-cone technique in group 2, and Calamus 3D obturation system in group 3. Each group was divided into two subgroups (n = 20) according to drill types (Gates Glidden and Peeso drills) leaving 5 mm of apical gutta-percha. The apical microleakage was measured using the computerized fluid filtration meter method. The results were evaluated using Kruskal-Wallis test with Bonferroni Corrected Mann-Whitney U multiple comparison post hoc tests.

RESULTS

There was no statistically significant difference between obturation techniques after post space preparation with Peeso drills (p > 0.05). In Gates Glidden drill groups, single-cone technique demonstrated higher leakage (0.0051 ± 0.0037 μl x min^-1 × cmH₂ O^-1 ) than Calamus techniques (0.0019 ± 0.0012 μl x min^-1 × cmH₂ O^-1 ) (p < 0.017).

CONCLUSIONS

Gates Glidden drills caused the highest apical leakage in teeth obturated with single-cone technique.

An in-vitro comparative study for assessment of apical sealing ability of Epiphany/AH Plus sealer with Resilon/gutta-percha root canal filling materials

AIMS AND OBJECTIVES

Endodontic treatment is directed to eliminate microbial challenges from the root canal system and to create a complete seal. The aim of this study was to assess the apical sealing ability of resin-based Epiphany-Resilon root canal filling system and to compare it with the sealing abilities of different combinations of AH Plus, gutta-percha, Epiphany, and Resilon.

MATERIALS AND METHODS

One hundred extracted human maxillary incisor roots were treated endodontically. The samples were divided into groups A, B, C, and D, with each group containing 25 samples. Group A: Canals obturated with gutta-percha and AH Plus sealer; Group B: Canals obturated with Resilon and Epiphany; Group C: Canals obturated with gutta-percha and Epiphany; Group D: Control group canals obturated with gutta-percha without a sealer. The sealing ability of each of the obturation techniques was tested using the dye penetration method followed by the clearing method using alcohol. Stereo microscope was used to measure the extent of dye penetration. Statistical data analysis was performed using analysis of variance and Tukey tests.

RESULTS

Microleakage was found in all the four groups. Apical extent of mean microleakage was maximum for gutta-percha, followed by Gutta-percha + AH-plus and Gutta-percha + Epiphany, and the least with Resilon + Epiphany. Statistically significant difference (P < 0.01) was seen in the apical leakage.

CONCLUSION

All the samples tested showed microleakage. The "Epiphany soft resin endodontic obturation system" showed a superior result compared to other obturation materials.

Resilon: a comprehensive literature review

Background and aims. An ideal root canal filling material should completely seal the entire root canal space and block communication between the root canal system and its surrounding tissues; it should also be nontoxic, noncarcinogenic, non-genotoxic, biocompatible, insoluble in tissue fluids and dimensionally stable. Bonding to dentin is a promising property, which can prevent leakage and improve the sealing ability of root canal filling materials. Resilon was developed and rec-ommended initially because the existing rootcanal filling materials did not bond to root canal dentin. Since its introduction in 2004, numerous reports have been published regarding various aspects of this material. The aim of this literature review is to present investigations regarding Resilon's physical and chemical properties and leakage studies. Materials and methods. A review of the literature was performed by using electronic and hand searching methods for Resilon from May 2004 to April 2012. Results. There are many published reports regarding Resilon. The searchshowed that Resilon is composed of a parent polymer, polycaprolactone or Tone, which is a biodegradable aliphatic polyester, with filler particles consisting of bioactive glass, bismuth oxychloride and barium sulfate. It possesses some antibacterial and antifungal properties. It is a promising material for root canal filling. Despite the presence of numerous case reports and case series regarding these applications, there are few designed research studies on clinical applications of this material. Resilon has some drawbacks such as high cost. Conclusion. Resilon seals well and is a biocompatible material. However, more clinical studies are needed to confirm its efficacy compared with other materials.