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Zamparini F, Lenzi J, Duncan HF, Spinelli A, Gandolfi MG, Prati C. The efficacy of premixed bioceramic sealers versus standard sealers on root canal treatment outcome, extrusion rate and post-obturation pain: A systematic review and meta-analysis. Int Endod J 2024; 57:1021-1042. [PMID: 38606520 DOI: 10.1111/iej.14069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/03/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Limited evidence is available regarding the superior clinical properties of bioceramic sealers comparted with traditional standard sealers. OBJECTIVES This review aimed to answer the following research questions: 'In healthy patients requiring a root canal treatment (P), what is the efficacy of premixed bioceramic sealers (I) compared with traditional root canal epoxy resin-based sealers (C) in terms of survival, success rates (PICO1) sealer extrusion and resorption (PICO2) post-obturation pain (PICO3) (O)?' METHODS Authors independently searched three electronic databases: PubMed (including MEDLINE), Web of Science, Embase and Scopus up to 31 October 2023. This was accompanied by both grey literature and manual search. Detailed selection criteria were applied, namely mature permanent teeth requiring root canal treatment, premixed bioceramic sealer with gutta-percha as an intervention group, a standard filling technique as control group and full-text available in English. A random-effect meta-analysis was used to synthesize the body of evidence regarding the use of bioceramic sealers in root canal treatment and their impact on post-obturation pain. Effect sizes were represented as relative risks on a logarithmic scale for binary outcomes and as mean differences for continuous outcomes. RESULTS A total of 941 articles were identified. Fifteen Comparative clinical studies were finally included. Eleven were randomized clinical trials, and four were prospective clinical trials with control group. The follow-up of these studies was not greater than 2 years. No publication bias was observed in any study. No significant differences were observed between the two groups in terms of survival and success rates. A small non-significant lower risk of extrusion was observed for bioceramics. A small, non-significantly lower post-operative-pain within 24-h was observed when bioceramics were used. DISCUSSION The majority of current evidence shows inconsistencies in reporting and is of short-term duration. Robust prospective long-term trials are needed in this area to better support future recommendations. CONCLUSION This systematic review is the first to analyse several clinical outcomes using premixed sealers. Included studies differed in terms of clinical protocol and operator expertise, but reported a similar outcome when comparing bioceramic versus standard sealers. Tooth survival, treatment outcome, post-operative pain and periapical extrusion were similar and presented no significant differences between the two sealer types. REGISTRATION PROSPERO database (CRD42023449151).
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Affiliation(s)
- Fausto Zamparini
- Endodontic Clinical Section, Dental School, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Laboratory of Green Biomaterials and Oral Pathology, Dental School, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Jacopo Lenzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Henry Fergus Duncan
- Division of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Andrea Spinelli
- Endodontic Clinical Section, Dental School, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Maria Giovanna Gandolfi
- Laboratory of Green Biomaterials and Oral Pathology, Dental School, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Carlo Prati
- Endodontic Clinical Section, Dental School, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Fristad I, Haug S, Bårdsen A. Biological properties versus solubility of endodontic sealers and cements. Biomater Investig Dent 2024; 11:40863. [PMID: 38903777 PMCID: PMC11187977 DOI: 10.2340/biid.v11.40863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024] Open
Abstract
Endodontic sealers and cements used in root canal treatment have different compositions and properties. Common to all materials is that their primary goal is to fill gaps and voids, making a permanent seal of the root canal system. Furthermore, aspects such as antibacterial properties, cytotoxicity, setting time, solubility and biocompatibility are also crucial and ought to be considered. Over the years, a shift in the view on the importance of these aspects has ocurred. Whereas the antibacterial properties were considered important when the technical factors in endodontics were less developed, the sealing ability and biocompatibility have later been considered the most critical factors. The introduction of tricalcium silicate cements and sealers has led to a renewed interest in material properties, as these cements seem to have good sealing ability and at the same time combine favourable antimicrobial effects with excellent biocompatibility. This review discusses how the various properties of root canal sealers and cements may conflict with the primary aim of providing a permanent seal of the root canal system.
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Affiliation(s)
- Inge Fristad
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Sivakami Haug
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Asgeir Bårdsen
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
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Abu-Zeid ST, Alamoudi RA. Comparative Analysis of Interfacial Adaptation and Depth Penetration of Recent HiFlow versus Regular Bioceramic Sealers in Conjunction with BC Gutta-Percha Points Using Two Different Obturation Techniques-A Preliminary Report of an Ex Vivo Study. J Funct Biomater 2024; 15:134. [PMID: 38786645 PMCID: PMC11122194 DOI: 10.3390/jfb15050134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/11/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
This study aimed to assess the adaptability and penetration depth capacity of recent bioceramic systems, including regular EndoSequence (BC) versus HiFlow (BCH) sealers in the presence of BC points. A total of 54 single-rooted teeth were instrumented and obturated with either the cold or warm compaction technique (n = 9), using either BC, BCH, or AH Plus (AHP) combined with BC points. The adaptation, film thickness, and gaps/voids were evaluated by scanning electron microscopy. The sealer/dentin interface was evaluated by Raman spectroscopy, and depth penetration was evaluated by a confocal laser scanning microscope. According to the normality test, the data were statistically analyzed by ANOVA or Kruskal-Wallis and Mann-Whitney U tests at p < 0.05. BCH sealer showed the significantly thinnest film with the greatest flow (p > 0.001), with further improvement when subjected to the warm compaction technique. Moreover, it exhibited close adaptation with deep penetration into radicular dentin, forming a tag-like structure. The Raman spectra also indicated close contact with the dentin surface. The use of BC sealer with BC points exhibited homogenous, single-unit obturation, either with a cold or warm technique. Furthermore, the use of the warm compaction technique with BCH sealer achieved a gap-free interface associated with tag-like structures, which exhibit the monoblock phenomenon.
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Affiliation(s)
- Sawsan T. Abu-Zeid
- Endodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah 22252, Saudi Arabia;
- Endodontic Department, Faculty of Dentistry, Cairo University, Giza 12345, Egypt
| | - Ruaa A. Alamoudi
- Endodontic Department, Faculty of Dentistry, King Abdulaziz University, Jeddah 22252, Saudi Arabia;
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Ashkar I, Sanz JL, Forner L, Ghilotti J, Melo M. A Literature Review of the Effect of Heat on the Physical-Chemical Properties of Calcium Silicate-Based Sealers. J Endod 2024:S0099-2399(24)00281-4. [PMID: 38729300 DOI: 10.1016/j.joen.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Recently, calcium silicate-based sealers (CSSs) have gained popularity in endodontic practice due to their biocompatibility and antimicrobial properties. They are considered viable alternatives to epoxy resin-based sealers. With the increased use of CSSs and warm vertical compaction techniques in root canal treatment, evaluating the impact of heat on CSSs properties is essential, therefore this review aimed to present a qualitative synthesis of available in vitro studies assessing the impact of heat on the physical-chemical properties of CSSs. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines, a systematic advanced electronic search was performed in Scopus, Embase, Medline (via PubMed), Web of Science, and Cochrane databases in November 2023 and updated in April 2024. In vitro studies that evaluated the physical-chemical properties of CSSs were eligible. PRILE 2021 guidelines were used for the assessment of the risk of bias-included studies. RESULTS The search identified a total of 6421 preliminary results and 10 studies were included for qualitative assessment. Eleven different physiochemical properties were assessed by the included studies. Setting time and flow were the most evaluated property among the studies. A qualitative synthesis of the evidence on each property is presented. CONCLUSIONS Based on the in vitro studies assessed in the present systematic review, results reveal that exposing CSSs to heat can accelerate their setting time, reduce their flow, and increase their film thickness. Concerns persist regarding solubility, viscosity, radiopacity, dimensional change, microhardness, porosity, and compressive strength, requiring further research. Certain CSSs, such as MTA Fillapex and Endosequence BC sealer HiFlow, show minimal changes under heat, making them potential candidates for warm filling techniques.
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Affiliation(s)
- Israa Ashkar
- Departament d'Estomatologia, Facultat de Medicina I Odontologia, Universitat de València, Valencia, Spain
| | - José Luis Sanz
- Departament d'Estomatologia, Facultat de Medicina I Odontologia, Universitat de València, Valencia, Spain.
| | - Leopoldo Forner
- Departament d'Estomatologia, Facultat de Medicina I Odontologia, Universitat de València, Valencia, Spain
| | - James Ghilotti
- Departament d'Estomatologia, Facultat de Medicina I Odontologia, Universitat de València, Valencia, Spain
| | - María Melo
- Departament d'Estomatologia, Facultat de Medicina I Odontologia, Universitat de València, Valencia, Spain
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Ito R, Watanabe S, Kouno A, Yamauchi S, Okiji T. Heat-Induced Changes in the Physical Properties of a New Premixed Calcium Silicate-Containing Root Canal Sealer: An In Vitro Study. Dent J (Basel) 2024; 12:106. [PMID: 38668018 PMCID: PMC11048785 DOI: 10.3390/dj12040106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/25/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
This study aimed to examine how heating affects the physical properties of a newly developed premixed calcium silicate-containing sealer (AH Plus Bioceramic Sealer; AHB), in comparison with EndoSequence BC Sealer (ES), AH Plus Jet (AH), and Pulp Canal Sealer. The setting time, flow, and film thickness were tested with or without heating at 100 °C for 30 or 60 s, in accordance with ISO6876:2012 standards. Ultrastructural and elemental analyses were performed with scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). Data were analyzed using one-way analysis of variance (ANOVA) with a Tukey post hoc test (α = 0.05). All sealers exhibited significantly shorter setting time and flow after heating at 100 °C for 30 and 60 s (p < 0.05). After heating, AHB showed a significantly higher film thickness compared to that of the other materials (p < 0.05). None of the tested properties of heat-applied AHB and ES met ISO standards, except the setting time in ES. The SEM/EDS results for AHB and ES were not affected by heating. The detected changes in physical properties can negatively impact the performance of premixed calcium silicate-containing sealers, particularly AHB, when warm vertical compaction is employed.
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Affiliation(s)
| | - Satoshi Watanabe
- Department of Pulp Biology and Endodontics, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan; (R.I.); (A.K.); (S.Y.); (T.O.)
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Brito-Júnior M, Silva-Sousa YTC, Pereira RD, Camilo CC, Mazzi-Chaves JF, Lopes-Olhê FC, Sousa-Neto MD. An automated method to analyze root filling voids and gaps using confocal microscopy images. Odontology 2024; 112:546-551. [PMID: 37803215 DOI: 10.1007/s10266-023-00859-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/21/2023] [Indexed: 10/08/2023]
Abstract
This study evaluated the feasibility of an automated method to delimit the required area to quantitatively analyze root filling voids and gaps from cross-sectional confocal laser scanning microscopy (CLSM) images. Root canals of maxillary canines were prepared with rotary instruments and filled by lateral compaction technique using gutta-percha and AH Plus sealer. The roots were stored (100% humidity, 37 °C) for a period of 24 h and then transversally sectioned to obtain 2-mm-thick slices from the apical and middle thirds. The areas corresponding to filling materials, gaps, and voids were manually delimited or automatically demarked by ImageJ software after converting the images to the RGB color system. Based on manual and automatic delimitations, the percentages of voids and gaps were calculated. Data of voids and gaps between middle and apical thirds were individually compared by paired t-test. Pearson`s correlation test was used to assess the correlation of data between the methods. Irrespective of the method of area delimitation, no difference was observed between the root thirds for both voids and gaps, while the p-values calculated for each method were similar. Almost perfect correlations between the methods were observed for both outcomes. The proposed method to automatically delimit the areas corresponding to filling material, voids, and gaps appears to be a valid method to facilitate the quantitative analysis of defects in root canal fillings using topographic CSLM images.
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Affiliation(s)
- Manoel Brito-Júnior
- Department of Dentistry, UNIMONTES - State University of Montes Claros, Montes Claros, MG, Brazil
| | | | - Rodrigo Dantas Pereira
- Department of Dentistry, UNIMONTES - State University of Montes Claros, Montes Claros, MG, Brazil
| | - Carla Cristina Camilo
- Department of Dentistry, UNIMONTES - State University of Montes Claros, Montes Claros, MG, Brazil
| | - Jardel Francisco Mazzi-Chaves
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo - USP, Rua Célia de Oliveira Meirelles 350, Ribeirão Preto, SP, 14024-070, Brazil
| | - Fabiane Carneiro Lopes-Olhê
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo - USP, Rua Célia de Oliveira Meirelles 350, Ribeirão Preto, SP, 14024-070, Brazil
| | - Manoel D Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo - USP, Rua Célia de Oliveira Meirelles 350, Ribeirão Preto, SP, 14024-070, Brazil.
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Azizi H, Hadad A, Levy DH, Ben Itzhak J, Kim HC, Solomonov M. Epoxy vs. Calcium Silicate-Based Root Canal Sealers for Different Clinical Scenarios: A Narrative Review. Dent J (Basel) 2024; 12:85. [PMID: 38667997 PMCID: PMC11048901 DOI: 10.3390/dj12040085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/02/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
This study aimed to review the considerations for choosing a suitable sealer according to various endodontic scenarios. An electronic search of PubMed, Scopus, and the Web of Science was undertaken for the keywords of 'sealer choosing', 'appropriate sealer', 'suitable sealer', 'sealer for clinical scenario', and 'sealer for clinical situations'. However, the literature review revealed a lack of studies with practical clinical recommendations regarding the choice of appropriate endodontic root canal sealers for particular clinical situations of root canal treatment. Therefore, a narrative review was undertaken under the basis of the characteristics of an epoxy resin-based sealer (ERS) versus a calcium silicate-based sealer (CSS). Based on the evidence found through the review, the choice of an appropriate sealer in a variety of clinical scenarios was proposed. An ERS is recommended for one-visit non-vital cases, teeth with periodontal involvement, cracked teeth, and internal root resorption without root perforation. A CSS is recommended for vital or non-vital cases in multiple visits, teeth with internal root resorption with perforation or internal approach for external cervical resorption, teeth with open apices, and teeth with iatrogenic aberrations.
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Affiliation(s)
- Hadas Azizi
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Ramat-Gan, Israel
- “Bina” Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Avi Hadad
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Ramat-Gan, Israel
- “Bina” Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dan Henry Levy
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Ramat-Gan, Israel
- “Bina” Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joe Ben Itzhak
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Ramat-Gan, Israel
- “Bina” Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hyeon-Cheol Kim
- Department of Conservative Dentistry, School of Dentistry, Dental Research Institute, Pusan National University, Yangsan 46241, Republic of Korea;
| | - Michael Solomonov
- Department of Endodontics, Israel Defense Forces (IDF) Medical Corps, Tel Hashomer, Ramat-Gan, Israel
- “Bina” Program, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Kapralos V, Camilleri J, Koutroulis A, Valen H, Ørstavik D, Sunde PT. Endodontic sealers after exposure to chlorhexidine digluconate: An assessment of physicochemical properties. Dent Mater 2024; 40:420-430. [PMID: 38123383 DOI: 10.1016/j.dental.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Final root canal irrigation should ideally maintain the physicochemical stability of root canal sealers. We seek to assess the effect of contact with 2% chlorhexidine digluconate (CHX) on the physicochemical properties of AH Plus, BioRoot™ RCS, and Pulp Canal Sealer (PCS). METHODS Mixed sealers were placed in cylindrical teflon molds and allowed to set for 1.5x the manufacturers' setting time. Half of the specimens had their free surface in contact with CHX for the first minute of their setting period. Solubility, radiopacity, surface roughness, microhardness and wettability of the sealers were assessed up to 28 days after setting. Elemental analysis of sealer surfaces and their leachates together with pH measurements were also performed. Appropriate parametric and non-parametric analysis with post hoc tests were performed (p < 0.05). RESULTS Exposure to CHX had no effect on solubility and radiopacity of all sealers. CHX altered the surface roughness of PCS and BioRoot RCS (p < 0.05). Contact with CHX reduced the microhardness of AH Plus and PCS (p < 0.05). AH Plus was more hydrophilic after CHX contact, whereas PCS became more hydrophobic (p < 0.05). AH Plus and PCS surfaces appeared to adsorb CHX as exhibited by chlorine peaks after contact with CHX. Sealer leachates' alkalinity was not affected. CHX increased elution of silicon and zirconium for BioRoot and zinc for PCS leachates. SIGNIFICANCE In our study, CHX affected sealers' physicochemical properties to various extents. Further studies are needed to confirm the obtained results by investigating various final irrigation strategies and correlating to biological properties.
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Affiliation(s)
- Vasileios Kapralos
- Department of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Box 1109 Blindern, 0317 Oslo, Norway.
| | - Josette Camilleri
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Andreas Koutroulis
- Department of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Box 1109 Blindern, 0317 Oslo, Norway
| | - Håkon Valen
- Nordic Institute of Dental Materials (NIOM), Sognsveien 70 A, 0855 Oslo, Norway
| | - Dag Ørstavik
- Department of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Box 1109 Blindern, 0317 Oslo, Norway
| | - Pia Titterud Sunde
- Department of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Box 1109 Blindern, 0317 Oslo, Norway
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Khabiri M, Kamgar S, Iranmanesh P, Khademi A, Torabinejad M. Postoperative pain of single-visit endodontic treatment with gutta-percha versus MTA filling: a randomized superiority trial. BMC Oral Health 2023; 23:1026. [PMID: 38114967 PMCID: PMC10731764 DOI: 10.1186/s12903-023-03372-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/30/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Postoperative pain has remained a challenge for clinicians. This randomized superiority trial compared the levels of postoperative pain following the use of gutta-percha (GP) and sealer or mineral trioxide aggregate (MTA) as root canal filling materials in teeth with asymptomatic apical periodontitis. METHODS A total of 119 patients were initially evaluated in this two-arm, parallel-group, single-blind, superiority randomized trial. The inclusion criteria were participants aged 18-65 years with single-canal premolars diagnosed with asymptomatic apical periodontitis. The participants were finally divided into two groups using the permuted block randomization method. In the GP group (N = 46), the cleaned and shaped root canals were filled with gutta-percha and AH Plus sealer, while in the MTA group (N = 48), the cleaned and shaped root canals were filled with an MTA apical filling and a coronal gutta-percha and sealer. Patient pain level was measured 6, 12, 24, 48, and 72 h postoperatively using a 10-point visual analog scale (VAS). The data were analyzed by the chi-square, independent t, Friedman, and Mann-Whitney U tests. RESULTS The mean of VAS scores decreased significantly over time in both groups (P < 0.001). The mean VAS scores were significantly lower in the MTA filling group than in the other group (P < 0.05). Female patients reported higher VAS scores at 6- and 12-hour periods in both groups (P < 0.05). CONCLUSION MTA as a root canal filling material might be a valuable option for clinicians due to its low postoperative pain. TRIAL REGISTRATION The trial protocol was registered at the Registry of Clinical Trials (IRCT20191104045331N1).
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Affiliation(s)
- Masoud Khabiri
- Department of Endodontics, Faculty of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Sahel Kamgar
- Department of Endodontics, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Pedram Iranmanesh
- Department of Endodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbasali Khademi
- Department of Endodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
- School of Dentistry, Isfahan University of Medical Sciences, Hezar-Jerib Ave, Isfahan, 81746-73461, Iran.
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Al-Askary RA, AL-Ashou WM, Al-Jubori SH. Remineralization ability of different root canal sealers. Saudi Dent J 2023; 35:1014-1022. [PMID: 38170034 PMCID: PMC10759546 DOI: 10.1016/j.sdentj.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/07/2023] [Accepted: 08/13/2023] [Indexed: 01/05/2024] Open
Abstract
Aims This research was designed to contrast the biocompatibility and remineralization ability of different sealers (BioRoot, MTA-FillApex and GuttaFlow-Bioseal). Method Twenty rabbits were used in this study, they were randomly divided into 4 groups equally depending on the observation time"3,7,14, and 28 days" post-implantation. Each rabbit was generally anesthetized,"7cm"long incision was made on the skin of the right and left sides of the ventral aspect of the mandible of each rabbit, 4 bony cavities of approximately"5mm"in depth and"2mm"in diameter (2 cavities on the left side and 2 cavities on the right side of mandible of each rabbit) were made in the cortical surface of the buccal alveolar bone. The sealers mixed depend on manufactural instructions and immediately insert into the prepared cavities (in the right side the BioRoot and MTA-FillApex were placed while on the left side, GuttaFlow-Bioseal was placed in one cavity and the other cavity was left unfilled as control).The same volume of each sealer was placed in the corresponding cavity using disposable syringes. After each observation period, the animals were sacrificed and bone biopsy from the tested area was taken and examined histologically using Olympus light microscopy at"400X"magnification. Results The obtained data were analyzed through non-parametric statistical tests using SPSS software version"22".Kruskal-Wallis test and Mann - Whitney test were utilized at"0.05"levels of significance to evaluate the results. GuttaFlow-Bioseal displayed excellent biocompatibility in comparison to other groups indicated by low inflammatory tissue reaction at all evaluation intervals. While the BioRoot group represented better osteo-conductivity although statistically not significant than GuttaFlow-Bioseal group. Conclusion BioRoot and GuttaFlow-Bioseal showed higher osteo-conductivity and biocompatibility than MTA-FillApex. However, all sealer used in this study were well tolerated by bone tissue and might accelerate bone repair.
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Affiliation(s)
- Raghad A Al-Askary
- Department of Conservative Dentistry, College of Dentistry, University of Mosul, Mosul, Iraq
| | - Wiaam M.O. AL-Ashou
- Department of Conservative Dentistry, College of Dentistry, University of Mosul, Mosul, Iraq
| | - Sawsan H. Al-Jubori
- Department of Conservative Dentistry, College of Dentistry, University of Mosul, Mosul, Iraq
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Pirani C, Camilleri J. Effectiveness of root canal filling materials and techniques for treatment of apical periodontitis: A systematic review. Int Endod J 2023; 56 Suppl 3:436-454. [PMID: 35735776 DOI: 10.1111/iej.13787] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/15/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Apical periodontitis (AP) is an inflammatory disease of the apical periodontium as sequelae of pulp death. It is managed by disinfection and filling of the root canal space. OBJECTIVES The aim of this systematic review was to investigate whether obturation techniques and materials used for root canal filling led to the management of AP. METHODS A systematic review protocol was written following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist and registered on the international prospective register of systematic reviews (PROSPERO; CRD42021260275) including two populations, interventions, comparisons, outcomes and time (PICOT) for the research questions querying the effectiveness of obturation techniques (PICOT 1) and materials (PICOT 2) for the management of AP. Electronic searches were conducted on PubMed, ScienceDirect, Scopus and Embase search engines. Searches on International Endodontic Journal, Journal of Endodontics, Clinical Oral Investigations, Journal of Dental Research and Journal of Dentistry websites were also conducted, until May 2021. Both primary (tooth survival) and secondary outcomes were evaluated. The risk of bias was assessed by Cochrane RoB2 for the randomized and ROBINS-I for the nonrandomized trials. RESULTS The search strategy identified 1652 studies, with 1600 excluded on the title and abstract screening, leaving 52 studies for full-text screening. In total, 10 studies met the inclusion criteria. The obturation technique and materials used did not affect the outcome of AP. Vertical compaction resulted in faster resolution of periapical lesions. The oral health-related quality of life of patients treated with lateral condensation exhibited poorer outcomes compared with single matched cone after 6 months of recall. DISCUSSION The inclusion and exclusion criteria used for this systematic review enabled the capture of all the literature available on the effect of obturation techniques and materials on the outcome of AP. The data were heterogenous, and a number of articles investigating obturation techniques had no information on the materials and techniques used as they looked at the quality of fill. CONCLUSIONS Included studies did not find any difference between different procedures (PICOT 1) and materials (PICOT 2). The risk of bias was high, thus the findings should be interpreted with caution. REGISTRATION PROSPERO registration number: CRD42021260275.
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Affiliation(s)
- Chiara Pirani
- Department of Biomedical and Neuromotor Sciences (DIBINEM), School of Dentistry, Endodontic Clinical Section, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Josette Camilleri
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Timis L, Gorea M, Har N, Cimpean S, Delean A, Bud MG, Campian RS. Biomineralization ability of an experimental bioceramic endodontic sealer based on nanoparticles of calcium silicates. Med Pharm Rep 2023; 96:434-440. [PMID: 37970195 PMCID: PMC10642743 DOI: 10.15386/mpr-2660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/29/2023] [Indexed: 11/17/2023] Open
Abstract
Background and aims The ultimate goal of endodontic therapy is to prevent periradicular disease or to promote the healing of the periradicular lesions. The use of nontoxic, biocompatible, and bioactive materials designed for root canal obturation is preferred due to their increased potential to induce healing and bone regeneration, thereby restoring the functionality of the tooth and the adjacent tissues. The aim of this study was to analyze the biomineralization ability of an experimental endodontic sealer based on synthesized nanoparticles of calcium silicates. Methods Six plastic moulds were filled with the freshly prepared experimental endodontic sealer and kept for 3 days at room temperature in a moist environment. After hardening, four samples were subsequently immersed in simulated body fluid (SBF) and introduced in incubator at 37°C and 100% relative humidity; two of them were kept for 7 days and the other two for 14 days. Two samples were not immersed in SBF and were used for comparison. The biomineralization potential was assessed by XRPD, SEM and EDS analysis. Results Following immersion in SBF, XRPD analysis identified apatite crystals for experimental material both after 7 and 14 days. SEM images displayed the specific microstructure for bioceramic materials alongside with the presence of apatite crystals on their surface. EDS identified the presence of phosphorus and calcium elements, underlining the biomineralization potential of the experimental material. Conclusion Interaction between experimental material and SBF succeeded in inducing precipitation of apatite on its surface, evidenced by XRDP, SEM and EDS analysis.
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Affiliation(s)
- Lucia Timis
- Department of Conservative Odontology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maria Gorea
- Department of Chemical Engineering, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Nicolae Har
- Department of Geology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Sanda Cimpean
- Department of Conservative Odontology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ada Delean
- Department of Conservative Odontology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marius Gheorghe Bud
- Department of Conservative Odontology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Septimiu Campian
- Department of Oral Rehabilitation, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Yang X, Zheng T, Yang N, Yin Z, Wang W, Bai Y. A Review of the research methods and progress of biocompatibility evaluation of root canal sealers. AUST ENDOD J 2023; 49 Suppl 1:508-514. [PMID: 36480411 DOI: 10.1111/aej.12725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/22/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022]
Abstract
The function of root canal sealer was to achieve an appropriate three-dimensional filling effect by filling the root canal and some irregular lumen, thereby inhibiting the residual bacteria. There were many types of sealers, but research to find the most suitable ones was still ongoing. In recent years, researchers had continuously improved the performance of sealers by developing new sealers or adding active ingredients to the sealers. However, most sealers exhibit varying degrees of cytotoxicity and tissue responses, which affect clinical therapy efficacy. This review describes different technical approaches, and recent research progress in the biocompatibility evaluation of root canal sealers and provides brief insights into this field by summarising the performance studies of different root canal sealers.
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Affiliation(s)
- Xiliang Yang
- Department of Oral, College of stomatology, North China University of Science and Technology, Tangshan City, China
| | - Tianxia Zheng
- Department of Oral, College of stomatology, North China University of Science and Technology, Tangshan City, China
| | - Nuoya Yang
- Department of Oral, College of stomatology, North China University of Science and Technology, Tangshan City, China
| | - Zihan Yin
- Department of Oral, College of stomatology, North China University of Science and Technology, Tangshan City, China
| | - Wuliang Wang
- Department of Oral, College of stomatology, North China University of Science and Technology, Tangshan City, China
| | - Yuhong Bai
- Department of Oral, College of stomatology, North China University of Science and Technology, Tangshan City, China
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Winkler A, Adler P, Ludwig J, Hofmann N, Soliman S, Krastl G, Krug R. Endodontic Outcome of Root Canal Treatment Using Different Obturation Techniques: A Clinical Study. Dent J (Basel) 2023; 11:200. [PMID: 37623296 PMCID: PMC10453118 DOI: 10.3390/dj11080200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/24/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE To evaluate the clinical outcome of root canal treatment by obturation technique, root canal filling quality, and tooth- and patient-related variables. METHODS This clinical study investigated the endodontic outcome of 114 teeth treated between the years 2009 and 2012. Three different obturation methods were used: (1) adhesive obturation using the continuous wave of condensation technique with Resilon® (CWR), (2) matching-taper single-cone technique with gutta-percha and AH Plus® (SCGP), and (3) matching-taper single-cone technique with gutta-percha and GuttaFlow® (SCGF). Pre- and postoperative periapical radiographs were performed to detect the presence of endodontic lesions (PAI classification) and to assess the quality of both the obturation and the restoration. Tooth- and patient-related data were collected. RESULTS The overall endodontic success rate was 75.4% after a mean observation period of 6.3 years. There were no significant correlations between the type or overall quality of obturation and the treatment outcome. Teeth with preoperative lesions had the highest odds ratio (factor of 4.98) for endodontic failure. Tooth- and patient-related variables had no significant effect on endodontic outcome. CONCLUSIONS The preoperative periapical status of teeth requiring endodontic treatment was a substantial prognostic factor for endodontic outcome, whereas the type of obturation material or technique did not affect it.
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Affiliation(s)
- Alexander Winkler
- Center of Dental Traumatology, Department of Conservative Dentistry and Periodontology, University Hospital Würzburg (UKW), Pleicherwall 2, 97070 Würzburg, Germany; (J.L.); (N.H.); (S.S.); (G.K.); (R.K.)
| | - Philipp Adler
- Department of Cranio-Maxillofacial Surgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude W 30, 48149 Münster, Germany;
| | - Julia Ludwig
- Center of Dental Traumatology, Department of Conservative Dentistry and Periodontology, University Hospital Würzburg (UKW), Pleicherwall 2, 97070 Würzburg, Germany; (J.L.); (N.H.); (S.S.); (G.K.); (R.K.)
| | - Norbert Hofmann
- Center of Dental Traumatology, Department of Conservative Dentistry and Periodontology, University Hospital Würzburg (UKW), Pleicherwall 2, 97070 Würzburg, Germany; (J.L.); (N.H.); (S.S.); (G.K.); (R.K.)
| | - Sebastian Soliman
- Center of Dental Traumatology, Department of Conservative Dentistry and Periodontology, University Hospital Würzburg (UKW), Pleicherwall 2, 97070 Würzburg, Germany; (J.L.); (N.H.); (S.S.); (G.K.); (R.K.)
| | - Gabriel Krastl
- Center of Dental Traumatology, Department of Conservative Dentistry and Periodontology, University Hospital Würzburg (UKW), Pleicherwall 2, 97070 Würzburg, Germany; (J.L.); (N.H.); (S.S.); (G.K.); (R.K.)
| | - Ralf Krug
- Center of Dental Traumatology, Department of Conservative Dentistry and Periodontology, University Hospital Würzburg (UKW), Pleicherwall 2, 97070 Würzburg, Germany; (J.L.); (N.H.); (S.S.); (G.K.); (R.K.)
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Ribeiro JS, Xavier SR, Cuevas Suárez CE, Pappen FG, Piva E, Lund RG, Bottino MC. Synthesis and characterization of calcium-releasing elastomeric resin-based endodontic sealers. Clin Oral Investig 2023; 27:3447-3456. [PMID: 36947264 DOI: 10.1007/s00784-023-04952-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/17/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVES To evaluate the incorporation of halloysite nanotubes (HNTs) loaded with one of two calcium sources (i.e., calcium hydroxide/CaOH2 or beta-tricalcium phosphate/β-TCP) on the physicochemical and biological properties of an experimental resin-based dual-cured endodontic sealer. MATERIALS AND METHODS HNTs were encapsulated with CaOH2 or β-TCP at 10 wt.%. HNTs containing CaOH2 or β-TCP were added into the experimental sealers at 50 wt.%. The control sealers were the calcium-free HNT-modified resin-based experimental sealer and AH Plus™, a commercially available endodontic sealer. Degree of conversion, setting time, flow, film thickness, radiopacity, dimensional stability, and calcium ions release were determined. Antibiofilm properties and cytocompatibility of the formulated sealers and commercial control were also evaluated. One and two-way ANOVA analysis followed by Tukey's post hoc test was conducted to evaluate the effect of the independent variable on the evaluated properties. RESULTS FTIR confirmed the encapsulation of calcium sources into HNTs. Regarding flow and film thickness, the values obtained from these sealers were in accordance with the specifications provided by ISO 6876. For radiopacity, AH Plus™ achieved the highest radiopacity (p<0.05). Among the experimental formulations, all experimental HNT-containing compositions exhibited values below 3 mm Al. The experimental sealers showed greater dimensional changes when compared to the commercial (AH Plus™) control. The release of calcium ions was observed for the HNT_CaOH2 and HNT_β-TCP sealers without statistical differences. Experimental sealers containing HNT_CaOH2 and HNT_β-TCP significantly reduced the CFU/mL count and showed cell compatibility. CONCLUSIONS The findings of this study demonstrate that the incorporation of HNT_CaOH2 or HNT_β-TCP into resin-based experimental sealers promoted antimicrobial effects and gradual calcium release without impairing cytocompatibility or physicochemical properties of the sealers. Still, an adjustment to reach the minimal radiopacity established by ISO 6876 is needed. CLINICAL RELEVANCE The experimental resin-based sealers seemed to be an alternative for endodontics. The incorporation of calcium sources exerts promising antimicrobial effects while displaying low cell toxicity.
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Affiliation(s)
- Juliana S Ribeiro
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, 48109, USA
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Samantha R Xavier
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Carlos E Cuevas Suárez
- Dental Materials Laboratory, Academic Area of Dentistry, Autonomous University of Hidalgo State, Circuito Ex Hacienda La Concepción S/N, 42160, San Agustín Tlaxiaca, Hidalgo, Mexico
| | - Fernanda G Pappen
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Evandro Piva
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Rafael G Lund
- Department of Restorative Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Marco C Bottino
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, MI, 48109, USA.
- Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA.
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Saghiri MA, Vakhnovetsky J, Vakhnovetsky A, Samadi E, Samadi F. Volume and power of expansion of novel polyurethane-based sealers. J Endod 2023:S0099-2399(23)00291-1. [PMID: 37276958 DOI: 10.1016/j.joen.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Shrinkage and lack of interfacial adaptation between endodontic sealers and root canal walls may jeopardize the root canal treatment outcome. This study aimed to evaluate the volume and power of expansion (and the relationship between the two) of three novel root canal sealers (polyurethane expandable sealer (PES), zeolite + PES (ZPES), and elastomeric polyurethane sealer (EPS)) in comparison with an epoxy-resin based sealer (AH Plus) and a calcium silicate-based sealer (EndoSequence BC). METHODS This study utilized 36 cylinders (30 plastic graduated cylinders for volume of expansion and 6 steel cylinders for power of expansion) (4x10mm) filled with PES, ZPES, EPS, AH Plus, EndoSequence BC, or water (n=5/group). The plastic graduated cylinders were inserted inside a customized Linear Swell Meter (LSM) apparatus to measure the percentage of volumetric expansion. The steel cylinders were placed inside an LSM apparatus mounted onto a universal testing machine to measure the maximum pressure in psi. Specimens were tested for 72 hours for both volume and power of expansion tests. Data were analyzed using Kolmogorov-Smirnov, one-way ANOVA, Post Hoc Tukey, and Pearson correlation tests (p<0.05). RESULTS The volume of expansion of PES, ZPES, and EPS was significantly higher than in AH Plus and EndoSequence BC (p<0.05). For the power of expansion, no significant differences were found between the root-filling materials (p>0.05). No correlation was seen between the volume and power of expansion (p>0.05). CONCLUSION Although polyurethane-based sealers showed a significantly higher volume of expansion compared to AH Plus and EndoSequence BC, their power of expansion did not increase significantly.
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Affiliation(s)
- Mohammad Ali Saghiri
- Director of Biomaterial and Prosthodontics Laboratory, Assistant Professor, Department of Restorative Dentistry, Rutgers School of Dental Medicine, Newark, NJ, USA; Adjunct Assistant Professor, Department of Endodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, USA.
| | - Julia Vakhnovetsky
- Clinical Researcher, Sector of Innovation in Dentistry, Dr. Hajar Afsar Lajevardi Research Cluster (DHAL), Hackensack, NJ, USA; Clinical Researcher, Biomaterial and Prosthodontics Laboratory, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Anna Vakhnovetsky
- Clinical Researcher, Biomaterial and Prosthodontics Laboratory, Rutgers School of Dental Medicine, Newark, NJ, USA; Pre-Med Student, Johns Hopkins University, Baltimore, MD, USA
| | - Elham Samadi
- Clinical Researcher, Sector of Innovation in Dentistry, Dr. Hajar Afsar Lajevardi Research Cluster (DHAL), Hackensack, NJ, USA; Clinical Researcher, Biomaterial and Prosthodontics Laboratory, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Fatereh Samadi
- Clinical Researcher, Sector of Innovation in Dentistry, Dr. Hajar Afsar Lajevardi Research Cluster (DHAL), Hackensack, NJ, USA; Clinical Researcher, Biomaterial and Prosthodontics Laboratory, Rutgers School of Dental Medicine, Newark, NJ, USA
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Razdan A, Benetti A, Bakhshandeh A, Darvann T, Bjørndal L. Dimensional changes of endodontic sealers-An in vitro model simulating a clinical extrusion scenario during 18 months. Clin Exp Dent Res 2023; 9:299-313. [PMID: 36628604 PMCID: PMC10098291 DOI: 10.1002/cre2.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/30/2022] [Accepted: 10/29/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To examine the dimensional changes of endodontic sealers during 18 months using three-dimensional (3D) surface scanning and subtraction radiography in a novel in vitro sealer-extrusion model. MATERIAL AND METHODS Fifty endodontically instrumented acrylic teeth were randomly allocated to five groups (n = 10) filled with Apexit Plus, AH Plus, BioRoot RCS, TubliSeal EWT, and gutta-percha (control). Freshly mixed sealers were intentionally extruded during obturation. All teeth were immersed in a physiologic solution for up to 18 months. Blinded 3D surface scans (resolution: ~10 μm) and digital radiographs of the teeth were obtained at baseline (immediately after obturation); and then after 1 week, and at 1, 3, and 18 months. For blinded assessment of sealer dimensional change, 3D models and radiographs were superimposed using specific software. Volumetric differences, root mean square (RMS), and area change from subtraction radiography measured at each period within each sealer group were thereafter calculated. Repeated measures analyses were done with Bonferroni adjustment for multiple comparisons; standard errors, p values, and 95% confidence intervals (CI) were reported. RESULTS Analyses of the volumetric data confirmed significant, progressive material loss for Apexit Plus when compared to the other investigated sealers or the control group (p ≤ 0.02). Immersion period significantly influenced the volumetric dimensional changes of Apexit Plus already after 1 month (p < 0.01). For TubliSeal EW, the effect of the immersion period on the dimensional changes was noted after immersion for 3 months (p ≤ 0.02), while for BioRoot RCS this was evident only at 18 months (p < 0.01). Same trends were noted for the RMS data, whereas progressive dimensional changes using subtraction radiography only revealed significant changes for Apexit Plus (p = 0.01). CONCLUSIONS The largest dimensional changes were shown by Apexit Plus, followed by Tubliseal EWT and BioRoot RCS. AH Plus remained stable throughout 18 months.
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Affiliation(s)
- Ankur Razdan
- Department of Odontology, Section of Dental Materials, Section of Clinical Oral Microbiology, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagen NDenmark
- Department of Odontology, Section of Cariology and Endodontics, Section of Clinical Oral Microbiology, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagen NDenmark
- Department of Dentistry and Oral Health, Section for Oral RadiologyAarhus UniversityAarhus CDenmark
| | - Ana R. Benetti
- Department of Odontology, Section of Dental Materials, Section of Clinical Oral Microbiology, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagen NDenmark
| | - Azam Bakhshandeh
- Department of Odontology, Section of Cariology and Endodontics, Section of Clinical Oral Microbiology, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagen NDenmark
| | - Tron A. Darvann
- 3D Craniofacial Image Research Laboratory, School of DentistryUniversity of CopenhagenCopenhagen NDenmark
- 3D Craniofacial Image Research Laboratory, Centre of Head and OrthopaedicsCopenhagen University Hospital RigshospitaletCopenhagen NDenmark
- 3D Craniofacial Image Research Laboratory, Department of Applied Mathematics and Computer ScienceTechnical University of DenmarkCopenhagen NDenmark
- Department of Oral and Maxillofacial SurgeryCopenhagen University Hospital RigshospitaletCopenhagen NDenmark
| | - Lars Bjørndal
- Department of Odontology, Section of Cariology and Endodontics, Section of Clinical Oral Microbiology, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagen NDenmark
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Alhindi OH, Atmeh AR, Alhawaj H, Omar O. Inflammatory response to epoxy resin and calcium silicate sealers preheated with different temperatures: an in vivo study. Clin Oral Investig 2023; 27:2235-2243. [PMID: 36977762 DOI: 10.1007/s00784-023-04960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To determine the impact of heat exposure of different sealers on inflammatory cytokine secretions and tissue response in vivo. MATERIALS AND METHODS Silicone tubes were prefilled with epoxy resin (ER) or calcium silicate (CS) sealers, preheated at 37, 60, or 120 °C, and implanted in rat subcutaneous site. Peri-implant exudate and tissue were analyzed after 1 and 4 weeks for cytokine secretions and tissue organization. RESULTS At 1 week, 120 °C-preheated CS and ER induced higher secretions of tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6), respectively, as compared to sham/empty tube groups. At 4 weeks, whereas TNF-α secretion was reduced in CS, it increased in ER group, particularly for 120 °C. Both sealers revealed high IL-6 after 4 weeks as compared to sham/empty tube, and generally, higher IL-6 secretions were associated with ER. Histology at 1 week revealed lower degree of inflammatory infiltrate in the groups of the highest preheating temperature (120 °C). Nonetheless, at 4 weeks, whereas fibrous capsule area and inflammatory infiltrate remained low in the CS120 group, they were high in ER120. CONCLUSION Preheating ER sealer to 120 °C induced high and prolonged secretion of proinflammatory cytokines (TNF-α and IL-6), whereas this effect was transient for the CS sealer. This was associated with increased fibrous capsule and inflammatory infiltrate in response to 120 °C-preheated ER. CLINICAL RELEVANCE Heat-induced changes in sealer properties alter the inflammatory response in vivo, which may affect the clinical outcome. This will not only help appropriate selection of obturation technique for different sealers, but also for optimizing the properties of new generation of sealers.
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Chang SJ, Kim YJ, Vu HT, Choi JM, Park JH, Shin SJ, Dashnyam K, Knowles JC, Lee HH, Jun SK, Han MR, Lee JH, Kim JS, Shin JS, Kim JB, Lee JH. Physicochemical, Pre-Clinical, and Biological Evaluation of Viscosity Optimized Sodium Iodide-Incorporated Paste. Pharmaceutics 2023; 15:pharmaceutics15041072. [PMID: 37111558 PMCID: PMC10143732 DOI: 10.3390/pharmaceutics15041072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
This study aimed to investigate the impact of different viscosities of silicone oil on the physicochemical, pre-clinical usability, and biological properties of a sodium iodide paste. Six different paste groups were created by mixing therapeutic molecules, sodium iodide (D30) and iodoform (I30), with calcium hydroxide and one of the three different viscosities of silicone oil (high (H), medium (M), and low (L)). The study evaluated the performance of these groups, including I30H, I30M, I30L, D30H, D30M, and D30L, using multiple parameters such as flow, film thickness, pH, viscosity, and injectability, with statistical analysis (p < 0.05). Remarkably, the D30L group demonstrated superior outcomes compared to the conventional iodoform counterpart, including a significant reduction in osteoclast formation, as examined through TRAP, c-FOS, NFATc1, and Cathepsin K (p < 0.05). Additionally, mRNA sequencing showed that the I30L group exhibited increased expression of inflammatory genes with upregulated cytokines compared to the D30L group. These findings suggest that the optimized viscosity of the sodium iodide paste (D30L) may lead to clinically favorable outcomes, such as slower root resorption, when used in primary teeth. Overall, the results of this study suggest that the D30L group shows the most satisfactory outcomes, which may be a promising root-filling material that could replace conventional iodoform-based pastes.
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Affiliation(s)
- Soo-Jin Chang
- Department of Pediatric Dentistry, College of Dentistry, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea (J.-S.S.)
| | - Yu-Jin Kim
- Department of Biomaterials Science, College of Dentistry, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
| | - Huong Thu Vu
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
| | - Ji-Myung Choi
- Department of Pediatric Dentistry, College of Dentistry, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea (J.-S.S.)
| | - Jeong-Hui Park
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
- Department of Nanobiomedical Science & BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
| | - Seong-Jin Shin
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
| | - Khandmaa Dashnyam
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
- Department of Nanobiomedical Science & BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
- Drug Research Institute, Mongolian Pharmaceutical University & Monos Group, Ulaanbaatar 14250, Mongolia
| | - Jonathan C. Knowles
- Department of Nanobiomedical Science & BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
- UCL Eastman-Korea Dental Medicine Innovation Centre, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
- Cell & Matter Institute, Dankook University, Cheonan 31116, Republic of Korea
- Division of Biomaterials and Tissue Engineering, Eastman Dental Institute, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - Hae-Hyoung Lee
- Department of Biomaterials Science, College of Dentistry, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
- Department of Nanobiomedical Science & BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
- UCL Eastman-Korea Dental Medicine Innovation Centre, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
| | - Soo-Kyung Jun
- Department of Biomaterials Science, College of Dentistry, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
- Department of Dental Hygiene, Hanseo University, 46 Hanseo 1ro, Seosan 31962, Republic of Korea
| | - Mi-Ran Han
- Department of Pediatric Dentistry, College of Dentistry, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea (J.-S.S.)
| | - Joon-Haeng Lee
- Department of Pediatric Dentistry, College of Dentistry, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea (J.-S.S.)
| | - Jong-Soo Kim
- Department of Pediatric Dentistry, College of Dentistry, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea (J.-S.S.)
| | - Ji-Sun Shin
- Department of Pediatric Dentistry, College of Dentistry, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea (J.-S.S.)
| | - Jong-Bin Kim
- Department of Pediatric Dentistry, College of Dentistry, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea (J.-S.S.)
- Correspondence: (J.-B.K.); (J.-H.L.)
| | - Jung-Hwan Lee
- Department of Biomaterials Science, College of Dentistry, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
- Department of Nanobiomedical Science & BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
- UCL Eastman-Korea Dental Medicine Innovation Centre, Dankook University, 119 Dandaero, Cheonan 31116, Republic of Korea
- Cell & Matter Institute, Dankook University, Cheonan 31116, Republic of Korea
- Mechanobiology Dental Medicine Research Center, Cheonan 31116, Republic of Korea
- Correspondence: (J.-B.K.); (J.-H.L.)
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Pushout Bond Strength of Root Fillings after Irrigation of Root Canals Utilizing Sodium Hypochlorite, Chlorhexidine, and Homeopathic Mother Tincture ( Arnica Montana). Clin Pract 2023; 13:305-314. [PMID: 36826170 PMCID: PMC9954886 DOI: 10.3390/clinpract13010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/03/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
The pushout bond strength of root fillings at radicular dentin was investigated employing NaOCl, CHX, and homoeopathic mother tincture (Arnica montana) as an irrigant. Sixty human permanent single-rooted extracted teeth were decoronated. The root canals were instrumented using Pro taper universal rotary system (Dentsply Tulsa Dental; Tulsa, Oklahoma) and were prepared up to F3 apical size. The roots were then randomly divided into three groups according to irrigation solution (n = 20) according to the final irrigation regimen: Group I: 3 mL 5.25% NaOCl followed by 3 mL Saline (control); Group II: 3 mL Arnica montana (10%, w/v) followed by 3 mL Saline; Group III: 3 mL CHX followed by 3 mL Saline. The canals were dried using paper points. The canals were coated with AH Plus sealer (Dentsply DeTey, Konstaz, Germany) with the aid of a Lentulo spiral (Dentsply DeTey, Konstaz, Germany) and obturated with #F3 gutta-percha. Each root was then horizontally sliced into three slices, labelled coronal, middle, and apical, each measuring 2 mm thick. Furthermore, at a crosshead speed of 2 mm/min, the test was carried out using the universal testing apparatus. The 5.25% NaOCl significantly decreased the bond strength of AH Plus to dentin. Both CHX and Arnica montana were capable of reversing the compromised pushout of AH Plus to NaOCl-treated dentin. After using NaOCl as an irrigant, the danger of diminished binding capacity of AH Plus to root canal walls arises. Final irrigation with Arnica montana and CHX reduces this risk.
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Monteiro CMC, Martins ACR, Reis A, de Geus JL. Effect of endodontic sealer on postoperative pain: a network meta-analysis. Restor Dent Endod 2023; 48:e5. [PMID: 36875812 PMCID: PMC9982236 DOI: 10.5395/rde.2023.48.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 01/11/2023] Open
Abstract
This systematic review and network meta-analysis aimed to answer the following focused research question: "Does the type of endodontic sealer affect the postoperative pain in patients who received endodontic treatment?" Different databases and grey literature were surveyed. Only one randomized controlled trial were included. The risk of bias in the studies was evaluated by using the Cochrane Collaboration's tool. A random-effects meta-analysis was conducted to compare the risk and intensity of postoperative pain. The quality of the body of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Out of 11,601 studies, 15 remained for qualitative analyses and 12 for meta-analysis. Seven studies were classified at high risk of bias, and 8 studies raised some concerns. No significant differences between the endodontic materials were observed in the direct comparisons, both in risk and in intensity of postoperative pain (pairwise comparisons with 2 studies: I2 = 0%; p > 0.05 and 8 studies: I2 = 23%; p > 0.05, respectively). The certainty of the evidence was graded as low or moderate. There was no difference in the risk and intensity of postoperative pain after filling with different endodontic sealers. Further systematic reviews should be conducted. Trial Registration PROSPERO Identifier: CRD42020215314.
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Affiliation(s)
| | | | - Alessandra Reis
- Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Juliana Larocca de Geus
- Department of Endodontics, Paulo Picanço School of Dentistry, Fortaleza, CE, Brazil.,Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
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22
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Penetration of Three Endodontic Sealers in Simulated Lateral Canals during the Lateral Condensation Technique: An In Vitro Study. Int J Dent 2022; 2022:2686247. [PMID: 36440093 PMCID: PMC9683939 DOI: 10.1155/2022/2686247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/19/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022] Open
Abstract
Objective This study aimed to compare the penetration depths of AH Plus, BioRoot RCS, and GuttaFlow 2 into simulated lateral canals when used with the cold gutta-percha lateral compaction technique. Materials and Methods Twelve resin training blocks (4 canals perch each resin block) were used. Each primary artificial canal had two lateral canals (apical and coronal). The main canals were instrumented with WaveOne Gold and irrigated with distilled water. The resin blocks were divided into three groups (N = 4 each/16 artificial canals), according to the type of root canal sealer; Group I: AH Plus, Group II: BioRoot RCS, and Group III: GuttaFlow 2. All canals were obturated with the cold lateral condensation technique. The linear extension of each endodontic sealer into the apical and coronal lateral canals was measured using a digital stereomicroscope and measuring software. Data were statistically analyzed using a one-way analysis of variance. The percentages of filling of the lateral canals were calculated and statistically compared using the Mann–Whitney test. Results The experimental sealers exhibited variable penetration depths into the lateral canals. All sealers showed significantly better penetration ability into the apical lateral canals than the coronal lateral canals (P < 0.05). AH Plus (3.184 ± 0.012 mm/99.5%) and GuttaFlow 2 (3.176 ± 0.017 mm/99.25%) were significantly better than BioRoot RCS (3.096 ± 0.026 mm/96.75%) in filling the apical lateral canals (P < 0.05). BioRoot RCS was the best sealer to fill coronal lateral canals (3.322 ± 0.085 mm/83.05%). Conclusion During the lateral condensation technique, the filling of the lateral canals is affected by the type of root canal sealer and the location of the lateral canals All the sealers tested have a good ability to fill the apical lateral, while BioRoot RCS was effective in filling both the coronal and apical lateral canals.
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Silva IA, Só GB, Weissheimer T, Mendes A, Hashizume LN, Só MVR, Rosa RAD. Does the ultrasonic activation of calcium silicate-based sealers affect their physicochemical properties? Braz Dent J 2022; 33:20-27. [PMID: 36477961 PMCID: PMC9733370 DOI: 10.1590/0103-6440202205100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/07/2022] [Indexed: 12/12/2022] Open
Abstract
This study aimed to evaluate the influence of ultrasonic activation (UA) on the physicochemical properties of hydraulic calcium silicate-based sealers. Nine experimental conditions were created based on the hydraulic calcium silicate-based sealers (Bio-C Sealer, Sealer Plus BC and Bio Root RCS) and the ultrasonic activation (no activation [NA], 10 seconds, and 20 seconds). Then the experimental groups were BC-NA, BC-10, BC-20, SPBC-NA, SPBC-10, SPBC-20, BR-NA, BR-10, and BR-20. Activation was performed with an ultrasonic insert 20/.01. The mold for the physicochemical analysis was filled and evaluated according to the ANSI/ADA specification nº. 57: initial and final setting time, flow, radiopacity and solubility. Tests were also performed to evaluate pH and calcium ion release with experimental periods of 1, 24, 72, and 168 hours with a pH meter and colorimetric spectrophotometer. Data were analyzed by one-way analysis of variance and post-hoc Tukey tests. The significance level was set at 5%. The time of UA progressively delayed the initial setting time for all hydraulic calcium silicate-based sealers (p < 0.05). Twenty seconds of UA increased the mean flow values of Sealer Plus BC and Bio-C Sealer compared to NA (p < 0.05). UA did not influence the radiopacity and solubility of the tested sealers (p > 0.05). UA for 20 seconds enhanced the pH levels and the calcium ion release of Sealer Plus BC and Bio-C Sealer at 168h (p < 0.05). UA for twenty seconds interferes with some physicochemical properties of hydraulic calcium silicate-based sealers.
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Affiliation(s)
- Isadora Ames Silva
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Gabriel Barcelos Só
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Theodoro Weissheimer
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Aline Mendes
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Lina Naomi Hashizume
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Marcus Vinícius Reis Só
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
| | - Ricardo Abreu Da Rosa
- Department of Endodontics, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), Porto Alegre, RS, Brazil
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The Influence of the Matrix on the Apatite-Forming Ability of Calcium Containing Polydimethylsiloxane-Based Cements for Endodontics. Molecules 2022; 27:molecules27185750. [PMID: 36144487 PMCID: PMC9504520 DOI: 10.3390/molecules27185750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 12/04/2022] Open
Abstract
This study aimed to characterize the chemical properties and bioactivity of an endodontic sealer (GuttaFlow Bioseal) based on polydimethylsiloxane (PDMS) and containing a calcium bioglass as a doping agent. Commercial PDMS-based cement free from calcium bioglass (GuttaFlow 2 and RoekoSeal) were characterized for comparison as well as GuttaFlow 2 doped with dicalcium phosphate dihydrate, hydroxyapatite, or a tricalcium silicate-based cement. IR and Raman analyses were performed on fresh materials as well as after aging tests in Hank’s Balanced Salt Solution (28 d, 37 °C). Under these conditions, the strengthening of the 970 cm−1 Raman band and the appearance of the IR components at 1455−1414, 1015, 868, and 600−559 cm−1 revealed the deposition of B-type carbonated apatite. The Raman I970/I638 and IR A1010/A1258 ratios (markers of apatite-forming ability) showed that bioactivity decreased along with the series: GuttaFlow Bioseal > GuttaFlow 2 > RoekoSeal. The PDMS matrix played a relevant role in bioactivity; in GuttaFlow 2, the crosslinking degree was favorable for Ca2+ adsorption/complexation and the formation of a thin calcium phosphate layer. In the less crosslinked RoekoSeal, such processes did not occur. The doped cements showed bioactivity higher than GuttaFlow 2, suggesting that the particles of the mineralizing agents are spontaneously exposed on the cement surface, although the hydrophobicity of the PDMS matrix slowed down apatite deposition. Relevant properties in the endodontic practice (i.e., setting time, radiopacity, apatite-forming ability) were related to material composition and the crosslinking degree.
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Boderé PJ, Calberson F, De Bruyne M, De Moor R, Meire M. Protocols for cleaning the incisor access cavity contaminated with epoxy resin sealer. Eur J Oral Sci 2022; 130:e12894. [PMID: 36065089 DOI: 10.1111/eos.12894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/09/2022] [Indexed: 11/28/2022]
Abstract
This study compared different methods for cleaning the sealer-contaminated access cavity of upper incisors. After standard endodontic access, the canals of 50 extracted maxillary incisors were chemomechanically prepared and obturated with gutta-percha and epoxy resin sealer. Teeth were randomly assigned to one of five different pulp chamber cleaning protocols (n = 10): air/water spray, ethanol-saturated cotton pellet (CP), ethanol-saturated microbrush reaching the root filling (MB), MB + air polishing (PROPHYflex; KaVo), or MB + etching with 37% phosphoric acid. Each tooth was split and the sealer-covered area of the pulp chamber was determined on images taken before and after cleaning using image analysis software. The sealer-covered area was compared across groups using one-way ANOVA. Greatest mean sealer-covered area reduction was observed for MB + etching (98.0%), MB + air polishing (95.2%), and MB alone (92.8%), yielding a significantly higher sealer-covered area reduction than after air/water spray (8.3%) and ethanol-saturated cotton pellet (53.4%). The upper incisor access cavity is best cleaned with an ethanol-saturated microbrush reaching up to the root filling, followed by air/water spraying and etching. The use of cotton pellets should be discouraged.
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Affiliation(s)
- Pieter-Jan Boderé
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - Filip Calberson
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - Mieke De Bruyne
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - Roeland De Moor
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
| | - Maarten Meire
- Department of Oral Health Sciences, Section of Endodontology, Ghent University, Ghent, Belgium
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Eğemen A, Belli S. The Effect of Primary Root Canal Treatment on Dentinal Tubule Penetration of Calcium Silicate-based Sealers during Endodontic Retreatment. J Endod 2022; 48:1169-1177. [PMID: 35667566 DOI: 10.1016/j.joen.2022.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/22/2022] [Accepted: 05/26/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the effect of previous root canal treatment on dentinal tubule penetration of calcium silicate-based sealers during endodontic retreatment and to compare 2 different (commonly used and modified) tubule penetration depth measurement techniques. METHODS The crowns of mandibular premolar teeth were removed, and root canals were prepared (ProTaper Universal; Dentsply Sirona, York, PA) and obturated using AH Plus (AH; Dentsply DeTrey, Konstanz, Germany), MTA Fillapex (MTAF; Angelus, Londrina, Brazil), and WellRoot ST (WRST; Vericom, Gyeonggi-do, South Korea); 0.1% red Rhod-2 dye (Chemodex, St Gallen, Switzerland) was added to the sealers. After storage for 3 weeks (37°C, 100% humid), the following sealer combination subgroups were created (the sealer used during the primary root canal treatment/the sealer used during the retreatment, n = 8): AH/AH, AH/MTAF, and AH/WRST; MTAF/AH, MTAF/MTAF, and MTAF/WRST; and WRST/AH, WRST/MTAF, and WRST/WRST. Green Fluo-3 dye (0.1%) was added to the sealers during retreatment. Sealer penetration depths were measured at 8 points and averaged, and the ratio of the retreatment sealer to the initial sealer was recorded as the mean tubule penetration depth ratio in the first technique, whereas the percentage of the circumferential penetration area ratios of the retreatment and initial sealers was calculated in the second technique. Statistical analyses were performed using Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U tests. RESULTS The mean penetration depth of AH and MTFA was found to be higher at the coronal third region in the control groups (P < .05). Both methods showed a significant difference among the groups at the coronal and median regions (P < .05). The AH/WRST, MTAH/AH, MTAF/MTAF, MTAF/WRSTS, and WRST/WRST groups showed deeper tubule penetration (first technique, P = .01). Both techniques showed that the penetration depth of the sealers was the same at the apical region (P > .05), whereas a difference was found among the techniques at the coronal and median regions. The sealers used in the previous root canal treatment limited the penetration depth of the sealers used during the retreatment process (P < .05). When MTAF was used as the initial sealer, the penetration depth of the second sealer did not change, whereas if WRST was the initial sealer, the penetration depth of the sealers at the median and apical regions is negatively affected during the retreatment process (P < .05). CONCLUSIONS Previous root canal treatment affects the penetration depth of calcium silicate-based sealers. The use of AH Plus and MTA Fillapex during the retreatment process showed an advantage. Both measurement techniques showed similar performances at the apical region, whereas the results varied at the coronal and midcoronal regions; therefore, a more stable sealer penetration measurement technique is still necessary.
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Affiliation(s)
- Ayşenur Eğemen
- Department of Endodontics, Selçuk University, Konya, Turkey
| | - Sema Belli
- Department of Endodontics, Selçuk University, Konya, Turkey.
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Casino Alegre A, Aranda Verdú S, Zarzosa López JI, Plasencia Alcina E, Rubio Climent J, Pallarés Sabater A. Intratubular penetration capacity of HiFlow bioceramic sealer used with warm obturation techniques and single cone: A confocal laser scanning microscopic study. Heliyon 2022; 8:e10388. [PMID: 36097475 PMCID: PMC9463577 DOI: 10.1016/j.heliyon.2022.e10388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/08/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this paper was to evaluate the intratubular penetration area of a bioceramic sealer, using continuous wave (CW), vertical condensation (VC) with two different types of gutta-percha (conventional (NG) and bioceramic-coated (BG)) and single cone (SC) technique with BG gutta-percha, in different root thirds. Methods A total of 150 mature single-root human teeth (including incisors, canines and premolars) were prepared and randomly divided into five groups (n = 30). Teeth were filled using a bioceramic sealer (TotalFill BC Sealer HiFlow ®) and two different types of gutta-percha, with CW and VC techniques, the teeth in the control group were filled with SC technique and BG gutta-percha. The teeth were sectioned and evaluated as one-third portions in each case under a confocal laser microscope. The penetration area measurements were carried out with the Autocad ® programme. Data was analyzed using the one-factor ANOVA test (p < 0.05) and Post Hoc Test (p < 0.05). Results The ANOVA Test showed significant differences in the penetration areas of the five obturation techniques (P < 0.05). The Post Hoc Test exhibited significant differences in multiple comparisons (P < 0.05). There was more dentinal tubule penetration in the coronal third than in the apical third in all techniques. Conclusions The intratubular penetration of the bioceramic sealer was influenced by the obturation techniques tested, but not by the different gutta-percha tested. There was more penetration of sealer in the warm obturation techniques than the SC, regardless of the type of gutta-percha used.
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Koçer A, Dönmez Özkan H, Turk T. Postoperative pain intensity and incidence following single visit root canal treatment with different obturation techniques: a randomized clinical trial. PeerJ 2022; 10:e13756. [PMID: 35915749 PMCID: PMC9338753 DOI: 10.7717/peerj.13756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/28/2022] [Indexed: 01/17/2023] Open
Abstract
Background There are few studies in the literature about the effect of obturation techniques on postoperative pain. Besides, GuttaFlow2 was used for the first time in this study regarding postoperative pain. This study aimed to compare the postoperative pain levels and incidence following single-visit root canal treatment with different canal filling techniques; cold lateral compaction (CLC), thermoplasticised solid-core carrier (GuttaCore) based filling and cold free-flow compaction (GuttaFlow2) technique. Methods The patients (n = 93) having single-rooted teeth with a single canal diagnosed with asymptomatic irreversible pulpitis or single-rooted vital teeth with a single canal requiring endodontic treatment because of prosthetic reasons were enrolled in this study. Patients were randomized into three groups (n = 31) according to the obturation technique. A single operator performed all the treatments in a single visit. Data on obturation levels, postoperative pain and analgesic intake frequency were recorded at postoperative 6, 12 and 24 h and daily afterward until the 7th day. Postoperative pain was measured by visual analogue scale (VAS). The date were statistically analyzed with chi-squared tests (for the analyses of the categorical data), the nonparametric Kruskal-Wallis test (for the comparisons of VAS score) and with the Friedman test (for the assessments of the changes in VAS scores over time). Results The GuttaCore group recorded the higher pain levels, except first 12 h, on the other hand, the GuttaFlow2 group recorded the lower pain levels at all time periods. Significant differences occurred among the groups during the first 4 days (p < 0.05), except at 12 h (p = 0.054). The patients in the CLC and GuttaFlow2 groups did not need to use the prescribed analgesic; however, one patient in the GuttaCore group used it once. Conclusions Postoperative pain levels following root canal therapy were affected by the obturation technique especially first 4 days following obturation.
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Affiliation(s)
- Aliye Koçer
- Department of Endodontics, Aydın Adnan Menderes University, Efeler, Aydın, Türkiye
| | - Hicran Dönmez Özkan
- Department of Endodontics, Aydın Adnan Menderes University, Efeler, Aydın, Türkiye
| | - Tugba Turk
- Department of Endodontics, Ege University, Bornova, İzmir, Türkiye
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Effect of chlorhexidine digluconate on antimicrobial activity, cell viability and physicochemical properties of three endodontic sealers. Dent Mater 2022; 38:1044-1059. [PMID: 35491276 DOI: 10.1016/j.dental.2022.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Assess the biological and physicochemical properties of AH Plus, BioRoot RCS and Pulp Canal Sealer (PCS) leachates with and without chlorhexidine (CHX). METHODS The sealers were studied in no contact and 1-minute contact with CHX. For biological properties (antibacterial activity and cytotoxicity), leachates were formed in saline of freshly mixed, 1-, 7- and 28 days set sealers. The antibacterial properties of sealer leachates were investigated for planktonic and biofilm growth of E. faecalis, S. mutans, S.epidermidis and S.aureus. The 3-(4,5 dimethylthiazolyl-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay was used to evaluate murine fibroblast cell viability after exposure to the leachates. The physical properties (water uptake, sorption, solubility, porosity, surface characteristics) of sealers and the pH of the immersion liquid (saline or distilled water) were also assessed over a 28-days period. RESULTS CHX improved the antibacterial properties of the sealer leachates and reduced cell viability for all sealer leachates, except for freshly mixed PCS. BioRoot RCS leachates presented the highest antibacterial properties and cell viability with and without CHX contact. PCS was the material most affected by CHX in terms of physical properties, whereas for AH Plus, solubility was increased. CHX did not affect the physical properties of BioRoot RCS, except for solubility that was decreased. CHX contact did not change sealers' alkalinity in distilled water whereas it increased it for AH Plus and BioRoot RCS in saline. SIGNIFICANCE CHX improved the antibacterial efficacy of sealer leachates and either compromised or did not affect cell viability. CHX affected to various extent sealers' physicochemical properties.
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Hydration Characterization of Two Generations of MTA-Based Root Canal Sealers. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12073517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Since the setting characterization of a root canal sealer has an impact on its biological behavior of final obturation, this study evaluated the setting characterization of mineral trioxide aggregate MTA-Fillapex versus MTA-Bioseal compared with epoxy resin (Adseal) root canal sealers. Freshly mixed sealer was inserted into the mold (n = 10). The initial and final setting times were evaluated using a Vicat needle and were then statistically analyzed by one-way ANOVA at p < 0.05. The raw pastes and the stages of the setting reaction were analyzed using Fourier Transform Infrared (FTIR) Spectroscopy. The phase compositions were evaluated using X-ray diffraction (XRD). A significant and fast setting time was recorded by Adseal (4.7 ± 0.46 h) followed by MTA-Bioseal (11.4 ± 1.34 h) at p < 0.001. The MTA-Fillapex did not set completely in three months. The FTIR and XRD of both MTA-Bioseal and Adseal detected bands of the polymerized phases, while those of MTA-Fillapex detected partial polymerization with a low percentage of polymerized silica. MTA-Bioseal and Adseal met the ISO standards for setting times. However, MTA-Fillapex did not fulfill the ideal requirement for the sealer. Although the raw pastes of both MTA-sealers had nearly similar compositions, they behaved differently during the hydration reaction. MTA-Bioseal set completely, while MTA-Fillapex was not completely set.
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31
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De-Deus G, Souza EM, Silva EJNL, Belladonna FG, Simões-Carvalho M, Moreira Cavalcante D, Versiani MA. A critical analysis of research methods and experimental models to study root canal fillings. Int Endod J 2022; 55 Suppl 2:384-445. [PMID: 35226760 DOI: 10.1111/iej.13713] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Gustavo De-Deus
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Erick Miranda Souza
- Department of Dentistry II, Federal University of Maranhão, São Luís, Maranhão
| | - Emmanuel João Nogueira Leal Silva
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil.,Department of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
| | | | - Marco Simões-Carvalho
- Department of Endodontics, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Kapralos V, Valen H, Koutroulis A, Camilleri J, Ørstavik D, Sunde PT. The dentine-sealer interface: modulation of antimicrobial effects by irrigation. Int Endod J 2022; 55:544-560. [PMID: 35080277 DOI: 10.1111/iej.13692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/29/2022]
Abstract
AIM Assess whether sodium hypochlorite (NaOCl) or chlorhexidine (CHX) and two irrigation protocols may alter the antibacterial properties of dentine and three endodontic sealers using a novel ex vivo tooth model. METHODOLOGY Prior to antibacterial testing, the tooth model was validated by means of scanning electron microscopy (SEM) to evaluate the separation between dentine and sealer surfaces. Root blocks prepared from extracted human roots were pretreated with 17% EDTA + 0.9% saline and subsequently treated with 1% NaOCl (G1), 2% CHX (G2) or no irrigant (G3). Two irrigation protocols were further investigated, "1% NaOCl + 17% EDTA" (P1) and "1% NaOCl + 17% EDTA + 2% CHX" (P2). Following irrigation, the root blocks were either filled with AH Plus, BioRoot RCS and Pulp Canal Sealer (PCS), or left empty. All groups were incubated for 1, 7 and 28 days. Direct contact tests for planktonic E. faecalis and 48 hours E. faecalis biofilms were performed at the level of dentine and sealer surfaces. Statistical analysis was performed on the bacterial survival between irrigants (G1, G2 and G3) and between irrigation protocols (P1 and P2) (p<0.05). RESULTS The model was considered reproducible as SEM examination of dentine samples indicated consistent separation between dentine and sealer surfaces. Irrigation with CHX (G2) and irrigation protocol (P2) enhanced the antibacterial properties of dentine without sealer application as well as dentine in contact with all three sealers tested, especially against planktonic E. faecalis. G2 and P2 also improved the antibacterial effect of AH Plus surfaces for all three incubation times. No irrigation groups (G1, G2) or irrigation protocols (P1, P2) altered the antibacterial properties of BioRoot RCS surfaces against planktonic bacteria or biofilms. Only BioRoot RCS surfaces eliminated the planktonic E. faecalis in all irrigation groups (G1, G2, G3) and protocols (P1, P2) investigated while PCS surfaces eliminated E. faecalis in biofilms in all groups up to 7 days. CONCLUSIONS The tooth model was reproducible. CHX improved the antibacterial activity upon both sealer and dentine surfaces. Among sealers, BioRoot RCS was less affected by NaOCl and CHX, and exhibited high antibacterial properties regardless the irrigation applied.
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Affiliation(s)
- V Kapralos
- Section of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Box 1109 Blindern, 0317, Oslo, Norway
| | - H Valen
- Nordic Institute of Dental Materials (NIOM), Sognsveien 70 A, 0855, Oslo, Norway
| | - A Koutroulis
- Section of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Box 1109 Blindern, 0317, Oslo, Norway
| | - J Camilleri
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - D Ørstavik
- Section of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Box 1109 Blindern, 0317, Oslo, Norway
| | - P T Sunde
- Section of Endodontics, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Box 1109 Blindern, 0317, Oslo, Norway
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Gavini G, Candeiro GTDM, Potgornik Ferreira F, Rubino GA, Aun CA, Bezerra AG, Malavasi M, Lemos ÉM, Caldeira CL, Akisue E. Retrospective study of endodontic treatment performed by undergraduate students using reciprocating instrumentation and single‐cone obturation. J Dent Educ 2022; 86:751-758. [DOI: 10.1002/jdd.12884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/13/2021] [Accepted: 12/23/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Giulio Gavini
- Department of Restorative Dentistry Faculty of Dentistry University of São Paulo São Paulo Brazil
| | | | | | - Gustavo Alberto Rubino
- Department of Restorative Dentistry Faculty of Dentistry University of São Paulo São Paulo Brazil
| | - Carmo Antônio Aun
- Department of Restorative Dentistry Faculty of Dentistry ‐ Discipline of Endodontics University Santa Cecília Santos Brazil
| | - Alexandre Gomes Bezerra
- Department of Restorative Dentistry Faculty of Dentistry ‐ Discipline of Endodontics University Santa Cecília Santos Brazil
| | - Maurílio Malavasi
- Department of Restorative Dentistry Faculty of Dentistry ‐ Discipline of Endodontics University Santa Cecília Santos Brazil
| | - Érico Melo Lemos
- Department of Restorative Dentistry Faculty of Dentistry ‐ Discipline of Endodontics University Santa Cecília Santos Brazil
| | - Celso Luiz Caldeira
- Department of Restorative Dentistry Faculty of Dentistry University of São Paulo São Paulo Brazil
| | - Eduardo Akisue
- Department of Restorative Dentistry Faculty of Dentistry ‐ Discipline of Endodontics University Santa Cecília Santos Brazil
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Abstract
A very extensive literature review presents the possibilities and needs of using, in endodontics, the alloys commonly known as nitinol. Nitinol, as the most modern group of engineering materials used to develop root canals, is equilibrium nickel and titanium alloys in terms of the elements’ atomic concentration, or very similar. The main audience of this paper is engineers, tool designers and manufacturers, PhD students, and students of materials and manufacturing engineering but this article can also certainly be used by dentists. The paper aims to present a full material science characterization of the structure and properties of nitinol alloys and to discuss all structural phenomena that determine the performance properties of these alloys, including those applied to manufacture the endodontic tools. The paper presents the selection of these alloys’ chemical composition and processing conditions and their importance in the endodontic treatment of teeth. The results of laboratory studies on the analysis of changes during the sterilization of endodontic instruments made of nitinol alloys are also included. The summary of all the literature analyses is an SWOT analysis of strengths, weaknesses, opportunities, and threats, and is a forecast of the development strategy of this material in a specific application such as endodontics.
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A comprehensive in vitro comparison of the biological and physicochemical properties of bioactive root canal sealers. Clin Oral Investig 2022; 26:6209-6222. [PMID: 35660956 PMCID: PMC9525420 DOI: 10.1007/s00784-022-04570-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/29/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate the biological and physicochemical features of bioactive root canal sealers. MATERIALS AND METHODS Human periodontal ligament fibroblasts (hPDLF) and human osteoblasts (hOB) were exposed to eluates of three bioactive root canal sealers, GuttaFlow® bioseal (GF), BioRoot™ RCS (BR), and TotalFill® BC Sealer (TF), and the epoxy resin-based sealer AH plus® (AH). Cytotoxicity and cellular inflammatory response were evaluated. The osteogenic potential was examined using human mesenchymal stem cells (hMSC). Film thickness, flowability, and pH were assessed. Root canal treatment was performed on human extracted teeth to evaluate the sealers' tightness towards bacterial penetration. The antibacterial activity against common pathogens in primary root canal infections was tested. RESULTS AH was severely cytotoxic to hPDLF and hOB (p < 0.001). The bioactive sealers were generally less cytotoxic. IL-6 levels in hPDLF were elevated in the presence of AH (p < 0.05). AH and GF suppressed IL-6 production in hOB (p < 0.05). AH and BR stimulated the PGE2 production in hPDLF and hOB (p < 0.05). BR was the only sealer that led to calcium deposits in hMSC (p < 0.05). TF and AH showed the lowest film thickness and the highest flowability. Bacterial tightness was best in teeth filled with AH and BR. All sealers showed similar antimicrobial activity, but the overall antimicrobial efficacy was moderate as the bacteria were reduced by just one log scale (p < 0.05). CONCLUSIONS This study revealed favorable in vitro results regarding the biocompatibility of the bioactive root canal sealers. CLINICAL RELEVANCE Bioactive root canal sealers may be a useful alternative to epoxy resin-based sealers.
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Ferreira GC, Pinheiro LS, Nunes JS, de Almeida Mendes R, Schuster CD, Soares RG, Kopper PMP, de Figueiredo JAP, Grecca FS. Evaluation of the biological and physicochemical properties of calcium silicate-based and epoxy resin-based root canal sealers. J Biomed Mater Res B Appl Biomater 2021; 110:1344-1353. [PMID: 34951737 DOI: 10.1002/jbm.b.35004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 12/02/2021] [Accepted: 12/09/2021] [Indexed: 12/17/2022]
Abstract
Biocompatibility, dimensional stability, radiopacity, flow, and low solubility are the characteristics of an ideal endodontic sealer. This study evaluated and compared in vivo and in vitro biological and physicochemical properties of calcium silicate-based sealers: Sealer Plus BC (BC), MTA Fillapex (MF); and resin-based sealers: AH Plus (AHP) and Sealer Plus (SP). Apical papilla cells were exposed to sealer extracts and subjected to MTT, SRB, scratch, alkaline phosphatase enzyme activity (ALP) and Alizarin red staining (ALZ) assays. Sealers were histologically evaluated in connective tissue of Wistar rats in different periods. Radiopacity, film thickness, flow, setting time, pH and element analyses were investigated. BC had better results compared to AHP and MF at hour 72 for MTT assay (p < .05), and the highest cell viability under SRB (p < .05). All sealers presented ALP activity. BC presented the highest mineralized deposition under ALZ (p < .05). BC and MF promoted wound healing. All sealers induced an initial inflammation reaction that decreased over time. Eosinophils were observed at day 7 in MF (p < .05). Despite MF did not present final setting time, the sealers properties were in accordance to ISO 6876/2012 and ASTM C266-08. All sealers presented cell viability and biocompatibility. BC presented higher pH values and bioactivity. The materials tested showed physico-chemical properties in accordance with standards, except for MF setting time.
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Affiliation(s)
- Gabriela Cardoso Ferreira
- Post Graduate Program in Dentistry, Dental School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Siqueira Pinheiro
- Post Graduate Program in Dentistry, Dental School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Júlia Silveira Nunes
- Post Graduate Program in Dentistry, Dental School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Roberta de Almeida Mendes
- Post Graduate Program in Dentistry, Dental School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Patrícia Maria Poli Kopper
- Department of Conservative Dentistry, Dental School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Fabiana Soares Grecca
- Department of Conservative Dentistry, Dental School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Influence of Commonly Used Endodontic Irrigants on the Setting Time and Metal Composition of Various Base Endodontic Sealers. Polymers (Basel) 2021; 14:polym14010027. [PMID: 35012047 PMCID: PMC8747268 DOI: 10.3390/polym14010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/17/2021] [Accepted: 12/19/2021] [Indexed: 11/18/2022] Open
Abstract
The present study aimed to evaluate if commonly used endodontic irrigants such as 3% sodium hypochlorite (NaOCl, Prime Dental, Thane, India), 2% chlorhexidine (CHX, Sigma-Aldrich Co., St. Louis, MO, USA), and 17% ethylenediaminetetraacetic acid (EDTA, Meta-Biomed Co. Ltd., Cheongju-si, South Korea) influenced the setting time and metal composition of different base endodontic sealers on exposure. AH Plus (Dentsply De Trey GmbH, Konstanz, Germany), Sealapex (SybronEndo, Orange, CA, USA), mineral trioxide aggregate (MTA) Fillapex (Angelus Soluções Odontológicas, Londrina, Brazil), and Tubli-Seal (Kerr Dental, Orange, CA, USA) were selected as the different base representatives of endodontic sealers. These sealers were exposed to 3% NaOCl, 2% CHX, and 17% EDTA, and the individual setting time of the sealers was analyzed. The samples were analyzed for heavy metal elements such as chromium (Cr), nickel (Ni), cobalt (Co), cadmium (Cd), arsenic (As), mercury (Hg), lead (Pb), and beryllium (Be) by using inductively coupled plasma mass spectrometry (ICP-MS) analysis. For statistical analysis, one-way ANOVA and post hoc Tukey’s tests were used. All selected sealers showed variation in setting time post-exposure to different irrigants. MTA Fillapex had the shortest mean setting time (215.7 min, post-exposure at 187.3 min) (p < 0.05). Mean setting time was also affected for AH Plus (479.6 min, post-exposure at 423.9 min) (p < 0.05) and Tubli-Seal (514.7 min, post-exposure at 465.2 min) (p < 0.05). Sealapex showed the maximum reduction of setting time (864.8 min, post-exposure at 673.4 min) (p < 0.05). All tested sealers showed heavy metals (Cr, Ni, Co, Cd, As, Hg, and Pb) in their composition, and the quantities were influenced by interaction with different irrigants. The heavy metal Be was not seen in any of the samples. Sealapex showed the longest setting time in comparison to other test sealers. Heavy metals were most present in Sealapex, followed by AH Plus, Tubli-Seal, and MTA Fillapex. MTA Fillapex was seen to have the shortest setting time, and heavy metal composition was least affected on interaction with different commonly used endodontic irrigants. Further, this study provides significant insight into the influence of different endodontic irrigants on interaction with different base endodontic sealers, which has not been reported previously, and future studies should emphasize endodontic irrigant-sealer interactions and their possible effects in the long run.
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Demirci GK, Kaval ME, Kurt SM, Serefoglu B, Güneri P, Hülsmann M, Caliskan MK. Energy-Dispersive X-Ray Spectrometry Analysis and Radiopacity of Five Different Root Canal Sealers. Braz Dent J 2021; 32:1-11. [PMID: 34877971 DOI: 10.1590/0103-6440202104638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/29/2021] [Indexed: 11/21/2022] Open
Abstract
Root canal sealers should have optimum adhesion to the root dentin, low cytotoxicity, sufficient radiopacity and high dimensional stability, which depend mainly on their chemical composition. The aims of this study were to evaluate the chemical composition of Syntex (Cerkamed, Stalowa Wola, Poland), Adseal (Meta Biomed, Cheongju-si, Korea), Sealapex (SybronEndo, Scafati, Italy), MTA Fillapex (Angelus, Londrina, Brazil) and GuttaFlow Bioseal (Coltene/Whaledent, Altstätten, Switzerland) and to determine their radiopacity comparatively. Stainless steel molds with an inner diameter of 5 mm and a depth of 2 mm were constructed. Tested root-canal sealers were mixed and poured into the molds. Following setting, digital periapical radiographs of the specimens (n=12) were taken under standard exposure conditions and the mean gray-values of specimens were measured using a computer graphics program. Then the specimens were examined by scanning electron microscopy, and Energy-dispersive X-ray analysis was performed. The data were analyzed using One-way ANOVA followed by Holm-Sidak multi-comparison test (p = 0.05). Sealapex showed higher calcium peak than MTA Fillapex, GuttaFlow Bioseal, Adseal and Syntex sealers. MTA Fillapex contained a highest amount of tungstate. Sealapex presented the highest radiopacity value among the tested materials (p < 0.05), whereas MTA Fillapex was the least radiopaque material (p < 0.05). Each root canal sealer contains different compositions of radiopacifiers including bismuth oxide, calcium tungstate and zirconium oxide. The tested root canal sealers had radiopacity values above the ISO-specified limit. Sealapex was the most radiopaque root canal sealer followed by GuttaFlow Bioseal, Syntex, Adseal and MTA Fillapex.
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Affiliation(s)
| | - Mehmet Emin Kaval
- Department of Endodontology, Faculty of Dentistry, Ege University, Izmir, Turkey
| | | | - Burcu Serefoglu
- Department of Endodontology, Faculty of Dentistry, Ege University, Izmir, Turkey
| | - Pelin Güneri
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Ege University, Izmir, Turkey
| | - Michael Hülsmann
- Department of Operative Dentistry, Periodontology and Cariology, Faculty of Dentistry, University of Göttingen, Göttingen, Germany
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Mokashi P, Shah J, Chandrasekhar P, Kulkarni GP, Podar R, Singh S. Comparison of the penetration depth of five root canal sealers: A confocal laser scanning microscopic study. J Conserv Dent 2021; 24:199-203. [PMID: 34759590 PMCID: PMC8562833 DOI: 10.4103/jcd.jcd_364_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 06/29/2021] [Accepted: 07/14/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Sealer penetration into dentinal tubules eliminates the pathways for bacterial leakage and entombs intratubular bacteria. Aim: The aim of this study was to evaluate and compare the depth of radicular dentinal tubule penetration of five root canal sealers using confocal laser scanning microscopy. Methods: Fifty freshly extracted single-rooted maxillary anterior teeth were used. After decoronation at the cementoenamel junction, they were prepared to ProTaper size F3. After irrigation with 5 mL smear clear, 5 mL 5% sodium hypochlorite and 5 mL distilled water alternatively, the samples were randomly divided into five groups (n = 10) and obturated by lateral compaction technique using the test sealers labeled by fluorescent rhodamine B dye (Mayor Diagnostics, Mumbai, India). Zinc oxide eugenol (ZOE) (Prime Dental Products), EndoREZ (Ultradent), Sealapex (SybronEndo), AH Plus (Dentsply Maillefer), and MTA-Fillapex (Angelus) formed the test groups. Teeth were then positioned in blocks of orthodontic resin. Three horizontal sections of 1-mm representing coronal middle and apical thirds were made and examined with Zeiss (laser scanning microscope [LSM] 780) confocal LSM. Images were analyzed using ZEN 2.1 software. Statistical Analysis: Data were recorded and subjected to statistical analysis using one-way ANOVA test. Results: Maximum penetration depth was demonstrated by AH Plus in the coronal and apical thirds, MTA-Fillapex in the middle thirds, while minimum penetration depth was seen in ZOE in the coronal and middle thirds and Sealapex in the apical thirds. None of the root canal sealers were able to penetrate the complete depth of radicular dentinal tubules. Conclusion: While AH Plus and MTA-Fillapex showed the highest penetration into radicular dentinal tubules, ZOE and Sealapex demonstrated the least penetration.
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Affiliation(s)
- Priyanka Mokashi
- Department of Conservative Dentistry and Endodontics, Terna Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Jinal Shah
- Department of Conservative Dentistry and Endodontics, Terna Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Padmini Chandrasekhar
- Department of Conservative Dentistry and Endodontics, Terna Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Gaurav Prakash Kulkarni
- Department of Conservative Dentistry and Endodontics, Terna Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Rajesh Podar
- Department of Conservative Dentistry and Endodontics, Terna Dental College and Hospital, Navi Mumbai, Maharashtra, India
| | - Shishir Singh
- Department of Conservative Dentistry and Endodontics, Terna Dental College and Hospital, Navi Mumbai, Maharashtra, India
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Ajina MA, Shah PK, Chong BS. Critical analysis of research methods and experimental models to study removal of root filling materials. Int Endod J 2021; 55 Suppl 1:119-152. [PMID: 34674279 DOI: 10.1111/iej.13650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/14/2022]
Abstract
Despite enjoying high favourable outcome rates, root canal treatment is not always successful. Root canal retreatment is a widely practised option for managing a non-healing root treated tooth. A basic distinction between retreatment and initial treatment is the requirement to remove the existing root filling material occupying the root canal space. Only then, can the technical deficiencies and possible causes of failure be addressed. Hence, the successful removal of the root filling material is critical to achieving the objectives of retreatment. Many different materials and techniques have been used for root canal filling, which have been documented in a plethora of studies; these are mainly laboratory studies investigating the removal of root filling materials. To help guide future research, which may then better inform clinical practice in relation to retreatment procedures, the focus of this narrative review is on the research methods and experimental models employed to study the removal of root filling materials. The current available literature demonstrates great variation in the research methodologies used to study the removal of root filling material, including direct visualization by splitting tooth samples or clearing, three-dimensional radiographic imaging including using microcomputed tomography or cone-beam computed tomography, and a combination of these techniques. Depending on the research method employed, variation also exists in quantification of root filling material removal; these include measurements of surface area, volume or weight, and criteria-based (semi-quantitative) assessment. Experimental models, using human teeth or resin models, differ with respect to standardization techniques and replication of the clinical scenario including initial sample preparation, canal filling, allocation and technical aspects of retreatment procedures. Future models should replicate, as closely as possible, the clinical scenario. Currently, microcomputed tomography provides a highly detailed, non-invasive and non-destructive method of objectively assessing and quantifying root filling removal.
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Affiliation(s)
- Mahdi A Ajina
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Pratik K Shah
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Bun San Chong
- Institute of Dentistry, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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Abu Zeid S, Edrees HY, Mokeem Saleh AA, Alothmani OS. Physicochemical Properties of Two Generations of MTA-Based Root Canal Sealers. MATERIALS 2021; 14:ma14205911. [PMID: 34683503 PMCID: PMC8538924 DOI: 10.3390/ma14205911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022]
Abstract
This study evaluated the physicochemical properties and the effect of solubility on the surface morphology and composition of the root canal sealers MTA-Bioseal, MTA-Fillapex, and Adseal. Discs (n = 10) of freshly mixed sealer were prepared and then analyzed by Fourier transform infrared (FTIR) spectroscopy and scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDX). The discs were immersed for 1, 7, 14, and 28 days in deionized water. The solubility %; pH change of the solution; and released calcium, phosphate, and silicon were measured for each period. The flowability and film thickness were also evaluated. Changes in the surface morphology and composition after 28 days of immersion were evaluated by SEM/EDX. The data were statistically analyzed by one-way ANOVA at p < 0.05. The FTIR and EDX results revealed similar compositions of MTA-Bioseal and MTA-Fillapex, but with different concentrations. The two MTA-based sealers had higher solution alkalinity (pH > 10) than Adseal (pH ≈ 8.5). MTA-Fillapex exhibited the highest solubility % and the largest calcium and silicon ion release. MTA-Bioseal had the highest phosphate ion release. After 28 days, the sealer surfaces showed large micropores, with larger pores in MTA-Fillapex. Adseal had an intermediate flowability but exhibited the greatest film thickness. Finally, the highest solubility and largest amount of silicon release was exhibited by MTA-Fillapex, which might predispose it to the development of large micropores, compromising the apical seal of obturation.
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Affiliation(s)
- Sawsan Abu Zeid
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (H.Y.E.); (A.A.M.S.); (O.S.A.)
- Department of Endodontics, Faculty of Dentistry, Cairo University, Cairo 12613, Egypt
- Correspondence:
| | - Hadeel Yaseen Edrees
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (H.Y.E.); (A.A.M.S.); (O.S.A.)
| | - Abeer Abdulaziz Mokeem Saleh
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (H.Y.E.); (A.A.M.S.); (O.S.A.)
| | - Osama S. Alothmani
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia; (H.Y.E.); (A.A.M.S.); (O.S.A.)
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Dhopavkar VV, Shivanand SS, Bhat K, Patil AC, Doddwad PK, Godbole NJ. Comparative Evaluation of Cytotoxic and Genotoxic Effects of Three Resin-Based Sealers by 3,(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide Assay and Comet Assay - An In Vitro Study. Contemp Clin Dent 2021; 12:376-382. [PMID: 35068836 PMCID: PMC8740790 DOI: 10.4103/ccd.ccd_213_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/22/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022] Open
Abstract
Background and Aim The complete sealing of the pulpal space contributes to the better healing potential after an root canal treatment, and root canal sealers are an integral part of this treatment which comes in contact with the periodontal tissue. Biocompatibility of an endodontic sealer plays an important role in the root canal treatment procedure. Hence, the aim of the study was to compare and evaluate the cytotoxicity and genotoxicity effect of three resin-based sealers on human periodontal fibroblast cells. Settings and Design This in vitro study was conducted in Dr. Prabhakar Kore's Basic Science and Research Center and K. L. E V. K. Institute of Dental Sciences, Belagavi. Materials and Methods Human periodontal fibroblasts were incubated with 15 specimens of Group 1 - AH Plus Group 2 - MTA Fillapex, and Group 3 - GuttaFlow 2, respectively. Cytotoxicity was assessed by 3,(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and genotoxicity was assessed by Comet assay at time intervals at 24 h and 48 h. Statistical Analysis Data were analyzed by the Kruskal-Wallis and Mann-Whitney U-test. Results AH Plus and GuttaFlow 2 did not show any cytotoxicity or genotoxicity. MTA Fillapex was slightly cytotoxic throughout the time interval, and it also showed low genotoxicity throughout the time periods for which it was tested. Conclusion AH Plus and GuttaFlow 2 did not show any cytotoxic and genotoxic effect; however, MTA Fillapex showed cytotoxic and genotoxic effect throughout the time interval.
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Affiliation(s)
- Vaidehi Vikas Dhopavkar
- Departmnt of Conservative Dentistry and Endodontics.KLE.V.K. Institute of Dental Sciences, Belgaum, Karnataka, India
| | - Sunita S Shivanand
- Departmnt of Conservative Dentistry and Endodontics.KLE.V.K. Institute of Dental Sciences, Belgaum, Karnataka, India
| | - Kishore Bhat
- Departmnt of Conservative Dentistry and Endodontics.KLE.V.K. Institute of Dental Sciences, Belgaum, Karnataka, India
| | - Anand C Patil
- Departmnt of Conservative Dentistry and Endodontics.KLE.V.K. Institute of Dental Sciences, Belgaum, Karnataka, India
| | - Preeti K Doddwad
- Departmnt of Conservative Dentistry and Endodontics.KLE.V.K. Institute of Dental Sciences, Belgaum, Karnataka, India
| | - Niraj Jayant Godbole
- Departmnt of Conservative Dentistry and Endodontics.KLE.V.K. Institute of Dental Sciences, Belgaum, Karnataka, India
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Liu H, Lai WWM, Hieawy A, Gao Y, von Bergmann H, Haapasalo M, Tay FR, Shen Y. Micro-computed Tomographic Evaluation of the Quality of Root Canal Fillings in Mandibular Molars after Obturation for 54 Months. J Endod 2021; 47:1783-1789. [PMID: 34492231 DOI: 10.1016/j.joen.2021.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The present study evaluated the percentage volume of voids in root canals of mandibular molars that had been obturated for 54 months. METHODS Thirty extracted human mandibular molars were instrumented and debrided. The teeth were assigned to 3 groups (n = 10) according to the filling technique and sealer used: the single-cone technique using AH Plus sealer (AHS; Dentsply Sirona Endodontics, Tulsa, OK) or EndoSequence BC sealer (BCS; Brasseler USA Dental LLC, Savannah, GA) and the warm vertical compaction technique using AH Plus sealer (AHW). The specimens were stored at 37°C and 100% humidity. Micro-computed tomographic imaging was used to scan each specimen 1 day 54 months after obturation. Data were analyzed using 1-way analysis of variance and the paired t test. RESULTS The percentage volume of voids in the teeth 1 day after obturation in the AHS group was higher than in the BCS group and the AHW group (P < .05). After 54 months, the proportion of voids decreased in all groups (P < .05). No significant difference was observed between the AHS group and the BCS group after 54 months. Teeth in the AHW group contained fewer voids than the AHS group (P < .05). CONCLUSIONS Voids in root canal filling were reduced 54 months after obturation. The warm vertical compaction technique achieved better root canal filling quality in mandibular molars than the single-cone technique when using AHS after long-term storage at 100% humidity.
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Affiliation(s)
- He Liu
- Department of Stomatology, Affiliated Hospital of Jining Medical University, Jining, China; Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy Wing Man Lai
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ahmed Hieawy
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yuan Gao
- Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Sichuan, China
| | - HsingChi von Bergmann
- Dental Education Research Lab, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Markus Haapasalo
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Franklin R Tay
- Department of Endodontics, The Dental College of Georgia, Augusta University, Augusta, Georgia.
| | - Ya Shen
- Division of Endodontics, Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada.
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Is Gutta-Percha Still the “Gold Standard” among Filling Materials in Endodontic Treatment? Processes (Basel) 2021. [DOI: 10.3390/pr9081467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
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.
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Ozturk G, Aydinbelge M, Gumus H. Comparison of Various Root Canal Filling Materials and Obturation Techniques for Primary Teeth Using Microcomputed Tomography. JOURNAL OF ADVANCED ORAL RESEARCH 2021. [DOI: 10.1177/23202068211036148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim: The aim of this study was to compare the effectiveness of different filling materials and obturation techniques for root canal obturation in primary teeth. Materials and Methods: Eighty maxillary primary incisors were included in this in vitro study. After biomechanical preparation, all samples were scanned using microcomputed tomography (micro-CT) and root canal volumes were calculated. Samples were grouped according to filling materials and obturation techniques, with ten samples in each group. The samples were filled with zinc oxide eugenol (ZOE) and Vitapex using four different obturation techniques (local anesthesia syringe, lentulo spiral, pastinject, and lentulo spiral–ultrasonic activation). After filling, samples were scanned a second time using micro-CT and root canal volumes were calculated. The statistical analysis was performed using SPSS version 24.0. Data were analyzed by Kruskal–Wallis and Mann–Whitney U tests. Results: When the ZOE and Vitapex were compared, it was observed that there were no significant differences between their postobturated volumes, percentage obturated volume (POV), internal void (IV), and percentage of internal void volume (PIV) ( P > .05). The local anesthesia syringe group had a significantly lower postobturated volume and POV, and a significantly higher IV and PIV for both filling materials than that by the other groups ( P < .05). There was no significant difference between the other obturation techniques ( P > .05). For the local anesthesia syringe group, postobturated volume and POV were significantly higher and IV and PIV were significantly lower with Vitapex than with ZOE ( P < .05). There was no significant difference between the other obturation techniques filled either with ZOE or Vitapex ( P > .05). Conclusion: Except for the syringe technique, no difference was observed between the ZOE and Vitapex materials. The syringe technique used in the primary root canal filling was less effective than the other techniques, which had similar efficacy, and in this technique, more effective canal filling was achieved with Vitapex.
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Affiliation(s)
- Gulce Ozturk
- Department of Pediatric Dentistry, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Mustafa Aydinbelge
- Department of Pediatric Dentistry, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
| | - Husniye Gumus
- Department of Pediatric Dentistry, Faculty of Dentistry, Erciyes University, Kayseri, Turkey
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Alsubait S, Alhathlol N, Alqedairi A, Alfawaz H. A micro-computed tomographic evaluation of retreatability of BioRoot RCS in comparison with AH Plus. AUST ENDOD J 2021; 47:222-227. [PMID: 33119208 DOI: 10.1111/aej.12456] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 12/28/2022]
Abstract
This study compared the retreatability of filling material from canals filled with BioRoot RCS (Septodont, Saint-Maur-des-Fosses, France) and AH Plus (Dentsply DeTrey, Konstanz, Germany) combined with gutta-percha using micro-computed tomography for evaluation. Thirty-four mandibular premolars were divided into two groups according to the sealer used. Thirty days after obturation, canals were retreated with a ProTaper Universal retreatment system (Dentsply Maillefer, Ballaigues, Switzerland) followed by passive ultrasonic irrigation (PUI). The time taken for retreatment was recorded. The roots were scanned after obturation, after retreatment and after PUI. Data were analysed using the Mann-Whitney and Wilcoxon tests. Canals filled with BioRoot RCS exhibited significantly less remaining filling material than canals filled with AH Plus (P < 0.05). The addition of PUI resulted in a significant decrease in the residual material in both groups (P < 0.05). A significantly shorter retreatment time was reported for the AH Plus group than the BioRoot RCS group (P < 0.05).
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Affiliation(s)
- Sara Alsubait
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Nuha Alhathlol
- Endodontic Residency Program, Saudi Commission for Health Specialist, Riyadh, Saudi Arabia
- Department of Clinical Dental Sciences, College of Dentistry, Princess Norah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abdullah Alqedairi
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Hussam Alfawaz
- Department of Restorative Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Bhandi S, Mashyakhy M, Abumelha AS, Alkahtany MF, Jamal M, Chohan H, Raj AT, Testarelli L, Reda R, Patil S. Complete Obturation-Cold Lateral Condensation vs. Thermoplastic Techniques: A Systematic Review of Micro-CT Studies. MATERIALS (BASEL, SWITZERLAND) 2021; 14:4013. [PMID: 34300930 PMCID: PMC8304925 DOI: 10.3390/ma14144013] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 01/31/2023]
Abstract
To prevent re-infection and provide a hermetic seal of the root canal system, an endodontist must aim to produce a void-free obturation. This review aimed to compare the completeness of root canal obturation between the two most prevalent methods-cold lateral condensation and warm gutta-percha techniques-using micro-CT (PROSPERO reg no. 249815). MATERIALS AND METHODS A search of Scopus, Embase, PubMed (Medline via PubMed), and Web of Science databases was done without any time restriction according to the PRISMA protocol. Articles that compared both techniques and were published in English were included. Data was extracted and the risk of bias was assessed using an adapted tool based on previous studies. RESULTS A total of 141 studies were identified by the search. Following the screening and selection of articles, 9 studies were included for review. Data was extracted manually and tabulated. Most studies had a moderate risk of bias. None determined operator skill in both methods before comparison. The data extracted from the included studies suggests that both techniques produce voids in the obturation. The thermoplasticized gutta-percha techniques may result in fewer voids compared to cold lateral condensation. CONCLUSION Considering the limitations of the included studies, it was concluded that neither technique could completely obturate the root canal. Thermoplasticized gutta-percha techniques showed better outcomes despite a possible learning bias in favor of cold lateral condensation. Establishing operator skills before comparison may help reduce this bias.
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Affiliation(s)
- Shilpa Bhandi
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia; (S.B.); (M.M.); (H.C.)
| | - Mohammed Mashyakhy
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia; (S.B.); (M.M.); (H.C.)
| | - Abdulaziz S. Abumelha
- Department of Restorative Dental Science, College of Dentistry, King Khalid University, Abha 61421, Saudi Arabia;
| | - Mazen F. Alkahtany
- Department of Restorative Dental Science, Division of Endodontics, College of Dentistry, King Saud University, Riyadh 11362, Saudi Arabia;
| | - Mohamed Jamal
- Department of Endodontics, Hamdan Bin Mohamed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health Care City, Dubai 505055, United Arab Emirates;
| | - Hitesh Chohan
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan 45412, Saudi Arabia; (S.B.); (M.M.); (H.C.)
| | - A. Thirumal Raj
- Department of Oral Pathology and Microbiology, Sri Venkateswara Dental College and Hospital, Chennai 600130, India;
| | - Luca Testarelli
- Department of Oral and Maxillo Facial Sciences, University of Rome La Sapienza, 00161 Rome, Italy; (L.T.); (R.R.)
| | - Rodolfo Reda
- Department of Oral and Maxillo Facial Sciences, University of Rome La Sapienza, 00161 Rome, Italy; (L.T.); (R.R.)
| | - Shankargouda Patil
- Department of Maxillofacial Surgery and Diagnostic Sciences, Division of Oral Pathology, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
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Debunking the Concept of Dentinal Tubule Penetration of Endodontic Sealers: Sealer Staining with Rhodamine B Fluorescent Dye Is an Inadequate Method. MATERIALS 2021; 14:ma14123211. [PMID: 34200848 PMCID: PMC8230462 DOI: 10.3390/ma14123211] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/22/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate the suitability of rhodamine B dye staining of an epoxy resin sealer (AH Plus) and calcium-silicate-based sealers (Total Fill BC Sealer, BioRoot RCS) to represent the penetration depth of the sealers into dentinal tubules after root canal obturation. In a three-step process, (1) leaching of rhodamine B from sealers into a buffer solution, (2) passive penetration of leached rhodamine B into dentinal tubules, and (3) conformity of rhodamine B penetration assessed by confocal laser scanning microscopy (CLSM), and sealer penetration assessed by scanning electron microscopy (SEM), in root-canal-filled teeth, were evaluated. Rhodamine B dye massively leached out of Total Fill BC Sealer and BioRoot RCS into the phosphate-buffered saline (PBS). A pinkish coloration of AH Plus was found after contact with PBS. Leached rhodamine B dye passively penetrated dentinal tubules from all three sealers when placed on root dentin. No correlation was observed between sealer penetration in SEM and rhodamine B penetration in CLSM. Staining of sealers using rhodamine B is an inadequate method with which to evaluate sealer penetration depth into dentinal tubules, as it overestimates the penetration of sealers into root dentin tubules.
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Saghiri MA, Dadvand S, Abdolmaleki A. The evaluation of physical properties of a polyurethane expandable endodontic sealer: a preliminary study. AUST ENDOD J 2021; 47:550-558. [PMID: 33988276 DOI: 10.1111/aej.12521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/19/2021] [Accepted: 04/11/2021] [Indexed: 11/28/2022]
Abstract
Endodontic sealers play a vital role in providing 3-dimensional (3D) filling of complex root canal system (RCS). This study intended to compare the physical properties of a Polyurethane Expandable Sealer (PES), AH Plus and EndoSequence. Three properties including setting time, radiopacity and flow (rheology) were evaluated based on ISO 6876 standard. For evaluation of each of these physical properties, five samples from experimental groups: AH Plus, EndoSequence, PES (controlled expansion) and PES (high expansion) were used (n = 5). Data were analysed by one-way ANOVA and Post Hoc Tukey tests (a = 0.05). EndoSequence showed the longest setting time (P < 0.000); AH Plus showed that highest radiopacity (P < 0.000); and PES (high expansion) showed the highest flow (diameter and surface area) (P < 0.000). EndoSequence and PES (controlled expansion) showed promising and comparable physical properties to the AH Plus sealer in terms of flow, setting time and radiopacity.
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Affiliation(s)
- Mohammad Ali Saghiri
- Director of Biomaterial and Prosthodontics Laboratory, Department of Restorative Dentistry, Rutgers School of Dental Medicine, Newark, NJ, USA.,Department of Endodontics, Arthur A. Dugoni School of Dentistry, University of the Pacific, San Francisco, CA, USA
| | - Sahar Dadvand
- Department of Preventive and Restorative Dental Sciences, San Francisco School of Dentistry, University of California, San Francisco, CA, USA
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Baghdadi I, AbuTarboush B, Zaazou A, Skienhe H, Özcan M, Zakhour M, Salameh Z. Effect of sintering temperature on the physiochemical properties, microstructure, and compressive strength of a bioceramic root canal sealer reinforced with multi-walled carbon nanotubes and titanium carbide. J Mech Behav Biomed Mater 2021; 119:104524. [PMID: 33895663 DOI: 10.1016/j.jmbbm.2021.104524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
AIM Bioceramic root canal sealers like BioRoot RCS have received significant attention for use in endodontics. The addition of a nanophase material like multi-walled carbon nanotubes (MWCNTs) and titanium carbide (TC) to its matrix combined with pressureless sintering might have the potential for improved physiochemical, microstructure, and compressive strength properties. METHOD ology: MWCNTs and TC nanomaterials were added at a percentage of 1 wt% to a definite weight of pristine BioRoot RCS. Two composites were prepared by ball milling followed by pressureless sintering in static nitrogen at temperatures 600 °C and 800 °C. The setting time, solubility, pH, compressive strength, and density were determined and compared to pristine BioRoot RCS. The microstructural properties of the composites were investigated by XRD, FTIR, Raman spectroscopy, and SEM. RESULTS The final setting time before and after sintering at 600 °C of the composites was accelerated compared to Bioroot RCS (p = 0.016). The solubility of Bioroot/TC sintered at 600 °C was the lowest (p = 0.07) and its compressive strength was the highest among the sintered samples (p = 0.01). The incorporation of MWCNTs and TC had a significant increase in the compressive strength of Bioroot RCS (p < 0.05). CONCLUSION The obtained results support the addition of nanomaterials to Bioroot RCS and the use of pressureless sintering.
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Affiliation(s)
- Inaam Baghdadi
- Doctorate School of Science and Technology, Lebanese University, Lebanon; Department of Endodontics, School of Dentistry, Beirut Arab University, Lebanon.
| | - BelalJ AbuTarboush
- Department of Chemical Engineering and Advanced Energy, American University of Beirut, Lebanon; Petroleum and Chemical Engineering Department, Sultan Qaboos University, Muscat 123, Oman
| | - Ashraf Zaazou
- Department of Endodontics, School of Dentistry, King Abdel Aziz University, Saudi Arabia; Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Egypt
| | - Hasan Skienhe
- PhD Department of Prosthodontic, Faculty of Dental Medicine, Lebanese University, Lebanon
| | - Mutlu Özcan
- Division of Dental Biomaterials, University of Zürich, Clinic for Reconstructive Dentistry, Zurich, Switzerland
| | - Mirvat Zakhour
- Laboratory of Physical Chemistry of Materials (LCPM), Faculty of Sciences, Lebanese University, Lebanon
| | - Ziad Salameh
- Research Center, Faculty of Dental Medicine, Lebanese University, Lebanon
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