Efficacy of Biodentine as an Apical Plug in Nonvital Permanent Teeth with Open Apices: An In Vitro Study

Effects of Access Cavity Design and Placement Techniques on Mineral Trioxide Aggregate Obturation Quality in Simulated Immature Teeth: A Micro-Computed Tomography Study

Background and Objectives: In teeth with open apices, performing single session apexification is a challenging treatment due to the difficulty in handling mineral trioxide aggregate (MTA). Minimally invasive approaches in dentistry have also influenced the cavity designs in endodontics. Until now, different techniques have not been investigated in addition to manual condensation during the process of placing MTA in traditional (TradACs) or conservative (ConsACs) endodontic access cavities. The aim of this in vitro study was to compare and evaluate the obturation quality of MTA apical plugs placed with different techniques in TradACs or ConsACs. Materials and Methods: Sixty upper central teeth were divided into two main groups based on cavity design, and then each main group was further divided into three subgroups according to MTA placement techniques (n = 10): TradAC-manual, TradAC-manual + indirect ultrasonic activation, TradAC-manual + XP-endo Shaper (XPS), ConsAC-manual, ConsAC-manual + indirect ultrasonic activation, and ConsAC-manual + XPS. Subsequently, the porosity percentages in the MTA apical plug were analyzed using micro-computed tomography. The statistical analysis was performed using the Kruskal-Wallis H test and Mann-Whitney U test. Statistical significance was set at p < 0.05. Results: There were differences in volume of porosity percentages (%) according to cavity designs and MTA application techniques (p < 0.05). Except for the XPS group, more porosity was observed in ConsACs compared to TradACs. In TradACs, the significantly lowest open and total porosity was observed in the manual, ultrasonic, and XPS techniques, respectively. In ConsACs, the significantly lowest porosity was observed in the manual, XPS, and ultrasonic techniques, respectively (p < 0.05). Conclusions: In MTA obturation, cavity designs and application techniques had an impact on the MTA porosity. Creating an apical plug in ConsACs may result in more porosity compared to TradACs, especially when manual or indirect ultrasonic activation is preferred. Opting for the manual technique alone may be considered sufficient for controlling porosity for both TradACs and ConsACs.

Evaluation of calcium ion release from apical plugs formed by Biodentine and MTA with and without incorporation of triple antibiotic powder and modified triple antibiotic powder (cefaclor) using atomic absorption spectrophotometry - An in vitro study

Introduction

Apexification procedure with Mineral trioxide aggregate (MTA) and Biodentine as apical plugs along with the incorporation of medicaments such as silver zeolite, chlorhexidine, and triple antibiotic powder (TAP) is a new area of research that is gradually gaining momentum in dentistry.

Aim

The study aimed to evaluate and compare the calcium released from the apical plugs formed by MTA and Biodentine with and without incorporation of 2% TAP and 2% modified triple antibiotic powder (mTAP).

Materials and Methods

Ninety single-rooted teeth were randomly divided (n = 15) into two experimental groups with three subgroups (n = 5) each based on the composition of apical plugs (4 mm) as follows: Group A: Biodentine - Subgroup 1: Biodentine, Subgroup 2: Biodentine + 2% TAP, and Subgroup 3: Biodentine + 2% modified TAP and Group B: MTA - Subgroup 1: MTA, Subgroup 2: MTA + 2% TAP, and Subgroup 3: MTA + 2% modified TAP. Each sample tooth was then immersed in 10 mL of deionized water. Evaluation of calcium release was done on days 7, 15, and 30 using an atomic absorption spectrophotometer. Data were analyzed using a one-way analysis of variance and a Tukey's post hoc test.

Results

Calcium ion release was maximum for Biodentine compared to MTA and was greater with materials incorporated with TAP and mTAP than materials alone at days 7, 15, and 30.

Conclusion

The incorporation of 2% TAP and 2% mTAP resulted in increased calcium ions released from MTA and Biodentine which helps in faster apexification.

Bioceramics in Endodontics: Updates and Future Perspectives

Bioceramics, with excellent bioactivity and biocompatibility, have been widely used in dentistry, particularly in endodontics. Mineral trioxide aggregate (MTA) is the most widely used bioceramic in endodontics. Recently, many new bioceramics have been developed, showing good potential for the treatment of endodontic diseases. This paper reviews the characteristics of bioceramics and their applications in various clinical endodontic situations, including root-end filling, root canal therapy, vital pulp therapy, apexification/regenerative endodontic treatment, perforation repair, and root defect repair. Relevant literature published from 1993 to 2023 was searched by keywords in PubMed and Web of Science. Current evidence supports the predictable outcome of MTA in the treatment of endodontic diseases. Although novel bioceramics such as Biodentine, EndoSequence, and calcium-enriched mixtures have shown promising clinical outcomes, more well-controlled clinical trials are still needed to provide high-level evidence for their application in endodontics. In addition, to better tackle the clinical challenges in endodontics, efforts are needed to improve the bioactivity of bioceramics, particularly to enhance their antimicrobial activity and mechanical properties and reduce their setting time and solubility.

Efficacy of Mineral Trioxide Aggregate Repair High Plasticity, Biodentine, and EndoSequence Root Repair Material Putty as Apical Barriers in Immature Permanent Teeth: An In Vitro Bacterial Leakage Study

AIM

To assess the microleakage of mineral trioxide aggregate (MTA) repair high plasticity (HP), EndoSequence root repair material (ESRRM) putty, and Biodentine, when used as an apical plug in immature permanent teeth.

MATERIALS AND METHODS

In an in vitro model, 55 extracted maxillary incisors were decoronated and resected 3 mm apically to obtain standardized 15-mm root blocks, which were then cleaned and shaped. All samples had a 1.1-mm standardized, prepared artificial open apex. The teeth were arbitrarily designated into three experimental groups (n = 15) and two control (positive/negative) groups (n = 5). In the experimental groups, orthograde 4-mm thick apical plugs of Biodentine (group I), ESRRM putty (group II), and MTA repair HP (group III) were placed. Positive control samples were left vacant while negative control samples were filled with Biodentine. The bacterial leakage method was used to appraise the sealing efficiency of the cements.

RESULTS

Statistical package for the social sciences (SPSS) software, version 21.0, was used for data analysis. Post hoc Tukey's test, one-way analysis of variance (ANOVA), and repeated measures of ANOVA were used for intergroup and intragroup comparisons. On day 1, there was a significant difference between the groups, with group II showing the least and group 1 showing the maximum microleakage. No significant difference among the groups was seen at other observational periods. There was a tendency for leakage to increase significantly from day 1 to 7, then decrease till the end of the experimental period.

CONCLUSION

It was concluded that the three materials evaluated, with time, exhibited comparable apical microleakage when treating teeth with open apices.

CLINICAL SIGNIFICANCE

MTA repair HP can be used as an apical plug material in open apices with similar success as ESRRM putty and marginally better outcome than Biodentine.

Pulp therapy and root canal treatment techniques in immature permanent teeth: an update

Background According to the Children's Dental Health Survey 2013, around one in ten children in Wales, Northern Ireland and England will have sustained dental trauma to a permanent incisor by the of age 15. Management of an exposed pulp in an immature permanent incisor is often urgent and has an impact on the long-term outcome of the tooth; therefore, it is essential that general dental practitioners feel confident in managing such a scenario to achieve an optimal outcome. This paper discusses the indications, technique, materials and outcomes.Aims This article aims to review the literature, which discusses various treatment modalities and materials for pulpal therapy and root canal treatment in the immature permanent tooth.Method Electronic searches were limited to English language, human studies, published within the past five years and the medical subject heading terms used were: direct pulp capping, apexogenesis, Cvek pulpotomy, full pulpotomy/pulpectomy, partial pulpotomy, apexification, non-vital pulp therapy and mineral trioxide aggregate apexification. Older, seminal articles identified through the references sections have also been included.Conclusion A number of options are available for the management of immature permanent teeth that have suffered an insult such as caries or trauma. This paper reviews the various methods of pulpal treatment, preservation therapy and root canal treatment options depending on the extent of the damage.

Sealing Efficiency of MTA, Accelerated MTA, Biodentine and RMGIC as Retrograde Filling Materials

Background/Aim: This in-vitro study evaluated the apical-sealing ability of MTA, MTA+10% CaCl2, Biodentine™ and RMGIC when used as retrograde material.

Material and Methods: A total of 80 single-rooted bovine incisors were decoronated, instrumented, and divided into 4 groups according to retrograde material, as follows: Group 1: MTA (ProRoot MTA, Dentsply); Group 2: MTA (ProRoot MTA, Dentsply) + 10% CaCl2; Group 3: Biodentine (Biodentine®, Septodont); Group 4: RMGIC (Nova Glass -LC, Imicryl). Root surfaces were isolated with nail polish, and teeth were immersed in 2% methylene blue dye at 37°C for 48 h. The extent of dye penetration (mm) was measured under a stereomicroscope.

Results: RMGIC had the highest mean-rank dye penetration score (MP=49.05), followed by MTA (MP=43.65), Biodentine (35.95) and MTA+CaCl2 (MP=33.35). The results of paired comparison tests found the mean microleakage value of MTA+10% CaCl2 and Biodentine (Group 3) to be significantly lower than that of RMGIC (respectively; p=0,020, p=0,019). No significant difference was found in the other group comparisons (p> 0.05).

Conclusions: These results suggest that the addition of an accelerator to MTA may reduce microleakage following endodontic surgery. Biodentine can be used as an alternative to MTA on retrograde obturation.

The Invasion of Bacterial Biofilms into the Dentinal Tubules of Extracted Teeth Retrofilled with Fluorescently Labeled Retrograde Filling Materials

In this study, we evaluated the invasion of bacteria into the dentinal tubules of retrofilled extracted human teeth, and the influence of different fluorescently labeled retrograde filling materials on the bacterial invasion and viability, by means of confocal laser scanning microscopy (CLSM). The root apices of extracted teeth were cut, prepared, and filled retrogradely using either intermediate restorative material (IRM), mineral trioxide aggregate (MTA), or Biodentine. The roots were filled with Enterococcus faecalis bacteria from their coronal part for 21 days. Then, 3-mm-long apical segments were cut to get root axial slices, and the bacteria were fluorescently stained and evaluated by CLSM. Bacterial penetration into the dentinal tubules favored the bucco-lingual directions. The filling materials penetrated up to 957 µm into the tubuli, and the bacteria, up to 1480 µm (means: 130 and 167 μm, respectively). Biodentine fillings penetrated less and the associated bacteria penetrated deeper into the tubuli compared to MTA or IRM (p = 0.004). Deeper filling penetration was associated with shallower penetration of both dead and live, or live alone, bacteria (p = 0.015). In conclusion, the current study enables better understanding of the microbiological–pathological course after endodontic surgical procedures. It was found that even with retrograde fillings, bacteria invade deep into the dental tubules, where deeper filling penetration prevents deeper penetration of the bacteria and adversely affects the viability of the bacteria.

The Effectiveness of Laser-Activated Irrigation on the Apical Microleakage Qualities of MTA Repair HP and NeoMTA Plus in Simulated Immature Teeth: A Comparative Study

There are limited data regarding the potential effect of erbium, chromium: yttrium–scandium–gallium–garnet (Er,Cr:YSGG) laser-activated irrigation (LAI) on the microleakage qualities of calcium silicate-based cements. The objective of the present study was to assess the effect of LAI on the microleakage qualities of MTA Repair HP (MTA-HP) and NeoMTA Plus (Neo) used in root-end filling and to compare the antimicrobial effectiveness of MTA- HP. Two experimental sets were conducted: antimicrobial activity (agar diffusion test/at 24, 48 h) and microleakage (glucose leakage model/at 1st, 10th, 20th days). Antimicrobial activities of MTA-HP, Neo, Biodentine, ProRoot and MTA Angelus were evaluated, and inhibition zones were observed not only against a range of Gram-positive and Gram-negative bacteria but also against yeast at 48h. For microleakage evaluation, fifty teeth were prepared to simulate the clinical situation where the root-tips (apex) are open, and randomly divided into two experimental groups (n = 20/group) according to the cement type (MTA-HP and Neo), and two control (n = 5/group) groups. Each experimental group was further divided into two subgroups (n = 10/group) with respect to LAI: MTA-HP, L-HP, Neo, L-Neo. A statistical difference was only detected between Neo and L-HP groups on day 1. Subsequently, MTA-HP exhibited superior microleakage quality compared to Neo in the short-term. Er,Cr:YSGG laser-activated irrigation could be used as a reliable technique without creating adverse effects on the sealing abilities of MTA Repair HP and NeoMTA Plus.

Comparison of the microleakage of mineral trioxide aggregate, calcium-enriched mixture cement, and Biodentine orthograde apical plug

BACKGROUND

One-visit apexification is a treatment of choice in necrotic immature open apex teeth. Calcium silicate base materials are suitable for this method. The purpose of this study was to investigate and compare the sealing efficiency of Biodentine, mineral trioxide aggregate (MTA) ProRoot, and calcium-enriched mixture (CEM) cement orthograde apical plug using bacterial leakage method.

MATERIALS AND METHODS

In this in vitro study a total of 70 extracted maxillary incisors were cleaned and shaped. A 1.1-mm standardized artificially open apex was created in all samples. The teeth were randomly divided into three experimental groups of 20, and two negative and positive control groups of 5. In experimental groups, 4-mm thick apical plugs of ProRoot MTA, CEM cement, or Biodentine were placed in an orthograde manner. Negative control samples were completely filled with MTA while positive control samples were left unfilled. Sealing efficiency was measured by bacterial leakage method, and results were analyzed by Kaplan-Meier and Chi-square tests. The level of significance was set at 0.05.

RESULTS

The highest number of turbidity was recorded for ProRoot MTA samples, while the lowest for Biodentine. There was a significant difference in the number of turbidity between ProRoot MTA and Biodentine groups (P < 0.001), but there was no significant difference between CEM cement and Biodentine (P = 0.133) and ProRoot MTA (P = 0.055).

CONCLUSION

Within the limitation of this in vitro study, Biodentine showed promising results as a substance with good-sealing efficiency.

Efficacy of Mineral Trioxide Aggregate and Biodentine as Apical Barriers in Immature Permanent Teeth: A Microbiological Study

Aim

To compare the bacterial leakage of mineral trioxide aggregate (MTA) and biodentine when used as an apical plug in immature permanent teeth.

Materials and methods

It was a randomized double-blind in vitro study. A total of 60 teeth were divided into 2 groups of MTA and biodentine, which were further divided into 2 subgroups (n = 30) each based on the apical plug thickness of 2 and 4 mm. The teeth were cleaned and shaped; root-end resection and canal preparation were done. Mineral trioxide aggregate and biodentine were mixed and filled as apical plugs of 2 or 4 mm thickness. Enterococcus faecalis was used to assess the bacterial leakage of the filled samples.

Statistical analysis

The comparison between the two groups was done by Chi-square test for categorical data. All p values <0.05 were considered as statistically significant.

Results

A 4 mm apical plug of biodentine showed the least amount of bacterial leakage followed by 2 mm MTA and 4 mm MTA. A 2 mm apical plug of biodentine showed the maximum bacterial leakage. But this was not statistically significant over a period of 3 months. There was a statistically significant difference (p value = 0.042) among the total number of samples that leaked in the 2 and 4 mm biodentine group.

Conclusion

Mineral trioxide aggregate and biodentine had a similar apical sealing ability. The apical sealing ability of biodentine at 4 mm thickness was greater than 2 mm thickness.

Clinical significance

The apical leakage of the materials used in apexification is one of the main causes of endodontic failures in immature necrotic teeth. Materials like MTA and biodentine have overcome various drawbacks of calcium hydroxide as apexification material. The thickness of the apical plug plays an important role in preventing any microorganism from entering the periapical area, hence maintaining an adequate seal.

How to cite this article

Abbas A, Kethineni B, Puppala R, et al. Efficacy of MTA and Biodentine as Apical Barriers in Immature Permanent Teeth: A Microbiological Study. Int J Clin Pediatr Dent 2020;13(6):656-662.

Effect of ultrasonic activation on dentinal tubule penetration of calcium silicate-based cements

This study investigated the dentinal tubule penetration of mineral trioxide aggregate (MTA), NeoMTA Plus and Biodentine placed by either manual condensation or ultrasonic activation in simulated open apex model. Standardized divergent open apex models were created using palatal roots of 60 human maxillary molars and divided into six groups according to the used cements and activation methods (n = 10): MTA-manual condensation, MTA-ultrasonic activation, NeoMTA Plus-manual condensation, NeoMTA Plus-ultrasonic activation, Biodentine-manual condensation, Biodentine-ultrasonic activation. For the measurement of penetration, the cements were mixed with 0.1% Rhodamin B and 6-mm apical portions of each root canal were obturated in an orthograde direction. The roots were embedded into acrylic blocks, and 1-mm-thick sections were obtained at 3 mm from the apex. Specimens were mounted onto glass slides and scanned under a confocal laser scanning microscope (CLSM) and stereomicroscope. Dentinal tubule penetration areas, depth and percentage were measured using LSM and ImageJ software. The data were analyzed using two-way analysis of variance (anova) with Bonferroni correction (α = 0.05). No correlation was found between stereomicroscope and CLSM analyses (p > .05). CLSM analysis showed no significant differences between MTA, NeoMTA Plus, and Biodentine groups when manual condensation was used (p > .05). Ultrasonic activation did not increase the tubular penetration of MTA, NeoMTA Plus or Biodentine as compared to manual condensation of each material (p > .05). MTA, NeoMTA Plus and Biodentine showed similar tubular penetration when manual condensation was used. Ultrasonic activation of these cements had no effect on tubular penetration of each material as compared to the manual condensation counterparts.

Regenerative Endodontic Procedures Using Contemporary Endodontic Materials

Calcium hydroxide apexification and Mineral Trioxide Aggregate (MTA) apexification are classical treatments for necrotic immature permanent teeth. The first tend to fail for lack of compliance given the high number of sessions needed; the second has technical difficulties such as material manipulation and overfilling. With both techniques, the root development is interrupted leaving the tooth with a fragile root structure, a poor crown-to-root ratio, periodontal breakdown, and high risk of fracture, compromising long-term prognosis of the tooth. New scientific literature has described a procedure that allows complete root development of these specific teeth. This regenerative endodontic procedure (REP) proposes the use of a combination of antimicrobials and irrigants, no canal walls instrumentation, induced apical bleeding to form a blood clot and a tight seal into the root canal to promote healing. MTA is the most used material to perform this seal, but updated guidelines advise the use of other bioactive endodontic cements that incorporate calcium and silicate in their compositions. They share most of their characteristics with MTA but claim to have fewer drawbacks with regards to manipulation and aesthetics. The purpose of the present article is to review pertinent literature and to describe the clinical procedures protocol with its variations, and their clinical application.

BiodentineTM versus formocresol pulpotomy technique in primary molars: a 12-month randomized controlled clinical trial

BACKGROUND

The objective of this clinical study was to prospectively compare the clinical and radiographic success rates of BiodentineTM pulpotomies versus formocresol pulpotomies in children vital primary molars.

METHODS

A randomized, split-mouth study design was used with a sample of 37 healthy children aged 4- to 8-year-old. A total of 56 pairs (112 teeth) of carious primary teeth, 1 pair per child, were selected for treatment. One tooth from each pair was randomly assigned to either the BiodentineTM pulpotomy group or the formocresol pulpotomy group. Children were followed-up at 3, 6 and 12 months for clinical evaluation and at 6 and 12 months for radiographic evaluation. Data were collected, tabulated and analyzed using Fisher exact and McNemar tests. The level of significance was set at P < 0.05.

RESULTS

At 12 months, the clinical success rates of both BiodentineTM and formocresol groups were 100%, while the radiographic success rates for BiodentineTM and formocresol groups were 100% and 98.1%, respectively. There was no statistically significant difference between both groups (P=1). The only observed radiographic failure was furcal radiolucency in the formocresol group at 12-month interval. Pulp canal obliteration was radiographically observed in 10/56 (17.9%) and 7/56 (12.5%) cases in the BiodentineTM and formocresol groups, respectively.

CONCLUSIONS

Both BiodentineTM and formocresol pulpotomy techniques demonstrated favorable clinical and radiographic outcomes over a 12-month period without any significant difference.

TRIAL REGISTRATION

Registered on NCT03779698 . Date of Registration: 18 December 2018.

Bacterial leakage and marginal adaptation of various bioceramics as apical plug in open apex model

AIM

The aim of the present study was to investigate bacterial leakage and marginal adaptation of bioceramic apical plugs.

METHODS

Extracted human mandibular premolars were prepared to simulate open apex using No. 4 Peeso reamer in retrograde direction. In total, 150 specimens were divided into 10 groups by obturation with five bioceramics in two thicknesses. Groups 1, 3, 5, 7, and 9 were obturated with ProRootMTA, Biodentine, TotalFill BC RRM paste, TotalFill BC RRM putty, and RetroMTA at 3 mm, and groups 2, 4, 6, 8, and 10 were obturated with the same materials at 4 mm. Ten specimens in each group were evaluated for bacterial leakage of Enterococcus faecalis for 75 days. Five specimens from each group were sectioned to investigate the gap area under scanning electron microscope.

RESULTS

The 3- and 4-mm Biodentine and TotalFill BC RRM putty groups and the 4-mm ProRootMTA group exhibited less bacterial leakage and lower mean percentage of gap area than those of the other groups. TotalFill BC RRM paste showed the highest leakage for both the 3- and 4-mm groups.

CONCLUSION

The 3- and 4-mm Biodentine and TotalFill BC RRM putty groups and the 4-mm ProRootMTA group exhibited the best sealing ability and marginal adaptation of apical plugs.

Biodentine™ material characteristics and clinical applications: a 3 year literature review and update

INTRODUCTION

Biodentine™ has frequently been acknowledged in the literature as a promising material and serves as an important representative of tricalcium silicate based cements used in dentistry.

AIM

To provide an update on the physical and biological properties of Biodentine™ and to compare these properties with those of other tricalcium silicate cements namely, different variants of mineral trioxide aggregate (MTA) such as ProRoot MTA, MTA Angelus, Micro Mega MTA (MM-MTA), Retro MTA, Ortho MTA, MTA Plus, GCMTA, MTA HP and calcium enriched mixture (CEM), Endosequence and Bioaggregate™.

STUDY DESIGN

A comprehensive literature search for publications from November 20, 2013 to November 20, 2016 was performed by two independent reviewers on Medline (PubMed), Embase, Web of Science, CENTRAL (Cochrane), SIGLE, SciELO, Scopus, Lilacs and clinicaltrials.gov. Electronic and hand search was carried out to identify randomised control trials (RCTs), case control studies, case series, case reports, as well as in vitro and animal studies published in the English language.

CONCLUSIONS

The enhanced physical and biologic properties of Biodentine™ could be attributed to the presence of finer particle size, use of zirconium oxide as radiopacifier, purity of tricalcium silicate, absence of dicalcium silicate, and the addition of calcium chloride and hydrosoluble polymer. Furthermore, as Biodentine™ overcomes the major drawbacks of MTA it has great potential to revolutionise the different treatment modalities in paediatric dentistry and endodontics especially after traumatic injuries. Nevertheless, high quality long-term clinical studies are required to facilitate definitive conclusions.

Effect of Calcium Hydroxide, Chlorhexidine Digluconate and Camphorated Monochlorophenol on the Sealing Ability of Biodentine Apical Plug

INTRODUCTION

Teeth with immature apex are managed by establishing an apical plug using various materials and techniques. However, the use of previously placed intracanal medicament may affect the sealing ability of permanent filling material used as an apical plug.

AIM

To evaluate the effect of removal of previously placed Calcium Hydroxide, Chlorhexidine Digluconate and Camphorated Monochlorophenol as an intracanal medicament on the sealing ability of the Biodentine as an apical plug.

MATERIALS AND METHODS

A total of 72 recently extracted human permanent teeth with single root were selected and stored in saline at room temperature. The crown portion of each tooth was removed at the level of cemento enamel junction; 14mm root length was taken as standard length. All the roots were submerged in 20% sulphuric acid up to 3 mm from the apex, for four days for root resorption. One sample was cut longitudinally to look for root resorption under stereo microscope. The canal preparation was done; the roots were kept in moist gauze after instrumentation. A total of 71 roots were randomly divided into three groups. GROUP 1:Calcium hydroxide paste, GROUP 2: Chlorhexidine digluconate, GROUP 3: Camphorated Monochlorophenol (CMCP). The medicaments were removed with stainless steel hand files and 0.5% sodium hypochlorite irrigation. After removal of medicament Biodentine was placed in apical third of resorbed roots and the remaining portion of the canals was filled with gutta-percha. All the 71 roots were analysed with fluid filtration method for evaluating microleakage.

RESULTS

Comparing all the three groups statistically there was no significant difference. The mean values were found more for group 1 followed by group 2 & 3.

CONCLUSION

All the groups showed microleakage. Calcium hydroxide showed the maximum microleakage followed by Chlorhexidine digluconate and least with CMCP.