Periapical repair after root canal filling with different root canal sealers

Laboratory study of tissue repair of resin-based endodontic sealers in critical surgical defects

Filling materials should be restricted to the root canal space. However, sometimes it is impossible to control the apical extrusion, in this case, the fate of the filling material and the result of the treatment will depend on its physicochemical properties and biocompatibility.

The Efficacy of Two Novel Retreatment Systems in the Removal of Root Canal Obturating Materials (An In vitro Study)

BACKGROUND: The complete removal of root filling material is one of the main goals of non-surgical endodontic retreatment. Thus, the development of new techniques and instruments aiming to promote this task presents clinical significance. AIM: The purpose of the study was to assess the amount of residual root canal filling materials (gutta-percha/sealer) after using two different endodontic retreatment systems and ultrasonic tip. METHODS: Forty-five mandibular premolar teeth were mechanically instrumented and obturated. Retreatment was performed using two different Endostar RE (Group 2), Rogin retreatment system (Group 3), and ultrasonic tip (Group 1). Roots were separated buccolingually into two halves. A digital camera connected to the stereomicroscope captured images to each half. Image-J software was used to evaluate and measure the areas with remaining filling material in each third (cervical, middle, and apical). RESULTS: Data analysis revealed significant differences between the groups in the coronal, middle, and apical thirds (p < 0.05). The ultrasonic retreatment tips (G1) were significantly more efficient in removing the gutta-percha and sealers compared to the Rogin (G3) and Endostar (G2) retreatment endodontic kits. CONCLUSIONS: All the file systems left some filling material in the canals. Ultrasonic retreatment tip had maximum efficacy for the removal of filling materials in comparison with the retreatment file systems under investigation.

The evaluation of physical properties of a polyurethane expandable endodontic sealer: a preliminary study

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.

Retreatability of BC Sealer and AH Plus root canal sealers using new supplementary instrumentation protocol during non-surgical endodontic retreatment

OBJECTIVE

The aim of this study was to evaluate the efficacy of supplementary techniques (ultrasonic tip/XP-endo Finisher R) in removing remaining filling materials (gutta-percha/AHPlus/BCSealer) from oval-shaped root canals during non-surgical endodontic retreatment.

MATERIAL AND METHODS

Twenty-eight distal roots of human mandibular molars with single and oval-shaped canals were initially shaped with a R40 instrument and filled with gutta-percha points and AH Plus (n = 14) or BC Sealer (n = 14) followed by an initial micro-CT scanning. Initial filling material removal was performed in all 28 samples with an R50 instrument, and all samples submitted to a second micro-CT. Supplementary techniques with ultrasonic tips or XP-endo Finisher R instruments were performed in each sealer group, and all samples submitted to a third micro-CT. The volume of remaining filling material was calculated for the entire canal as well as for the coronal, middle, and apical thirds. Statistical analyses were performed using T, ANOVA 3-way, and Tukey tests.

RESULTS

Lower values of remnant filling material were found for BC Sealer (16.06 ± 14.34) compared to AH Plus (28.30 ± 10.54) (P < 0.001), and considering the supplementary technique, lower values of remnant filling material were found for the ultrasonic tip (18.95 ± 11.05) compared to XP-endo Finisher R (25.41 ± 15.81) (P = 0.025). Ultrasonic instruments significantly reduced the percentage of remaining filling material for both AH Plus (P = 0.04) and BC Sealer (P = 0.02) while XP-endo Finisher R was effective for AHPlus only (P = 0.04). The remaining filling material was observed in all samples regardless the filling material or the supplementary technique employed.

CONCLUSIONS

Supplementary techniques increased filling material removal; however, none of them was able to render root canals completely free from root fillings. Ultrasonic tips should be considered a good option for endodontic retreatment, especially for bioceramic cases.

CLINICAL RELEVANCE

Supplementary instrumentation techniques are effective tools to reduce the amount of filling materials during root canal retreatment.

Biocompatibility of Root Canal Sealers: A Systematic Review of In Vitro and In Vivo Studies

(1) Aim: To perform a systematic review of the literature on the biocompatibility of root canal sealers that encompasses the various types of sealers that are commercially available as well as both in vitro and in vivo evidence. (2) Methods: This systematic review has been registered in PROSPERO (ID 140445) and was carried out according to PRISMA guidelines using the following databases: PubMed, Cochrane Library, ClinicalTrials.gov, Science Direct, and Web of Science Core Collection. Studies published between 2000 and 11 June 2019 that evaluated cytotoxicity (cell viability/proliferation) and biocompatibility (tissue response) of root canal sealers were included. (3) Results: From a total of 1249 studies, 73 in vitro and 21 in vivo studies were included. In general, studies suggest that root canal sealers elicit mild to severe toxic effects and that several factors may influence biocompatibility, e.g., material setting condition and time, material concentration, and type of exposure. Bioactive endodontic sealers seem to exhibit a lower toxic potential in vitro. (4) Conclusions: The available evidence shows that root canal sealers exhibit variable toxic potential at the cellular and tissue level. However, the methodological heterogeneity among studies included in this systematic review and the somewhat conflicting results do not allow a conclusion on which type of sealer presents higher biocompatibility. Further research is crucial to achieve a better understanding of the biological effects of root canal sealers.

Assessment of pain and dissolution of apically extruded sealers and their effect on the periradicular tissues

Aim:

This study aimed to evaluate the intensity of pain after unintentional extrusion of resin-based and calcium hydroxide (Ca[OH]₂)-based endodontic sealers as well as their influence on the periradicular tissues.

Materials and Methods:

A total of 120 single-rooted teeth exhibiting extrusion of sealer in the postoperative radiographs were included in the study. According to the sealers used, the teeth were divided into four groups (n = 30): Group I – AH Plus^®, Group II – Resino Seal, Group III – Sealapex™, and Group IV – Apexit^® Plus. Postoperative pain was assessed at 0–6 h, 6–12 h, 12–24 h, and 24–48 h of obturation using Visual Analog Scale. Radiographs were taken at 3, 6, and ≥9 months to 1-year follow-up and compared with baseline radiographs to assess the dissolution of extruded sealers and healing of periradicular tissues.

Statistical Analysis:

ANOVA, Kruskal–Wallis, and Pearson's Chi-square test were used. Statistical significance level was set at P ≤ 0.05.

Results:

Postoperative pain intensity was higher in case of AH Plus^® sealer followed by Sealapex™ up to 12 h of obturation and was statistically nonsignificant. Apexit^® Plus at all time intervals showed statistically significant less pain intensity than AH Plus^® and Sealapex™ but not from Resino Seal group. At 9-month follow-up, better healing of periradicular tissues was shown by AH Plus^® (48.1%) followed by Apexit^® Plus (44.4%) and Sealapex™ (41.2%) with statistically nonsignificant difference.

Conclusion:

In case of periapical extrusion, both resin-based and Ca(OH)₂-based sealers caused postoperative pain. Both Ca(OH)₂- and resin-based sealers did not influence the treatment outcome.

Development of a root canal treatment model in the rat

Root canal treatment is performed to treat apical periodontitis, and various procedures and techniques are currently used. Although animal models have been used in the developmental research of root canal treatment, little of this research has used small animals such as rats, because of their small size. In this study, root canal treatment was performed on the rat mandibular first molar, which had four root canals, using a microscope, and the therapeutic effect was evaluated bacteriologically, radiologically and histopathologically. By performing root canal treatment, the level of bacteria in the mesial root of the treated teeth was reduced by 75% compared with the control. Additionally, the volume of the periapical lesions of the treated teeth as measured by micro-computed tomography decreased significantly 2 weeks after the root canal treatment when compared with the control. Histological evidence of healing was observed in the treatment group 8 weeks after root canal treatment. These results suggest that a root canal treatment model using rats can be used in developmental research for novel methods of root canal treatment.

Clinical and radiographic assessment of periapical pathology in single versus multivisit root canal treatment: An in vivo study

Objective:

The objective of the study was to compare and evaluate the clinical and radiographic outcome of single- versus multivisit endodontic treatment in teeth with periapical pathology at the end of 1, 3, and 6 months.

Materials and Methods:

Sixty single- and multi-rooted teeth indicated for root canal treatment with periapical pathology were included in the study. The teeth were assigned randomly into two groups Group I and Group II (n = 30 each), which were further subdivided into subgroup IA, subgroup IB and subgroup IIA, subgroup IIB (n = 15 each), respectively. Group I was medicated with ApexCal paste and obturated using the standardized protocol in second visit 7–10 days later, whereas Group II was obturated at the first visit. In subgroup IA and subgroup IIA, obturation was done using Apexit Plus sealer, whereas, in subgroup IB and subgroup IIB, AH Plus sealer was used. Patients were recalled at intervals of 1, 3, and 6 months to evaluate teeth for periapical healing.

Results:

Kruskal–Wallis and one-way ANOVA test showed no significant difference between Groups I and II, whereas Wilcoxon signed-rank test showed improvement in all the subgroups with highly significant P value (≤0.001).

Conclusion:

Single-visit root canal treatment can be considered as a viable option for treatment of teeth with periapical pathology.

Evaluation of three different rotary systems during endodontic retreatment - Analysis by scanning electron microscopy

Background

Endodontic therapy is considered a series of important and interdependent steps, and failure of any of these steps may compromise the treatment outcome. This study aimed to evaluate the effectiveness of three different rotary systems in removing obturation materials during endodontic retreatment using scanning electron microscopy (SEM) analysis.

Material and Methods

Thirty-six endodontically treated teeth were selected and divided into 3 groups of 10 and 1 control group with 6 dental elements. The groups were divided according to the rotary system used for removing gutta-percha, as follows: G1: ProTaper system; G2: K3 system; G3: Mtwo system; and G4: Control group. Thereafter, the roots were split and the sections were observed under SEM, for analysis and counting of clear dentinal tubules, creating the variable “degree of dentinal tubule patency” (0: intensely clear; 1: moderately clear; 2: slightly clear; 3: completely blocked). The data were subjected to the Friedman and Kruskal-Wallis statistical tests.

Results

No differences were observed in the “degree of dentinal tubule patency” neither between the root thirds (to each evaluated group) nor between the groups (to each evaluated third). Nevertheless, when the three root thirds were grouped (providing evaluation of all root extension), the “degree of dentinal tubule patency” was lower in G1 than in G3 (p<0.05), but showed no differences neither between G1 and G2 nor G2 and G3.

Conclusions

No technique was able to completely remove the canal obturation material, despite G1 having shown better results, although without significant difference to G2

Key words:Scanning electron microscopy, NiTi, retreatment.

Influence of radiopaque fillers on physicochemical properties of a model epoxy resin-based root canal sealer

Objective

To verify the influence of radiopaque fillers on an epoxy resin-based sealer.

Material and Methods

Experimental sealers were formulated by adding 20%, 40%, 60%, 80%, 100% and 120% of calcium tungstate, ytterbium trifluoride or barium sulphate by weight to an epoxy-resin-base. Setting time, flow, film thickness, radiopacity, sorption, solubility, pH and push-out bond strength were evaluated.

Results

The setting time ranged from 373 to 612.66 min, the flow varied from 13.81±0.49 to 22.49±0.37 mm, and the film thickness ranged from 16.67±5.77 to 33.33±11.54 µm. The lowest pH was 5.47±0.53, and the highest was 6.99±0.03. Radiopacity varied from 0.38±0.04 to 2.57±0.21 mmAl and increased with the amount of filler. Calcium tungstate sealers had a higher sorption and solubility than other sealers. There was no significant difference in the push-out bond strength among the fillers at the 120% concentration.

Conclusion

The inorganic fillers evaluated and their concentrations affect the physicochemical properties of an epoxy resin-based root canal sealer.

Influence of Sealer Placement Technique on the Quality of Root Canal Filling by Lateral Compaction or Single Cone

The aim of this study was to evaluate the influence of the sealer placement technique on the quality of root canal filling using Lateral Compaction (LC) or Single Cone (SC). In order to do that, 60 mesial roots of mandibular first molars were prepared and divided into 2 groups (n=30), according to the filling technique: LC and SC. Each group was subdivided into 3 subgroups (n=10), according to the different sealer placement methods: A: Master gutta-percha (GP) cone; B: Lentulo spiral; C: File. The roots were sectioned at 2, 4 and 6 mm from the apex and photographed with the aid of a digital microscope. Then, areas of GP, endodontic sealer and voids were measured, and these data were subjected to statistical analysis. LC technique showed no statistically difference (p>0.05) in the percentage of GP area, sealer and voids between the subgroups at any of the three levels. After use of SC, higher percentages of sealer area were found at all levels (p<0.01) when the sealer was placed with a file. At 2 mm, higher percentage of void areas (p<0.05) was observed when the cone was used, lower percentage with K-file and the lowest percentage with Lentulo. At 4 mm, cone showed higher percentage of void areas (p<0.05). At 6 mm, there were no significant differences (p>0.05) between the three methods. Considering these results, using an instrument for sealer placement was important in the SC technique to reduce voids. Regarding LC, the sealer placement techniques provided similar results.

Ability of new obturation materials to improve the seal of the root canal system: a review

New obturation biomaterials have been introduced over the past decade to improve the seal of the root canal system. However, it is not clear whether they have really produced a three-dimensional impervious seal that is important for reducing diseases associated with root canal treatment. A review of the literature was performed to identify models that have been employed for evaluating the seal of the root canal system. In vitro and in vivo models are not totally adept at quantifying the seal of root canals obturated with classic materials. Thus, one has to resort to clinical outcomes to examine whether there are real benefits associated with the use of recently introduced materials for obturating root canals. However, there is no simple answer because endodontic treatment outcomes are influenced by a host of other predictors that are more likely to take precedence over the influence of obturation materials. From the perspective of clinical performance, classic root filling materials have stood the test of time. Because many of the recently introduced materials are so new, there is not enough evidence yet to support their ability to improve clinical performance. This emphasizes the need to translate anecdotal information into clinically relevant research data on new biomaterials.

Resilon: a comprehensive literature review

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

Histopathological examination of newly-developed adhesive silicone denture relining material

We aimed to evaluate the subcutaneous tissue reaction to a newly developed adhesive silicone denture relining material, SG, (Neo Dental Chemical Products Co., Ltd. Tokyo, Japan). We embedded the experimental material SG and another existing control material, Roeko Seal (RS), in the dorsal area of 22 male ddY mice. One week and 12 weeks after the embedding, the tissues surrounding the embedded materials were removed and a histopathological examination was performed. The results demonstrate that the basic histopathological aspects are the formation of granulation tissue and the change of the tissue to fibrous capsule over time. The results suggests that the newly-developed SG is safe as compared with the control RS, whose composition is similar.

Apical sealing of root canal fillings performed with five different endodontic sealers: analysis by fluid filtration

Objectives

To evaluate the sealing ability of five root canal sealers, including two experimental cements (MBP and MTA-Obtura) using the fluid filtration method.

Material and Methods

Teeth were divided into 5 study groups: G1-AH Plus; G2-Acroseal; G3-Sealapex; G4-MBP; G5-MTA-Obtura; and two controls. Chemical-mechanical preparation was performed with ProFile rotary nickel-titanium instruments 1 mm short of the apical foramen. The sealing ability was evaluated by fluid filtration at 15, 30, and 60 days.

Results

The statistical analysis showed significant difference between the materials at different periods (p<0.05). AH Plus and MBP had similar leakage values at 15 and 60 days, alternating with significant reduction at 30 days, while the other materials showed progressive increase in leakage values. Acroseal and Sealapex presented the best results at 15 days and the worst at 60 days.

Conclusions

All sealers evaluated presented fluid leakage, with AH Plus and MBP showing the best results at the end of the experimental period. Acroseal, Sealapex, and MTA-Obtura presented increase in leakage values at longer observation periods.