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

Assessing the Sealing Performance and Clinical Outcomes of Endodontic Treatment in Patients with Chronic Apical Periodontitis Using Epoxy Resin and Calcium Salicylate Seals

Background and Objectives: Recognizing the significance of a hermetic apical seal for successful root canal treatment, the present investigation aimed to evaluate two sealing materials through an in vitro analysis, as well as to ascertain the clinical outcomes of patients treated with these two sealers in an in vivo setting. Materials and Methods: For the in vitro part of the study, two control groups of thirty monoradicular teeth were obturated with two sealers. Then, the sealers' performance was tested based on a predefined protocol. Group A included 30 patients treated with an epoxy oligomer resin-based sealer (Adseal, MetaBiomed), while Group S comprised 30 patients treated with a polymeric calcium salicylate-based sealer (Sealapex, Kerr). Samples were sectioned and evaluated under the microscope to determine the sealer's tightness by measuring the dye penetration into the root canal filling. For the in vivo part, a prospective study was designed to include 60 patients with chronic apical periodontitis in two endodontic treatment groups, using the same two sealers. Results: The in vitro analysis found that dye penetration in Group A was 0.82 mm (±0.428), while in Group S, the dye penetration was statistically significantly deeper, being 1.23 mm (±0.353). In the in vivo part of the study, the periapical index (PAI) significantly decreased 6 months after endodontic treatment, with 80.0% of patients in Group A having a PAI score of 2 compared to only 56.7% in Group S (p-value = 0.018). Similarly, tooth mobility scores significantly decreased after treatment, but with no difference between groups. The marginal bone loss decreased significantly more in the Adseal group compared to the Sealapex group (23.3% vs. 50.0%, p-value = 0.032). At the same time, 40.0% of patients in Group S had failed tooth healing compared to only 13.3% in Group A (p-value = 0.048). Conclusions: The in vitro study showed that Adseal had a better sealing capacity and a lower degree of dye penetration compared to Sealapex. However, on clinical evaluation in the in vivo study, both patient groups exhibited significant improvements in periapical index, tooth mobility scores, and pain reduction following endodontic treatment. Nevertheless, patients treated with Adseal showed a significantly greater improvement in PAI values, tooth mobility, and teeth healing after treatment. Overall, Adseal, as an endodontic sealer, may provide better sealing capabilities and enhanced clinical outcomes in the treatment of chronic apical periodontitis.

Coronal and apical leakage among five endodontic sealers

PURPOSE

The aim of this study was to use dye penetration to measure apical and coronal leakage simultaneously in single-canal teeth that had been treated endodontically using a single-cone obturation technique.

METHODS

One hundred single-canal, extracted human teeth were cleaned and shaped with ProTaper NEXT rotary files to size-X5 (50/.06), then randomly assigned to five sealer groups for single-cone gutta-percha obturation. The teeth were soaked in 0.6% rhodamine B at 37°C for seven days, then the roots were ground mesiodistally and the maximum apical and coronal dye penetration was measured. Differences in leakage among the sealer groups were examined using the Kruskal-Wallis test. Pairwise comparisons were made using the Mann-Whitney test with Bonferroni correction.

RESULTS

The mean values (mm) of dye penetration for AH Plus, Pulp Canal Sealer, NeoSEALER Flo, EndoSequence BC, and Super-Bond RC Sealer were 0.200, 0.300, 0.675, 0.850, and 0.900 apically, whereas 1.675, 2.075, 4.800, 6.500, and 4.125 coronally. Pairwise comparisons showed significant apical differences between AH Plus/Super-Bond RC Sealer (P = 0.047) and significant coronal differences between AH Plus/NeoSEALER Flo (P = 0.001), AH Plus/EndoSequence BC (P < 0.01), AH Plus/Super-Bond RC Sealer (P < 0.01), Pulp Canal Sealer/NeoSEALER Flo (P = 0.010), Pulp Canal Sealer/EndoSequence BC (P < 0.01), and Pulp Canal Sealer/Super-Bond RC Sealer (P < 0.01).

CONCLUSION

Coronal leakage was worse than apical leakage for all sealers. AH Plus exhibited the least leakage apically and coronally; Super-Bond RC Sealer showed the most leakage apically, and EndoSequence BC showed the most leakage coronally.

An In Vitro Comparative Evaluation of Apical Leakage Using Different Root Canal Sealers

Background

Successful endodontic therapy requires a fluid-tight apical seal. The aim of this in vitro study was to evaluate and compare the apical sealing ability of 3 root canal sealers: Apexit Plus, AH Plus, and Resilon/Epiphany sealers.

Material/Methods

Samples of 152 single-rooted teeth were divided into 2 test groups, and each group was divided into 3 subgroups based on the preparation and obturation technique. After preparation with the step-back technique, the first group of root canals were obturated with lateral gutta-percha compaction in combination with AH Plus sealer or Apexit Plus or with the Resilon/Epiphany system alone. In the second group, preparation was done with the crown-down technique and root canals were then obturated with Thermafil obturator in combination with AH Plus or Apexit Plus or with Resilon/Epiphany sealer alone. Apical leakage was determined using a dye leakage test observed with a stereomicroscope. The degree of dye leakage was assessed using the t test to comparing the arithmetic averages of the groups.

Results

In the groups prepared with the step-back technique, the average dye leakage was lower in samples obturated with Resilon/Epiphany, than in those filled with AH Plus/lateral gutta-percha compaction or Apexit Plus/lateral gutta-percha compaction. In groups prepared with the crown-down technique and obturated with the Resilon/Epiphany system, the average dye leakage was lower than in those filled with AH Plus/Thermafil obturation and those filled with Apexit Plus/Thermafil obturation.

Conclusions

Although all preparation and obturation techniques showed dye penetration, the crown-down technique paired with the Resilon/Epiphany system showed the least leakage.