Effect of Different Irrigating Solutions on Depth of Penetration of Sealer into Dentinal Tubules: A Confocal Microscopic Study

Dual- or single rinse? The tubular sealer penetration of endodontic chelating agents

INTRODUCTION

In this study, we aimed to compare the effectiveness of various chelating agents, ethilenediaminetetraacetic acid (EDTA), citric acid (CA), and etidronic acid (HEDP) mixed in two different forms, in removing the smear layer and promoting the penetration of an endodontic sealer into the dentinal tubules of extracted single-rooted teeth.

METHODS

The study used 75 teeth divided into five groups: 17% EDTA, 10% CA, 9% HEDP + NaOCl, 9% HEDP + distilled water (DW), and a control (DW) group. Scanning electron microscopy was used to assess smear layer removal and confocal laser microscopy was used to evaluate tubular sealer penetration at different depths from the apical tip.

RESULTS

Sealer penetration was highest with 17% EDTA and 10% CA as compared with the other agents (p<0.001). At the cervical third, the sealer penetration for EDTA, HEDP + NaOCl, and HEDP + DW groups were significantly different than those in DW (p = 0.020). For the middle third, EDTA, CA, and HEDP + NaOCl groups were significantly higher than those of the DW group (p<0.001). Cervical-level values were significantly higher than apical-level values for HEDP + NaOCl, HEDP + DW, and DW (p<0.001). Smear layer removal was lower with 9% HEDP + DW than with 17% EDTA and 10% CA at all depths (p<0.001). A significancy in smear layer removal was observed between 10% CA and control (p = 0.015) in middle depth.

CONCLUSION

Within the limitations of this study, highest values were seen in EDTA and CA in terms of sealer penetration and smear layer removal. In the light of these findings, the use of strong chelating agents highlights better clinical efficiency than dual-rinse or single HEDP irrigation.

Is a mix - A fix? "A microscopic analysis of depth of penetration of three combinations of irrigants"

Aims

The aim of the study is to evaluate the penetration depth of irrigants mixed with NaOCl into dentinal tubules at the apical third of the root canal using a confocal laser scanning microscope (CLSM).

Materials and Methods

Thirty-six single-rooted teeth were selected, decoronated, and straight-line access established. Then, the canal was enlarged with hand Protaper till size F3. The samples were divided randomly into three groups: Group 1 was irrigated with 3% NaOCl mixed with 1% phytic acid; Group 2 was irrigated with 3% NaOCl mixed with 18% etidronic acid; and Group 3 was irrigated with 3% NaOCl mixed with chitosan. The samples were subjected to CLSM evaluation. One-way analysis of variance with Tukey's post hoc was used for statistical analysis.

Results

Group 3 (NaOCl with chitosan) showed a greater depth of penetration in comparison to Groups 1 and 2.

Conclusion

Within limitations, it can be concluded that chitosan, in combination with NaOCl can be used as an alternative to the current irrigation protocol.

Comparison of the dentin tubule penetration of AH Plus, WellRoot ST, and MTA BioSeal after obturation, retreatment, and re-shaping of the root canals

It was aimed to compare the dentine tubule penetration of AH Plus, MTA Bioseal, and WellRoot ST after filling, retreating, and reshaping the root canals by using a novel microscopic method. Seventy-five mandibular incisors with single root canals were shaped with Protaper Next system (PTN; X2-25/0.06) The teeth were obturated with AH Plus labeled with Rhodamin B and MTA Bioseal or WellRoot ST sealer which were labeled with Fluo-3. Then the root canal fillings were removed with Protaper Universal Retreatment files. At the last stage, the teeth were reshaped with PTN (X3-30/0.07). The samples were transversally sectioned and examined using a Cytation 5 reader and Gen5 software regarding the mean and the maximum depth of sealer penetration. No significant difference was observed between the groups, except for the 6 mm level after reshaping the root canals (p < .05). It is not possible to completely remove the sealer remnants from the dentin walls even after reshaping the root canals. RESEARCH HIGHLIGHTS: Even after reshaping the root canals in the retreatment procedure, it is not possible to completely remove the filling residues of the epoxy-resin-based, calcium-silicate-based and MTA-based endodontic pastes from the dentin walls.

Evaluation of interfacial adaptation and penetration of bioceramic-based sealers in oval root canals: A confocal laser scanning microscope study

To assess the interfacial adaptation and penetration depth of three different bioceramic-based sealers (CeraSeal, EndoSeal MTA, Nishika Canal Sealer BG) compared to an epoxy resin-based sealer (AH Plus) in oval root canals. Fourty extracted single-rooted mandibular premolar with oval canal were prepared and randomly allocated according to the obturation into; CeraSeal, EndoSeal MTA, Nishika Canal Sealer BG and AH Plus. The roots were sectioned at 3, 6 and 9 mm from the apex. The sealer adaptation and the penetration depth were evaluated under confocal laser scanning microscope. One-way ANOVA and Repeated measure ANOVA were used to statistically analyze the data. Nishika Canal Sealer BG showed significantly higher sealer adaptation than EndoSeal MTA (P < .001) at apical and middle thirds. Meanwhile, AH Plus showed significantly higher sealer adaptation than EndoSeal MTA (P = 0.011) at middle third. For sealer penetration, Nishika Canal Sealer BG showed the longest sealer penetration that was significant compared to AH Plus (P < .001) and EndoSeal MTA (P < .001) whereas CeraSeal was significantly higher than EndoSeal MTA (P = 0.029) at coronal third. For AH Plus, there was a significant less sealer penetration at coronal third compared to apical and middle thirds (P < .05). Whereas for EndoSeal MTA, the coronal third has significant less penetration compared to the middle third (P = 0.032). Endoseal has the lowest adaptation and penetration depth. Nishika Canal Sealer BG has better adaptation and penetration depth using single cone obturation technique in oval canal. RESEARCH HIGHLIGHTS: All the tested root canal sealers have some percentage of gaps and vary in their penetration capability into dentinal tubules. Nishika Canal Sealer BG has significantly better sealer adaptation to root dentinal walls than that of EndoSeal MTA at the apical and middle third but not significantly different from other type of sealers used. Nishika Canal Sealer BG has significantly better penetration depth than AH Plus and EndoSeal MTA at the coronal third of radicular dentin.

Calcium Silicate-Based Sealer Dentinal Tubule Penetration-A Systematic Review of In Vitro Studies

The aim of this systematic review was to perform a qualitative synthesis of in vitro studies which evaluate and compare the penetration of calcium silicate-based sealers into dentinal tubules. A systematic advanced search was performed in Scopus, Embase, Medline (via PubMed), Web of Science, and Cochrane databases on the 1 December 2022. In vitro studies that compared the tubular penetration of at least two calcium silicate-based sealers in extracted human teeth were eligible. PRILE 2021 guidelines were used for the assessment of the risk of bias included studies. The search identified a total of 680 preliminary records, among which 12 studies were eligible for review. The most used methodology to evaluate sealer penetration was the use of a fluorochrome together with the tested sealers and the analysis of their penetration under confocal laser microscopy. Regarding the results of the included studies, calcium silicate-based sealers exhibit a favorable dentinal tubule penetration. Tubular penetration, however, can be affected by factors such as the irrigation protocol, sealer activation, the filling method used, and root canal morphology. EndoSequence BC Sealer showed the highest sealer penetration among the tested sealers. The influence of different fluorochromes on the results of dentinal tubule penetration studies should also be further explored. The in vitro nature of the included studies limits the applicability of the results into the clinical setting. Prospero registration: CRD42022383896.

Comparison of Dentinal Tubule Penetration between a Calcium Silicate-Based Sealer with Ultrasonic Activation and an Epoxy Resin-Based Sealer: A Study Using Confocal Laser Scanning Microscopy

OBJECTIVE

 The aim of this study was to compare the degree of dentinal penetration between an epoxy resin-based sealer applied by using two different filling methods and an ultrasonically activated calcium silicate-based sealer via confocal laser scanning microscopy (CLSM).

MATERIALS AND METHODS

 Forty-five extracted permanent maxillary premolars with type II canals (Vertucci's classification) were subjected to the experiment. The root canals were instrumented and distributed randomly into the following three groups: AH Plus + continuous wave technique (AHC group); AH Plus + single cone technique (AHS group); and Endoseal MTA + single cone technique with ultrasonic activation (EMS) group. Each sealer was labeled with rhodamine B dye to allow visualization under CLSM. The sealer penetration depth in each sample was observed at 2 mm and 5 mm from the apex by using CLSM. The data were statistically analyzed by using analysis of variance or Kruskal-Wallis H test according to normality of variable (α = 0.05).

RESULTS

 In all groups, the maximum sealer penetration depth, mean fluorescence intensity, and sum fluorescence intensity values were higher at the 5-mm level than at the 2-mm level. At the 5-mm level, the EMS group showed the lowest value (p = 0.02). At the 2-mm level, there were no statistically significant differences among any of the groups. The AHC group showed higher values than the other groups, but there was no statistically significant difference in the apical area where access of instruments was difficult.

CONCLUSION

 The AHC group showed the highest dentinal tubule penetration, but had questionable filing efficacy in the apical area, which is of particular importance for the success of root canal treatment. Therefore, in areas such as the apical 2 mm of premolars with type II canals, which are difficult to access by using instruments such as heat carriers, other appropriate approaches may be required accordingly.

Nanoparticles in Dentistry: A Comprehensive Review

In recent years, nanoparticles (NPs) have been receiving more attention in dentistry. Their advantageous physicochemical and biological properties can improve the diagnosis, prevention, and treatment of numerous oral diseases, including dental caries, periodontal diseases, pulp and periapical lesions, oral candidiasis, denture stomatitis, hyposalivation, and head, neck, and oral cancer. NPs can also enhance the mechanical and microbiological properties of dental prostheses and implants and can be used to improve drug delivery through the oral mucosa. This paper reviewed studies from 2015 to 2020 and summarized the potential applications of different types of NPs in the many fields of dentistry.

Influence of chelating solutions on tubular dentin sealer penetration: A systematic review with network meta-analysis

This systematic review assessed the influence of conventional final irrigation with chelating solutions (CS) on tubular dentin sealer penetration (TDSP). The literature search was conducted in eight electronic databases using MeSH, DeCS, EMTREE and free terms. The study protocol followed the PRISMA guidelines and was registered on the PROSPERO database (CRD42020203080). Twelve studies were included, and a qualitative synthesis and network meta-analysis of the data were performed. The risk of bias of the studies was assessed using an adaptation of the JBI Critical Appraisal tool. QMix was the solution with the highest probability of having the highest percentage of TDSP in the apical (34.1%), middle (86.5%) and coronal (97.7%) thirds. Eleven studies presented a moderate risk of bias, whereas one study presented a high risk of bias. In conclusion, CS improves sealer penetration into the dentinal tubules with QMix demonstrating superior results.

Time-Dependent Effect of Chitosan Nanoparticles as Final Irrigation on the Apical Sealing Ability and Push-Out Bond Strength of Root Canal Obturation

Materials and Methods

Fifty-six premolars were used in this study and divided by two evaluations: 28 teeth for apical sealing ability and 28 others for bond strength. Each study was assigned randomly into two groups of fourteen teeth: Group-1, final irrigation with 17% EDTA; Group-2, with 0.5% chitosan nanoparticles. Each group was further divided into two groups of 7 each: Group-A, final irrigation was applied for 1 minute; Group-B, for 3 minutes. All teeth were obturated with epoxy resin-based sealer and gutta-percha. In the apical sealing ability study, the obturated teeth were immersed in 2% methylene blue and observed under a stereomicroscope (8x magnification). In the bond strength study, the teeth were tested using the push-out technique and observed under a stereomicroscope (40x magnification) to determine the failure type. Data from each evaluation were analysed with two-way ANOVA followed by the LSD test.

Results

Final irrigation using 0.5% chitosan nanoparticles produced the same apical sealing ability and bond strength as 17% EDTA (p > 0.05). A significant difference occurred between application times (p < 0.05). The failure type was observed predominantly as cohesive, and the least was adhesive.

Conclusion

Regardless of the final irrigation solution used, 3-minute application time produced greater apical sealing ability and push-out bond strength than 1-minute application time.

Sealer penetration: effect of separated file's cross-section, taper and motion characteristics

OBJECTIVES

The separated root canal instruments may affect the quality of root canal filling, hence the success of endodontic treatment. The aim of this study was to evaluate the effects of separated file fragments of nickel-titanium rotary systems with different cross-section, taper and motion characteristics on the apical sealer penetration in oval-shaped root canals via confocal laser scanning microscope (CLSM).

MATERIALS AND METHODS

Distal roots of 60 mandibular molars with oval-shaped root canals were randomly divided into 4 groups as follows: group 1, FlexMaster Nickel Titanium Rotary File System (NTRFS) (separated instrument: 30/.06); group 2, ProTaper Next NTRFS (X3); group 3, ProTaper Universal NTRFS (F3); group 4, Revo-S NTRFS (AS30/.06). Root canals were filled with gutta-percha and AH plus labelled with 0.1% rhodamine B using a warm vertical compaction technique. Each specimen was horizontally sectioned at 1st, 3rd and 5th mm from apical foramen. Amount of maximum and average penetration depths, penetration percentage and sealer penetrated area were measured and analysed with one-way repeated measures of ANOVA and the Bonferroni post hoc tests. p < 0.05 was considered significant.

RESULTS

The penetration depth, percentage and penetrated area of the sealer increased from apical to coronal in all systems. The maximum and average penetration depths and penetration areas were higher in FlexMaster and Revo-S groups at the 3rd mm (p < 0.05). At the 5th mm, the Revo-S group had a higher penetration percentage, when compared with ProTaper Next and ProTaper Universal groups (p < 0.05).

CONCLUSIONS

In the 1st mm, separated fragments of any system did not allow the penetration of the sealer, while it was observed that the files with constant taper showed more positive results in terms of sealer penetration at apical 3rd and 5th mm.

CLINICAL RELEVANCE

In the presence of a separated file, the taper of the file might significantly affect the amount of penetrated sealer into the dentinal tubules as compared with the cross-section and motion characteristics of the file.