Search Results (8)

Background and objectives: Post-operative pain (POP) is a common complication after root canal treatment and is influenced by various clinical and patient-related factors. The present study evaluated the incidence and intensity of POP following root canal treatment using a bioceramic sealer performed by operators with different levels of experience. Methods: A total of 115 patients were included in this prospective observational study. Patients were treated by operators with different levels of experience: postgraduate students (PGSs) and endodontic specialists (ESs). Standardized protocols were used in two distinct appointments: an instrumentation visit and an obturation visit. Obturation was performed using the continuous wave condensation technique and Total Fill Hi-Flow BC Sealer (TFHF). POP, mastication discomfort, and sleep disturbance were assessed at 24, 48, and 72 h after the instrumentation and obturation phases using a numeric rating scale (NRS). Results: The results indicate significantly higher POP after the instrumentation phase, compared to the obturation phase (p < 0.001). The pain intensity progressively decreased over time for both phases. No significant differences were observed between the PGS and ES groups regarding POP, mastication discomfort, or sleep disturbance at any time. Sealer extrusion did not significantly impact POP (p > 0.05). Conclusions: This study found that operator experience does not significantly influence POP when a standardized protocol is followed. The use of TFHF with the continuous wave condensation technique was associated with minimal POP. Full article

The impact of adding silver nanoparticles (AgNPs) to bioceramic (BC) sealer on their ability to penetrate dentinal tubules is still unknown. Thus, this confocal laser scanning microscopic (CLSM) study aimed to assess the extent of dentinal tubule penetration of BC sealer (TotalFill^® Hiflow BC Sealer™, FKG, Switzerland) with and without AgNPs using the single-cone (SC) technique and the continuous-wave condensation (CWC) technique. AgNPs alone as well as in a mixture with the BC sealer were characterized using scanning electron microscopy and transmission electron microscopy. Single-rooted extracted human teeth (N = 100) were selected and prepared, and then divided into four groups (n = 25). Group 1 (BC/SC): BC sealer obturated with the SC technique. Group 2 (BC+AgNPs/SC): BC sealer with AgNPs obturated with the SC technique. Group 3 (BC/CWC): BC Sealer obturated with the CWC technique. Group 4 (BC+AgNPs/CWC): BC Sealer with AgNPs obturated with the CWC technique. After 2 weeks, roots were horizontally sectioned to obtain 1 mm thick dentin slices that were evaluated with CLSM. Sealer dentinal tubule penetration area and the maximum depth of penetration were measured. Data were analyzed with one-way ANOVA and the Tukey multiple comparison tests (p ≤ 0.05). The characterization process demonstrated a spherical-shaped nanoparticles without obvious agglomeration. The results showed that Group 2 (BC+AgNPs/SC) significantly demonstrated the highest mean tubular penetration depth, while group 3 (BC/CWC) had the lowest mean depth. Group 2 (BC+AgNPs/SC) exhibited the significantly highest mean value for the total area of penetration. However, groups 1 (BC/SC) and 3 (BC/CWC) exhibited the lowest mean value of total penetration area, with no statistically significant difference. The integration of AgNPs with BC sealer markedly enhanced penetration into dentinal tubules. The SC technique demonstrated superior penetration relative to the CWC technique. Full article

The aim of this study was to evaluate the bond strength of the calcium silicate-based sealer (CSS) modified with the silver nanoparticles (AgNPs) using the single-cone technique (SC) and the continuous wave condensation (CWC) technique, measured by a universal testing machine. The AgNPs and the modified sealers were characterized by scanning electron microscopy and transmission electron microscopy. One hundred single-rooted extracted human permanent teeth with a single root canal were cleaned and shaped with a Protaper Next system. The teeth were randomly divided into four groups (n = 25) as follows: Group 1, canals were obturated using the SC technique with TotalFill^® BC Sealer. Group 2, canals were obturated using the SC technique with TotalFill^® BC Sealer mixed with AgNPs. Group 3, canals were obturated using the CWC technique with TotalFill^® HiFlow BC Sealer. Group 4, canals were obturated using the CWC technique with TotalFill^® HiFlow BC Sealer mixed with AgNPs. After two weeks, 1 mm-thick dentin slices were cut and exposed to a push-out bond strength test using a universal testing machine. Specimens were examined under a digital microscope to determine the mode of failure. Statistical analysis was performed using ANOVA and Tukey multiple comparison tests (p < 0.05). The nanoparticle characterization revealed a spherical morphology with no obvious aggregations. The results showed that group 4 had the highest dislodgement resistance compared to all groups (p < 0.05). Group 4 was significantly higher in push-out bond strength value than group 1 (p < 0.001) and group 3 (p < 0.003), but not significantly higher than group 2. Cohesive failure was the most prevalent failure mode among all groups. It can be concluded that the incorporation of silver nanoparticles into the calcium silicate-based sealer significantly increased the bond strength. The warm obturation approach demonstrated significantly higher resistance to dislodgment as compared to the single-cone technique. Full article

The present study aimed to evaluate and compare the radiopacity and surface morphology of AH Plus Bioceramic Sealer (AHPB), Bio-C Sealer (BIOC), Biodentine (BD), BioRoot RCS (BR), Grey-MTAFlow (GMF), White-MTAFlow (WMF), TotalFill BC Sealer (TF), and TotalFill BC Sealer HiFlow (TFHF) at different time moments—30 min, 24 h, and 28 days. Ten specimens of each material were prepared according to the ISO-6876:2012 standard and radiographed next to an aluminum step wedge using a digital sensor. The specimens were stored in a gelatinized Hank’s balanced salt solution at 37 °C between assessments. The mean grayscale values of each specimen were converted into equivalent aluminum thickness by a linear regression model. Characterization of the surface morphology was performed by using a scanning electron microscope at ×4.0k and ×10.0k magnifications. The radiographic analysis revealed that all the tested materials exceeded the ISO-specified limit of 3 mm Al, with the highest radiopacity presented by AHPB and the lowest by BD. None of the tested materials demonstrated considerable variances between the 30 min and the 24 h radiopacity level (p < 0.05), and statistically significant long-term radiopacity changes were exhibited by BR, TFHF, and TF (p > 0.05). All the specimens demonstrated a common feature of limited precipitate formation, with numerous unreacted particles still presented on the surface after 24 h, whereas the particle rearrangement and the deposition of precipitates were clearly observed after 28 days. Full article

The aim of the present in vitro study was to evaluate the intratubular penetration of three bioceramic sealers in root canal retreatment. Here, 30 single-rooted human teeth were instrumented with the Protaper Universal system and filled with gutta-percha and the epoxy-resin-based sealer AH Plus mixed with rhodamine B. After two weeks in a humid environment, they were re-instrumented with Reciproc Blue and divided into three groups according to the endodontic sealer to be used in the re-filling (n = 10): G1: CeraSeal, G2: TotalFill BC Sealer, G3: TotalFill BC Sealer HiFlow. For the filling, a single cone technique was used, and the respective sealers were mixed with fluorescein. The roots were then sectioned at 2, 5, and 8 mm (apical, medial, and coronal measurement points, respectively) from the apex, and the dentinal tubule penetration depth and percentage of penetration around the canal perimeter were evaluated by means of confocal laser scanning microscopy (CLSM). Penetration between groups was compared using the Kruskal−Wallis test, and within each group using the Wilcoxon test. Statistical significance was established at p < 0.05. A non-significant reduction was found in the penetration depths and in a percentage of penetration around the canal perimeter between AH Plus and the tested calcium-silicate-based sealers (p > 0.05). Consequently, this reduction may not affect the three-dimensional seal of the root canal system in a negative manner. The penetration depth and percentage of penetration around the canal perimeter at both the root canal treatment and retreatment were significantly reduced from the coronal to apical points in all groups (p < 0.05). Full article

Sealer staining using rhodamine B dye to investigate the penetration depth of endodontic sealers was proven unsuitable for this purpose. This study aimed to investigate the sealer penetration depth into dentinal tubules by scanning electron microscopy (SEM). Root canals of 52 human upper central incisors were instrumented using the ProTaper Gold NiTi system (Dentsply Sirona, York, PA, USA) up to size F3. After irrigation with sodium hypochlorite and citric acid combined with ultrasonic activation, the root canals were either filled using the epoxy resin sealer AH Plus (Dentsply Sirona) or the calcium silicate-based sealer Total Fill BC Sealer HiFlow (TFHF, FKG Dentaire, La Chaux-de-Fonds, Switzerland) by warm vertical compaction. Root slices of 1 mm thickness were obtained at 2 to 3, 5 to 6 and 8 to 9 mm from the apex. The root slices were investigated for sealer penetration into the dentinal tubules using SEM according to four root quadrants (buccal, mesial, oral, distal). Statistical analysis was performed by the Kruskal-Wallis test (p = 0.05) as data were not normally distributed according to the Shapiro-Wilk test. AH Plus penetrated significantly deeper into the dentinal tubules compared to TFHF at each root level (p < 0.05). Dentinal sealer penetration was deeper in the bucco-oral direction compared to the mesio-distal direction. AH Plus penetrated deeper into dentinal tubules than TFHF. Warm vertical compaction exerting high pressure on the root canal filling material is not able to press sealers deep into dentinal tubules as penetration depth values did not exceed a mean of 110 µm in SEM. Full article

The aim of this study was to gain information about the effect of thermal treatment of calcium silicate-based sealers. BioRoot RCS (BR), Total Fill BC Sealer (TFBC), and Total Fill BC Sealer HiFlow (TFHF) were exposed to thermal treatment at 37 °C, 47 °C, 57 °C, 67 °C, 77 °C, 87 °C and 97 °C for 30 s. Heat treatment at 97 °C was performed for 60 and 180 s to simulate inappropriate application of warm obturation techniques. Thereafter, specimens were cooled to 37 °C and physical properties (setting time/flow/film thickness according to ISO 6876) were evaluated. Chemical properties (Fourier-transform infrared spectroscopy) were assessed after incubation of the specimens in an incubator at 37 °C and 100% humidity for 8 weeks. Statistical analysis of physical properties was performed using the Kruskal-Wallis-Test (P = 0.05). The setting time, flow, and film thickness of TFBC and TFHF were not relevantly influenced by thermal treatment. Setting time of BR decreased slightly when temperature of heat application increased from 37 °C to 77 °C (P < 0.05). Further heat treatment of BR above 77 °C led to an immediate setting. FT-IR spectroscopy did not reveal any chemical changes for either sealers. Thermal treatment did not lead to any substantial chemical changes at all temperature levels, while physical properties of BR were compromised by heating. TFBC and TFHF can be considered suitable for warm obturation techniques. Full article

Calcium silicate-based sealers were recently introduced as a new class of endodontic sealers, with potential further benefits due to their bioactivity. The aim of this study was to evaluate the biocompatibility of two new hydraulic calcium silicate-based sealers, TotalFill BC Sealer (FKG, La Chaux-des-Fonds, Switzerland) and TotalFill BC Sealer HiFlow (FKG, La Chaux-des-Fonds, Switzerland) through subcutaneous implantation in connective tissue of rats. Subcutaneous implantation was performed in 16 young Wistar rats. Four polyethylene tubes were implanted in each animal, one empty to serve as a control, and three filled with tested sealers: AH Plus as reference (Dentsply DeTrey, Konstanz, Germany), TotalFill BC Sealer (BC) and TotalFill BC Sealer HiFlow (HiFlow). Eight rats were euthanized at 8 days and the remaining eight at 30 days. Hematoxylin-eosin staining was used to score the inflammatory reaction, macrophage infiltrate and to measure the thickness of the fibrous capsule. von Kossa staining was performed to evaluate the mineralization level. Kruskal–Wallis test followed by Dunn’s post hoc test was used to analyze non-parametric data. To analyze the influence of the implantation time within each material, a Mann–Whitney U test was performed. At eight days post-implantation, AH Plus induced a more intense inflammatory reaction when compared both with the control (p $\le$ 0.001) and BC (p $\le$ 0.01). HiFlow presented a higher score of macrophage infiltrate than control (p $\le$ 0.01) and BC (p $\le$ 0.05). The fibrous capsule thickness in this period was significantly higher for the BC group when compared to control (p $\le$ 0.01) and AH Plus (p $\le$ 0.05). The mineralization potential was higher for the HiFlow group when compared with the control (p $\le$ 0.001) and AH Plus (p $\le$ 0.001). At 30 days post-implantation, the score for the inflammatory reaction remained higher for the AH Plus group when compared both to control (p $\le$ 0.01) and BC (p $\le$ 0.001). The macrophage infiltrate of the HiFlow was significantly higher than control (p $\le$ 0.001) and AH Plus groups (p $\le$ 0.01), additionally, the fibrous capsule of the BC (p $\le$ 0.001) and HiFlow (p $\le$ 0.01) groups were both thicker than control. Mineralization potential was observed only on BC (p $\le$ 0.05) and HiFlow groups (p $\le$ 0.001), when compared to control). BC exhibited the best biocompatibility performance of all tested sealers and HiFlow provided the greatest induction of mineralized tissues. Both TotalFill BC Sealer and TotalFill BC Sealer HiFlow are biocompatible and show potential bioactivity when implanted in the subcutaneous tissue. Bioactivity was not found in AH Plus. Full article