Search Results (71)

This study evaluated how varying calcium silicate (30–50%) and radiopacifier (45–65%) ratios affected the physicochemical properties of experimental sealers (P1–P3) compared to Bio-C Sealer, AH Plus Bioceramic, and AH Plus Jet. Properties such as flowability, solubility, and radiopacity were assessed per ISO 6876/2012, and setting time followed ASTM C266-2008. pH and volumetric changes were measured in acrylic teeth (n = 10) filled with each sealer, with pH evaluated at 3, 24, 72, and 168 h, and volume changes assessed via micro-CT at baseline and after 7 days. P1 showed setting time similar to AH Plus Bioceramic (p > 0.05). All calcium silicate-based sealers had greater solubility than AH Plus Jet (p < 0.05), with only P3 meeting ISO standards. P1 and AH Plus Jet exhibited higher radiopacity (p < 0.05). Bio-C Sealer and AH Plus Bioceramic had more volume change than P2 (p < 0.05). All experimental sealers showed stable volume and increasing alkalinity, peaking at 72h. Bio-C Sealer showed a consistent pH rise, except between 24 and 168 h (p > 0.05). Sealer properties were strongly influenced by the composition. P1 (30% calcium silicate/65% radiopacifier) had superior flowability and radiopacity, while P3 (50% calcium silicate/45% radiopacifier) was the only one to meet solubility standards. Full article

The development of bioactive materials in endodontics has advanced tissue regeneration by enhancing the biological responses of periradicular tissues. Recently, calcium silicate-based sealers have gained attention for their superior biological properties, including biocompatibility, osteoconductivity, and cementogenic potential. This study aimed to evaluate the cytotoxicity, biocompatibility, and bioactivity of EndoSequence BC Sealer (ES BC) and AH Plus Bioceramic Sealer (AHP BC) using human periodontal ligament stromal cells (hPDLSCs). Biocompatibility was assessed using MTT, Live/Dead, and wound healing assays. ES BC and AHP BC demonstrated significantly higher cell viability and proliferation compared to AH Plus used as a control. Gene expression analysis via real-time quantitative PCR demonstrated that ES BC, especially in set form, significantly upregulated osteogenic markers—alkaline phosphatase (2.49 ± 0.10, p < 0.01), runt-related transcription factor 2 (2.33 ± 0.13), and collagen type I alpha 1 chain (2.85 ± 0.40, p < 0.001)—more than cementogenic markers (cementum protein 1, cementum attachment protein, and cementum protein 23). This differential response may reflect the fibroblast-dominant nature of hPDLSCs, which contain limited cementoblast-like cells. This study supports the superior biocompatibility and regenerative capacity of ES BC and AHP BC compared to AH Plus. While in vitro models provide foundational insights, advanced ex vivo approaches are crucial for translating findings to clinical practice. Full article

This study compared the efficacy of different solutions in achieving patency in teeth filled with AH Plus Bioceramic sealer. Eighty-five premolars with a straight canal were prepared. After sealer placement, a master gutta-percha cone was introduced 2 mm short of the working length. The teeth were stored at 37 °C and 100% humidity for five weeks before retreatment. Filling materials were removed up to the gutta-percha cone’s length. The canals were then randomly assigned to groups: G1 (control, no solution), G2 (5.25% NaOCl), G3 (17% EDTA), G4 (10% citric acid), and G5 (10% formic acid). The apical patency was attempted with a 10 K file within a period of 10 min, by a blinded operator. Additionally, sealer samples were immersed in the solutions, followed by scanning electron microscopy analysis. The Kruskal–Wallis test was used for statistical analysis. Patency was achieved in all canals except one in the control and one in the NaOCl groups. No significant differences were found in the time required to achieve patency. Acid solutions had a greater impact on the sealer’s structural integrity, and a decalcifying effect of EDTA and citric acid was registered. Apical patency in straight canals obturated with AH Plus Bioceramic sealer was consistently achieved regardless of the solution used. Full article

Calcium silicate-based sealers (CSBS) vary in chemical composition, which can influence treatment outcomes. Therefore, the study aimed at comparing several commercially available CSBS regarding microstructure and elemental characterization. Four CSBS (AH Plus Bioceramic Sealer, BioRoot RCS, BioRoot Flow, TotalFill BC Sealer) and a control resin-based sealer (AH Plus) were evaluated using scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), and X-ray powder diffraction analysis (XRD). The specimens were analyzed after setting (SEM, EDX, XRD), as well as after 7 (SEM) and 28 days (SEM, EDX) of incubation in Hank’s balanced salt solution. AH Plus exhibited a uniform matrix and small amounts of calcium (Ca), significantly decreasing after incubation. In contrast, CSBSs exhibited crystalline forms on the surface and increased Ca content, significantly increasing after 28 days of incubation. The main crystalline phase for all tested CSBS was zirconium oxide, while for ERBS it was calcium tungstate. In conclusion, the amount of calcium increased on the surface of CSBSs after incubation, which alkalinized the pH, promoting mineralization, apatite formation, and antibacterial potential. Despite this, the formation of a hydroxyapatite layer was not demonstrated, possibly due to the high dissolution potential of CSBSs. Full article

Background: The primary objective of this study was to evaluate the cytotoxic and genotoxic effects of calcium silicate-based sealers (BioRoot RCS and MTA Fillapex) compared to an epoxy-based sealer (AH Plus). Materials and methods: The study was conducted in vitro with the cell lines HepG2 and V79 to evaluate cytotoxicity and genotoxicity using the comet and micronucleus assays. Eluates of the materials were tested at two different concentrations (3 cm²/mL and 0.5 cm²/mL) after an exposure time of 72 h. Data were analyzed using the Mann–Whitney and Kruskal–Wallis tests (p < 0.05). Results: At lower concentrations in both cell lines, MTA Fillapex showed no significant difference in the measured comet assay parameters compared to the negative control (p > 0.05). In addition, it showed significantly lower genotoxic effects compared to AH Plus for all comet assay parameters, concentrations, and cell lines (p ≤ 0.001). BioRoot RCS showed lower primary DNA damage (p ≤ 0.001) than AH Plus, only at higher concentrations and in the HepG2 cell line. Concerning the two tested bioceramic sealers, BioRoot RCS showed higher tail intensity values compared to MTA Fillapex (p < 0.05). In contrast to the results of the comet assay, BioRoot RCS significantly reduced the number of nuclear buds and nucleoplasmic bridges in the HepG2 cell line compared to MTA Fillapex, whereas reduction in the V79 cell line was only observed for nuclear buds (p < 0.05). Both materials increased the number of apoptotic cells compared to the negative control (p < 0.05). In comparison to AH Plus, BioRoot RCS and MTA Fillapex significantly reduced the number of cells with micronuclei and increased the number of cells with undamaged chromatin (p < 0.05). Conclusions: The findings suggest that MTA Fillapex and BioRoot RCS exhibit superior biocompatibility over AH Plus, as evidenced by their lower cytotoxic and genotoxic effects in vitro. These results support the use of calcium silicate-based sealers in clinical practice, highlighting the need for further studies to evaluate their performance in vivo and their implications for patient safety. Full article

The calcium silicate-based sealers currently available on the market have different compositions and formulations, which is why their physical and chemical properties may vary. (1) The aim of the study was to measure the physico-chemical properties of calcium silicate-based sealers and their push-out bond strength to root dentine, comparing two push-out testing protocols. (2) Standardized specimens of EndoSequence BC, BioRoot RCS, MTA Fillapex, and AH Plus (control) were subjected to pH measurements over 28 days. Radiopacity was measured using a CCD sensor, and flexural strength was assessed using a three-point bending setup. Push-out bond strength was measured in coronal, middle, and apical sections of 40 single-root teeth (conventional method), and cylindrical cavities were prepared for all sealers on the same root dentine disks in 11 third molars (disk method). (3) EndoSequence BC exhibited a higher pH than MTA Fillapex and the highest radiopacity (p < 0.05). The highest flexural and push-out bond strengths were found for AH Plus. The push-out bond strength of EndoSequence BC and BioRoot RCS was higher than MTA Fillapex (p < 0.05). The conventional and disk methods exhibited similar push-out bond strength results, but the data were more homogeneously distributed in the disk method. (4) All calcium silicate-based sealers exhibited a higher pH than AH Plus. MTA Fillapex did not meet the ISO standard. Calcium silicate-based sealers showed weaker performance in terms of physical properties compared to AH Plus. Full article

Bioceramic materials for endodontic treatments have gradually transformed over the years into materials with enhanced biocompatibility and chemical and mechanical properties compared to earlier generations. In endodontics procedures, these materials are used as restorative material in applications such as root-end fillings, pulp capping, perforations repair, and apexification repair procedures. However, they have far from ideal mechanical and handling properties, biocompatibility issues, aesthetic concerns due to tooth discolouration, limited antibacterial activity, and affordability, which are amongst several key limitations. Notably, bioceramic materials are popular due to their biocompatibility, sealing ability, and durability, consequently surpassing traditional materials such as gutta-percha and zinc oxide–eugenol sealers. A lack of recent advancements in the field, combined with nanomaterials, has improved the formulations of these materials to overcome these limitations. The existing literature emphasises the benefits of bioceramics while underreporting their poor mechanical properties, handling difficulties, cost, and various other drawbacks. The key gaps identified in the literature are the insufficient coverage of emerging materials, narrow scope, limited insights into future developments, and underreporting of failures and complications of the existing materials. Consequently, this review aims to highlight the key limitations of various endodontic materials, primarily focusing on calcium silicate, calcium phosphate, and bioactive glass-based materials, which are the most abundantly used materials in dentistry. Based on the literature, bioceramic materials in endodontics have significantly improved over recent years, with different combinations of materials and technology compared to earlier generations while preserving many of their original properties, with some having affordable costs. This review also identified key innovations that could shape the future of endodontic materials, highlighting the ongoing evolution and advancements in endodontic treatments. Full article

Background/Objectives: Since biomineralization by calcium silicate-based sealers (CSBSs) was reported, retrieving canal filling materials may be challenging during endodontic retreatment due to their adhesion to dentin. This study aimed to evaluate the possibility of removing residual mineral deposits from two kinds of CSBSs compared to the AH Plus Jet (AHJ). Methods: Root canals of mandibular premolars were prepared, obturated with the sealer-based obturation method using a WOG medium gutta-percha cone and one of the following sealers: AHJ, AH Plus Bioceramic (AHB), and Ceraseal (CER) (n = 12/group). After 3 weeks, endodontic retreatment was conducted with the WOG files, followed by instrumentation with XP-endo Finisher (XPF). Micro-computed tomography scanning was obtained after canal filling, after retreatment with WOG, and after the use of XPF. The percentage of the removed filling volume was calculated. One-way ANOVA with Tukey’s test and a non-parametric test with Bonferroni’s correction were performed. Root canal dentin after retreatment was examined using a scanning electron microscope (SEM). Results: After supplementary instrumentation with XPF, the mean residual filling volumes for the AHJ, AHB, and CER groups were 1.35 mm³, 0.55 mm³, and 0.82 mm³, respectively. The AHJ group showed greater residual volume compared to the AHB group (p < 0.05). The AHB and CER groups demonstrated higher mean percentages of removed filling volume at 94.8%, and 92.5%, respectively, compared to 87.1% for the AHJ group (p < 0.05). More mineral deposits were observed in the CER group with SEM. Conclusions: AHB and CER are retrievable during endodontic retreatment, with CER preferable due to greater mineral deposits in dentinal tubules. 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

Background: Adhesion within endodontic obturation material and root canal walls improves the efficacy of the endodontic treatment by establishing a barrier that inhibits reinfection and entombs residual bacteria. This study evaluates the push-out bond strength (POBS) of calcium silicate sealers compared to an epoxy-resin-based sealer. Methods: A total of 36 extracted mono-radicular teeth were prepared with Pro Taper Ultimate and irrigated with 5.25% sodium hypochlorite and 17% EDTA. The specimens were randomly split into three groups (n = 12) according to the endodontic sealer and filling technique used as follows: Ah Plus with the continuous wave condensation technique (CWC), Ah Bioceramic (Ah Bio) with the single-cone technique, and Total Fill Hi-Flow (FKG Hi-Flow) with the CWC technique. The material was allowed to set for 4 weeks, and afterwards, the roots were placed in acrylic resin and sectioned into 1 mm transverse slices. A POBS test was conducted using a universal testing machine, and the mode of bond failure was assessed at 4× magnification using a stereomicroscope. Six specimens from each group were selected for SEM-EDX examination to evaluate dentinal tubule penetration. The data were analysed using analysis of variance and Tukey and Bonferroni post hoc tests. Results: The POBS tests revealed higher values for Ah Plus in comparison to both calcium silicate sealers (p < 0.001), while FKG Hi-Flow showed superior results to Ah Bio (p < 0.001). The cohesive mode of failure was prevalent in all three groups. Conclusions: In conclusion, the resin-based sealer showed higher bond strength and better dentinal tubule penetration than the two calcium silicate sealers tested, while FKG Hi-Flow outperformed AH Bio. Full article

This in vitro study evaluated the sealing ability and microleakage of calcium silicate-based sealers compared to an epoxy resin-based sealer. One hundred twenty-five roots from anterior teeth were chemo-mechanically prepared and divided into four groups: AH Plus (AH), ProRoot MTA (PR), Medcem MTA (MC), and Total Fill BC Sealer/BC-coated gutta-percha (TF); n = 30. Confocal laser scanning microscopy was used to measure sealer penetration at three horizontal levels in 10 roots per group, while glucose leakage over 30 days was assessed in 20 roots. A lateral compaction technique was used for most groups, except for TF, which employed a single-cone method. Data were analyzed using Python with a Kruskal–Wallis test and Dunn’s post hoc test. TF showed significantly greater penetration in the coronal and middle sections, while PR had the least penetration in the apical section. PR exhibited the highest canal circumference penetration, especially compared to MC and TF. Glucose leakage increased over time in all groups, with TF showing the highest permeability after 30 days. Overall, calcium silicate-based sealers PR, MC, and TF performed similarly to the epoxy resin standard AH, with all groups exhibiting decreasing penetration from coronal to apical and increased leakage over time. Full article

The aim of this study was to evaluate the effects of mechanized final irrigation protocols (XPE, XP-Endo Finisher; XPC, XP-Clean; and ECL, Easy Clean) compared to PUI (passive ultrasonic irrigation) on the debris incidence and open dentinal tubules, and their effects on the adhesion interface after 48 h and 6 months. One hundred twenty maxillary central incisors were submitted to chemical–mechanical preparation using a rotary instrument and 2.5% sodium hypochlorite. Specimens were distributed in 4 groups (n = 30) in accordance with the mechanized final irrigation protocol: XPE, XPC, ECL, or PUI. Forty specimens (n = 10/group) were submitted to SEM analysis to evaluate the residue incidence and dentin open tubules. The other specimens were obturated using Bio-C Sealer and submitted to push-out bond strength and adhesive failure mode evaluations in the cervical, middle, and apical thirds after 48 h or 6 months (n = 10/group). Only in the apical third, ECL presented the highest residue incidence and fewer open dentinal tubules when compared to the XPE, XPC, and PUI groups (p < 0.05). In the cervical and middle root thirds, no significant differences were observed regardless of the group evaluated (p > 0.05). After 48 h, ECL resulted in the lowest bond strength only in the apical third (p < 0.05), while the XPE, XPC, and PUI groups remained similar in the cervical and middle thirds (p > 0.05). At 6 months, all groups showed lower bond strength values regardless of the root third evaluated, but ECL showed the lowest bond strength in the apical and middle root thirds when compared to the other groups (p < 0.05). The ECL protocol did not provide adequate residue removal on the apical radicular third and negatively affected the longevity of endodontic obturation using a calcium silicate-based sealer. 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

Background: Using endodontic sealers with long-term antimicrobial properties can increase the success of endodontic treatment. This study aimed to assess the antimicrobial activity over time of two calcium silicate (CS)-based sealers, AH Plus Bioceramic and BioRoot RCS, and to compare them with an epoxy resin-based sealer, AH Plus Jet, against mature polymicrobial biofilms grown on human radicular dentin. Methods: The antimicrobial activity of the sealers was tested using a direct contact test after 1 and 6 weeks of contact with the biofilms. Cell viability was determined by the adenosine triphosphate (ATP) method and flow cytometry (FC). The results of the ATP test were analyzed using an ANOVA with Welch’s correction, followed by the Games–Howell test. The number of cells with damaged membranes obtained by FC in each period was compared by means of an ANOVA and Duncan’s test. For the comparison between times, a Student’s t-test was used. Results: Globally, after a week of contact, the epoxy resin-based sealer obtained the best results. However, at 6 weeks, the two CSs showed the highest antimicrobial efficacy, with a significant increase in this activity over time. Conclusions: Calcium silicate-based sealers exert long-term antimicrobial activity against endodontic biofilms. Full article

The aim of the present in vitro study was to evaluate specific mechanical and physicochemical properties of three calcium silicate-based sealers, BioRoot™ Flow (BRF), CeraSeal (CRS) and TotalFill^® (TF). Samples were prepared to evaluate different physicochemical and mechanical properties of the tested sealers. These evaluations were accomplished by investigating the pH changes over time, porosity, roughness, flow properties, compressive strength and wettability. The results were statistically evaluated using one-way analysis of variance. All three sealers demonstrated an alkaline pH from 1 h of immersion in water to 168 h. A higher porosity and hydrophily were detected in BRF samples compared to CRS and TF. No significant difference was found between the tested materials in the flow properties. Lower compressive strength values were observed for BRF compared to TF and CRS. Differently shaped structures were detected on the three materials after 7 days of immersion in PBS. The three materials demonstrated a higher solubility than 3% after 24 h of immersion in water (CRS < BRF < TF). The novel premixed calcium silicate sealer (BRF) had comparable physicochemical properties to the existing sealers. The lower compressive strength values could facilitate the removal of these materials during retreatment procedures. Further studies should investigate the biological effects of the novel sealer. Full article