Search Results (122)

Objectives: This study evaluated the effect of three root canal filling material (RCFM) removal techniques—mechanical, thermo-mechanical, and chemico-mechanical—on the micro push-out bond strength of fiber posts to root dentin in endodontically treated teeth. Materials and Methods: Forty-five single-rooted human premolars were endodontically treated and randomly allocated into three groups (n = 15) according to the RCFM removal technique used during post-space preparation: mechanical, thermo-mechanical, or chemico-mechanical. Fiber posts were luted using a dual-cure resin cement. Roots were embedded in resin and sectioned into coronal, middle, and apical thirds. Micro push-out bond strength was measured using a universal testing machine. Failure modes were examined under a stereomicroscope and validated using scanning electron microscopy. Statistical analysis used two-way ANOVA and Chi-square tests (α = 0.05). Results: Both the thermo-mechanical and mechanical groups showed significantly higher bond strength values than the chemico-mechanical group (p < 0.001). Across all groups, the coronal third recorded the highest bond strength, while the apical third presented the lowest values (p < 0.001). Adhesive failure at the dentin–cement interface was the most frequent failure mode. Conclusions: The gutta-percha removal technique and the root canal region significantly influence fiber-post bond strength. Solvent-based chemico-mechanical methods may adversely affect adhesion quality. Clinical Relevance: Thermo-mechanical and mechanical removal techniques may provide more reliable post retention during retreatment procedures, improving adhesion and reducing the risk of post debonding in daily practice. Full article

Effective gutta-percha/sealer removal is essential for predictable nonsurgical endodontic retreatment, but the effects of key operational parameters on nickel–titanium rotary removal instruments remain insufficiently understood. This study aimed to examine how varying downward loads and rotational speeds affect the removal efficiency and torque/force generation of the HyFlex Remover. Sixty transparent straight resin canals filled with gutta-percha and AH Plus sealer were prepared using the HyFlex Remover at two rotational speeds (400 and 800 rpm) and three downward loads (2, 3, and 4 N; n = 10/group). The removal rate, calculated using micro-computed tomography, as well as removal time, maximum force, maximum torque, and cumulative torque were recorded and evaluated using two-way analysis of variance with Bonferroni correction (α = 0.05). The removal rate was consistently higher at 400 rpm than at 800 rpm (p < 0.001), while removal time and cumulative torque were greater at 400 rpm (p < 0.001). Maximum torque differed only between the 800-2 N and 800-4 N groups (p = 0.006). Maximum force increased with higher loads (p < 0.001), and at 3 N and 4 N, it was lower at 400 rpm than at 800 rpm (3 N: p = 0.039, 4 N: p < 0.001). Overall, lower downward loads reduced torque but prolonged working time, whereas higher rotational speeds shortened both working time and torque but decreased the removal rate. Full article

Objectives: This study evaluated and compared the sealing ability and elemental composition of a resin-based endodontic sealer (AH Plus) used with three root canal obturation techniques: single cone (SC), lateral compaction (LC), and warm vertical condensation (WVC). The investigation focused on microstructural characteristics, interfacial integrity, and elemental distribution within filled root canals. Material and Methods: Sixty extracted single-root teeth were instrumented using the ProTaper Gold system and randomly assigned to three groups (n = 20) according to the obturation technique. The AH Plus Jet sealer was applied in all cases. Following obturation, samples were subjected to radiographic investigation and analyzed using optical microscopy and scanning electron microscopy (SEM) coupled with energy-dispersive X-ray spectroscopy (EDX) to assess the sealing performance and chemical composition. Results: Radiographic and microscopic assessments indicated that the SC method showed strong gutta-percha adhesion to dentin with a thin cement layer, whereas WVC provided excellent adaptation and penetration of gutta-percha. The LC technique demonstrated good adhesion but displayed occasional structural irregularities. SC has the thicker adhesion layer with uneven distribution regarding coronal, median, and apical, regions ranging from 45 to 80 μm, while WVC ensures a thin and uniform sealing layer of about 35 μm in all regions. SEM and EDX analyses detailed the interfacial microstructure and confirmed the presence of carbon (C), oxygen (O), calcium (Ca), zinc (Zn), barium (Ba), and sulfur (S) across all groups. Conclusions: All three obturation techniques (SC, WVC, LC) achieved effective sealing when combined with the AH Plus sealer. The main difference between the methods consists of the sealer layer thickness and its even distribution regarding gutta-percha cones. Full article

The aim of this preliminary study was to compare two core-carrier obturation techniques—GuttaFusion (GF) and SoftCore (SC)—used in combination with a bioceramic sealer (NeoSealer Flo), and to evaluate their ability to fill simulated root canals. Eight standardized resin models of maxillary first molars were used, and only the P and DV canals of each model were obturated. Cross-sections were obtained at 1 mm and 3 mm from the apex, and the percentage areas occupied by gutta-percha (PGFA), sealer (PSFA), and voids (VA) were measured. This study provides novel comparative data on the performance of these two carrier-based techniques when used with a bioceramic sealer. GF showed higher PGFA and lower PSFA compared with SC at 1 mm from the apex, while SC presented slightly higher VA. At 3 mm, PGFA increased for both techniques. Descriptive statistics (means and percentage values) were calculated; no inferential statistical analysis was performed due to the preliminary nature of the study and the limited sample. Full article

Background/Objectives: Non-surgical retreatment aims to remove infected filling material, prepare the canal for disinfection, and re-obturate. This ex vivo study evaluated the residual filling material and dentin volume removed after retreatment using a rotary or reciprocating system. Methods: Twenty mesial roots of mandibular molars with two independent, straight canals were decoronated to a 16 mm working length and obturated. Pre-operative nano-CT scans measured the initial dentin and filling material volumes. Specimens were randomly assigned to two groups: Solite RE Black system (RE1-30/0.08; RE2-20/0.06) and WaveOne Gold—small file (20/0.07). Post-operative nano-CT scans were superimposed to calculate the remaining filling material and dentin volume removed. Data are presented as the mean ± SD, and groups were compared using independent t-tests. Results: Neither system completely removed the intracanal filling material. The mean residual filling material volume was 1.42 ± 0.21 mm³ (Solite RE Black) vs. 1.56 ± 0.27 mm³ (WaveOne Gold), representing approximately 14% vs. 16% of the initial filling material, respectively (p < 0.05). Mean dentin volume removed was 0.95 ± 0.18 mm³ vs. 1.12 ± 0.22 mm³, with no significant difference (p > 0.05). Conclusions: In single-rooted, straight canals, Solite RE Black removed more filling material than WaveOne Gold, while dentin loss was similar. These findings are specific to straight canals, and further studies are required for curved or multi-rooted teeth. Full article

Premixed bioceramic sealers represent a recent advancement in endodontic obturation, combining bioactivity, moisture-induced mineralization and favorable handling properties. When used with warm gutta-percha techniques, these calcium silicate-based sealers are exposed to elevated temperatures that may influence their physicochemical behavior and interfacial performance. This review aimed to summarize current evidence on premixed bioceramic sealers used in conjunction with thermoplastic obturation techniques. A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science for studies published between January 2020 and July 2025 evaluating the physicochemical properties, bioactivity, sealing ability, fracture resistance, clinical outcomes and retreatability of premixed bioceramic sealers under warm obturation conditions. No meta-analysis was performed—this review provides a narrative synthesis of the available evidence within this scope. Twenty-five studies met the inclusion criteria. In vitro and ex vivo data indicate that premixed bioceramic sealers generally maintain chemical stability and bioactivity when exposed to clinically relevant heating protocols, with favorable dentinal tubule penetration, interfacial adaptation and the formation of calcium silicate hydrate, and hydroxyapatite at the sealer–dentin interface. These characteristics are associated with improved filling homogeneity, potential reinforcement of root dentin and high rates of periapical healing reported in limited short-term clinical studies. However, the evidence also highlights important challenges, including technique-sensitive retreatability, material remnants after re-instrumentation and concerns regarding overextension, and long-term dimensional stability. Within the limitations of predominantly in vitro and short-term clinical evidence, premixed bioceramic sealers used with warm gutta-percha techniques appear to be promising functional materials that combine mechanical sealing with bioactive and mineralizing potential. Standardized protocols and robust long-term clinical studies are needed to confirm their durability, retreatability and prognostic impact in routine endodontic practice. Full article

This study aimed to evaluate the biomechanics of maxillary first molar teeth following palatal, disto-buccal, and mesio-buccal root amputation. An intact maxillary molar underwent root canal treatment using Reciproc R25 files (VDW, Munich, Germany). The canals were obturated with gutta-percha (DiaDent, Seoul, Republic of Korea) and 2Seal sealer (VDW, Munich, Germany), and the access cavity was restored with composite resin. A high-resolution CBCT scan of an intact maxillary first molar was obtained using a Planmeca Promax 3D Max system (Planmeca Oy, Helsinki, Finland) at 75 kVp and 10 mA. The acquired data were processed in 3D Slicer software (v5.8.0, BSD license, Boston, MA, USA) to segment enamel, dentin, and pulp based on pixel density variations using the three-point cloud method. A baseline intact model and three root-resected models (palatal, disto-buccal, mesio-buccal) were reconstructed in SolidWorks 2021, with resected roots simulated as being sealed with MTA. Finite element analysis was conducted in CosmosWorks to evaluate von Mises stress distribution under a 300 N static occlusal load. Maximum von Mises stresses were detected at occlusal force application sites. Among root dentin tissues, stress values ranked highest after palatal root resection, followed by the mesio-buccal, disto-buccal, and non-resected models. Conclusions: Palatal root amputation of maxillary first molars generated the highest von Mises stresses in root dentin, suggesting a higher biomechanical risk than disto-buccal or mesio-buccal resections. Full article

Successful endodontic treatment relies on effective shaping, disinfection and obturation. Calcium silicate sealers such as BioRoot™ RCS show promise due to their bioactivity and sealing properties, but more clinical evidence using standardized protocols is needed. This observational clinical study aimed to assess periapical healing at 6 and 12 months following single-visit root canal treatment using BioRoot™ RCS with hydraulic condensation in teeth with irreversible pulpitis or apical periodontitis. Sixty-six teeth were treated using a standardized protocol: ProTaper Gold instrumentation, sonic-activated irrigation, and hydraulic condensation with gutta-percha cone and BioRoot™ RCS. Periapical healing was evaluated using the periapical index (PAI) at baseline, 6 months, and 12 months. Clinical success was defined as functional, asymptomatic teeth and a PAI ≤ 2. Statistical analysis included repeated measures of ANOVA and McNemar’s test. All 66 teeth remained asymptomatic and functional of 12 months, yielding a 100% survival rate. Clinical success was confirmed in 97% of cases. PAI scores decreased significantly over time (p < 0.001) in apical periodontitis cases. Single-visit endodontic treatment with BioRoot™ RCS and hydraulic condensation demonstrated excellent clinical and radiographic outcomes. This approach promotes resolution of apical periodontitis in non-vital cases and supports the preservation of periapical health in teeth initially diagnosed with irreversible pulpitis. Full article

Background/Objectives: Periradicular disease is largely microbial in origin. Even gutta-percha (GP) cones manufactured under aseptic conditions can acquire contaminants during handling or storage, undermining otherwise adequate canal preparation. To assess residual antimicrobial activity on GP cones after brief exposure to five endodontic disinfectants: sodium hypochlorite (NaOCl) 1%, 2.5%, 5.25%; chlorhexidine (CHX) 2%; and glutaraldehyde 2% against Enterococcus faecalis and Candida albicans. Methods: Standardized GP cones were dipped for 5–120 s, blotted on neutralizing gauze, and placed on agar inoculated with either organism. Using an agar diffusion approach, inhibition-zone diameters were recorded at 0, 24, and 48 h. Data were summarized using descriptive statistics (means, standard deviations, and 95% confidence intervals) for each disinfectant–dip-time combination. Results: By 24 h, inhibition zones were observed for most disinfectants; for C. albicans, glutaraldehyde 2% showed no measurable effect. At later time points, performance depended on both disinfectant and contact time. For E. faecalis, NaOCl 2.5% and 5.25% yielded the largest zones at 48 h (20–21 mm at 120 s), whereas NaOCl 1% was smaller (10 mm) and glutaraldehyde 2% modest (9 mm). For C. albicans, NaOCl 2.5% and CHX 2% were most effective at 48 h (17–19 mm at 120 s); NaOCl 5.25% was intermediate, NaOCl 1% weak, and glutaraldehyde 2% showed no measurable antifungal effect. Longer immersions (≥45 s) consistently increased inhibition zone diameters. Conclusions: Residual antimicrobial activity on GP cones depends on both the agent and the immersion time. For E. faecalis, higher concentration NaOCl produced the largest zones at short contact time, whereas for C. albicans, CHX 2% and NaOCl 2.5% provided the most reliable carryover. Selecting an appropriate concentration and allowing sufficient dip time may reduce reinfection risk at obturation. Full article

Background and Objectives: This in vitro trial aimed to investigate if there is a correlation between the homogeneities of different composite materials and their adhesion to glass fiber posts (GFPs). Materials and Methods: Twenty intact human upper jaw central incisors extracted due to periodontal diseases were selected for this trial. Endodontic treatment was performed according to ISO recommendations. A total of 4 mm of guttapercha was left in the apical region. Canals were prepared for post insertion. Teeth were randomly allocated into the two following groups depending on the core restorative material (n = 10): I—cores build up with light cured composite; II—cores build up with dual cured composite resin. GFPs were inserted and cores were rebuilt with different composite resins. Longitudinal cuts were made across the axis of the teeth and examined under a scanning electron microscope (SEM). Statistical analysis was accomplished using Mann–Whitney U and Spearman tests (p < 0.05). Results: In the group where the number and size of pores at the interface of GFPs were analyzed, pores were found only in the specimens restored with the light-cured “bulk-filled” composite. In the group where the number and size of pores in the core material were analyzed, pores were found in specimens restored with both the light-cured “bulk-filled” composite and dual-cured resin composite. However, the dual-cured resin composite yielded better results in terms of core integration. Conclusions: There is no statistically significant correlation between the homogeneities of different composite materials and their adhesion to GFP. Full article

This study evaluated the chemical composition and subcutaneous tissue biocompatibility of C-Point, a root canal filling material, compared to ProTaper gutta-percha cones (control). Material characterization was conducted using scanning electron microscopy with energy-dispersive spectroscopy (SEM-EDS). For biocompatibility assessment, both materials were implanted subcutaneously in the dorsal connective tissue of sixteen albino rats (n = 8 per group). Histological evaluation of inflammatory infiltrate intensity was performed at 30 and 60 days post-implantation, with statistical analysis (significance set at p < 0.05). SEM-EDS analysis revealed distinct elemental compositions: C-Point primarily contained zirconium and cobalt ions, while gutta-percha cones demonstrated a strong zinc signature with trace amounts of barium, aluminum, and sulfur. Both materials exhibited similar particulate morphology with radiopaque inclusions. Histologically, no significant difference in inflammatory response was observed between C-Point and gutta-percha at any time point (p > 0.05). All specimens developed a fibrous encapsulation. The inflammatory profile showed temporal dynamics, with lymphocyte predominance during early stages that progressively diminished by the study endpoint. These findings demonstrate that while C-Point possesses a unique elemental profile dominated by zirconium, its tissue biocompatibility parallels that of conventional gutta-percha obturation materials. However, due to the absence of mechanical testing and the limited in vivo follow-up period, the long-term stability of the material remains uncertain. Full article

The fundamental goal of endodontic surgery is to remove the infection cause and create an ideal environment for periapical tissue and bone recovery. This systematic review aims to present evidence-based findings regarding the healing ability of endodontic materials in retrograde treatment. The study evaluates the advantages and drawbacks of commonly utilized materials, empowering clinicians with valuable insights for preoperative planning in endodontic surgery. A comprehensive search was conducted across multiple databases, including MEDLINE, Scielo, Web of Science, Scopus, Embase, and Google Scholar, using the PIOT framework. A total of 3124 papers were identified, of which 2534 remained after removing duplicates. Following a stringent selection process, 35 clinical studies were included for qualitative assessment. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies—of Interventions (ROBINS-I) tool for non-randomized trials, the Newcastle–Ottawa Scale for cohort studies, and the Joanna Briggs Institute (JBI) critical appraisal checklist for cross-sectional studies. Due to high heterogeneity in study designs and outcomes, a meta-analysis could not be performed. The review identified Super Ethoxybenzoic Acid (Super EBA), Mineral Trioxide Aggregate (MTA), and Intermediate Restorative Material (IRM^®), Retroplast, Endosequence^®, and gutta-percha as the primary retrograde root filling materials. Follow-up periods ranged from 6 months to 17.5 years. Although the materials showed varying degrees of success, the overall findings highlighted that no single material demonstrated universally superior healing ability. The review also emphasized the need for standardization in future clinical trials to facilitate better comparisons. The selection of retrograde filling materials plays a pivotal role in the success of endodontic surgery. New bioceramic materials like MTA and Biodentine offer improved sealing, biocompatibility, and tissue regeneration compared to traditional materials, leading to better clinical outcomes. Full article

The aim of this study is to evaluate the apical sealing ability of novel bioceramic-based (BCB) and widely used resin-based (RB) root canal sealers in combination with traditional or bioceramic-coated gutta-percha points. A total of 92 human single-root extracted teeth were endodontically treated and divided into three groups (A, B, and C) of 30 samples based on the endodontic sealer/type of gutta-percha points/obturation method used. One tooth sample was used for the negative and positive controls (each). Group A: BCB sealer BioRoot RCS (Septodont, Saint-Maur-des-Fossés, France)/bioceramic-impregnated gutta-percha TotalFill BC points (FKG Dentaire, La Chaux-de-Fonds, Switzerland)/cold hydraulic single-cone. Group B: BioRoot RCS (Septodont, France)/traditional Protaper Gold Gutta-Percha Points (Dentsply Sirona, Charlotte, NC, USA)/cold hydraulic single-cone. Group C: RB sealer AdSeal (Meta Biomed, Cheongju, Republic of Korea)/traditional Protaper Gold Gutta-Percha Points (Dentsply Sirona, USA)/warm vertical condensation. A dye penetration method was applied, and the length of apicocoronal penetration was measured using a surgical microscope. The data were statistically analyzed to evaluate differences at the 0.05 significance level. A significant difference was found between groups A and C, p = 0.0003, and groups B and C, p = 0.003. The data analysis proved that the BCB sealer using the cold hydraulic single-cone method ensured a substantially better seal than the RB sealer using the warm vertical condensation method. The choice of the type of gutta-percha points (bioceramic-coated or regular) appeared to be unimportant. No statistical significance was found between groups A and B, which indicates that using bioceramic-coated gutta-percha points does not bring any considerable benefit in view of a no-gap root canal obturation. 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

Essential oils are a common alternative to chloroform for dissolving gutta–percha. This study evaluated the antimicrobial effects of chloroform and six essential oil gutta–percha solvents: eucalyptus oil, orange oil, clove oil, rosemary oil, grapefruit oil, and castor oil, against Enterococcus faecalis and Candida albicans by using disk diffusion techniques. The impregnated sterile disk with 10 μL of pure, tested solvents was inoculated on agar plates at three time contacts: 3 min, 10 min, and 24 h. The mean diameter of the zone of inhibition (ZOI) of each solvent was measured after 24 h of incubation. Against Enterococcus faecalis, in both 3 min and 10 min contact, rosemary oil had the largest ZOI (11.40 ± 0.90 and 11.55 ± 0.68 mm), and orange oil showed the smallest ZOI (7.90 ± 0.31 and 9.05 ± 0.68 mm), respectively. Eucalyptus oil exhibited ZOI with persistence, while grapefruit oil and castor oil showed no ZOI. After 24 h of contact, the largest ZOI was recorded for orange oil. Against Candida albicans, at all three time points, clove oil produced the largest ZOI (20.25 ± 0.82, 23.10 ± 0.93, 30.59 ± 0.74 mm) and chloroform the smallest (10.4 ± 0.77, 9.85 ± 0.62, 11.6 ± 0.65 mm), for 3 min, 10 min, and 24 h, respectively. Conclusively, clove oil, orange oil, and rosemary oil exhibit significant antimicrobial activity like chloroform. Full article