Search Results (25)

Background and Objectives: Warm injectable gutta-percha techniques may improve three-dimensional filling of complex canal anatomy, but heat transfer to the external root surface may threaten periodontal tissues when the 47 °C threshold is exceeded. This in vitro study quantified external root-surface temperature changes during obturation with the Woodpecker FI-G/FI-P system and compared manufacturer preset temperatures with actual device output. Materials and Methods: Twenty extracted single-rooted human teeth standardized to 18 mm were prepared and assigned to obturation at 180 °C (Group A, n = 10) or 230 °C (Group B, n = 10). Infrared thermography recorded coronal, middle, and apical root-surface temperatures. A second device-based experiment measured FI-G and FI-P output at preset temperatures of 150 °C, 180 °C, 200 °C, and 230 °C. Results: The 230 °C setting produced significantly higher middle-third temperatures than the 180 °C setting (41.84 ± 5.52 °C vs. 36.99 ± 3.21 °C; p = 0.027; Cohen’s d = 1.07), whereas coronal and apical differences were not significant. The highest external root-surface value was 49.6 °C, and 3/10 specimens obturated at 230 °C exceeded 47 °C in the middle third. A significant coronal-to-middle gradient reversal was observed at 230 °C (p = 0.045). Device measurements showed strong attenuation between preset and output temperatures: at 230 °C, the FI-G tip base reached 150.0 °C but the tip apex reached 51.3 °C, while FI-P plugger tips reached 120.0 °C. Conclusions: The 180 °C setting produced a more predictable thermal profile, whereas 230 °C increased localized middle-third overheating risk. These in vitro findings support cautious temperature selection, especially in teeth with reduced dentin thickness or compromised root anatomy. Full article

Apical perforation is a possible complication during root canal treatment, often caused by instrumentation beyond the working length, and requires prompt, precise sealing. In immature teeth needing endodontic therapy, the same principles used for managing apical perforations apply. Despite the widespread use of calcium silicate cement (CSC)-based materials, there is limited evidence comparing the sealing performance of putty-type CSCs and injectable bioceramic sealers in apical perforations under standardized laboratory conditions. This study aimed to compare the sealing ability of Retro-MTA cement and Endoseal MTA sealer in standardized apical perforations using the fluid-filtration method. In this in vitro study, 34 extracted human maxillary central incisors were used and divided into two groups. In Group 1, apical perforations were sealed with Retro-MTA and obturated using warm vertical compaction. In Group 2, perforations were sealed with Endoseal MTA and obturated using the single-cone technique. Micro-leakage was assessed using the fluid-filtration method. Data were analyzed with an independent t-test (α = 0.05). All samples exhibited leakage after two weeks. However, Retro-MTA demonstrated significantly lower micro-leakage than Endoseal MTA (0.265 vs. 0.473 μL/min/cmH₂O; p < 0.001), corresponding to approximately a 44% difference in leakage values between the two materials. The findings indicate that Retro-MTA provides a superior apical seal and lower leakage rates than Endoseal MTA. Therefore, Retro-MTA appears to be the more effective material for sealing apical perforations and managing open apices, potentially providing more stable apical seal under controlled laboratory conditions. Full article

The introduction of calcium-silicate-based sealers has renewed interest in simplified obturation protocols such as the single-cone technique, although warm techniques, including carrier-based obturation, are still considered the gold standard. The aim of this in vitro study was to compare the quality of root canal obturation achieved with single-cone and carrier-based techniques when used with the same calcium-silicate-based sealer. Thirty extracted mandibular molars were prepared using a standardized rotary instrumentation protocol and randomly assigned to two groups (n = 15 each): Group A was obturated using a carrier-based technique (Soft-Core obturators), while Group B was obturated with the single-cone technique. All canals were filled with the same calcium-silicate-based sealer (NeoSEALER Flo). Micro–computed tomography was used to evaluate the number and volume of voids of the obturation. Quantitative analysis showed that Group A exhibited a significantly lower number of voids (9.0 ± 5.0) and reduced total void volume (2.58 ± 0.8 mm³) compared with Group B (22.0 ± 10.1 voids; 4.71 ± 1.1 mm³; p = 0.00002 and p = 0.0026, respectively). Qualitative analysis confirmed that carrier-based obturation achieved a denser and more homogeneous filling, while the single-cone technique showed larger voids mainly in the coronal and middle thirds. Both techniques provided a reliable apical seal. Within the limitations of this in vitro study, carrier-based obturation demonstrated superior overall filling quality compared with the single-cone technique when used with a calcium-silicate-based sealer, particularly in the middle and coronal regions of the root canal. Full article

Background and Objectives: The anatomically demanding structure of curved root canals increases the technical difficulty of retreatment procedures. This study aimed to evaluate the retreatment efficacy of various rotary and reciprocating instruments in curved root canals obturated with cold and warm techniques regarding root canal filling material removal, apical transportation, and retreatment time. Materials and Methods: Sixty-four curved mesial root canals of mandibular molars with Vertucci type IV morphology were prepared using the ProTaper Gold system and obturated with AH Plus sealer using either the single-cone (SC) (n = 32) or continuous wave vertical compaction (CWC) (n = 32) technique. Each group was divided into four subgroups (n = 8) and retreated using MicroMega Remover (MM Remover), ProTaper Universal Retreatment (PTUR), Reciproc (Rec), and Hedstrom file systems. Micro-computed tomography was used to assess residual filling material volume and apical transportation. The time required for retreatment was recorded. The level of statistical significance was set at p < 0.05. Results: Across both obturation techniques, the MM Remover and PTUR groups demonstrated shorter retreatment times compared with the CWC–Hedstrom group (p < 0.05). No statistically significant differences were observed among the file systems in terms of filling material removal and apical transportation (p > 0.05). Conclusions: All tested instruments effectively preserved root canal anatomy within clinically acceptable apical transportation limits. The MM Remover and PTUR systems achieved significantly shorter retreatment times, indicating clinical advantages in efficiency. None of the evaluated systems achieved complete removal of the filling materials in either obturation technique. This study provides one of the first comparative evaluations of the MM Remover system, supporting its applicability in complex canal configurations. 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

Background/Objectives: The objective of this study was to investigate current endodontic practice patterns and the adoption of newer technologies among dentists, endodontic specialists, and postgraduate students in Spain and Latin America. Methods: A cross-sectional survey was conducted using a structured 30-item questionnaire covering demographics, training, technology adoption (NiTi instrumentation, magnification, CBCT, irrigation adjuncts, bioceramic sealers), obturation techniques, irrigant selection, and clinical procedures. The survey was distributed through a professional Instagram account and WhatsApp groups of dentists, specialists, and postgraduate students. Participation was voluntary, anonymous, and restricted to qualified professionals. Data were collected via Google Forms, cleaned, and grouped into Spain, Mexico, Venezuela, Colombia, Southern Cone & Andes (Argentina, Chile, Peru, Ecuador, Bolivia), and other countries. Descriptive statistics were calculated, and intergroup comparisons were performed using Chi-square or Fisher’s exact tests with Bonferroni correction (p < 0.05). Multiple regression analyses were performed. Results: A total of 1358 valid responses were analyzed, distributed as follows: Spain (219), Mexico (353), Venezuela (162), Colombia (108), Southern Cone & Andes (260), and other countries (256). Most respondents (62.8%) had ≤10 years of experience, and 61.2% reported postgraduate training. Loupes (55.4%) were the most frequent magnification system, followed by microscopes (18.6%). Sodium hypochlorite (98.3%) was the irrigant of choice, commonly used with EDTA (83.5%) and, to a lesser extent, chlorhexidine (33.4%). Sonic (83.2%) and ultrasonic (52.9%) activation were frequent. Bioceramic sealers were used by 18.9%, while calcium hydroxide medication was applied by 37.4%. Specialists and master-level clinicians showed greater use of rotary NiTi systems, CBCT, magnification, and bioceramic sealers, whereas general practitioners relied more on manual instrumentation and single-cone obturation. Success was mainly verified by combined clinical and radiographic evaluation (86.7%). Spain demonstrated higher adoption of microscopes, warm vertical compaction, and CBCT. Conclusions: Core practices such as sodium hypochlorite irrigation and rubber dam use were widespread, while advanced technologies and irrigant protocols varied with training level and region. Continuous education remains essential to promote evidence-based practice and reduce disparities in endodontic innovation. 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

Background/Objectives: We aimed to assess the bond strength of AH Plus Jet (AH) and an epoxy resin-based root canal sealer prototype (K-0189) adhered to three different obturation points. Methods: A total of 120 single-rooted teeth were selected after radiographic analysis, and their root canals were instrumented with ProTaper Next files (PTN) up to size X5. The teeth were randomly assigned to two sealer groups (G) (G1: AH, G2: K-0189, each n = 60) and further divided into three subgroups: (A) ConformFit X5 points (PTN) cold obturation (CO), (B) ProTaper Universal F5 points (PTU) (CO), (C) GuttaCore X5 (GC) warm obturation (WO). After final irrigation (NaOCl 3%, EDTA 17%, NaOCl 3%) and drying, root canals were obturated and stored for 30 days at 37 °C in Simulated Body Fluid (SBF). The specimens were embedded in acrylate and sectioned horizontally; then, push-out bond strength (POBS) analysis was performed. Results: The median POBS values [MPa] were G1A: 2.03; G1B: 2.12; G1C: 3.2; G2A: 1.91; G2B: 2.56; and G2C: 3.36. WO showed significantly higher POBS (p < 0.001 *) than CO. The POBS was not significantly different between the two WO groups (p = 0.508). The POBS of G2B was significantly higher compared to all other CO groups. Conclusions: The epoxy resin sealer prototype demonstrated POBS values comparable to AH Plus when used with WO and PTU points, indicating significantly higher POBS values compared to all other CO points. 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

Depending on the obturation technique, the tooth and surrounding tissues may heat up during root canal filling, particularly with warm methods. This study aimed to analyze the temperature increase in the periradicular and -apical region during various warm obturation techniques with a present simulated periodontal blood flow. Seventy-five extracted human teeth were shortened to 11 mm (cut-grinder Primus diamond cutting device; Walter Messner GmbH, Oststeinbek, Germany) and prepared using the ProTaper Gold system (Dentsply Sirona Inc., Charlotte, NC, USA) ISO size 40/.06. Specimens were prepared to ensure stable fluid circulation in an artificially created periodontal space, and the procedure was recorded with a thermal infrared camera (VarioCAM HD; InfraTec GmbH Infrarotsensorik und Messtechnik, Dresden, Germany). The following obturation methods were applied: I, cold single-cone obturation (control group); II, gutta-percha-coated rigid carrier technique (GuttaFusion); III, squirting technique (injection technique); IV, continuous wave technique; and V, Schilder technique. Statistical analysis was performed using the Kruskal–Wallis test, followed by the Mann–Whitney pairwise test using the sequential Bonferroni procedure for significant differences (p < 0.05). The Schilder technique with 0 mL/min showed the lowest temperature change, with a median of 0.00 °C (max. 0.00 °C, min. 0.00 °C, IQR 0.00 °C). In contrast, the continuous wave technique at a circulation rate of 2.6 mL/min exhibited the highest temperature change, with a median of 3.76 °C (max. 5.33 °C, min. 2.42 °C, IQR 1.46 °C). Although warm obturation techniques can increase surface temperature, none of the methods produced changes that were potentially damaging to the periodontium or surrounding bone. 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

This study evaluated the effect of the use of EDTA solution at various intervals to remove intracanal calcium hydroxide medication on fracture resistance. One hundred and one extracted lower premolar teeth were randomly allocated into one control group (n = 5), two main experimental groups (CH(+), with calcium hydroxide dressing, and CH(−), without calcium hydroxide dressing), with four subgroups (EDTA intervals: 1 min, 3 min, 5 min, 10 min, n = 12). Ready-to-use injectable calcium hydroxide was used for the samples in the four CH(+) subgroups, and the samples were kept in an incubator at 37 °C and 100% humidity for seven days. All samples (CH(+), CH(−)) were irrigated with 17% EDTA, which was accompanied by activation with EndoActivator for 1, 3, 5, and 10 min, and then rinsed with 2.5% NaOCl in a standardized manner. The obturation was conducted using the warm obturation technique; experiments were conducted with a universal testing device, and their fracture strength was recorded. Compliance with the normal distribution was examined with ±2 skewness coefficients. Two-way ANOVA, Tukey’s, one-way ANOVA, and Dunnett’s tests were used for statistics (p < 0.050). A statistically significant difference was found between the mean values of the force between the groups (p = 0.009). The mean strength of the tooth at fracture that CH(−) was 401.7, CH(+) was 335.35. There was no statistically significant difference between the mean values of the forces according to time intervals (p = 0.387). While there was no significant difference among the experimental groups (p = 0.229), the mean fracture strength of the negative control group was found to be significantly higher (p < 0.001). The highest fracture resistance was observed in the nonprepared group. Irrigation with EDTA for up to 5 min showed more acceptable fracture resistance results than the other groups. Using calcium hydroxide significantly and negatively affected the root strength. Full article

This study aimed to assess the adaptability and penetration depth capacity of recent bioceramic systems, including regular EndoSequence (BC) versus HiFlow (BCH) sealers in the presence of BC points. A total of 54 single-rooted teeth were instrumented and obturated with either the cold or warm compaction technique (n = 9), using either BC, BCH, or AH Plus (AHP) combined with BC points. The adaptation, film thickness, and gaps/voids were evaluated by scanning electron microscopy. The sealer/dentin interface was evaluated by Raman spectroscopy, and depth penetration was evaluated by a confocal laser scanning microscope. According to the normality test, the data were statistically analyzed by ANOVA or Kruskal–Wallis and Mann–Whitney U tests at p < 0.05. BCH sealer showed the significantly thinnest film with the greatest flow (p > 0.001), with further improvement when subjected to the warm compaction technique. Moreover, it exhibited close adaptation with deep penetration into radicular dentin, forming a tag-like structure. The Raman spectra also indicated close contact with the dentin surface. The use of BC sealer with BC points exhibited homogenous, single-unit obturation, either with a cold or warm technique. Furthermore, the use of the warm compaction technique with BCH sealer achieved a gap-free interface associated with tag-like structures, which exhibit the monoblock phenomenon. Full article

Introduction: We compared the effects of heat on the physicochemical properties of recently developed calcium silicate-based sealers (CSBSs), including BioRoot Flow, BioRoot RCS, and AH Plus Bioceramic sealer, with those of the epoxy-resin-based sealer (ERBS) AH Plus. Methods: The flow, film thickness, setting time, and solubility of sealers were evaluated at 37 °C and 100 °C using ISO 6876/2012. Furthermore, pH and calcium ion release were evaluated at these temperatures. In addition, the mass change in sealers at a high temperature was assessed via thermogravimetric analysis. Then, the chemical composition and components of the sealers were analyzed using a scanning electron microscope and Fourier-transform infrared spectroscopy (FTIR). Results: BioRoot Flow, AH Plus Bioceramic, and AH Plus complied with ISO standards in terms of flow and film thickness, both before and after heat application. However, BioRoot RCS exhibited significantly increased film thickness at 100 °C. The setting times of all sealers were significantly reduced at 100 °C. The solubility of CSBS was >3%, exceeding the ISO 6876/2012 standard, both before and after heat exposure. Conversely, the solubility of AH Plus complied with the standard, regardless of the thermal condition. For 4 weeks, CSBS showed a significantly higher pH than AH Plus at both 37 °C and 100 °C. After heat treatment, calcium release decreased in Bioroot RCS and BioRoot Flow, while AH Plus showed no significant differences before and after treatment. However, CSBS consistently exhibited significantly higher calcium release than AH Plus at both temperatures. An FTIR analysis revealed that the chemical composition of the sealers did not change at the high temperature, whereas a thermogravimetric analysis demonstrated a >5% weight reduction in CSBS and a 0.005% weight reduction in AH Plus at 100 °C. Conclusions: BioRoot Flow, AH Plus Bioceramic, and AH Plus possess favorable physicochemical properties, which make them suitable for application under thermal conditions. At a high temperature, BioRoot RCS did not exhibit changes in its chemical composition. However, its film thickness was increased, and pH and solubility were reduced. Therefore, caution is needed when it is applied at high temperatures, such as during the warm obturation technique. Full article

Background: The proper sealing of the root canal seems to be critical to obtain a stable result of endodontic therapy. The sealer’s penetration into dentinal tubules during root canal treatment is probably a crucial factor to provide better clinical results. The aim of this study was to compare the effect of three irrigation protocols on the penetration of the epoxy sealer into dentinal tubules and two dyes used to stain the sealer. Methods: Ninety single-canaled human teeth with straight roots were used. The root canals were instrumented with Reciproc instruments up to the size 40/04 ISO. The teeth were divided into three groups (n = 30). The root canals of each group were rinsed accordingly: the control group 1: 5.25% sodium hypochlorite (NaOCl); the experimental group 2: smear layer removal (two times alternatively: 40% citric acid and 5.25% NaOCl) and NaOCl; the experimental group 3: smear layer removal (same as in group 2) and isopropyl alcohol. In each group the roots were further divided into 2 subgroups (n = 15). The root canals were obturated using warm vertical compaction technique of gutta-percha with AH Plus sealer marked with hydrophilic fluorescein (subgroup F) or hydrophobic porphyrin (subgroup P). After 72 h, one-millimeter-thick cross-sections were cut in two, five and eight millimeters distance from the apex. The depth of the penetration of the sealer into the dentinal tubules (resin tags) was measured with the use of a confocal laser microscope. Results: In of all the root parts, the longest resin tags were observed in group 2, whereas the shortest ones were found in group 1 (in the porphyrin subgroups all differences were statistically significant). Within the fluorescein subgroups, the differences between all groups were statistically significant in the middle section of the roots. In the apical and the coronal sections, significant differences were observed between group 1 and the other two groups. Conclusions: The isopropyl alcohol at the end of the irrigating protocol did not affect the higher sealer penetration of the sealer into the dentinal tubules compared with sodium hypochlorite. With the limitation of this study, the hydrophobic porphyrin may be considered as the favorable dye choice to stain endodontic sealers in further studies with confocal laser scanning microscopy, but the methods and reagents used should still be in the research phase. Full article