• Restorative Dentistry and Endodontics
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• v.42 no.1
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• pp.19-26
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• 2017

Objectives: Recently, bioceramic sealers like EndoSequence BC Sealer (BC Sealer) have been introduced and are being used in endodontic practice. However, this sealer has limited research related to its retreatability. Hence, the aim of this study was to evaluate the retreatability of two sealers, BC Sealer as compared with AH Plus using micro-computed tomographic (micro-CT) analysis. Materials and Methods: Fifty-six extracted human maxillary incisors were instrumented and randomly divided into 4 groups of 14 teeth: 1A, gutta-percha, AH Plus retreated with chloroform; 1B, gutta-percha, AH Plus retreated without chloroform; 2A, gutta-percha, EndoSequence BC Sealer retreated with chloroform; 2B, gutta-percha, EndoSequence BC Sealer retreated without chloroform. Micro-CT scans were taken before and after obturation and retreatment and analyzed for the volume of residual material. The specimens were longitudinally sectioned and digitized images were taken with the dental operating microscope. Data was analyzed using an ANOVA and a post-hoc Tukey test. Fisher exact tests were performed to analyze the ability to regain patency. Results: There was significantly less residual root canal filling material in the AH Plus groups retreated with chloroform as compared to the others. The BC Sealer samples retreated with chloroform had better results than those retreated without chloroform. Furthermore, patency could be re-established in only 14% of teeth in the BC Sealer without chloroform group. Conclusion: The results of this study demonstrate that the BC Sealer group had significantly more residual filling material than the AH Plus group regardless of whether or not both sealers were retreated with chloroform.

• Journal of dental hygiene science
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• v.21 no.4
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• pp.243-250
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• 2021

Background: Endodontic sealers or their toxic components may become inflamed and lead to delayed wound healing when in direct contact with periapical tissues over an extended period. Moreover, an overfilled sealer can directly interact with adjacent tissues and may cause immediate necrosis or further resorption. Therefore, the treatment outcome conceivably depends on the endodontic sealer's biocompatibility and osteogenic potential. This study aimed to evaluate the cell viability and osteogenic effects of four different sealers in osteoblastic cells. Methods: AH Plus (resin-based sealer), Pulp Canal Sealer EWT (zinc oxide-eugenol sealer), BioRoot RCS (calcium silicate-based sealer), and Well-Root ST (MTA-based calcium silicate sealer) were mixed strictly according to the manufacturer's instructions, and dilutions of sealer extracts (1/2, 1/5 and 1/10) were determined. Cell viability was measured using the water-soluble tetrazolium-8 (WST-8) assay. Differentiation was assessed by alkaline phosphatase (ALP) activity and mineralized nodule formation by Alizarin Red S staining. Results: The cell viability of the extracts derived from the sealers excluding Well-Root ST was concentration dependent, with sealer extracts having the least viability at a 1/2 dilution. At sealer extract dilution of 1/10, the test groups showed the same survival rate as that control group, with the exception of BioRoot RCS. Among all experimental groups, BioRoot RCS showed the highest cell viability after 48 hours. The ALP activity was significantly higher in a concentration-dependent manner. Furthemore, all four materials promoted ALP activity and mineralized nodule formation compared to the control at 1/10 dilutions. Conclusion: This is the first study to highlight the differences in biological activity of these four materials. These results suggest that the composition of root canal sealers appears to alter the form of biocompatibility and osteoblastic differentiation.

• Restorative Dentistry and Endodontics
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• v.48 no.1
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• pp.5.1-5.22
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• 2023

This systematic review and network meta-analysis aimed to answer the following focused research question: "Does the type of endodontic sealer affect the postoperative pain in patients who received endodontic treatment?" Different databases and grey literature were surveyed. Only one randomized controlled trial were included. The risk of bias in the studies was evaluated by using the Cochrane Collaboration's tool. A random-effects meta-analysis was conducted to compare the risk and intensity of postoperative pain. The quality of the body of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Out of 11,601 studies, 15 remained for qualitative analyses and 12 for meta-analysis. Seven studies were classified at high risk of bias, and 8 studies raised some concerns. No significant differences between the endodontic materials were observed in the direct comparisons, both in risk and in intensity of postoperative pain (pairwise comparisons with 2 studies: I² = 0%; p > 0.05 and 8 studies: I² = 23%; p > 0.05, respectively). The certainty of the evidence was graded as low or moderate. There was no difference in the risk and intensity of postoperative pain after filling with different endodontic sealers. Further systematic reviews should be conducted.

• The Journal of Advanced Prosthodontics
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• v.5 no.1
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• pp.16-20
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• 2013

PURPOSE. To assess the retention of glass fiber post cemented with self-adhesive resin cement into optimum and over-prepared root canals following obturation in the presence of either eugenol (EB) or calcium hydroxide (CB)-based sealers. MATERIALS AND METHODS. Roots of extracted premolars were endodontically-treated in 5 groups (n = 10). Roots of Group 1 (control) were left with no obturation and then optimally prepared to receive endodontic dowels. Other root canals were obturated with gutta-percha in the presence of either eugenol-based (Groups 2 and 4) or calcium hydroxide-based (Groups 3 and 5) sealer. Dowel spaces were prepared with optimal diameter in Groups 2 and 3, one size larger in Groups 4 and 5. Standardized fiber posts were luted to the prepared spaces using self-adhesive resin cement and its retention was then tested on an universal testing machine. Both one-way ANOVA and Tukey's HSD comparisons (${\alpha}$=0.05) were used to identify the significance of inter-group retention differences. Scanning electron microscopy (SEM) of both optimally and over-prepared dowel spaces was also considered to figure the nature of their interior out. RESULTS. The post retention was significantly higher to the non-obturated, optimally-prepared dowel spaces of Group 1 compared to the obturated, optimally-prepared ones of Groups 2 and 3. For each dowel space diameter, root canals obturated using CB of Groups 3 and 5 showed significantly higher dowel retention compared to those obturated using EB of Groups 2 and 4. Post retention to the over-prepared dowel spaces of Groups 4 and 5 was significantly higher than that recorded for the optimally-prepared ones of Groups 1-3. SEM images revealed traces of endodontic sealer and gutta-percha on the walls of the optimally-prepared dowel spaces. CONCLUSION. Despite the adverse effect of endodontic sealers on the retention of fiber posts, the over-preparation of dowel spaces helps to improve the retention.

• Restorative Dentistry and Endodontics
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• v.15 no.2
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• pp.104-114
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• 1990

The purpose of this study was to evaluate the adaptation of root canal filling material to the dentinal wall of root canal and to compare the sealing ability of the root canal filling materials using ultrasonic endodontic instrument with injection-molded thermoplasticized gutta-percha filling method and lateral condensation method. Fifty fresh human single root exlracted for orthodontic treatment, were randomly selected, and instrumented by step-back technique. And then, the teeth were divided into 5 groups according to each root canal filling methods. In the experimental group 1 and group 2, the root canals were filled with gutta perdia cases using ultrasonic instrument with and without sealer. In the experimental group 3 and 4, using jection-moldeed thermoplasticized gutta-percha method by obtul$^{(R)}$ canals were filled with and without sealer. In the control group, the canals were filled with sealer by lateral candensation. And then, 5 teeth of each group were immersed in black Indian ink, decalcified and cleared. The depth of dye penetration into the root canal were evaluated with stereoscope (Reichert Ltd., USA). Among the 5 teeth remaining in each group, the single longituding grooves were made on the labial and lingual root surfaces and then immersed in the liquid nitrogen to fracture the teeth spontaneously without any distortions of gutta-percha. Each specimens were examined with X-650 Scanning Electron Microscope(Hitachi ltd, Japan) to show the adaptation to the canal wall, void, homogenicity of filling material and location of gutta-percha or sealer in the dentinal tubules of the root canal. The observations were as follows : 1. The experimental group 1 showed smaller mean dye penetration than control group, and showed the penetraton of sealer in the dentinal tubules of apical third of the root canal. 2. The experimental group 2 and group 4 showed the penetration of gutta-percha in the dentinal tubules of root canals. 3. The experimental group 1 and group 3 showed less mean dye penetration than the experimental group 2 and group 4. 4. The experimental group 1 and group 2 showed better adaptation of filling materials than control group.

• Restorative Dentistry and Endodontics
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• v.46 no.2
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• pp.25.1-25.12
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• 2021

Objectives: This study used micro-computed tomography (µCT) to compare voids and interfaces in single-cone obturation among AH Plus, EndoSequence BC, and prototype surface pre-reacted glass ionomer (S-PRG) sealers and to determine the percentage of sealer contact at the dentin and gutta-percha (GP) interfaces. Materials and Methods: Fifteen single-rooted human teeth were shaped using ProTaper NEXT size X5 rotary files using 2.5% NaOCl irrigation. Roots were obturated with a single-cone ProTaper NEXT GP point X5 with AH Plus, EndoSequence BC, or prototype S-PRG sealer (n = 5/group). Results: The volumes of GP, sealer, and voids were measured in the region of 0-2, 2-4, 4-6, and 6-8 mm from the apex, using image analysis of sagittal µCT scans. GP volume percentages were: AH Plus (75.5%), EndoSequence BC (87.3%), and prototype S-PRG (94.4%). Sealer volume percentages were less: AH Plus (14.3%), EndoSequence BC (6.8%), and prototype S-PRG (4.6%). Void percentages were AH Plus (10.1%), EndoSequence BC (5.9%), and prototype S-PRG (1.0%). Dentin-sealer contact ratios of AH Plus, EndoSequence BC, and prototype S-PRG groups were 82.4% ± 6.8%, 71.6% ± 25.3%, and 70.2% ± 9.4%, respectively. GP-sealer contact ratios of AH Plus, EndoSequence BC, and prototype S-PRG groups were 65.6% ± 29.1%, 80.7% ± 25.8%, and 87.0% ± 8.6%, respectively. Conclusions: Prototype S-PRG sealer created a low-void obturation, similar to EndoSequence BC sealer with similar dentin-sealer contact (> 70%) and GP-sealer contact (> 80%). Prototype S-PRG sealer presented comparable filling quality to EndoSequence BC sealer.

• Restorative Dentistry and Endodontics
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• v.46 no.3
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• pp.31.1-31.13
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• 2021

Objectives: To evaluate postoperative pain after endodontic treatment of necrotic teeth using large intentional foraminal enlargement (LIFE). Materials and Methods: The sample included 60 asymptomatic necrotic teeth (with or without chronic apical periodontitis), and a periodontal probing depth of 3 mm, previously accessed and referred to perform endodontic treatment. After previous procedures, the position and approximate size of the apical foramen (AF) were determined by using an apex locator and K flexo-files, respectively. The chemomechanical preparation was performed with Profile 04 files 2 mm beyond the AF to achieve the LIFE, using 2.5 mL of 2.5% NaOCl at each file change. The filling was performed by Tagger's hybrid technique and EndoFill sealer. Phone calls were made to all the patients at 24, 48 and 72 hours after treatment, to classify postoperative pain. Statistical analysis was performed by different tests with a significance level of 5%. Results: Age, gender, periradicular status and tooth type did not influence postoperative pain (p > 0.05). Only 1 patient (1.66%) reported severe pain after 72 hours. Moderate pain was reported by 7, 4 and 3 patients after 24, 48 and 72 hours, respectively (p = 0.0001). However, paired analyses showed a statistically significant difference only between 24 and 72 hours (p = 0.04). Sealer extrusion did not influence the postoperative pain (p > 0.05). Conclusions: Acute or moderate postoperative pain was uncommon after endodontic treatment of necrotic teeth with LIFE.

• Restorative Dentistry and Endodontics
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• v.47 no.2
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• pp.21.1-21.11
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• 2022

Objectives: This study aimed to investigate the bonding effects of cleaning protocols on dentin impregnated with endodontic sealer residues using ethanol (E) or xylol (X). The effects of dentin acid etching immediately (I) or 7 days (P) after cleaning were also evaluated. For bonding to dentin, universal adhesive (Scotchbond Universal; 3M ESPE) was used. The persistence of sealer residues, hybrid layer formation and microshear bond strength were the performed analysis. Materials and Methods: One hundred and twenty bovine dentin specimens were allocated into 4 groups (n = 10): G1 (E+I); G2 (X+I); G3 (E+P); and G4 (X+P). The persistence of sealer residues was evaluated by SEM. Confocal laser scanning microscopy images were taken to measure the formed hybrid layer using the Image J program. For microshear bond strength, 4 resin composite cylinders were placed over the dentin after the cleaning protocols. ANOVA followed by Tukey test and Kruskal-Wallis followed by Dunn test were used for parametric and non-parametric data, respectively (α = 5%). Results: G2 and G4 groups showed a lower persistence of residues (p < 0.05) and thicker hybrid layer than the other groups (p < 0.05). No bond strength differences among all groups were observed (p > 0.05). Conclusions: Dentin cleaning using xylol, regardless of the time-point of acid etching, provided lower persistence of residues over the surface and thicker hybrid layer. However, the bond strength of the universal adhesive system in etch-and-rinse strategy was not influenced by the cleaning protocols or time-point of acid etching.

• Restorative Dentistry and Endodontics
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• v.46 no.2
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• pp.27.1-27.10
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• 2021

This study describes 6 cases of endodontic overfilling with successful clinical outcomes during long-term (up to 35 years) radiographic follow-up. Successful endodontic treatment depends on proper shaping, disinfection, and obturation of root canals. Filling materials should completely fill the root canal space without exceeding the anatomical apex. Overfilling may occur when the filling material extrudes into the periapical tissues beyond the apex. The present case series describes 6 root canal treatments in which overfilling of root canal sealer and gutta-percha accidentally occurred. Patients' teeth were periodically checked with periapical radiographs in order to evaluate the outcomes during long-term follow-up. All cases showed healing and progressive resorption of the extruded materials in the periapex. The present cases showed that if a 3-dimensional seal was present at the apical level, overfilling did not negatively affect the long-term outcomes of root canal treatment.

• Journal of Korean Dental Science
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• v.14 no.2
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• pp.61-68
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• 2021

Purpose: The aim of this study was to investigate the outcomes of endodontic treatment of mandibular second molar with C-shaped canal in elderly patients and related factors affecting the survival of the tooth. Materials and Methods: From 2010 to 2015, the survival rate following endodontic treatment was evaluated in elderly patients over 60 years who visited the Veterans Health Service Medical Center for endodontic treatment. The presence of C-shaped canals was confirmed using clinical records and radiographic features. Patient's age, sex, systemic diseases, tooth location, vitality, signs and symptoms, fractures, caries, apical radiolucency, canal shaping methods, sealer leakage, filling voids, and restoration of prosthesis were included in the analyses as confounding variables. The survival rate of teeth was analyzed using Kaplan-Meire analysis and the relationship between the survival rate and variables was analyzed using Simple and Multiple Cox regression analysis. Result: In total, 107 teeth in elderly patients had C-shaped canal. The survival rate of teeth that received endodontic treatment was 63.70%. None of the factors investigated significantly influenced the survival rate (P>0.05). Conclusion: In elderly patients with C-shaped canal, the survival rate after root canal treatment was not significantly different from that of other mandibular molars.