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This study aimed to evaluate the long-term outcome of 16 permanent maxillary central incisors with nonvital pulps and open apices treated with apexification and corono-radicular adhesive restorations, within a follow-up span of 5 to 22 years.Fourteen patients providing a total of 16 teeth treated with mineral trioxide aggregate (n = 12), Biodentine (n = 3), or β-tricalcium phosphate (n = 1) apical barrier and corono-radicular restoration, with or without fiberglass post, were included. Clinical and radiographic criteria were defined for assessment at recall. Restoration and periapical tissue status evaluation were performed according to FDI World Dental Federation's esthetic, functional, and biological criteria and Ørstavik Periapical Index (PAI). Outcome was dichotomized as "healed" (PAI ≤ 2, asymptomatic with absence of signs of infection) or "not healed" (PAI ≥ 3, presence of clinical signs and/or symptoms).Fourteen of 24 patients were available for the present study (recall rate = 58%). Within a follow-up of 5 to 22 years, 10 (62.5%) teeth were considered "healed," fulfilling both strict clinical and radiographic success criteria. Only 1 tooth was missing due to root resorption and 1 patient was presenting with clinical signs and symptoms at recall, resulting in a survival rate of 93.8%.Adhesive corono-radicular restoration in nonvital permanent immature teeth treated with apexification allows for favorable long-term outcomes, by ensuring structural reinforcement and coronal microleakage prevention. Teeth sustaining a substantial loss of coronal structure may require post/core placement. In the case of failure, this endodontic-restorative combination ensured teeth survival until growth phase conclusion, thus allowing for proper prosthetic rehabilitation approaches.

The aim of this study was to evaluate the effect of previous root canal treatment on dentinal tubule penetration of calcium silicate-based sealers during endodontic retreatment and to compare 2 different (commonly used and modified) tubule penetration depth measurement techniques.The crowns of mandibular premolar teeth were removed, and root canals were prepared (ProTaper Universal; Dentsply Sirona, York, PA) and obturated using AH Plus (AH; Dentsply DeTrey, Konstanz, Germany), MTA Fillapex (MTAF; Angelus, Londrina, Brazil), and WellRoot ST (WRST; Vericom, Gyeonggi-do, South Korea); 0.1% red Rhod-2 dye (Chemodex, St Gallen, Switzerland) was added to the sealers. After storage for 3 weeks (37°C, 100% humid), the following sealer combination subgroups were created (the sealer used during the primary root canal treatment/the sealer used during the retreatment, n = 8): AH/AH, AH/MTAF, and AH/WRST; MTAF/AH, MTAF/MTAF, and MTAF/WRST; and WRST/AH, WRST/MTAF, and WRST/WRST. Green Fluo-3 dye (0.1%) was added to the sealers during retreatment. Sealer penetration depths were measured at 8 points and averaged, and the ratio of the retreatment sealer to the initial sealer was recorded as the mean tubule penetration depth ratio in the first technique, whereas the percentage of the circumferential penetration area ratios of the retreatment and initial sealers was calculated in the second technique. Statistical analyses were performed using Kolmogorov-Smirnov, Kruskal-Wallis, and Mann-Whitney U tests.The mean penetration depth of AH and MTFA was found to be higher at the coronal third region in the control groups (P .05). Both methods showed a significant difference among the groups at the coronal and median regions (P .05). The AH/WRST, MTAH/AH, MTAF/MTAF, MTAF/WRSTS, and WRST/WRST groups showed deeper tubule penetration (first technique, P = .01). Both techniques showed that the penetration depth of the sealers was the same at the apical region (P .05), whereas a difference was found among the techniques at the coronal and median regions. The sealers used in the previous root canal treatment limited the penetration depth of the sealers used during the retreatment process (P .05). When MTAF was used as the initial sealer, the penetration depth of the second sealer did not change, whereas if WRST was the initial sealer, the penetration depth of the sealers at the median and apical regions is negatively affected during the retreatment process (P .05).Previous root canal treatment affects the penetration depth of calcium silicate-based sealers. The use of AH Plus and MTA Fillapex during the retreatment process showed an advantage. Both measurement techniques showed similar performances at the apical region, whereas the results varied at the coronal and midcoronal regions; therefore, a more stable sealer penetration measurement technique is still necessary.

The purpose of this study was to assess the antimicrobial activity of root canal sealers modified with novel highly loaded antimicrobial drug-silica coassembled particles (DSPs) on Enterococcus faecalis-infected root canal dentin.DSPs were synthesized through coassembly of silica and octenidine dihydrochloride (OCT) surfactant drug (35% w/w OCT). DSPs (1% wt of the total mass of the sealer) were mixed homogenously with either epoxy resin sealer (AH Plus [AH]; Dentsply Sirona, Tulsa, OK) or calcium silicate-based sealer (EndoSequence BC Sealer [BC]; Brasseler, Savannah, GA). To assess the antimicrobial activity of DSP-loaded sealers, the apical third of single-rooted teeth was obtained and infected with E. faecalis for 3 weeks followed by the application of experimental (DSP-loaded) sealers or corresponding controls for up to 28 days. Microbiological analysis and laser scanning confocal and scanning electron microscopy were used to determine the colony-forming unit (CFU)/mL, the percentage of live bacteria, and the intratubular bacterial and sealer penetrations. Factorial analysis of variance and Tukey post hoc tests were used to assess the antimicrobial effect of DSPs on different sealers.All experimental groups showed significant reductions in CFUs at all-time points compared with positive controls (P .05). The addition of DSPs to BC significantly reduced the CFUs (2.11 ± 0.13, 2.22 ± 0.19, and 2.25 ± 0.17 at 1, 7, and 28 days, respectively) compared with the unmodified sealer (3.21 ± 0.11, 4.3 ± 0.15, and 4.2 ± 0.2 at 0, 7, and 28 days). DSPs enhanced the antimicrobial performance of AH only at 1 day (4.21 ± 0.17 vs 5.19 ± 0.12, P .05). AH and AH + DSPs showed higher bacterial viability compared with BC and BC + DSPs at all incubation periods (P .05).Loading endodontic sealers with DSPs had a material-dependent effect on the antimicrobial properties and could reduce the incidence of secondary infections.

Introduction Mineral trioxide aggregate (MTA)-based sealers are endodontic materials with widespread success in distinct clinical applications, potentially embracing direct contact with the bone tissue. Bone response to these materials has been traditionally addressed in vitro. Nonetheless, translational data are limited by the absence of native cell-to-cell and cell-to-matrix interactions that hinder the representativeness of the analysis. Ex vivo organotypic systems, relying on the culture of explanted biological tissues, preserve the cell/tissue composition, reproducing the spatial and organizational in situ complexity. This study was grounded on an innovative research approach, relying on the assessment of an ex vivo organotypic bone tissue culture system to address the osteogenic response to 3 distinct MTA-based sealers. Methods Embryonic chick femurs were isolated and grown ex vivo for 11 days in the presence of MTA Plus (Avalon Biomed Inc, Bradenton, FL), ProRoot MTA (Dentsply Tulsa Dental, Hohnson City, Germany), Biodentine (Septodont, Saint Maurdes Fosses, France), or AH Plus (Dentsply Sirona, Konstanz, Germany); the latter was used as a control material. Femurs were characterized by histologic, histochemical, and histomorphometric analysis. Gene expression assessment of relevant osteogenic markers was conducted by quantitative polymerase chain reaction. Results All MTA-based sealers presented an enhanced osteogenic performance compared with AH Plus. Histochemical and histomorphometric analyses support the increased activation of the osteogenic program by MTA-based sealers, with enhanced collagenous matrix deposition and tissue mineralization. Gene expression analysis supported the enhanced activation of the osteogenic program. Comparatively, ProRoot MTA induced the highest osteogenic functionality on the characterized femurs. Conclusions MTA-based sealers enhanced the osteogenic activity within the assayed organotypic bone model, which was found to be a sensitive system for the assessment of osteogenic modulation mediated by endodontic sealers.

Dens invaginatus (DI), which often occurs in the maxillary lateral incisor, is an important issue in endodontics because the treatment complexity increases depending on the degree of invagination and the vitality or nonvitality of the pulp. An 11-year-old female patient with a sinus tract in the gingiva of the maxillary lateral incisors showed peri-invagination periodontitis and double DI on radiography. Cone-beam computed tomographic imaging was used to examine the structure in the root canal in detail, and Oehlers type IIIA and IIIB DI was found. It was also shown that the patient’s bone defect was caused by type IIIA. Because a healthy reaction was observed in the pulp test, the final diagnosis was peri-invagination periodontitis associated with type IIIA of the double DI with vital pulp. We expected the lesion to heal by treating only the type IIIA invaginated pseudo–root canal while preserving the healthy pulp. The invaginated root canal was cleaned under a microscope using ultrasonic instruments and nickel-titanium files to minimize irritation to the pulp. Because the lesion shrinkage was confirmed by cone-beam computed tomographic imaging taken 3 months after the start of treatment, vertical compaction of the warm gutta-percha technique was performed. At the 6-month postoperative recall, the pulp was normal, and the lesions were further improved. Treatment of the main root canal of double DI is complicated. However, proper diagnosis and careful cleaning of the invaginated root canal are essential for healing while preserving the pulp.

Introduction Dynamic navigation systems are used in dental implantology to optimize the accuracy of dental implant placement. Methods A 30-year-old man was seen at the endodontic clinic of the Universidad Autonoma de Yucatan for pain in the left maxillary lateral incisor. A previously treated tooth with symptomatic apical periodontitis was diagnosed. The patient accepted treatment, and after signing an informed consent form, minimally invasive coronal access was performed through a zirconia crown. Then a post removal was performed with an ultrasonic tip to 2 mm before the apical gutta-percha limit, and the removal of material was completed manually with a K-file. Results This case report demonstrates the use of dynamic navigation to remove a post from under a zirconia crown for the retreatment of a failing root canal procedure. The removal of fiber posts from endodontically treated teeth can present a unique challenge for clinicians. Numerous techniques and instrument kits are recommended for the removal of fiber posts, but the risk of excessive root structure damage is a major concern because the ability to differentiate the color difference between peripheral dentin and a bonded fiber post can complicate the accuracy of the removal. Conclusions The dynamic navigation system enabled minimally invasive removal of the fiber post with a high degree of accuracy, thus ensuring that there was no unnecessary removal of root structure. Dynamic navigation using real-time monitoring could reduce the attendant risk of iatrogenic errors in complex treatment cases.

The aim of this retrospective study was to estimate the outcome of nonsurgical root canal treatment using matched single-cones with a calcium hydroxide-based sealer and to identify the various prognostic factors influencing the outcome.This was a retrospective study that enrolled 272 patients who underwent routine endodontic therapy and were obturated with matched single-cones and Sealapex as sealer. This study involved 223 patients with 261 teeth meeting the selection criteria and recalled between 24 and 84 months. The outcome was categorized as success (healed/healing clinically and radiographically) or failure (not healed clinically and/or radiographically). Two calibrated examiners assessed the treatment outcomes. A binomial logistic regression model was performed to identify the effect of various prognostic factors. The χThe overall success rate was found to be 89.7% for a mean recall period of 39.18 (±11.05) months. An increase in age was associated with increased odds of success, whereas the success rates were reduced by an increase in the number of roots and negative pulp sensibility status. Initial periapical index scores, presence of preoperative sinus tract, number of visits, and sealer extrusion did not affect the outcome significantly (P .05).Within the limitations of this study, it was found that teeth obturated with matched single-cone and Sealapex achieved substantial success rates. Sealer extrusion did not have any significant effect on the treatment outcome.

A study was performed of the healing rate of teeth subjected to endodontic microsurgery after a minimum follow-up of 5 years with an analysis of the influence of different pre- and postoperative factors on the outcome.This was a retrospective study of patients subjected to endodontic microsurgery with the use of mineral trioxide aggregate (MTA) for retrograde filling between January 2011 and December 2015. In patients with multiple treated teeth, only 1 random tooth was selected for the statistical analysis. Clinical and radiographic parameters were used to assess healing. Simple binary logistic regression models were used to analyze the influence of patient age and sex, the type of tooth, prior radiographic lesion size, the presence of a post, the type of restoration, and the apical extent of prior filling of the root canal on the endodontic microsurgery success rate. Two calibrated observers evaluated the periapical radiographs on an independent basis.A total of 111 patients (63.1% women and 36.9% men) were included in the study. Of the 111 teeth analyzed, 90 were classified as healed (mean healing rate = 81.1%). Patient age and sex, the presence of a post, the type of tooth, the type of restoration, and the apical extent of prior filling of the root canal had no significant impact on the outcome. Large lesions (5 mm) were associated with a lower healing rate than smaller lesions, although the difference was not significant. Anterior teeth had a significantly higher healing rate (93.8% maxillary and 100% mandibular) than molars (70.8% maxillary and 57.1% mandibular) (P.05). The differences between the anterior teeth and the molars were statistically significant.The mean healing rate of teeth subjected to endodontic microsurgery was 81% after 5-9 years of follow-up. The success rate was lower for upper and lower molars than for teeth in the anterior zone, although the sample was small and further studies are needed to establish whether the type of tooth influences the treatment outcome.

The aim of this study was to conduct a micro-computed tomographic assessment of the effectiveness of 3 supplementary cleaning techniques in reducing the residual volume of gutta-percha and a bioceramic sealer after performing endodontic retreatment procedures in teeth with oval canals.Thirty-six mandibular premolars were instrumented with the ProTaper Next system (instruments X1-X3; Dentsply Maillefer, Ballaigues, Switzerland) and filled with gutta-percha and Bio-C Sealer (Angelus, Londrina, PR, Brazil) using the single-cone technique. The teeth were reinstrumented with the Reciproc R40 instrument (VDW, Munich, Germany) and divided into 3 groups according to the supplementary cleaning technique used (n = 12): ultrasonic-assisted irrigation (UAI), EndoActivator (Dentsply Tulsa Dental Specialties, Tulsa, OK) irrigation (EAI), or the XP-endo Finisher R system (XPR; FKG Dentaire, La Chaux-de-Fonds, Switzerland). Micro-computed tomographic imaging was used to quantify the residual volume of filling material. One-way analysis of variance complemented by the Tukey test was used to perform the statistical analysis (P.05).Significant reductions were obtained in the residual filling material after supplementary cleaning (P.05). XPR (47.5%) led to significantly greater (P.05) filling material removal than UAI (16.6%) or EAI (22.6%). The removal values of the 2 latter systems were not significantly different.XPR was more effective than UAI and EAI in removing filling material in mandibular premolars with oval canals. None of the tested supplementary cleaning techniques completely removed the residual filling material.

Introduction New tricalcium silicate cements have been shown to induce less coronal discoloration. The purpose of this in vitro study was to evaluate the degree of color change induced by various silicate materials in the presence and absence of blood. Methods One hundred human extracted anterior single-canal teeth were sectioned to standardized root lengths, accessed, and instrumented. Eight random experimental groups and 2 control groups were created wherein specimens were filled with experimental materials below the buccal cementoenamel junction as follows: EndoSequence RRM putty (Brasseler USA, Savannah, GA), EndoSequence RRM fast set putty (Brasseler USA), Biodentine (Septodont, Saint-Maur-des-Fosses, France), and white mineral trioxide aggregate (Dentsply Sirona, York, PA) either with the presence or absence of blood. Blood-only and saline-only samples were used for the positive and negative controls. After incubation in 100% humidity at 37°C, color changes were evaluated with a spectrophotometer (Ocean Optics, Dunedin, FL) on days 0, 30, 60, and 180 after material placement. Data were transformed into Commission International de I'Eclairage's L∗a∗b color values, and corresponding ΔE values were calculated. The 1-way analysis of variance test was performed for statistical analysis. Results Discoloration was observed in all specimens in the presence of blood. There was no statistical significance when comparing different materials in contact with blood. Intragroup observation at various time points, Biodentine, and EndoSequence RRM fast set putty showed significant difference between the presence and absence of blood at 180 days (P Conclusions Contamination with blood of tricalcium silicate materials has the potential to cause coronal tooth discoloration.

Few data are available on the long-term efficacy of mineral trioxide aggregate (MTA) in treating root canal perforations. This prospective cohort study builds on a previously reported trial to determine the outcome for teeth with root perforations treated with orthograde MTA after longer follow-up and identify potential prognostic factors.A prospective cohort study was performed, enrolling (1999-2009) patients with a single dental perforation treated with MTA. Preoperative, intraoperative, and postoperative information was evaluated, and the outcomes were dichotomized as healed or nonhealing. Patients were followed up yearly until 2018 for a maximum of 17 years after treatment, with controls carried out until 14 years. Clinical and radiographic outcomes were evaluated using standardized follow-up protocols.Of the 124 entrolled patients (median age = 36.5 years, 53.2% male), 115 were healed at the first (n = 110, 89%) or second (n = 5, 4%) annual posttreatment checkup, while 9 subjects (7%, 4 females, 18-65 years old) did not heal. Characteristics significantly associated with nonhealing were gender, positive probing, size, and perforation site. Perforations recurred in 48 teeth during the follow-up with the estimated probability of reversal at 5, 10, and 14 years of 6% (95% confidence interval [CI], 2%-10%), 30% (95% CI, 20%-38%), and 62% (95% CI, 46%-73%), respectively. Positive probing had a higher reversal risk (hazard ratio = 3.3, P ≤ .001), and perforations3 mm were more likely to have a reversal (hazard ratio = 4.1, P .001).The risk of reversal for healed MTA-treated root canal perforations, initially relatively low, vastly increases over time.

Introduction The purpose of this in vitro study was to determine whether the methods used to treat endodontically and to restore anterior immature teeth with a necrotic pulp influence their resistance to fracture. Methods Following access opening and cleaning and shaping, 80 specimen teeth were assigned into 5 groups according to the endodontic obturation method and coronal restoration: A1 – apexification with a composite restoration in the crown area, A2 – apexification with a composite restoration in the crown and 3 mm into the root, group IR – immediate revascularization with a composite restoration in the crown area, group SR – successful revascularization with a composite in the crown area, and control group (CG) – mature tooth treated with gutta percha and sealer with a composite restoration in the crown area. The teeth were mounted in acrylic blocks and brought to fracture under compressive forces in a universal testing machine. Both the fracture strength and the location where the fracture occurred were recorded. Results There were no statistically significant differences in the fracture resistance among the 5 groups (one-way ANOVA, F = .545, df = 4, p = .703). No statistically significant differences were found in the location where the fracture occurred either (X2=4.1 df=4 p=.391). Conclusions Within the limitations of this in vitro study, it can be concluded that the treatment options used to treat non-vital immature teeth provided the same resistance to fracture.

Introduction The aim of this study was to investigate whether mineral trioxide aggregate (MTA) can be modified with caffeic acid (CA) to form caffeic acid/mineral trioxide aggregate (CAMTA) cement and to evaluate its physicochemical and biological properties as well as its capability in immune suppression and angiogenesis. Methods MTA was immersed in trishydroxymethyl aminomethane buffer with CA to allow coating onto MTA powders. X-ray diffractometry and tensile stress-strain tests were conducted to assess for physical characteristics of CAMTA and to evaluate for successful modification of MTA. Then, the CAMTA cement was immersed in simulated body fluid to evaluate its hydroxyapatite formation capabilities and Si release profiles. In addition, RAW 264.7 cells and human dental pulp stem cells were used to evaluate CAMTA’s immunosuppressive capabilities and cell responses, respectively. hDPSCs were also used to assess CAMTA’s angiogenic capabilities. Results The X-ray diffractometry results showed that CA can be successfully coated onto MTA without disrupting or losing MTA’s original structural properties, thus allowing us to retain the initial advantages of MTA. CAMTA was shown to have higher mechanical properties compared with MTA and had rougher pitted surfaces, which were hypothesized to lead to enhanced adhesion, proliferation, and secretion of angiogenic- and odontogenic-related proteins. In addition, it was found that CAMTA was able to enhance hydroxyapatite formation and immunosuppressive capabilities compared with MTA. Conclusions CAMTA cements were found to have improved physicochemical and biological characteristics compared with their counterpart. In addition, CAMTA cements had enhanced odontogenic, angiogenic, and immunosuppressive properties compared with MTA. All of the results of this study proved that CAMTA cements could be a biomaterial for future clinical applications and tissue engineering use.

The outcome of root canal obturation might be affected by the chemical components of the chosen filling materials. Niobium phosphate glass-based gutta-percha (GNB) was proposed as a biomaterial-based obturation point. This study aimed to investigate the cytotoxic and cell modulation effects of GNB points on human periodontal ligament fibroblasts (PDLFs) in vitro.Human PDLFs were cultured for the assays. Extracts of regular gutta-percha (GP) points and GNB were obtained, serially diluted (1:5, 1:10, and 1:25), and used to stimulate PDLFs. A cell viability assay was performed using alamarBlue reagent (Molecular Probes, Waltham, MA), and reverse transcription quantitative polymerase chain reaction was used to assess the gene expression for collagen type I and cementum protein 1. One-way analysis of variance followed by the Tukey post hoc test was performed (P.05).Regular GP reduced cell viability only in pure extracts, whereas GNB exhibited cytotoxicity to PDLFs in pure extracts as well as 1/5 and 1/10 dilutions. The gene expression of collagen type I was down-regulated only in the GNB group (P.05). The expression of cementum protein 1 remained unaltered by both tested materials.The addition of niobium phosphate glass to GP points increased cytotoxicity, affecting PDLF viability and partially disturbing physiological cell function.

Introduction The purpose of this study is to evaluate the amount of residual obturation material of retroinstrumented surgically resected roots using controlled memory files and to evaluate the incidence of adverse treatment outcomes. Methods Thirty maxillary anterior teeth in human cadavers were selected, and nonsurgical root canal treatment was performed on these teeth. A standardized 4-mm osteotomy and a 3-mm root resection with as close to 0° bevel as possible were made on each tooth. A microsurgical diamond tip was used to create a 1- to 2-mm starting point for each retropreparation. A 25/06 and 30/06 VTaper 2H were bent at about 90° angle to mimic the clinical and anatomic restrictions and used to create a retropreparation to a depth of 14 mm. Micro–computed tomography scans were taken and analyzed for volume and percentage of residual obturation material at 5 and 10 mm. In addition, the incidences of instrument separation and crack and ledge formation in the teeth were recorded. Results The median volume of residual obturation at 5 and 10 mm was 0.18 mm3 (interquartile range, 0.36 mm3) and 1.97 mm3 (interquartile range, 1.99 mm3), respectively. The overall incidence of file separation during retropreparation was 13.33% (4/30). Among the cases analyzed with micro–computed tomography, none showed crack or ledge formation. Conclusions Retroinstrumentation of surgically resected roots using controlled memory files cleans the canal effectively with relatively low adverse treatment outcomes. Although this novel technique is limited in application, it is a safe and effective way to achieve a deep, clean retropreparation.

This study aimed to evaluate the effect of ultrasonic activation (UA) of endodontic sealers on dentin tubule penetration and the bond strength to root dentin.One hundred single-rooted teeth were prepared with 40.06 nickel-titanium instruments and divided into 2 groups: with or without UA. Three resin-based sealers (MTA Fillapex [Angelus Dental Solutions, Londrina, PR, Brazil], Sealer Plus [MK Life Medical and Dental Products, Porto Alegre, RS, Brazil], and AH Plus [Dentsply, DeTrey GmbH, Konstanz, Germany]; n = 20) and 2 calcium silicate-based sealers (Sealer Plus BC [MK Life Medical and Dental Products] and EndoSequence BC [Brasseler, Savannah, GA], n = 20) were used and subdivided (n = 10) according to the protocols. Fluo-3 (Thermo Fisher Scientific, Waltham, MA) and rhodamine B dyes were added to the calcium silicate- and resin-based sealers, respectively. In the UA groups, the activation was performed for 40 seconds followed by lateral compaction. Samples were transversely sectioned to evaluate the dentin tubule penetration and the bond strength to root dentin. The penetration data were analyzed with the Student t test, 1-factor analysis of variance, and Bonferroni tests. Bond strength was evaluated using the Student t test, Kruskal-Wallis, and Dunn post hoc test.Resin-based sealers showed the highest tubule penetration without UA (P.05). UA significantly enhanced MTA Fillapex and Endosequence BC dentin tubule penetration (P.05). AH Plus and Sealer Plus BC improved their bond strength to root dentin after UA (P.05). AH Plus/UA, Sealer Plus/UA, and Sealer Plus BC/UA presented the highest bond strength values (P.05). Adhesive failures were predominant in all groups regardless of the use of ultrasound.UA interferes with tubule penetration and the bond strength to root dentin of resin- and calcium silicate-based sealers.

The purpose of this study was to compare the speed of removal of root canal filling material and re-establishment of apical patency in root canals filled with a tricalcium silicate-based sealer (BioRoot RCS [BRCS]; Septodont, Saint-Maur-des-Fossés, France) versus a zinc oxide-eugenol sealer (Pulp Canal Sealer [PCS]; Sybron Endo Kerr, Orange, CA) and to analyze the effect of the operator's experience.One hundred twenty root canals of 40 Dentalike dental simulators (Dentsply Sirona, York, PA) were shaped with a WaveOne (Dentsply Sirona) reciprocating file using short 3-mm strokes. Root canals were obturated using a single gutta-percha cone and either BRCS or PCS. Samples treated either with BRCS or PCS were equally dispatched between experienced practitioners and junior practitioners. The time required to remove root filling material and establish apical patency was recorded for each root canal. Samples were compared according to the sealer used and the practitioner's experience (Mann-Whitney test).One hundred fifteen root canals were successfully retreated. No differences in the time required to remove the filling material were observed between the 2 materials for mesiobuccal or distobuccal canals (P.05). In contrast, the procedure was longer for palatal canals filled with BRCS compared with PCS (79.10 vs 182.45 seconds, P.01). Experienced practitioners took significantly less time than junior practitioners (P.05).BRCS can be successfully removed from root canals as quickly as a zinc oxide-eugenol sealer in both mesiobuccal and distobuccal canals but not in palatal ones. The duration of the procedure was affected by the operator's experience independent of the filling material used or the canal type.

Introduction The purpose of this retrospective study was to determine the clinical and radiographic outcomes of root-end microsurgery in a postgraduate program in endodontics using modern techniques and calcium silicate–based root-end filling materials (ProRoot MTA; Dentsply International, Johnson City, TN, and EndoSequence Root Repair Material [ERRM]; Brasseler USA, Savannah, GA) and to identify any potential prognostic factors that may have affected healing outcomes. Methods Clinical records and periapical radiographs were collected from patients who had undergone endodontic microsurgery between 2007 and 2018 in a postgraduate endodontic clinic with a minimum follow-up interval of 6 months. Either ProRoot MTA or ERRM was used as the root-end filling material. Outcomes were categorized into healed, healing, and nonhealing based on clinical and radiographic findings. Healed and healing cases were pooled and considered as successes, whereas nonhealing cases were considered as failures. Results A total of 129 patients with 142 teeth were included in the final analysis. Seventy-six cases were root-end filled with ProRoot MTA and 66 root-end filled with ERRM. The ProRoot MTA group had a success rate of 92.1%, and the ERRM group had a success rate of 92.4% with no significant difference between the groups (P > .05). Vertical root fracture was found to be the predominant cause of failure. No patient- or treatment-related factor was identified to have any significant impact on healing. Conclusions High overall success can be achieved in a postgraduate endodontic program when either ProRoot MTA or ERRM is used as the root-end filling material.

Pulpal/periapical responses of human teeth that are treated successfully with tricalcium silicate-based materials are extremely difficult to obtain because of the typical unavailability of these teeth for histologic examination. The present case series reports histologic and histobacteriologic findings of 3 human teeth that had undergone pulpotomy, orthograde retreatment, and apicoectomy/root-end filling using tricalcium silicate-based endodontic materials. The teeth were extracted after 34 days, 7 weeks, and 20 months, respectively, because of unusual circumstances. The extracted teeth were processed, paraffin embedded, sectioned, stained with hematoxylin-eosin or the modified Brown and Brenn technique, and examined with light microscopy. The recurrent observation for the 3 cases presented was the absence of inflammatory or foreign body reactions of the host tissues in contact with tricalcium silicate-based materials after different observation periods despite the identification of bacteria in dentinal tubules close to the site of operation. Wound healing was rapid with repair/regeneration of lost tissues with cementum and new bone trabeculae. Although the level of evidence for a case series is low because of the anecdotal nature of the reported episodes, the histologic results reported in the present case series illustrate the highly biocompatible and bioactive nature of the tricalcium silicate-based materials used in treating these cases.

Introduction In the current study, we investigate the effect of the inflammation occupying the apical foramen—a phenomenon we refer to as “inflammatory plug”—on the regenerative potential of a root canal therapy. Methods We performed root canal treatment (RCT) in 12 canine root canals while aseptically instrumenting the apex to a 0.5-mm-wide foramen and obturating the canals with the following materials: collagen sponge, platelet-rich fibrin, and blood clot (no material introduced). Results We were successful in maintaining the integrity of the periapical tissue in 8 of 12 RCTs. Injury to the periapical tissue occurred during the remaining 4 RCTs, which initiated inflammation accompanied by bone and dentin resorption. Our histologic analyses showed that the resulting inflammatory plug contained abundant M1 macrophages and was associated with an absence of intracanal cellular infiltration. On the contrary, noninflamed samples showed signs of repair, as indicated by the migration of periapical cells throughout the root canal. Conclusions We conclude that controlling periapical inflammation is key while attempting to achieve dental pulp regeneration.

Introduction The purpose of this study was to evaluate the effect of chitosan-hydroxyapatite precursor (C-HA) nanocomplex conditioning on the chemical modifications at the tricalcium silicate sealer-dentin interface using time-of-flight secondary ion mass spectrometry. Methods Dentin slabs from human premolar root dentin were prepared, demineralized, and randomly distributed between control and C-HA nanocomplex conditioned groups. Tricalcium silicate sealer was applied, and the slabs were allowed to set in 100% humidity for 10 days. The cross-sectional area was exposed, and the sealer-dentin interface was characterized for chemical/ultrastructural evaluation with time-of-flight secondary ion mass spectrometry and transmission electron microscopy, respectively. Results Chemical analysis revealed the presence of an ion-rich layer constituted of abundant phosphates (PO2−, PO3−, and PO4−), hydroxide (OH−), and chitosan fragments (C2H4NO−, C3H4NO2−, C2H5O2+, C2H6NO+, C4H6NO2+, C5H6NO+, and C5H5O2+) on the dentin surface at the sealer-dentin interface and subsurface dentin after conditioning with C-HA nanocomplexes. In contrast, a decreased interfacial presence of calcium (Ca+) and calcium phosphates (CaPO2+, CaPO3+, CaPO4+, and Ca2PO3+) and the absence of phosphate fragments in the control were noted. Ultrastructural evaluation showed an interfacial layer ( Conclusions C-HA nanocomplex conditioning of dentin before tricalcium silicate sealer application resulted in a chemically modified dentin substrate with an ion-rich layer consisting of phosphate, calcium, calcium phosphates, and chitosan that chemically modified the dentin surface/subsurface.

The retrievability of calcium silicate-based sealers (CSSs) during nonsurgical retreatment has been equivocal. This study compared the retrievability of 3 different CSSs using 1 of 3 different solutions or no solution.A total of 130 extracted teeth with a straight canal were decoronated to a standardized root length. The canals were instrumented to 35/.04 and divided into 3 groups (BC: EndoSequence BC sealer; EBC: EdgeBioceramic; NEO: NeoSEALERFlo), and each group was further divided into 4 subgroups (6% sodium hypochlorite; 5% acetic acid; carbonated water; no solution). After sealer placement, each master gutta-percha cone was placed intentionally 2 mm short of the working length (WL) to ensure the apical 2 mm was filled only with sealer. After storage for 21 days at 37°C and 100% humidity, retreatment was performed until apical patency was obtained. The operator was blinded to the CSS and solution used. Data were analyzed using analysis of variance to compare apical patency rates and the mock chair-times.Overall success rates for apical patency in BC, EBC, and NEO were 63.64%, 69.77%, and 100%, respectively. There was significantly higher apical patency rate in NEO than BC and EBC. The chair-time for NEO was significantly shorter than BC (P.05) and EBC sealer (P.001). There was no significant difference in the chair-time between BC and EBC sealer groups.BC, EBC, and NEO sealers in a straight canal were consistently retrievable when no solution was used. Compared with no solution, the retrievability of BC, EBC, and NEO decreased when solutions were used.

This study aimed to characterize the effectiveness of dentin conditioning with bio-mineralizable chitosan-hydroxyapatite precursor (CS-HA) nanocomplexes alone or associated with tricalcium silicate sealer (TCS/CS-HA) on the mechanical property and antibiofilm efficacy in root dentin.Flow tests were performed following ISO6876:2012 specifications. Solubility was measured. Micromorphology was assessed using scanning electron microscopy (SEM). Nanohardness/elastic modulus were also determined. Fracture resistance was determined on lower premolars that were prepared, and randomly distributed among 7 groups (n = 8/group), including the control, CS-HA dentin-conditioning, and root canal-filled groups. Similar canal preparation/distribution procedure was followed to test the antibacterial effect on Enterococcus faecalis-infected roots. Descriptive statistics was used to report SEM findings. Flowability results were analyzed using paired t test. Multiple comparisons from solubility, fracture, and antibacterial assays were assessed by one-way analysis of variance-Tukey's tests.TCS/CS-HA showed optimal flow and no effect on solubility after immersion for 4 weeks (P .05). TCS/CS-HA significantly increased nanohardness and elastic modulus (210 ± 11.3 MPa, 7.9 ± 0.9 GPa) compared with TCS (44.5 ± 7.8 MPa, 2.1 ± 0.3 GPa, P .05). SEM revealed needle-shaped mineralized structures resulting in fewer voids and a well-adapted sealer-dentin interface in the TCS/CS-HA groups. NaOCl-EDTA irrigation resulted in reduced fracture resistance (444.34 N), whereas CS-HA dentin conditioning alone (928.28 N, P .05) and CS-HA dentin-conditioning plus CS-HA/TCS resulted in higher fracture resistance (1134.06 N, P .05). CS-HA dentin conditioning also reduced bacteria by 2.04 log (4.50 ± 0.43) from the initial bacterial load (6.54 ± 0.07, P .05). There was further bacterial reduction when CS-HA-conditioned root canals were filled with TCS or TCS/CS-HA (0.00 to 0.98 ± 0.57, P .05).Dentin modification with CS-HA increased the fracture resistance of root dentin, and decreased the residual bacterial burden. TCS/CS-HA potentiated the nanomechanical and physical properties of TCS.

Introduction This randomized controlled clinical trial compared the clinical efficacy and outcome of a sealer-based obturation technique (SBO) with calcium silicate sealers and a continuous wave of condensation technique (CWC) with a resin-based sealer. Methods Root canals were prepared using rotary instruments and 2.5% sodium hypochlorite. At the next visit, patients were enrolled and randomly assigned into two groups, based on the obturation protocol: CWC with AH Plus sealer (Dentsply DeTrey GmbH, Konstanz, Germany) and SBO with Endoseal TCS (Maruchi, Wonju, Korea) . Patients were assessed for the level of postoperative pain using a numerical rating scale. The quality of root canal obturation was evaluated in terms of the sealer extrusion, root filling voids, and level of root filling. The participants were recalled after at least 6 months. Healing of the teeth was determined as a decrease in PAI score and resolution of symptoms. The results were statistically compared using the chi-square test or Fisher’s exact test, followed by multivariate analysis with logistic regression. Results A total of 74 teeth were included in the analysis (79% recalls) and the mean follow-up period was 17 months (6–29 months). Two groups expressed identical distribution of postoperative pain (P = 0.973) and similar quality of root canal obturation. The total success rates were 93.2% (CWC 92.3%, SBO 94.3%) by loose criteria and 60.8% (CWC 51.3%, SBO 71.4%) by strict criteria, with no significant difference s between the two groups. The success rate by loose criteria in teeth with sealer extrusion was significantly lower than those in teeth without sealer extrusion (P = 0.049). Conclusion SBO using an endoseal TCS could be a possible alternative to CWC using AH Plus. Sealer extrusion and postoperative pain were found to negatively impact prognosis of the endodontic treatment.

The present study evaluated the percentage volume of voids in root canals of mandibular molars that had been obturated for 54 months.Thirty extracted human mandibular molars were instrumented and debrided. The teeth were assigned to 3 groups (n = 10) according to the filling technique and sealer used: the single-cone technique using AH Plus sealer (AHS; Dentsply Sirona Endodontics, Tulsa, OK) or EndoSequence BC sealer (BCS; Brasseler USA Dental LLC, Savannah, GA) and the warm vertical compaction technique using AH Plus sealer (AHW). The specimens were stored at 37°C and 100% humidity. Micro-computed tomographic imaging was used to scan each specimen 1 day 54 months after obturation. Data were analyzed using 1-way analysis of variance and the paired t test.The percentage volume of voids in the teeth 1 day after obturation in the AHS group was higher than in the BCS group and the AHW group (P .05). After 54 months, the proportion of voids decreased in all groups (P .05). No significant difference was observed between the AHS group and the BCS group after 54 months. Teeth in the AHW group contained fewer voids than the AHS group (P .05).Voids in root canal filling were reduced 54 months after obturation. The warm vertical compaction technique achieved better root canal filling quality in mandibular molars than the single-cone technique when using AHS after long-term storage at 100% humidity.

The purpose of this study was to evaluate the ability of the XP-endo Shaper instrument (FKG Dentaire, La Chaux-de-Fonds, Switzerland) during the removal of root fillings from oval-shaped canals. M-Wire Reciproc and Reciproc Blue systems (VDW, Munich, Germany) were used as reference instruments for comparison, and micro-computed technology was used as an analytical tool.Thirty mandibular incisors with oval-shaped canals were matched based on similar anatomic features of the canal (eg, volume, aspect ratio, and 3-dimensional configuration) after scanning procedures. The canals were prepared with M-Wire Reciproc R25 instruments and filled with gutta-percha and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) using the continuous wave of condensation technique. Then, the sample was allocated into 3 experimental groups (n = 10) according to the retreatment protocol used: M-Wire Reciproc, Reciproc Blue, and XP-endo Shaper. M-Wire Reciproc R25, Reciproc Blue R25, and XP-endo Shaper instruments were used to remove the root fillings. Apical enlargement was performed with M-Wire Reciproc R40, Reciproc Blue R40, and BioRace BR5 (FKG Dentaire) instruments. Each sample was scanned after each endodontic procedure. The volume of remaining root filling material was quantified before and after apical enlargement. The percentage volumes of root filling reduction in relation to the instrumented canals at both time points (before and after apical enlargement) were calculated and considered for statistical analysis. Data were analyzed statistically with a significance level of 5%.Reciproc Blue presented significantly lower removal of filling material compared with the XP-endo Shaper (Tukey test, P.05). No difference was detected either between M-Wire Reciproc and Reciproc Blue (Tukey test, P.05) or M-Wire Reciproc and XP-endo Shaper (Tukey, P.05). The increase of apical enlargement significantly improved the removal of root fillings from the root canals (P.05); this effect was similar for all systems (time point × file system, P.05).The XP-endo Shaper instrument showed a higher percentage of root filling removal, but no differences were observed comparing M-Wire Reciproc with the XP-endo Shaper or Reciproc Blue. The increase of apical enlargement improved the removal of root fillings in all groups. None of them was able to render root canals completely free from root fillings.

Introduction The balance between periapical tissue inflammation and regeneration after the removal of necrotic/infected tissues is pivotal in determining the success of endodontic treatment. This study was designed to investigate the effect of silicate-based root canal sealer BioRoot RCS (BRCS; Septodont, Saint-Maur-des-Fosses, France) on modulating the inflammatory mechanisms and early steps of regeneration initiated by human periodontal ligament (PDL) fibroblasts. Methods Samples of BRCS and Pulp Canal Sealer (PCS; SybronEndo, Orange, CA) were incubated in culture medium to obtain material extracts. To simulate bacterial infection and endodontic sealer use, PDL fibroblasts were stimulated with lipopolysaccharides and cultured with material extracts. The secretion of proinflammatory cytokine (interleukin 6) and growth factor (transforming growth factor beta 1) were quantified by enzyme-linked immunosorbent assay. Inflammatory cell recruitment sequence was investigated using a human inflammatory monocytic cell line (THP-1) that can be activated into macrophage-like cells. The adhesion of THP-1 to endothelial cells (human umbilical vein endothelial cells) was studied using fluorescent THP-1, their migration using Boyden chambers, and their activation into macrophage-like cells using a cell adhesion assay. The proliferation of PDL fibroblasts was quantified by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, whereas the migration of PDL stem cells was investigated using Boyden chambers after immunofluorescence and reverse transcription polymerase chain reaction characterization. Results Interleukin 6 secretion decreased with BRCS, whereas it increased with PCS. Transforming growth factor beta 1 secretion significantly increased only with BRCS. The material extracts did not affect THP-1 adhesion to human umbilical vein endothelial cells, but only BRCS inhibited their migration. Moreover, activation of THP-1 decreased with BRCS and to a lesser extent with PCS. Finally, BRCS increased PDL fibroblast proliferation without affecting PDL stem cell migration. By contrast, PCS decreased PDL fibroblast proliferation and PDL stem cell migration. Conclusions This work shows that the endodontic sealers modulate the PDL inflammatory and regeneration potentials in vitro. It demonstrates that BRCS has anti-inflammatory effects and the potential to promote tissue regeneration.

Introduction The purpose of this randomized clinical trial was to evaluate healing after endodontic microsurgery (EMS) using mineral trioxide aggregate (MTA) versus EndoSequence root repair material (RRM; Brasseler, Savannah, GA) as root-end filling materials. Methods Two hundred forty-three teeth with persistent or recurrent apical periodontitis were randomly assigned to either the MTA or RRM group. EMS was performed, and follow-up visits with clinical and radiographic investigation were scheduled at 6, 12, and 24 months with follow-up cone-beam computed tomographic (CBCT) imaging after 12 months. Results One hundred twenty teeth with an average follow-up of 15 months were evaluated. The overall success rate was 93.3% for periapical (PA) evaluation and 85% for CBCT evaluation. The RRM group exhibited 92% and 84% success rates as assessed on PA and CBCT imaging, respectively. The MTA group exhibited 94.7% and 86% success rates as assessed on PA and CBCT imaging, respectively. No significant difference was observed between the 2 groups. Microsurgical classification, root canal filling quality, root-end filling material depth, and root fracture were found to be significant outcome predictors. Conclusions EMS is a predictable procedure with successful outcome both 2-dimensional and 3-dimensional radiographic evaluation when RRM or MTA was used as the root-end filling material.

Introduction Various factors may influence intracanal calcification in teeth treated with regenerative endodontic procedures. Bioactive materials, including ProRoot MTA (MTA; Dentsply Tulsa Dental Specialties, Memphis, TN) and Biodentine (BD; Septodont, Saint-Maur-des-Fosses, France), have been widely used as a coronal barrier in the final step of regenerative endodontic procedures. The purposes of this study were to evaluate the effect of either MTA or BD after application as a coronal barrier on transforming growth factor beta 1 (TGF-β1) release from root canal dentin and to observe the impact of these materials on human apical papilla cell (APC) mineralization. Methods Either MTA or BD was applied in enlarged root canals of human root segments. After storing for 14 days in phosphate-buffered saline, TGF-β1 release was evaluated using an enzyme-linked immunosorbent assay. To investigate the effect of the materials on APC mineralization, APCs were grown in the presence of either the materials alone or material-filled root segments. Cell mineralization was quantified after 14 and 21 days using alizarin red S staining. Calcium deposits were quantitatively analyzed. Statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney U tests with the significance level at .05. Results The greatest amount of TGF-β1 release was observed in the root segments treated with BD. BD, used either alone or as a coronal barrier, promoted greater APC mineralization than did MTA on both days 14 and 21. Interestingly, when BD was applied as a coronal barrier, the mineralization effect was significantly reduced compared with the use of the materials alone (P Conclusions When used as a coronal barrier, BD promoted the release of TGF-β1 from the root canal dentin. A higher mineralization effect was observed with BD than with MTA.

An ideal root canal sealer creates a bacteria-resistant seal and exhibits antimicrobial activity, biocompatibility, and osteoconductivity. The aim of this study was to assess the effects of 3 root canal sealers on cell viability, inflammatory response, and osteogenic potential in MC3T3-E1 cells.AH Plus (Dentsply Caulk, Milford, DE), MTA Fillapex (Angelus Solucxoes Odontologicas, Londrina, Brazil), and EndoSequence BC (Brasseler, Savannah, GA) were mixed according to the manufacturer's instructions, and samples were prepared as extraction media (final dilution: 1/10). Lipopolysaccharide (LPS) (100 ng/mL) treatment was used to induce an inflammatory response in this study. Cell viability was evaluated using the Water soluble tetrazolium-1 (WST-1) assay. The levels of inflammatory mediators (interleukin 6 and tumor necrosis factor alpha) and osteogenic marker genes (ALP and OCN) were measured by reverse-transcription polymerase chain reaction and real-time polymerase chain reaction. Osteogenic potential was evaluated by alkaline phosphatase staining and alizarin red staining.Calcium silicate-based sealers such as MTA Fillapex and EndoSequence BC showed strong cell viability compared with AH Plus. AH Plus, MTA Fillapex, and EndoSequence BC decreased the levels of LPS-induced inflammatory mediators (P .05). The expression of osteogenic marker genes, alkaline phosphatase activity, and mineralized nodule formation decreased with LPS treatment. However, AH Plus and calcium silicate-based sealers increased the osteogenic potential reduced by LPS treatment (P .05).Calcium silicate-based sealers exhibit anti-inflammatory effects and induce osteogenic differentiation in MC3T3-E1 cells.

Introduction A root canal obturated with a calcium silicate–based sealer (bioceramic sealer [BCS]) and a modified gutta-percha cone (bioceramic cone [BCC]) might improve the fracture resistance of the root. The objective of this study was to evaluate root reinforcement of a bioceramic cone/sealer (TotalFill; FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) by investigating the fracture resistance, push-out bond strength, sealer penetration, and modulus of elasticity (MOE) in comparison with gutta-percha/AH Plus (Dentsply Maillefer, Tulsa, OK) (GP/AH). Methods Eighty-four roots from bilateral mandibular premolars were prepared. For fracture resistance, 40 teeth were randomly divided into 4 groups (n = 10 each): intact roots (negative control), prepared roots (positive control), and the roots obturated with either BCC/BCS or GP/AH. Root canals were obturated with the matched single-cone technique and vertically loaded with a spreaderlike tip until fracture. For push-out bond strength (n = 10 each), coronal, middle, and apical root slices of BCC/BCS and GP/AH were loaded with a cylindrical plunger, and failure modes were determined. Sealer penetration of BCC/BCS and GP/AH (n = 12 each) was evaluated for the maximum depth and the circumferential and total area of penetration at the coronal, middle, and apical levels using confocal laser scanning microscopy. The MOE was investigated according to ISO 4049:2000. Results The fracture load of BCC/BCS, GP/AH, and the intact roots was not significantly different but significantly higher than the prepared, nonobturated roots. BCC/BCS provided a higher bond strength, maximum depth, and circumferential penetration at the apical root level as well as a greater sealer penetration area at all levels compared with GP/AH. The MOE of all materials was much lower than dentin. Conclusions BCC/BCS and GP/AH bonded and reinforced the prepared roots; their fracture resistances were similar to the intact roots.

Immature necrotic teeth are at a high risk of fracture, especially at the cervical region, after treatment. This study aimed to compare the impact and fracture strength of immature permanent teeth treated with revascularization versus a mineral trioxide aggregate (MTA) plug and fiber post.This in vitro, experimental study was conducted on 160 maxillary central incisors, which were randomly divided into 10 groups. The groups included a fracture (F) and impact (I) negative control group, F and I positive control groups, F and I MTA groups, F and I revascularizing group, and F and I revascularized groups. Fracture strength was measured using a universal testing machine with a crosshead speed of 1 mm/min. Other tooth samples were then subjected to the Charpy impact test for impact strength measurements, and the amount of energy absorbed by the teeth was determined. Data were analyzed using the Kolmogorov-Smirnov test, analysis of variance, and the Tukey test.The mean load to fracture of the negative, positive, MTA, revacularizing, and revascularized groups was 1931.8, 1350.1, 1003.8, 1262.5, and 1100.2 N, respectively, and the mean impact strength was 5.04, 3.6, 3.68, 3.16, and 3.65 J, respectively. The fracture and impact strength of the negative control group was significantly higher than that of the other groups (P .05), but the other groups were not significantly different in this respect (P .05).Despite the limitations of this study, the results showed that none of the tested modalities could significantly increase the impact and fracture strength of simulated immature teeth.

INTRODUCTION The objective of this retrospective study was to assess the outcome of periapical surgery in a large number of molars in order to identify possible variables that might affect the outcome. METHODS The healing outcome of patients undergoing periapical surgery of molars from October 1999 to October 2019 was retrospectively evaluated. Outcome was dichotomized into "healed" and "nonhealed" using well-established clinical and radiographic healing criteria. The potential influence of patient-, tooth-, and treatment-related parameters on the healing outcome was analyzed. RESULTS A total of 424��molars in the same number of patients (45.5% male and 54.5% female) were evaluated. Three hundred seventy-two��molars were classified as healed (87.7%). Three significant outcome predictors were identified: 1-year follow-up versus >1-5��years, >5-10��years, and >10��years (95.3% vs 82.2%, 76.3%, and 76.5% healed, respectively; P��

Introduction This study compared the intensity of postobturation pain after unintentional apical extrusion of calcium silicate–based root canal sealers (EndoSequence BC Sealer [Brasseler USA, Savannah, GA] and Bio-C Sealer [Angelus, Londrina, PR, Brazil]) with a resin-based sealer (AH Plus; Dentsply Sirona, York, PA). Methods A total of 330 patients referred for root canal treatment on molar teeth with asymptomatic irreversible pulpitis were recruited. Root canals were prepared using WaveOne Gold instruments (Dentsply Sirona) in a crown-down technique and irrigated with 2% chlorhexidine gel and saline solution. Next, patients were randomly distributed into 3 groups according to the root canal sealer used (n = 110): AH Plus, BC Sealer, and Bio-C Sealer. Root canal filling was then accomplished with a vertical compaction technique. Patients presenting with an unintentional extrusion of sealers (n = 13/group) were assessed for postobturation pain experience using a visual descriptor scale ranging from 0–10 at 6-, 12-, 24-, and 48-hour and 1-week intervals after treatment. Mixed analysis of variance repeated measures were used to assess the results (α = 0.05). Results The extrusion rate was similar for all sealers (~12%). There was no significant difference in the postobturation pain results between the root canal sealers evaluated (P > .05). However, after the time interval of 12 hours, AH Plus (P = .04073) and Bio-C Sealer (P = .04327) demonstrated a significant reduction in pain, whereas BC Sealer did not show differences in pain intensity, even in the maximum period evaluated of 1 week (P > .05). Conclusions The occurrence of unintentional apical extrusion of calcium silicate–based root canal sealers presents similar postoperative pain results compared with resin-based sealers with low-intensity pain.

The aim of this study was to evaluate pain perception, pain medication intake, and sealer extrusion after single-visit root canal treatment of asymptomatic teeth with or without foraminal enlargement. The correlation between sealer extrusion and pain was also investigated.One hundred forty necrotic, single-rooted teeth were divided into 2 groups (n = 70): foraminal patency (FP), in which treatment was performed up to 1 mm short of the apex, and foraminal enlargement (FE), in which treatment was performed up to the apex. The canals were instrumented using WaveOne Gold files (Dentsply Maillefer, Ballaigues, Switzerland), irrigated with 2.5% sodium hypochlorite, and filled using the single-cone technique and AH Plus sealer (Dentsply Maillefer). A visual analog scale was used to record pain 24, 48, and 72 hours and 1 week postoperatively. The presence or absence of sealer extrusion was recorded.Pain levels were significantly higher for FE than FP at 24 hours (P .05), namely 0.3 ± 0.9 versus 0.1 ± 0.1; no difference was found at 48 hours, namely 0.1 ± 0.5 versus 0.0 ± 0.0 (P .05). No pain was reported 72 hours or 1 week postoperatively in either group. Although all patients requiring pain medication at 24 hours were from the FE group, the difference between FE and FP was not statistically significant with respect to this variable (P .05). Nevertheless, the intake amount was significantly higher in FE than in FP at this time point (P .05). Sealer extrusion occurred more frequently in FE than FP, namely 57.14 % versus 14.29% (P .05). There was no association between pain and sealer extrusion (P .05) or between pain and sex, age, or tooth type (P .05).FE was related to higher pain levels 24 hours postoperatively and to higher rates of filling material extrusion; however, there was no association between filling material extrusion and postoperative pain.

INTRODUCTION: Endodontic sealers play a vital role in the obturation of root canal space. The aim of this study was to evaluate the utility of a recently developed polyurethane expandable sealer (PES), along with its cytotoxicity and dimensional changes. METHODS: L929 fibroblasts and an cell viability assay (MTS assay) were used to determine the cytotoxicity of dental sealers (AH Plus [Dentsply Maillefer, Ballaigues, Switzerland], Sure-Seal Root [Sure Dent Corporation, Gyeonggi-do, South Korea], and the PES) at 24, 48, 72, and 96 hours. An advanced choroidal neovascularization model was used to assess the effect of these sealers on angiogenesis. Thirty-six extracted single-rooted human teeth were prepared and randomly divided into 3 groups (n = 12). Obturation was performed with gutta-percha and a sealer using lateral compaction as follows: group 1, AH Plus; group 2, Sure-Seal; and group 3, PES. The average depth of sealer penetration into dentinal tubules was measured with a scanning electron microscope. Data were analyzed using 1-way analysis of variance and post hoc Tukey tests (level of significance, P < .05). RESULTS: The values of MTS, choroidal neovascularization, and the penetration depth of PES were significantly higher than in other experimental groups (P < .05). The lowest values were noted in specimens of AH Plus, whereas the highest were detected in the PES group. CONCLUSIONS: PES showed promising results in terms of biocompatibility and dentinal tubule adaptation and penetration.