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Purpose: Endodontic inflammation typically results from root canal infections and sensitizations to filling materials after root canal treatment (RCT), potentially leading to systemic inflammation and disease. We therefore aimed to characterize the inflammatory alterations after RCT as well as the inflammatory molecule levels following tooth extraction or renewed RCT. Patients and Methods: All (a total of 2585) walk-in patients with or without RCT history were included in this retrospective study. During the 3-year observation period, blood levels of RANTES/CCL5 (regulated on activation, normal T-cell expressed and secreted/chemotactic cytokine ligand 5), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ), and interleukin-10 (IL-10) were measured before and after tooth extraction or renewed RCT. Control patients did not undergo any dental treatment. Results: A total 49.38% of patients had a history of at least one RCT. In RCT patients, RANTES/CCL5 values were significantly reduced by both tooth extraction (p=0.03) and renewed dental RCT (p=0.038), while a non-significant increase was observed in untreated patients. TNF-α levels were reduced by tooth extraction (p=0.014) but not by renewed RCT and no intervention. CRP levels were not significantly changed by either treatment. Tooth extraction significantly lowered IFN-γ levels (p=0.003), while in control patients, IFN-γ levels did not change. IL-10 levels were non-significantly reduced by tooth extraction (p=0.061). In a subcohort of RCT patients, the lymphocyte transformation test revealed an allergic reaction to at least one of the root filling materials in 39.46% of patients, with raw gutta percha (56%) and eugenol (19%) being frequent triggers. Conclusion: Here, we demonstrate the involvement of root-treated teeth in inflammatory processes, as tooth extraction and renewed RCT could significantly reduce individual cytokine levels. Our data support the use of biomarkers for in vivo monitoring of treatment success. [ABSTRACT FROM AUTHOR]

Introduction: The zinc oxide–eugenol (ZOE) sealer is used till now in many private dental clinics although many sealers have been developed. The current study aimed to compare the biocompatibility and remineralizing capacity of ZOE sealer following the addition of nanohydroxyapatite-tyrosine amino acid. Materials and Methods: Twenty rabbits were used in this investigation, and they were divided into four groups based on the test observation period (3, 7, 21, and 28 days) following surgical implantation. General anesthesia was given for each rabbit with a subcutaneous incision of about 1 cm ± 0.5 cm made along the symphyseal area of the mandible of each rabbit. Each rabbit had four bone cavities generated in the interdental space of the lower jaw between the central and molar teeth, with one longitudinal subcutaneous incision. The ZOE sealers were mixed and directly inserted within the cavities as follows: ZOE alone on the central area of the right side of the jaw (Group A), 10% nHAp and Tyrosine mixed ZOE at the molar area (Group B), empty cavity (−ve control) located at the central area of the left side of the jaw (Group C) and 20%/nHAp and Tyrosine mixed ZOE located at the molar area on the left side of the jaw (Group D). Animals were scarified and bone biopsy samples from the tested parts were collected. Histological analysis was performed using a low-power light microscope and immunohistochemistry using runt-related transcription factor 2 (Runx2) antibody. Data were statistically analyzed utilizing the SPSS software. One-way analysis of variance was used and the post hoc test Duncan’s test was utilized to measure the significance among various groups at P ≤ 0.01. Results: The inflammatory process decreased over time for all experimental groups, associated with an increase in granulation tissue formation which was gradually decreasing over time to permit an increase in new blood vessels and new bone formation for all experimental groups that increased with time. Group D displayed the highest levels of new bone formation. Runx2 antibody expression declined progressively, particularly in Group D on 28 days. Conclusion: Superior new bone formation and biocompatible properties were demonstrated by the 20% nHAp and tyrosine mixed ZOE sealer.

Aim: This study aimed determine the influence of the type of root canal instrumentation file systems and obturating materials on the success of pulpectomized teeth. Methods: Two hundred eighty-eight primary molars from children aged 4–7 years were selected and divided into three groups of 96 teeth each. In the first, second, and third groups, root canal instrumentation was performed using Kedo-SG pediatric rotary files (KS), HERO Shaper rotary files (HS), and manual Ni-Ti K-files (MF), respectively. Following instrumentation, these three groups were subdivided into three subgroups of 32 teeth each and obturated using zinc oxide eugenol, Endoflas®, and DiaPex Plus®. The quality of the root filling was assessed immediately and evaluated clinically and radiographically over two years. The Chi-Square Test was used to analyze the data, with the level of significance set at P

Introduction: The root canal obturating material provides a three-dimensional fluid-impervious seal. Root canal sealers play a major role in providing a seal between the core material and the tooth for the long-term success of endodontic treatment. Aim: To evaluate the intratubular penetration and Bond Strength (BS) and push-out BS of AH Plus, GuttaFlow 2, and GuttaFlow Bioseal sealers. Materials and Methods: The in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India, from October 2019 to April 2021. A total of 75 human mandibular first premolars were decoronated at the Cemento-enamel Junction (CEJ) with a standardised length of 16 mm. The root canal was prepared using the crown-down technique with HyFlex Electrical Discharge Machining (EDM) rotary files and divided into three groups: Group-I: AH Plus, Group-II: GuttaFlow 2, and Group-III: GuttaFlow Bioseal. 0.1% Rhodamine B dye was added to the sealer and obturated using the single cone technique. These samples were transversely sectioned into beams at the middle third of the root. A confocal laser scanning microscope was used to evaluate the depth of sealer penetration in the dentinal tubule, and a Universal Testing Machine was utilised to measure the push-out BS (MPa). The recorded data were subjected to statistical analysis {one-way Analysis of Variance (ANOVA) test, Tukey’s post-hoc test, and Pearson’s correlation coefficient}. Results: The results obtained indicated that there was a significant difference in the depth of penetration and push-out BS of AH Plus and GuttaFlow 2 sealers (p

Endodontic retreatment is a procedure to remove root canal filling material from the tooth, followed by cleaning, shaping, and obturation of the canals. Treatment outcomes may be influenced by incomplete removal of filling materials. The present literature review aimed to identify the techniques and materials used to remove Bioceramic Sealers (BCS) from the root canal system using Micro-Computed Tomography (Micro-CT) and Scanning Electron Microscopy (SEM). A search of the PubMed, Web of Science, Scopus, Science Direct, and Google Scholar databases using applicable keywords such as ‘‘BCS’’ and ‘‘calcium silicate-based sealer’’ and ‘‘retreatment’’ and ‘‘retreatability’’ and ‘‘micro-CT’’ and ‘‘SEM’’ identified studies on techniques and materials used to remove BCSs from the root canal system, as assessed by micro-CT and SEM. A total of 46 studies were included in the review. Of these, 32 studies used Nickel-titanium (NiTi) rotary instruments, 11 used reciprocating systems, and three compared continuous nickel-titanium rotary and reciprocating systems with rotary systems and reciprocation in removing filling materials. Apical patency and Working Length (WL) could be achieved in a canal obturated with gutta-percha and a BCS. The review revealed that removing filling materials using various instrumentation protocols can be successful but incomplete. Both rotary and reciprocating systems can efficiently remove root-filling material. Using supplemental techniques can improve the cleanliness of the root canal during retreatment. Solvents require less time to reach the WL and achieve patency; however, they leave a larger amount of residual root canal-filling material than non solvents. Additionally, the formation of dentinal microcracks remains controversial during the non surgical retreatment of canals filled using BCSs.

Aim: This study aimed determine the influence of the type of root canal instrumentation file systems and obturating materials on the success of pulpectomized teeth. Methods: Two hundred eighty-eight primary molars from children aged 4-7 years were selected and divided into three groups of 96 teeth each. In the first, second, and third groups, root canal instrumentation was performed using Kedo-SG pediatric rotary files (KS), HERO Shaper rotary files (HS), and manual Ni-Ti K-files (MF), respectively. Following instrumentation, these three groups were subdivided into three subgroups of 32 teeth each and obturated using zinc oxide eugenol, Endoflas®, and DiaPex Plus®. The quality of the root filling was assessed immediately and evaluated clinically and radiographically over two years. The Chi-Square Test was used to analyze the data, with the level of significance set at P<0.05. Results: The quality of obturation was superior in root canals instrumented with rotary file systems compared to manual files. No significant difference in obturation quality was noted among the obturating materials used. The clinical success rate after two years was 100%. Radiologically, success rates were 97% for Kedo-SG, 94% for HERO Shaper, and 89% for manual file systems. For obturating materials, the success rates were 90%, 96%, and 94% for zinc oxide eugenol, Endoflas®, and DiaPex Plus®, respectively. Conclusions: The success of pulpectomized teeth was not significantly influenced by the type of root canal instrumentation file systems or the choice of obturating materials. [ABSTRACT FROM AUTHOR]

Introduction: The root canal obturating material provides a three-dimensional fluid-impervious seal. Root canal sealers play a major role in providing a seal between the core material and the tooth for the long-term success of endodontic treatment. Aim: To evaluate the intratubular penetration and Bond Strength (BS) and push-out BS of AH Plus, GuttaFlow 2, and GuttaFlow Bioseal sealers. Materials and Methods: The in-vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Ranjeet Deshmukh Dental College and Research Centre, Nagpur, Maharashtra, India, from October 2019 to April 2021. A total of 75 human mandibular first premolars were decoronated at the Cemento-enamel Junction (CEJ) with a standardised length of 16 mm. The root canal was prepared using the crown-down technique with HyFlex Electrical Discharge Machining (EDM) rotary files and divided into three groups: Group-I: AH Plus, Group-II: GuttaFlow 2, and Group-III: GuttaFlow Bioseal. 0.1% Rhodamine B dye was added to the sealer and obturated using the single cone technique. These samples were transversely sectioned into beams at the middle third of the root. A confocal laser scanning microscope was used to evaluate the depth of sealer penetration in the dentinal tubule, and a Universal Testing Machine was utilised to measure the push-out BS (MPa). The recorded data were subjected to statistical analysis {one-way Analysis of Variance (ANOVA) test, Tukey's post-hoc test, and Pearson's correlation coefficient}. Results: The results obtained indicated that there was a significant difference in the depth of penetration and push-out BS of AH Plus and GuttaFlow 2 sealers (p <0.0001). However, there was no significant difference found between AH Plus and GuttaFlow Bioseal sealers (p=0.206). In addition, there was no significant difference in the correlation between intratubular penetration and push-out BS of the sealers (negative correlation). Conclusion: Considering the results, the GuttaFlow Bioseal sealer was found to have comparable clinical performance with AH Plus sealer; hence, it can be used as an acceptable root canal sealer. [ABSTRACT FROM AUTHOR]

Endodontic retreatment is a procedure to remove root canal filling material from the tooth, followed by cleaning, shaping, and obturation of the canals. Treatment outcomes may be influenced by incomplete removal of filling materials. The present literature review aimed to identify the techniques and materials used to remove Bioceramic Sealers (BCS) from the root canal system using Micro-Computed Tomography (Micro-CT) and Scanning Electron Microscopy (SEM). A search of the PubMed, Web of Science, Scopus, Science Direct, and Google Scholar databases using applicable keywords such as "BCS" and "calcium silicate-based sealer" and "retreatment" and "retreatability" and "micro-CT" and "SEM" identified studies on techniques and materials used to remove BCSs from the root canal system, as assessed by micro-CT and SEM. A total of 46 studies were included in the review. Of these, 32 studies used Nickel-titanium (NiTi) rotary instruments, 11 used reciprocating systems, and three compared continuous nickel-titanium rotary and reciprocating systems with rotary systems and reciprocation in removing filling materials. Apical patency and Working Length (WL) could be achieved in a canal obturated with gutta-percha and a BCS. The review revealed that removing filling materials using various instrumentation protocols can be successful but incomplete. Both rotary and reciprocating systems can efficiently remove root-filling material. Using supplemental techniques can improve the cleanliness of the root canal during retreatment. Solvents require less time to reach the WL and achieve patency; however, they leave a larger amount of residual root canal-filling material than non solvents. Additionally, the formation of dentinal microcracks remains controversial during the non surgical retreatment of canals filled using BCSs. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the effectiveness of the Tagger technique and the lateral condensation technique with different obturation cements in achieving optimal apical sealing in endodontic treatments. Methods: An in vitro study was conducted on 68 extracted human upper or lower first premolars. Teeth were randomly divided into four experimental groups (n=17) based on two obturation techniques and endodontic sealers employed, as follows: Group 1, Tagger technique with the zinc oxide-eugenol sealer; Group 2, Tagger technique with the resin-based sealer; Group 3, lateral condensation technique with zinc oxide-eugenol sealer, and Group 4, lateral condensation technique with resin-based sealer. Homogeneity of the gutta-percha mass and apical obliteration were evaluated under a digital stereomicroscope. Data were analyzed using the chi-square test, and a P-value<0.05 was considered statistically significant. Results: Most group specimens exhibited non-homogeneous gutta-percha, whereas apical obliteration was achieved in a significant proportion of samples across all groups. No significant difference was found between the study groups either in the homogeneity of the gutta-percha mass (P=0.978) or in the optimal apical obliteration (P=0.782). Conclusions: The study found no significant difference in the effectiveness of the Tagger hybrid and lateral condensation techniques using different sealers in achieving optimal apical sealing and gutta-percha homogeneity. This highlights the critical role of the clinician's expertise in ensuring successful endodontic outcomes. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to evaluate remaining filling materials of a bioceramic sealer (TotalFill BC sealer) and an epoxy resin sealer (AH Plus) after retreatment using a supplementary instrumentation (XP-endo Finisher). Materials and Methods Forty single-rooted teeth were selected for the study. The teeth were instrumented using ProTaper system and randomly divided into two groups (n = 20). Then they were obturated with either TotalFill BC/gutta-percha or AH Plus/gutta-percha using lateral compaction technique. Canals were retreated using ProTaper retreatment files and a solvent. The groups were subdivided (n = 10) according to the application or not of the XP-endo Finisher as a final step of retreatment. All roots were cleaved longitudinally and examined under scanning electron microscope to evaluate root canal filling remnants. A scoring system was utilized to quantify the amount of residual filling material at the three predetermined portions of each root canal. Statistical analysis was performed using IBM SPSS.25 with a significant value p < 0.05. Data were compared using the Mann–Whitney test and Kruskal–Wallis test. Results There was no statistically significant difference in the remaining filling materials for each third of the root canal after initial retreatment procedure between the TotalFill group and AH Plus group. Similar results were observed among the TotalFill groups with or without the application of XP-endo Finisher supplementary step. However, the remaining filling materials of AH Plus in the middle third of root canal were significantly less after the XP-endo Finisher application (p = 0.015). Conclusion No retreatment protocol tested in this study allowed the total elimination of root canal filling materials. The residual root canal filling materials is similar for the bioceramic and resinous sealers. The XP-endo Finisher is not effective in improving the removal of bioceramic root canal filling material while it is able to improve the removal of resinous cement. [ABSTRACT FROM AUTHOR]

Background: To provide a continuous seal of the root canal, root-filling material should bond to the root canal dentin, ensuring the integrity of both the root-filling material and dentin remains in a static and functional state. The present study assessed the push-out bond strength of mineral trioxide aggregate (MTA) and cold ceramic (CC). Materials and Methods: In this laboratory trial study, 20 single-rooted, extracted human teeth without caries and cracks were selected. Each tooth was mounted in cold-curing resin. Then, 3 mm slices of mid-root dentin were obtained from each tooth. The specimens were randomly divided into two groups (n = 10) and filled with MTA ProRoot and CC. All specimens were stored for 30 days in an incubator at 37°C and 100% humidity. The push-out bond strength of the test materials was measured using a cylindrical punch with a 1-mm diameter. The punch was pushed against the test specimen at a speed of 1.0 mm/min using a universal material testing machine, extruding the filling test material. The push-out force during the test was recorded, and then, the internal surface of the teeth was examined to evaluate the mode of failure. Independent t-test and Chi-square were used to analyze the data. P < 0.05 was considered a significance threshold. Results: The mean push-out bond strength in the CC group was 24.58 (MPa), and in MTA ProRoot, it was 23.77. No significant difference was observed between the two groups. The most frequent mode of failure in both groups was adhesive failure. Conclusion: The two materials have adequate push-out bond strength to root dentin, and there is no difference between the bond strength and mode of failure of the two materials. [ABSTRACT FROM AUTHOR]

This study aimed to examine how heating affects the physical properties of a newly developed premixed calcium silicate-containing sealer (AH Plus Bioceramic Sealer; AHB), in comparison with EndoSequence BC Sealer (ES), AH Plus Jet (AH), and Pulp Canal Sealer. The setting time, flow, and film thickness were tested with or without heating at 100 °C for 30 or 60 s, in accordance with ISO6876:2012 standards. Ultrastructural and elemental analyses were performed with scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). Data were analyzed using one-way analysis of variance (ANOVA) with a Tukey post hoc test (α = 0.05). All sealers exhibited significantly shorter setting time and flow after heating at 100 °C for 30 and 60 s (p < 0.05). After heating, AHB showed a significantly higher film thickness compared to that of the other materials (p < 0.05). None of the tested properties of heat-applied AHB and ES met ISO standards, except the setting time in ES. The SEM/EDS results for AHB and ES were not affected by heating. The detected changes in physical properties can negatively impact the performance of premixed calcium silicate-containing sealers, particularly AHB, when warm vertical compaction is employed. [ABSTRACT FROM AUTHOR]

Abstract Both root canal sealer-based and supplementary protocols may influence removal of filling material during endodontic retreatment. Mesial root canals of extracted mandibular molars were prepared using HyFlex EDM 25/.08, and filled with a calcium silicate sealer (Bio-C Sealer), or an epoxy resin (AH Plus), using the single cone technique (n = 12). Retreatment was performed using ProDesign Logic (PDL) RT and PDL 35/.05. The specimens were randomly divided into two experimental groups (n = 12), and the sealers were distributed similarly. A supplementary protocol was performed with PDL 50/.01 or XP-endo Finisher. Root canal transportation and volume, in addition to the remaining filling material percentage were evaluated using high-resolution (5 µm voxel size) micro-CT. Statistical analysis was performed using t-tests (α = 0.05). Root canals filled with AH Plus presented high residual filling material (p < 0.05). Both protocols decreased residual volume of filling material in the apical third (p < 0.05). PDL 50/.01 increased the apical root canal volume (p < 0.05). No difference was observed between the systems regarding canal transportation (p > 0.05). In conclusion, AH Plus is more difficult to remove from the apical third than Bio-C Sealer. PDL 50/.01 and XP-endo Finisher enabled greater removal of filling materials in the apical third, in the retreatment of curved root canals, without promoting apical transport.

Abstract Background The objective of the present study was to evaluate in vitro the cytotoxicity and bioactivity of various endodontic sealers (CeraSeal, BioRoot™ and AH Plus®) in pre-osteoblast mouse cells (MC3T3 cells). Methods MC3T3 cells (ATCC CRL-2594) were plated in 1 × 104 cells/well in 96-well plates in contact with endodontic sealers at concentrations of 1:10 and 1:100. Cell viability was evaluated by MTT assay after 24 and 48 h. In addition, sealer bioactivity was measured by RT-PCR for mediator of inflammation (Tnf, Ptgs2) and mineralization (Runx2, Msx1, Ssp1 and Dmp1) after 24 h and by Alizarin Red S Assay of mineralization after 28 days. Data were analyzed using one-way ANOVA followed by the Tukey’s post-test at a significance level of 5%. Results BioRoot™ presented 24-hour cytotoxicity (p 0.05). TNF-α gene expression was induced by AH Plus® (p 0.05). Conclusion CeraSeal, BioRoot™ and AH Plus® sealers were not cytotoxic to MC3T3 cells within 48 h, but differentially induced the expression of genes related to inflammation and mineralization without impacting biomineralization by the cells.

Objective: The removal of the root canal sealer is an important factor in nonsurgical retreatment. The aim of this study was to compare the removal of AH Plus, Well Root ST, and AH Plus Bioceramic Sealer using Protaper Universal retreatment files. Methods: The curved mesio-buccal canals of extracted mandibular molars were prepared with the Protaper Gold file system (up to F2). Specimens were randomly divided into 3 groups and filled with the single cone technique using AH Plus, Well-Root ST, and AH Plus Bioceramic Sealer, respectively. After two weeks, the root canal filling of all specimens was removed using Protaper Universal retreatment files. All specimens were scanned using micro-CT. The remaining volume of the root canal filling was recorded in total and the coronal, middle, and apical third of each specimen. Results: Well-Root ST and AH Plus Bioceramic Sealer groups had a higher percentage of total remaining filling material than the AH Plus group (P

Background: The objective of the present study was to evaluate in vitro the cytotoxicity and bioactivity of various endodontic sealers (CeraSeal, BioRoot™ and AH Plus®) in pre-osteoblast mouse cells (MC3T3 cells). Methods: MC3T3 cells (ATCC CRL-2594) were plated in 1 × 104 cells/well in 96-well plates in contact with endodontic sealers at concentrations of 1:10 and 1:100. Cell viability was evaluated by MTT assay after 24 and 48 h. In addition, sealer bioactivity was measured by RT-PCR for mediator of inflammation (Tnf, Ptgs2) and mineralization (Runx2, Msx1, Ssp1 and Dmp1) after 24 h and by Alizarin Red S Assay of mineralization after 28 days. Data were analyzed using one-way ANOVA followed by the Tukey's post-test at a significance level of 5%. Results: BioRoot™ presented 24-hour cytotoxicity (p < 0.05) at 1:10 concentration. In the period of 48 h, no endodontic cement was cytotoxic to the cells compared to the control (p > 0.05). TNF-α gene expression was induced by AH Plus® (p < 0.05), while Ptgs2 was induced by the CeraSeal and BioRoot™ (p < 0.05). The expression of Runx2 was stimulated by BioRoot™ and AH Plus® (p < 0.05). In contrast, the expression of Dmp-1Dmp1 was higher for the CeraSeal and BioRoot™ (p < 0.05). Nonetheless, the sealers did not impact the formation of mineralization nodules (p > 0.05). Conclusion: CeraSeal, BioRoot™ and AH Plus® sealers were not cytotoxic to MC3T3 cells within 48 h, but differentially induced the expression of genes related to inflammation and mineralization without impacting biomineralization by the cells. [ABSTRACT FROM AUTHOR]

Objectives: The present study aimed to determine in silico toxicity predictions of test compounds from hydraulic calcium silicate-based sealers (HCSBS) and AH Plus and computationally simulate the interaction between these substances and mediators of periapical inflammation via molecular docking. Materials and Methods: All chemical information of the test compounds was obtained from the PubChem site. Predictions for bioavailability and toxicity analyses were determined by the Molinspiration Cheminformatics, pkCSM, ProTox-II and OSIRIS Property Explorer platforms. Molecular docking was performed using the Autodock4 AMDock v.1.5.2 program to analyse interactions between proteins (IL-1β, IL-6, IL-8, IL-10 and TNF-α) and ligands (calcium silicate hydrate, zirconium oxide, bisphenol-A epoxy resin, dibenzylamine, iron oxide and calcium tungstate) to establish the affinity and bonding mode between systems. Results: Bisphenol-A epoxy resin had the lowest maximum dose tolerated in humans and was the test compound with the largest number of toxicological properties (hepatotoxicity, carcinogenicity and irritant). All systems had favourable molecular docking. However, the ligands bisphenol-A epoxy resin and dibenzylamine had the greatest affinity with the cytokines tested. Conclusion: In silico predictions and molecular docking pointed the higher toxicity and greater interaction with mediators of periapical inflammation of the main test compounds from AH Plus compared to those from HCSBS. Clinical Relevance: This is the first in silico study involving endodontic materials and may serve as the basis for further research that can generate more data, producing knowledge on the interference of each chemical compound in the composition of different root canal sealers. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to investigate the morphometric parameters of dental pulp in open apices immature teeth in a sheep model after mechanical pulp exposure and restoration with reinforced zinc oxide-eugenol. Materials and Methods: In this experimental study, a total of 12 immature mandibular central incisors from six adult male sheep, weighing 30-40 kg and with the age of 1 year old with Merino race were examined. After anesthesia, the pulps of the teeth in the case group were mechanically exposed and then were restored with reinforced zinc oxide-eugenol and amalgam. In the control group, the teeth remained intact. The animals were sacrificed at intervals of 2, 4, 6, and 8 weeks (E2, E4, E6, and E8) in the case and 2 and 8 weeks (C2 and C8) in the control groups. Then, their teeth were removed with the surrounding supporting tissues and alveolar bones. Tissue processing and staining were done, and the sections were examined under a light microscope. The Kruskal-Wallis and Mann-Whitney U tests were used to analyze the data and compare the changes between the two groups. P < 0.05 was considered statistically significant. Results: In response to mechanical exposure, reparative or tertiary dentin was formed, and its thickness increased during the time of the study. The thickness of the odontoblastic layer in the E4 group was the highest amount. The pulp chamber diameter in the C2 group was significantly larger than the other groups, and the diameter of the apical foramen in the E8 was decreased significantly compared to the controls (P < 0.05). Conclusion: In response to mechanical exposure and restoration with reinforced zinc oxide-eugenol, some morphometric parameters of the dental pulp changed significantly in the sheep model compared to the controls. [ABSTRACT FROM AUTHOR]

Objectives: Antibacterial activity against endodontic pathogens is a desirable feature for root canal sealers. The objective of this study was to compare the antibacterial effect of three resin-based endodontic sealers (AH26, Adseal, and Beta RCS) against Enterococcus faecalis in vitro. Materials and Methods: The antibacterial properties of the sealers were assessed against E. faecalis using agar diffusion test (ADT) for fresh state (N=10) and direct contact test (DCT) for freshly-mixed and set states of the materials (N=10). In ADT, the diameter of the zones of inhibition was measured after 24h of contact. In DCT, the colony-forming units of the bacteria were counted after 30 minutes and 180 minutes of exposure. The results were analyzed with two-way ANOVA and independent sample t-test. P<0.05 was considered significant. Results: Regarding DCT results, all test materials indicated an antibacterial effect, both in freshly-mixed and set states. The highest antibacterial effect was related to Adseal, whereas the lowest was observed in Beta RCS. There was a significant difference between all study groups (different sealers, setting states, and contact times; P<0.001), except for freshly-mixed AH26 and Adseal at 180 minutes (P>0.05). According to ADT, AH26 and Adseal represented the widest and the smallest inhibition zones, respectively (P<0.001). Conclusion: Within the limitations of this in vitro study, AH26, Adseal, and Beta RCS showed antibacterial effects against E. faecalis in both freshly-mixed and set states. The antibacterial effect increased over time in all of the studied sealers. [ABSTRACT FROM AUTHOR]

The single-cone technique, also known as the hydraulic condensation technique, is widely employed in endodontics. However, the aforementioned method is presented with certain limitations; specifically concerning the coronal seal and the adaptation of the coronal third of a master guttapercha (GP) with a round cross-section to the coronal dentinal walls of root canals with semi-round or oval cross-sections. Through two case reports, the current article introduces the coronal vertical condensation (CVC) technique; aiming to enhance GP adaptation to canal walls in similar scenarios. In fact, the coronal vertical condensation technique amalgamates the different aspects of warm vertical condensation and single-cone techniques. In CVC, following the placement of the master GP cone, an electrical heat carrier is inserted immediately a few millimeters apical from the canal orifice to remove the coronal portion of the master GP cone. Subsequently, a hand plugger is used to condense GP in the vertical dimension, and the coronal space is backfilled using melted GP. The implementation of CVC technique has demonstrated an improved coronal adaptation of GP with canal walls. The stated technique seems beneficial; especially in the obturation of severely curved canals or root canals with a final preparation shape of variable taper. [ABSTRACT FROM AUTHOR]

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Objective: To evaluate the possible renal and hepatic alteration by root canal filling pastes in mice. Material and Methods: Fifty-four mice were divided into nine groups and received one polyethylene tube implant containing two filling pastes (CTZ or calcium hydroxide pastes). Empty polyethylene tubes were used as a negative control. All tubes were implanted subcutaneously in the back of the mice. After time intervals of 7, 21, and 63 days, 1.5 mL of blood was collected by cardiac puncture, and serum samples were used for serological testing. Urea, creatinine, aspartate transferase (AST), alanine transferase (ALT), alkaline phosphatase (ALP), and gamma-glutamyltransferase (GGT) were evaluated. Data were analyzed by 2-way ANOVA (p0.05). No differences were observed in the interactions (material*experimental time intervals) and the biochemical parameters analyzed (p>0.05). Conclusion: CTZ and calcium hydroxide pastes did not cause hepatic and renal alterations in mice, demonstrating the pastes' safety.

Abstract Objectives This study was assessed the biocompatibility of three different root canal sealers (Well-Root St, GuttaFlow Bioseal, and AH-Plus) following implantation in rat subcutaneous tissues, using histopathological immunohistochemical analysis. Methods Four groups of eighty-four male rats each underwent subcutaneous dorsal implantation of a polyethylene tube, either empty or filled. Tissues were collected, fixed, and processed for histological analysis after 7, 15, and 30 d. Slides were photographed and digitally processed to identify lymphocytes and macrophages using Cluster of differentiation 3 (CD3) and cluster of differentiation 68 (CD68) markers, respectively. P was set at 0.05, when lymphocyte and macrophage infiltration was compared between groups and observation times using one-way analysis of variance (ANOVA). Results Histopathological analysis of all groups revealed an inflammatory reaction followed by the emergence of a fibrous capsule after 7 days. After 30 days, the thickness of the fibrous capsule and the inflammatory response subsided. CD3 staining for immunohistochemical analysis revealed that the AH-Plus group had the highest mean percentage of lymphocyte infiltration at 7 and 15 days, followed by the Well-Root St, GuttaFlow Bioseal, and Control groups. After 30 days, no discernible difference was observed between the groups in terms of the mean percentage of lymphocyte infiltration. After 7, 15, and 30 days, there was a significant difference in the mean percentage of macrophage infiltration across the groups, as demonstrated by CD68 staining. After 7, 15, and 30 days, the AH-Plus group had the highest mean percentage of macrophage infiltration, followed by the Well-Root St. and GuttaFlow Bioseal groups, while the control group had the lowest mean percentage. Conclusion All observational periods showed minimal inflammatory reactions to GuttaFlow Bioseal. After subcutaneous tissue implantation in a rat model, the initial inflammatory reactions to Well-Root St and AH-Plus had abated by day 30, and all tested sealers had outstanding biocompatibility.

Abstract Background This study aimed to assess the effect of blood contamination on marginal adaptation of cold ceramic (CC) and mineral trioxide aggregate (MTA) Angelus using scanning electron microscopy (SEM). Methods This in vitro experimental study was conducted on 24 extracted single-rooted human teeth. After cleaning and shaping, the root canals were filled with lateral compaction technique. The apical 3 mm of the roots was cut, and cavities with 3 mm depth were created at the apex. The teeth were randomly assigned to two group (n = 12) for the application of CC and MTA Angelus as retrograde filling materials. CC and MTA Angelus were prepared by mixing the powder with blood, and applied in the cavities. After 24 h, their marginal adaptation to the canal walls was assessed by SEM. Data were statistically analyzed by t-test (alpha = 0.05). Results The mean marginal gap was 8.98 μm in the CC, and 16.26 μm in the MTA Angelus group; this difference was statistically significant (P

Background: To provide a continuous seal of the root canal, root-filling material should bond to the root canal dentin, ensuring the integrity of both the root-filling material and dentin remains in a static and functional state. The present study assessed the push-out bond strength of mineral trioxide aggregate (MTA) and cold ceramic (CC). Materials and Methods: In this laboratory trial study, 20 single-rooted, extracted human teeth without caries and cracks were selected. Each tooth was mounted in cold-curing resin. Then, 3 mm slices of mid-root dentin were obtained from each tooth. The specimens were randomly divided into two groups (n = 10) and filled with MTA ProRoot and CC. All specimens were stored for 30 days in an incubator at 37°C and 100% humidity. The push-out bond strength of the test materials was measured using a cylindrical punch with a 1-mm diameter. The punch was pushed against the test specimen at a speed of 1.0 mm/min using a universal material testing machine, extruding the filling test material. The push-out force during the test was recorded, and then, the internal surface of the teeth was examined to evaluate the mode of failure. Independent t-test and Chi-square were used to analyze the data. P < 0.05 was considered a significance threshold. Results: The mean push-out bond strength in the CC group was 24.58 (MPa), and in MTA ProRoot, it was 23.77. No significant difference was observed between the two groups. The most frequent mode of failure in both groups was adhesive failure. Conclusion: The two materials have adequate push-out bond strength to root dentin, and there is no difference between the bond strength and mode of failure of the two materials.

Objectives: Antibacterial activity against endodontic pathogens is a desirable feature for root canal sealers. The objective of this study was to compare the antibacterial effect of three resin-based endodontic sealers (AH26, Adseal, and Beta RCS) against Enterococcus faecalis in vitro. Materials and Methods: The antibacterial properties of the sealers were assessed against E. faecalis using agar diffusion test (ADT) for fresh state (N=10) and direct contact test (DCT) for freshly-mixed and set states of the materials (N=10). In ADT, the diameter of the zones of inhibition was measured after 24h of contact. In DCT, the colony-forming units of the bacteria were counted after 30 minutes and 180 minutes of exposure. The results were analyzed with two-way ANOVA and independent sample t-test. P0.05). According to ADT, AH26 and Adseal represented the widest and the smallest inhibition zones, respectively (P

Aim: To assess the observed volume of filled C-shaped root canals from different CBCT and micro-CT having nano-CT as a reference. Materials and methods: Twelve extracted mandibular molars with C-shaped root canals were endodontically treated using Reciproc Blue R25 (VDW GMBH, Munich, Germany) in a reciprocating system and filled with gutta-percha (Dentsply Maillefer) and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany). CBCT scans were performed using 3 units—3D Accuitomo 170 (J. Morita, Kyoto, Japan), ProMax 3D Max (Planmeca, Helsinki, Finland), and NewTom VGi EVO (Cefla QR, Verona, Italy)—at two resolution modes: standard and high. Micro-CT and nano-CT scans were also obtained. The volume of all filled C-shaped root canals was obtained using CTAn software (Bruker, Kontich, Belgium), and the blooming artifact, in relation to nano-CT volume, was calculated. The data were evaluated by the Bland–Altman plots and ANOVA two-way for repeated measures (α = 0.05). Results: All CBCT units and micro-CT showed significantly larger observed volume of root canal filling when compared to nano-CT. The blooming artifact of root canal filling in standard resolution was significantly larger than that in high resolution (p < 0.05) in all CBCT units. Conclusions: Endodontic filling material with AH Plus sealer causes blooming artifacts in CBCT units and micro-CT. Clinical relevance: Considering the anatomical complexity of C-shaped root canals and the challenges associated with endodontic treatment, CBCT is frequently recommended for follow-up evaluations. However, the presence of endodontic filling material can result in blooming artifacts that may potentially impact the accurate diagnosis of endodontic complications. [ABSTRACT FROM AUTHOR]

We investigated three calcium silicate-based sealers with respect to their chemical characterization, cytotoxicity, and attachment to RAW264.7 cells. BioRoot RCS (BR), Bio-C Sealer (BC), and Sealer Plus BC (SPBC) were assessed using Fourier transform infrared spectroscopy (FTIR), X-ray fluorescence spectroscopy (XRF), and energy-dispersive X-ray spectroscopy (EDX) (n = 4) for elemental characterization, and using scanning electron microscopy (SEM) to evaluate cell morphology and adhesion. Cytotoxicity was determined at different dilutions (1:1, 1:2, and 1:5) using the succinate dehydrogenase activity (MTT assay). Statistical analysis was performed for normal distribution using the Shapiro–Wilk test and for homoscedasticity using Levene's test, and one-way ANOVA, Tukey's/Dunnett's post hoc tests for cell viability and XRF (α = 0.05). Calcium silicate hydrate and calcium hydroxide were detected by FTIR in all groups. EDX detected a higher calcium content for BR and SPBC and aluminum only in the premixed sealers. XRF detected the highest calcium release in BR (p < 0.05). The surface morphology showed irregular precipitates for all the sealers. SPBC at a 1:2 dilution resulted in the lowest cell viability compared to BR (p < 0.05) and BC (p < 0.05). The calcium silicate-based sealers produced a statistically significant reduction in cellular viability at a 1:1 dilution compared to the control group (p < 0.0001). All the sealers maintained viability above 70%. [ABSTRACT FROM AUTHOR]

Objectives: This study was assessed the biocompatibility of three different root canal sealers (Well-Root St, GuttaFlow Bioseal, and AH-Plus) following implantation in rat subcutaneous tissues, using histopathological immunohistochemical analysis. Methods: Four groups of eighty-four male rats each underwent subcutaneous dorsal implantation of a polyethylene tube, either empty or filled. Tissues were collected, fixed, and processed for histological analysis after 7, 15, and 30 d. Slides were photographed and digitally processed to identify lymphocytes and macrophages using Cluster of differentiation 3 (CD3) and cluster of differentiation 68 (CD68) markers, respectively. P was set at 0.05, when lymphocyte and macrophage infiltration was compared between groups and observation times using one-way analysis of variance (ANOVA). Results: Histopathological analysis of all groups revealed an inflammatory reaction followed by the emergence of a fibrous capsule after 7 days. After 30 days, the thickness of the fibrous capsule and the inflammatory response subsided. CD3 staining for immunohistochemical analysis revealed that the AH-Plus group had the highest mean percentage of lymphocyte infiltration at 7 and 15 days, followed by the Well-Root St, GuttaFlow Bioseal, and Control groups. After 30 days, no discernible difference was observed between the groups in terms of the mean percentage of lymphocyte infiltration. After 7, 15, and 30 days, there was a significant difference in the mean percentage of macrophage infiltration across the groups, as demonstrated by CD68 staining. After 7, 15, and 30 days, the AH-Plus group had the highest mean percentage of macrophage infiltration, followed by the Well-Root St. and GuttaFlow Bioseal groups, while the control group had the lowest mean percentage. Conclusion: All observational periods showed minimal inflammatory reactions to GuttaFlow Bioseal. After subcutaneous tissue implantation in a rat model, the initial inflammatory reactions to Well-Root St and AH-Plus had abated by day 30, and all tested sealers had outstanding biocompatibility. [ABSTRACT FROM AUTHOR]

Background/Aim. The ability to effectively and consistently penetrate dentinal tubules is considered a favorable factor for the evaluation of root canal sealers (RCSs). The aim of the study was to assess the penetration depth into dentinal tubules of three RCSs combined with four obturation techniques. Methods. The mesial canals of 66 extracted human mandibular molars were endodontically prepared and randomly allocated into 12 experimental groups depending on the RCS type used (AH Plus™, EndoREZ™, Sealapex™) as well as the obturation technique applied [cold lateral compaction, cone-fit, carrier-based (with heated gutta-percha), warm vertical compaction]. Using scanning electron microscopy, transversal root cross-sections were analyzed, and the maximum depth of RCS penetration was measured (396 sections, in total, corresponded to the apical, middle, and coronary third). Results. Group AH Plus™/warm vertical compaction yielded the highest penetration depth - 1,165 µm, followed by EndoREZ™/cone-fit - 1,154 µm; the lowest depth was measured for EndoREZ™/warm vertical compaction - 502 µm. The mean value of the maximum penetration depth of RCS yielded 1,204 µm in the coronary thirds, 1,005 µm in the middle thirds, and 770 µm in the apical thirds. The AH Plus™ RCS penetrated deeper into dentinal tubules when the obturation techniques with heated gutta-percha were applied, while the opposite findings were obtained for the EndoREZ ™ RCS. Conclusion. According to our research, the RCS penetration depth appears to be influenced by the RCS type used, as well as the obturation technique applied. [ABSTRACT FROM AUTHOR]

This study aimed to assess the influence of the e-vol DX BAR filter on the diagnostic accuracy of complete and incomplete vertical root fractures (VRFs). Twenty single-rooted teeth were selected. The tooth crowns were removed, and the root canals were prepared up to a 40/.06 instrument (ProTaper Next). Each specimen was scanned in a Prexion 3D cone-beam computed tomography (CBCT) device, in a dry human skull, in 4 different situations: no root canal filling, gutta-percha, fiberglass post, and metal post. The specimens were fractured in a universal testing machine by using a customized wedge. Each specimen was reinspected to confirm the presence of incomplete VRFs. Another set of CBCT scans was performed. Then, the fractures were completed in the universal testing machine, the teeth were reinspected, and the CBCT images were acquired again. Images were assessed by using the e-Vol DX software system, with the BAR filter and with the original images, for the diagnosis of VRFs. Statistical analysis was performed by using the DeLong and McNemar tests for the comparison of the area under the receiver operating characteristic curves (AUC), accuracy, sensitivity, and specificity values. The use of the BAR filter did not improve the diagnostic values of AUC, accuracy, sensitivity, and specificity in both fracture patterns (P >.05). Incomplete VRFs presented significantly lower AUC, accuracy, and sensitivity compared with complete VRFs (P <.0001). The BAR filter did not improve the diagnostic accuracy of VRFs. The intracanal materials also did not influence the diagnosis. Incomplete VRFs were highly associated with a decrease in sensitivity. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the effect of blood contamination on marginal adaptation of cold ceramic (CC) and mineral trioxide aggregate (MTA) Angelus using scanning electron microscopy (SEM). Methods: This in vitro experimental study was conducted on 24 extracted single-rooted human teeth. After cleaning and shaping, the root canals were filled with lateral compaction technique. The apical 3 mm of the roots was cut, and cavities with 3 mm depth were created at the apex. The teeth were randomly assigned to two group (n = 12) for the application of CC and MTA Angelus as retrograde filling materials. CC and MTA Angelus were prepared by mixing the powder with blood, and applied in the cavities. After 24 h, their marginal adaptation to the canal walls was assessed by SEM. Data were statistically analyzed by t-test (alpha = 0.05). Results: The mean marginal gap was 8.98 μm in the CC, and 16.26 μm in the MTA Angelus group; this difference was statistically significant (P < 0.001). Conclusions: The present in vitro study revealed that following complete blood contamination of powder, CC showed significantly superior marginal adaptation than MTA Angelus as shown by SEM assessment. [ABSTRACT FROM AUTHOR]

This study assessed the influence of pH variation on the volumetric change of EndoSequence BC Sealer compared to AH Plus Jet. Eighteen single‐rooted teeth were uniformly prepared and filled with one of the sealers. After 24‐h storing, samples were scanned in a micro‐CT device. Then, roots were immersed in 20 ml phosphate‐buffered saline (PBS) with pH of 5, 7 or 12 at 37°C for 7 and 30 days and rescanned. Statistical analysis was performed using Shapiro–Wilk's test, one‐way ANOVA and Tukey's or Student's t‐tests (p < 0.05). Differences between sealers were observed only at neutral pH and after 30 days of acidic pH exposure, with a higher loss of EndoSequence (p < 0.05). After 7 days, alkaline pH reduced and increased the volumetric loss of EndoSequence and AH Plus, respectively, compared to neutral pH (p < 0.05). It can be concluded that the pH directly influenced the volumetric change of both tested root canal sealers in different ways. [ABSTRACT FROM AUTHOR]

This study compared the performance of Reciproc and Reciproc Blue endodontic files in retreatment time and re‐establishment of apical patency, plus removal of a bioceramic sealer from the canal surface with the supplementary use of the XP‐endo Finisher R. Following preparation, slightly curved oval root canals in mandibular incisors were filled using a corresponding gutta‐percha point and a bioceramic sealer. Apical patency achievement was assessed and the time required to reach the original working length was recorded. The samples were split longitudinally and were photographed to assess the material remaining on the canal walls. No significant differences were observed regarding patency achievement or retreatment times when comparing Reciproc and Reciproc Blue. Significant less material remained on the canal walls when Reciproc was followed by XP‐endo compared with Reciproc alone, and when the data for Reciproc and Reciproc Blue were pooled. [ABSTRACT FROM AUTHOR]

This study aimed to examine how heating affects the physical properties of a newly developed premixed calcium silicate-containing sealer (AH Plus Bioceramic Sealer; AHB), in comparison with EndoSequence BC Sealer (ES), AH Plus Jet (AH), and Pulp Canal Sealer. The setting time, flow, and film thickness were tested with or without heating at 100 °C for 30 or 60 s, in accordance with ISO6876:2012 standards. Ultrastructural and elemental analyses were performed with scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS). Data were analyzed using one-way analysis of variance (ANOVA) with a Tukey post hoc test (α = 0.05). All sealers exhibited significantly shorter setting time and flow after heating at 100 °C for 30 and 60 s (p < 0.05). After heating, AHB showed a significantly higher film thickness compared to that of the other materials (p < 0.05). None of the tested properties of heat-applied AHB and ES met ISO standards, except the setting time in ES. The SEM/EDS results for AHB and ES were not affected by heating. The detected changes in physical properties can negatively impact the performance of premixed calcium silicate-containing sealers, particularly AHB, when warm vertical compaction is employed.

Objectives: To evaluate the incorporation of halloysite nanotubes (HNTs) loaded with one of two calcium sources (i.e., calcium hydroxide/CaOH2 or beta-tricalcium phosphate/β-TCP) on the physicochemical and biological properties of an experimental resin-based dual-cured endodontic sealer. Materials and methods: HNTs were encapsulated with CaOH2 or β-TCP at 10 wt.%. HNTs containing CaOH2 or β-TCP were added into the experimental sealers at 50 wt.%. The control sealers were the calcium-free HNT-modified resin-based experimental sealer and AH Plus™, a commercially available endodontic sealer. Degree of conversion, setting time, flow, film thickness, radiopacity, dimensional stability, and calcium ions release were determined. Antibiofilm properties and cytocompatibility of the formulated sealers and commercial control were also evaluated. One and two-way ANOVA analysis followed by Tukey's post hoc test was conducted to evaluate the effect of the independent variable on the evaluated properties. Results: FTIR confirmed the encapsulation of calcium sources into HNTs. Regarding flow and film thickness, the values obtained from these sealers were in accordance with the specifications provided by ISO 6876. For radiopacity, AH Plus™ achieved the highest radiopacity (p<0.05). Among the experimental formulations, all experimental HNT-containing compositions exhibited values below 3 mm Al. The experimental sealers showed greater dimensional changes when compared to the commercial (AH Plus™) control. The release of calcium ions was observed for the HNT_CaOH2 and HNT_β-TCP sealers without statistical differences. Experimental sealers containing HNT_CaOH2 and HNT_β-TCP significantly reduced the CFU/mL count and showed cell compatibility. Conclusions: The findings of this study demonstrate that the incorporation of HNT_CaOH2 or HNT_β-TCP into resin-based experimental sealers promoted antimicrobial effects and gradual calcium release without impairing cytocompatibility or physicochemical properties of the sealers. Still, an adjustment to reach the minimal radiopacity established by ISO 6876 is needed. Clinical relevance: The experimental resin-based sealers seemed to be an alternative for endodontics. The incorporation of calcium sources exerts promising antimicrobial effects while displaying low cell toxicity. [ABSTRACT FROM AUTHOR]

Objective: Bioceramic-based sealers, in combination with bioceramic-coated gutta-perchas, have become more commonly used in root canal obturation. The present study aimed to assess the influence of laser-assisted dentin conditioning compared with conventional conditioning protocols on the push-out bond strength (PBS) of a bioceramic-based root canal filling. Material and Methods: Sixty extracted mandibular premolars with one root canal were instrumented with EndoSequence rotary files up to size 40/0.04. Four types of dentin conditioning protocols were used: 1) 5.25% NaOCl (con-trol), 2) 17% EDTA+5.25% NaOCl, 3) Diode laser-agitated 17% EDTA+5.25% NaOCl, 4) Er,Cr:YSGG laser irradiation+5.25% NaOCl. Teeth were obturated using the single-cone technique with Endo-Sequence BC sealer+BC points (EBCF). After having obtained 1-mm-thick horizontal slices from the apical, middle and coronal root thirds, push-out test was carried out, and failure modes were de-termined. The data were analyzed by two-way analysis of variance and Tukey’s test with a significance level of p0.05). Conclusions: Laser-assisted dentin conditioning had distinct effects on the PBS of the EBCF at different root segments. Although Er, Cr: YSGG was ineffective in the apical segments, generally, laser-assisted dentin conditioning affected PBS more favorably than conventional irrigation groups, with a more pronounced effect in the diode laser-agitated EDTA group.

Background/Aim. During retreatment, filling material and debris may extrude and trigger an inflammatory reaction of periapical tissues. Resilon™ has not been investigated in terms of solvent use and influence on apical extrusion during retreatment. The aim of the study was to evaluate the amount of apically extruded debris during Resilon™ removal using ProTaper (PT), Twisted File (TF), and Hedstrom instruments, with and without solvent. Methods. In total, 72 extracted teeth with single canals were used. Canals were prepared with PT Universal (F2) and filled with Resilon™ and RealSeal sealer before being assigned randomly to 6 groups (n = 12 in each group). Retreatment in Groups 1–3 was done with PT, TF, or Hedstrom instruments, without solvent. In Groups 4–6, the same instruments were used with chloroform. Apically extruded debris was collected in a simulated periapical environment and assessed visually. Additionally, the time required for retreatment was recorded. Data were analyzed statistically using the Mann-Whitney U test, with a significance level of 0.05. Results. There were no significant differences in apical extrusion debris between groups (p > 0.05) regarding solvent use. Rotary instruments, without solvent, were associated with significantly less debris extrusion when compared with hand files (p < 0.05). When solvent was used, rotary instruments caused a higher degree of extruded material, which was similar to the results of hand instruments. Conclusion. The use of rotary instruments without solvent resulted in a lower degree extrusion of Resilon ™ material compared to hand instruments, while greater caution is advised in the presence of solvent when rotary instruments are used to remove this material.

Background: This study evaluated the effects of using different root canal sealers and protocols for cleaning intraradicular dentin on the bond strength of a composite resin used to reinforce weakened roots. Material and Methods: Sixty-four roots of extracted human maxillary canines were weakened, prepared and filled with two different endodontic sealers (Endofill and AH Plus). In half of the sample, set aside for each respective sealer, excess filling material was cleaned. In the other half, the weakened areas were not cleaned, and the excess of sealer was spread on the intraradicular dentin. Intentionally worn areas inside each root were restored with a microhybrid light-cure composite resin (Z100) to reinforce them, with and without acid etching. Prefabricated metal posts were fixed with a dual resin cement (RelyX ARC), and the specimens were submitted to a pull-out test. Statistical analysis was performed by means of Shapiro-Wilk, analysis of variance (one-way ANOVA) and Tukey-Kramer tests (p0.05).The greatest bond strength values were observed in roots filled with AH Plus (GV, GVI, GVII, GVIII), mainly without cleaning of the weakened areas, and followed by acid etching (GVII), and also with cleaning of the weakened areas, however, with no acid etching (GVI) (p

Background: The purpose of this study was to evaluate the composition of the crystal phases of various calcium silicate-based materials (CSMs): ProRoot white MTAⓇ (mineral trioxide aggregate) (WMTA), Ortho MTAⓇ (OM), Endocem MTAⓇ (EM), Retro MTAⓇ (RM), Endocem ZrⓇ (EN-Z), BiodentineTM (BD), EZ-sealTM (EZ), and OrthoMTA III (OM3).Methods: In a sample holder, 5 g of the powder sample was placed and the top surface of the material was packed flat using a sterilized glass slide. The prepared slides were mounted on an X-ray diffraction (XRD) instrument (D8 Advance; Bruker AXS GmbH, Germany). The X-ray beam 2θ angle range was set at 10∼90o and scanned at 1.2o per minute. The Cu X-ray source set to operate at 40 kV and 40 mA in the continuous mode. The peaks in the diffraction pattern of each sample were analyzed using the software Diffrac (version 2.1). Then, the peaks were compared and matched with those of standard materials in the corresponding Powder Diffraction File (PDF-2, JCPDS International Center for Diffraction Data). A powder samples of the materials were analyzed using XRD and the peaks in diffraction pattern were compared to the Powder Diffraction File data.Results: Eight CSMs showed a similar diffraction pattern because their main component was calcium silicate. Eight CSMs showed similar diffraction peaks because calcium silicate was their main component. Two components were observed to have been added as radiopacifiers: bismuth oxide was detected in WMTA, OM, and EM while zirconium oxide was detected in RM, EN-Z, BD, EZ, and OM3. Unusual patterns were detected for the new material, OM3, which had strong peaks at low angles.Conclusion: It was caused by the presence of Brushite, which is believed to have resulted in crystal growth in a particular direction for a specific purpose.

Background: This study aimed to evaluate the reaction of the periapical tissue to Cold ceramic and mineral trioxide aggregate (MTA) following periapical endodontic surgery. Materials and Methods: In this experimental study, a total of 12 mandibular first, second, and third premolars of two male dogs were selected. All procedures were performed under general anesthesia. The access cavities were prepared, and the length of canals was determined. Root canal treatment was performed. A week later, periradicular surgery was performed. After osteotomy, 3 mm of the root end was cut. Then, a 3-mm cavity was created by an ultrasonic. The teeth were randomly divided into two groups (n = 12). The root-end cavities were filled with MTA in the first group and with Cold ceramic in the second group. After 4 months, the animals were scarified. Histological evaluation of the periapical tissues was performed. Data were analyzed using SPSS 22 and Chi-square test and P = 0.05. Results: The findings showed 87.5% and 58.3% cementum formation in MTA and Cold ceramic groups, respectively, indicating a significant difference (P < 0.001). In addition, the results showed 91.7% and 83.3% bone formation in MTA and Cold ceramic groups, respectively, but the difference was not statistically significant (P = 0.6). Furthermore, the findings revealed 87.5% and 58.3% periodontal ligament (PDL) formation in MTA and Cold ceramic groups, respectively (P = 0.05). Conclusion: Cold ceramic was able to induce the regeneration of cementum, bone, and PDL; hence, it can be considered as a biocompatible root-end filling material in endodontic surgery. [ABSTRACT FROM AUTHOR]

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Objective: To compare clinical and radiographical pulpectomy outcomes in primary teeth filled with different pastes. Material and Methods: The sample included thirty-eight teeth indicated for pulpectomy due to irreversible pulp inflammation or necrosis from thirty patients (2 to 9 years old). The first appointment comprised chemomechanical preparation (2.5% sodium hypochlorite), smear layer removal (6% citric acid), intracanal dressing and temporary restoration. Seven days later, teeth were randomly assigned to filling with iodoform (IP) or calcium hydroxide with zinc oxide (CHZO) based pastes and temporarily restored. Final restoration (composite resin) occurred at the 3rd appointment. Data from baseline, 6 and 12 months were analysed using descriptive and inferential statistics (p≤0.05). Results: The overall frequency of success was 63.6% (n=21), with no significant difference between groups (IP=62.5% n=10; CHZO=64.7% n=11, p=0.59). Multiradicular teeth, overfilled canals and teeth whose coronal restoration have been lost were significantly associated with failure (p=0.01, p=0.04 and p

Background: The aim of the study was to investigate the morphometric parameters of dental pulp in open apices immature teeth in a sheep model after mechanical pulp exposure and restoration with reinforced zinc oxide-eugenol. Materials and Methods: In this experimental study, a total of 12 immature mandibular central incisors from six adult male sheep, weighing 30–40 kg and with the age of 1 year old with Merino race were examined. After anesthesia, the pulps of the teeth in the case group were mechanically exposed and then were restored with reinforced zinc oxide-eugenol and amalgam. In the control group, the teeth remained intact. The animals were sacrificed at intervals of 2, 4, 6, and 8 weeks (E2, E4, E6, and E8) in the case and 2 and 8 weeks (C2 and C8) in the control groups. Then, their teeth were removed with the surrounding supporting tissues and alveolar bones. Tissue processing and staining were done, and the sections were examined under a light microscope. The Kruskal–Wallis and Mann–Whitney U tests were used to analyze the data and compare the changes between the two groups. P < 0.05 was considered statistically significant. Results: In response to mechanical exposure, reparative or tertiary dentin was formed, and its thickness increased during the time of the study. The thickness of the odontoblastic layer in the E4 group was the highest amount. The pulp chamber diameter in the C2 group was significantly larger than the other groups, and the diameter of the apical foramen in the E8 was decreased significantly compared to the controls (P < 0.05). Conclusion: In response to mechanical exposure and restoration with reinforced zinc oxide-eugenol, some morphometric parameters of the dental pulp changed significantly in the sheep model compared to the controls.

Objective: To compare clinical and radiographical pulpectomy outcomes in primary teeth filled with different pastes. Material and Methods: The sample included thirty-eight teeth indicated for pulpectomy due to irreversible pulp inflammation or necrosis from thirty patients (2 to 9 years old). The first appointment comprised chemomechanical preparation (2.5% sodium hypochlorite), smear layer removal (6% citric acid), intracanal dressing and temporary restoration. Seven days later, teeth were randomly assigned to filling with iodoform (IP) or calcium hydroxide with zinc oxide (CHZO) based pastes and temporarily restored. Final restoration (composite resin) occurred at the 3rd appointment. Data from baseline, 6 and 12 months were analysed using descriptive and inferential statistics (p≤0.05). Results: The overall frequency of success was 63.6% (n=21), with no significant difference between groups (IP=62.5% n=10; CHZO=64.7% n=11, p=0.59). Multiradicular teeth, overfilled canals and teeth whose coronal restoration have been lost were significantly associated with failure (p=0.01, p=0.04 and p<0.001, respectively). Conclusion: After 12 months, both pastes showed similar outcomes and can be used as good options for pulpectomies in primary teeth. Moreover, tooth location, extent of the root canal filling, and integrity of final restoration during the follow-up influenced the outcome of pulpectomies. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the antimicrobial activity and physicochemical properties of a novel dual-cure endodontic sealer containing copaiba oil. The copaiba oil was obtained and characterized by gas chromatography (GC), and the minimum inhibitory concentration (MIC) was performed. The experimental sealers were formulated with copaiba oil concentrations of 0, 0.5, 1, and 2%, and the RealSeal™ (Sybron endo, Orange, USA) and AH Plus (Dentsply De Trey Gmbh, Konstanz, Germany) were used as the commercial references. The antimicrobial activity of the sealers was evaluated by the direct contact test for 1h and 24h. To evaluate the physicochemical properties of the sealers, the degree of conversion, setting time, film thickness, dimensional stability, and radiopacity tests were performed. The data were statistically analyzed by one-way ANOVA and Tukey's test (α = 0.05). Concerning the results, the sealers containing copaiba oil showed antimicrobial activity without harming the physicochemical properties. [ABSTRACT FROM AUTHOR]

Objective: Confocal laser scanning microscopy (CLSM) was used to investigate the penetration of endodontic sealers into the dentinal tubules after retreatment using two different obturation techniques. Materials and methods: Thirty mandibular premolars were prepared up to instrument F3 (ProTaper Universal, Dentsply) and filled with Endofill using the single cone technique. The canals were retreated using Mtwo instruments. Reobturation was performed with the Bio-C sealer mixed with a fluorophore dye (Fluo-3) using either the lateral condensation technique (group LC) or the single cone technique (group SC) (n = 15). Teeth were sectioned 2, 4, and 6 mm from the apex and analyzed with CLSM to assess the penetration of the sealer into the canal perimeter and the maximum depth of penetration of the sealer into the dentinal tubules. Data were analyzed using ANOVA and the Student-t and Holm-Sidak tests. Results: In the apical segment, the penetrated perimeter was significantly higher in the LC group than in the SC group (p < 0.05); no significant difference was found in the middle and cervical segments (p > 0.05). In terms of penetration depth, no significant differences were found for any of the segments studied (p > 0.05). Conclusion: The LC technique promoted a higher percentage of canal circumference penetrated by the sealer than the SC technique in the apical segment after endodontic retreatment. Clinical relevance: CLSM demonstrated that the LC technique promoted a higher percentage of canal perimeter penetrated by the Bio-C sealer than the SC technique in the apical segment of mandibular premolars after retreatment. [ABSTRACT FROM AUTHOR]

Background and Aim: This study aimed to compare the cytotoxicity of AH Plus and DC Canal SE sealer after final setting. Materials and Methods: In this in vitro, experimental study, human gingival fibroblasts (HGFs) were cultured in Dulbecco’s modified Eagle’s medium supplemented with 10% fetal bovine serum, 100 U/mL penicillin, and 100 µg/mL streptomycin, and incubated at 37°C and 5% CO2. Cells at a density of 5000 cells/well were seeded in a 96-well plate for the methyl thiazolyl tetrazolium (MTT) assay. The cells were incubated with AH Plus and DC Canal SE sealers. Specimens of freshly mixed sealers were fabricated with 4 mm height and 10 mm diameter, and incubated at 37°C for 24 hours for setting. Each specimen was incubated with 10 mL of diluted culture medium at 37°C and 5% CO2 for 24 hours. Finally, the solution was filtered using a 0.22-µm filter. Different dilutions (1, 1/2, 1/4, 1/8) were prepared, and cell viability was assessed at 24 and 72 hours by measuring the optical density of the solutions spectrophotometrically. Data were analyzed by ANOVA and Tukey’s test. Results: Cell viability in presence of all concentrations of AH Plus and DC Canal SE was significantly lower at 72 hours compared with 24 hours (P

Introduction: This study aimed to prepare a new root repair material including Portland cement, bismuth oxide, and nano-hydroxyapatite and analyze its physicochemical properties and its effects on the proliferation and differentiation of human dental pulp stem cells (hDPSCs). Material and Methods: Bismuth oxide as a radiopaque component and nano-hydroxyapatite particles were added to white Portland cement at 20% and 5% weight ratio, respectively. Characterization of the prepared cement was done using con-ventional methods. To examine the bioactivity of this new material, atomic absorption spectroscopy (AAS) was used for the investigation of the rate of calcium ions dissolution in simulated body fluid media. The viability of hDPSCs was assessed by an MTT assay after 1, 3 and 7 days. The odontogenic potential of this substance was evaluated by measuring alkaline phosphatase activity and alizarin red S staining. Results: Based on the bioactivity results, the cement presented high bio-activity, corroborating sufficiently with the calcium release patterns. The cell viability was significantly increased in new root repair ma-terial containing hydroxyapatite nanoparticles after 3 and 7 days (p