Antibiofilm Effects of Endodontic Sealers Containing Quaternary Ammonium Polyethylenimine Nanoparticles

Introduction

This study evaluated the antibiofilm effects of 2 endodontic sealers incorporated with quaternary ammonium polyethylenimine (QPEI) nanoparticles at a 2% concentration (w/w).

Methods

The materials tested were AH Plus and Pulp Canal Sealer EWT (PCS) in the commercial unmodified form or containing 2% QPEI. Antibiofilm assays were conducted by using direct-contact and membrane-restricted tests for evaluation of bacterial viability in biofilms grown onto membranes or paper disks and the crystal violet microtiter-plate assay to evaluate the effects of sealer extracts on the biofilm biomass. Two Enterococcus faecalis strains (ATCC and an endodontic isolate) were used.

Results

Direct contact and membrane-restricted antibiofilm tests revealed that PCS 2% was the only material to promote total killing of E. faecalis ATCC biofilms. All the materials significantly reduced bacterial counts in E. faecalis ATCC biofilms when compared with the positive control in both tests (P < .05). In the direct test against E. faecalis RW35, PCS 2% was significantly more effective than the other materials and was the only one that showed significantly lower counts than the positive control (P < .05). In the crystal violet assay, only AH Plus 2% presented optical density readings significantly lower than the positive control of the ATCC strain (P < .05). No other significant effects on the biofilm biomass of the 2 E. faecalis strains were observed for any of the sealers tested (P > .05).

Conclusions

Addition of QPEI nanoparticles improved the killing ability of PCS against biofilms of both E. faecalis strains and the effects of AH Plus on the biomass of biofilms from the ATCC strain.     

Interface of dentine to root canal sealers

Objective

Root canal sealers can interact physically or chemically with dentine. The aim of this study was to characterize the dentine-root canal sealer interface of experimental sealers based on Portland cement using an epoxy-based vehicle in comparison to an epoxy resin sealer, AH Plus.

Methods

Root canals were biomechanically prepared and filled with any one of the four experimental epoxy sealers containing Portland cement with micro- and nano-particles of either zirconium oxide or niobium oxide radiopacifers, or AH Plus. The dentine-sealer's interfaces were assessed by coronal penetration of fluorescent microspheres, the penetration of sealers labelled with Rhodamine B inside the dentine tubules (following obturation with gutta–percha and sealers using System B technique) assessed by confocal laser scanning microscopy, and the chemical characterization of dentine-sealers interface by scanning electron microscopy (SEM) and energy dispersive spectroscopy (EDS) line scans.

Results

No penetration of fluorescent microspheres at the root-dentine to sealer interface was recorded for all test materials. Sealers presented greater ability to penetrate within the dentinal tubules at the coronal and mid-root thirds. The experimental sealers containing radiopacifier nano-particles exhibited a more homogeneous microstructure along the whole length of the canal. EDS-line scans results showed a migration of silicon and niobium into dentine. Peak overlap between zirconium and the phosphorous compromised the identification of the migration of the zirconium oxide into dentine.

Conclusions

All five sealers promoted coronal sealing. The experimental sealers exhibited promising characteristics and were comparable to AH Plus sealer. Elemental migration of the experimental sealers suggests material interaction with dentine which was not displayed by AH Plus.     

Dentin Extends the Antibacterial Effect of Endodontic Sealers against Enterococcus faecalis Biofilms

Introduction

The purpose of this study was to evaluate the antimicrobial effects of root canal sealers on Enterococcus faecalis biofilms in dentinal tubules by using a novel dentin infection model.

Methods

Cells of E. faecalis were introduced into the dentinal tubules by centrifugation and incubated in brain-heart infusion broth for 3 weeks. An equal thickness of AH Plus, Endosequence BC sealer (BC sealer), and pulp canal sealer EWT (PCEWT) was placed on the root canal wall of the dentin specimens for 1, 7, and 30 days in humid conditions at 37°C. Gutta-percha and water were used in a similar manner as the tested sealers. The proportions of dead and live bacteria inside the dentinal tubules after exposure to root canal sealers were assessed by confocal laser scanning microscopy.

Results

Significantly more bacteria were killed in the 3 sealer groups than in the 2 control groups (P < .05). BC sealer and AH Plus resulted in significantly more dead cells than PCEWT did. There was no statistically significant difference between BC sealer and AH Plus at any time point (P > .05). Thirty days of exposure to BC sealer and AH Plus resulted in significantly more dead bacteria in dentin than 7-day and 1-day exposures in the biofilms, whereas no statistically significant increase of the proportion of dead bacteria was detected between 7-day and 30-day PCEWT (P > .05).

Conclusions

The 3 endodontic root canal sealers had antibacterial effects against E. faecalis in the dentinal tubules. BC sealer and AH Plus had superior antibacterial effects compared with PCEWT. The antibacterial effects of sealers in dentinal tubules continued after setting.     

Wettability of root canal sealers on intraradicular dentine treated with different irrigating solutions

Objectives

The aim of this in vitro study was to evaluate the wettability of AH Plus and ThermaSeal Plus sealers on intraradicular dentine treated with different irrigating solutions.

Methods

Fifty anterior teeth were decoronated and split longitudinally. Each root half was divided into 5 groups (n = 10). Group I: 5 mL of 2.5% NaOCl + QMix. Group II: 5 mL of 2.5% NaOCl + 17% EDTA. Group III: 5 mL of 2.5% NaOCl + 7% maleic acid. Group IV: 5 mL of 2.5% NaOCl. Group V: 5 mL of distilled water. Irrigation regimens were performed for 1 min. Each specimen was placed inside a Dynamic Contact Angle Analyser. A controlled-volume droplet of sealer was placed on each specimen and the static contact angle was analysed.

Results

The contact angle made by both sealers with EDTA-irrigated dentine was significantly larger when compared to the other irrigants (P < 0.05). For ThermaSeal Plus, contact angles produced on maleic acid-, NaOCl- and distilled water-irrigated dentine were not significantly different, but were all significantly larger than the contact angle produced on QMix-irrigated dentine (P < 0.05). For AH Plus, contact angles produced on NaOCl- and distilled water-irrigated dentine were not significantly different, but were significantly larger than those made by maleic acid and QMix.

Conclusion

When used as a final irrigant, QMix favours the wetting of root canal dentine by both AH Plus and ThermaSeal Plus sealers. Maleic acid shows a promising result when compared to EDTA and NaOCl. Wettability of both sealers is the worst on EDTA-irrigated dentine.

Clinical significance

The present study highlights the effect of newer endodontic irrigating solutions on the wettability of sealers on to the root canal dentine, which is required for obtaining good obturation seal.     

Chemical characterization and bioactivity of epoxy resin and Portland cement-based sealers with niobium and zirconium oxide radiopacifiers

Objective

The purpose of this study was to characterize and to evaluate the bioactivity potential of experimental root canal sealers (ES) based on Portland cement, epoxy resin with nano- and micro-particles of niobium or zirconium oxide used as radiopacifiers in comparison to AH Plus and MTA Fillapex.

Methods

Specimens of the sealers (10 mm in diameter × 1 mm thick) were prepared and the radiopacity was evaluated according to ISO 6876 (2012) specifications. Characterization of the sealers was performed under the scanning electron microscope (SEM) immediately after setting and after immersion for 28 days in Hank's balanced salt solution (HBSS). In addition X-ray energy dispersive spectroscopy (EDS), X-ray diffraction (XRD) and Fourier transform infrared (FT-IR) spectroscopy were also performed. The pH and calcium ion release were measured after 1, 7, 14, 21 and 28 days after completion of seating using a digital pH meter and an atomic absorption spectrophotometer, respectively.

Results

The experimental sealers exhibited an average radiopacity of 2.5 mm thickness of aluminum, which was similar to MTA Fillapex (P > 0.05) and inferior to AH Plus (P < 0.05). AH Plus did not show bioactivity. Although the experimental sealers did not exhibit the formation of hydration product, they encouraged the deposition of crystalline spherical structures of calcium deficient phosphate. The highest pH and calcium release values were observed with the experimental sealers (P < 0.01). ES-Nb-micro was the only sealer to present hexagonal shaped crystal deposition.

Significance

Novel root canal sealers based on a mixture of Portland cement, epoxy resin and radiopacifier exhibited a degree of bioactivity although no evidence of cement hydration was demonstrated on material characterization. The radiopacifier particle size had limited effect on the sealer microstructure and chemical properties.     

Physical Properties of 5 Root Canal Sealers

Introduction

The aim of this study was to evaluate the pH change, viscosity and other physical properties of 2 novel root canal sealers (MTA Fillapex and Endosequence BC) in comparison with 2 epoxy resin-based sealers (AH Plus and ThermaSeal), a silicone-based sealer (GuttaFlow), and a zinc oxide-eugenol–based sealer (Pulp Canal Sealer).

Methods

ISO 6876/2001 specifications were followed. The pH change of freshly mixed and set sealers was evaluated during periods of 1 day and 5 weeks, respectively. The viscosity was investigated at different injection rates (72, 10, and 5 mm/min) at room temperature by using a syringe-based system that was based on the Instron 3360 series universal testing system.

Results

The flow, dimensional change, solubility, and film thickness of all the tested sealers were in agreement with ISO 6876/2001 recommendations. The MTA Fillapex sealer exhibited a higher flow than the Endosequence BC sealer (P < .05). The MTA Fillapex and Endosequence BC sealers showed the highest film thicknesses among the tested samples. The Endosequence BC sealer exhibited the highest value of solubility, which was in accordance with 3% mass fraction recommended by the ISO 6876/2001, and showed an acceptable dimensional change. The MTA Fillapex and Endosequence BC sealers presented an alkaline pH at all times. The pH of fresh samples of the AH Plus and ThermaSeal sealers was alkaline at first but decreased significantly after 24 hours. The viscosity of the tested sealers increased with the decreased injection rates.

Conclusions

The tested sealers were pseudoplastic according to their viscosities as determined in this study. The MTA Fillapex and Endosequence BC sealers each possessed comparable flow and dimensional stability but higher film thickness and solubility than the other sealers tested.     

In Vitro Evaluation of Antibacterial Effect of AH Plus Incorporated with Quaternary Ammonium Epoxy Silicate against Enterococcus faecalis

Introduction

The purpose of this study was to evaluate the in vitro antibacterial effect of AH Plus (Dentsply, DeTrey, Konstanz, Germany) incorporated with quaternary ammonium epoxy silicate (QAES) against Enterococcus faecalis.

Methods

QAES particles were synthesized by the cocondensation of tetraethoxysilane with 2 trialkoxysilanes (3-[trimethoxysilyl]propyldimethyloctadecyl ammonium chloride and 3-glycidyloxypropyltrimethoxysilane) through a 1-pot sol-gel route. Dried QAES particles were then characterized by attenuated total reflection Fourier transform infrared spectroscopy and scanning electron microscopy. AH Plus sealers incorporated with 0–8 wt% QAES were tested after 4 weeks of water aging to assess the in vitro antibacterial activity against E. faecalis by the direct contact test (DCT) and 3-dimensional image analysis of live/dead-stained E. faecalis biofilms using confocal laser scanning microscopy.

Results

The Fourier transform infrared spectroscopy spectrum of QAES particles revealed the coexistence of the characteristic absorbance band of the siloxane backbone (Si-O-Si) from 1,000–1,100 cm⁻¹, epoxide band peaking at ∼916 cm⁻¹, and C-N stretching vibration peaking at 1,373 cm⁻¹. The scanning electron microscopic image showed the spherical morphology of QAES particles with ∼120 nm in diameter and a rough surface. DCT results revealed that AH Plus alone (0 wt% QAES) after 4 weeks of water aging had no inhibitory effect on E. faecalis growth (P = .569). AH Plus incorporated with QAES (2–8 wt%) showed antibacterial activity against E. faecalis as shown in DCT and biofilm viability results (P < .001).

Conclusions

The incorporation of QAES into epoxy resin–based AH Plus may be a promising approach for controlling endodontic infection at the time of canal filling and preventing subsequent reinfection.     

Setting Time Affects In Vitro Biological Properties of Root Canal Sealers

Introduction

Biocompatibility of root canal sealers is important because of the long-term contact of their eluates and/or degradation products with periapical tissues. The literature still lacks studies about the genotoxic effects of these materials and the influence of setting time on biological properties. The cytotoxicity and genotoxicity of an epoxy resin–based sealer (AH Plus), a single methacrylate-based sealer (EndoRez), and a silicone-based sealer (RoekoSeal) were assessed.

Methods

Chinese hamster fibroblasts (V79) were cultured and exposed to different dilutions of extracts from the sealers that were left to set for 0, 12, and 24 hours before contact with culture medium. Cell viability was measured by the methyl-thiazol-diphenyltetrazolium assay. Genotoxicity was assessed by the comet assay. Data were statistically analyzed by Kruskal-Wallis and Dunn tests (P < .05).

Results

Root canal sealers were statistically more cytotoxic than the untreated control group, except for the silicon-based sealer. Cell viability ranking was the following (from the most to the least cytotoxic): methacrylate-based > epoxy resin–based > silicone-based. The setting time influenced the epoxy resin–based sealer cytotoxicity (decreased at 12 hours) and the general genotoxicity (increased at 24 hours). DNA damage ranking was the following (from the most to the least genotoxic): methacrylate-based > silicone-based = epoxy resin–based.

Conclusions

The setting time had influence on the cytotoxicity of the epoxy resin–based sealer and genotoxicity of all tested sealers. The methacrylate-based sealer was the most cytotoxic, and the silicone-based sealer was not cytotoxic. Genotoxicity was observed for all sealers.     

Direct Effect of Endodontic Sealers on Trigeminal Neuronal Activity

Introduction

Endodontic sealers are selected on the basis of their antimicrobial properties and ability to provide a tight seal. Sealer extrusions, whether intentional or unintentional, are common during obturation procedures. Such events have been correlated with increased postoperative discomfort and persistent pain states. However, the mechanisms underlying this phenomenon are largely unknown. Thus, we sought to evaluate the effect of commonly used endodontic sealers on peripheral nociceptors. We hypothesized that endodontic sealers can directly activate trigeminal nociceptors in a concentration-dependent manner, resulting in release of calcitonin gene-related peptide (CGRP), a potent modulator of neurogenic inflammation.

Methods

Rat trigeminal sensory neurons were exposed in vitro to vehicle, zinc oxide-eugenol (ZOE)–based sealer, AH Plus, EndoSequence BC sealer, or RealSeal SE. Neuronal activation was measured by quantification of neuropeptide (CGRP) release. In addition, cultured neurons were also subjected to the set form of all 4 sealers. The concentration of CGRP released was quantified by using a radioimmunoassay. Data were analyzed by using one-way analysis of variance with Newman-Keuls multiple comparison post hoc test.

Results

Both ZOE-based sealer and AH Plus in their fresh form evoked greater CGRP release than the control groups. Conversely, EndoSequence BC and RealSeal sealers both reduced basal GCRP release at all concentrations tested. Evaluation of the set sealers revealed that only ZOE-based sealer evoked significant CGRP release compared with its control group.

Conclusions

Overall, our results suggest that sealers can directly activate trigeminal nociceptors, leading to a robust release of CGRP, and may therefore lead to pain and neurogenic inflammation. This direct activation along with the immunologic response may underlie the symptoms and flare-up occurrences often seen with sealer extrusions.     

Cytotoxicity Evaluation of a New Resin-based Hybrid Root Canal Sealer: An In Vitro Study

Objective

This study evaluated the cytotoxicity of the new experimental self-adhesive, methachrylate-based hybrid root canal sealer XT and compared it with the epoxy resin-based AH Plus Jet.

Methods

The cytotoxicity of the tested materials was evaluated after 1, 24, 48, and 72 hours by using growing and confluent mouse fibroblast cell line L929. L929 fibroblasts were maintained in Dulbecco modified medium containing 10% fetal calf serum at 37°C and 5% CO₂. At confluence, cells were seeded in 24-well plates at concentration of 1.5 × 10⁵ cells (growing cells) or 2.5 × 10⁵ (confluent cells) for each well. An amount of 5 μL of each root sealer (mixed according to manufacturer's specifications) was placed into individual wells containing a monolayer of L929 cells to mimic the in vivo condition of the possible extrusion of sealer in the periapical tissues. Neutral Red and [3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyl tetrazolium bromide] were used for the cytotoxicity evaluation. Untreated cells were used as control. Two-way analysis of variance with Bonferroni test was used to compare the toxicity of the 2 sealers; one-way analysis of variance with Tukey test was performed to compare the cytotoxicity of each sealer at any considered time points (P < .05). Results were confirmed by examination with optical microscope.

Results

Both sealers induced a time-dependent cell death of mouse fibroblast L929; however, XT was less cytotoxic than AH Plus Jet as indicated by viability and morphologic analyses, and its initial cytotoxicity decreased progressively over time.

Conclusions

These data support the possible use of XT as an endodontic sealer.     

Investigation of the Effect of Sealer Use on the Heat Generated at the External Root Surface during Root Canal Obturation Using Warm Vertical Compaction Technique with System B Heat Source

Introduction

During warm vertical compaction of gutta-percha, root canal sealers with different chemical compositions absorb the heat generated inside the root canal. The aim of this research was to assess physicochemical modifications of sealers subjected to the System B heat source (Analytic Technology, Redmond, WA) and to evaluate the effect that the use of different sealers has on the heat transfer to the external root surface.

Methods

Three proprietary brand sealers (AH Plus [Dentsply International, Addlestone, UK], Pulp Canal Sealer [Kerr Corporation, Orange, CA], MTA Fillapex [Angelus Dental Solutions, Londrina, PR, Brazil]) and a prototype sealer based on Portland cement were assessed. The heat generated on the surfaces of System pluggers and the heat dissipation at different levels (apical, midroot, and cervical) over root surface while using different sealers was assessed using thermocouples. Data were collected in 3 different environmental conditions with the tooth suspended in air, immersed in Hank's balanced salt solution, or gelatinized Hank's balanced salt solution. Chemical changes in the sealers induced by the heat were monitored by Fourier transform infrared spectroscopy. The effect of heat changes on the setting time and compressive strength of the sealers was also assessed.

Results

The continuous wave plugger sustained a rise in temperature at a maximum of 80°C at the instrument shank. The highest change in temperature on the external root surface was recorded after 1.5 minutes from the start of heating, and it was restored to body temperature by 6 minutes. Environmental conditions affected heat dissipation for all the sealers in the midroot and cervical regions and the highest increase in temperature (∼60°C) recorded in air. In the midroot and cervical regions, the type of sealer used did not affect the rise in temperature. In the apical region, AH Plus obturations resulted in a greater rise in temperature, and the chemical composition of this sealer was affected by high temperature; it also induced a reduction in sealer setting time and strength.

Conclusions

It could be concluded that surrounding conditions, such as temperature and humidity, exerted influence on heating dissipation during the continuous wave of the condensation obturation technique and that root canal sealers presented different conductive/isolating properties. Furthermore, the physical and chemical properties of AH Plus were negatively affected by the changes in temperature.     

Influence of Ultrasonic Activation of 4 Root Canal Sealers on the Filling Quality

Introduction

The purpose of this study was to evaluate the effects of ultrasonic activation on the filling quality (intratubular sealer penetration, interfacial adaptation, and presence of voids) of 4 epoxy resin–based sealers.

Methods

Eighty-four extracted human canines were divided into 4 groups (n = 20) according to the sealer used to obturate the root canals instrumented with F5 ProTaper instruments (50/05) (Dentsply Maillefer, Ballaigues, Switzerland). The canals were filled by the lateral compaction technique. Previously, the sealers were labeled with rhodamine B dye to allow analysis under a confocal microscope. At the time of obturation, the specimens were divided again into 2 groups (n = 10) according to the ultrasonic activation of the sealers: ultrasonically activated and nonultrasonically activated groups. All samples were sectioned at 2, 4, and 6 mm from the apex. The percentages of voids, gaps, and dentinal sealer penetration segments of the canal were analyzed.

Results

Regarding the sealer penetration segments, there was a significant increase for the AH Plus (Dentsply Maillefer), Acroseal (Specialités Septodont, Saint Maur-des-Fossés, France), and Sealer 26 (Dentsply Maillefer) at the 4-mm level and the AH Plus and Sealer 26 at the 6-mm level with ultrasonic activation (P < .05). Concerning the gaps, the ultrasonic activation promoted a smaller presence for all sealers at the 4- and 6-mm levels (P < .05). No statistical significant differences were found for the percentages of voids (P < .05).

Conclusions

The use of ultrasonic activation of an epoxy resin–based sealer promoted greater dentinal sealer penetration and less presence of gaps.     

In Vitro Cytotoxicity of GuttaFlow 2 on Human Gingival Fibroblasts

Introduction

The primary aim of this study was to evaluate the cytotoxic effects of GuttaFlow 2 (Coltène Whaledent, GmBH+Co KG, Langenau, Switzerland) on human gingival fibroblasts (HGFs).

Methods

Samples of the test materials GuttaFlow 2, mineral trioxide aggregate (MTA), AH Plus (Dentsply DeTrey, Konstanz, Germany), and RealSeal sealer (SybronEndo, Orange, CA) were fabricated in cylindrical nonreactive plastic tubes of 3-mm diameter and 2-mm height. Extracts of freshly mixed and set samples were prepared using the ratio of 0.5 cm²/mL, 1 cm²/mL, and 1.5 cm²/mL according to ISO 10993 series. The extracts were incubated with HGF cells for 24 and 72 hours. A cell counting kit-8 assay (Dojindo, Kumamoto, Japan) assay was used to examine cytotoxicity. The results were analyzed with the independent t test and 1-way analysis of variance test (P < .05).

Results

At all experimental conditions, the extracts of freshly mixed GuttaFlow 2 were nontoxic, whereas the extracts of freshly mixed and set AH Plus and RealSeal sealers were toxic to HGF cells (P < .05). The extracts of set GuttaFlow 2 were toxic at 72 hours (P < .05) and nontoxic at 24 hours. The extracts of freshly mixed MTA were nontoxic at both time points. For the extracts of set MTA, 1.5 cm²/mL was toxic at 72 hours and 1.5 cm²/mL and 1 cm²/mL were toxic at 24 hours (P < .05).

Conclusions

Both GuttaFlow 2 and MTA evoked a less toxic response to HGF cells than AH Plus and RealSeal sealer.     

Antibacterial and Anti-biofilm Activity of AH Plus with Chlorhexidine and Cetrimide

Introduction

The use of root canal filling materials with antibacterial activity can be considered beneficial to reduce the remaining microorganisms in the root canal system, where Enterococcus faecalis is often found, and prevent recurrent infection. The aim of this study was to evaluate the antimicrobial activity and capacity for inhibiting E. faecalis biofilm formation of AH Plus, alone and mixed with chlorhexidine (CHX), cetrimide (CTR), and combinations of the two.

Methods

AH Plus alone and mixed with 1% and 2% CHX, 0.1%–0.5% CTR, and combinations of both were tested to assess antimicrobial activity by a modified direct contact test and determine inhibition of E. faecalis biofilm formation at 24 hours. The results were expressed as log₁₀ viable counts. Eradication and inhibition of biofilm formation were understood as no bacterial growth or log₁₀ reduction = 5 with respect to the control (AH Plus alone).

Results

AH Plus + CHX showed a low antimicrobial activity with respect to the control (at 2%, log₁₀ reduction = 1.30). None of the tested concentrations achieved eradication or inhibition of biofilm. AH Plus + CTR showed a direct relationship of concentration-antimicrobial effect, reaching a log₁₀ reduction of 2.92 at 0.5% and inhibition of biofilm formation at 0.2%. With the combination CHX + CTR, lower concentrations were needed for the same effect, and eradication and inhibition of biofilm were achieved.

Conclusions

The addition of CHX, CTR, or some combination of both to AH Plus confers it with bactericidal and anti-biofilm activity against E. faecalis.     

Influence of Drying Protocol with Isopropyl Alcohol on the Bond Strength of Resin-based Sealers to the Root Dentin

Introduction

This study compared the bond strength, interfacial ultrastructure, and tag penetration of resin-based sealers applied to smear-free radicular dentin using 70% isopropyl alcohol as the active final rinse.

Methods

Eighty root canals were prepared and assigned to 2 groups (n = 40) according to the drying protocol: paper points or 70% isopropyl alcohol. Then, roots were divided into 4 subgroups (n = 10) with respect to the sealer and obturation material: AH Plus (Dentsply De Trey GmbH, Konstanz, Germany) and gutta-percha (AH/GP), Hybrid Root SEAL (Sun Medical, Tokyo, Japan) and gutta-percha (HR/GP), Epiphany SE (Pentron Clinical Technologies, Wallingford, CT) and gutta-percha (EP/GP), and Epiphany SE and Resilon (EP/RS). Roots were sectioned, and the push-out test was performed. Failure modes were examined under stereomicroscopy and sealer penetration into the dentinal tubules under scanning electron microscopy. Data were statistically analyzed by 2-way analysis of variance post hoc Tukey tests with a significant level of 5%.

Results

Overall, canals dried with isopropyl alcohol showed significantly higher bond strength values (2.11 ± 1.74 MPa) than with paper points (1.81 ± 1.73 MPa) (P < .05). The HR/GP group showed lower bond strength than the AH/GP group (P < .05) but higher than the EP/GP and EP/RS groups (P < .05). The most frequent type of failure was cohesive in the AH/GP and HR/GP groups and adhesive in the EP/GP and EP/RS groups. Scanning electron microscopic evaluation revealed better adaptation of the adhesive interface in the AH/GP and HR/GP groups in comparison with the EP/GP and EP/RS groups.

Conclusions

A final rinse with EDTA and 70% isopropyl alcohol improved the bond strength and penetration of the sealers into dentinal tubules of the root.     

In Vitro Fracture Resistance of Roots Obturated with Epoxy Resin–based,Mineral Trioxide Aggregate–based,and Bioceramic Root Canal Sealers

Introduction

The aim of this study was to evaluate the fracture resistance of teeth filled with 3 different endodontic sealers.

Methods

Seventy-five single-rooted extracted mandibular premolars were decoronated to a length of 13 mm. The teeth were randomly divided into 5 groups (n = 15 for each group). In group 1, the teeth were left unprepared and unfilled (negative control), and in group 2, the teeth were left unobturated (positive control). The rest of the roots were prepared by using the ProTaper System up to a master apical file size of F3: group 3, bioceramic sealer (Endosequence BC sealer) + gutta-percha; group 4, mineral trioxide aggregate–based sealer (Tech Biosealer Endo) + gutta-percha; and group 5, epoxy resin–based sealer (AH Plus Jet) + gutta-percha. All root specimens were stored for 2 weeks at 100% humidity to allow the complete setting of the sealers. Each specimen was then subjected to fracture testing by using a universal testing machine at a crosshead speed of 1.0 mm/min⁻¹ until the root fractured. The force required to fracture each specimen was recorded, and the data were analyzed statistically.

Results

The fracture values of groups 3 and 5 were significantly higher than those of group 4 (P < .05). There was no significant difference between groups 3 and 5 (P > .05).

Conclusions

In contrast to Tech Biosealer Endo, Endosequence BC and AH Plus Jet sealer increased the force to fracture in root-filled single-rooted premolar teeth.     

Push-out Bond Strength of RealSeal SE and AH Plus after Using Different Irrigation Solutions

Introduction

The aim of this investigation was to evaluate the influence of different endodontic irrigants (sodium hypochlorite [NaOCl], chlorhexidine [CHX], and EDTA) on the push-out bond strength of the obturation materials RealSeal SE (SybronEndo, Orange, CA) and AH Plus (Dentsply International Inc, York, PA).

Methods

Two hundred human root canals were prepared and divided into 2 groups according to the filling material (RealSeal SE vs AH Plus). Each group was subdivided into 5 groups according to the irrigation protocol (0.9% saline [control], 3% NaOCl, 3% NaOCl with saline, 17% EDTA, and 2% CHX). After obturation, roots were sliced into 1-mm discs for push-out assessment. Compressive loading was performed using an universal testing machine at a speed of 0.5 mm/min. Two-way analysis of variance and the Kruskal-Wallis test were performed for pair-wise comparisons to assess the differences between the experimental groups.

Results

AH Plus exhibited a significantly higher bond strength than RealSeal SE (mean = 2.53 and 1.53 MPa, respectively; P < .05), except with saline alone (P > .05). Within the AH Plus groups, no significant differences existed between the irrigants and saline alone (P > .05). The bond strength of RealSeal SE with saline alone or with NaOCl and saline did not differ from that of AH Plus with saline alone (P > .05). However, the push-out bond strength of RealSeal SE decreased by approximately half (P < .05 compared with RealSeal SE with saline alone) after rinsing with NaOCl alone, EDTA, or CHX.

Conclusions

The bond strength of RealSeal SE is highly influenced by the irrigant used.     

A Novel GuttaFlow Sealer Supports Cell Survival and Attachment

Introduction

The purpose of this in vitro study was to compare the biocompatibility of a novel formulation of a silicone-based endodontic sealer GuttaFlow 2 (GF2; Coltène/Whaledent, Langenau, Germany) with the original (GFO) and fast-set (GFF) formulations of GuttaFlow and with an epoxy resin sealer, AHPlus Jet (AH+J; Dentsply, York, PA).

Methods

Sealers were set into 3 × 5.5 mm discs. Cell culture media was used to extract leachable products at 24 hours and 1, 2, and 4 weeks. Primary human periodontal ligament fibroblasts were incubated with sealer elutes for 24 hours and evaluated using the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide assay and the calcein AM assay. Cell attachment was evaluated on set sealer that was either rinsed or unrinsed with cell media for 1 week. Statistical analysis was performed using the Student t test.

Results

Both calcein and 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide assays revealed that periodontal ligament cell viability was reduced on AH+J at 1, 2, and 4 weeks compared with all GuttaFlow sealers. There were no differences in cell viability between the GuttaFlow samples, and all displayed high rates of cell survival at all time periods. After 2 hours, cell attachment to the rinsed GFO and GFF samples exceeded the control, and at 24 hours cell attachment on all GuttaFlow samples exceeded the control. AH+J sealers supported significantly less cell attachment when compared with all GuttaFlow sealers. Cell attachment to set sealers showed better cell attachment when rinsed compared with unrinsed.

Conclusions

GuttaFlow sealers were more biocompatible than AHJ in vitro. The novel GF2 displayed comparable biocompatibility with GFF and GFO.     

Characterization of Leachates from 6 Root Canal Sealers

Introduction

The aim of this study was to evaluate 6 different endodontic sealers by characterizing their leachates and comparing their solubility in water over a 4-week period.

CYTOTOXICITY EVALUATION OF TWO ROOT CANAL SEALERS AND A COMMERCIAL CALCIUM HYDROXIDE PASTE ON THP1 CELL LINE BY TRYPAN BLUE ASSAY

Objective:

The aim of this investigation was to evaluate the cytotoxicity of two brands of root canal sealers, epoxy-resin based and zinc oxide-eugenol based, and one commercial calcium hydroxide paste on a monocyte cell line THP-1.

Material and methods:

Undiluted (crude extract) and diluted extracts to 10%, 1%, 0.1%, 0.01%, 0.001% and 0.0001% of the sealers were tested for cytotoxicity to THP-1 cells using the trypan blue assay. Extracts were obtained according to ISO standard. Data were analyzed statistically by the Kruskal-Wallis and Mann-Whitney tests at 5% significance level.

Results:

Crude extract of AH Plus and Fill Canal killed approximately 90% of THP-1 cells versus 36% of THP-1 cells killed by L&C crude extract (p<0.05). Ten-fold dilutions of L&C, Fill Canal and AH Plus killed 24, 35 and 61% of THP-1 cells (p<0.05), respectively. Dilutions lesser than 1% caused minimal cell death as compared to the control groups (p>0.05), except for L&C 1% extract.

Conclusions:

The results revealed that the L&C paste crude extract was less cytotoxic to THP-1 cells than AH Plus or Fill Canal crude extracts.