Search Results (33)

Background: Root canal sealers remain in long-term contact with dental tissues, raising concerns about their potential adverse effects. Methods: This study evaluates the physicochemical properties and ion-release profiles of three dental materials: zinc oxide/eugenol-based sealer, zinc phosphate cement (luting agent), and glass-ionomer cement (restorative material) under acidic (pH 4) and neutral (pH 7) conditions over 24 h and 30 days to determine their behavior and bioactivity in vitro. The materials were evaluated for their setting time, consistency, film thickness, solubility, and ion release using atomic emission spectrometry. The influence of pH and exposure time on ion release was analyzed using multiple regression analysis. Results: All tested materials met the ISO standards for their respective categories. The zinc oxide/eugenol and zinc phosphate cements released increased levels of zinc in acidic environments (pH 4), suggesting potential antimicrobial properties. The glass-ionomer cement exhibited higher silicon and strontium release under a neutral pH (pH 7), indicating potential remineralization effects. Silver from the zinc oxide/eugenol material was below the detection limit of the applied method, suggesting minimal ion release under the tested conditions. Maximum zinc release from root canal sealer occurred after 30 days at pH 4 (1.39 ± 0.26 mg), while the highest silicon release from glass-ionomer cement was observed at pH 7 after 30 days (1.03 ± 0.21 mg). Conclusions: Zinc oxide/eugenol materials exhibited increased zinc release under acidic conditions. In contrast, the restorative and luting materials demonstrated distinct ion-release patterns, aligning with their respective intended applications rather than endodontic purposes. Full article

(1) Background: Pulp canal obliteration (PCO) is a common condition characterized by an abnormal dentinal apposition within the canal wall, which often rises as a consequence of dental trauma. In recent years, “guided endodontics” has offered a reliable and safer procedure for endodontic access in case of PCO. The present case report aims to introduce a new endodontic guided system with a sleeveless, open-frame titanium guide designed to reduce costs compared to traditional templates. (2) Methods: The patient is a 19-year-old female who was referred to a private clinic to treat a calcified and symptomatic tooth (3.3) with apical periodontitis. Following the first unsuccessful treatment attempt using the operating microscope, a three-dimensional cone beam computed tomography (CBCT) examination and an optical impression were performed in agreement with the patient. The Digital Imaging and Communications in Medicine (DICOM) and Standard Tessellation Language (STL) files were sent to the lab for the template packaging, and the patient was scheduled for a second appointment. The endodontic guide was accurately positioned, and shaping and filling were concluded with success. The canal was sealed with the single-cone technique and bioceramic sealer. (3) Results: The patient reported no significant post-operative symptoms. Notably, the treatment achieved total symptom resolution, as evidenced by radiographic assessments conducted 3 and 24 months post-treatment, confirming the procedure’s success. (4) Conclusions: This innovative sleeveless, open-frame static titanium guide presents a promising advancement in guided endodontics for PCO treatment. The advantages include preserving healthy dental tissue, reduced chairside operating time, and cost savings compared to conventional templates. This approach holds promise for enhancing the quality and efficiency of endodontic procedures in cases of PCO. While the static guide holds promise, larger prospective studies are necessary to validate its efficacy, safety, and broader applicability in routine endodontic procedures. Full article

The present in vitro study focuses on the filling ability of three different bioceramic cements with or without the addition of a bioceramic sealer in an open apex model on the marginal apical adaptation, tubule infiltrations, and void distributions as well as the interface between the cement and the sealer materials. To this end, sixty mandibular premolars were used. MTA-Biorep (BR), Biodentine (BD), and Well-Root Putty (WR) were used to obturate the open apex model with or without the addition of a bioceramic sealer, namely TotalFill^® BC sealer™ (TF). A digital optical microscope and scanning electron microscope (SEM) were used to investigate the cement–dentin interface, marginal apical adaptation, and the material infiltration into the dentinal tubules. Micro-computed X-ray tomography and digital optical microscopy were used to investigate the cement–sealer interface. The results were analyzed by using the Kruskal–Wallis test. No significant difference was found between the groups for the marginal apical adaptation quality (p > 0.05). Good adaptation of the dentin–cement interface was found for all tested groups and the sealer was placed between the cement material and dentinal walls. All the groups demonstrated some infiltrations into the dentinal tubules at the coronal part except for the BR group. A good internal interface was found between the cement and the sealer with the presence of voids at the external interface. A larger number of voids were found in the case of the BD-TF group compared to each of the other two groups (p < 0.05). Within the limitations of the present in vitro study, all the groups demonstrated good marginal apical adaptation. The use of a sealer in an open apex does not guarantee good filling and, in addition, creates voids at the external interfaces with the dental walls when the premixed sealer is used with powder–liquid cement systems. The use of a premixed bioceramic cement could offer fewer complications than when a powder–liquid cement system is used. Full article

Zeolites and zeolitic imidazolate frameworks (ZIFs) are crystalline aluminosilicates with porous structure, which are closely linked with nanomaterials. They are characterized by enhanced ion exchange capacity, physical–chemical stability, thermal stability and biocompatibility, making them a promising material for dental applications. This review aimed to provide an overview of the application of zeolites and ZIFs in dentistry. The common zeolite compounds for dental application include silver zeolite, zinc zeolite, calcium zeolite and strontium zeolite. The common ZIFs for dental application include ZIF-8 and ZIF-67. Zeolites and ZIFs have been employed in various areas of dentistry, such as restorative dentistry, endodontics, prosthodontics, implantology, periodontics, orthodontics and oral surgery. In restorative dentistry, zeolites and ZIFs are used as antimicrobial additives in dental adhesives and restorative materials. In endodontics, zeolites are used in root-end fillings, root canal irritants, root canal sealers and bone matrix scaffolds for peri-apical diseases. In prosthodontics, zeolites can be incorporated into denture bases, tissue conditioners, soft denture liners and dental prostheses. In implantology, zeolites and ZIFs are applied in dental implants, bone graft materials, bone adhesive hydrogels, drug delivery systems and electrospinning. In periodontics, zeolites can be applied as antibacterial agents for deep periodontal pockets, while ZIFs can be embedded in guided tissue regeneration membranes and guided bone regeneration membranes. In orthodontics, zeolites can be applied in orthodontic appliances. Additionally, for oral surgery, zeolites can be used in oral cancer diagnostic marker membranes, maxillofacial prosthesis silicone elastomer and tooth extraction medicines, while ZIFs can be incorporated to osteogenic glue or used as a carrier for antitumour drugs. In summary, zeolites have a broad application in dentistry and are receiving more attention from clinicians and researchers. Full article

Endodontic treatment aims to eliminate infection of the root canals and fill the dental pulp space. The biocompatibility studies of the sealers used in root canals obturation are crucial since they are applied in direct contact with periradicular tissues. Objective: The aim of this study was to evaluate the cytotoxicity of three root canal sealers—AH Plus, Bio MTA+, and Bio C sealer—on immortalized human gingival fibroblasts. Methods: AH Plus, Bio MTA+, and Bio C sealers were evaluated through incubation in real-time and material-conditioned media. Cells were incubated for 24 h and 72 h, at three different concentrations (1, 10, and 100 mg/mL) of each sealer. The cytotoxic activity of the sealers was assessed by Methyl tetrazolium (MTT) and Sulforhodamine B (SRB) assays. Cell morphology and cytogenetic alterations were studied microscopically. Results: MTT and SRB assays revealed similar results within both approaches. Cell culture exposed to sealers through incubation in real-time revealed a cytotoxic effect of AH Plus at 100 mg/mL. Material-conditioned media study revealed a cytotoxic effect of Bio MTA+ and Bio C, increasing with higher compound concentration and reaching 50% with 100 mg/mL. Regarding the cell’s morphology, Bio C sealer revealed a decrease in cell confluence and several morphological changes. AH Plus and Bio MTA+ did not seem to affect the cell confluence however morphology alterations were observed. In the cytogenetic study, a severe decrease of the mitotic index and a large number of chromosomal aberrations were observed. The present study represents an advance in the understanding of the biocompatibility of AH Plus, Bio MTA+, and Bio C sealers. These sealers demonstrated some cytotoxicity, depending on the concentration used. Although more validation studies are still needed, this study brings very relevant results in terms of cytotoxicity, cell morphology, and cytogenetic alterations. Conclusions: These results could help in the selection of the most appropriate compounds to be used in clinical practice as well as to determine the maximum recommended amounts of each sealer. Clinical Relevance: This study highlights the potential cytotoxic effects of three commonly used root canal sealers on human gingival fibroblasts, with varying degrees of impact depending on the concentration used. The results emphasize the importance of careful consideration when selecting and applying these materials in clinical practice. Full article

Knowledge of dental anatomy and the three-dimensional principles of debridement, sterilization and obturation is necessary for effective root canal treatment. The chemo–mechanical preparation of the root canal biomechanically significantly reduces the number of microorganisms present. However, research has demonstrated that microorganisms frequently persist. The antimicrobial effect of the irrigants is essential to their biological function. Several obturation techniques are currently available, the selection of which depends on the canal’s morphology and the individual therapeutic goals of each instance. New sealing materials and methods for regenerative root canal obturation are enhancing and improving the predictability of three-dimensional (3D) sealing procedures. Epoxy sealers and gutta-percha are currently employed by clinicians as the gold standard in obturation procedures. The most recent developments in endodontic sealing materials are related to bioceramic sealers. Reports indicate that bioceramic sealers are biocompatible, harmless, hydrophilic, expandable and antibacterial. In the therapy of teeth with periapical lesions, not only the effective treatment of the root canal system but also the quality of the used sealer are of particular importance. Regenerative processes in the bone lesion are potentiated by the action of the sealer due to its highly biocompatible, non-toxic, aluminum-free and antibacterial capabilities. This paper discusses sophisticated root canal sealing materials and contemporary filling techniques in the regenerative therapy protocol for teeth with periapical bone lesions. Full article

Rotary instrumentation has been proposed in undergraduate teaching. The aim of this study was to evaluate student’s performance, through the obturation quality and treatment time, in a sequential range of L-simulated root canals. A senior undergraduate dental student sequentially prepared randomly numbered canals from 1 to 40, with the WaveOne Gold glider and primary file, according to the manufacturer instructions. A gutta-percha cone matched with the finishing instrument and epoxy resin-based sealer (AH Plus) was selected for the obturation. Three independent observers evaluated the obturation quality according to both density and length. Active, total instrumentation and obturation times were also measured. Statistical analysis was obtained by Mann–Whitney and Kruskal–Wallis tests with a significance level of p < 0.05. The quality of the obturation was independent of the number of prepared canals with adequate length and density in 87.5% of the prepared canals. Both active and total instrumentation, as well as obturation times, reduced significantly as the number of the prepared canals by the student increased (p ˂ 0.05). The use of WaveOne Gold instrumentation and matched cone obturation by an inexperienced operator provided an adequate obturation quality in most of the curved simulated canals. The working time was significantly reduced through a short learning curve. Full article

Background: Root canal sealers and repair materials should have the desirable physical, chemical, and biological characteristics, and an antibacterial effect if possible. There is little information available on the biocompatibility of new sealers on the market. Fourier transform infrared spectroscopy (FTIR) can offer trustworthy data to examine chemical structures; another technique for revealing the elements in the constituents that may contribute to the cytotoxicity of these sealers is scanning electron microscopy (SEM), with the goal of elemental mapping utilizing energy-dispersive X-ray spectroscopy (EDX). Methodology: All the root canal sealers were mixed as per the manufacturers’ instructions and allowed to set in molds for 24 h. Then, the samples were placed into an incubator (Memmert GmbH + Co. KG, Schwabach, Germany for 72 h, in a moist environment to allow complete chemical setting of the sealers. The organic and inorganic components of the sample were identified using FTIR with the wavelength length in the infra-red region measuring 400–450 nm. The finely crushed samples were coated with gold metal; following that, the sealer samples were examined under a scanning electron microscope (SEM) at 5000×, 10,000×, and 20,000× magnification, followed by energy-dispersive X-ray spectroscopy. Results: The surfaces of BioRoot and DiaRoot sealers revealed a relatively uniform distribution of irregular micro-sized particles aggregated in clusters, with the particle size ranging from 1 to 65 µm and 0.4 to 55 µm, respectively. OneFill, iRoot, and CeraSeal demonstrated irregularly shaped particles with particle sizes of 0.5 to 105 µm, 0.5 to 195 µm, and 0.3 to 68 µm, respectively. The EDX microanalysis revealed that oxygen, calcium, and carbon were found in all the tested sealer materials. Silicone and zirconium were absent in DiaRoot, but DiaRoot contained fluoride and ytterbium. Moreover, aluminum was noted in DiaRoot, One Fill, and CeraSeal, and chloride was only observed in BioRoot. FTIR analysis revealed strong absorption bands at 666 cm⁻¹ and 709 cm⁻¹ in BioRoot. Bands at 739 cm⁻¹, 804 cm⁻¹, 863 cm⁻¹, 898 cm⁻¹, and 1455 cm⁻¹ were observed in DiaRoot. Bands at 736 cm⁻¹ and 873 cm⁻¹ in OneFill suggested the presence of C-H bending. Similarly, bands were observed at 937 cm⁻¹, 885 cm⁻¹, 743 cm⁻¹, and 1455 cm⁻¹ in iRoot, representing C-H stretching. Conclusions: All root canal sealers had diverse surface morphologies that contained irregular, micro-sized particles that were uniformly distributed, and they lacked heavy metals. All the experimental sealers comprised mainly calcium, oxygen, and carbon. Full article

Optimizing the interface between biomaterials and dental hard tissues can prevent leakage of bacteria or inflammatory mediators into periapical tissues and thus avoid alveolar bone inflammation. In this study, an analysis system for testing the periodontal–endodontic interface using gas leakage and subsequent mass spectrometry was developed and validated using the roots of 15 single-rooted teeth in four groups: (I) roots without root canal filling, (II) roots with an inserted gutta-percha post without sealer, (III) roots with gutta-percha post and sealer, (IV) roots filled with sealer only, and (V) adhesively covered roots. Helium was used as the test gas, and its leakage rate was found by measuring the rising ion current using mass spectrometry. This system made it possible to differentiate between the leakage rates of tooth specimens with different fillings. Roots without filling showed the highest leakage values (p < 0.05). Specimens with a gutta-percha post without sealer showed statistically significantly higher leakage values than groups with a filling of gutta-percha and sealer or sealer alone (p < 0.05). This study shows that a standardized analysis system can be developed for periodontal–endodontic interfaces to prevent biomaterials and tissue degradation products from affecting the surrounding alveolar bone tissue. Full article

The pushout bond strength of root fillings at radicular dentin was investigated employing NaOCl, CHX, and homoeopathic mother tincture (Arnica montana) as an irrigant. Sixty human permanent single-rooted extracted teeth were decoronated. The root canals were instrumented using Pro taper universal rotary system (Dentsply Tulsa Dental; Tulsa, Oklahoma) and were prepared up to F3 apical size. The roots were then randomly divided into three groups according to irrigation solution (n = 20) according to the final irrigation regimen: Group I: 3 mL 5.25% NaOCl followed by 3 mL Saline (control); Group II: 3 mL Arnica montana (10%, w/v) followed by 3 mL Saline; Group III: 3 mL CHX followed by 3 mL Saline. The canals were dried using paper points. The canals were coated with AH Plus sealer (Dentsply DeTey, Konstaz, Germany) with the aid of a Lentulo spiral (Dentsply DeTey, Konstaz, Germany) and obturated with #F3 gutta-percha. Each root was then horizontally sliced into three slices, labelled coronal, middle, and apical, each measuring 2 mm thick. Furthermore, at a crosshead speed of 2 mm/min, the test was carried out using the universal testing apparatus. The 5.25% NaOCl significantly decreased the bond strength of AH Plus to dentin. Both CHX and Arnica montana were capable of reversing the compromised pushout of AH Plus to NaOCl-treated dentin. After using NaOCl as an irrigant, the danger of diminished binding capacity of AH Plus to root canal walls arises. Final irrigation with Arnica montana and CHX reduces this risk. Full article

Bioceramic root canal sealers have been introduced in clinical dental use, but less is known about the antibacterial activity against Streptococcus mutans, Streptococcus salivarius, and Streptococcus sanguis. The purpose of the study is to compare new bioceramic sealers with a traditional zinc-oxide eugenol material considered as a control. The different bioceramic root canal sealants tested were FillRoot ST, BioRoot™RCS, Well-Root™ PT, and CeraSeal. In vitro antibacterial activity against Streptococci was assessed using the agar disc diffusion test at two different intervals, 24 h and 48 h. A non-parametric statistical analysis was performed to compare the inhibition zones for each of the different materials. Bioceramic root canal sealers showed mild antibacterial activity, while zinc-oxide eugenol-based material showed a stronger inhibition of Streptococci diffusion. No differences were detected for the measurements of inhibition zones between 24 h and 48 h except for FillRoot ST and BioRoot™RCS. Full article

Currently, titanium oxide (TiO₂) nanoparticles are successfully employed in human food, drugs, cosmetics, advanced medicine, and dentistry because of their non-cytotoxic, non-allergic, and bio-compatible nature when used in direct close contact with the human body. These NPs are the most versatile oxides as a result of their acceptable chemical stability, lower cost, strong oxidation properties, high refractive index, and enhanced aesthetics. These NPs are fabricated by conventional (physical and chemical) methods and the latest biological methods (biological, green, and biological derivatives), with their advantages and disadvantages in this epoch. The significance of TiO₂ NPs as a medical material includes drug delivery release, cancer therapy, orthopedic implants, biosensors, instruments, and devices, whereas their significance as a dental biomaterial involves dentifrices, oral antibacterial disinfectants, whitening agents, and adhesives. In addition, TiO₂ NPs play an important role in orthodontics (wires and brackets), endodontics (sealers and obturating materials), maxillofacial surgeries (implants and bone plates), prosthodontics (veneers, crowns, bridges, and acrylic resin dentures), and restorative dentistry (GIC and composites). Full article

Recently, bioactive glass nanoparticles (BGns) have been acknowledged for their ability to promote interactions with the periapical tissue and enhance tissue regeneration by releasing therapeutic ions. However, there have been no studies on calcium silicate sealers with bioactive glass nanoparticle (BGn) additives. In the present study, a premixed calcium silicate root canal sealer reinforced with BGn (pre-mixed-RCS@BGn) was developed and its physicochemical features and biological effects were analyzed. Three specimens were in the trial: 0%, 0.5%, and 1% bioactive glass nanoparticles (BGns) were gradually added to the premixed type of calcium silicate-based sealer (pre-mixed-RCS). To elucidate the surface properties, scanning electron microscopy, X-ray diffraction, and energy-dispersive spectroscopy were used and flowability, setting time, solubility, and radiopacity were analyzed to evaluate the physical properties. Chemical properties were investigated by water contact angle, pH change, and ion release measurements. The antibacterial effects of the bioactive set sealers were tested with Enterococcus faecalis and the viability of human bone marrow-derived mesenchymal stem cells (hMSCs) with this biomaterial was examined. In addition, osteogenic differentiation was highly stimulated, which was confirmed by ALP (Alkaline phosphatase) activity and the ARS (Alizarin red S) staining of hMSCs. The pre-mixed-RCS@BGn satisfied the ISO standards for root canal sealers and maintained antimicrobial activity. Moreover, pre-mixed-RCS@BGn with more BGns turned out to have less cytotoxicity than pre-mixed-RCS without BGns while promoting osteogenic differentiation, mainly due to calcium and silicon ion release. Our results suggest that BGns enhance the biological properties of this calcium silicate-based sealer and that the newly introduced pre-mixed-RCS@BGn has the capability to be applied in dental procedures as a root canal sealer. Further studies focusing more on the biocompatibility of pre-mixed-RCS@BGn should be performed to investigate in vivo systems, including pulp tissue. Full article

(1) Background: In endodontics, anatomical complexities and irregularities in the root canal system may interfere with sealer penetration, increasing the risk of treatment failure. This work aimed to investigate the effects of sonicated Thermafil (Dentsply, Tulsa Dental Specialties, Johnson City, TN, USA) on sealer penetration into the dentinal tubules. (2) Methods: Thirty teeth with single round-shaped root canals were used to compare Sonicated Thermafil with sonication (ST—10 teeth), System B (EIE Analytical Technology, Orange, CE, USA) (SB—10 teeth), and Thermafil without sonication (T—10 teeth). A confocal laser scanning microscope (CLSM) was used to determine the depth, area, and percentage of sealer penetration into the dentinal tubules. (3) Results: ST showed the deepest average penetration at 6 mm from the apex compared to SB (p < 0.01) and T (p < 0.01) and at 3 mm compared to SB (p < 0.01). In addition, it had the highest penetration values at both levels compared to SB (p < 0.01) and T (p < 0.05) and a higher penetration area at 6 mm compared to T (p < 0.05) and SB (p < 0.05). (4) Conclusion: Sonic activation can improve the carrier-based obturation technique thanks to deeper sealer penetration and thus better retention of materials. Full article

This study aimed to evaluate the effectiveness of the Endostar REvision system (Poldent, Warsaw, Poland) in the removal of filling materials from oval root canals using sonic irrigation as an additional cleaning method. Thirty human-extracted mandibular premolars with oval canals were prepared using the ProTaper Universal system (Dentsply Maillefer, Ballaigues, Switzerland) up to instrument F1 (20/.07), and then filled by the continuous wave vertical compaction technique using pulp canal sealer EWT (Sybron Dental Specialties, Orange, CA, USA). The teeth were randomly divided into two groups (n = 15) according to the instrumentation system and the additional cleaning method, as follows: REvision (30/.08, 25/.06) with EQ-S sonic activation (Meta Biomed, Chungcheongbuk-do, Korea), REvision (30/.08, 25/.06) without additional activation. All specimens were sectioned longitudinally at 3 and 7 mm from the apex, and analyzed using digital microscopy (KEYENCE, Osaka, Japan) to measure the total area of the residual obturation materials, followed by SEM analysis. The data on the percentage of remaining filling material were analyzed by Kruskal–Wallis one-way Analysis of Variance on ranks. None of the retreatment protocols completely removed the filling material from the root canals (p > 0.05); the retreatment technique using sonic activation showed statistically less residual filling materials than the retreatment technique using irrigants without activation at the coronal third (p < 0.05), whilst no significant difference was found between both tested groups at the apical and middle thirds (p > 0.05). The REvision system showed promising results in the removal of filling materials from oval canals. Full article