Push-out bond strength of different root canal obturation systems to root canal dentin

Comparative analysis of an epoxy resin-based and a premixed calcium silicate-based sealer's push-out bond strength with and without incorporation of chitosan nanoparticles: An in vitro investigation

Aim and Objectives

The aim of the study was to compare and evaluate the push-out bond strength (POBS) of epoxy resin-based and calcium silicate-based sealers with and without incorporating chitosan nanoparticles (CSNPs).

Methodology

Eighty human mandibular premolars with a single canal were taken. A standard root length of 15 mm was established. Canals were instrumented with Neoendo files up to size 30, 4% and were irrigated with 5 ml of 2.5% NaOCl, and 5 ml of ethylenediaminetetraacetic acid 17%. Then, samples were obturated using the size 30, 4% gutta-percha, single-cone technique using respective sealers. For POBS, it was grouped as Group 1 Adseal, Group 2 CeraSeal, Group 3 Adseal + 2% wt/vol CSNP, and Group 4 CeraSeal + 2% wt/vol CSNP. Samples embedded in acrylic resin were sectioned transversely at 11 and 7 mm from the apex. Dislodgment resistance was calculated using a universal testing machine. The data were analyzed using a one-way ANOVA test, followed by Tukey's post hoc analysis. The level of significance (P value) was set at P < 0.05.

Results

At 7 mm from the apex, Group 4 (CeraSeal + 2% wt/vol CSNP) demonstrated significantly higher mean POBS. However, no significant difference was observed between Groups 1 (Adseal), Group 2 (CeraSeal), and Group 3 (Adseal + 2% wt/vol CSNP). At 11 mm from the apex, Group 2 (CeraSeal) and Group 4 (CeraSeal + 2% wt/vol CSNP) demonstrated significantly higher mean POBS. On comparison between POBS at 7 mm and 11 mm from the apex, the mean POBS at the 11 mm region from the apex was significantly higher in all study groups, which was statistically significant.

Conclusion

Within the limitations of the study, it has been concluded that Group 4 (CeraSeal + 2% wt/vol CSNP) has better bond strength compared to the other groups.

PEEK and glass fiber post pushout bond strength and vickers hardness of canal disinfected with curcumin photosensitizer activated by microbubble emulsion and sodium-hypochlorite with EDTA

AIMS

Impact of different post-space disinfectants (Saline, Sodium hypochlorite (NaOCl) followed by ethylene-diamine-tetra-acetic acid (EDTA) and curcumin activated by microbubble emulsion (MBE) on the Vickers hardness (VH) of root canal dentin and extrusion bond strength (EBS) of Glass fiber post (GFP) and PEEK post.

METHODS

Ninety maxillary central incisors having fully formed roots were included. After the specimen's disinfection, root canal treatment was completed. Post space was prepared by removing gutta-percha using gates glidden drills. Teeth were then arbitrarily allocated into three groups based on the methods of disinfection regime used. Group 1: Saline, Group 2: NaOCl+ EDTA and Group 3: Curcumin activated by MBE (n = 30). Analysis of VH of radicular dentin was performed using a micro-Vickers tester on ten samples from each group. After post-space disinfection, twenty specimens from each group were further divided into two subgroups (n = 10) In group-1A 2A, and 3A, GFP was used. Whereas, prefabricated PEEK posts were used in 1B, 2B, and 3B subgroups. The PBS and failure modes were performed using a universal testing machine and stereomicroscope respectively. Data was analyzed using ANOVA and Tukey post hoc test to identify significant variations among groups concerning the MH and EBS of the different posts used (p = 0.05).

RESULTS

Group 2 (5.25 % NaOCl + 17 % EDTA) (0.15 ± 0.02 GPa) treated specimens presented lowest scores of VH. However, Group 1 (Saline) irrigated canals displayed the highest scores of surface hardness (0.25 ± 0.07 GPa). Additionally, a cervical third of 3A (CP activated by MBE + GFP) (11.22 ± 0.79 MPa) presented the highest scores of bond integrity. Whereas Group 1B (Saline + PEEK post) treated specimens presented the lowest scores of PBS (4.15 ± 0.15 MPa).

CONCLUSION

Curcumin activated by microbubble emulsion for disinfection of canal dentin demonstrated favorable VH. Similarly, glass fiber post-cemented in radicular walls disinfected with curcumin activated with MBE showed promising post-bond integrity to the canal dentin.

A Comparative Evaluation of Push-Out Bond Strength of Six Different Root Canal Sealers: An In-Vitro Study

BACKGROUND

Adhesiveness with radicular dentin is absent with gutta-percha, leading to microleakage and hence re-infection. Root canal sealer helps to achieve an adhesive interface between gutta-percha and root dentin thereby resisting the displacement forces during the functioning of teeth which is evaluated by the push-out test. The aim of this study is to compare the push-out bond strength and to assess the relative bond failure between dentin-sealer, sealer-main cone of (1) epoxy resin, (2) silicon, (3) mineral trioxide aggregate (MTA), (4) calcium hydroxide, (5) bioceramic, (6) zinc oxide eugenol containing root canal sealers.

METHODOLOGY

Sixty human permanent lower premolars with one root were collected, disinfected, and decoronated at cemento-enamel junction. Instrumentation was done with a K3 40,0.06 Ni-Ti rotary file and obturated using the main cone and sealer. Based on the sealer utilized, six groups were created: Group 1: AH-Plus, Group 2: RoekoSeal, Group 3: MTA Fillapex, Group 4: Apexit, Group 5: Smart Paste Bio, and Group 6: Procosol. One slice each was obtained from the coronal, middle, and apicalsections of all the obturated canals. Push-out bond strength and failure modes were studied. Statistics involved analysis of variance (ANOVA) followed by the post hoc Tukey test.

RESULTS

All three sections exhibited the highest strength for Smart Paste Bio sealer and the least was for RoekoSeal. With all the sealers, the apical section had the highest strength followed by the middle and coronal.

CONCLUSION

The smart seal system was superior to all other sealers and displayed a good bond to dentin.

Comparative Evaluation of Push-Out Bond Strength of Conventional Mineral Trioxide Aggregate, Biodentine, a Modified Mineral Trioxide Aggregate, and Two Novel Antibacterial-Enhanced Mineral Trioxide Aggregates

Background The challenges associated with incorporating antimicrobial agents, such as the potential diminishment of the cement's physical properties, highlight the need for comprehensive evaluations. Balancing antimicrobial efficacy with the maintenance of structural integrity is a crucial aspect of material development. The acknowledgment of cytotoxic properties associated with tricalcium aluminate, a major constituent in conventional mineral trioxide aggregate (MTA), is critical in terms of long-term evaluation of treatment procedures. The primary focus of the push-out test is to evaluate the resistance of the tested material to dislodgement. Greater push-out strength implies stronger adhesion between the tested material and the tooth surface. Aim This study aims to evaluate the push-out bond strength of two antibacterial-enhanced MTAs with conventional MTA and Biodentine. Material and methods A total of five materials were tested: a) modified MTA, b) doxycycline-enhanced MTA, c) metronidazole-enhanced MTA, d) conventional MTA, and e) Biodentine. All the materials were mixed based on a predetermined powder:liquid ratio and then carried using a plastic instrument to the desired experimental design. Single-rooted permanent teeth, preferably incisors, were used in the present study. Teeth were embedded vertically in a rubber mold, and sectioning of the tooth was performed. A single operator instrumented the canal space in each slice using Gates-Glidden burs, and the mixed cements were placed in the respective groups and stored for 72 hours. A push-out test was carried out using a universal testing machine. Following the bond failure, the slices were examined under a stereomicroscope to determine the nature of the bond failure. The collected data was subjected to a one-way analysis of variance test, post hoc test, and chi-square test for statistical analysis. Results The mean push-out bond strength was found to be the highest for Biodentine (43.25 ± 0.62 megapascals (MPa)), followed by doxycycline- and metronidazole-enhanced MTAs (39.54 ± 0.65 MPa and 39.29 ± 0.16 MPa, respectively), modified MTA formulation (37.75 ± 0.73 MPa), and the lowest for conventional MTA (25.93 ± 0.7 MPa). Conventional MTA samples had an adhesive failure (89.4%), while Biodentine samples had a cohesive failure (80.3%). Mixed failures were noticed with the samples containing modified MTA formulation (71.3%), doxycycline-enhanced MTA (76.6%), and metronidazole-enhanced MTA (78.0%). Conclusion Despite not surpassing Biodentine in bond strength, antibacterial-enhanced MTAs are considered potential alternatives to conventional MTA in day-to-day clinical practice.

Assessment of the impact of XP-Endo Finisher file on push-out bond strength of various endodontic sealers

Background

An endodontic treatment is considered a success after thorough chemomechanical debridement coupled with obturating root canals in a concrete way thereby providing hermetic seal. Gutta-percha being nonadherent necessitates use of a sealer to achieve hermetic seal. Adequate adhesion of root canal sealer with gutta-percha core and radicular dentin ensures lack of apical leakage.

Materials and Methods

Sixty extracted mandibular premolars with single root canal decoronated at cementoenamel junction were selected and randomly allocated to two groups (n = 30). Samples in Group 1 were prepared with BT Race file, while Group 2 samples were prepared with BT Race alongwith XP Endo file. Absorbent paper points were used for canal drying and samples were randomly divided into six subgroups. In Subgroup I, obturation was done with bio-ceramic (BC) sealer (Endosequence BC) and BC gutta-percha. In Subgroup II, resin-based (AH plus) sealer and gutta-percha were used. In Subgroup III, calcium hydroxide-based (Sealapex) sealer and gutta-percha were used. Sectioning of root samples was done perpendicularly into coronal, middle, and apical segments of 3 mm each. A universal testing machine was used for sample testing, in which push-out bond strength corresponded to the highest value obtained. Stereomicroscopic (×20) study of the samples determined the failure mode at dentin/sealer/main cone interface.

Statistical Analysis

Analysis of variance and post hoc Tukey's tests were used for data analysis.

Results

Endosequence BC with XP-Endo files showed the highest mean push-out bond strength (16.31 MPa), whereas Sealapex without XP-Endo file had the lowest values (12.76 MPa). Mixed failure of adhesive and cohesive mode was observed for most samples.

Conclusion

Adjunctive irrigation agitation technique utilizing XP-Endo Finisher facilitates biofilm eradication from difficult niches in root canals, thereby improving adhesion of sealer and subsequently the sealer bond strength.

An In Vitro Comparative Study of the Push-out Bond Strengths of Various Endodontic Sealers to Radicular Dentin

BACKGROUND

The bond strength of an endodontic sealer to the root dentin is an important factor in maintaining the integrity of the root canal seal. The present study aimed to assess the push-out bond strength of three endodontic sealers used with the single-cone obturation technique.

MATERIALS AND METHODS

The root canals of 40 central maxillary incisors were instrumented using ProTaper Universal NiTi rotary files. The roots were divided into 4 groups (N = 10) according to the type of root canal sealers: Group 1 (control group): AH Plus/Gutta-percha lateral condensation technique (LC); Group 2: AH Plus/Gutta-percha single-cone technique (SC); Group 3: GuttaFlow 2/SC; Group 4: Realseal SE/SC. After obturation, each tooth was prepared for push-out assessment. The total and sectional push-out bond strengths were measured and statistically analysed. Furthermore, failure modes were identified microscopically.

RESULTS

The results indicated that samples in the first group showed the highest total and sectional bond strengths. Samples from other groups showed statistically similar total bond strengths. The highest sectional bond strength was found mainly in the apical root sections. Cohesive failure was predominant for the first group, whereas adhesive failure was predominant in the other groups.

CONCLUSIONS

It could be concluded that the dentin bond strengths of the tested sealers used with the single-cone technique were nearly similar but lower than those of AH Plus/LC. The highest sectional bond strength was observed in the apical thirds. The failure mode was mostly cohesive for AH Plus/LC and adhesive for sealers used with the single-cone obturation technique.

Calcium Silicate-Based Sealer Dentinal Tubule Penetration-A Systematic Review of In Vitro Studies

The aim of this systematic review was to perform a qualitative synthesis of in vitro studies which evaluate and compare the penetration of calcium silicate-based sealers into dentinal tubules. A systematic advanced search was performed in Scopus, Embase, Medline (via PubMed), Web of Science, and Cochrane databases on the 1 December 2022. In vitro studies that compared the tubular penetration of at least two calcium silicate-based sealers in extracted human teeth were eligible. PRILE 2021 guidelines were used for the assessment of the risk of bias included studies. The search identified a total of 680 preliminary records, among which 12 studies were eligible for review. The most used methodology to evaluate sealer penetration was the use of a fluorochrome together with the tested sealers and the analysis of their penetration under confocal laser microscopy. Regarding the results of the included studies, calcium silicate-based sealers exhibit a favorable dentinal tubule penetration. Tubular penetration, however, can be affected by factors such as the irrigation protocol, sealer activation, the filling method used, and root canal morphology. EndoSequence BC Sealer showed the highest sealer penetration among the tested sealers. The influence of different fluorochromes on the results of dentinal tubule penetration studies should also be further explored. The in vitro nature of the included studies limits the applicability of the results into the clinical setting. Prospero registration: CRD42022383896.

The effect of 400 nm femtosecond laser and Zn(II)chlorin e6 methyl ester (Zn(II)e6Me) photosensitizer on disinfection of radicular dentin bonded to glass fiber post

AIM

To assess and compare push-out bond strength (PBS) when canal disinfected with 5.25% NaOCl, 400 nm femtosecond laser, and natural PS activated by PDT (CP and Zn (II) Ce6 methyl ester) on bond efficacy of radicular dentin bonded to glass fiber post.

MATERIAL AND METHODS

A sum of 40 non-traumatic, cautiously extracted with closed apex human mandibular premolars were collected and decoronated up to the cement-o-enamel junction. Canals of all specimens were cleaned and shaped using a Protaper universal NiTi system via a crown-down approach, then finally dried out and obturated with gutta-percha. Post alignment space was formed with peso reamers and sanitized. Then samples were randomly allocated into four groups as per the radicular dentin designated disinfection protocols. Group 1 disinfected with curcumin photosensitizer + EDTA, group 2: 5.25% NaOCl and EDTA, group 3: Zn (II) Ce6 methyl ester and EDTA and group 4 sanitized with 400 nm fs-laser + EDTA. GFP was cemented into the radicular canal space and specimens were placed in a thermocycler. Segmentation of the root was done at three levels (coronal, middle, and apical) and positioned in a universal testing machine for PBS analysis. Failure mode analysis was performed using a stereomicroscope and statistical analysis was executed by one-way ANOVA and Tukey multiple comparison tests at a statistically significant level of p < 0.05.

RESULTS

The highest PBS was revealed by group 2 canal disinfected with 5.25% NaOCl +17% EDTA (control) at coronal (9.49 ± 1.42 MPa) and middle (7.545 ± 0.15 MPa) root levels. Whereas, the lowest PBS was displayed by group 3: Zn (II) Ce6 methyl ester +17% EDTA at coronal (6.31 ± 0.54 MPa) middle (4.85 ± 0.11 MPa) root levels respectively. Intergroup comparison presented that radicular dentin disinfected with 400 nm femtosecond laser + 17% EDTA substantiated comparable PBS result to group 2 (control) at all three root levels (p > 0.05). Likewise, root surface disinfection with Curcumin activated by PDT+17% EDTA unveiled no statistically significant result for specimens disinfected with Zn(II) Ce6 methyl ester +17% EDTA(p > 0.05). Furthermore, apical root segments in all groups showed a substantial decrease in PBS value and were comparable (p > 0.05).

CONCLUSION

The bond efficacy of glass fiber post to radicular dentin disinfected with 400 nm femtosecond laser has the potential to be used as an alternative to conventional sodium hypochlorite.

Role of Riboflavin; Curcumin photosensitizers and Ozone when used as canal disinfectant on Push-out bond strength of glass fibre post to radicular dentin

AIM

To assess the efficacy of photosensitizers (CP, riboflavin) and gaseous ozone in comparison to the conventional radicular dentin disinfectant (NaOCl) on push-out bond strength (PBS) of PFRC post cemented to radicular dentin MATERIAL AND METHOD: Human single-rooted teeth were collected, steriled implanted in polyvinyl pipes up to a cement-o-enamel junction and de coronated. Cleaning and shaping of the canal were performed using the crown down technique followed by obturation of the canal space. Canal space was prepared using peso reamers and samples were divided into four groups based on types of canal disinfectant protocols. Group 1: Riboflavin+ 17%EDTA; group 2: Curcumin Photosensitizer + 17% EDTA; group 3: Gaseous Ozone disinfection (O3) +17% EDTA and group 4 control 2.5% NaOCl +17% EDTA. Within the canal space, fiber post was cemented and cured, and thermocycled. PBS was evaluated using a Universal testing machine (UTM) and failure modes using a stereomicroscope at 40x magnification. One-way analysis of variance (ANOVA) was used to determine the mean and standard deviation of push-out bond strength (PBS). The Tukey multiple comparison tests (p = 0.05) was used to compare the means of PBS RESULTS: The highest PBS was displayed in group 2 CP+ 17% EDTA at all three root levels, coronal (8.81±0.61), middle (7.77±0.55), and apical (5.25±0.61). The lowest PBS was revealed in group 4, disinfected with 2.5% NaOCl +17% EDTA (control) at coronal (6.12±0.54), middle (5.46±0.84), and apical (3.00±1.88) levels. The most prevailed fracture mode was an adhesive failure (cement-dentin interface).

CONCLUSION

Radicular dentin disinfected with PDT using CP, riboflavin, and O3 displayed similar PBS at all root segments. NaOCl is a convenient, traditional, and commonly used disinfectant, and it's effects on PBS is still controversial.

Time-Dependent Effect of Chitosan Nanoparticles as Final Irrigation on the Apical Sealing Ability and Push-Out Bond Strength of Root Canal Obturation

Materials and Methods

Fifty-six premolars were used in this study and divided by two evaluations: 28 teeth for apical sealing ability and 28 others for bond strength. Each study was assigned randomly into two groups of fourteen teeth: Group-1, final irrigation with 17% EDTA; Group-2, with 0.5% chitosan nanoparticles. Each group was further divided into two groups of 7 each: Group-A, final irrigation was applied for 1 minute; Group-B, for 3 minutes. All teeth were obturated with epoxy resin-based sealer and gutta-percha. In the apical sealing ability study, the obturated teeth were immersed in 2% methylene blue and observed under a stereomicroscope (8x magnification). In the bond strength study, the teeth were tested using the push-out technique and observed under a stereomicroscope (40x magnification) to determine the failure type. Data from each evaluation were analysed with two-way ANOVA followed by the LSD test.

Results

Final irrigation using 0.5% chitosan nanoparticles produced the same apical sealing ability and bond strength as 17% EDTA (p > 0.05). A significant difference occurred between application times (p < 0.05). The failure type was observed predominantly as cohesive, and the least was adhesive.

Conclusion

Regardless of the final irrigation solution used, 3-minute application time produced greater apical sealing ability and push-out bond strength than 1-minute application time.