Cytocompatibility and bioactive potential of AH Plus Bioceramic Sealer: an in vitro study

Retreatment of Two Bioceramic Sealers Included Two Different Percentages of Calcium Silicate Using Two Endodontic File Systems: An In Vitro Study

Calcium silicate materials are widely used in endodontic treatment. Different calcium silicate percentages can be included in bioceramic sealers. The aim of this in vitro study was to investigate the effect of the calcium silicate percentages on mineral deposition into dentinal tubules at 7 days, 1 month, and 4 months of aging, as well as the effect of calcium silicate percentages on the quality of retreatment using two endodontic retreatment systems.Single rooted premolars were used in the present study. After the shaping and irrigation steps, the obturation was performed using high (Ceraseal "CRS") and low (AH Plus Bioceramic "AHB") calcium silicate percentage sealers. ReTreaty (RT) and ProTaper Universal Retreatment (PUR) were used to perform the retreatment process. The time required to achieve the apex was recorded. A digital microscope and a cone-beam computed tomography (CBCT) were used to evaluate the remaining materials after the retreatment procedure. Scanning electron microscope was used to investigate the presence of mineral deposition into dentinal tubules and the change in mineral morphology at 7 days, 1 month, and 4 months. The data was statistically analyzed using two-way analysis of variance and t-test.Both materials (CRS and AHB) demonstrated different mineral depositions onto their surfaces after 24 hours, 1 month, and 4 months, and showed mineral depositions into dentinal tubules at 4 months. RT was faster in achieving the apex for CRS group compared to PUR (p < 0.001), while no difference was found between both systems among the AHB groups. Both retreatment systems were quicker to achieve the apex in AHB compared to the CRS group (RT p = 0.035 and PUR p < 0.001). CBCT demonstrated a more precise measurement compared to the digital microscope in which the instrument and the material factors influence the removal ability at the coronal and middle thirds (p < 0.05). No significant difference was found at the apical third.The retreatment of AHB was easier and faster than CRS. RT demonstrated higher removal ability and faster time compared to PUR. The apical third proved to be a difficult area to achieve an optimal cleaning. Calcium silicate percentages included in bioceramic sealers could play an important role in root canal retreatment. Higher percentages of calcium silicate can decrease the capacity of the retreatment process and increase the needed time to remove the materials.

From Cockle Shell to Bioceramic Root Canal Sealer: The Manufacturing and its Physical and Biological Properties

INTRODUCTION AND AIMS

Cockle shells, which are discarded as waste by the food industry, have been used in medical fields. This study aimed to manufacture a newly developed cockle shell-derived bioceramic sealer (NDBS) and evaluate its physical and biological properties.

METHODS

Cockle shell-derived tricalcium silicate (C-C3S) was synthesized via the solid-state reaction technique and analysed for chemical composition and particle size. NDBS was prepared by mixing C-C3S with specific additives. The chemical composition and surface morphology of fully set sealers were assessed using X-ray diffraction, Fourier-transform infrared spectroscopy, and scanning electron microscopy. Physical properties were tested according to International Organization for Standardization 6876 standards. For biological testing, both sealers were extracted and diluted for cytotoxicity and proliferation assays on human periodontal ligament cells using the MTT assay. Reverse transcription-quantitative polymerase chain reaction was performed to evaluate changes in proinflammatory (interleukin-6, interleukin-8, tumour necrosis factor-alpha-α) and mineralization (alkaline phosphatase) gene expression.

RESULTS

C-C3S was found to contain 55% tricalcium silicate with a particle size of 5.32 microns. Both fully set sealers contained tricalcium silicate and calcium silicate hydrate. They demonstrated acceptable flowability, setting time, film thickness, and radiopacity, although their solubility exceeded International Organization for Standardization limits. Both sealers maintained a pH above 7, with no significant difference in calcium release after 2 weeks. The MTT assay indicated improved cell viability with increasing dilution. Reverse transcription-quantitative polymerase chain reaction showed that both sealers showed a tendency to reduce proinflammatory gene expression. Both sealers showed a tendency to upregulate alkaline phosphatase gene expression.

CONCLUSION

Within the limitations of this study, it was shown that cockle shells can be used to manufacture NDBS, which demonstrated physical and biological properties comparable to those of iRoot SP.

CLINICAL RELEVANCE

This study highlights the potential of NDBS to be further developed as a root canal sealer.

Calcium Silicate-Based Sealers: Apatite Deposition on Root Canal Dentin and pH Variation Analysis

OBJECTIVE

 This study analyzes the biomineralization potential of calcium silicate-based sealers Ceraseal (Meta Biomed Co., Cheongju, Korea) and AH Plus Bioceramic (Dentsply Sirona, United States), focusing on evaluating apatite deposition in root canal dentin and pH increases.

MATERIALS AND METHODS

 Calcium silicate-based sealers Ceraseal (Meta Biomed Co.) and AH Plus Bioceramic (Dentsply Sirona) were applied to the root canal dentin of premolars that had undergone root canal preparation procedures. This was followed by a 14-day immersion in phosphate-buffered saline (PBS). Biomineralization analysis was performed by analyzing the formation of the apatite layer after the 14-day immersion. The thickness of the apatite layer deposits was observed using a scanning electron microscope (SEM). Additionally, the sealers were placed in molds and submerged in PBS solution with pH measurements taken on days 0, 7, and 14 using a digital pH meter.

STATISTICAL ANALYSIS

 The average thickness of apatite deposition in the interfacial layer was analyzed using the Mann-Whitney's test. The pH value differences among the groups were analyzed using a one-way analysis of variance test, followed by a post hoc least significant difference.

RESULTS

 There were differences in the apatite deposition in the interfacial layer between Ceraseal and AH Plus Bioceramic within 14 days of observation. There was a significant difference (p < 0.05) between the pH values of Ceraseal and AH Plus Bioceramic at 7 and 14 days of observation. Ceraseal showed greater alkalizing activity compared with AH Plus Bioceramic.

CONCLUSION

 Calcium silicate-based sealer Ceraseal showed better biomineralization potential than AH Plus Bioceramic.

Biocompatibility and Bioactivity Evaluation of Novel Calcium Silicate-Based Sealer: In Vitro Study on Human Dental Pulp Stem Cells

OBJECTIVE

 This article evaluates the biocompatibility and bioactivity of a novel calcium silicate-based sealer by assessing its impact on the viability, mineral deposition, wound closure, and migration activity of human dental pulp stem cells (hDPSCs).

MATERIAL AND METHODS

 AH Plus and AH Plus Bioceramic were pulverized and sterilized according to International Organization for Standardization 10993-5:2009. The hDPSCs were stored raw materials, reaching 80% confluence after passing stem cell marker tests (CD90 98%, CD105 99.7%, CD73 94%, and LinNeg 0.5%) and were at passage 5 to 6 after serum starvation for 24 hours. The study consisted of four groups: AH Plus at concentrations of 1:1 and 1:4, and AH Plus Bioceramic at concentrations of 1:1 and 1:4. Viability was assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay by measuring optical density values, while mineral deposition was evaluated through Alizarin red staining and analyzed with ImageJ software. Migration activity was measured by calculating migration speed and wound closure percentage using a scratch assay at 24 and 72 hours, with results analyzed by ImageJ.

STATISTICAL ANALYSIS

 Viability, migration, and wound closure results were analyzed using one-way analysis of variance. Mineral deposition was analyzed descriptively.

RESULTS

 There were significant differences in the viability and mineral deposition of hDPSCs between calcium silicate-based sealers and epoxy resin-based sealers. Calcium silicate-based sealers showed higher viability and better mineral deposition. The migration speed rate of hDPSCs at 24 hours and wound closure at 24 and 72 hours were significantly greater with the novel calcium silicate-based sealer compared with the epoxy resin-based sealer.

CONCLUSION

 This study suggests that calcium silicate-based sealers offer advantages over traditional epoxy resin-based sealers, demonstrating superior biocompatibility and bioactivity. These properties may lead to improved clinical outcomes, such as faster healing and fewer posttreatment complications. Further research is needed to explore the full potential of these materials in endodontics.

Retrieval of AH Plus Bioceramic and Ceraseal Versus AH Plus in Endodontic Retreatment

Background/Objectives: Since biomineralization by calcium silicate-based sealers (CSBSs) was reported, retrieving canal filling materials may be challenging during endodontic retreatment due to their adhesion to dentin. This study aimed to evaluate the possibility of removing residual mineral deposits from two kinds of CSBSs compared to the AH Plus Jet (AHJ). Methods: Root canals of mandibular premolars were prepared, obturated with the sealer-based obturation method using a WOG medium gutta-percha cone and one of the following sealers: AHJ, AH Plus Bioceramic (AHB), and Ceraseal (CER) (n = 12/group). After 3 weeks, endodontic retreatment was conducted with the WOG files, followed by instrumentation with XP-endo Finisher (XPF). Micro-computed tomography scanning was obtained after canal filling, after retreatment with WOG, and after the use of XPF. The percentage of the removed filling volume was calculated. One-way ANOVA with Tukey's test and a non-parametric test with Bonferroni's correction were performed. Root canal dentin after retreatment was examined using a scanning electron microscope (SEM). Results: After supplementary instrumentation with XPF, the mean residual filling volumes for the AHJ, AHB, and CER groups were 1.35 mm3, 0.55 mm3, and 0.82 mm3, respectively. The AHJ group showed greater residual volume compared to the AHB group (p < 0.05). The AHB and CER groups demonstrated higher mean percentages of removed filling volume at 94.8%, and 92.5%, respectively, compared to 87.1% for the AHJ group (p < 0.05). More mineral deposits were observed in the CER group with SEM. Conclusions: AHB and CER are retrievable during endodontic retreatment, with CER preferable due to greater mineral deposits in dentinal tubules.

Comparative analysis of viability, proliferation, and mineralization potential of human pulp and osteoblastic cells exposed to different bioceramic endodontic sealers

Background

The present study aimed to compare the viability, proliferation, and mineralization potential of human dental pulp cells (hDPCs) and osteoblasts cell line (Saos-2) after exposure to AH Plus® Bioceramic (AHP-B), Bio-C® Sealer (BIO-C), NeoMTA Plus® (NEOMTA-P), and MTA-FILLAPEX® endodontic sealers (MTA-F).

Methods

All materials were prepared according to the manufacturer's instructions. Before exposing the cells, we measured the release of calcium ions (Ca2+) from the dental materials to the culture media once Ca2+ can trigger signaling pathways. After that, hDPCs and Saos-2 were exposed to the sealers for MTT assay to assess the cell viability and wound healing to evaluate the cell proliferation. To investigate the potential of mineralization, we assessed the alkaline phosphatase activity and calcium deposition by Alizarin red staining. Statistical analysis was performed using Two-way ANOVA for calcium release and wound healing assays and One-way ANOVA for other assays, with post-test Bonferroni correction. The results were significant when p < 0.05.

Results

The sealers released diverse concentrations of calcium at different times. The hDPCs viability and proliferation were low in the AHP-B group at 24h of exposure (NEOMTA-P ∼ BIO-C ∼ CT > AHP-B > MTA-F), distinct from the osteoblastic cells (NEOMTA-P ∼ AHP-B ∼ CT > BIO-C > MTA-F) and (proliferation: AHP-B > NEOMTA-P ∼ CT > BIO-C > MTA-F). The ALP activity, an early marker of osteogenesis, was higher in hDPCs exposed to NEOMTA-P, while the osteoblastic cells showed higher ALP when exposed to AHP-B.

Conclusion

AHP-B, NEOMTA-P, and BIO-C stimulated osteogenesis in hDPCs and Saos-2 cells, with marked differences between groups. AHP-B showed an improved early stimulation of osteoblastic cells, while hDPCs were more responsive to NEOMTA-P.

Dentinal tubular penetration ability of epoxy resin-based and bioceramic-based root canal sealers

BACKGROUND

The purpose of this study was to compare AH Plus Bioceramic Sealer (AHPB), AH Plus (AHP), MTA Fillapex (MTAF), and Sure-Seal (SS) sealers for dentinal tubular penetration ability.

METHODS

Forty extracted human mandibular premolars were instrumented and divided into 4 groups based on the sealer used for filling (n = 10): AHPB, AHP, MTAF, SS. After filling the root canals, the roots were entombed in acrylic resin blocks and cut vertically in the long axis to obtain 1-mm-thick disks from 3 mm (at apical third), 8 mm (at middle third) and 13 mm (at coronal third) away the apical foramen. The images of 120 samples (30 for each group) were scanned by using confocal laser scanning microscopy and analyzed with the ImageJ software. Total penetration area and the root canal area were measured, and the ratio of these values were recorded as sealer penetration ratio. The data were evaluated for each third and in total using one-way ANOVA with post-hoc Tukey's test. The significance level was set to P < 0.05.

RESULTS

In the apical, middle and coronal thirds and in total, MTAF and AHP, and SS and AHPB had statistically significant identical penetration ratio values. Both SS and AHPB demonstrated statistically considerably greater penetration % as compared to MTAF and AHP in all thirds (P < 0.05), and in total (P < 0.05).

CONCLUSION

AHPB and SS provided a higher penetration % than AHP and MTAF in apical, middle and coronal thirds, and in total.

Comparison of biocompatibility of epoxy resin and bioceramic-based root canal sealers

OBJECTIVES

The purpose of this study is to compare the cytotoxicity of 2 bioceramic-based (Bioserra and AH Plus Bioceramic (Bio)) and 2 epoxy resin-based (Sealart and AH Plus) root canal sealers on the Saos-2 cell line.

METHODS

The cytotoxicity of the root canal sealers was determined using the MTT metabolic activity assay. The mRNA expression levels of Bcl-2, Beclin1, Cas-3, IL-6, LC3, MMP-9 and TNF-α genes were assessed by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and the expression of Beclin1 and LC3 proteins were assessed using western blot (WB) method. The canal sealers' total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were measured using photometric kits.

RESULTS

AH Plus Bio significantly increased metabolic activity compared to the 2 resin-containing sealers, but there was no difference with Bioserra. Sealart was clearly the most cytotoxic group. QRT-PCR analysis revealed that the mRNA expressions of Bcl-2, Beclin1, Cas-3, IL-6, LC3, and MMP-9 in the Bioserra group, Bcl-2, Cas-3, and IL-6 in the Sealart group, Beclin1, Cas-3, IL-6, and MMP-9 in the AH Plus group, and Bcl2 in the AH Plus Bio group were stimulated. The OSI results showed no significant difference between the root canal sealer groups.

CONCLUSIONS

In the study, the best biocompatibility results in MTT, qRT-PCR, WB and OSI were in the AH Plus Bio group. Although Bioserra, the study's other bioceramic paste, was found to be biocompatible according to MTT and OSI measurements, it increased the expression of all genes in qRT-PCR except for TNF-α, and also increased LC3 protein levels in WB.

CLINICAL RELEVANCE

Since periradicular tissues can be directly affected by the materials used in root canal treatment, the sealers with high biocompatibility are being developed. In vitro studies examining the biocompatibility of newly produced root canal sealers are guiding for clinical success.

Cone-Beam Computed Tomography Analysis of Retreatability of Resin and Bio-ceramic Sealer For Root Canal Treatment: An In Vitro Study

Root canal retreatment (Re-RCT) cases have shortcomings due to the ineffective removal of the root canal filling material, eventually leading to endodontic failure. This study aims to test the comparative efficacy of retreatment files in removing calcium silicate-based sealer and epoxy resin-based sealer. Thirty-two single-rooted teeth were decoronated at 15 mm and bio-mechanical preparation was performed. These samples were divided into two groups based on the sealer used - Angelus Bio-C ceramic sealer (Angelus, Londrina-PR, Brazil) and AH Plus sealer (Dentsply Sirona, North Carolina, US). Obturation was done and all the samples were stored in the incubator according to the respective setting time of the sealer. After this, the samples in each group were subdivided into two groups based on the retreatment files used, i.e., Neoendo (Orikam Healthcare India Pvt. Ltd., Haryana, India) and Dentsply (Dentsply Sirona, North Carolina, US) retreatment files. The specimens were then sectioned vertically into two halves and analyzed by cone-beam computed tomography (CBCT). A one-way ANOVA F test was used for an intragroup comparison, whereas a post hoc Tukey test was used for an intergroup comparison. The Dentsply retreatment files were superior to the Neoendo retreatment files and the Bio-C ceramic sealer was left behind to a greater extent than the AH Plus sealer. Thus, Dentsply retreatment files were more efficient than Neoendo files and the removal of the Bio-C ceramic sealer was more difficult than the AH Plus sealer.

Effect of bioceramic-based and resin-based sealers on postoperative discomfort following root canal therapy: a systematic review and meta-analysis

Background

The aim of this systematic review and meta-analysis was to furnish evidence-based recommendations for the utilization of bioceramic-based and resin-based sealers in clinical endodontics, with a focus on reducing postoperative discomfort.

Methods

The investigation's methodology was registered on the International Prospective Database of Systematic Reviews (PROSPERO: CRD42022355506) and executed using the 2020 PRISMA protocol. Articles were selected utilizing the PICO technique and applying specific inclusion and exclusion criteria. Articles published between January 2000 and August 2022, PubMed, MEDLINE, and DOAJ were utilized as primary data sources. After the identification of studies, two autonomous reviewers evaluated the titles and abstracts, and data from qualifying studies were extracted.

Results

Nine published studies were included in this analysis. The findings indicate that there were no significant differences in the Visual Analog Scale (VAS) scores between resin-based and bioceramic root canal sealers at intervals of 6 hours, 12 hours, 24 hours, and 48 hours after treatment.

Conclusion

The findings of this systematic review and meta-analysis suggest that after the utilization of bioceramic sealers during root canal therapy, the pain and discomfort levels were not significantly different from those experienced pain after the use of resin-based sealers.

Effects of radiotherapy dose and application time on the load-to-failure values of teeth filled with different sealers

BACKGROUND

The materials used in root canal filling and radiotherapy (RT) application can affect the load-to-failure of the teeth. This study aimed to compare the load-to-failure of the teeth filled with AH Plus (AHP) or AH Plus bioceramic (AHPB) before or after 60 Gy- and 70 Gy-dose radiotherapy.

MATERIALS AND METHODS

One hundred and ten maxillary incisors were endodontically prepared up to ProTaper Next X4 instruments. The teeth were randomly divided into 5 main groups as: non-irradiated, root canal treatment (RCT) before 60 Gy radiotherapy, RCT before 70 Gy radiotherapy, RCT after 60 Gy radiotherapy, RCT after 70 Gy radiotherapy. These groups were divided into 2 subgroups for filling material: AHP ve AHPB. After filling and radiotherapy procedures, the teeth were fixed on the thermoplastic mask plane. The plane were placed in the middle of a rectangular prism shaped glass phantom, and irradiated via a linear accelerator device. The teeth were then embedded in cylindrical acrylic blocks and the force (N) that caused the fracture was recorded under the Universal testing device. Student t-test was used for statistical comparisons. Statistical significance level was determined as p < 0.05.

RESULTS

After 70 Gy dose radiotherapy, the group filled with AHPB showed statistically significantly lower fracture strength than the group filled with AHP (p < 0.05). In the control group, before 60 Gy RT group, after 60 Gy RT group, and before 70 Gy RT group, the sealers had statistically significantly similar load-to-failure. (p > 0.05).

CONCLUSION

The group filled with AHPB caused a lower fracture strength than the group filled with AHP following a 70 Gy dose of RT. The sealers in the control group, before 60 Gy RT group, after 60 Gy RT group, and before 70 Gy RT group exhibited comparable load-to-failure values.

Comparative evaluation of the effect of three different obturation techniques on push-out bond strength of AH Plus Bioceramic and EndoCeramic sealers: An in vitro study

Context

Effect of three different obturation techniques on bond strength of bioceramic sealers.

Aim

This study aimed to investigate the effect of cold lateral compaction, thermafil, and thermoplasticized obturation techniques on the push-out bond strength of AH Plus Bioceramic and EndoCeramic sealers.

Settings and Design

The design of the study was an in vitro study.

Materials and Methods

Forty-two extracted teeth that were single-rooted and had fully developed apices were chosen, decoronated, and biomechanically prepared using rotary nickel-titanium (NiTi) instruments. Samples were divided into two groups of n = 21. Group 1: AH Plus Bioceramic sealer, Group 2: EndoCeramic sealer. Then, based on the obturation technique employed, each group was divided into three subgroups (n = 7): subgroups 1a, 2a: Cold lateral compaction; Subgroups 1b, 2b: Thermafil; and Subgroups 1c, 2c: Thermoplasticized (obtura). Using universal testing machine, slices from the middle third of the sample's root were analyzed to determine the push-out bond strength values.

Results

Compared to other groups push-out bond strength was noticeably higher for the cold lateral compaction technique with EndoCeramic sealer (Subgroup 2a), followed by the Thermafil technique with EndoCeramic sealer (Subgroup 2b).

Conclusions

In the present study, compared to heat-based obturation techniques, cold lateral compaction showed better push-out bond strength values for both sealers. EndoCeramic sealer resulted in greater push-out bond strength values than AH Plus Bioceramic sealer.

Osteoinductive and regenerative potential of premixed calcium-silicate bioceramic sealers on vascular wall mesenchymal stem cells

AIM

The osteogenic potential of new premixed calcium-silicate-containing bioceramic sealers (Ca-Si sealers) was tested with porcine vascular wall-mesenchymal stem cells (pVW-MSCs).

METHODOLOGY

Two Ca-Si-containing sealers: Ceraseal (MetaBiomed, Cheong-si, South Korea) and AH Plus Bioceramic (Maruchi, Wonju-si, South Korea), and an epoxy resin sealer (AH Plus; Dentsply, Konstanz, Germany) as a control, were prepared according to the manufacturers' indications. All samples were allowed to set for 100% of their setting time in a sterile humid cabinet at 37°C and 95% relative humidity. pVW-MSC seeding efficiency and osteogenic differentiation were analysed as marker of gene/protein expression for up to 12 days. Mineralization assay and immunofluorescence staining were performed and evaluated over a period of 21 days. Statistical analyses were conducted using one-way analysis of variance (p < .05). Additional samples were prepared and stored under the same conditions and inspected using an environmental scanning electron microscope equipped with an energy dispersive X-ray spectroscopy system.

RESULTS

Significantly higher cell seeding efficiency (p < .05) was observed for both Ca-Si sealers from day 8. pVW-MSCs showed a significant shift towards the osteogenic lineage only when seeded in contact with Ca-Si sealers. Gene expression of osteopontin was upregulated significantly. Collagen I and osteocalcin were clearly expressed by cells in contact with Ca-Si sealers. Mineralization granules were observed in Alizarin red assays and confocal laser scanning microscopy analysis of both Ca-Si sealers. No gene expression or granule mineralization were observed on the epoxy resin sealer.

CONCLUSIONS

Premixed Ca-Si sealers displayed a higher potential for osteogenic activity on pVW-MSCs. Epoxy resin sealer was unable to induce any osteogenic activity. The properties of both Ca-Si sealers suggest their potential as osteoinductive platforms for vascular MSCs in periapical bone.

Biocompatibility, bioactivity and immunomodulatory properties of three calcium silicate-based sealers: an in vitro study on hPDLSCs

OBJECTIVES

To assess the biocompatibility, bioactivity, and immunomodulatory properties of three new calcium silicate cement-based sealers: Ceraseal (CS), Totalfill BC Sealer (TFbc) and WellRoot ST (WR-ST) on human periodontal ligament stem cells (hPDLSCs).

MATERIALS AND METHODS

HPDLSCs were isolated from extracted third molars from healthy patients. Eluates (1:1, 1:2, and 1:4 ratio) and sample discs of CS, TFbc and WR-ST after setting were prepared. A series of assays were performed: cell characterization, cell metabolic activity (MTT assay) cell attachment and morphology (SEM assay), cell migration (wound-healing assay), cytoskeleton organization (phaloidin-based assay); IL-6 and IL-8 release (ELISA); differentiation marker expression (RT-qPCR assay), and cell mineralization (Alizarin Red S staining). HPDLSCs cultured in unconditioned (negative control) or osteogenic (positive control) culture media were used as a comparison. Statistical significance was established at p < 0.05.

RESULTS

All the tested sealers exhibited similar results in the cytocompatibility assays (cell metabolic activity, migration, attachment, morphology, and cytoskeleton organization) compared with a negative control group. CS and TFbc exhibited an upregulation of at least one osteo/cementogenic marker compared to the negative and positive control groups. CS and TFbc also showed a significantly higher calcified nodule formation than the negative and positive control groups. Both the marker expression and calcified nodule formation were significantly higher in CS-treated cells than TFbc treated cells. WR-ST exhibited similar results to the control group. CS and TFbc-treated cells exhibited a significant downregulation of IL-6 after 72 h of culture compared to the negative control group (p < 0.05).

CONCLUSION

All the tested sealers exhibited an adequate cytocompatibility. CS significantly enhances cell differentiation by upregulating the expression of key genes associated with bone and cementum formation. Additionally, CS was observed to facilitate the mineralization of the extracellular matrix effectively. In contrast, the effects of TFbc and WR-ST on these processes were less pronounced compared to CS. Furthermore, both CS and TFbc exhibited an anti-inflammatory potential, contributing to their potential therapeutic benefits in regenerative endodontics.

CLINICAL RELEVANCE

This is the first study to compare the biological properties and immunomodulatory potential of Ceraseal, Totalfill BC Sealer, and WellRoot ST. The results act as supporting evidence for their use in root canal treatment.

Premixed calcium silicate-based ceramic sealers promote osteogenic/cementogenic differentiation of human periodontal ligament stem cells: A microscopy study

To evaluate the effects of premixed calcium silicate based ceramic sealers on the viability and osteogenic/cementogenic differentiation of human periodontal ligament stem cells (hPDLSCs). The materials evaluated were TotalFill BC Sealer (TFbc), AH Plus Bioceramic Sealer (AHPbc), and Neosealer Flo (Neo). Standardized discs and 1:1, 1:2, and 1:4 eluates of the tested materials were prepared. The following in vitro experiments were carried out: ion release, cell metabolic activity 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, cell migration, immunofluorescence experiment, cell attachment, gene expression, and mineralization assay. Statistical analyses were performed using one-way ANOVA followed by Tukey's post hoc test (p < .05). Increased Ca2+ release was detected in TFbc compared to AHPbc and Neo (*p < .05). Biological assays showed a discrete cell metabolic activity and cell migration in Neo-treated cell, whereas scanning electronic microscopy assay exhibited that TFbc group had a better cell adhesion process of substrate attachment, spreading, and cytoskeleton development on the niche-like structures of the cement than AHPbc and Neo. The sealers tested were able to induce overexpression of the CEMP-1, ALP, and COL1A1 genes in the first days of exposure, particularly in the case of TFbc (***p < .001). All materials tested significantly increased the mineralization of hPDLSCs when compared to the negative control, although more pronounced calcium deposition was observed in the TFbc-treated cells (***p < .001). Our results suggested that TFbc promotes cell differentiation, both by increasing the expression of key osteo/odontogenic genes and by promoting mineralization of the extracellular matrix, whereas this phenomenon was less evident in Neo and AHPbc. RESEARCH HIGHLIGHTS: TFbc group had a better cell adhesion process of substrate attachment, spreading, and cytoskeleton development on the niche-like structures of the cement than AHPbc and Neo. The sealers tested were able to induce overexpression of the CEMP-1, ALP, and COL1A1 genes in the first days of exposure, particularly in the case of TFbc. All materials tested significantly increased the mineralization of hPDLSCs when compared to the negative control, although more pronounced calcium deposition was observed in the TFbc-treated cells.

Nanostructured ZnO thin film to enhance gutta-percha's adhesion to endodontic sealers

BACKGROUND

Gutta-percha (GP) combined with an endodontic sealer is still the core material most widely used for tridimensional obturation. The sealer acts as a bonding agent between the GP and the root dentinal walls. However, one of the main drawbacks of GP core material is the lack of adhesiveness to the sealer. ZnO thin films have many remarkable features due to their considerable bond strength, good optical quality, and excellent piezoelectric, antibacterial, and antifungal properties, offering many potential applications in various fields. This study aimed to explore the influence of GP surface's functionalization with a nanostructured ZnO thin film on its adhesiveness to endodontic sealers.

METHODS

Conventional GP samples were divided randomly into three groups: (a) Untreated GP (control); (b) GP treated with argon plasma (PT); (c) Functionalized GP (PT followed by ZnO thin film deposition). GP's surface functionalization encompassed a multi-step process. First, a low-pressure argon PT was applied to modify the GP surface, followed by a ZnO thin film deposition via magnetron sputtering. The surface morphology was assessed using SEM and water contact angle analysis. Further comprehensive testing included tensile bond strength assessment evaluating Endoresin and AH Plus Bioceramic sealers' adhesion to GP. ANOVA procedures were used for data statistical analysis.

RESULTS

The ZnO thin film reproduced the underlying surface topography produced by PT. ZnO thin film deposition decreased the water contact angle compared to the control (p < 0.001). Endoresin showed a statistically higher mean bond strength value than AH Plus Bioceramic (p < 0.001). There was a statistically significant difference between the control and the ZnO-functionalized GP (p = 0.006), with the latter presenting the highest mean bond strength value.

CONCLUSIONS

The deposition of a nanostructured ZnO thin film on GP surface induced a shift towards hydrophilicity and an increased GP's adhesion to Endoresin and AH Bioceramic sealers.

The efficacy of 3 root canal sealers combined with warm gutta-percha vertical compression technique in the treatment of dental pulp disease

To investigate the efficacy of 3 root canal sealants such as AH Plus, GuttaFlow and iRoot SP combined with warm gutta-percha vertical compression technique in the treatment of dental pulp disease. This was a single-center retrospective study. 180 patients with dental pulp disease were divided into AH Plus group (n = 60), GuttaFlow group (n = 60) and iRoot SP group (n = 60) according to the different treatment methods. Patients in different groups were treated with corresponding root canal sealant combined with warm gutta-percha vertical compression technique. The quality of root canal filling, filling time, filling area ratio, the incidence of pain after operation, serum interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) and efficacy at 6 months after operation were compared among the 3 groups, respectively. The filling time in the GuttaFlow group and the iRoot SP group was significantly shorter than that in the AH Plus group (P < .001). There were significant differences in pain grade (P = .015) and pain rate (P = .016) among the 3 groups, and the pain rate in the GuttaFlow group and the iRoot SP group was significantly lower than that in the AH Plus group (P = .016). The time-point effect, intergroup effect and time-groups effect of serum TNF-α and IL-6 were significantly different (P < .001), and the levels of the 3 groups after treatment were significantly lower than those before treatment (P < .05), and the levels were significantly lower in the GuttaFlow group and the iRoot SP group (P < .05). There were significant differences in efficacy grading and effective rate among the 3 groups (P = .028), and the effective rate of iRoot SP group was significantly higher than that of AH Plus group (P < .05). The iRoot SP or GuttaFlow as root canal sealant combined with warm gutta-percha vertical compression technique in the treatment of dental pulp disease is better than AH Plus, and the former one can shorten the filling time, relieve the postoperative pain and improve the inflammatory response, but the long-term apical sealing effect of iRoot SP is better than GuttaFlow.

Evaluation of the root dentin bond strength and intratubular biomineralization of a premixed calcium aluminate-based hydraulic bioceramic endodontic sealer

PURPOSE

This study evaluated the dentin bonding strength and biomineralization effect of a recently developed premixed calcium aluminate-based endodontic sealer (Dia-Root Bio Sealer) in comparison with existing calcium silicate-based sealers.

METHODS

The root canals of 80 mandibular premolars were filled with Dia-Root Bio Sealer, Endoseal MTA, EndoSequence BC Sealer, and AH Plus Bioceramic Sealer. Medial and apical specimens were then obtained by sectioning. The push-out bond strength was measured using the medial specimens, and the failure mode was recorded. Intratubular biomineralization in the apical specimens was analyzed using scanning electron microscopy and energy-dispersive X-ray spectroscopy (EDS). The data were analyzed using one-way analysis of variance followed by the Tukey test (P < 0.05).

RESULTS

The push-out bond strength of Dia-Root Bio Sealer was significantly higher than that of the other tested materials, and a cohesive failure pattern was observed in all groups. Dia-Root Bio Sealer also exhibited a significantly higher degree of biomineralization than the other groups, and EDS analysis indicated that the biomineralized precipitates were amorphous calcium phosphate.

CONCLUSION

The results of this study indicate that Dia-Root Bio Sealer has the potential to be used as an adequate root canal sealer due to its favorable bonding performance.

Premixed calcium silicate-based root canal sealers have better biological properties than AH Plus: A systematic review and meta-analysis of in vivo animal studies and in vitro laboratory studies

Objectives

The aim was to determine whether premixed calcium silicate-based root canal sealers have better biological properties than AH Plus.

Materials and Methods

Searches of studies published up to January 2023 were performed in the PubMed/MEDLINE and EMBASE and via other methods (databases of the International Endodontic Journal, Journal of Endodontics, and gray literature). The inclusion criteria were in vivo animal and in vitro studies that analyzed the response in the dorsal subcutaneous tissue of rats, cell viability, and genotoxicity. Systematic Review Centre for Laboratory Animal Experimentation Risk of Bias (RoB) tool for in vivo studies and modified CONSORT checklist for in vitro were appraised. Meta-analysis was performed using the Stata.

Results

Fifty-two studies were included. In the RoB, in vivo studies fulfilled 20%-50% of the items and in vitro 60%-100%. The studies included in the meta-analysis demonstrated better histocompatibility with the premixed calcium silicate-based sealers at 30 days and greater cell viability with these sealers when used in undiluted extracts in experimental period of 72 h and in extracts with 1:2 and 1:4 dilution in 24 and 72 h. In contrast, no difference between materials was found concerning genotoxicity.

Conclusion

Premixed calcium silicate-based root canal sealers have better histocompatibility and are less cytotoxic than the epoxy resin-based sealer AH Plus, demonstrating favorable biological behavior.

Comparative bioactivity and immunomodulatory potential of the new Bioroot Flow and AH Plus Bioceramic sealer: An in vitro study on hPDLSCs

OBJECTIVES

To evaluate the cytocompatibility, bioactivity, and anti-inflammatory potential of the new pre-mixed calcium silicate cement-based sealers Bioroot Flow (BrF) and AH Plus Bioceramic Sealer (AHPbcs) on human periodontal ligament stem cells (hPDLSCs) compared to the epoxy resin-based sealer AH Plus (AHP).

MATERIALS AND METHODS

Standardized discs and 1:1, 1:2, and 1:4 eluates of BrF, AHPbcs and AHP after setting were prepared. The following assays were performed: cell attachment and morphology via SEM, cell viability via a MTT assay, cell migration/proliferation via a wound-healing assay, cytoskeleton organization via immunofluorescence staining; cytokine release via ELISA; osteo/cemento/odontogenic marker expression via RT-qPCR, and cell mineralized nodule formation via Alizarin Red S staining. HPDLSCs were isolated from extracted third molars from healthy patients. Comparisons were made with hPDLSCs cultured in unconditioned (negative control) or osteogenic (positive control) culture media. Statistical significance was established at p < 0.05.

RESULTS

Both BrF and AHPbcs showed significantly positive results in the cytocompatibility assays (cell metabolic activity, migration, attachment, morphology, and cytoskeleton organization) compared with a negative control group, while AHP showed significant negative results. BrF exhibited an upregulation of at least one osteo/cementogenic marker compared to the negative and positive control groups. BrF showed a significantly higher calcified nodule formation than AHPbcs, the negative and positive control groups, while AHPbcs was higher than the negative control group. Both were also significantly higher than AHP group.

CONCLUSION

BrF and AHPbcs exhibit adequate and comparable cytocompatibility on hPDLSCs. BrF also promoted the osteo/cementogenic differentiation of hPDLSCs. Both calcium silicate-based sealers favored the downregulation of the inflammatory cytokine IL-6 and the calcified nodule formation from hPDLSCs. BrF exerted a significantly higher influence on cell mineralization than AHPbcs.

CLINICAL RELEVANCE

This is the first study to elucidate the biological properties and immunomodulatory potential of Bioroot Flow and AH Plus Bioceramic Sealer. The results act as supporting evidence for their use in root canal treatment.

Physicochemical properties of calcium silicate cement based endodontic sealers

AIM

To mensure the physicochemical properties of three ceramic cement endodontic sealers AH Plus Bioceramic, Bio-C Sealer and Bio-C Sealer Ion+ with an epoxy resin sealer, AH Plus.

MATERIAL AND METHODS

These properties were measured: hardening time (HT), dimensional change (DC), solubility (SL), flow (FL) and radiopacity (RD). The distilled water obtained from the SL test was analyzed with atomic absorption spectrometry. A sample calculation was made considering n = 5 repetitions for each experimental sealer evaluated. Statistical analysis was performed using one-way ANOVA and post hoc Tukey tests (p < 0.05).

RESULTS

For the HT, AH Plus (484 ± 2.76 min) and AH Plus Bioceramic (424 ± 1.23 min) set more slowly than of Bio-C Sealer (370 ± 4.50 min) and Bio-C Sealer Ion+ (380 ± 1.42 min) (p < 0.05). AH Plus Bioceramic (12.56 ± 2.71 %) was more soluble than Bio-C Sealer (6.69 ± 1.67 %), Bio-C Sealer Ion+ (5.67 ± 2.16 %) and AH Plus (0.15 ± 0.01 %) (p < 0.05). AH Plus (0.03 ± 0.01 %) had slight expansion while the cement-based sealers had shrinkage: AH Plus Bioceramic (-1.60 ± 0.63 %) and Bio-C Sealer (-1.38 ± 0.69 %), Bio-C Sealer Ion+ (-5.19 ± 1.23 %) (p < 0.05). Bio-C Sealer Ion+ (59.80 ± 0.86 mm) and Bio-C Sealer (58.60 ± 0.98 mm) had the highest flow compared with AH Plus (56.90 ± 0.56 mm) and AH Plus Bioceramic (49.50 ± 0.63 mm) (p < 0.05). AH Plus (9.17 ± 0.06 mmAl) and AH Plus Bioceramic (8.27 ± 0.84 mmAl) showed radiopacity values when compared with those of Bio-C Sealer (4.90 ± 0.08 mmAl) and Bio-C Sealer Ion+ (4.14 ± 0.05 mmAl) (p > 0.05).

CONCLUSION

Ion release is inhered to these cement-based sealers and this result in calcium ion release.

Analysis of the cytotoxicity and bioactivity of CeraSeal, BioRoot™ and AH Plus® sealers in pre-osteoblast lineage cells

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-1 Dmp1 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.

Cytotoxicity and genotoxicity of bioceramic root canal sealers compared to conventional resin-based sealer

The aim of this study was to evaluate cytotoxicity and genotoxicity of calcium-silicate based sealers and comparing them with a gold standard-an epoxy-based sealant. Two experimental cell lines were used, gingival fibroblasts (hGF) and monocyte/macrophage peripheral blood cell line (SC). The cytotoxicity (XTT assay) and genotoxicity (comet assay) were evaluated both after 24-h and 48-h incubation. Additionally, after 48-h incubation, the cell apoptosis and cell cycle progression was detected. BioRoot Flow induced a significant decrease in hGF cells viability compared to the negative control groups both after 24-h (p < 0.001) and 48-h incubation (p < 0.01). In group with SC cells, after 24-h incubation significant increase in cells viability was detected for AH Plus Bioceramic Sealer in comparison to negative control (p < 0.05). BioRoot Flow and BioRoot RCS can be considered potentially genotoxic for the hGF cells after 48-h incubation (> 20% DNA damage). BioRoot Flow and BioRoot RCS, may have potential genotoxic effects and induce apoptosis in hGF cells which may irritate periapical tissues, resulting in a delayed healing. The findings of the study would be useful in selection of an appropriate sealant for root canal filling without causing cytotoxicity and genotoxicity.

The flow behavior and sealing ability of calcium silicate root canal cement containing dimethyl sulfoxide: An in vitro study

INTRODUCTION

To develop a calcium silicate (CaSi)-based cement containing dimethyl sulfoxide (DMSO) and cement deliver device for new root canal filling technique, and to assess the flow behavior, leakage, and root canal filling quality of CaSi containing DMSO.

METHODS

CaSi containing DMSO (CSC-DMSO) and CaSi containing PEG (CSC-PEG) were prepared, and the flow characteristics of both cements were compared in gypsum and resin channels using a high-speed camera. Eight root canals were obturated by CSC-DMSO or CSC-PEG using a cement delivery device, and root canal filling quality was assessed in terms of filling length using periapical radiographs. The filling length was evaluated by 'apico-coronal extension,' measuring length in reference to apical constriction. Microleakage was measured for thirty human molars that were randomly filled with CSC-DMSO, CSC-PEG, or gutta-percha and AH plus. Preliminary obturation of CSC-DMSO with cement delivery device in human teeth was analyzed in terms of filling length and void, using periapical radiographs. Statistical analysis was performed with the Kruskal Wallis test for simulated root canal fillings and one-way ANOVA for leakage test.

RESULTS

The flow speed of CSC-DMSO reduced in gypsum channels compared to resin channels, but CSC-PEG did not exhibit significant differences in the channels. The median absolute value of apico-coronal extension was significantly lower in CSC-DMSO compared to CSC-PEG (p < 0.05). Microleakage did not statistically differ between the groups (p > 0.05). In the preliminary obturation, the mean apico-coronal extension of CSC-DMSO was -0.297 ± 0.724 mm, while CSC-PEG was not feasible due to excess apical extrusions.

CONCLUSIONS

CSC-DMSO could be considered as an alternative filling material for root canal obturation.

Assessing the impact of obturation techniques, kinematics and irrigation protocols on apical debris extrusion and time required in endodontic retreatment

The aim of the study was to evaluate the impact of kinematics and irrigation protocols on the extrusion of apical debris during removal of different obturation techniques. A total of 144 single-rooted teeth were instrumented and obturated with Thermafil+AH Plus, Thermafil+AH Plus Bioceramic and single gutta-percha cone+AH Plus Bioceramic. Samples were divided according to the retreatment kinematics: continuous rotation or Jeni motion. Each sub-group was subjected to conventional irrigation or irrigation activated by EDDY. Extruded debris was collected in Eppendorf tubes, weighted and retreatment time was digitally recorded. Data were analysed with two-way ANOVA (p < 0.05). Debris extrusion was not significantly different between all groups. EDDY activation system and CanalPro Jeni required significantly longer time compared with other groups to remove Thermafil+AH Plus and single cone+AH Plus Bioceramic. Within current limitations, obturation technique, irrigation protocol and kinematics tested had no influence on apical extrusion debris, while they significantly impacted the retreatment time.

Influence of bioceramic cones on the quality of root canal filling relative to bond strength and adaptation of the adhesive interface

AIM

To evaluate the bond strength (BS) and analysis of the adhesive interface in root canals filled with bioceramic gutta percha sealers and cones.

MATERIAL AND METHODS

Ninety-six maxillary canines were divided into eight groups according to the endodontic sealer (AH Plus, AH Plus Bioceramic, Bio-C Sealer or Bio-C Sealer Ion+ and gutta percha cones (conventional or bioceramic) tested. They were analyzed using the BS test, failure pattern, analysis of the adhesive interface by scanning electron microscopy and confocal laser scanning microscopy. The BS data were compared between groups using the analysis of variance test with the Turkey post-test. The chi-square test was used to assess the type of failure and the non-parametric Mann-Whitney and Kruse-Wallis tests (P < 0.05).

RESULTS

Analysis of variance showed higher BS values for the groups of bioceramic gutta percha cones in Bio-C Sealer Ion+ (8.38 ± 4.27), AH Plus Bioceramic (6.19 ± 3.28), Bio-C Sealer (5.70 ± 3.18), AH Plus (4.61 ± 2.11) and for conventional gutta percha cones in AH Plus sealers (4.26 ± 2.35), Bio-C Sealer Ion + (3.63 ± 2.29), Bio-C Sealer (2.94 ± 2.32) and AH Plus Bioceramic (1.19 ± 0.89) (P < 0.05). Relative to the type of failure and adaptation of the types of filling material, a higher percentage of mixed failures was observed (gaps between 1 µm-10 µm) for the group with bioceramic gutta percha cones (P < 0.001).

CONCLUSION

The bond between sealers and bioceramic gutta percha cones showed higher bond strength values and greater penetration into the dentin tubules.

CLINICAL RELEVANCE

The filling the root canal system with bioceramic sealers should be associated with bioceramic gutta percha cones.

Physical-chemical properties and acellular bioactivity of newly prepared nano-tricalcium silicate-58s bioactive glass-based endodontic sealer

OBJECTIVES

To evaluate the physiochemical properties and apatite-forming ability of a newly prepared nano-tricalcium silicate-58s bioactive glass-based endodontic sealer (C3S-BG-P) and compare its results with the Nishika BG canal sealer and BioRoot™ RCS.

METHODS

The physicochemical properties (setting time, flow, solubility, film thickness, and radiopacity) of C3S-BG-P, Nishika BG canal sealer, and BioRoot™ RCS were evaluated in accordance with ANSI/ADA 57/2000 (reaffirmed 2012) and ISO 6876:2012 for root canal sealing materials. The in vitro apatite-forming ability was evaluated after 28 days of immersion of disc-shaped specimens in phosphate-buffered saline (PBS) using field emission scanning electron microscopy and energy-dispersive X-ray spectroscopy.

RESULTS

The results of physiochemical tests indicated that all the tested sealers complied with the ADA and ISO standards; however, the solubility of the BioRoot did not meet the two standards. C3S-BG-P revealed significantly superior properties in all physicochemical tests compared to Nishika and BioRoot; however, the solubility of Nishika was significantly lower than that of C3S-BG-P. Furthermore, all tested sealers exhibited apatite precipitation on their surfaces after 28 days of immersion in PBS.

CONCLUSIONS

C3S-BG-P had superior physicochemical properties, which mitigated the disadvantages of calcium silicate-based sealers. Moreover, it exhibited apatite precipitation after immersion in PBS. Further in vivo studies utilizing animal models or clinical studies are necessary to support the rationale of the newly developed sealer for clinical application.

Comparison of the Fracture Resistance of Root-Canal-Treated Premolars Obturated With Dissimilar Materials: An In Vitro Study

Introduction The utilization of endodontic sealers is of paramount importance in ensuring the sustained efficacy and resilience of endodontic treatment. The primary objective of the research was to appraise and contrast the fracture resistance (FR) of three distinct categories of endodontic sealing materials that are frequently employed in the context of endodontic therapy. Materials and methods This research used an in vitro experimental design. Sixty single-rooted human teeth indicated for extraction were utilized according to established protocols. These teeth were then arbitrarily divided into four piles, one for each of the four possible sealants. All specimens were put through a standardized thermal cycling procedure to simulate clinical conditions after the root canals were obturated. The subsequent step involved testing the FR of each group by utilizing a universal testing machine up until failure. Any statistically significant difference in FR among the three sealing materials was identified through appropriate statistical analysis. Results Group 1, which utilized a particular sealing material, exhibited the highest mean fracture resistance, measuring at an impressive 1198.33 ± 321.4 Newtons (N). A post hoc analysis was done to see the exact differences between each group and statistically significant differences between Groups 1 and 2 (p<0.05), Groups 1 and 4 (p<0.05), and Groups 3 and 4 (p<0.001) were observed. Conclusion The FR of Group 1 specimens were noticeably greater than those of Group 2 and Group 4 while the FR of Group 3 specimens was more than that of the Group 4 specimens. This study provides important insights into the fracture resistance of various endodontic sealing materials.

Lycium barbarum polysaccharide-glycoprotein promotes osteogenesis in hPDLSCs via ERK activation

OBJECTIVE

A lack of relevant research on Lycium barbarum polysaccharide-glycoprotein (LBP) application in oral diseases. Here, we focused on the effect of LBP on osteogenic differentiation of human periodontal ligament stem cells (hPDLSCs) and periodontitis bone loss.

METHODS

Human periodontal ligament stem cells (hPDLSCs) were isolated and identified by flow cytometry. Alkaline phosphatase (ALP) activity, Alizarin Red staining, and combined qPCR and Western blot analyses were performed to elucidate the effects of LBP on the osteogenic potential of hPDLSCs. In vivo experiments were performed with the treatment of LBP in rat periodontal model. MicroCT scanning and histological analysis were conducted to evaluate osteogenesis in situ.

RESULTS

Human periodontal ligament stem cells (hPDLSCs) were successfully isolated and identified with CD90, CD29, and CD45. LBP enhanced hPDLSCs proliferation and migration and promoted RUNX2, ALP, Collagen I, and Osteocalcin expression through activating the ERK1/2 signaling pathway in vitro. The inflammatory factors, including interleukin 6 (IL-6) and interleukin 8 (IL-8) were reduced after LBP treatment. Alveolar bone resorption was significantly decreased in the LBP-treated groups in vivo, and osteoclast was markedly decreased by LBP application.

CONCLUSION

LBP promoted hPDLSC osteogenesis by targeting the ERK1/2 signaling pathway and reverse bone loss by reducing inflammation. These findings provided latent hope for LBP application in periodontal therapy.

Biocompatibility of three different root canal sealers, experimental study

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.

The solubility, pH value, chemical structure, radiopacity, and cytotoxicity of four different root canal sealers: an in vitro study

OBJECTIVE

The aim of this study was to investigate solubility, pH value, chemical structure, radiopacity, and cytotoxicity of AH Plus BC, TotalFill BC, AH Plus, and AH Plus Jet sealers.

MATERIALS AND METHODS

Cytotoxicity analysis with direct and extraction tests at 3 different concentrations (1:1, 1:2, 1:4 v/v%) and time (24 h, 48 h, and 72 h) on Saos-2, PdLF, and THP-1 cell lines, chemical structure with scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) analysis, solubility, pH, and radiopacity values of AH Plus BC, TotalFill BC, AH Plus, and AH Plus Jet were evaluated. For statistical analyses of the groups, repeated measures, factorial, and one-way ANOVA tests were used. The statistical significance level was set at p < .05.

RESULTS

Resin-based sealers showed higher cytotoxicity values than the bioceramic-based sealers (p < 0.05). Time and concentrations were effective on the cell viabilities for cell lines. Higher peaks of calcium were detected bioceramic-based sealers and higher amount of zirconium was detected in AH Plus BC (p < 0.05). AH Plus BC showed similar radiopacity value with AH Plus, AH Plus Jet, whereas TotalFill BC showed the lowest radiopacity (p < 0.05). Bioceramic-based sealers had higher pH values in all experiment periods, and the difference between resin- and bioceramic-based sealer groups was significant (p < 0.05). However, the solubility values of the tested root canal sealers revealed no differences (p > 0.05).

CONCLUSIONS

The newly produced AH Plus BC Sealer showed similar properties with TotalFill BC, and their biological properties were better than AH Plus and AH Plus Jet.

CLINICAL RELEVANCE

AH Plus BC could be a possible alternative to other bioceramic- or resin-based sealers.

Biological properties of Ceraputty as a retrograde filling material: an in vitro study on hPDLSCs

OBJECTIVES

To assess the cytocompatibility and bioactive potential of the new calcium silicate-based cement Ceraputty on human periodontal ligament stem cells (hPDLSCs) compared to Biodentine and Endosequence BC root repair material (ERRM).

MATERIALS AND METHODS

hPDLSCs were isolated from extracted third molars from healthy donors. Standardized sample discs and 1:1, 1:2, and 1:4 eluates of the tested materials were prepared. The following assays were performed: surface element distribution via SEM-EDX, cell attachment and morphology via SEM, cell viability via a MTT assay, osteo/cemento/odontogenic marker expression via RT-qPCR, and cell calcified nodule formation via Alizarin Red S staining. hPDLSCs cultured in unconditioned or osteogenic media were used as negative and positive control groups, respectively. Statistical analysis was performed using one-way ANOVA or two-way ANOVA and Tukey's post hoc test. Statistical significance was established at p < 0.05.

RESULTS

The highest Ca2+ peak was detected from Biodentine samples, followed by ERRM and Ceraputty. hPDLSC viability was significantly reduced in Ceraputty samples (p < 0.001), while 1:2 and 1:4 Biodentine and ERRM samples similar results to that of the negative control (p > 0.05). Biodentine and ERRM exhibited an upregulation of at least one cemento/odonto/osteogenic marker compared to the negative and positive control groups. Cells cultured with Biodentine produced a significantly higher calcified nodule formation than ERRM and Ceraputty (p < 0.001), which were also higher than the control groups (p < 0.001).

CONCLUSION

Ceraputty evidenced a reduced cytocompatibility towards hPDLSCs on its lowest dilutions compared to the other tested cements and the control group. Biodentine and ERRM promoted a significantly higher mineralization and osteo/cementogenic marker expression on hPDLSCs compared with Ceraputty. Further studies are necessary to verify the biological properties of this new material and its adequacy as a retrograde filling material.

CLINICAL RELEVANCE

This is the first study to elucidate the adequate biological properties of Ceraputty for its use as a retrograde filling material.

Impact exerted by scaffolds and biomaterials in periodontal bone and tissue regeneration engineering: new challenges and perspectives for disease treatment

The periodontium is an appropriate target for regeneration, as it cannot restore its function following disease. Significantly, the periodontium's limited regenerative capacity could be enhanced through the development of novel biomaterials and therapeutic approaches. Notably, the regenerative potential of the periodontium depends not only on its tissue-specific architecture and function but also on its ability to reconstruct distinct tissues and tissue interfaces, implying that the development of tissue engineering techniques can offer new perspectives for the organized reconstruction of soft and hard periodontal tissues. With their biocompatible structure and one-of-a-kind stimulus-responsive property, hydrogels have been utilized as an excellent drug delivery system for the treatment of several oral diseases. Furthermore, bioceramics and three-dimensional (3D) printed scaffolds are also appropriate scaffolding materials for the regeneration of periodontal tissue, bone, and cartilage. This work aims to examine and update material-based, biologically active cues and the deployment of breakthrough bio-fabrication technologies to regenerate the numerous tissues that comprise the periodontium for clinical and scientific applications.

Physicochemical and Mechanical Properties of Premixed Calcium Silicate and Resin Sealers

The aim of the present in vitro study was to evaluate specific mechanical and physicochemical properties of two calcium silicate based sealers, (AH Plus Bioceramic “AHPB”; Well-Root ST “WRST”), and a conventional resin sealer (AH Plus “AHP”). These aims were accomplished by assessing the porosity, pH, compression strength, roughness, wettability and cell attachment of the tested materials. The results were compared statistically using the one-way ANOVA test. Higher pH values were obtained in both AHPB and WRST compared to AHP at 3, 24 and 72 h (p < 0.05). A greater level of porosity and wettability was detected for both AHPB and WRST compared to the resin sealer AHP (p < 0.05). Evident cell growth characterized by elongated morphology was observed on the surface of AHPB and WRST, while only a thin layer of cells was seen on the surface of AHP. A significant lower compression strength and modulus were obtained in the specimens created using AHPB compared to those made with AHP and WRST (p < 0.05). The removal of calcium silicates may be quite tricky during endodontic retreatment. In conclusion, considering the limitations of the present in vitro study, both calcium silicate sealers demonstrated good physicochemical properties. However, the lower compression strength and modulus of AHPB may facilitate its removal and make the retreatment procedures considerably easier.

Impact of antimicrobial photodynamic therapy on the bond-strength and penetration of endodontic sealers: A systematic review

BACKGROUND

Antimicrobial photodynamic therapy (aPDT) has been used for the disinfection of root canals. Studies have been carried out on its effect on the bond-strength and penetration of endodontic sealers. The aim of this systematic review is to critically analyze the literature and summarize the outcomes of these studies.

MATERIALS AND METHODS

An electronic search was conducted on research databases PubMED/Medline, ISI Web of Knowledge, Embase, Scopus and Europe PMC using the following the medical subject headings (MeSH) terms and keywords: [((endodontic sealer) OR (endodontic sealant) OR (root canal sealer)) AND ((anti-microbial photodynamic therapy) OR (laser-assisted) OR (light-assisted) OR (photosensitive dye) OR (photosensitizer)) AND ((bond-strength) OR (penetration))] for all literature published from inception to September 2022. Clinical studies, animal studies, laboratory investigations and case reports were included. Data was extracted and the quality of the included studies was assessed.

RESULTS

Of the 204 studies screen initially, 12 laboratory studies were included in this review. Majority of the outcomes revealed that aPDT does not have an adverse impact on the bond-strength or sealer penetration. Furthermore, AH Plus (an epoxy-based sealer) resulted in higher bond-strengths than other types of sealers (MTA Fillapex, Sealapex and Bioceramics). 11 studies were graded as having 'medium' quality and one study was graded as 'low'.

CONCLUSION

Within the limitations of this review, aPDT does not have a significant impact on the bonding and penetration of endodontic sealers. Future studies should focus on standardization and optimization of aPDT procedures when assessing their impact on the interaction between sealers and dentine.

Chemical-Physical Properties and Bioactivity of New Premixed Calcium Silicate-Bioceramic Root Canal Sealers

The aim of the study was to analyze the chemical−physical properties and bioactivity (apatite-forming ability) of three recently introduced premixed bioceramic root canal sealers containing varied amounts of different calcium silicates (CaSi): a dicalcium and tricalcium silicate (1−10% and 20−30%)-containing sealer with zirconium dioxide and tricalcium aluminate (CERASEAL); a tricalcium silicate (5−15%)-containing sealer with zirconium dioxide, dimethyl sulfoxide and lithium carbonate (AH PLUS BIOCERAMIC) and a dicalcium and tricalcium silicate (10% and 25%)-containing sealer with calcium aluminate, tricalcium aluminate and tantalite (NEOSEALER FLO). An epoxy resin-based sealer (AH PLUS) was used as control. The initial and final setting times, radiopacity, flowability, film thickness, open pore volume, water absorption, solubility, calcium release and alkalizing activity were tested. The nucleation of calcium phosphates and/or apatite after 28 days aging in Hanks balanced salt solution (HBSS) was evaluated by ESEM-EDX, vibrational IR and micro-Raman spectroscopy. The analyses showed for NeoSealer Flo and AH Plus the longest final setting times (1344 ± 60 and 1300 ± 60 min, respectively), while shorter times for AH Plus Bioceramic and Ceraseal (660 ± 60 and 720 ± 60 min, respectively). Radiopacity, flowability and film thickness complied with ISO 6876/12 for all tested materials. A significantly higher open pore volume was observed for NeoSealer Flo, AH Plus Bioceramic and Ceraseal when compared to AH Plus (p < 0.05), significantly higher values were observed for NeoSealer Flo and AH Plus Bioceramic (p < 0.05). Ceraseal and AH Plus revealed the lowest solubility. All CaSi-containing sealers released calcium and alkalized the soaking water. After 28 days immersion in HBSS, ESEM-EDX analyses revealed the formation of a mineral layer that covered the surface of all bioceramic sealers, with a lower detection of radiopacifiers (Zirconium for Ceraseal and AH Plus Bioceramic, Tantalum for NeoSealer Flo) and an increase in calcium, phosphorous and carbon. The calcium phosphate (CaP) layer was more evident on NeoSealer Flo and AH Plus Bioceramic. IR and micro-Raman revealed the formation of calcium carbonate on the surface of all set materials. A thin layer of a CaP phase was detected only on AH Plus Bioceramic and NeoSealer Flo. Ceraseal did not show CaP deposit despite its highest calcium release among all the tested CaSi-containing sealers. In conclusion, CaSi-containing sealers met the required chemical and physical standards and released biologically relevant ions. Slight/limited apatite nucleation was observed in relation to the high carbonation processes.

Short and Long-Term Solubility, Alkalizing Effect, and Thermal Persistence of Premixed Calcium Silicate-Based Sealers: AH Plus Bioceramic Sealer vs. Total Fill BC Sealer

This study aimed to investigate the short- and long-term solubility, alkalizing potential, and suitability for warm-vertical compaction of AH Plus Bioceramic Sealer (AHBC), and Total Fill BC Sealer (TFBC) compared to the epoxy-resin sealer AH Plus (AHP). A solubility test was performed according to ISO specification 6876 and further similar to ISO requirements over a period of 1 month in distilled water (AD) and 4 months in phosphate-buffered saline (PBS). The pH of the immersion solution was determined weekly. Sealers were exposed to thermal treatment at 37, 57, 67, and 97 °C for 30 s. Furthermore, heat treatment at 97 °C was performed for 180 s to simulate inappropriate implementation of warm vertical filling techniques. Physical properties (setting time, flow, film thickness according to ISO 6876) and chemical properties (Fourier transformed infrared spectroscopy) were assessed. AHBC and TFBC were associated with significantly higher solubility than AHP over 1 month in AD and 4 months in PBS (p < 0.05). AHBC and TFBC both reached high initial alkaline pH, while TFBC was associated with a longer-lasting alkaline potential than AHBC. Initial pH of AHBC and TFBC was higher in AD than in PBS. None of the sealers were compromised by thermal treatment.