Bioceramic-based root canal sealers are considered to be an advantageous technology in endodontics. The aim of this review was to consider laboratory experiments and clinical studies of these sealers. An extensive search of the endodontic literature was made to identify publications related to bioceramic-based root canal sealers. The outcome of laboratory and clinical studies on the biological and physical properties of bioceramic-based sealers along with comparative studies with other sealers was assessed. Several studies were evaluated covering different properties of bioceramic-based sealers including physical properties, biocompatibility, sealing ability, adhesion, solubility, and antibacterial efficacy. Bioceramic-based sealers were found to be biocompatible and comparable to other commercial sealers. The clinical outcomes associated with the use of bioceramic-based root canal sealers are not established in the literature.

This study evaluated and compared the sealer thickness and interfacial adaptation of bioceramic sealers (Sankin Apatite III, MTA Fillapex ® , EndoSequence ® BC) to root dentin against AH Plus ® sealer. Sixty extracted single-root premolars were prepared and equally divided into four groups. Sealers were labeled with 0.1% Rhodamine B fluorescent dye. Roots were dissected along the transverse plane at 1 mm (apical), 3 mm (middle), and 6 mm (coronal) levels. Sealer-to-whole canal area ratio was evaluated. Percentage of gap-containing region to canal circumference was calculated using a confocal laser microscope. Sealer thickness was significantly higher at apical and middle levels than at coronal level. EndoSequence BC had the significantly highest thickness compared with MTA Fillapex and AH Plus. The coronal level had significantly less interfacial gaps compared with apical and middle levels. Bioceramic sealers showed more gaps compared with AH Plus, with no significant differences among them.

Background/purpose Intraradicular moisture is not standardized and alters the sealing properties and adhesion of root sealers. The aim of this work was to evaluate the effect of different moisture on the constitution of bioceramic sealers. Materials and methods The sealers were evaluated before mixing, and after setting using X-ray diffraction (XRD), Energy Dispersive Analysis (EDX) and Scanning Electron Microscope (SEM) techniques. Twenty four extracted teeth were prepared and assigned to four groups according to the moisture conditions: (1) dry: using ethanol as final irrigation, (2) normal: using paper points until the last one appeared dry, (3) moist: using a Luer adapter for 5 s followed by 1 paper point, and (4) wet: the canals remained totally flooded. The roots were filled with MTA Fillapex ® and Endosequence ® BC and kept in phosphate buffer solution at 37 °C for 10 days. Each root was sectioned transversally and longitudinally. The sealers harvested from longitudinal sections were analysed using XRD. Whilst the transverse sections were analysed using SEM/EDX. Results The XRD analysis showed MTA Fillapex composed of Bismuth trioxide, calcium silicate and tricalcium aluminate. The intensity of peaks in the wet condition was reduced. Endosequence BC contained mainly calcium silicate, calcium silicate hydrate, zirconia and calcium hydroxide. The wet condition showed a small increase in hydrated calcium silicate. The EDX analysis showed changes in the elemental concentrations with different moisture conditions. The surface morphology differed with different moisture conditions. Conclusion Tested sealers have different constitution that not affected by the degree of moisture. However, it changed their relative quantity.

Objective: To evaluate the push-out bond strength and failure modes of different sealers/obturation systems to intraradicular dentin at 2 weeks and 3 months after obturation compared to AH Plus®/gutta-percha. Materials and Methods: A total of 180 root slices from 60 single-canal anterior teeth were prepared and assigned to 5 experimental groups (n = 36 in each group), designated as G1 (AH Plus®/gutta-percha), G2 (TotalFill BC™ sealer/BC-coated gutta-percha), G3 (TotalFill BC™ sealer/gutta-percha), G4 (EndoREZ® sealer/EndoREZ®-coated gutta-percha), and G5 (EndoREZ® sealer/gutta-percha). Push-out bond strengths of 18 root slices in each group were assessed at 2 weeks and the other 18 at 3 months after obturation using a universal testing machine. Data were analyzed using repeated measures ANOVA. An independent t test was used to compare the mean push-out bond strength for each group at 2 weeks and 3 months after obturation. Results: The mean push-out bond strengths of G4 and G5 were significantly lower than those of G1, G2, and G3 (p < 0.05) at both 2 weeks (G1: 1.46 ± 0.29 MPa, G2: 1.74 ± 0.43 MPa, G3: 1.74 ± 0.43 MPa, G4: 0.66 ± 0.31 MPa, G5: 0.74 ± 0.47 MPa) and 3 months after obturation (G1: 1.70 ± 1.05 MPa, G2: 3.69 ± 1.20 MPa, G3: 2.84 ± 0.83 MPa, G4: 0.14 ± 0.05 MPa, G5: 0.24 ± 0.10 MPa). The mean push-out bond strengths of G2 (3.69 ± 1.20 MPa) and G3 (2.84 ± 0.83 MPa) were higher at 3 months compared to 2 weeks after obturation (G2: 1.74 ± 0.43 MPa, G3: 1.33 ± 0.29 MPa). Conclusion: The TotalFill BC™ obturation system (G2) and the TotalFill BC™ sealer/gutta-percha (G3) showed comparable bond strength to AH Plus®. Their bond strength increased over time, whereas the EndoREZ® obturation system (G4) and EndoREZ sealer (G5) had low push-out bond strength which decreased over time.

Background. There is no sufficient literature on the effect of post location on endodontically treated premolar teeth with 2 roots. Objectives. The aim of the study was to evaluate the effect of fiber post location on fracture resistance and failure mode of endodontically treated premolars with 2 roots. Material and methods. Fifty extracted maxillary first premolars with 2 roots were divided randomly into 5 groups. Group 1 was comprised of sound teeth, which received only metal crowns (control). Teeth from groups 2, 3, 4, and 5 were decoronated 2 mm above the cementoenamel junction (CEJ) and were endodontically treated. No post was placed in group 2 teeth. Teeth from groups 3, 4 and 5 were given a fiber post placed in the buccal canal, palatal canal, and both buccal and palatal canals, respectively. All teeth in groups 2, 3, 4, and 5 were built up with composite and full coverage metal crowns. A compressive static load was applied at an angle of 25° to the crowns with a crosshead speed of 0.5 mm/min, until fracture. Results. One-way analysis of variance (ANOVA) showed significant differences among the groups (p = 0.002). A post hoc test showed significantly lower fracture resistance of group 4 compared to group 5 (p = 0.011). Furthermore, group 2 had significantly less fracture resistance compared to group 1 (p = 0.021) and group 5 (p = 0.002). According to Fisher's exact test, different post locations are non-significantly associated with fracture mode (p = 0.256). Conclusions. Fiber post location has a significant effect on fracture resistance of severely damaged, endodontically treated maxillary premolars with 2 roots. However, post placement in the palatal root is preferred, as it maintains the restorability of the tooth.

Objectives To evaluate the push-out bond strength of experimental apatite calcium phosphate coated gutta-percha (HAGP) compared to different commercially available coated gutta-percha root obturation points. Methods Extracted teeth were selected and instrumented using ProTaper rotary files. The canals were assigned into five equal groups and obturated using matching single cone technique as follows: EndoREZ cones and EndoREZ sealer, Bioceramic Endosequence gutta-percha (BCGP) with Endosequence BC sealer, Active GP with Endosequence BC sealer (ActiV GP), conventional GP with Endosequence BC sealer, and HAGP with Endosequence BC sealer. Each root was sectioned transversally at the thickness of 1±0.1 mm to obtain 5 sections (n=25 per group). The specimens were subjected to push-out test using a Universal Test Machine at a loading speed of 0.5 mm/ min. Failure modes after push-out test was examined under stereomicroscope and the push-out data were analyzed using ANOVA and the post hoc Dunnett T3 test (p = 0.05). Results The highest mean bond strength was yielded by HAGP followed by BCGP, ActiV GP, conventional GP, and EndoREZ. There were significant differences between EndoREZ and all other groups (p<0.001). The prominent failure mode of HAGP was mixed mode, whereas EndoREZ exhibited adhesive failure mode. Conventional GP, ActiV GP, and BCGP showed cohesive failure mode. Conclusion HAGP showed promising results to be used as root canal filling material in combination with bioceramic sealer.

Dental Gutta-percha (GP) is a polymer based standard root canal filling material that has been widely used in dentistry. However, it has an inadequate sealing ability and adhesion to root dentin. The aim of this study is to coat GP with a bioactive material to enhance its sealing ability and adhesion to the root sealer and subsequently to the root dentin. The choice of coating method is limited by the nature of GP as it requires a technique that is not governed by high temperatures or uses organic solvents. In this study, biomimetic coating technique using 1.5 Tas-simulated body fluids (SBF) was employed to coat the treated GP cones. The coated samples were characterized using Fourier transform infrared spectroscopy (FTIR), X-ray Diffraction (XRD), and field emission scanning electron microscope (FESEM). The presence of hydroxyl, carbonate, and phosphate groups was detected by FTIR while the formation of hydroxyapatite (HA)/calcium phosphate was confirmed with XRD. FESEM revealed uniform, thin, and crystalline HA calcium phosphate coating. The adhesion of the coating to the GP substrate was assessed with microscratch technique. It was viable with cohesive failure mode. In conclusion, Tas-SBF is able to coat pretreated GP cones with a crystalline apatitic calcium phosphate layer.

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