phosphate EndoSequence bioceramic sealer and root repair material (Brasseler USA) (Figure 1) were introduced to endodontics, there was much excitement. Introducing a revolutionary premixed and injectable root canal sealer utilizing new bioceramic nanotechnology! EndoSequence BC Sealer’s nano particle size . EndoSequence BC Sealer and Root Repair Material Replacement BC Tips.
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However, this sealer has limited research related to its retreatability. Hence, the aim of this study was to evaluate the retreatability of two sealers, BC Endoseqyence as compared with AH Plus using micro-computed tomographic micro-CT analysis.
Fifty-six extracted human maxillary incisors were instrumented and randomly divided into 4 groups of 14 teeth: Micro-CT scans were taken before and after obturation and retreatment and analyzed for the volume of residual material. The specimens were longitudinally sectioned and digitized images were taken with the dental operating microscope. Fisher exact tests were performed to analyze the ability to regain wealer.
There was significantly less residual root canal filling material in the AH Plus groups retreated with chloroform as compared to the others. The BC Sealer samples retreated with chloroform had better results than those retreated without chloroform. The results of this study demonstrate that the BC Sealer group had significantly more residual filling material than the AH Plus group regardless of whether or not both sealers were retreated with chloroform.
The success of nonsurgical endodontic therapy depends on the removal of necrotic and inflamed tissue, microorganisms, and debris from the root canal system and the prevention of recontamination. Gutta-percha GP in conjunction with sealers is the most common root canal filling material. BC Sealer is a premixed bioceramic endodontic sealer that is composed of zirconium oxide, calcium silicates, calcium phosphate monobasiccalcium hydroxide, filler, and thickening agents.
Previous studies on bioceramic sealers have evaluated their bond strength, sealing ability, root fracture resistance, setting properties, cytotoxicity, and antibacterial effects. The efficacy of removing the root filling materials during retreatment has been assessed by many different methods. However, most methodologies destroy the specimens.
These methodologies include horizontal or vertical splitting of the examined teeth or clearing to render the teeth transparent. It is important to understand if these newer sealers are retreatable, especially since these materials are being used routinely in endodontics and could affect periapical healing.
Fifty-six extracted human single-rooted maxillary anterior teeth with straight roots were selected. Roots with curvatures higher than twenty degrees were excluded.
Only fully formed apices with a single root canal and a single apical foramen were included. The presence of a single canal was verified with buccal and proximal radiographs. Teeth were divided into 4 groups of 14 teeth each:.
Teeth that had an initial apical file size of more than a size 25 were discarded. Teeth were decoronated with a diamond disk Keystone industries, Gibbstown, NJ, USA to standardize the lengths to 17 mm with the aid of calipers. After access, cavity preparation patency and working length were determined by introducing a size 10 Flexofile Dentsply Maillefer, Tulsa, OK, USA in the canal until it was visible at the apical foramen and by subtracting 1 mm from this measurement for a working length WL of 16 mm.
Files were used to instrument 5 canals and then replaced. Each canal was filled with irrigant during instrumentation. A size 10 Flexofile was used to reconfirm patency. Each specimen was scanned three times: The scanning parameters for each scan were kept constant: Raw scan data were reconstructed into multiplanar slice data using the computer program, NRecon V1. After reconstruction of the initial scan dataset, the degree of curvature of the root canals was re-evaluated from images rendered with the 3D volume exploration software, Drishti V2.
The curvatures were checked once again to ensure none had curvatures greater than 20 degrees. For calculation of the root canal volume following instrumentation, the canal was reverse filled by inverting the rendering settings ie.
EndoSequence BC Sealer Bioceramic Root Canal Sealing Material Cement Brasseler | eBay
To enable calculation of total remaining sealer after retreatment, rendering settings were applied that readily detected the radiopaque sealer Figure 1. The same rendering settings were applied to both the second obturated and third retreated scan datasets and the volumes of sealer determined again using the getvolume function. For visualization purposes, the 3D renderings of each tooth was manually aligned and oriented in the same multi-dimensional space and different transfer functions applied to show both the surface of the root and the sealer Figure 1root, black; obturation material, orange.
For subdivision of the root canal into thirds apical, middle, and coronalthe rendered datasets were virtually cut in the horizontal plane such that each third consisted of the exact number of rendered slices.
The volume of sealer remaining in each third was then determined using the getvolume function of Drishti as described above. The teeth were randomly divided into 2 groups Groups 1 and 2 of 28 each. All canals were obturated by the continuous wave compaction technique. The same volumes of sealer were used for both groups of teeth. The specimens were scanned a second time with the micro-CT using the same scanning parameters to confirm the homogeneity of root canal obturation.
A single operator performed all the procedures. Each group was divided into two subgroups: Groups 1A and 2A were retreated using chloroform; Groups 1B and 2B were retreated without chloroform.
Briefly, for Groups 1A and 2A, Cavit was removed and a total of 0. Two drops of chloroform were introduced in the access preparations. The remaining volume of chloroform was introduced in the canals and any remaining gutta-percha was removed with paper points. For Groups 1B and Group 2B, retreatment was done as stated above in the methods section with the similar rotary files but without chloroform.
After retreatment of all samples, a third micro-CT scan was performed using the same parameters as the first two scans.
The required sample size was calculated to be 14 samples per group. Data from the experiments were analyzed using an analysis of variance ANOVA to determine differences among the groups, with further pairwise multiple comparisons with a post hoc Tukey test. The percentages of residual filling material was calculated based on an equation stated in a previous study. These results were verified and related closely with the longitudinal sections of the teeth Figure 1. Group 1B showed less residual material compared to Group 2B, however, these results were not statistically significant.
All teeth were scanned using micro-CT but only representative images have been shown in Figure 1. The teeth were further analyzed after micro-CT analysis for residual filling material in the coronal, middle, and apical thirds of the canal.
There was significantly less residual root canal filling material in all the areas of Group 1A compared to those one-thirds of Groups 1B, 2A, and 2B Figure 3. Establishing patency and WL in retreatment cases has been shown to significantly improve periapical healing rates. For WLs there were no significant differences between the groups.
Root canal failures occur due to persistent periapical disease after treatment. Hence, it is imperative that the root canal system be adequately cleaned which would entail removing the entire existing root canal filling.
Furthermore, establishing patency and WL in retreatment cases has been shown to significantly improve periapical healing rates. Many new sealers have been introduced in the market; however, the retreatability of some of these sealers is still unknown. Hence, this study evaluated the retreatability of the relatively new BC Sealer compared to the more commonly used AH Plus sealer. Nevertheless, when treated with chloroform, the BC Sealer group left less residual material when compared to the group without chloroform Figure 2.
This notable difference between the sealers could be attributed to the fact that BC Sealer has the potential to adhere to the dentin.
In this study, we employed non-destructive, quantitative high resolution micro-CT-based imaging to assess the percentage of residual filling material of EndoSequence BC Sealer compared to AH Plus with or without the use of chloroform. This methodology, which has been successfully used in other studies, allows stepwise assessment by repeated scans of the same root specimen. Analysis of the apical, middle, and coronal one-thirds of the canals of retreated teeth indicated that AH Plus with the use chloroform had significantly less residual filling material compared to all one-thirds from all the other groups Figure 3.
The longitudinal sections of the teeth corroborated the findings from the micro-CT scans Figure 1. Most sections showed only residual sealer, however, there were a few specimens in all the groups that did show some residual gutta percha with sealer Figure 1.
This is an important finding as it correlates to some earlier studies that mention that no technique or solvent was effective in completely cleaning the root canal system during retreatment procedures. Another important factor to consider is the concern related to the toxicity of chloroform.
Inthe U. Food and Drug Administration FDA banned the use of chloroform in drugs and cosmetics due to toxicity concerns. Our study focused on single rooted teeth based on previous studies and the fact that we wanted to demonstrate differences in less complex anatomy.
Another important aspect that was taken into consideration was the volume of sealer and the quantity of chloroform used in the study. The quantity of chloroform was standardized between Groups 1A and 2A, and the same volume of sealer was used for all the groups. Both these aspects of this study are important as these could have been potential variables when analyzing the results of the study.
EndoSequence BC Sealer Bioceramic Root Canal Sealing Material Cement Brasseler
In this study, we had similar results. This is an important factor to consider especially during retreatments as this could affect periapical healing.
Koch and Brave published a series of three review articles that included retreatment techniques for the removal of gutta-percha and EndoSequence BC Sealer. A recent study suggested the use of solvents during retreatments as this technique reduced the amount of debris extruded apically and also reduced the time taken to retreat teeth. However, we believe that it may be necessary to develop a solvent that has superior effect on bioceramic sealers to improve its retreatability.
The results of this in vitro study show that conventional retreatment techniques are not always able to fully remove all the filling material from the canal; however, the AH Plus group retreated with chloroform had significantly less material remaining than BC Sealer whether or not chloroform was used.
We believe this information is important for practitioners especially when they are retreating teeth that have been previously obturated with BC Sealer. No potential conflict of interest relevant to this article was reported. National Center for Biotechnology InformationU. Journal List Restor Dent Endod v. Published online Dec 8. Enrique Oltra1 Timothy C. Cox2, 3, 4 Matthew R. LaCourse3 James D.
Johnson1 and Avina Paranjpe 1. Find articles by Enrique Oltra. Find articles by Timothy C. Find articles by Matthew R.