Apical Microleakage of Endoseal MTA, AH26, and Sure-Seal Root Canal Sealers Using a Bacterial Leakage Model: An In-Vitro Study
Abstract
Objectives: Lack of a proper apical seal is one of the most common reasons for root canal treatment failure. Several sealers have been developed in an attempt to enhance the quality of apical seal. Nevertheless, it is essential to evaluate their effectiveness in preventing bacterial penetration. The present study employed a bacterial leakage model to assess and compare the apical sealing ability of three root canal sealers namely AH26, Endoseal MTA, and Sure-Seal Root.
Materials and Methods: This in vitro study evaluated 148 extracted single-rooted permanent teeth with almost identical root lengths. The teeth were prepared using the modified crown-down technique, and underwent cleaning and shaping using ProTaper rotary files. Five teeth were selected as positive controls, and five as negative controls. The remaining teeth were randomly assigned to three groups (n=46), and obturated using the abovementioned root canal sealers according to the manufacturers’ instructions. A bacterial leakage model was used to evaluate microleakage. The samples were evaluated daily regarding turbidity resulting from microbial microleakage. The data were analyzed with the Chi-square test and the log-rank test using SPSS 24 (alpha=0.05).
Results: The highest bacterial microleakage was recorded in the Sure-Seal Root group (7.21%), while the lowest microleakage was noted in the AH26 group (2.16%). However, there was no significant difference in bacterial microleakage among the three sealer groups (P=0.718).
Conclusion: According to the results of this in vitro study, the three sealers evaluated in the present study exhibited a similar performance regarding apical microleakage.
1. Rai K, Mandhotra P, Sharma N, Patil L, Sharma A, Singh S. In vitro Assessment of Apical Microleakage of Teeth Sealed with Three Different Root Canal Sealers: A Comparative Study. J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S375-S378.
2. Kaur A, Shah N, Logani A, Mishra N. Biotoxicity of commonly used root canal sealers: A meta-analysis. J Conserv Dent. 2015 Mar-Apr;18(2):83-8.
3. Kelmendi T, Koçani F, Kurti A, Kamberi B, Kamberi A. Comparison of Sealing Abilities Among Zinc Oxide Eugenol Root-Canal Filling Cement, Antibacterial Bioceramic Paste, and Epoxy Resin, using Enterococcus faecalis as a Microbial Tracer. Med Sci Monit Basic Res. 2022 Jun 1;28:e936319.
4. Watson TF, Atmeh AR, Sajini S, Cook RJ, Festy F. Present and future of glass-ionomers and calcium-silicate cements as bioactive materials in dentistry: biophotonics-based interfacial analyses in health and disease. Dent Mater. 2014 Jan;30(1):50-61.
5. Li X, De Munck J, Van Landuyt K, Pedano M, Chen Z, Van Meerbeek B. How effectively do hydraulic calcium-silicate cements re-mineralize demineralized dentin. Dent Mater. 2017 Apr;33(4):434-445.
6. Chybowski EA, Glickman GN, Patel Y, Fleury A, Solomon E, He J. Clinical Outcome of Non-Surgical Root Canal Treatment Using a Single-cone Technique with Endosequence Bioceramic Sealer: A Retrospective Analysis. J Endod. 2018 Jun;44(6):941-945. doi: 10.1016/j.joen.2018.02.019. Epub 2018 Mar 29. Erratum in: J Endod. 2018 Jul;44(7):1199. doi: 10.1016/j.joen.2018.06.001.
7. Vouzara T, Dimosiari G, Koulaouzidou EA, Economides N. Cytotoxicity of a New Calcium Silicate Endodontic Sealer. J Endod. 2018 May;44(5):849-852.
8. Carvalho CN, Grazziotin-Soares R, de Miranda Candeiro GT, Gallego Martinez L, de Souza JP, Santos Oliveira P, et al. Micro Push-out Bond Strength and Bioactivity Analysis of a Bioceramic Root Canal Sealer. Iran Endod J. 2017 Summer;12(3):343-348.
9. Taylor JK, Jeansonne BG, Lemon RR. Coronal leakage: effects of smear layer, obturation technique, and sealer. J Endod. 1997 Aug;23(8):508-12.
10. Wu MK, De Gee AJ, Wesselink PR. Leakage of AH26 and Ketac-Endo used with injected warm gutta-percha. J Endod. 1997 May;23(5):331-6.
11. Forghani M, Bidar M, Sadeghalhoseini N, Naghavi N, Attaran Mashhadi N. In Vitro Evaluation of Apical Microleakage of MTA Fillapex, iRoot SP and AH-Plus. J Mashhad Dent Sch. 2014 Sep;38(3):1-2.
12. Sönmez IS, Oba AA, Sönmez D, Almaz ME. In vitro evaluation of apical microleakage of a new MTA-based sealer. Eur Arch Paediatr Dent. 2012 Oct;13(5):252-5.
13. Assmann E, Scarparo RK, Böttcher DE, Grecca FS. Dentin bond strength of two mineral trioxide aggregate-based and one epoxy resin-based sealers. J Endod. 2012 Feb;38(2):219-21.
14. Milani AS, Kuzegari S, Zand V, Mokhtari H, Rahbar M. Ability of Calcium Silicate and Epoxy Resin-based Sealers to Fill the Artificial Lateral Canals in the Presence or Absence of Smear Layer. Maedica (Bucur). 2021 Sep;16(3):458-462.
15. Haïkel Y, Wittenmeyer W, Bateman G, Bentaleb A, Allemann C. A new method for the quantitative analysis of endodontic microleakage. J Endod. 1999 Mar;25(3):172-7.
16. Pisano DM, DiFiore PM, McClanahan SB, Lautenschlager EP, Duncan JL. Intraorifice sealing of gutta-percha obturated root canals to prevent coronal microleakage. J Endod. 1998 Oct;24(10):659-62.
17. Thakur S, Emil J, Paulaian B. Evaluation of mineral trioxide aggregate as root canal sealer: A clinical study. J Conserv Dent. 2013 Nov;16(6):494-8.
18. Asawaworarit W, Pinyosopon T, Kijsamanmith K. Comparison of apical sealing ability of bioceramic sealer and epoxy resin-based sealer using the fluid filtration technique and scanning electron microscopy. J Dent Sci. 2020 Jun;15(2):186-192.
19. Al-Ashou WMO, Al-Shamaa RM, Hassan SS. Sealing Ability of Various Types of Root Canal Sealers at Different Levels of Remaining Gutta Percha After Post Space Preparation at Two Time Intervals. J Int Soc Prev Community Dent. 2021 Nov 30;11(6):721-728.
20. Stabholz A, Friedman S, Abed J. Marginal adaptation of retrograde fillings and its correlation with sealability. J Endod. 1985 May;11(5):218-23.
21. Al-Hezaimi K, Naghshbandi J, Oglesby S, Simon JH, Rotstein I. Human saliva penetration of root canals obturated with two types of mineral trioxide aggregate cements. J Endod. 2005 Jun;31(6):453-6.
22. Lamb EL, Loushine RJ, Weller RN, Kimbrough WF, Pashley DH. Effect of root resection on the apical sealing ability of mineral trioxide aggregate. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Jun;95(6):732-5.
23. Martin RL, Monticelli F, Brackett WW, Loushine RJ, Rockman RA, Ferrari M, et al. Sealing properties of mineral trioxide aggregate orthograde apical plugs and root fillings in an in vitro apexification model. J Endod. 2007 Mar;33(3):272-5.
24. Post LK, Lima FG, Xavier CB, Demarco FF, Gerhardt-Oliveira M. Sealing ability of MTA and amalgam in different root-end preparations and resection bevel angles: an in vitro evaluation using marginal dye leakage. Braz Dent J. 2010;21(5):416-9.
25. Yildirim T, Er K, Taşdemir T, Tahan E, Buruk K, Serper A. Effect of smear layer and root-end cavity thickness on apical sealing ability of MTA as a root-end filling material: a bacterial leakage study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Jan;109(1):e67-72.
26. Valois CR, Costa ED Jr. Influence of the thickness of mineral trioxide aggregate on sealing ability of root-end fillings in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Jan;97(1):108-11.
27. Taylor MJ, Lynch E. Microleakage. J Dent. 1992 Feb;20(1):3-10.
28. Afkhami F, Nasri S, Valizadeh S. Bacterial leakage assessment in root canals sealed with AH Plus sealer modified with silver nanoparticles. BMC Oral Health. 2021 Nov 12;21(1):577.
29. Pappen AF, Bravo M, Gonzalez-Lopez S, Gonzalez-Rodriguez MP. An in vitro study of coronal leakage after intraradicular preparation of cast-dowel space. J Prosthet Dent. 2005 Sep;94(3):214-8.
30. Naulakha D, Hussain M, Alam M, Howlader M. An in vitro dye leakage study on apical microleakage of root canal sealers. J Nepal Dent Assoc. 2011;12(1):33-9.
31. Ørstavik D, Nordahl I, Tibballs JE. Dimensional change following setting of root canal sealer materials. Dent Mater. 2001 Nov;17(6):512-9.
32. YaghotiKhorasani M, Norozzadeh Z. Comparison of apical seal of three root canal sealers (AH26, AHPlus and Tubliseal) in root canal obturated by lateral condensation technique. J Mashhad Dent Sch. 2012 Oct;36(3):249-58.
33. Han L, Okiji T. Bioactivity evaluation of three calcium silicate-based endodontic materials. Int Endod J. 2013 Sep;46(9):808-14.
34. Jardine AP, Rosa RA, Santini MF, Wagner M, Só MV, Kuga MC, Pereira JR, Kopper PM. The effect of final irrigation on the penetrability of an epoxy resin-based sealer into dentinal tubules: a confocal microscopy study. Clin Oral Investig. 2016 Jan;20(1):117-23.
35. Torabinejad M, Rastegar AF, Kettering JD, Pitt Ford TR. Bacterial leakage of mineral trioxide aggregate as a root-end filling material. J Endod. 1995 Mar;21(3):109-12.
36. Rosa RA, Bier CAS, Só MVR, Tanomaru JMG, Tanomaru-Filho M. Push-out bond strength of Calcium hydroxide and Mineral Trioxide Aggregate based sealers to root canal dentin. Rev Odonto Cienc. 2012 Oct;27(4):320-4.
37. Dastorani M, Malekpour B, AminSobhani M, Alemrajabi M, Mahdian A, Malekpour B. Comparison of bacterial microleakage of three bioactive endodontic sealers in simulated underwater diving and aviation conditions. BMC Oral Health. 2021 Jul 15;21(1):345.
2. Kaur A, Shah N, Logani A, Mishra N. Biotoxicity of commonly used root canal sealers: A meta-analysis. J Conserv Dent. 2015 Mar-Apr;18(2):83-8.
3. Kelmendi T, Koçani F, Kurti A, Kamberi B, Kamberi A. Comparison of Sealing Abilities Among Zinc Oxide Eugenol Root-Canal Filling Cement, Antibacterial Bioceramic Paste, and Epoxy Resin, using Enterococcus faecalis as a Microbial Tracer. Med Sci Monit Basic Res. 2022 Jun 1;28:e936319.
4. Watson TF, Atmeh AR, Sajini S, Cook RJ, Festy F. Present and future of glass-ionomers and calcium-silicate cements as bioactive materials in dentistry: biophotonics-based interfacial analyses in health and disease. Dent Mater. 2014 Jan;30(1):50-61.
5. Li X, De Munck J, Van Landuyt K, Pedano M, Chen Z, Van Meerbeek B. How effectively do hydraulic calcium-silicate cements re-mineralize demineralized dentin. Dent Mater. 2017 Apr;33(4):434-445.
6. Chybowski EA, Glickman GN, Patel Y, Fleury A, Solomon E, He J. Clinical Outcome of Non-Surgical Root Canal Treatment Using a Single-cone Technique with Endosequence Bioceramic Sealer: A Retrospective Analysis. J Endod. 2018 Jun;44(6):941-945. doi: 10.1016/j.joen.2018.02.019. Epub 2018 Mar 29. Erratum in: J Endod. 2018 Jul;44(7):1199. doi: 10.1016/j.joen.2018.06.001.
7. Vouzara T, Dimosiari G, Koulaouzidou EA, Economides N. Cytotoxicity of a New Calcium Silicate Endodontic Sealer. J Endod. 2018 May;44(5):849-852.
8. Carvalho CN, Grazziotin-Soares R, de Miranda Candeiro GT, Gallego Martinez L, de Souza JP, Santos Oliveira P, et al. Micro Push-out Bond Strength and Bioactivity Analysis of a Bioceramic Root Canal Sealer. Iran Endod J. 2017 Summer;12(3):343-348.
9. Taylor JK, Jeansonne BG, Lemon RR. Coronal leakage: effects of smear layer, obturation technique, and sealer. J Endod. 1997 Aug;23(8):508-12.
10. Wu MK, De Gee AJ, Wesselink PR. Leakage of AH26 and Ketac-Endo used with injected warm gutta-percha. J Endod. 1997 May;23(5):331-6.
11. Forghani M, Bidar M, Sadeghalhoseini N, Naghavi N, Attaran Mashhadi N. In Vitro Evaluation of Apical Microleakage of MTA Fillapex, iRoot SP and AH-Plus. J Mashhad Dent Sch. 2014 Sep;38(3):1-2.
12. Sönmez IS, Oba AA, Sönmez D, Almaz ME. In vitro evaluation of apical microleakage of a new MTA-based sealer. Eur Arch Paediatr Dent. 2012 Oct;13(5):252-5.
13. Assmann E, Scarparo RK, Böttcher DE, Grecca FS. Dentin bond strength of two mineral trioxide aggregate-based and one epoxy resin-based sealers. J Endod. 2012 Feb;38(2):219-21.
14. Milani AS, Kuzegari S, Zand V, Mokhtari H, Rahbar M. Ability of Calcium Silicate and Epoxy Resin-based Sealers to Fill the Artificial Lateral Canals in the Presence or Absence of Smear Layer. Maedica (Bucur). 2021 Sep;16(3):458-462.
15. Haïkel Y, Wittenmeyer W, Bateman G, Bentaleb A, Allemann C. A new method for the quantitative analysis of endodontic microleakage. J Endod. 1999 Mar;25(3):172-7.
16. Pisano DM, DiFiore PM, McClanahan SB, Lautenschlager EP, Duncan JL. Intraorifice sealing of gutta-percha obturated root canals to prevent coronal microleakage. J Endod. 1998 Oct;24(10):659-62.
17. Thakur S, Emil J, Paulaian B. Evaluation of mineral trioxide aggregate as root canal sealer: A clinical study. J Conserv Dent. 2013 Nov;16(6):494-8.
18. Asawaworarit W, Pinyosopon T, Kijsamanmith K. Comparison of apical sealing ability of bioceramic sealer and epoxy resin-based sealer using the fluid filtration technique and scanning electron microscopy. J Dent Sci. 2020 Jun;15(2):186-192.
19. Al-Ashou WMO, Al-Shamaa RM, Hassan SS. Sealing Ability of Various Types of Root Canal Sealers at Different Levels of Remaining Gutta Percha After Post Space Preparation at Two Time Intervals. J Int Soc Prev Community Dent. 2021 Nov 30;11(6):721-728.
20. Stabholz A, Friedman S, Abed J. Marginal adaptation of retrograde fillings and its correlation with sealability. J Endod. 1985 May;11(5):218-23.
21. Al-Hezaimi K, Naghshbandi J, Oglesby S, Simon JH, Rotstein I. Human saliva penetration of root canals obturated with two types of mineral trioxide aggregate cements. J Endod. 2005 Jun;31(6):453-6.
22. Lamb EL, Loushine RJ, Weller RN, Kimbrough WF, Pashley DH. Effect of root resection on the apical sealing ability of mineral trioxide aggregate. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Jun;95(6):732-5.
23. Martin RL, Monticelli F, Brackett WW, Loushine RJ, Rockman RA, Ferrari M, et al. Sealing properties of mineral trioxide aggregate orthograde apical plugs and root fillings in an in vitro apexification model. J Endod. 2007 Mar;33(3):272-5.
24. Post LK, Lima FG, Xavier CB, Demarco FF, Gerhardt-Oliveira M. Sealing ability of MTA and amalgam in different root-end preparations and resection bevel angles: an in vitro evaluation using marginal dye leakage. Braz Dent J. 2010;21(5):416-9.
25. Yildirim T, Er K, Taşdemir T, Tahan E, Buruk K, Serper A. Effect of smear layer and root-end cavity thickness on apical sealing ability of MTA as a root-end filling material: a bacterial leakage study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 Jan;109(1):e67-72.
26. Valois CR, Costa ED Jr. Influence of the thickness of mineral trioxide aggregate on sealing ability of root-end fillings in vitro. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Jan;97(1):108-11.
27. Taylor MJ, Lynch E. Microleakage. J Dent. 1992 Feb;20(1):3-10.
28. Afkhami F, Nasri S, Valizadeh S. Bacterial leakage assessment in root canals sealed with AH Plus sealer modified with silver nanoparticles. BMC Oral Health. 2021 Nov 12;21(1):577.
29. Pappen AF, Bravo M, Gonzalez-Lopez S, Gonzalez-Rodriguez MP. An in vitro study of coronal leakage after intraradicular preparation of cast-dowel space. J Prosthet Dent. 2005 Sep;94(3):214-8.
30. Naulakha D, Hussain M, Alam M, Howlader M. An in vitro dye leakage study on apical microleakage of root canal sealers. J Nepal Dent Assoc. 2011;12(1):33-9.
31. Ørstavik D, Nordahl I, Tibballs JE. Dimensional change following setting of root canal sealer materials. Dent Mater. 2001 Nov;17(6):512-9.
32. YaghotiKhorasani M, Norozzadeh Z. Comparison of apical seal of three root canal sealers (AH26, AHPlus and Tubliseal) in root canal obturated by lateral condensation technique. J Mashhad Dent Sch. 2012 Oct;36(3):249-58.
33. Han L, Okiji T. Bioactivity evaluation of three calcium silicate-based endodontic materials. Int Endod J. 2013 Sep;46(9):808-14.
34. Jardine AP, Rosa RA, Santini MF, Wagner M, Só MV, Kuga MC, Pereira JR, Kopper PM. The effect of final irrigation on the penetrability of an epoxy resin-based sealer into dentinal tubules: a confocal microscopy study. Clin Oral Investig. 2016 Jan;20(1):117-23.
35. Torabinejad M, Rastegar AF, Kettering JD, Pitt Ford TR. Bacterial leakage of mineral trioxide aggregate as a root-end filling material. J Endod. 1995 Mar;21(3):109-12.
36. Rosa RA, Bier CAS, Só MVR, Tanomaru JMG, Tanomaru-Filho M. Push-out bond strength of Calcium hydroxide and Mineral Trioxide Aggregate based sealers to root canal dentin. Rev Odonto Cienc. 2012 Oct;27(4):320-4.
37. Dastorani M, Malekpour B, AminSobhani M, Alemrajabi M, Mahdian A, Malekpour B. Comparison of bacterial microleakage of three bioactive endodontic sealers in simulated underwater diving and aviation conditions. BMC Oral Health. 2021 Jul 15;21(1):345.
| Issue | Vol 22 (Continuously Published Article-Based) | |
| Section | Original Article | |
| DOI | https://doi.org/10.18502/fid.v22i53.20713 | |
| Keywords | ||
| Dental Leakage Epoxy Resin AH-26 Mineral trioxide Aggregate | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mokhtari H, Salem Milani A, Yeghaneh Sefidan F, Ejlali M, Abedi A. Apical Microleakage of Endoseal MTA, AH26, and Sure-Seal Root Canal Sealers Using a Bacterial Leakage Model: An In-Vitro Study. Front Dent. 2026;22.
