Retrieval of AH Plus, MTA Fillapex, and Endoseal MTA in Endodontic Retreatment: An in Vitro Cone-Beam Computed Tomography Study
-
Salma Omidi
,
Sadaf Rahmanirad
,
Ali Jafari
,
Mahmood Moosazadeh
,
Hadis Abbaspourrokni
,
Mona Alimohammadi
Abstract
Objectives: Retrievability is an important characteristic for an endodontic sealer. This study compared the retrieval of Endoseal MTA, AH Plus, and MTA Fillapex in endodontic retreatment using cone-beam computed tomography (CBCT).
Materials and Methods: This in vitro study was conducted on 45 radiographically confirmed single-rooted and single-canal mandibular premolars. The root canals were instrumented by the Denco Universal rotary system up to size F3, and randomly divided into 3 groups for the application of either AH Plus, Endoseal MTA, or MTA Fillapex and subsequent root canal obturation. Next, the root filling materials were removed using chloroform solvent and Denco Universal retreatment rotary system. The roots then underwent CBCT with the Gaussian and nonlinear diffusion filters for noise reduction. The residual sealer volume on the root canal walls was quantified on axial CBCT sections using MATLAB R2012 version 14 software. Data were analyzed by the Kruskal-Wallis and Dunn tests (alpha=0.05).
Results: The residual sealer volume was significantly different among the three groups (P<0.001) and was the highest in Endoseal MTA (2.70±2.41mm3). The residual volume of Endoseal MTA sealer was significantly greater than MTA Fillapex (P=0.009). However, the difference between AH Plus and Endoseal MTA (P=0.592), or AH Plus and MTA Fillapex (P=0.352) was not significant.
Conclusion: Within the limitations of this in vitro study and considering the residual sealer volume, retrieval of Endoseal MTA was comparable to that of AH Plus, and lower than that of MTA Fillapex in endodontic retreatment.
1. Athkuri S, Mandava J, Chalasani U, Ravi RC, Munagapati VK, Chennareddy AR. Effect of different obturating techniques and sealers on the removal of filling materials during endodontic retreatment. J Conserv Dent. 2019 Nov-Dec;22(6):578-82.
2. Kim K, Kim DV, Kim SY, Yang S. A micro-computed tomographic study of remaining filling materials of two bioceramic sealers and epoxy resin sealer after retreatment. Restor Dent Endod. 2019 Apr 26;44(2):e18.
3. Rossi-Fedele G, Ahmed HM. Assessment of root canal filling removal effectiveness using micro-computed tomography: A systematic review. J Endod. 2017 Apr;43(4):520-6.
4. Zuolo AS, Mello JE Jr, Cunha RS, Zuolo ML, Bueno CE. Efficacy of reciprocating and rotary techniques for removing filling material during root canal retreatment. Int Endod J. 2013 Oct;46(10):947-53.
5. Mokhtari H, Shahi S, Janani M, Reyhani MF, Mokhtari Zonouzi HR, Rahimi S, et al. Evaluation of apical leakage in root canals obturated with three different sealers in presence or absence of smear layer. Iran Endod J. 2015;10(2):131-4. Epub 2015 Mar 18.
6. Shokrzadeh M, Motafeghi FS, Lotfizadeh A, Ghorbani M, Haddadi Kohsar A. Cytotoxicity and Mineralization Activity of Calcium Silicate-Based Root Canal Sealers Compared to Conventional Resin-Based Sealer in Human Gingival Fibroblast Cells. Int J Dent. 2023 May 31;2023:4376579.
7. Dagna A, Colombo M, Poggio C et al. In vitro antibacterial activity of different bioceramic root canal sealers. Ceramics. 2022,Nov;5(4):901-7.
8. Cirstea AC, Gheorghita L, Diaconu OA et al. Bioceramic-based root canal sealers: a review. Rom J Oral Rehabil. 2020,Jul;12(3):48-54.
9. Silva EJ, Rosa TP, Herrera DR, Jacinto RC, Gomes BP, Zaia AA. Evaluation of cytotoxicity and physicochemical properties of calcium silicate-based endodontic sealer MTA Fillapex. J Endod. 2013 Feb;39(2):274-7.
10. Javidi M, Zarei M, Omidi S, Ghorbani A, Gharechahi M, Shayani Rad M. Cytotoxicity of a New Nano Zinc-Oxide Eugenol Sealer on Murine Fibroblasts. Iran Endod J. 2015 Fall;10(4):231-5.
11. Kangarlou A, Neshandar R, Matini N, Dianat O. Antibacterial efficacy of AH Plus and AH26 sealers mixed with amoxicillin, triple antibiotic paste and nanosilver. J Dent Res Dent Clin Dent Prospects. 2016 Fall;10(4):220-225.
12. Omidi S, Dehghani M, Alimohamadi M, Charati JY, Hashemi RS. Evaluation of dimensional changes in EndoSeal mineral trioxide aggregate and AH Plus sealers using micro-computed tomography imaging. Dent Res J (Isfahan). 2024 Jul 12;21:33.
13. Donnermeyer D, Bunne C, Schäfer E, Dammaschke T. Retreatability of three calcium silicate-containing sealers and one epoxy resin-based root canal sealer with four different root canal instruments. Clin Oral Investig. 2018 Mar;22(2):811-7.
14. Adl A, Sadat Shojaee N, Pourhatami N. Evaluation of the Dislodgement Resistance of a New Pozzolan-Based Cement (EndoSeal MTA) Compared to ProRoot MTA and Biodentine in the Presence and Absence of Blood. Scanning. 2019 May 9;2019:3863069.
15. Yoo YJ, Baek SH, Kum KY, Shon WJ, Woo KM, Lee W. Dynamic intratubular biomineralization following root canal obturation with pozzolan-based mineral trioxide aggregate sealer cement. Scanning. 2016 Jan-Feb;38(1):50-6.
16. Akbulut MB, Akman M, Terlemez A, Magat G, Sener S, Shetty H. Efficacy of twisted file adaptive, reciproc and protaper universal retreatment instruments for root-canal-filling removal: a cone-beam computed tomography study. Dent Mater J. 2016;35(1):126-31.
17. Venskutonis T, Plotino G, Juodzbalys G, Mickevičienė L. The importance of cone-beam computed tomography in the management of endodontic problems: a review of the literature. J Endod. 2014 Dec;40(12):1895-901.
18. Neelakantan P, Grotra D, Sharma S. Retreatability of 2 mineral trioxide aggregate-based root canal sealers: a cone-beam computed tomography analysis. J Endod. 2013 Jul;39(7):893-6.
19. Kim SR, Kwak SW, Lee JK, Goo HJ, Ha JH, Kim HC. Efficacy and retrievability of root canal filling using calcium silicate-based and epoxy resin-based root canal sealers with matched obturation techniques. Aust Endod J. 2019 Dec;45(3):337-45.
20. Alsubait S, Alhathlol N, Alqedairi A, Alfawaz H. A micro-computed tomographic evaluation of retreatability of BioRoot RCS in comparison with AH Plus. Aust Endod J. 2021 Aug;47(2):222-7.
21. Omidi S, Ahadian A, Hadidi G, Mousavi SJ, Forghani M. Evaluation of dentin adaptability of fluoride varnish as a root canal sealer using scanning electron microscopy. Front Dent. 2019 Sep-Oct;16(5):335-41.
22. Sharma S, Raghu R, Shetty A et al. An in vitro comparative evaluation of retreatability of a bioceramic and resin sealer using cone-beam computed tomography analysis. Endodontology. 2022,Jul;34(3):173-9.
23. Zare S, Shen I, Zhu Q, Ahn C, Primus C, Komabayashi T. Micro-computed tomographic evaluation of single-cone obturation with three sealers. Restor Dent Endod. 2021 Apr 16;46(2):e25.
24. Miyashita H, Asaumi R, Sakamoto A, Kawai T, Igarashi M. Root canal sealers affect artifacts on cone-beam computed tomography images. Odontology. 2021 Jul;109(3):679-86.
25. Yavari H, Shahi S, Galledar S, Samiei M, Janani M. Effect of retreatment on the push-out bond strength of MTA-based and epoxy resin-based endodontic sealers. J Dent Res Dent Clin Dent Prospects. 2017 Winter;11(1):43-7.
26. Donyavi Z, Shokri A, Pakseresht Z et al. Comparative evaluation of retreatability of endodontically treated teeth using AH 26, fluoride varnish and mineral trioxide aggregate-based endodontic sealers. Open Dent J. 2019,May;13(1).
27. Alsofi L, Rajkhan W, Al-Habib M, Ashe H, Alnowailaty Y, Balto K. Characterization of the differential efficacy of austenitic vs martensitic NiTi rotary files in non-surgical root canal retreatment: a micro-CT analysis. Front Biosci (Landmark Ed). 2021 Sep 30;26(9):465-74.
28. Yang R, Han Y, Liu Z, Xu Z, Liu H, Wei X. Comparison of the efficacy of laser-activated and ultrasonic-activated techniques for the removal of tricalcium silicate-based sealers and gutta-percha in root canal retreatment: a microtomography and scanning electron microscopy study. BMC Oral Health. 2021 May 22;21(1):275.
29. Neelakantan P, Subbarao C, Subbarao CV. Comparative evaluation of modified canal staining and clearing technique, cone-beam computed tomography, peripheral quantitative computed tomography, spiral computed tomography, and plain and contrast medium-enhanced digital radiography in studying root canal morphology. J Endod. 2010 Sep;36(9):1547-51
30. Colmenar D, Tamula T, Zhu Q, Ahn C, Primus C, Komabayashi T. Micro CT pilot evaluation of removability of two endodontic sealers. J Oral Sci. 2021 Oct 1;63(4):306-9.
31. Singh G, Gupta I, Elshamy FMM, Boreak N, Homeida HE. In vitro comparison of antibacterial properties of bioceramic-based sealer, resin-based sealer and zinc oxide eugenol based sealer and two mineral trioxide aggregates. Eur J Dent. 2016 Jul-Sep;10(3):366-9.
32. Kim H, Kim E, Lee SJ, Shin SJ. Comparisons of the retreatment efficacy of calcium silicate and epoxy resin-based sealers and residual sealer in dentinal tubules. J Endod. 2015 Dec;41(12):2025-30.
33. Gomes-Cornélio AL, Rodrigues EM, Salles LP, Mestieri LB, Faria G, Guerreiro-Tanomaru JM, Tanomaru-Filho M. Bioactivity of MTA Plus, Biodentine and an experimental calcium silicate-based cement on human osteoblast-like cells. Int Endod J. 2017 Jan;50(1):39-47.
34. Oltra E, Cox TC, LaCourse MR, Johnson JD, Paranjpe A. Retreatability of two endodontic sealers, EndoSequence BC Sealer and AH Plus: a micro-computed tomographic comparison. Restor Dent Endod. 2017 Feb;42(1):19-26.
35. Bhavana V, Chaitanya KP, Gandi P, Patil J, Dola B, Reddy RB. Evaluation of antibacterial and antifungal activity of new calcium-based cement (Biodentine) compared to MTA and glass ionomer cement. J Conserv Dent. 2015 Jan-Feb;18(1):44-6.
36. Reszka P, Grocholewicz K, Droździk A et al. Evaluation of the radiopacity of selected calcium-silicate root canal sealers. Pomeranian J Life Sci. 2019,Dec;65(4):17-24.
37. Kim JC, Moe MMK, Kim SK. A micro-computed tomographic evaluation of root canal filling with a single gutta-percha cone and calcium silicate sealer. Restor Dent Endod. 2020 Feb 12;45(2):e18.
38. Henrique Borges A, Aguirre Guedes O, Evaristo Ricci Volpato L, Siebert Filho G, Meireles Borba A, Zina O, et al.physicochemical properties of mta and portland cement after addition of aloe vera. Iran Endod J. 2017 Summer;12(3):312-17.
39. Almeida LH, Gomes APN, Gastmann AH, Pola NM, Moraes RR, Morgental RD, et al. Bone tissue response to an MTA-based endodontic sealer, and the effect of the addition of calcium aluminate and silver particles. Int Endod J. 2019 Oct;52(10):1446-56.
2. Kim K, Kim DV, Kim SY, Yang S. A micro-computed tomographic study of remaining filling materials of two bioceramic sealers and epoxy resin sealer after retreatment. Restor Dent Endod. 2019 Apr 26;44(2):e18.
3. Rossi-Fedele G, Ahmed HM. Assessment of root canal filling removal effectiveness using micro-computed tomography: A systematic review. J Endod. 2017 Apr;43(4):520-6.
4. Zuolo AS, Mello JE Jr, Cunha RS, Zuolo ML, Bueno CE. Efficacy of reciprocating and rotary techniques for removing filling material during root canal retreatment. Int Endod J. 2013 Oct;46(10):947-53.
5. Mokhtari H, Shahi S, Janani M, Reyhani MF, Mokhtari Zonouzi HR, Rahimi S, et al. Evaluation of apical leakage in root canals obturated with three different sealers in presence or absence of smear layer. Iran Endod J. 2015;10(2):131-4. Epub 2015 Mar 18.
6. Shokrzadeh M, Motafeghi FS, Lotfizadeh A, Ghorbani M, Haddadi Kohsar A. Cytotoxicity and Mineralization Activity of Calcium Silicate-Based Root Canal Sealers Compared to Conventional Resin-Based Sealer in Human Gingival Fibroblast Cells. Int J Dent. 2023 May 31;2023:4376579.
7. Dagna A, Colombo M, Poggio C et al. In vitro antibacterial activity of different bioceramic root canal sealers. Ceramics. 2022,Nov;5(4):901-7.
8. Cirstea AC, Gheorghita L, Diaconu OA et al. Bioceramic-based root canal sealers: a review. Rom J Oral Rehabil. 2020,Jul;12(3):48-54.
9. Silva EJ, Rosa TP, Herrera DR, Jacinto RC, Gomes BP, Zaia AA. Evaluation of cytotoxicity and physicochemical properties of calcium silicate-based endodontic sealer MTA Fillapex. J Endod. 2013 Feb;39(2):274-7.
10. Javidi M, Zarei M, Omidi S, Ghorbani A, Gharechahi M, Shayani Rad M. Cytotoxicity of a New Nano Zinc-Oxide Eugenol Sealer on Murine Fibroblasts. Iran Endod J. 2015 Fall;10(4):231-5.
11. Kangarlou A, Neshandar R, Matini N, Dianat O. Antibacterial efficacy of AH Plus and AH26 sealers mixed with amoxicillin, triple antibiotic paste and nanosilver. J Dent Res Dent Clin Dent Prospects. 2016 Fall;10(4):220-225.
12. Omidi S, Dehghani M, Alimohamadi M, Charati JY, Hashemi RS. Evaluation of dimensional changes in EndoSeal mineral trioxide aggregate and AH Plus sealers using micro-computed tomography imaging. Dent Res J (Isfahan). 2024 Jul 12;21:33.
13. Donnermeyer D, Bunne C, Schäfer E, Dammaschke T. Retreatability of three calcium silicate-containing sealers and one epoxy resin-based root canal sealer with four different root canal instruments. Clin Oral Investig. 2018 Mar;22(2):811-7.
14. Adl A, Sadat Shojaee N, Pourhatami N. Evaluation of the Dislodgement Resistance of a New Pozzolan-Based Cement (EndoSeal MTA) Compared to ProRoot MTA and Biodentine in the Presence and Absence of Blood. Scanning. 2019 May 9;2019:3863069.
15. Yoo YJ, Baek SH, Kum KY, Shon WJ, Woo KM, Lee W. Dynamic intratubular biomineralization following root canal obturation with pozzolan-based mineral trioxide aggregate sealer cement. Scanning. 2016 Jan-Feb;38(1):50-6.
16. Akbulut MB, Akman M, Terlemez A, Magat G, Sener S, Shetty H. Efficacy of twisted file adaptive, reciproc and protaper universal retreatment instruments for root-canal-filling removal: a cone-beam computed tomography study. Dent Mater J. 2016;35(1):126-31.
17. Venskutonis T, Plotino G, Juodzbalys G, Mickevičienė L. The importance of cone-beam computed tomography in the management of endodontic problems: a review of the literature. J Endod. 2014 Dec;40(12):1895-901.
18. Neelakantan P, Grotra D, Sharma S. Retreatability of 2 mineral trioxide aggregate-based root canal sealers: a cone-beam computed tomography analysis. J Endod. 2013 Jul;39(7):893-6.
19. Kim SR, Kwak SW, Lee JK, Goo HJ, Ha JH, Kim HC. Efficacy and retrievability of root canal filling using calcium silicate-based and epoxy resin-based root canal sealers with matched obturation techniques. Aust Endod J. 2019 Dec;45(3):337-45.
20. Alsubait S, Alhathlol N, Alqedairi A, Alfawaz H. A micro-computed tomographic evaluation of retreatability of BioRoot RCS in comparison with AH Plus. Aust Endod J. 2021 Aug;47(2):222-7.
21. Omidi S, Ahadian A, Hadidi G, Mousavi SJ, Forghani M. Evaluation of dentin adaptability of fluoride varnish as a root canal sealer using scanning electron microscopy. Front Dent. 2019 Sep-Oct;16(5):335-41.
22. Sharma S, Raghu R, Shetty A et al. An in vitro comparative evaluation of retreatability of a bioceramic and resin sealer using cone-beam computed tomography analysis. Endodontology. 2022,Jul;34(3):173-9.
23. Zare S, Shen I, Zhu Q, Ahn C, Primus C, Komabayashi T. Micro-computed tomographic evaluation of single-cone obturation with three sealers. Restor Dent Endod. 2021 Apr 16;46(2):e25.
24. Miyashita H, Asaumi R, Sakamoto A, Kawai T, Igarashi M. Root canal sealers affect artifacts on cone-beam computed tomography images. Odontology. 2021 Jul;109(3):679-86.
25. Yavari H, Shahi S, Galledar S, Samiei M, Janani M. Effect of retreatment on the push-out bond strength of MTA-based and epoxy resin-based endodontic sealers. J Dent Res Dent Clin Dent Prospects. 2017 Winter;11(1):43-7.
26. Donyavi Z, Shokri A, Pakseresht Z et al. Comparative evaluation of retreatability of endodontically treated teeth using AH 26, fluoride varnish and mineral trioxide aggregate-based endodontic sealers. Open Dent J. 2019,May;13(1).
27. Alsofi L, Rajkhan W, Al-Habib M, Ashe H, Alnowailaty Y, Balto K. Characterization of the differential efficacy of austenitic vs martensitic NiTi rotary files in non-surgical root canal retreatment: a micro-CT analysis. Front Biosci (Landmark Ed). 2021 Sep 30;26(9):465-74.
28. Yang R, Han Y, Liu Z, Xu Z, Liu H, Wei X. Comparison of the efficacy of laser-activated and ultrasonic-activated techniques for the removal of tricalcium silicate-based sealers and gutta-percha in root canal retreatment: a microtomography and scanning electron microscopy study. BMC Oral Health. 2021 May 22;21(1):275.
29. Neelakantan P, Subbarao C, Subbarao CV. Comparative evaluation of modified canal staining and clearing technique, cone-beam computed tomography, peripheral quantitative computed tomography, spiral computed tomography, and plain and contrast medium-enhanced digital radiography in studying root canal morphology. J Endod. 2010 Sep;36(9):1547-51
30. Colmenar D, Tamula T, Zhu Q, Ahn C, Primus C, Komabayashi T. Micro CT pilot evaluation of removability of two endodontic sealers. J Oral Sci. 2021 Oct 1;63(4):306-9.
31. Singh G, Gupta I, Elshamy FMM, Boreak N, Homeida HE. In vitro comparison of antibacterial properties of bioceramic-based sealer, resin-based sealer and zinc oxide eugenol based sealer and two mineral trioxide aggregates. Eur J Dent. 2016 Jul-Sep;10(3):366-9.
32. Kim H, Kim E, Lee SJ, Shin SJ. Comparisons of the retreatment efficacy of calcium silicate and epoxy resin-based sealers and residual sealer in dentinal tubules. J Endod. 2015 Dec;41(12):2025-30.
33. Gomes-Cornélio AL, Rodrigues EM, Salles LP, Mestieri LB, Faria G, Guerreiro-Tanomaru JM, Tanomaru-Filho M. Bioactivity of MTA Plus, Biodentine and an experimental calcium silicate-based cement on human osteoblast-like cells. Int Endod J. 2017 Jan;50(1):39-47.
34. Oltra E, Cox TC, LaCourse MR, Johnson JD, Paranjpe A. Retreatability of two endodontic sealers, EndoSequence BC Sealer and AH Plus: a micro-computed tomographic comparison. Restor Dent Endod. 2017 Feb;42(1):19-26.
35. Bhavana V, Chaitanya KP, Gandi P, Patil J, Dola B, Reddy RB. Evaluation of antibacterial and antifungal activity of new calcium-based cement (Biodentine) compared to MTA and glass ionomer cement. J Conserv Dent. 2015 Jan-Feb;18(1):44-6.
36. Reszka P, Grocholewicz K, Droździk A et al. Evaluation of the radiopacity of selected calcium-silicate root canal sealers. Pomeranian J Life Sci. 2019,Dec;65(4):17-24.
37. Kim JC, Moe MMK, Kim SK. A micro-computed tomographic evaluation of root canal filling with a single gutta-percha cone and calcium silicate sealer. Restor Dent Endod. 2020 Feb 12;45(2):e18.
38. Henrique Borges A, Aguirre Guedes O, Evaristo Ricci Volpato L, Siebert Filho G, Meireles Borba A, Zina O, et al.physicochemical properties of mta and portland cement after addition of aloe vera. Iran Endod J. 2017 Summer;12(3):312-17.
39. Almeida LH, Gomes APN, Gastmann AH, Pola NM, Moraes RR, Morgental RD, et al. Bone tissue response to an MTA-based endodontic sealer, and the effect of the addition of calcium aluminate and silver particles. Int Endod J. 2019 Oct;52(10):1446-56.
| Issue | Vol 22 (Continuously Published Article-Based) | |
| Section | Original Article | |
| Keywords | ||
| Epoxy Resin-Based Root Canal Sealer Cone-Beam Computed Tomography Retreatment | ||
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How to Cite
1.
Omidi S, Rahmanirad S, Jafari A, Moosazadeh M, Abbaspourrokni H, Alimohammadi M. Retrieval of AH Plus, MTA Fillapex, and Endoseal MTA in Endodontic Retreatment: An in Vitro Cone-Beam Computed Tomography Study. Front Dent. 2025;22.
