Dentinal Tubule Penetration of Various Root Canal Sealers after Removal of Calcium Hydroxide Intracanal Medicament: An In Vitro Confocal Laser Scanning Microscopic Study
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Abstract
Objectives: This study compared the penetration depth of three different root canal sealers—AH Plus resin-based, Apexit Plus calcium hydroxide (CH)-based, and BioRoot RCS bioceramic-based sealers—into dentin after removal of CH intracanal medicament.
Materials and Methods: In this in vitro study, 60 extracted single-rooted mandibular premolars were decoronated with a diamond disc under water cooling to a standard length of 16mm; 12 samples were selected as control, and the rest received CH mixed with rhodamine dye as an intracanal medicament. Two weeks later, CH was removed by manual filing and irrigant activation using EndoActivator. Samples were then divided into 3 groups (n=12) depending upon the sealer used as AH Plus, Apexit Plus, and Bioroot RCS sealer. All sealers were combined with fluorescein dye, and obturation was performed using F3 gutta-percha with lateral compaction technique. After 2 weeks, the teeth were transversally sectioned into coronal, middle, and apical thirds. The penetration depth of sealers was measured via an imaging software. Statistical analysis was performed using ANOVA followed by the Tukey’s post-hoc test (alpha=0.05).
Results: A statistically significant difference was observed among the groups (P<0.05). The penetration depth of sealers was the lowest in the apical third, and the highest in the coronal third in all three groups. BioRoot RCS showed the highest penetration depth at all three levels, despite CH medicament remnants.
Conclusion: Bioroot RCS bioceramic sealer was superior to AH Plus resin-based and Apexit Plus CH-based sealers regarding penetration depth into dentin after removal of CH intracanal medicament.
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2. Ordinola-Zapata R, Bramante CM, Graeff MS, del Carpio Perochena A, Vivan RR, Camargo EJ, et al. Depth and percentage of penetration of endodontic sealers into dentinal tubules after root canal obturation using a lateral compaction technique: a confocal laser scanning microscopy study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Sep;108(3):450-7.
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11. De-Deus G, Gurgel-Filho ED, Maniglia-Ferreira C, Coutinho-Filho T. Influence of the filling technique on depth of tubular penetration of root canal sealer: scanning electron microscopy study. Braz J Oral Sci. 2004 Jan;3(9):433-8.
12. Aayushi A, Dax R. Calcium hydroxide in endodontics. J Appl Dent Med Sci. 2016 Jul-Sep;2(3):78-88.
13. Khalap ND, Kokate S, Hegde V. Ultrasonic versus sonic activation of the final irrigant in root canals instrumented with rotary/reciprocating files: an in-vitro scanning electron microscopy analysis. J Conserv Dent. 2016 Jul-Aug;19(4):368-72.
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15. Taşdemir T, Celik D, Er K, Yildirim T, Ceyhanli KT, Yeşilyurt C. Efficacy of several techniques for the removal of calcium hydroxide medicament from root canals. Int Endod J. 2011 Jun;44(6):505-9.
16. Torres D, González-Rodríguez MP, Ferrer-Luque CM. Effectiveness of Endoactivator System in removing the smear layer after root canal instrumentation. J Endod. 2010 Feb;36(2):308-11.
17. Alturaiki S, Lamphon H, Edrees H, Ahlquist M. Efficacy of 3 different irrigation systems on removal of calcium hydroxide from the root canal: a scanning electron microscopic study. J Endod. 2015 Jan;41(1):97-101.
18. Parikh M, Kishan KV, Solanki NP, Parikh M, Savaliya K, Bindu VH, et al. Efficacy of removal of calcium hydroxide medicament from root canals by endoactivator and endovac irrigation techniques: a systematic review of in vitro studies. Contemp Clin Dent. 2019 Jan-Mar;10(1):135-42.
19. Gupta R, Sharma H, Kumari RA, Prakash AC, Rai N, Jain L. Effectiveness of two techniques in removal of calcium hydroxide medicament from root canals: an in-vitro assessment. J Clin Diagn Res. 2018 Jul;12(7):ZC53-5.
20. Bharti R, Tikku AP, Chandra A, Shakya VK, Yadav S. Depth and percentage of resin-based sealer penetration inside the dentinal tubules using Endovac, Endoactivator, Navi tip FX irrigation system: a confocal laser scanning microscope study. J Conserv Dent. 2018 Mar-Apr;21(2):216-20.
21. Komabayashi T, Colmenar D, Cvach N, Bhat A, Primus C, Imai Y. Comprehensive review of current endodontic sealers. Dent Mater J. 2020 Sep;39(5):703-20.
22. Rai RU, Singbal KP, Parekh V. The effect of temperature on rheological properties of endodontic sealers. J Conserv Dent. 2016 Mar-Apr;19(2):116-9.
23. Pius A, Mathew J, Theruvil R, George S, Paul M, Baby A, et al. In vitro study of dentinal tubule penetration and filling quality of bioceramic sealer. Cons Dent Endod J. 2019 Jan-Jun;4:6-13.
24. Wang Y, Liu S, Dong Y. In vitro study of dentinal tubule penetration and filling quality of bioceramic sealer. PLoS One. 2018 Feb;13(2):e0192248.
25. Sonu KR, Girish TN, Ponnappa KC, Kishan KV, Thameem PK. Comparative evaluation of dentinal penetration of three different endodontic sealers with and without smear layer removal – scanning electron microscopic study. Saudi Endod J. 2016 Jan-Apr;6(1):16-20.
26. Chen H, Zhao X, Qiu Y, Xu D, Cui L, Wu B. The tubular penetration depth and adaption of four sealers: a scanning electron microscopic study. Biomed Res Int. 2017;2017:2946524.
27. Arikatla SK, Chalasani U, Mandava J, Yelisela RK. Interfacial adaptation and penetration depth of bioceramic endodontic sealers. J Conserv Dent. 2018 Jul-Aug;21(4):373-7.
28. Shieh K, Yang J, Zhu EH, Peters OA, Hosseinpour S. Dentinal tubule penetrability and bond strength of two novel calcium silicate-based root canal sealers. Materials. 2023 Apr;16(9):3309.
29. Khullar S, Aggarwal A, Chhina H, Kaur T, Sharma M, Bala D. Sealer penetration in the dentinal tubules: a confocal laser scanning microscopy study. Endodontology. 2021 Apr;33(2):92-6.
30. Dsouza AP, Suvarna N, Shetty SH, Farhana F, Syed AA. To compare and evaluate the sealing ability of Guttaflow bioseal, Bioroot RCS and MTA fillapex with AH plus: an in vitro study. IOSR-JDMS. 2020 Aug;9(8):43-9.
2. Ordinola-Zapata R, Bramante CM, Graeff MS, del Carpio Perochena A, Vivan RR, Camargo EJ, et al. Depth and percentage of penetration of endodontic sealers into dentinal tubules after root canal obturation using a lateral compaction technique: a confocal laser scanning microscopy study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Sep;108(3):450-7.
3. Wang Y, Guo LY, Fang HZ, Zou WL, Yang YM, Gao Y, et al. An in vitro study on the efficacy of removng calcium hydroxide from curved root canal systems in root canal therapy. Int J Oral Sci. 2017 Jun;9(2):110-6.
4. Pawar SS, Pujar MA, Makandar SD. Evaluation of the apical sealing ability of bioceramic sealer- AH Plus & epiphany: an in vitro study. J Conserv Dent. 2014 Nov-Dec;17(6):579-82.
5. Silva RV, Silveira FF, Horta MC, Duarte MA, Cavenago BC, Morais IG, et al. Filling effectiveness and dentinal penetration of endodontic sealers: a stereo and confocal laser scanning microscopy study. Braz Dent J. 2015 Sep-Oct;26(5):541-6.
6. Uzunoğlu-Özyürek E, Erdoğan Ö, Türker S. Effect of Calcium Hydroxide Dressing on the Dentinal Tubule Penetration of 2 Different Root Canal Sealers: A Confocal Laser Scanning Microscopic Study. J Endod. 2018 Jun;44(6):1030-5
7. Haragushiku GA, Sousa-Neto MD, Silva-Sousa YT, Alfredo E, Silva SC, Silva RG. Adhesion of endodontic sealers to human root dentine submitted to different surface treatments. Photomed Laser Surg. 2010 Jun;28(3):405-10.
8. Siboni F, Taddei P, Zamparini F, Prati C, Gandolfi MG. Properties of BioRoot RCS, a tricalcium silicate endodontic sealer modified with povidone and polycarboxylate. Int Endod J. 2017 Dec;50 Suppl 2:e120-e136.
9. Kumar A, Tamanna S, Iftekhar H. Intracanal medicaments – Their use in modern endodontics: a narrative review. J Oral Res Rev. 2019 Jul-Dec;11:94-9.
10. Ba-Hattab R, Al-Jamie M, Aldreib H, Alessa L, Alonazi M. Calcium hydroxide in endodontics: an overview. Open J Stomatol. 2016 Dec;6(12):274-89.
11. De-Deus G, Gurgel-Filho ED, Maniglia-Ferreira C, Coutinho-Filho T. Influence of the filling technique on depth of tubular penetration of root canal sealer: scanning electron microscopy study. Braz J Oral Sci. 2004 Jan;3(9):433-8.
12. Aayushi A, Dax R. Calcium hydroxide in endodontics. J Appl Dent Med Sci. 2016 Jul-Sep;2(3):78-88.
13. Khalap ND, Kokate S, Hegde V. Ultrasonic versus sonic activation of the final irrigant in root canals instrumented with rotary/reciprocating files: an in-vitro scanning electron microscopy analysis. J Conserv Dent. 2016 Jul-Aug;19(4):368-72.
14. Plotino G, Cortese T, Grande NM, Leonardi DP, Di Giorgio G, Testarelli L, et al. New technologies to improve root canal disinfection. Braz Dent J. 2016 Jan-Feb;27(1):3-8.
15. Taşdemir T, Celik D, Er K, Yildirim T, Ceyhanli KT, Yeşilyurt C. Efficacy of several techniques for the removal of calcium hydroxide medicament from root canals. Int Endod J. 2011 Jun;44(6):505-9.
16. Torres D, González-Rodríguez MP, Ferrer-Luque CM. Effectiveness of Endoactivator System in removing the smear layer after root canal instrumentation. J Endod. 2010 Feb;36(2):308-11.
17. Alturaiki S, Lamphon H, Edrees H, Ahlquist M. Efficacy of 3 different irrigation systems on removal of calcium hydroxide from the root canal: a scanning electron microscopic study. J Endod. 2015 Jan;41(1):97-101.
18. Parikh M, Kishan KV, Solanki NP, Parikh M, Savaliya K, Bindu VH, et al. Efficacy of removal of calcium hydroxide medicament from root canals by endoactivator and endovac irrigation techniques: a systematic review of in vitro studies. Contemp Clin Dent. 2019 Jan-Mar;10(1):135-42.
19. Gupta R, Sharma H, Kumari RA, Prakash AC, Rai N, Jain L. Effectiveness of two techniques in removal of calcium hydroxide medicament from root canals: an in-vitro assessment. J Clin Diagn Res. 2018 Jul;12(7):ZC53-5.
20. Bharti R, Tikku AP, Chandra A, Shakya VK, Yadav S. Depth and percentage of resin-based sealer penetration inside the dentinal tubules using Endovac, Endoactivator, Navi tip FX irrigation system: a confocal laser scanning microscope study. J Conserv Dent. 2018 Mar-Apr;21(2):216-20.
21. Komabayashi T, Colmenar D, Cvach N, Bhat A, Primus C, Imai Y. Comprehensive review of current endodontic sealers. Dent Mater J. 2020 Sep;39(5):703-20.
22. Rai RU, Singbal KP, Parekh V. The effect of temperature on rheological properties of endodontic sealers. J Conserv Dent. 2016 Mar-Apr;19(2):116-9.
23. Pius A, Mathew J, Theruvil R, George S, Paul M, Baby A, et al. In vitro study of dentinal tubule penetration and filling quality of bioceramic sealer. Cons Dent Endod J. 2019 Jan-Jun;4:6-13.
24. Wang Y, Liu S, Dong Y. In vitro study of dentinal tubule penetration and filling quality of bioceramic sealer. PLoS One. 2018 Feb;13(2):e0192248.
25. Sonu KR, Girish TN, Ponnappa KC, Kishan KV, Thameem PK. Comparative evaluation of dentinal penetration of three different endodontic sealers with and without smear layer removal – scanning electron microscopic study. Saudi Endod J. 2016 Jan-Apr;6(1):16-20.
26. Chen H, Zhao X, Qiu Y, Xu D, Cui L, Wu B. The tubular penetration depth and adaption of four sealers: a scanning electron microscopic study. Biomed Res Int. 2017;2017:2946524.
27. Arikatla SK, Chalasani U, Mandava J, Yelisela RK. Interfacial adaptation and penetration depth of bioceramic endodontic sealers. J Conserv Dent. 2018 Jul-Aug;21(4):373-7.
28. Shieh K, Yang J, Zhu EH, Peters OA, Hosseinpour S. Dentinal tubule penetrability and bond strength of two novel calcium silicate-based root canal sealers. Materials. 2023 Apr;16(9):3309.
29. Khullar S, Aggarwal A, Chhina H, Kaur T, Sharma M, Bala D. Sealer penetration in the dentinal tubules: a confocal laser scanning microscopy study. Endodontology. 2021 Apr;33(2):92-6.
30. Dsouza AP, Suvarna N, Shetty SH, Farhana F, Syed AA. To compare and evaluate the sealing ability of Guttaflow bioseal, Bioroot RCS and MTA fillapex with AH plus: an in vitro study. IOSR-JDMS. 2020 Aug;9(8):43-9.
| Issue | Vol 23 (Continuously Published Article-Based) | |
| Section | Original Article | |
| Keywords | ||
| Calcium Hydroxide Epoxy Resin-Based Root Canal Sealer Microscopy Confocal | ||
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How to Cite
1.
Patil S, Patil C, Medha A, Patil N, Karade P. Dentinal Tubule Penetration of Various Root Canal Sealers after Removal of Calcium Hydroxide Intracanal Medicament: An In Vitro Confocal Laser Scanning Microscopic Study. Front Dent. 2026;23.
