|Year : 2017 | Volume
| Issue : 2 | Page : 146-150
An in vitro comparative analysis of sealing ability of bioceramic-based, methacrylate-based, and epoxy resin-based sealers
Mariyam Hasnain, Parul Bansal, Vineeta Nikhil
Department of Conservative Dentistry and Endodontics, Subharti Dental College, Meerut, Uttar Pradesh, India
|Date of Web Publication||6-Nov-2017|
58/6, Jagriti Vihar, Meerut, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Aim: The aim of this study is to evaluate and compare the apical sealing ability of new bioceramic-based (TotalFill BC) and methacrylate-based (Hybrid Root SEAL) sealers with epoxy resin-based (AH Plus) sealer using a dye penetration method.
Materials and Methods: A total of 74 extracted mandibular premolars were selected and decoronated to the root length of 14 mm. The root canals were prepared using high flex to size 35, 0.06 taper to the working length. After completion of the biomechanical preparation of root canal, samples were divided into four experimental groups (n = 16) and two control groups (n = 5). Experimental groups were obturated as follows - Group A: Obturated with AH Plus + 6% conventional gutta-percha, Group B: Obturated with TotalFill BC + 6% conventional gutta-percha, Group C: Obturated with TotalFill BC + 6% bioceramic gutta-percha, and Group D: Obturated with Hybrid Root SEAL + 6% conventional gutta-percha.
Results: The best results were obtained with TotalFill BC with bioceramic gutta-percha followed by TotalFill BC with conventional gutta-percha, AH Plus, and Hybrid Root SEAL.
Conclusion: Bioceramic sealer with bioceramic gutta-percha or conventional gutta-percha provides comparable sealing ability to AH Plus and superior to Hybrid Root SEAL.
Keywords: AH Plus, Hybrid Root SEAL, microleakage, sealing ability, TotalFill BC
|How to cite this article:|
Hasnain M, Bansal P, Nikhil V. An in vitro comparative analysis of sealing ability of bioceramic-based, methacrylate-based, and epoxy resin-based sealers. Endodontology 2017;29:146-50
|How to cite this URL:|
Hasnain M, Bansal P, Nikhil V. An in vitro comparative analysis of sealing ability of bioceramic-based, methacrylate-based, and epoxy resin-based sealers. Endodontology [serial online] 2017 [cited 2020 Mar 31];29:146-50. Available from: http://www.endodontologyonweb.org/text.asp?2017/29/2/146/217702
| Introduction|| |
The three-dimensional obturation of the root canal system is widely accepted as a key factor for successful endodontic therapy. A variety of materials are available for root canal obturations; however, the gutta-percha cones along with the sealer remain the most accepted choice of the clinician. Different types of sealers have been used in conjunction with gutta-percha for root canal obturation with varied success.
Ideally, the root canal sealer should be capable of creating an effective bond to the core material and the dentin of the root canal to prevent microleakage at interface. Epoxy resin-based sealers have shown good physiochemical properties as well as excellent apical sealing. AH Plus is an epoxy-bisphenol resin-based sealer that also contains adamantine and bonds to root canal. Although at present, epoxy resin-based sealers (AH Plus) have gained popularity, no material fulfills all the properties to hermetically seal the root canal system.
Bioceramics are inorganic, nonmetallic, biocompatible materials that have mechanical properties similar to dental hard tissues. They are chemically stable, noncorrosive, and interact well with organic tissue. Newer Bioceramic sealers such as TotalFill BC (BUSA, Brasseler, USA) possess very high bond strength with dentin walls by formation of hydroxyapatite crystals.
Hybrid Root SEAL (Sun Medical Co. Ltd., Japan) is a commercially available fourth-generation self-adhesive dual-cure sealer. It is an insoluble, radiopaque material that can be used either with resilon or gutta-percha. Four-META present in the liquid is able to promote monomer diffusion into the acid conditioned and underlying intact dentin and produces functional hybridized dentin with polymerization., The formation of hybrid dentin is the major mechanism of bonding and resist acid challenges.
Presentin vitro study was conducted to evaluate and compare the apical sealing ability of two new bioceramic-based (TotalFill BC) and methacrylate-based (Hybrid Root SEAL) sealers with epoxy resin-based (AH Plus) sealer, which is considered the gold standard in term of sealing and adhesion to dentin.
| Materials and Methods|| |
Noncarious, intact, extracted mandibular premolar teeth with single root and single canal were collected. Soft tissue deposits and calculus were removed with an ultrasonic scaler. Teeth were optically inspected under stereomicroscope for the presence of any crack or resorption areas. Teeth with root fractures, root caries, evidence of periapical resorptive processes, or multiple canals were excluded from the study. Preoperative cone-beam computed tomography was done to assess the presence of a single canal, and the teeth presented with variation were discarded. Seventy-four selected teeth were stored in chloramine-T solution for 24 h followed by normal saline till used in the study within 3 months.
Root canal preparation
Selected teeth were decoronated, to obtain a standardized root length of 14 mm using water-cooled double-sided diamond disc along with the straight handpiece and micromotor. The decoronated samples had visible canal orifices through which a # 10 K-file (Dentsply Malliefer, Ballaigues, Switzerland) was inserted to check the patency of the canal. A # 15 K-file with a rubber stopper was introduced into the root canal until the tip of the file was just visible at the apical foramen. The length of file was determined by measuring the length from file tip to stopper, and the working length was established by reducing 0.5 mm from this length; these readings were registered as actual working length. To prevent the escape of irrigants from the apex by simulating a clinical situation, the apex was sealed with aluminum foil coated with molten wax, simulating the clinical conditions.
The root canals were prepared using high flex to size 35, 0.06 taper to the working length. The manufacturer instructions were followed for the sequence of instrument, speed, and the torque to be used for biomechanical preparation. Between the use of each instrument, the canals were irrigated with 5.25% sodium hypochlorite solution using Max-i-Probe (Dentsply Maillefer). During the biomechanical preparation, the canal patency was maintained by #10 K-file. After the use of the last file, the roots were irrigated with physiological saline and dried with paper points, and thereafter, canals were irrigated with 5 mL of 17% ethylenediaminetetraacetic acid (EDTA) for 1 min as a rinse to remove the smear layer. To remove the remaining NaOCl and EDTA solution, final irrigation was done using 5 mL normal saline. Thereafter, the roots were dried with corresponding paper points. This protocol was employed for all the teeth experimental as well as for control group.
After completion of the biomechanical preparation of root canal, samples were obturated except for teeth of positive and negative control group. Experimental teeth were randomly divided into four groups (n = 16). Group A: 6% Conventional gutta-percha along with AH Plus sealer was used in this group. Group B: 6% Conventional gutta-percha along with TotalFill BC sealer was used. Group C: 6% Bioceramic gutta-percha along with TotalFill BC sealer was used. Group D: 6% conventional gutta-percha along with Hybrid Root SEAL sealer was used.
The AH Plus and hybrid sealers were dispensed and mixed as per manufacturer's instruction. TotalFill BC sealer is available as premixed paste. Before placement of sealers, gutta-percha alone were placed to assess the fit and to determine their extend till working length.
The canals were coated with the sealers with the help of Lentulo spiral #30 (Dentsply Maillefer) till 2 mm short of apex. Thereafter, selected gutta-percha points were uniformly coated with sealer and placed inside the root canal. Excess gutta-percha was removed with heated plugger 1 mm below the canal opening. The teeth were obturated using the single-cone technique. The root canal orifices were sealed with temporary filling material cavitemp (Ammdent, SARONNO-ITALIA) except for Group D in which sealer was cured for 40 s from cervical area before placement of temporary restoration.
Subsequently, all specimens were stored at 37°C temperature and 100% humidity for 1 week in humidifier (Universal Humidifier, Delhi).
Experimental group teeth were covered with double coat of nail varnish and then with sticky wax except the apical 1 mm of the root apex to prevent dye penetration through the root surface. Teeth of positive control group were not coated with nail varnish and sticky wax, whereas teeth of negative control were completely covered including apex with nail varnish and sticky wax. 0.2% rhodamine B dye solution was prepared by dissolving 2 g of rhodamine B dye powder in 1000 mL of distilled water. Samples were then placed vertically in 0.2% rhodamine B solution for 1 week at 37°C and 100% relative humidity. After 1 week, samples were rinsed under running water for 5 min and allowed to dry. External layers of wax were removed from teeth and then the grooves were made on buccal and lingual aspect of all the samples. Roots were sectioned into two equal halves along the long axis, in buccolingual direction with a double-sided diamond disc. The dye penetration was measured for each sample from the apex to the most coronal extant of the dye penetration under a stereomicroscope at ×10 magnification with digital vernier calliper. Data were collected and all the groups were compared using analysis of variance using SPSS Version 21.0 (IBM, US). P < 0.05 was considered significant.
| Observations and Results|| |
The best results were obtained with TotalFill BC with bioceramic gutta-percha (Group C) followed by TotalFill BC with conventional gutta-percha (Group B), AH Plus sealer (Group A), and Hybrid Root SEAL (Group D). The difference between Group A versus Group D, Group B versus Group D, and Group C versus Group D was statistically significant (P< 0.05). The differences among Group A versus Group B, Group A versus Group C, and Group B versus Group C were statistically insignificant (P > 0.05) [Table 1] and [Table 2].
|Table 2: Analysis of variance for amount of microleakage among different groups |
Click here to view
| Discussion|| |
A fluid-tight seal is the main requisite to achieve a successful obturation. Several types of endodontic sealers have been recommended to achieve this goal which includes silicon-based sealers, epoxy resin-based sealers, mineral trioxide aggregate-based sealer, calcium silicate-phosphate-based bioceramic sealer, and methacrylate resin-based sealer. Although various techniques have been advocated for detection and evaluation of apical microleakage, in the present study, dye penetration method using rhodamine B dye was used. Dye penetration method is a very popular technique for microleakage evaluation, and the advantages include its low cost, low toxicity, good availability, and ease of storage. Rhodamine B dye was used as there may be reduction in the optical density of methylene blue in the presence of alkaline pH (TotalFill BC) which can cause false results, and moreover, in a study conducted by Vogt et al., rhodamine B presented more penetrability in apical dentin. The teeth were placed vertically in the dye as Goldman et al. suggested that horizontal placement of teeth in dye may lead to air entrapment which may result in incomplete penetration of the dye. Roots were sectioned longitudinally as Wu and Wesselink  found greater dye penetration after longitudinal splitting than after cross sectional or decalcification and clearing of the specimen.
Among all the tested groups used in this study, TotalFill BC sealer with bioceramic gutta-percha was the best group which showed the least leakage.
Better performance of TotalFill BC can be explained on the basis of its small particle size, hydrophilicity, and low contact angle which enable the cement to spread easily over the dentin walls of the root canal and get inside and fill the lateral microcanals. BC root canal sealers also exhibit chemical bonding to root canal dentin walls as well as its corresponding bioceramic particle impregnated gutta-percha. It also exhibits a significant expansion of 0.20%. These features result in gap-free chemical bond between the sealer and dentinal walls, thus making it an effective sealer.
Although TotalFill BC sealer with bioceramic gutta-percha showed better results in comparison to TotalFill BC with conventional gutta-percha, results were statistically insignificant. It may be because of chemical bonding between TotalFill BC and bioceramic gutta-percha, thereby causing less leakage.
TotalFill BC sealer with bioceramic gutta-percha or conventional gutta-percha showed less leakage when compared with AH Plus sealer, but results were statistically insignificant. AH Plus is considered as gold standard as it has better penetration into microirregularities because of its creep capacity and long setting time, which increases the mechanical interlocking between sealer and root dentin. Moreover, it has low solubility, small expansion while setting and bond to root dentin through adamantine.
The results of the present study are in accordance to thein vitro study by Zhang et al. who evaluated the microleakage in canals obturated with TotalFill BC and AH Plus sealers using fluid filtration method and scanning electron microscope analysis. Samples showed gaps at sealer dentin and cone-sealer interface for specimens that leaked the most, and it was concluded that TotalFill BC performed better than AH Plus sealer. In both the studies, results were statistically nonsignificant. Furthermore, in a study conducted by Ersahan and Aydin, no statistical difference in microleakage was found between AH Plus and TotalFill BC, whereas in a study conducted by Pawar et al, TotalFill BC performed better than AH Plus and the results were found statistically significant.
In the present study, Hybrid Root SEAL showed the highest amount of microleakage compared with all groups. Formation of the hybrid dentin is the major mechanism of bonding for resin-based sealers. Hybrid Root SEAL being a methacrylate based sealers inherently undergo polymerization shrinkage coupled with high C-factor inside the root canals. Immediate light curing from the coronal side of the roots may also create a large polymerization stress during setting by preventing flow of resin-based sealers and may lead to debonding of the resin from the root canal walls, which results in gap formation and subsequently affecting the sealing ability of the sealer.
In accordance to our study, a study conducted by Setia et al. showed that the mean leakage in Hybrid Root SEAL was more as compared to TotalFill BC. Although in the study conducted by Setia et al., the results were statistically insignificant, whereas in our study, results were statistically significant.
In contrast to our study Belli et al.,in vitro study found that Hybrid Root SEAL performed equal to AH Plus, whereas in our study, AH Plus performed statistically significantly better than Hybrid Root SEAL.
Within the limitations of this study, TotalFill BC along with bioceramic impregnated gutta-percha or conventional gutta-percha performed better to gold standard AH Plus sealer and Hybrid Root SEAL did not performed up to remark. However, further clinical studies are required to see the long-term results of these materials.
| Conclusion|| |
Within the limitations of the study, it can be concluded that TotalFill BC along with BC impregnated gutta-percha seems to be promising endodontic complete obturating material. However, further clinical studies are required to see the long-term results of this material.
We affirm that we have no financial affiliation (e.g., employment, direct payment, stock holdings, retainers, consultantships, patent licensing arrangements, or honoraria) or involvement with any commercial organization with direct financial interest in the subject or materials discussed in this manuscript nor have any such arrangements existed in the past 3 years. Any other potential conflict of interest is disclosed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lee KW, Williams MC, Camps JJ, Pashley DH. Adhesion of endodontic sealers to dentin and gutta-percha. J Endod 2002;28:684-8.
Gettleman BH, Messer HH, ElDeeb ME. Adhesion of sealer cements to dentin with and without the smear layer. J Endod 1991;17:15-20.
Al-Haddad A, Che Ab Aziz ZA. Bioceramic-based root canal sealers: A review. Int J Biomater 2016;2016:9753210.
Ari H, Belli S, Gunes B. Sealing ability of Hybrid Root SEAL (MetaSEAL) in conjunction with different obturation techniques. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e113-6.
Akman M, Akman S, Derinbay O, Belli S. Evaluation of gaps or voids occurring in roots filled with three different sealers. Eur J Dent 2010;4:101-9.
Marin-Bauza GA, Rached-Junior FJ, Souza-Gabriel AE, Sousa-Neto MD, Miranda CE, Silva-Sousa YT. Physicochemical properties of methacrylate resin-based root canal sealers. J Endod 2010;36:1531-6.
Roggendorf M, Zahnärzteblatt B. Penetration of sealers in root canal: Anin vitro
study. Bavar Dent J 2004;45:32-4.
Branstetter J, von Fraunhofer JA. The physical properties and sealing action of endodontic sealer cements: A review of the literature. J Endod 1982;8:312-6.
Wu MK, Wesselink PR. Endodontic leakage studies reconsidered. Part I. Methodology, application and relevance. Int Endod J 1993;26:37-43.
Wu MK, Kontakiotis EG, Wesselink PR. Decoloration of 1% methylene blue solution in contact with dental filling materials. J Dent 1998;26:585-9.
Vogt BF, Xavier CB, Demarco FF, Padilha MS. Dentin penetrability evaluation of three different dyes in root-end cavities filled with mineral trioxide aggregate (MTA). Braz Oral Res 2006;20:132-6.
Goldman M, Simmonds S, Rush R. The usefulness of dye-penetration studies reexamined. Oral Surg Oral Med Oral Pathol 1989;67:327-32.
Kossev D, Stefanov V. Ceramics-based sealers as new alternative to currently used endodontic sealers. Roots 2009;1:42-8.
Sagsen B, Ustün Y, Pala K, Demirbuga S. Resistance to fracture of roots filled with different sealers. Dent Mater J 2012;31:528-32.
Almeida JF, Gomes BP, Ferraz CC, Souza-Filho FJ, Zaia AA. Filling of artificial lateral canals and microleakage and flow of five endodontic sealers. Int Endod J 2007;40:692-9.
Zhang W, Li Z, Peng B. Assessment of a new root canal sealer's apical sealing ability. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e79-82.
Ersahan S, Aydin C. Solubility and apical sealing characteristics of a new calcium silicate-based root canal sealer in comparison to calcium hydroxide-methacrylate resin-and epoxy resin-based sealers. Acta Odontol Scand 2013;71:857-62.
Pawar SS, Pujar MA, Makandar SD. Evaluation of the apical sealing ability of bioceramic sealer, AH plus & epiphany: Anin vitro
study. J Conserv Dent 2014;17:579-82. [Full text]
Belli S, Ozcan E, Derinbay O, Eldeniz AU. A comparative evaluation of sealing ability of a new, self-etching, dual-curable sealer: Hybrid root SEAL (MetaSEAL). Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:e45-52.
Mai S, Kim YK, Hiraishi N, Ling J, Pashley DH, Tay FR. Evaluation of the true self-etching potential of a fourth generation self-adhesive methacrylate resin-based sealer. J Endod 2009;35:870-4.
Setia P, Sikri VK, Sroa RB, Sidhu B. Apical sealing ability of two novel root canal sealers: An ex-vivo
study. J Int Clin Dent Res Organ 2013;5:9-13. [Full text]
[Table 1], [Table 2]