A comparative evaluation of cytotoxicity of root canal sealers: an in vitro study

Gautam Pyarelal Badole,Manjusha Madhukar Warhadpande,Ganesh Kothiramji Meshram,Rakesh Namdeoraoji Bahadure,Shubha Gopal Tawani,Shital Gautam Badole 대한치과보존학회 2013 Restorative Dentistry & Endodontics Vol.38 No.4

Objectives The objective of this in vitro study was to evaluate and compare the cytotoxicity of four different root canal sealers i.e. Apexit Plus (Ivoclar Vivadent), Endomethasone N (Septodont), AH-26 (Dentsply) and Pulpdent Root Canal Sealer (Pulpdent), on a mouse fibroblast cell line (L929). Materials and Methods Thirty two discs for each sealer (5 mm in diameter and 2 mm in height) were fabricated in Teflon mould. The sealer extraction was made in cell culture medium (Dulbecco's Modified Eagle's Medium, DMEM) using the ratio 1.25 cm2/mL between the surface of the sealer samples and the volume of medium in a shaker incubator. Extraction of each sealer was obtained at 24 hr, 7th day, 14th day, and one month of interval. These extracts were incubated with L929 cell line and 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide (MTT) assay was done. Two-way ANOVA for interaction effects between sealer and time and Post-hoc multiple comparison using Tukey's test across all the 16 different groups were used for statistical analysis. Results Apexit Plus root canal sealer was significantly less toxic than other sealers (p < 0.05) and showed higher cellular growth than control. Endomethasone N showed mild cytotoxicity. AH-26 showed severe toxicity which became mild after one month while Pulpdent Root Canal Sealer showed severe to moderate toxicity. Conclusions Apexit Plus was relatively biocompatible sealer as compared to other three sealers which were cytotoxic at their initial stages, however, they became biocompatible with time. Objectives The objective of this in vitro study was to evaluate and compare the cytotoxicity of four different root canal sealers i.e. Apexit Plus (Ivoclar Vivadent), Endomethasone N (Septodont), AH-26 (Dentsply) and Pulpdent Root Canal Sealer (Pulpdent), on a mouse fibroblast cell line (L929). Materials and Methods Thirty two discs for each sealer (5 mm in diameter and 2 mm in height) were fabricated in Teflon mould. The sealer extraction was made in cell culture medium (Dulbecco's Modified Eagle's Medium, DMEM) using the ratio 1.25 cm2/mL between the surface of the sealer samples and the volume of medium in a shaker incubator. Extraction of each sealer was obtained at 24 hr, 7th day, 14th day, and one month of interval. These extracts were incubated with L929 cell line and 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide (MTT) assay was done. Two-way ANOVA for interaction effects between sealer and time and Post-hoc multiple comparison using Tukey's test across all the 16 different groups were used for statistical analysis. Results Apexit Plus root canal sealer was significantly less toxic than other sealers (p < 0.05) and showed higher cellular growth than control. Endomethasone N showed mild cytotoxicity. AH-26 showed severe toxicity which became mild after one month while Pulpdent Root Canal Sealer showed severe to moderate toxicity. Conclusions Apexit Plus was relatively biocompatible sealer as compared to other three sealers which were cytotoxic at their initial stages, however, they became biocompatible with time.

The status of clinical trials regarding root canal sealers

Malak Ahmad AL,Masri Yasmina EL,Al Ziab Mira,Zrara Nancy,Baroud Tarek,Salameh Pascale 대한치과보존학회 2024 Restorative Dentistry & Endodontics Vol.49 No.1

Objectives This study aimed to present the results and analyses of clinical trials, including updates on the different functions of root canal sealers. Materials and Methods In June 2023, we performed a comprehensive search of ClinicalTrials.gov to identify interventional clinical trials pertaining to root canal sealers. In total, 23 clinical trials conducted up to June 2023 were included in this study. Results Approximately half of the trials (11 out of 23) were completed, while none were terminated or withdrawn. Each included trial had a minimum of 10 participants, with 11 trials having more than 100 participants. None of the assessed trials provided outcomes, and the majority (17 out of 23) lacked associated publications. In terms of geographic distribution, the USA and Canada did not contribute to any root canal sealer trials. Conclusions This study highlights the lack of diversity in trial locations, the absence of reported results, and a scarcity of clinical trials examining the physicochemical properties of different sealers. Most published trials primarily focused on assessing the post-operative pain effect of these sealers, but no significant difference was found regarding post-operative pain control. Objectives This study aimed to present the results and analyses of clinical trials, including updates on the different functions of root canal sealers. Materials and Methods In June 2023, we performed a comprehensive search of ClinicalTrials.gov to identify interventional clinical trials pertaining to root canal sealers. In total, 23 clinical trials conducted up to June 2023 were included in this study. Results Approximately half of the trials (11 out of 23) were completed, while none were terminated or withdrawn. Each included trial had a minimum of 10 participants, with 11 trials having more than 100 participants. None of the assessed trials provided outcomes, and the majority (17 out of 23) lacked associated publications. In terms of geographic distribution, the USA and Canada did not contribute to any root canal sealer trials. Conclusions This study highlights the lack of diversity in trial locations, the absence of reported results, and a scarcity of clinical trials examining the physicochemical properties of different sealers. Most published trials primarily focused on assessing the post-operative pain effect of these sealers, but no significant difference was found regarding post-operative pain control.

A Study Comparing the Characteristics of Zinc Oxide Eugenol-Based and Mineral Trioxide Aggregate-Based Root Canal Sealers

Seok-Eun Lee,조자원,유현준,Myung-Gu Lee,Yeol-Mae Jeon,김다희,Hye-Won Park 대한예방치과학회 2021 International Journal of Clinical Preventive Denti Vol.17 No.3

Objective: This study aimed to investigate the antimicrobial activity and cytotoxicity of zinc oxide eugenol (ZOE)-based and mineral trioxide aggregate (MTA)-based root canal sealers. Methods: The root canal sealers used in this study were Tubli-Seal (a ZOE-based sealer) and ProRoot (an MTA-based sealer). The antimicrobial activity of ProRoot and Tubli-seal was assessed using a susceptibility assay using Enterococcus faecalis, Porphyromonas endodontalis, and Porphyromonas gingivalis. The cytotoxicity of the root canal sealers was investigated using MTT assay, real-time RT-PCR, and ELISA after the pulp cells were treated with sealers. Additionally, the components of the root canal sealers were analyzed using X-ray fluorescence. Results: The MTA-based sealer showed stronger antimicrobial activity against E. faecalis than the ZOE-based sealer, and the antimicrobial activities of both sealers against P. endodontalis and P. gingivalis were not significantly different. The ZOE-based sealer showed strong cytotoxicity towards pulp cells and induced the expression and production of inflammatory cytokines. However, the MTA-based sealer did not affect the viability of pulp cells or significantly induce the expression of inflammatory cytokines such as TNF-α, IL-6, and IL-8. In the component analysis, the MTA-based sealer had more kinds of metal oxides than the ZOE-based sealer. Conclusion: The MTA-based sealers had stronger antimicrobial activity against E. faecalis compared to the ZOE-based sealer, and did not show significant cytotoxicity towards pulp cells. Based on these results, MTA-based sealers may be a suitable material for root canal therapy.

Resilon을 이용한 근관충전 시 레진계열의 근관실러와 자가-접착 레진시멘트에 따른 미세누출

함선영,김진우,신혜진,조경모,박세희 大韓齒科保存學會 2008 Restorative Dentistry & Endodontics Vol.33 No.3

The purpose of this study was to compare the apical microleakage in root canal filled with Resilon by methacrylate-based root canal sealer or 2 different self-adhesive resin cements. Seventy single-rooted extracted human teeth were sectioned at the CEJ perpendicular to the long axis of the roots with diamond disk. Canal preparation was performed with crown-down technique using Profile NiTi rotary instruments and GG drill. Each canal was prepared to ISO size 40, .04 taper and 1 ㎜ short from the apex. The prepared roots were randomly divided into 4 experimental groups of 15 roots each and 5 roots each for positive and negative control group. The root canals were filled by lateral condensation as follows. Group 1: Gutta-percha with AH-26, Group 2: Resilon with RealSeal primer & sealer, Group 3: Resilon with Rely-X Unicem, Group 4: Resilon with BisCem. After stored in 37℃, 100% humidity chamber for 7 days, the roots were coated with 2 layers of nail varnish except apical 3 ㎜. The roots were then immersed in 1% methylene blue dye for 7 days. Apical microleakage was measured by a maximum length of linear dye penetration after roots were separated longitudinally. One way ANOVA and Scheffe' s post-hoc test were performed for statistical analysis. Group 1 showed the least apical leakage and there was no statistical significance between Group 2, 3, 4. According to the results, the self adhesive resin cement is possible to use as sealer instead of primer & sealant when root canal filled by Resilon. 본 연구의 목적은 Resilon을 이용한 근관충전시 methacrylate-based root canal sealer와 자가-접착 레진시멘트의 사용에 따른 치근단 미세누출을 비교해 보는 것이다. 70개 단근치를 ProFile NiTi rotary instrument와 GG drill을 이용해 근관성형 하였다. 치근을 4개의 실험군 (n = 15)과 2개의 대조군 (n = 5)으로 분류하여 측방가압법으로 충전하였다. <1군: GP + AH-26, 2군: Resilon + RealSeal primer&sealant, 3군: Resilon + Rely-X Unicem 4군: Resilon + Biscem> 7일간 1% 메틸렌블루 용액에 침적 후 수직절단하여 치근첨부터 색소의 침투도를 측정하였다. 1군에서 가장 적은 미세누출값이 측정되었고, 2, 3, 4군 간의 통계적 유의성은 없었다. 이번 연구의 결과에 따르면, 자가-접착 레진시멘트는 Resilon을 이용한 근관충전시 sealer로 사용이 가능하리라 생각된다.

A micro-computed tomographic study of remaining filling materials of two bioceramic sealers and epoxy resin sealer after retreatment

김경재,김다빈,김신영,양성은 대한치과보존학회 2019 Restorative Dentistry & Endodontics Vol.44 No.2

Objective: This study evaluated the presence of residual root canal filling material after retreatment using micro-computed tomography (micro-CT). Materials and Methods: Extracted human teeth (single- and double-rooted, n = 21/each; C-shaped, n = 15) were prepared with ProFile and randomly assigned to three subgroups for obturation with gutta-percha and three different sealers (EndoSeal MTA, EndoSequence BC sealer, and AH Plus). After 10 days, the filling material was removed and the root canals were instrumented one size up from the previous master apical file size. The teeth were scanned using micro-CT before and after retreatment. The percentage of remaining filling material after retreatment was calculated at the coronal, middle, and apical thirds. Data were analyzed using the Kruskal-Wallis test and Mann-Whitney U test with Bonferroni post hoc correction. Results: The tested sealers showed no significant differences in the percentage of remaining filling material in single- and double-rooted teeth, although EndoSeal MTA showed the highest value in C-shaped roots (p < 0.05). The percentage of remaining filling material of AH Plus and EndoSeal MTA was significantly higher in C-shaped roots than in single- or double-roots (p < 0.05), while that of BC sealer was similar across all root types. EndoSeal MTA showed the highest values at the apical thirds of single- and double-roots (p < 0.05); otherwise, no significant differences were observed among the coronal, middle, and apical thirds. Conclusions: Within the limitations of this study, a large amount of EndoSeal MTA remained after retreatment, especially in C-shaped root canals.

A micro-computed tomographic study of remaining filling materials of two bioceramic sealers and epoxy resin sealer after retreatment

Kim, KyungJae,Kim, Da Vin,Kim, Sin-Young,Yang, SungEun The Korean Academy of Conservative Dentistry 2019 Restorative Dentistry & Endodontics Vol.44 No.2

Objective: This study evaluated the presence of residual root canal filling material after retreatment using micro-computed tomography (micro-CT). Materials and Methods: Extracted human teeth (single- and double-rooted, n = 21/each; C-shaped, n = 15) were prepared with ProFile and randomly assigned to three subgroups for obturation with gutta-percha and three different sealers (EndoSeal MTA, EndoSequence BC sealer, and AH Plus). After 10 days, the filling material was removed and the root canals were instrumented one size up from the previous master apical file size. The teeth were scanned using micro-CT before and after retreatment. The percentage of remaining filling material after retreatment was calculated at the coronal, middle, and apical thirds. Data were analyzed using the Kruskal-Wallis test and Mann-Whitney U test with Bonferroni post hoc correction. Results: The tested sealers showed no significant differences in the percentage of remaining filling material in single- and double-rooted teeth, although EndoSeal MTA showed the highest value in C-shaped roots (p < 0.05). The percentage of remaining filling material of AH Plus and EndoSeal MTA was significantly higher in C-shaped roots than in single- or double-roots (p < 0.05), while that of BC sealer was similar across all root types. EndoSeal MTA showed the highest values at the apical thirds of single- and double-roots (p < 0.05); otherwise, no significant differences were observed among the coronal, middle, and apical thirds. Conclusions: Within the limitations of this study, a large amount of EndoSeal MTA remained after retreatment, especially in C-shaped root canals.

A comparative evaluation of cytotoxicity of root canal sealers: an in vitro study

Badole, Gautam Pyarelal,Warhadpande, Manjusha Madhukar,Meshram, Ganesh Kothiramji,Bahadure, Rakesh Namdeoraoji,Tawani, Shubha Gopal,Tawani, Gopal,Badole, Shital Gautam The Korean Academy of Conservative Dentistry 2013 Restorative Dentistry & Endodontics Vol.38 No.4

Objectives: The objective of this in vitro study was to evaluate and compare the cytotoxicity of four different root canal sealers i.e. Apexit Plus (Ivoclar Vivadent), Endomethasone N (Septodont), AH-26 (Dentsply) and Pulpdent Root Canal Sealer (Pulpdent), on a mouse fibroblast cell line (L929). Materials and Methods: Thirty two discs for each sealer (5 mm in diameter and 2 mm in height) were fabricated in Teflon mould. The sealer extraction was made in cell culture medium (Dulbecco's Modified Eagle's Medium, DMEM) using the ratio 1.25 $cm^2/mL$ between the surface of the sealer samples and the volume of medium in a shaker incubator. Extraction of each sealer was obtained at 24 hr, 7th day, 14th day, and one month of interval. These extracts were incubated with L929 cell line and 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyltetrazolium bromide (MTT) assay was done. Two-way ANOVA for interaction effects between sealer and time and Post-hoc multiple comparison using Tukey's test across all the 16 different groups were used for statistical analysis. Results: Apexit Plus root canal sealer was significantly less toxic than other sealers (p < 0.05) and showed higher cellular growth than control. Endomethasone N showed mild cytotoxicity. AH-26 showed severe toxicity which became mild after one month while Pulpdent Root Canal Sealer showed severe to moderate toxicity. Conclusions: Apexit Plus was relatively biocompatible sealer as compared to other three sealers which were cytotoxic at their initial stages, however, they became biocompatible with time.

근관 실러의 분류와 특성 비교

방난심,정복영,최동진,박원서,정지은,김기덕,곽은정 대한통합치과학회 2017 대한통합치과학회지 Vol.6 No.2

The aim of this review was to compare calcium hydroxide-based root canal sealers with various contemporary commercial sealers especially leakage / solubility aspect. An extensive search of the endodontic literature through pubmed was made to identify publications related to calcium hydroxide-based sealers, epoxy resin-based sealers, methacrylate resin-based sealers and bioceramic-based sealers. 1. All sealers leak in long-term evaluation (>60 days). (except MTA sealers, because they do not have long-term [>120 days] evaluation data yet.) 2. Some sealers have better short-term sealing ability (<30 days). (but, the result could be reversed in long-term evaluation and meaningless after some period, because all sealers leak eventually.) 3. Regardless of the type of sealers, leakage increases over time. 4. A lot of endodontic treatment failure cases are because of re-infection through various route. 5. It is very important for the long-term survival of endodontically treated teeth that installation of full coverage-type final restoration as soon as possible after endodontical treatment. (further research is required to estabilish the sealing ability of luting cement or core material) It seems right to use sealers that have best bacterial sealing ability during those period (about 20 days) until the installation of full coverage-type final restoration right after the endodontical treatment finished. In that case, calcium hydroxide-based sealers are very effective and efficient.

수종의 수산화칼슘 근관 첩약제와 레진계 근관 실러의 사용 후 통증 발생 빈도에 관한 연구

곽상원(Sang Won Kwak),김현철(Hyeon-Cheol Kim) 대한치과의사협회 2018 대한치과의사협회지 Vol.56 No.5

Objectives: This study aimed to compare the postoperative pain and clinical performance after applying three different intracanal medicaments and root canal sealers. Materials and Methods: Sixty-five patients requiring root canal treatment due to symptomatic apical periodontitis were included in this study. After a glide path preparation by using PathFile, each canal was shaped with ProTaper Next file system. After the canal cleaning and shaping procedure, the canal was dried and each intracanal medicaments were adjusted (Calcipex II, TRC-paste, Metapaste). At the next visit, the patients were requested to answer the absence of the pain after the procedure. Once the patients showed no symptom, the canal was obturated with each corresponded root canal sealers (AH plus, Radic-sealer, ADseal). The patients were recalled after 1 week, 1, 3, and 6 months to check the postoperative pain or unexpected clinical signs. One-way ANOVA and Duncan’s post hoc comparison, and Chi-square test were used for statistical analysis to evaluate any differences among tested materials. Results: The average number of visits for intracanal medication was 2.69, 2.65, and 2.61 for Calcipex II, TRC-paste, and Metapaste. There were no statistically differences in post-obturation pain among three groups obturated with different root canal sealers (P > 0.05). Conclusions: Under the limitations of this study, three tested intracanal medicaments and epoxy resin root canal sealers showed clinically acceptable similar results.

레진 계열 근관봉함재 Adseal의 세포독성에 관한 연구

김희정,백승호,이우철,박한수,배광식 大韓齒科保存學會 2004 Restorative Dentistry & Endodontics Vol.29 No.6

The properties of ideal root canal sealers include the ability of sealing the total root canal system and no toxic effects to periradicular tissues. Cytotoxicity test using cell culture is a common screening method for evaluation of the biocompatibility of root canal sealers. The purpose of this study was to investigate the cytotoxic effect of newly developed resin-based sealer (Adseal 1, 2, and 3) comparing with those commercial resin-based sealers (AH26 and AH Plus), ZOE-based sealers (Tubliseal EWT, Pulp Canal Sealer EWT) and calcium hydroxide based sealer (Sealapex). An indirect contact test of cytotoxicity by agar diffusion was performed according to the international standard ISO 10993-5. L929 fibroblast cells were incubated at 37℃ in humidified 5% CO₂-containing air atmosphere. The freshly mixed test materials were inserted into glass rings of internal diameter 5 ㎜ and height 5 ㎜ placed on the agar. After the 24 hrs incubation period, the decolorization zones around the test materials were assessed using an inverted microscope with a calibrated screen. A Decolorization Index was determined for each specimen. Adseal 1, 2, and 3 did not exert any cytotoxic effects, whereas AH26, AH Plus, Tubliseal EWT, Pulp Canal Sealer EWT, and Sealapex produced mild cytotoxicity.