Bioceramic and Resin-Based Sealers Removal Using XP-Endo Finisher: A Scanning Electron Microscopy Study

Abstract

Objectives The aim of this study was to evaluate remaining filling materials of a bioceramic sealer (TotalFill BC sealer) and an epoxy resin sealer (AH Plus) after retreatment using a supplementary instrumentation (XP-endo Finisher).

Materials and Methods Forty single-rooted teeth were selected for the study. The teeth were instrumented using ProTaper system and randomly divided into two groups (n = 20). Then they were obturated with either TotalFill BC/gutta-percha or AH Plus/gutta-percha using lateral compaction technique. Canals were retreated using ProTaper retreatment files and a solvent. The groups were subdivided (n = 10) according to the application or not of the XP-endo Finisher as a final step of retreatment. All roots were cleaved longitudinally and examined under scanning electron microscope to evaluate root canal filling remnants. A scoring system was utilized to quantify the amount of residual filling material at the three predetermined portions of each root canal.

Statistical analysis was performed using IBM SPSS.25 with a significant value p < 0.05. Data were compared using the Mann–Whitney test and Kruskal–Wallis test.

Results There was no statistically significant difference in the remaining filling materials for each third of the root canal after initial retreatment procedure between the TotalFill group and AH Plus group. Similar results were observed among the TotalFill groups with or without the application of XP-endo Finisher supplementary step. However, the remaining filling materials of AH Plus in the middle third of root canal were significantly less after the XP-endo Finisher application (p = 0.015).

Conclusion No retreatment protocol tested in this study allowed the total elimination of root canal filling materials. The residual root canal filling materials is similar for the bioceramic and resinous sealers. The XP-endo Finisher is not effective in improving the removal of bioceramic root canal filling material while it is able to improve the removal of resinous cement.

Keywords

epoxy resin-based root canal sealer - retreatment - root canal filling materials - scanning electron microscopy - tricalcium silicate - XP-endo Finisher

Publikationsverlauf

Artikel online veröffentlicht:
13. März 2024

• References

• 1 Silva Almeida LH, Moraes RR, Morgental RD, Pappen FG. Are premixed calcium silicate–based endodontic sealers comparable to conventional materials? A systematic review of in vitro studies. J Endod 2017; 43 (04) 527-535
• 2 de Oliveira NG, de Souza Araújo PR, da Silveira MT, Sobral APV, Carvalho MV. Comparison of the biocompatibility of calcium silicate-based materials to mineral trioxide aggregate: systematic review. Eur J Dent 2018; 12 (02) 317-326
• 3 Al-Haddad A, Che Ab Aziz ZA. Bioceramic-based root canal sealers: a review. Int J Biomater 2016; 2016: 9753210
• 4 de Siqueira Zuolo A, Zuolo ML, da Silveira Bueno CE, Chu R, Cunha RS. Evaluation of the efficacy of trushape and reciproc file systems in the removal of root filling material: an ex vivo micro–computed tomographic study. J Endod 2016; 42 (02) 315-319
• 5 Agrafioti A, Koursoumis AD, Kontakiotis EG. Re-establishing apical patency after obturation with Gutta-percha and two novel calcium silicate-based sealers. Eur J Dent 2015; 9 (04) 457-461
• 6 Versiani MA, Abi Rached-Junior FJ, Kishen A, Pécora JD, Silva-Sousa YT, de Sousa-Neto MD. Zinc oxide nanoparticles enhance physicochemical characteristics of Grossman sealer. J Endod 2016; 42 (12) 1804-1810
• 7 Rossi-Fedele G, Ahmed HMA. Assessment of root canal filling removal effectiveness using micro–computed tomography: a systematic review. J Endod 2017; 43 (04) 520-526
• 8 Silva EJNL, Belladonna FG, Zuolo AS. et al. Effectiveness of XP-endo Finisher and XP-endo Finisher R in removing root filling remnants: a micro-CT study. Int Endod J 2018; 51 (01) 86-91
• 9 Uzunoglu-Özyürek E, Küçükkaya Eren S, Karahan S. Contribution of XP-Endo files to the root canal filling removal: a systematic review and meta-analysis of in vitro studies. Aust Endod J 2021; 47 (03) 703-714
• 10 Somma F, Cammarota G, Plotino G, Grande NM, Pameijer CH. The effectiveness of manual and mechanical instrumentation for the retreatment of three different root canal filling materials. J Endod 2008; 34 (04) 466-469
• 11 Ng YL, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 1: periapical health. Int Endod J 2011; 44 (07) 583-609
• 12 Stuart CH, Schwartz SA, Beeson TJ, Owatz CB. Enterococcus faecalis: its role in root canal treatment failure and current concepts in retreatment. J Endod 2006; 32 (02) 93-98
• 13 El Hachem R, Khalil I, Le Brun G. et al. Dentinal tubule penetration of AH Plus, BC Sealer and a novel tricalcium silicate sealer: a confocal laser scanning microscopy study. Clin Oral Investig 2019; 23 (04) 1871-1876
• 14 Penha da Silva PJ, Marceliano-Alves MF, Provenzano JC, Dellazari RLA, Gonçalves LS, Alves FRF. Quality of root canal filling using a bioceramic sealer in oval canals: a three-dimensional analysis. Eur J Dent 2021; 15 (03) 475-480
• 15 Eymirli A, Sungur DD, Uyanik O, Purali N, Nagas E, Cehreli ZC. Dentinal tubule penetration and retreatability of a calcium silicate–based sealer tested in bulk or with different main core material. J Endod 2019; 45 (08) 1036-1040
• 16 Rödig T, Reicherts P, Konietschke F, Dullin C, Hahn W, Hülsmann M. Efficacy of reciprocating and rotary NiTi instruments for retreatment of curved root canals assessed by micro-CT. Int Endod J 2014; 47 (10) 942-948
• 17 Marques da Silva B, Baratto-Filho F, Leonardi DP, Henrique Borges A, Volpato L, Branco Barletta F. Effectiveness of ProTaper, D-RaCe, and Mtwo retreatment files with and without supplementary instruments in the removal of root canal filling material. Int Endod J 2012; 45 (10) 927-932
• 18 Roggendorf MJ, Legner M, Ebert J, Fillery E, Frankenberger R, Friedman S. Micro-CT evaluation of residual material in canals filled with Activ GP or GuttaFlow following removal with NiTi instruments. Int Endod J 2010; 43 (03) 200-209
• 19 Pinto JC, Torres FFE, Santos-Junior AO, Duarte MAH, Guerreiro-Tanomaru JM, Tanomaru-Filho M. Safety and effectiveness of additional apical preparation using a rotary heat-treated nickel-titanium file with larger diameter and minimum taper in retreatment of curved root canals. Eur J Dent 2021; 15 (02) 247-252
• 20 Shokouhinejad N, Gorjestani H, Nasseh AA, Hoseini A, Mohammadi M, Shamshiri AR. Push-out bond strength of gutta-percha with a new bioceramic sealer in the presence or absence of smear layer. Aust Endod J 2013; 39 (03) 102-106
• 21 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; 63 (04) 306-309
• 22 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; 41 (12) 2025-2030
• 23 Ersev H, Yilmaz B, Dinçol ME, Dağlaroğlu R. The efficacy of ProTaper Universal rotary retreatment instrumentation to remove single gutta-percha cones cemented with several endodontic sealers. Int Endod J 2012; 45 (08) 756-762
• 24 Simsek N, Keles A, Ahmetoglu F, Ocak MS, Yologlu S. Comparison of different retreatment techniques and root canal sealers: a scanning electron microscopic study. Braz Oral Res 2014; 28: 1-7
• 25 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; 42 (01) 19-26
• 26 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; 22 (02) 811-817
• 27 Uzunoglu E, Yilmaz Z, Sungur DD, Altundasar E. Retreatability of root canals obturated using gutta-percha with bioceramic, MTA and resin-based sealers. Iran Endod J 2015; 10 (02) 93-98
• 28 Karova E, Dogandzhiyska V, Tsenova-Ilieva I, Raykovska M, Zongova-Adem S. Supplementary approaches in endodontic retreatment. Journal of Medical and Dental Practice 2021; 8 (01) 1312-1316
• 29 Jayakumaar A, Ganesh A, Kalaiselvam R, Rajan M, Deivanayagam K. Evaluation of debris and smear layer removal with XP-endo finisher: a scanning electron microscopic study. Indian J Dent Res 2019; 30 (03) 420-423
• 30 Turkaydin D, Demir E, Basturk FB, Sazak Övecoglu H. Efficacy of XP-Endo finisher in the removal of triple antibiotic paste from immature root canals. J Endod 2017; 43 (09) 1528-1531
• 31 Hamdan R, Michetti J, Pinchon D, Diemer F, Georgelin-Gurgel M. The XP-Endo Finisher for the removal of calcium hydroxide paste from root canals and from the apical third. J Clin Exp Dent 2017; 9 (07) e855-e860
• 32 Crozeta BM, Lopes FC, Menezes Silva R, Silva-Sousa YTC, Moretti LF, Sousa-Neto MD. Retreatability of BC Sealer and AH Plus root canal sealers using new supplementary instrumentation protocol during non-surgical endodontic retreatment. Clin Oral Investig 2021; 25 (03) 891-899
• 33 Kontogiannis TG, Kerezoudis NP, Kozyrakis K, Farmakis ETR. Removal ability of MTA-, bioceramic-, and resin-based sealers from obturated root canals, following XP-endo® Finisher R file: an ex vivo study. Saudi Endod J 2019; 9 (01) 8-13
• 34 Zhang W, Liu H, Wang Z, Haapasalo M, Jiang Q, Shen Y. Long-term porosity and retreatability of oval-shaped canals obturated using two different methods with a novel tricalcium silicate sealer. Clin Oral Investig 2022; 26 (01) 1045-1052
• 35 Volponi A, Pelegrine RA, Kato AS. et al. Micro–computed tomographic assessment of supplementary cleaning techniques for removing bioceramic sealer and gutta-percha in oval canals. J Endod 2020; 46 (12) 1901-1906
• 36 Rechenberg DK, Paqué F. Impact of cross-sectional root canal shape on filled canal volume and remaining root filling material after retreatment. Int Endod J 2013; 46 (06) 547-555
• 37 Aksel H, Küçükkaya Eren S, Askerbeyli Örs S, Serper A, Ocak M, Çelik HH. Micro-CT evaluation of the removal of root fillings using the ProTaper Universal Retreatment system supplemented by the XP-Endo Finisher file. Int Endod J 2019; 52 (07) 1070-1076