Original Research

Effectiveness of Four Different Obturation Techniques

on the Penetration Depth of Bioceramic Sealers into
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the Dentin Tubules: An In Vitro Study

Ghaith Hamid Faris, Raghad Abdulrazzaq Alhashimi
Department of Conservative Dentistry, College of Dentistry, University of Baghdad, Iraq
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Abstract
Introduction: We aimed to assess the penetration depth of bioceramic sealers into the dentin tubules following different root canal obturation
techniques included (A) warm vertical compaction, (B) carrier-based technique, (C) cold lateral compaction, and (D) single-cone obturation.
Methods: This study utilized 40 extracted lower first premolars with developed apices and circular and straight root canals. The roots were
eliminated to achieve an 11-mm length with a coronal flat measurement point. ProTaper Next rotary system was used for instrumentation. For
obturation procedures, gutta-percha and Bio-C bioceramic sealer were employed, and the roots were randomly divided into four study groups,
including (A) warm vertical compaction, (B) carrier-based technique, (C) cold lateral compaction, and (D) single-cone obturation. Depth of
sealer penetration into the tubules was assessed using scanning electron microscopy. Result: We found significant differences in the
penetration depth of bioceramic sealers based on obturation techniques (p < 0.001), location of dentin tubules (coronal, middle, or apical third)
(p < 0.001), and the interaction between obturation techniques and location (p = 0.042). Conclusion: The warm vertical compaction and
carrier-based technique showed superior penetration depth into the dentin tubules.

Keywords: Endodontics, Root canal obturation, Root canal sealants, Dentin, Scanning transmission electron microscopy

INTRODUCTION Epoxy resin-based sealers are currently the most widely

utilized root canal sealants that are clinically available.[8]
The two major substances required for obtaining the desired
Because of their low solubility, disintegration, and adequate
three-dimensional (3D) sealing of the root canal space are
dimensional stability, these sealants have been used
gutta-percha (GP) and root canal sealer.[1] To seal off root
extensively for decades.[9] Although resin-based sealers
canals in three dimensions while maintaining fluid tightness,
have been widely utilized, they now face challenges
a few obturating techniques have been suggested, such as cold
including volumetric shrinkage, the release of harmful
lateral compaction, single-cone technique, Tagger’s hybrid
substances such as formaldehyde, an extended working
technique, carrier-based obturation, and continuous wave.
period, and tooth staining.[2] Kim et al. found that
Each of these methods uses a different kind and form of
compared to calcium silicate–based sealers, resin-based
GP, as well as a different type of sealer material.[2,3]
sealers lack bioactive characteristics, or osteogenic
Endodontic sealers help with sealing the canal system by
filling irregularities in anatomical structure, ramifications,
Address for correspondence: Ghaith Hamid Faris,
and dentinal tubules, enhancing the adaptability of root filling Master Student, Department of Conservative Dentistry,
at the dentin material contact.[4] Root canal sealers must have College of Dentistry, University of Baghdad, Iraq.
both bioactivity and biocompatibility since they are in close E-mail: gaith1999hamid@gmail.com
proximity to the surrounding tissues and can alter the healing
process.[5,6] They come in a variety of chemical forms, Received: 14 June 2023 Revised: 1 October 2023
Accepted: 5 October 2023 Published: 28 November 2023
including those based on calcium silicate cement, glass
ionomer, zinc oxide eugenol, silicone, and epoxy resin.[3,7] This is an open access journal, and articles are distributed under the terms of the
Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows
Access this article online others to remix, tweak, and build upon the work non-commercially, as long as
appropriate credit is given and the new creations are licensed under the identical
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How to cite this article: Faris GH, Alhashimi RA. Effectiveness of Four
DOI: Different Obturation Techniques on the Penetration Depth of Bioceramic
10.4103/denthyp.denthyp_69_23 Sealers into the Dentin Tubules: An In Vitro Study. Dent Hypotheses
2023;14:107-10.

© 2023 Dental Hypotheses | Published by Wolters Kluwer - Medknow 107

 Faris and Alhashimi: Penetration depth of bioceramic sealers into the dentin tubules
potential.[10] Moreover, the ability of recently developed
calcium silicate–based bioceramic sealers to release
calcium, exhibit bioactivity, possess biocompatibility, and
possess antibacterial and antifungal properties is making
them more and more popular.[7,8]
The penetrability of the sealer into the root dentin and its
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marginal sealing ability are crucial factors influencing the
success of endodontic treatment. An ideal sealer should have
low surface tension to facilitate penetration into irregularities
and exhibit good wettability for achieving a hermetic seal.
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Excellent penetration and adaptability from a root canal sealer
increase the surface area of contact between the obturating
substance and root canal dentin, improving sealability and
overall obturation effectiveness.[11] The removal of the smear
layer, the permeability of the dentin, and the utilized filling
technique all have an impact on how well sealer cement
penetrates into the tubules of root dentin. Therefore, it is
important to assess the penetration and adaptability of sealers
to root dentin when using various obturation techniques.[12]
The purpose of this study is to assess the penetration depth of
bioceramic sealers into the dentin tubules following different
root canal obturation techniques, including warm vertical
compaction, carrier-based technique, cold lateral
compaction, and single-cone obturation.
MATERIALS AND METHODS
The research was conducted in accordance with the principles
outlined in the Declaration of Helsinki, and the study protocol
was approved by the ethics committee of Dentistry School,
University of Baghdad on April 17, 2022 (Ref number 548,
Project No. 548522). This study utilized 40 extracted lower
first premolars with developed apices and circular and
straight root canals. The teeth were extracted for
orthodontic reasons, cleaned, and disinfected with 2.5%
NAOCL (Promida, Odunpazarı, Turkey) for 30 minutes
and stored in normal saline. The roots were eliminated to
achieve an 11-mm length with a coronal flat measurement
point. ProTaper Next rotary system (Dentsply Sirona,
Charlotte, USA) was used for instrumentation, beginning
Figure 1: Box and whisker plot demonstrated variations in the amount of bioceramic sealers penetration depth into the dentin tubules.
108
with a size 17/04 rotary file and increasing up to a size
25/06 with a speed of 300 rpm and torque of 300 g/cm until
the working length. For obturation procedures, GP (DiaDent,
British Columbia, Canada) and Bio-C bioceramic sealer
(Angelus Dental, Londrina, Brazil) were employed, and
the roots were randomly (using random.org) divided into
four study groups, including the following: (A) warm vertical
compaction, (B) carrier-based technique (GuttaCore
Obturator, Dentsply Sirona, Charlotte, USA), (C) cold
lateral compaction, and (D) single-cone obturation.
Instrumentation and obturation of the root canal were
carried out according to well-known guidelines published
by the American Association of Endodontists (www.aae.org/
specialty/wp-content/uploads/sites/2/2018/04/
TreatmentStandards_Whitepaper.pdf).
The obturated samples were then wrapped in gauze, soaked in
normal saline, and kept in an incubator for 2 weeks at 37°C
and 100% humidity to allow the sealers to fully set. Then, the
filled roots were sectioned longitudinally using a diamond
disk. The samples were dehydrated, mounted on an aluminum
stub, and coated with gold using a sputtering technique, and
the depth of sealer penetration into the tubules was assessed
using scanning electron microscopy (SEM) (Axia
ChemiSEM, Waltham, USA). Data were analyzed via two-
way analysis of variance (ANOVA) and the Tukey post hoc
test using R 4.3.0 (R Foundation for Statistical Computing,
Vienna, Austria).
RESULTS
The study (overall model test: p < 0.001) found significant
differences in the penetration depth of bioceramic sealers
based on obturation techniques (p < 0.001), the location of
dentin tubules (coronal, middle, or apical third) (p < 0.001),
and the interaction between obturation techniques and
location (p = 0.042). Post hoc analysis revealed significant
differences for all pairwise comparisons related to obturation
techniques and location of dentin tubules (p < 0.05), except
for pairwise comparisons between lateral condensation
technique and single-cone obturation (p = 0.998) [Figure 1].
Dental Hypotheses ¦ Volume 14 ¦ Issue 4 ¦ October-December 2023
 Faris and Alhashimi: Penetration depth of bioceramic sealers into the dentin tubules
DISCUSSION
To achieve the most favorable results in root canal obturation,
a high volume of GP and a low volume of sealer with
improved penetration into the canal irregularities and
dentinal tubules are required.[13] In the current study, the
findings revealed that across all four groups, the penetration
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depth was higher in the coronal part compared to the middle
part, while the apical part exhibited the lowest penetration
depth. Similarly, according to Dasari et al., who studied the
effects of three obturation techniques, including lateral
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compaction, warm vertical compaction, and injectable
thermoplasticized technique, on the depth of penetration
and adaptation of a bioceramic root canal sealer, the sealer
penetration at coronal level was significantly deeper than the
middle and apical portions of the root canal in all of the
obturation techniques tested.[2] A systematic review of in
vitro studies conducted by Ashkar et al. about calcium
silicate-based sealer dentinal tubule penetration also
showed that in all included studies, the sealer penetration
into the dentinal tubules was lower apically and increased
coronally.[14] This can be attributed primarily to the
histological characteristics of the apical root dentin, which
is characterized by being sclerotic and poorly permeable and
containing fewer dentinal tubules compared to the middle and
cervical thirds of dentin.[15,16]
Donnermeyer et al. [17]
demonstrated the excellent tubule
penetration of bioceramic sealers, which can be attributed
to their smaller particle size, fluidity, and hydrophilicity.
These properties enable bioceramic sealers to penetrate
deeper into the dentinal tubules and adapt more
effectively.[17,18] The viscosity and flow of endodontic
sealers also play a significant role in their ability to enter
the dentinal tubules.[19] Variables such as particle size,
temperature, and setting time can influence the viscosity of
the sealer.[20,21]
The use of thermal obturation procedures with bioceramic
sealers has been a topic of debate. It has been observed that
the characteristics of bioceramic sealers can undergo
significant alterations after heating during
thermoplasticized obturation procedures.[22] Additionally,
the biomineralization process, which is a desirable
characteristic of calcium silicate sealers, may be hindered
by rising temperatures.[23] Therefore, it is crucial to
understand the chemomechanical characteristics of
bioceramic sealers and how their properties may be
affected by the application of heat.
Based on the findings of this study concerning the penetration
depth among the groups of the two cold obturation techniques
and the two hot obturation techniques, it was observed that the
hot techniques demonstrated superior penetration depth.
Additionally, within the two warm obturation techniques,
the warm vertical technique outperformed the carrier-based
strategy. Supporting this, Dasari et al. also reported that the
highest depth of sealer penetration into radicular dentin was
observed in the warm vertical compaction technique,
Dental Hypotheses ¦ Volume 14 ¦ Issue 4 ¦ October-December 2023
followed by the injectable GP technique, while the lateral
compaction technique demonstrated the least penetration.[2]
The lower pressure levels used in the single-cone obturation
technique compared to warm obturation procedures may
cause one of the observed discrepancies in the penetration
of the sealer into dentinal tubules, as demonstrated by our
analysis. This contrast in pressure levels may facilitate
enhanced sealer penetration into dentinal tubules during
the heated obturation processes across all three thirds of
the root.[24]
However, one of the main limitations of this study is the
utilization of a scanning electron microscope instead of a
confocal laser microscope, which could have provided more
detailed imaging and analysis. Another limitation is the
inclusion of only four obturation techniques rather than
examining all available techniques and using a sealer from
a single company, which may not fully represent the entire
range of obturation options and sealer variations.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Thejeswar E, Ranjan M. Evolution of root canal sealers and its impact
on success of endodontics. Int J Sci Dev Res 2020;5:264-9.
2. Dasari L, Anwarullah A, Mandava J, Konagala RK, Karumuri S,
Chellapilla PK. Influence of obturation technique on penetration
depth and adaptation of a bioceramic root canal sealer. J Conserv
Dent 2020;23:505-11.
3. Kok D, Duarte MAH, da Rosa RA, Wagner MH, Pereira JR, Só MVR.
Evaluation of epoxy resin sealer after three root canal filling techniques
by confocal laser scanning microscopy. Microsc Res Technol
2012;75:1277-80.
4. Mohammadian F, Farahanimastary F, Dibaji F, Kharazifard MJ.
Scanning electron microscopic evaluation of the sealer-dentine
interface of three sealers. Iran Endod J 2017;12:38-42.
5. Polineni S, Bolla N, Mandava P, et al. Marginal adaptation of
newer root canal sealers to dentin: a SEM study. J Conserv Dent
2016;19:360-3.
6. Silva GF, Guerreiro-Tanomaru JM, da Fonseca TS, et al. Zirconium
oxide and niobium oxide used as radiopacifiers in a calcium silicate-
based material stimulate fibroblast proliferation and collagen
formation. Int Endod J 2017;50:e95-108.
7. Al-Haddad A, Aziz ZACA. Bioceramic-based root canal sealers: a
review. Int J Biomater 2016;9753210:1-10.
8. Patel A, Somani MC, Patel H, Joshi C, Shah M, Kansagra D.
Bioceramics as root canal sealers: a literature review. J Pharm
Negat 2022;13:4371-81.
9. Zhang W, Peng B. Tissue reactions after subcutaneous and intraosseous
implantation of iRoot SP, MTA and AH plus. Dent Mater J
2015;34:774-80.
10. Kim TG, Lee YH, Lee NH, et al. The antioxidant property of pachymic
acid improves bone disturbance against AH plus-induced inflammation
in MC-3T3 E1 cells. J Endod 2013;39:461-6.
11. Balguerie E, Lucas V, Karan V, Marie G. Sealer penetration and
adaptation in the dentinal tubules: a scanning electron microscopy
study. J Endod 2011;37:1576-9.
109
 Faris and Alhashimi: Penetration depth of bioceramic sealers into the dentin tubules
12. Mamootil K, Messer H. Penetration of dentinal tubules by endodontic
sealer cements in extracted teeth and in vivo. Int Endod J 2007;40:
873-81.
13. De-Deus G, Brandão MC, Leal F, et al. Lack of correlation between
sealer penetration into dentinal tubules and sealability in nonbonded
root fillings. Int Endod J 2012;45:642-51.
14. Ashkar I, Sanz JL, Forner L, Melo M. Calcium silicate-based sealer
dentinal tubule penetration: a systematic review of in vitro studies.
Downloaded from http://journals.lww.com/dhyp by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW
Materials (Basel) 2023;16:2734.
15. Elmuttalibi HTF, Mahdi JA. Push out bond strength of GuttaFlow 2,
Therma-fil and GuttaCore (an invitro study). J Oral Dent Res 2019;
6:7-16.
16. El Hachem R, Khalil I, Le Brun G, et al. Dentinal tubule penetration
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 02/13/2024
of AH plus, BC sealer and a novel tricalcium silicate sealer: a
confocal laser scanning microscopy study. Clin Oral Investig
2019;23:1871-6.
17. Donnermeyer D, Bürklein S, Dammaschke T, Schäfer E. Endodontic
sealers based on calcium silicates: a systematic review. Odontology
2019;107:421-36.
110
18. Buchanan LS, Santa BK. Filing root canal system with centered
condensation. Dent Today. Published online 2004.
19. Reynolds JZ, Augsburger RA, Svoboda KKH, Jalali P. Comparing
dentinal tubule penetration of conventional and “HiFlow” bioceramic
sealers with resin-based sealer: an in vitro study. Aust Endod J
2020;46:387-93.
20. Naser SH, Al-Zaka IM. Push-out bond strength of different root canal
obturation materials. J Baghdad Coll Dent 2013;325:1-7.
21. Arikatla SK, Chalasani U, Mandava J, Yelisela RK. Interfacial
adaptation and penetration depth of bioceramic endodontic sealers. J
Conserv Dent 2018;21:373-7.
22. Antunes TBM, Janini ACP, Pelepenko LE, et al. Heating stability,
physical and chemical analysis of calcium silicate-based endodontic
sealers. Int Endod J 2021;54:1175-88.
23. Camilleri J. Sealers and warm gutta-percha obturation techniques. J
Endod 2015;41:72-8.
24. Eid D, Medioni E, De-Deus G, Khalil I, Naaman A, Zogheib C. Impact of
warm vertical compaction on the sealing ability of calcium silicate-based
sealers: a confocal microscopic evaluation. Materials 2021;14:372.
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