UNASSIGNED: This research aimed to assess the push-out bond strength (PBS) to dentin of three distinct obturation materials inside the root canal and identify the failure mechanism.
UNASSIGNED: The research used 30 undamaged human mandibular premolars. The specimens were randomly assigned to three groups, each employing a different sealer (n = 10). Group 1 used AH Plus sealer, Group 2 used GuttaFlow-2 sealer, and Group 3 used bioceramic sealer (CeraSeal). The obturation procedure was performed utilizing the single-cone method with gutta-percha. The specimens were divided into sections and loaded using a universal testing machine. Following PBS testing, every sample underwent a stereomicroscope examination, and the specific failure mechanism was documented.
UNASSIGNED: The average PBS was greatest for AH Plus, followed by CeraSeal and Guttaflow-2. Notable disparities existed between the coronal and apical levels.
UNASSIGNED: AH Plus exhibited superior PBS qualities to root dentin compared to other sealers.

BACKGROUND: The purpose of this study was to evaluate whether the mixing method of AH Plus Jet sealer affects its physicochemical and mechanical properties.
METHODS: The properties of AH Plus Jet sealer were analyzed when mixed using either the Auto Mix Tip or manual mixing. The evaluated properties included radiopacity (n = 5), initial and final setting times (n = 5), flow (n = 5), and solubility (n = 3), following specifications outlined in ISO 6876/2012 and ADA Nº 57/2000. pH levels were measured at intervals of 3, 24, 72, and 168 hours (n = 10). The push-out bond strength test was conducted using a universal testing machine and using bovine teeth (n = 30). Failure modes were analyzed with stereomicroscopy. Porosity was evaluated under micro-CT (n = 5), and scanning electron microscopy was also performed (n = 5). One-way analysis of variance and Tukey, unpaired t-tests, or Mann-Whitney tests were used with a significance level of 5%.
RESULTS: The Auto Mix exhibited a radiopacity value of 12.11 mmAl, whereas manual mixing resulted in 12.55 mmAl (P > .05). For initial and final setting times, Auto Mix showed 901 minutes and 1779 minutes, respectively, while manual mixing recorded values of 631 minutes and 1504 minutes (P < .05). In terms of flow, Auto Mix demonstrated higher values (25.26 mm) than manual mixing (21.71 mm) (P < .05). No statistical differences were observed between the two methods for solubility and pH (P > .05). Manual mixing presented a higher bond strength value (14.52 MPa) than Auto Mix (9.81 MPa) (P < .05). The mixed failure mode was the most frequent outcome for both methods. The highest porosity was observed for Auto Mix (P < .05). Scanning electron microscopy analysis revealed that manual mixing resulted in a smoother surface with fewer pores and smaller, more evenly distributed agglomerates compared to automatic mixing.
CONCLUSIONS: The mixing method employed for AH Plus Jet sealer influences some physicochemical and mechanical properties of the material.

UNASSIGNED: The effective disinfection of the entire root canal system aids in the penetration of irrigants into the dentinal tubules further improving sealer penetration and achieving a three-dimensional seal in endodontically treated teeth. Various final irrigation techniques can be employed to achieve this goal. Therefore, this study intended to assess and compare the efficacy of three final irrigation techniques on the depth of penetration of two root canal sealers into dentinal tubules using confocal laser scanning microscope (CLSM).
UNASSIGNED: Forty-eight single-rooted mandibular premolars were selected and decoronated to a length of 12 mm. All the samples were prepared using ProTaper Gold rotary files and divided into three groups: Group 1 - Conventional syringe irrigation (CSI), Group 2 - passive ultrasonic irrigation (PUI), and Group 3 - Pro-agitator tip system (PATS). Each group was divided into two subgroups: Subgroup A - AH Plus and Subgroup B - GuttaFlow Bioseal (GFB). Then, sealers were mixed with 0.1% rhodamine B dye and the samples were obturated. All the samples were sectioned at 2 mm and 5 mm from the apex and visualized under confocal laser scanning microscope (CLSM) (10×) for maximum mean penetration depth and percentage of sealer penetration. Statistical analysis was done using the independent t-test and one-way analysis of variance test, followed by Tukey\'s Post hoc analysis.
UNASSIGNED: PUI performed better in the apical third, whereas PUI and PATS showed comparable results in the middle third for both depth and percentage of sealer penetration. Among the two sealers, GFB performed better than AH Plus in both the apical and middle third. These values were statistically significant. (P < 0.05).
UNASSIGNED: Final irrigation activation with PUI or PATS can significantly improve sealer penetration. The average depth of penetration of GFB both at the middle and apical third of the root was significantly superior to AH Plus.

OBJECTIVE: This study aimed to compare the bond strength of AH Plus sealer to root canal dentin when used with or without various antibiotics including amoxicillin, clindamycin, and triple antibiotic mixture (TAM).
METHODS: A total of 80 single-rooted extracted human teeth were instrumented and obturated with gutta-percha and four different sealer-antibiotic combinations (n = 20). Group I: AH Plus without any antibiotics, Group II: AH Plus with amoxicillin, Group III: AH Plus with clindamycin, and Group IV: AH Plus with TAM. After seven days, the roots were sectioned perpendicular to their long axis and 1 mm thick slices were obtained from the midroots. The specimens were subjected to a push-out bond strength test and failure modes were also evaluated. Data was analyzed using Kruskal-Wallis and Dunn\'s post hoc tests.
RESULTS: Group IV had significantly higher bond strength compared to other groups (p ≤ 0.05). No significant differences were found between other groups. While the sealer-antibiotic groups predominantly showed cohesive failure modes, the control group displayed both cohesive and mixed failure modes.
CONCLUSIONS: Within the limitations of this study, the addition of TAM increased the push-out bond strength of AH Plus.
CONCLUSIONS: Amoxicillin, clindamycin, or TAM can be added to AH Plus for increased antibacterial efficacy without concern about their effects on the bond strength of the sealer. How to cite this article: Adl A, Shojaei NS, Ranjbar N. The Effect of Adding Various Antibiotics on the Push-out Bond Strength of a Resin-based Sealer: An In Vitro Study. J Contemp Dent Pract 2024;25(3):231-235.

The correct obturation of the root canal system achieved by means of a core and a cement is essential for the success of endodontic treatment. There are several root canal cements (RCCs) on the market; however, because of their excellent characteristics, epoxy resin-based sealers (ERBSs) have been widely used. The main aim of this review was to analyze and integrate the available information on different ERBSs. An electronic search was performed in the PubMed and Scopus databases, using \"epoxy resin\" AND \"root canal treatment\", and \"epoxy resin\" AND \"endodontics\" as search terms. In general, ERBSs have good flow properties, film thickness, solubility, dimensional stability, sealing capacity, and radiopacity. They are also able to adhere to dentin while exhibiting low toxicity and some antibacterial effects. However, their main disadvantage is the lack of bioactivity and biomineralization capability. A large number of ERBSs are available on the market, and AH Plus keeps being the gold standard RCC. Yet, information on many of them is limited or non-existent, which could be due to the fact that some of them are relatively new. The latter emphasizes the need for relevant research on the physicochemical and biological properties of some ERBSs, with the aim of supporting their clinical use with sufficient evidence via prospective and long-term studies.

OBJECTIVE: To evaluate the cytocompatibility, bioactivity, and anti-inflammatory potential of the new pre-mixed calcium silicate cement-based sealers Bioroot Flow (BrF) and AH Plus Bioceramic Sealer (AHPbcs) on human periodontal ligament stem cells (hPDLSCs) compared to the epoxy resin-based sealer AH Plus (AHP).
METHODS: Standardized discs and 1:1, 1:2, and 1:4 eluates of BrF, AHPbcs and AHP after setting were prepared. The following assays were performed: cell attachment and morphology via SEM, cell viability via a MTT assay, cell migration/proliferation via a wound-healing assay, cytoskeleton organization via immunofluorescence staining; cytokine release via ELISA; osteo/cemento/odontogenic marker expression via RT-qPCR, and cell mineralized nodule formation via Alizarin Red S staining. HPDLSCs were isolated from extracted third molars from healthy patients. Comparisons were made with hPDLSCs cultured in unconditioned (negative control) or osteogenic (positive control) culture media. Statistical significance was established at p < 0.05.
RESULTS: Both BrF and AHPbcs showed significantly positive results in the cytocompatibility assays (cell metabolic activity, migration, attachment, morphology, and cytoskeleton organization) compared with a negative control group, while AHP showed significant negative results. BrF exhibited an upregulation of at least one osteo/cementogenic marker compared to the negative and positive control groups. BrF showed a significantly higher calcified nodule formation than AHPbcs, the negative and positive control groups, while AHPbcs was higher than the negative control group. Both were also significantly higher than AHP group.
CONCLUSIONS: BrF and AHPbcs exhibit adequate and comparable cytocompatibility on hPDLSCs. BrF also promoted the osteo/cementogenic differentiation of hPDLSCs. Both calcium silicate-based sealers favored the downregulation of the inflammatory cytokine IL-6 and the calcified nodule formation from hPDLSCs. BrF exerted a significantly higher influence on cell mineralization than AHPbcs.
CONCLUSIONS: This is the first study to elucidate the biological properties and immunomodulatory potential of Bioroot Flow and AH Plus Bioceramic Sealer. The results act as supporting evidence for their use in root canal treatment.

UNASSIGNED: The objective of the study was to compare and evaluate the depth of penetration of an epoxy resin-based sealer following a final rinse of 17% ethylenediaminetetraacetic acid (EDTA) and 18% 1-hydroxyethylidene 1, 1-diphosphonate (HEDP), with diode laser and passive ultrasonic activation (PUI): an in vitro confocal laser scanning microscopy study.
UNASSIGNED: Fifty-two extracted human mandibular premolar teeth with single root and single canal were selected. They were disinfected in 0.1% thymol solution, cleaned of calculus and soft tissues, and stored in 0.1% thymol solution till use. All teeth were radiographed and selected as per the inclusion and exclusion criteria. The teeth were decoronated using a diamond disk under copious water spray to acquire a standardized root length of 14 mm. Working length was established by inserting a size 10-K file into each root canal until it is visible at the apical foramen and by subtracting 1 mm from the recorded length. Instrumentation of the root canal was done till master apical file size of F3 using ProTaper universal, rotary instruments. The canals were irrigated with 2 mL of 3% sodium hypochlorite between successive files. Teeth were randomly divided into four subgroups n = 12 according to the intervention. Passive ultrasonic irrigation and diode laser were used to activate the irrigants. Final irrigation was performed with distilled water. These specimens were examined using confocal laser scanning microscope (OLYMPUS FLUOVIEW FV 3000) for dentinal tubule penetration of the sealer. Two-way ANOVA test and Tukey\'s multiple post hoc test were used for statistical analysis.
UNASSIGNED: Highly significant difference was seen between the groups with EDTA and HEDP, with HEDP demonstrating the highest penetration. Among the activation techniques used in this study, PUI showed the highest penetration of the sealer. The least penetration was seen with diode laser activation and EDTA.
UNASSIGNED: The irrigation activation techniques significantly influence the penetration of sealer into root dentinal tubules. When penetration of sealer with different irrigation techniques and irrigants was evaluated, significant greater level of sealer penetration was attained with PUI activation of HEDP.

UNASSIGNED: An endodontic treatment is considered a success after thorough chemomechanical debridement coupled with obturating root canals in a concrete way thereby providing hermetic seal. Gutta-percha being nonadherent necessitates use of a sealer to achieve hermetic seal. Adequate adhesion of root canal sealer with gutta-percha core and radicular dentin ensures lack of apical leakage.
UNASSIGNED: Sixty extracted mandibular premolars with single root canal decoronated at cementoenamel junction were selected and randomly allocated to two groups (n = 30). Samples in Group 1 were prepared with BT Race file, while Group 2 samples were prepared with BT Race alongwith XP Endo file. Absorbent paper points were used for canal drying and samples were randomly divided into six subgroups. In Subgroup I, obturation was done with bio-ceramic (BC) sealer (Endosequence BC) and BC gutta-percha. In Subgroup II, resin-based (AH plus) sealer and gutta-percha were used. In Subgroup III, calcium hydroxide-based (Sealapex) sealer and gutta-percha were used. Sectioning of root samples was done perpendicularly into coronal, middle, and apical segments of 3 mm each. A universal testing machine was used for sample testing, in which push-out bond strength corresponded to the highest value obtained. Stereomicroscopic (×20) study of the samples determined the failure mode at dentin/sealer/main cone interface.
UNASSIGNED: Analysis of variance and post hoc Tukey\'s tests were used for data analysis.
UNASSIGNED: Endosequence BC with XP-Endo files showed the highest mean push-out bond strength (16.31 MPa), whereas Sealapex without XP-Endo file had the lowest values (12.76 MPa). Mixed failure of adhesive and cohesive mode was observed for most samples.
UNASSIGNED: Adjunctive irrigation agitation technique utilizing XP-Endo Finisher facilitates biofilm eradication from difficult niches in root canals, thereby improving adhesion of sealer and subsequently the sealer bond strength.

OBJECTIVE: To compare calcium silicate-based endodontic sealer and epoxy resin-based sealer remnants on root canal walls after post space preparation and their influence on the bond strength of fibre posts fixed with a dual-cured resin cement.
METHODS: Thirty-six extracted single-root mandibular premolars were instrumented and divided randomly into two equal groups with different endodontic sealers. iRoot SP (Innovative BioCeramix, Vancouver, Canada) was employed in the experimental group and AH Plus (Dentsply Sirona, Charlotte, NC, USA) was used in the control group. Sealer remnants were observed under an endodontic microscope after root canal therapy and post space preparation. Fibre posts were fixed with dual-cured resin cement. Specimens were taken at each third of the post space. The push-out bond strength was measured using a universal testing machine and fracture modes were assessed. Statistical analysis was performed using an independent samples t test and one-way analysis of variance.
RESULTS: There was no statistically significant difference in bond strength of fibre posts between the control and experimental group (P > 0.05); however, sealer remnants were observed in 38.9% of the samples treated with iRoot SP and none of the samples treated with AH Plus. The major fracture mode in samples treated with iRoot SP was adhesive failure between the resin cement and the post, and no adhesive failure between the resin cement and dentine occurred at the site of the sealer remnant. The presence of iRoot SP remnants on the root canal walls after post space preparation did not interfere with bonding.
CONCLUSIONS: iRoot SP is a viable option for root canal obturation before fibre post cementation.

This study was assessed the biocompatibility of three different root canal sealers (Well-Root St, GuttaFlow Bioseal, and AH-Plus) following implantation in rat subcutaneous tissues, using histopathological immunohistochemical analysis.
Four groups of eighty-four male rats each underwent subcutaneous dorsal implantation of a polyethylene tube, either empty or filled. Tissues were collected, fixed, and processed for histological analysis after 7, 15, and 30 d. Slides were photographed and digitally processed to identify lymphocytes and macrophages using Cluster of differentiation 3 (CD3) and cluster of differentiation 68 (CD68) markers, respectively. P was set at 0.05, when lymphocyte and macrophage infiltration was compared between groups and observation times using one-way analysis of variance (ANOVA).
Histopathological analysis of all groups revealed an inflammatory reaction followed by the emergence of a fibrous capsule after 7 days. After 30 days, the thickness of the fibrous capsule and the inflammatory response subsided. CD3 staining for immunohistochemical analysis revealed that the AH-Plus group had the highest mean percentage of lymphocyte infiltration at 7 and 15 days, followed by the Well-Root St, GuttaFlow Bioseal, and Control groups. After 30 days, no discernible difference was observed between the groups in terms of the mean percentage of lymphocyte infiltration. After 7, 15, and 30 days, there was a significant difference in the mean percentage of macrophage infiltration across the groups, as demonstrated by CD68 staining. After 7, 15, and 30 days, the AH-Plus group had the highest mean percentage of macrophage infiltration, followed by the Well-Root St. and GuttaFlow Bioseal groups, while the control group had the lowest mean percentage.
All observational periods showed minimal inflammatory reactions to GuttaFlow Bioseal. After subcutaneous tissue implantation in a rat model, the initial inflammatory reactions to Well-Root St and AH-Plus had abated by day 30, and all tested sealers had outstanding biocompatibility.