Use of Calcium-containing Endodontic Sealers as Apical Barrier in Fluid-contaminated Wide-open Apices

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Abstract
Purpose: The sealing of wide-open apex roots is still a challenge and requires the use of apical barrier techniques. The aim was to evaluate ex vivo the sealing and the apical morphology of 3 commercial calcium oxide (CaO)-containing sealers - namely, 2 zinc oxide-based (CRCS and Sealapex) and a calcium silicate MTA-based (TechBiosealer Endo) - placed in wet root canals with artificial wide-open apices. Methods: Thirty human single-rooted teeth were shaped with Protaper and an artificial open apex (diameter size 110) was created. Each root was inserted in a custom-designed support containing simulated body fluid (Hank's balanced salt solution, HBSS) at the bottom simulating the presence of periapical fluid in the canal. Each sealer (TechBiosealer Endo, CRCS, Sealapex) was compacted to the apical 5 mm and the filled roots stored in HBSS at 37°C. The sealing was evaluated as micro-infiltrated fluid since 24 hours up to 6 months using a high-precision digital fluid flow meter. The sealers were also studied for setting time in HBSS, calcium releasing (statistical analysis by 2-way ANOVA followed by Student-Newman-Keuls test, P<0.05) and surface morpho-chemistry by environmental scanning electron microscope with energy dispersive X-ray (ESEM-EDX) and optical microscopy (OM) analysis. Results: All sealers showed a stable seal. TechBiosealer Endo maintained a better seal than the other materials (P<0.05) and ESEM-EDX and OM analyses showed the presence of apatite deposits. Conclusions: The clinical use of hydraulic hydrophilic MTA-based sealers can be recommended to stop/reduce the fluid flow rate through the apex. The artificial apical barrier in wet wide apices is a suitable technique able to seal wet root canals.

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