Removal of AH Plus Bioceramic Sealer from Artificial Internal Resorption Cavities Using Different Irrigation Activation Systems

Mine Büker; Meltem Sümbüllü; Emine Şimşek; Fadime Sena Sezer

doi:10.7126/cumudj.1669314

EN

Removal of AH Plus Bioceramic Sealer from Artificial Internal Resorption Cavities Using Different Irrigation Activation Systems

Abstract

Objectives: This study aimed to evaluate the effectiveness of XP-Endo Finisher (XPF), XP-Endo Finisher R (XPF-R), passive ultrasonic irrigation (PUI), and conventional needle irrigation (CNI) systems in removing AH Plus Bioceramic Sealer from artificial internal root resorption (IRR) cavities. Materials and methods: A total of 52 mandibular premolar with single oval canals were selected. After instrumentation, each tooth was sectioned longitudinally, and an artificial resorption cavity was created to a depth of 0.8 mm and a diameter of 1.6 mm, at 8 mm from the apex. These cavities were filled with sealer, and the root halves were then reassembled. The specimens were randomly allocated into four groups (n = 13) based on the activation methods. The residual sealer was assessed under X20 magnification using a 4-grade scoring system. Results: None of the methods completely removed the sealer from the artificial resorption cavities. XPF, XPF-R, and PUI showed significantly greater efficacy in sealer removal compared to CNI (P < 0.001), with no statistically significant differences between XPF, XPF-R and PUI. Although statistical differences were not observed, the XPF-R system demonstrated a higher percentage of ‘Score 0’ outcomes compared to XPF and PUI. Conclusions: XPF, XPF-R and PUI removed more sealer from artificial IRR cavities compared with CNI. These findings indicate that XPF-R is an effective additional activation system in IRR cavities filled with bioceramic sealers.

Keywords

Ethical Statement

All procedures involving human participants were performed in accordance with the ethical standards of the institution and the Declaration of Helsinki. The study protocol received approval from the university ethical committee board (Decision No: 2024/927).

References

1. Tek V, Türker SA. A micro-computed tomography evaluation of voids using calcium silicate-based materials in teeth with simulated internal root resorption. Restor Dent Endod 2020;45:e5.
2. Küçükkaya Eren S, Aksel H, Askerbeyli Örs S, Serper A, Koçak Y, Ocak M, Çelik HH. Obturation quality of calcium silicate-based cements placed with different techniques in teeth with perforating internal root resorption: a micro-computed tomographic study. Clin Oral Investig 2019;23:805-811.
3. Lyngdoh D, Alam S, Iftekhar H, Mishra SK. Evaluation of canal patency and cleanliness following retreatment of bioceramic sealer‐obturated root canals using three different irrigant activation protocols. Aust Endod J 2024;50:475-485.
4. Ruggiero SL, Dodson TB, Aghaloo T, Carlson ER, Ward BB, Kademani D. American Association of Oral and Maxillofacial Surgeons’ position paper on medication-related osteonecrosis of the jaws—2022 update. J Oral Maxillofac Surg 2022;40:920-943.
5. Aminoshariae A, Donaldson M, Horan M, Mackey SA, Kulild JC, Baur D. Emerging antiresorptive medications and their potential implications for dental surgeries. J Am Dent Assoc 2022;153: 649-658.
6. Gulabivala K, Ng YL. Factors that affect the outcomes of root canal treatment and retreatment—A reframing of the principles. Int Endod J 2023; 56:82-115.
7. Drukteinis S, Camilleri J. Bioceramic materials in clinical endodontics. Springer 2021.
8. Sanz JL, López-García S, Rodríguez-Lozano FJ, Melo M, Lozano A, Llena C, Forner L. Cytocompatibility and bioactive potential of AH Plus Bioceramic Sealer: An in vitro study. Int Endod J 2022;55:1066-1080.

9. Sanz JL, López-García S, García-Bernal D, Rodríguez-Lozano FJ, Forner L, Lozano A, Murcia L. Comparative bioactivity and immunomodulatory potential of the new Bioroot Flow and AH Plus Bioceramic sealer: An in vitro study on hPDLSCs. Clin Oral Investig 2024;28:195.
10. Hamdy TM, Galal MM, Ismail AG, Saber S. Physicochemical properties of AH plus bioceramic sealer, Bio-C Sealer, and ADseal root canal sealer. Head Face Med 2024;20:2.
11. Jiang S, Zou T, Li D, Chang JW, Huang X, Zhang C. Effectiveness of sonic, ultrasonic, and photon-induced photoacoustic streaming activation of NaOCl on filling material removal following retreatment in oval canal anatomy. Photomed Laser Surg 2016;34:3-10.
12. Fischer BV, Goulart TS, Vitali FC, de Souza DL, Teixeira CDS, Garcia LDFR. Supplementary methods for filling material removal: A systematic review and meta-analysis of Micro-CT imaging studies. J Dent 2024:105445.
13. da Rosa AF, Fischer BV, Dias-Junior LCL, Serique AVC, Bortoluzzi EA, Teixeira CDS, da Fonseca Roberti Garcia L. Effectiveness of different supplementary protocols for remaining filling material removal in endodontic reintervention: an integrative review. Odontology 2024;112:51-73.
14. van der Sluis LW, Versluis M, Wu MK, Wesselink PR. Passive ultrasonic irrigation of the root canal: a review of the literature. Int Endod J 2007;40:415-426.
15. Căpută PE, Retsas A, Kuijk L, Chávez de Paz LE, Boutsioukis C. Ultrasonic irrigant activation during root canal treatment: a systematic review. J Endod 2019 45:31-44.e13.
16. Cavenago BC, Ordinola-Zapata R, Duarte MA, del Carpio-Perochena AE, Villas-Bôas MH, Marciano MA, Bramante CM, Moraes IG. Efficacy of xylene and passive ultrasonic irrigation on remaining root filling material during retreatment of anatomically complex teeth. Int Endod J 2014;47:1078-1083.
17. De-Deus G, Belladonna FG, Zuolo AS, Cavalcante DM, Carvalhal JCA, Simões-Carvalho M, Souza EM, Lopes RT, Silva EJNL. XP‐endo Finisher R instrument optimizes the removal of root filling remnants in oval‐shaped canals. Int Endod J 2019;52:899-907.
18. Sağlam BC, Hazar E, Koçak S, Koçak MM. Efficacy of XP-Endo Finisher and passive ultrasonic irrigation on modified triple antibiotic paste removal. Cumhuriyet Dent J 2019;22:108-113.
19. Silva EJNL, Belladonna FG, Zuolo AS, Rodrigues E, Ehrhardt IC, Souza EM, De-Deus G. Effectiveness of XP‐endo Finisher and XP‐endo Finisher R in removing root filling remnants: a micro‐CT study. Int Endod J 2018;51:86-91.
20. Sinsareekul C, Hiran-Us S. Comparison of the efficacy of three different supplementary cleaning protocols in root-filled teeth with a bioceramic sealer after retreatment—a micro-computed tomographic study. Clin Oral Investig 2022;26:1-7.
21. Schneider SW. A comparison of canal preparations in straight and curved root canals. Oral Surg Oral Med Oral Pathol 1971;32:271-275.
22. van der Sluis LW, Wu MK, Wesselink PR. The evaluation of removal of calcium hydroxide paste from an artificial standardized groove in the apical root canal using different irrigation methodologies. Int Endod J 2007;40:52-57.
23. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-174.
24. Crozeta BM, Silva-Sousa YT, Leoni GB, Mazzi-Chaves JF, Fantinato T, Baratto-Filho F, Sousa-Neto MD. Micro–computed tomography study of filling material removal from oval-shaped canals by using rotary, reciprocating, and adaptive motion systems. J Endod 2016;42:793-797.
25. Arul B, Varghese A, Mishra A, Elango S, Padmanaban S, Natanasabapathy V. Retrievability of bioceramic-based sealers in comparison with epoxy resin-based sealer assessed using microcomputed tomography: A systematic review of laboratory-based studies. J Conserv Dent 2021;24:421-434.
26. Bernardes RA, Duarte MAH, Vivan RR, Alcalde MP, Vasconcelos BC, Bramante CM. Comparison of three retreatment techniques with ultrasonic activation in flattened canals using micro‐computed tomography and scanning electron microscopy. Int Endod J 2016;49:890-897.
27. Düzgün S, Topçuoğlu HS, Kahraman Ö, Eminsoy AT. Efficacy of different irrigation agitation systems in the removal of root canal sealers from artificial standardized grooves. Aust Endod J 2023;49:339-344.
28. Uzunoglu‐Özyürek E, Küçückkaya 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;47:703-714.
29. Sümbüllü M, Ali A, Büker M, Arslan H. The efficiency of different irrigation activation techniques in the removal of calcium silicate‐based endodontic sealer from artificially created groove. Aust Endod J 2023;49:238-244.
30. Da Silva V, Loroño G, Valencia de Pablo O, Estevez R, Conde AJ, Rossi-Fedele G, Cisneros R. The supplementary use of XP‐endo Finisher R after Reciproc enhances the removal of a bioceramic sealer in oval root canals. Aust Endod J 2023;49:156-161.
31. 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;25:891-899.
32. De-Deus G, Belladonna FG, Zuolo AS, Cavalcante DM, Simões Carvalho M, Marinho A, Souza EM, Lopes RT, Silva EJNL. 3-dimensional ability assessment in removing root filling material from pair-matched oval-shaped canals using thermal-treated instruments. J Endod 2019;45:1135-1141.
33. Asgary S, Eghbal MJ, Mehrdad L, Kheirieh S, Nosrat, A. Surgical management of a failed internal root resorption treatment: a histological and clinical report. Restor Dent Endod 2014;39:137-142.
34. Ersahan, S. & Aydin, C. Solubility and apical sealing characteristics of a new calcium silicate-based root canal sealer in comparison to calcium hydroxide-, methacrylate resin-and epoxy resin-based sealers. Acta Odontologica Scandinavica 2013;71:857-862.
35. Weller RN, Tay KC, Garrett LV, Mai S, Primus CM, Gutmann JL, Pashley DH, Tay FR. Microscopic appearance and apical seal of root canals filled with gutta‐percha and ProRoot Endo Sealer after immersion in a phosphate‐containing fluid. Int Endod J 2008;41:977-986.
36. Pedullà E, Abiad RS, Conte G, Khan K, Lazaridis K, Rapisarda E, Neelakantan P. Retreatability of two hydraulic calcium silicate‐based root canal sealers using rotary instrumentation with supplementary irrigant agitation protocols: a laboratory‐based micro‐computed tomographic analysis. Int Endod J 2019;52:1377-1387.
37. van der Sluis LW, Vogels MP, Verhaagen B, Macedo R, Wesselink PR. Study on the influence of refreshment/activation cycles and irrigants on mechanical cleaning efficiency during ultrasonic activation of the irrigant. J Endod 2010;36:737-740.

Details

Primary Language

English

Subjects

Endodontics

Journal Section

Research Article

Authors

Mine Büker ^*
0000-0003-4833-4547
Türkiye

Meltem Sümbüllü
0000-0002-2647-7988
Türkiye

Emine Şimşek
0000-0001-9195-2012
Türkiye

Fadime Sena Sezer
0009-0005-3028-1848
Türkiye

Publication Date

September 30, 2025

Submission Date

April 2, 2025

Acceptance Date

May 29, 2025

Published in Issue

Year 1970 Volume: 28 Number: 3

DOI

https://doi.org/10.7126/cumudj.1669314

IZ

https://izlik.org/JA92GY23XA

Cite

RIS / Bibtex

EndNote

Büker M, Sümbüllü M, Şimşek E, Sezer FS (September 1, 2025) Removal of AH Plus Bioceramic Sealer from Artificial Internal Resorption Cavities Using Different Irrigation Activation Systems. Cumhuriyet Dental Journal 28 3 383–389.

Öz

Removal of AH Plus Bioceramic Sealer from Artificial Internal Resorption Cavities Using Different Irrigation Activation Systems

Abstract

Keywords

Ethical Statement

References

Details

Primary Language

Subjects

Journal Section

Authors

Publication Date

Submission Date

Acceptance Date

Published in Issue

DOI

IZ

Cite