Table 1.
Recent advances in nanomaterials used in endodontic sealers
| Type | Base materials | Nanomaterials | Properties assessed | Main findings | Year | References |
|---|---|---|---|---|---|---|
| Zinc oxide-eugenol (ZOE) | Endomethasone N (Septodont, France) | AgVO3 nanomaterial | Biocompatibility (human gingival fibroblasts) | A reduction in cell viability due to AgVO3. | 2021 | [229,230] |
| Lab-made experimental materials* | Nano-ZOE | Biocompatibility (L929 cells), sealing ability, and post-treatment pain control | The biocompatibility of the nano-ZOE was comparable to Pulpdent but lower than AH-26. In addition, nano-ZOE showed less leakage than AH-26 and commercial ZOE. However, almost half of the subjects treated with nano-ZOE reported severe to very severe pain in the first 6 h of follow-up. | 2015, 2013, 2020 | [231–233] | |
| Lab-made experimental materials | ZnO NPs | Physiochemical properties | Addition of 25% ZnO NPs significantly improved dimensional stability. | 2016 | [130] | |
| Calcium hydroxide | Apexit Plus (Ivoclar Vivadent, Liechtenstein) | Chitosan NPs and ZnO NPs | Antimicrobial activity (E. faecalis) | ZnO NPs had superior antibacterial activity to chitosan NPs. | 2018 | [159] |
| Calcium silicate | Lab-made experimental materials (β-dicalcium silicate) | Attapulgite (ATT) nanofibers | Physiochemical properties | ATT (1–4%) enhanced the compressive strength and retarded bio-dissolution. | 2022 | [152] |
| BioRoot RCS (Septodont, France) | Multi-walled carbon nanotubes, titanium carbide nanopowder, and boron nitride nanotubes | Physiochemical properties | The incorporation of nanomaterials enhanced compressive strength and shortened the setting time. | 2021, 2020 | [153,234] | |
| EndoSequence BC Sealer (Brasseler, USA) | Chitosan-hydroxyapatite nanocomplexes | Physiochemical properties | Addition of nanocomplexes increased nanohardness and elastic modulus. | 2022 | [163] | |
| Bright Endo MTA Sealer (Genoss, Korea) | Bioactive glass NPs | Bioactivity | Osteogenic differentiation was stimulated by the addition of bioactive glass NPs (0.5% and 1%). | 2022 | [140] | |
| Lab-made experimental materials* | Silver/zinc-loaded mesoporous Ca–Si nanoparticles (MCSNs) | Antimicrobial activity (E. faecalis and animal root canal infection model) and biocompatibility (MC3T3-E1 cells) | Ag/Zn ratios influenced antibacterial activity and cytotoxicity. Ag/Zn-MCSNs demonstrated strong impacts against bacteria in vitro and in vivo, without compromising biocompatibility and hardness of materials. | 2021, 2020 | [20,186] | |
| Epoxy resin | AH 26 (Dentsply Sirona, Germany) | Chitosan NPs | Antimicrobial activity (E. faecalis) | Incorporation of chitosan NPs (10, 20, and 30%) produced a larger inhibition zone with improved cytocompatibility. | 2022 | [160] |
| AH Plus (Dentsply Sirona, Germany) | Bismuth lipophilic (BisBAL) NPs | Antimicrobial activity (E. faecalis) | Incorporation of BisBAL NPs produced a larger inhibition zone and inhibited biofilm formation completely on both the E. faecalis ATCC strain and the clinical isolates from endodontic patients. | 2022 | [235] | |
| AH Plus (Dentsply Sirona, Germany) | Ag NPs | Antimicrobial activity (Klebsiella and E. coli, and E. faecalis) | The incorporated Ag NPs did not prevent apical bacterial leakage after 3 months. Ag NPs-loaded sealers exhibited comparable antibacterial activity to those added with chitosan NPs. | 2021, 2019 | [114,120] | |
| AH Plus (Dentsply Sirona, Germany) | Chitosan NPs | Antimicrobial activity (E. faecalis) | Chitosan NP-loaded sealers had comparable antibacterial activity to those with Ag NPs. | 2019 | [114] | |
| ADSEAL (META BIOMED, Korea) | Chlorhexidine (CHX)/Ag NPs @ multi-walled carbon nanotubes (CNTs) | Antimicrobial activity (E. faecalis, C. albicans and S. aureus) | Addition of CNTs incorporating CHX and Ag NPs enhanced antibacterial and antifungal efficacy. | 2021 | [180] | |
| AH Plus (Dentsply Sirona, Germany) | Quaternary ammonium polyethyleneimine NPs | Antimicrobial activity (E. faecalis) | The incorporation of quaternary ammonium polyethyleneimine NPs significantly improved antibacterial activity. | 2015 | [173] | |
| AH Plus (Dentsply Sirona, Germany) | AgVO3 nanomaterials | Biocompatibility (human gingival fibroblast) | A reduction in cell viability was due to AgVO3. | 2021 | [229,230] | |
| Sealer 26 (containing calcium hydroxide; Dentsply Sirona, Brazil) | AgVO3 nanomaterials | Biocompatibility (human gingival fibroblast) | A reduction in cell viability was due to AgVO3. | 2021 | [229,230] | |
| AH Plus (Dentsply Sirona, Germany) | Mg(OH)2 NPs | Biocompatibility (MC3T3-E1 cells), bioactivity and antimicrobial activity (S. mutans) | The addition of 3% Mg(OH)2 NPs promoted cell proliferation and osteogenic differentiation. 5% and 7% Mg(OH)2 NPs enhanced the antibacterial function of AH Plus in the fresh state. | 2020 | [146,147] | |
| AH Plus (Dentsply Maillefer, USA) | β-TCP nanocrystals | Biocompatibility (human periodontal ligament fibroblasts), antimicrobial activity (E. faecalis, C. albicans, E. coli) and physiochemical property | The addition of β-TCP did not affect antibacterial activity, but supported higher cell viability as well as increased adhesiveness to root canal walls. | 2019 | [236] | |
| AH Plus (Dentsply Sirona, Germany) | Fluoridated bioactive glass NPs (F-nBG) | Physiochemical property | F-nBG incorporated sealers released fluoride and gave enhanced bond strengths. | 2020 | [142] | |
| AH 26 (Dentsply Sirona, Germany) | Fluoridated hydroxyapatite NPs, hydroxyapatite NPs and bioactive glass NPs | Physiochemical property and bioactivity | BAG and HA NPs enhanced the in vitro apatite-forming ability and did not alter the physical performance of AH 26. However, fluoridated HA NPs did not improve the apatitic layer formation. | 2019 | [139] | |
| AH Plus (Dentsply Sirona, Germany) | ZnO NPs | Penetrability to dentinal tubule | Addition of ZnO NPs significantly enhanced tubular sealer penetration depth. | 2020 | [131] | |
| Methacrylate resin | Lab-made experimental materials | Ag@SiO NPs | Antimicrobial activity (E. faecalis) | The addition of Ag@SiO up to 10 wt % did not affect the biocompatibility, radiopacity, flow, film thickness, and showed an immediate and long-term (9 months) antibacterial effect. | 2023 | [2] |
| Lab-made experimental materials | Calcium hydroxide-containing halloysite nanotube (HNT_CaOH2) and β-tricalcium phosphate-containing nanotube (HNT_β-TCP) | Antimicrobial activity (unknown species) | The incorporation of HNT_CaOH2 or HNT_β-TCP reduced the bacterial count. | 2022 | [178] | |
| Lab-made experimental materials | Halloysite nanotubes (HNT) doped with alkyl trimethyl ammonium bromide(ATAB) | Antimicrobial activity (E. faecalis) | The incorporation of ATAB/HNT enhanced antibacterial activity against biofilm and planktonic E. faecalis. | 2019 | [177] | |
| Lab-made experimental materials | ZnO NPs with needle-like nanostructure | Antimicrobial activity (E. faecalis) | ZnO NPs improved the antibacterial effect without a significant detrimental impact on the chemical and physical properties. | 2020 | [124] | |
| EndoREZ (Ultradent, USA) with 2.5% quaternary ammonium salt | Magnetic nanoparticles or Fe3O4 NPs | Penetrability to dentinal tubule and antimicrobial activity (E. faecalis) | Fe3O4 NPs could penetrate into dentinal tubes under a magnetic field to kill bacteria embedded in the deeper dentinal tubules in vitro and in vivo. | 2022 | [132,237] | |
| Lab-made experimental materials | Hydroxyapatite NPs | Bioactivity | Hydroxyapatite NPs were inferior to α-TCP in terms of stimulating mineralized nodule formation. | 2021 | [137] | |
| Lab-made experimental materials | Amorphous calcium phosphate NPs (ACP NPs) | Mineralization | The incorporation of ACP NPs increased the release of Ca and P ions at pH levels below 7. | 2019, 2017 | [148–150] | |
| Others | Lab-made experimental materials (polyurethane base) | nano-ZnO and nano-hydroxyapatite | Antimicrobial activity (S. mutans, S. aureus, and E. faecalis) and biocompatibility (L929 cells) | Zn-containing sealers exhibited more robust and long-lasting antibacterial activity and lower cytotoxicity than the Ag-containing sealers. Nano-HA exhibited stable antibacterial activity. | 2021, 2019 | [126,127] |
| Lab-made experimental materials (urethane-acrylate base) | Nanoscale silicate platelets (NSPs) immobilized with Ag NPs and/or ZnO NPs (Ag@NSP, ZnO@NSP, or Ag/ZnO@NSP) | Antimicrobial activity (E. faecalis) and biocompatibility (3T3 cells) | Simultaneous immobilization of Ag NPs and ZnO NPs on silicate platelets enhanced the antibacterial activities, and also reduced the dose of Ag NPs needed, resulting in acceptable cytotoxicity. | 2020 | [125] | |
| Lab-made experimental materials* | Monodispersed silica-based bioactive glass NPs (SBG-NS) grafted with quaternary ammonium polymethacrylate (QAPM) | Antimicrobial activity (E. faecalis, S. mutans, and S. sanguis) and biocompatibility (periodontal ligament stem cells, calvarial implantation model) | SBG-QAPM had the strongest long-term antibacterial effect and lowest inflammatory reaction when compared with ProRoot MTA, Endomethasone C, and AH Plus. | 2017 | [151] | |
| Lab-made experimental materials* | Polymeric PLGA NPs loaded with Egyptian propolis extract (ProE) | Biocompatibility (subcutaneous implantation model) and sealing ability | ProE-loaded PLGA NPs caused milder inflammatory reactions and gave comparable sealing ability when compared with AH Plus. | 2020 | [188] |
*The main compositions of sealers are listed nanomaterials.