Abstract
Objective
This study compared the dentinal tubule penetration of NeoSEALER Flo bioceramic sealer using single cone and cold lateral compaction obturation techniques.
Methods
Eighteen extracted single-rooted mandibular premolars were randomly divided into two groups (n=9) according to the obturation technique used. The maximum penetration depth in microns, percentage of penetration depth, and percentage of penetration area of the NeoSEALER Flo bioceramic sealer were assessed using confocal laser scanning microscopy at different root levels; coronal, middle, and apical. Data was statistically analyzed using Kruskal-Wallis's test followed by Dunn's post hoc test with Bonferroni correction and Friedman's test followed by Nemenyi post hoc test with the significance level set at p<0.05.
Results
The single cone obturation technique has shown a statistically significantly higher percentage area of NeoSEALER Flo penetration than the lateral compaction technique at the coronal root level only. Otherwise, both obturation techniques have shown no statistically significant differences in NeoSEALER Flo penetration distance, percentage of penetration distance, and percentage of area penetration at the middle and apical root levels.
Conclusion
The single cone obturation technique can be used with bioceramic sealers yielding comparable results to the cold lateral compaction technique.
Keywords: Bioceramic sealer, lateral compaction, sealing ability, single cone
HIGHLIGHTS
Single cone obturation technique can be used with bioceramic sealers.
Single cone and lateral compaction obturation techniques yield comparable sealer penetration into dentinal tubules.
Bioceramic sealers show acceptable dentinal tubule penetration at various root levels.
INTRODUCTION
Following root canal disinfection, proper sealing of the root canal space is deemed mandatory for the prevention of reinfection and maintenance of long-term success of the treatment (1). Bioceramic sealers have several key properties that enhance their effectiveness in endodontic applications. Their excellent biocompatibility stems from their similarity to biological hydroxyapatite, a primary component of natural bone (2). Bioceramic sealers create an exceptional hermetic seal, preventing bacteria and fluids from leaking into the root canal system (3). They can chemically bond with the tooth structure and exhibit antibacterial properties due to their alkaline pH and in situ precipitation after setting. This process sequesters bacteria, effectively reducing the microbial load within the root canal system and lowering the risk of reinfection (4–6).
The sealer's ability to penetrate dentinal tubules ensures superior sealing, preventing fluids and microorganisms from passing between the periodontium and the root canal. Additionally, bioceramic sealers with good penetration ability can exert antimicrobial effects, lowering the risk of reinfection. Proper penetration also ensures the sealer adapts well to the irregularities of the dentinal tubules, creating a hermetic seal (7).
The penetration depth of bioceramic sealers into dentinal tubules can be influenced by several factors such as smear layer removal, dentine permeability, sealer properties, filling technique, root canal dimension, and interaction with dentine (8). Understanding the penetration depth of bioceramic sealers helps optimize endodontic treatment outcomes.
NeoSEALER Flo (Avalon Biomed, Houston, TX, USA) exhibits excellent handling properties, allowing for easy application and adaptation within the root canal system. Its bioactive formulation promotes the formation of hydroxyapatite upon contact with moisture, enhancing the seal and facilitating biological integration. NeoSEALER Flo is composed of a bioactive paste of fine inorganic powder of tricalcium/dicalcium silicate in an organic medium. This sealer is packed in a ready-to-use syringe and designed to set in the presence of moisture provided by the surrounding tissues. Additionally, this sealer demonstrates favorable biologic properties, antibacterial and cytotoxicity (9).
The lateral compaction obturation technique involves the insertion of a master gutta-percha cone into the root canal, followed by using a spreader to laterally compact the cone against the canal walls. Additional accessory cones are then placed into the spaces created by the spreader to achieve a dense fill. This method provides excellent control over the fill and adaptation of the material to the canal walls, ensuring a thorough seal. This technique ensures a dense and well-adapted root canal filling with minimal shrinkage. It provides excellent length control, reducing the risk of overextension beyond the apical foramen. Additionally, it does not require expensive equipment or high temperatures, making it a practical choice in various clinical settings. However, it requires significant skill and time, and the risk of canal damage or overfilling is higher if not performed correctly (10–12).
Single cone obturation, on the other hand, is a more straightforward and faster technique. It involves the insertion of a single gutta-percha cone that matches the taper of the root canal preparation. Bioceramic sealers are often used with this technique to enhance sealing capabilities. This method is less technique-sensitive and reduces the risk of overfilling and canal damage. It reduces the procedural steps and minimizes the risk of overfilling. It enhances sealer distribution within the canal system, as bioceramic sealers have excellent flowability and the ability to bond to dentine, promoting a superior seal. Additionally, the single cone technique is less technique-sensitive than the cold lateral compaction technique, making it an efficient and time-saving approach, especially in cases with minimally flared canal preparations. The single cone method has gained popularity due to its simplicity and the improved properties of modern sealers, although some concerns remain about its ability to achieve the same level of fill density and adaptation as lateral compaction (13–15).
The effect of the obturation technique on bioceramic sealer penetration into the dentinal tubules has not been fully understood. Therefore, this study was held to evaluate the penetration depth of NeoSEALER Flo bioceramic sealers inside dentinal tubules in permanent teeth when obturated with lateral compaction and single cone obturation techniques at different root levels. The null hypothesis tested is that there is no statistically significant difference between obturation techniques, lateral compaction and single cone, on dentinal tubule penetration of NeoSEALER Flo bioceramic sealer at different root levels.
MATERIALS AND METHODS
Ethical Approval and Sample Size Calculation
This study was approved by the local institutional review board with registration no. MIU-IRB-21222223-172. A power analysis was performed at an alpha level of 0.05, a beta of 0.2, and an effect size (f) of 0.586 calculated based on the results of Dasari et al. (16) who evaluated the penetration depth of BioRoot bioceramic sealer using three obturation techniques by Confocal laser scanning microscopy (CLSM). The predicted sample size (n) was found to be a total of 18 samples (i.e., 9 samples per group).
Sample Selection and Preparation
A total of 18 single-rooted permanent premolars with type I canal according to Vertucci classification and straight mature roots were selected. Premolars showing cracks, fractures, pulp stones, calcifications, and external or internal resorption were excluded.
The crowns were removed at the level of the cementoenamel junction using a 0.3 mm high-speed diamond disc under water coolant. For all root samples, manual K files # 10 (Mani, Tochigi, Japan) with taper 2 % were first introduced until the tip was visible just beyond the apex to confirm patency. Working length was determined by subtracting 1 mm from this length. Canals were subsequently irrigated with a total of 3 ml of sodium hypochlorite, NaOCl 5.25% (Clorox, Cairo, Egypt). Hyflex EDM- glide path file tip size 10 and taper 5% (Coltene, Altstatten, Switzerland) was used to shape the coronal part of the root canals. Irrigation was done followed by scouting with manual K files # 10 to reestablish patency. Hyflex EDM- one file tip size 25 and taper of 6% was introduced into canals to complete canal shaping.
Final Irrigation Protocol and Smear Layer Removal
Each canal was irrigated with 20 ml of 17% Ethylenediaminetetraacetic acid (EDTA) (PrevesDenpro, Jammu, India), and Ultra X ultrasonic tip (Eighteeth, Jiangsu Province, China) was placed inside the canal 2 mm short of the working length and activated for 30 seconds followed by a saline flush. The same step was repeated using NaOCl 2.6%, and an Ultra X ultrasonic tip was activated for 30 seconds. The water cooling of the ultrasonic unit was turned on to rinse the canal using a continuous ultrasonic flow (17). Each canal was partially dried using absorbent points #25 before obturation. All endodontic procedures were performed by the first author.
Samples Classification
Teeth were coded and randomly assigned for each group (n=9) according to an Excel sheet generated by www.random.org. In order to allow the CLSM analysis to be performed, one drop of 1% Rhodamine B dye was mixed with 2.5 ml of the bioceramic sealer before obturation (7). For the single cone group, properly fitting and matching Hyflex EDM gutta percha point size #25 was nicely coated with NeoSEALER Flo bioceramic sealer (Avalon Biomed, Houston, TX, USA).
For the lateral compaction group, obturation was done using the cold lateral compaction technique by placing a single cone of gutta-percha size 25 and taper 2 % coated with NeoSEALER Flo bioceramic sealer in the prepared root canal and adding auxiliary gutta percha cones that are compacted together with the use of the selected spreader size 20 and taper 2%.
The excess gutta percha was cut using a heated stainless-steel condenser and vertical compaction was performed at the orifice level. Orifices were sealed with Cavit (3M, Maplewood, Minnesota, USA) temporary filling material. Radiographic assessment was done both buccolingual and mesiodistal using digital periapical radiographs to verify the quality of obturation. To ensure the full setting of the bioceramic sealer used, all samples were stored in an incubator (Memmert, Schwabach, Germany) at 37°C and 100% humidity for two weeks after root canal obturation.
Evaluation of Bioceramic Sealer Penetration
All samples were sectioned horizontally at 4, 8, and 12 mm from the apex using a digital caliper to have 3 mm thickness discs. The process was done with a 0.3 mm Isomet saw (Buehler, Lake Bluff, IL, USA) at 200 rpm, under continuous water cooling to prevent frictional heat. Evaluation of the penetration depth and area of bioceramic sealer inside dentinal tubules was done using a CLSM (ZEISS, Oberkochen, Germany). Each third was mounted on glass slides and scanned from both sides under a magnification of 10X. The penetration of the sealer was represented in microns as a red fluorescence area.
The penetration depth of the sealer was measured in each third at a standard point from the wall of the lumen to the maximum extension of the red fluorescence area in four directions buccal, lingual, mesial, and distal as shown in Figure 1. The maximum penetration depth from each third was selected and converted to a percentage as follows (18):
Figure 1.
CLSM images at ×10 showing NeoSEALER Flo maximum tubular penetration depth in all directions (a) single cone technique at the coronal one-third; (b) single cone technique at the middle one-third; (c) single cone technique at the apical one-third; (d) lateral compaction technique at the coronal one-third; (e) lateral compaction technique at the middle one-third; (f) lateral compaction technique at the apical one-third
CLSM: Confocal laser scanning microscopy
Percentage of maximum penetration depth = maximum penetration depth x 100/total dentine thickness.
Where the full dentine thickness was measured from the inner wall of the root canal to the outer wall of the dentine.The penetration area was also calculated and converted to a percentage as the following equation (19):
Percentage of penetration area = (total penetration area- canal lumen area) x 100/ dentine thickness
Statistical Analysis
The data were skewed and failed to represent a normal distribution using Shapiro test. Intergroup comparisons were analyzed using Kruskal-Wallis's test followed by Dunn's post hoc test with Bonferroni correction, while intragroup comparisons were analyzed using Friedman's test followed by Nemenyi post hoc test. R statistical analysis software (R Development Core Team, University of Auckland, New Zealand) was used for the analysis at a significance level of 0.05.
RESULTS
Descriptive statistics including mean, standard deviation, median, interquartile range, and 95% confidence interval for median, for all measurements are presented in Table 1.
TABLE 1.
Mean, standard deviation, median, interquartile range, and 95% confidence interval for medians, for maximum penetration depth in (μm), percentage, or area, for both obturation techniques
| Measurement | Obturation technique | Section | Mean | Standard deviation | Median | 95% CI for Median* | Interquartile range | |
|---|---|---|---|---|---|---|---|---|
| Lower | Upper | |||||||
| Maximum penetration depth (μm) | Single cone | Coronal | 1853.72 | 226.54 | 1877.24 | 1606.20 | 2077.70 | 250.06 |
| Middle | 1488.05 | 269.54 | 1534.82 | 1194.13 | 1735.19 | 257.28 | ||
| Apical | 833.16 | 347.57 | 695.54 | 561.34 | 1242.59 | 366.67 | ||
| Lateral compaction | Coronal | 1868.66 | 496.46 | 1831.06 | 1386.14 | 2388.77 | 494.30 | |
| Middle | 1681.72 | 314.66 | 1602.52 | 1403.80 | 2038.86 | 362.12 | ||
| Apical | 1185.00 | 479.37 | 1103.60 | 731.35 | 1720.05 | 485.61 | ||
| Maximum penetration percentage (%) | Single cone | Coronal | 98.03 | 1.93 | 98.37 | 95.80 | 99.91 | 2.99 |
| Middle | 96.03 | 8.17 | 98.31 | 87.96 | 101.81 | 4.50 | ||
| Apical | 93.02 | 9.99 | 97.72 | 81.78 | 99.55 | 7.48 | ||
| Lateral compaction | Coronal | 99.03 | 2.48 | 99.93 | 96.84 | 100.30 | 0.35 | |
| Middle | 97.36 | 3.23 | 97.26 | 94.25 | 100.58 | 2.52 | ||
| Apical | 98.07 | 2.49 | 98.69 | 95.11 | 100.42 | 3.36 | ||
| Penetration area (%) | Single cone | Coronal | 76.27 | 13.69 | 79.16 | 57.16 | 89.61 | 9.63 |
| Middle | 59.66 | 22.35 | 54.60 | 40.96 | 88.50 | 29.19 | ||
| Apical | 48.08 | 26.51 | 52.39 | 12.63 | 74.93 | 25.83 | ||
| Lateral compaction | Coronal | 42.55 | 18.71 | 41.55 | 20.68 | 66.42 | 11.54 | |
| Middle | 52.82 | 5.84 | 53.16 | 45.39 | 59.56 | 4.77 | ||
| Apical | 29.72 | 22.39 | 34.84 | 0.32 | 48.87 | 27.87 |
: Calculated using bootstrapping. CI: Confidence interval
Maximum Penetration Depth
Although the lateral compaction group showed more penetration depth than the single cone group, the difference was shown to be not significant statistically (p>0.05). For the single cone obturation technique, there was a significant difference between values measured at different sections, with the coronal section having a significantly higher value than the apical section (p=0.002). For the lateral compaction technique, the coronal section also showed more penetration than the middle and apical levels; yet, the difference was not statistically significant (p=0.223) as demonstrated and clarified in Table 2 and Figure 2.
TABLE 2.
Comparisons, mean, and standard deviation values of maximum penetration depth for different obturation techniques
| Section | Maximum penetration depth (μm) (Mean±SD) | p | |
|---|---|---|---|
| Single cone | Lateral compaction | ||
| Coronal | 1853.72±226.54A | 1868.66±496.46A | 0.936 |
| Middle | 1488.05±269.54AB | 1681.72±314.66A | 0.689 |
| Apical | 833.16±347.57B | 1185.00±479.37A | 0.128 |
| p-value | 0.002* | 0.223 | |
: Significant at (p<0.05). Different superscript letters indicate a statistically significant difference within the same vertical column. SD: Standard deviation
Figure 2.
CLSM images at ×10 showing NeoSEALER Flo maximum tubular penetration depth (a) single cone technique at the coronal one-third; (b) single cone technique at the middle one-third; (c) single cone technique at the apical one-third; (d) lateral compaction technique at the coronal one-third; (e) lateral compaction technique at the middle one-third; (f) lateral compaction technique at the apical one-third
CLSM: Confocal laser scanning microscopy
Percentage of Maximum Penetration
Regardless of the root section, there was no significant difference between the two obturation techniques tested (p>0.05). For both obturation techniques, there was no significant difference between values measured at different root sections (p>0.05) as clearly shown in Table 3.
TABLE 3.
Comparisons, mean, and standard deviation values of maximum penetration percentage for different obturation techniques
| Section | Maximum penetration percentage (%) (Mean±SD) | p | |
|---|---|---|---|
| Single cone | Lateral compaction | ||
| Coronal | 98.03±1.93A | 99.03±2.48A | 0.230 |
| Middle | 96.03±8.17A | 97.36±3.23A | 0.689 |
| Apical | 93.02±9.99A | 98.07±2.49A | 0.471 |
| p-value | 0.846 | 0.311 | |
Different superscript letters indicate a statistically significant difference within the same vertical column
Percentage of Penetration Area
In the coronal sections, the single cone technique had significantly higher values than the lateral compaction technique (p=0.027). For other sections, the difference was not statistically significant between the two obturation techniques (p>0.05). For the single cone obturation technique, the coronal section shows significantly higher values than other sections (p=0.039). For the lateral compaction obturation technique, the difference was not statistically significant (p=0.174) as shown in Table 4 and Figure 3.
TABLE 4.
Comparisons, mean, and standard deviation values of penetration area for different obturation techniques
| Section | Penetration area (%) (Mean±SD) | p | |
|---|---|---|---|
| Single cone | Lateral compaction | ||
| Coronal | 76.27±13.69A | 42.55±18.71A | 0.027* |
| Middle | 59.66±22.35B | 52.82±5.84A | 1 |
| Apical | 48.08±26.51B | 29.72±22.39A | 0.312 |
| p-value | 0.039* | 0.174 | |
: Significant at (p<0.05). Different superscript letters indicate a statistically significant difference within the same vertical column
Figure 3.
CLSM images at ×10 showing NeoSEALER Flo area of tubular penetration (a) single cone technique at the coronal one-third; (b) single cone technique at the middle one-third; (c) single cone technique at the apical one-third; (d) lateral compaction technique at the coronal one-third; (e) lateral compaction technique at the middle one-third; (f) lateral compaction technique at the apical one-third
CLSM: Confocal laser scanning microscopy
DISCUSSION
The use of bioceramic-based sealers in endodontics has been steadily increasing due to their exceptional physiochemical and biological properties, including biocompatibility, hydrophilic setting characteristics, and strong bonding to root dentine. Improvements in bioceramic sealers are achieved by incorporating nano-spheric particles smaller than 2 µm, which enhance the sealer's flowability and enable it to effectively penetrate complex root canal irregularities, accessory canals, isthmuses, and dentinal tubules (7, 9).
CLSM was employed in this study due to its ability to visualize sealer infiltration into dentinal tubules by generating high-contrast points observable at various depths. CLSM is superior to scanning electron microscopy (SEM) because it can detect sealer penetration into dentinal tubules using fluorescent Rhodamine B isothiocyanate-marked sealer. Additionally, CLSM eliminates artifacts, a capability not possible with SEM or light microscopy. Finally, CLSM facilitates complete image reconstruction from multiple optical sections during image acquisition, regardless of the specimen's thickness (20).
Measurement of the maximum penetration depth of sealer might be misleading in the results due to the difference in dentinal properties from one tooth to another as previously highlighted (21, 22). Therefore, the percentage of penetration depth and the percentage of penetration area were calculated in the current study as well.
The null hypothesis tested was partially rejected as the single cone obturation technique has shown a statistically significant higher percentage area of NeoSEALER Flo penetration than the lateral compaction technique at the coronal root level only. Otherwise, both obturation techniques tested have shown no statistically significant differences in NeoSEALER Flo penetration distance, percentage of penetration distance, and percentage of area penetration at the middle and apical root levels.
For the penetration distance and percentage of penetration distance, the cold lateral compaction technique yielded higher penetrations at all root levels, although not statistically significant. This higher penetration can be related to the use of the finger spreader and applying successive forces of compaction, which will in turn provide more force pushing the sealer deeper into the dentinal tubules compared to the single cone technique (10). These results come in accordance with Faris et al. (23), and can explain the results obtained earlier by Nouroloyouni et al. (10) who showed higher push-out bond strength with cold lateral compaction of bioceramic sealer compared to the single cone obturation.
Dasari et al. (16) compared the penetration depth of the BioRoot RCS bioceramic sealer with three different obturation techniques. The penetration depth was higher with warm vertical compaction technique followed by injectable GP technique and lateral condensation technique. This was explained by the fact that heat can plasticize GP allowing sealer to penetrate more inside dentinal tubules. On the other hand, Casino Alegre et al. (15) compared the single cone and warm vertical compaction techniques and showed no statistically significant difference between both techniques.
The higher penetration distance and area of NeoSEALER Flo at the coronal root level compared to the middle and apical ones with both obturation techniques can be attributed to the dentinal tubule diameter and number. The dentinal tubules in the coronal third are larger in diameter and more in number than those present in the middle and apical thirds, which increases its permeability, allowing the sealer to penetrate further inside the dentinal tubules (24). Additionally, the presence of sclerotic dentine and the challenge of removing the smear layer in the apical dentine can hinder the deeper infiltration of the sealer and irrigants into the tubules. This, in turn, reduces the penetration of the root canal sealer in that area. This finding is in full agreement with the previous studies that evaluated bioceramic sealer penetration into the dentinal tubules either with different obturation techniques (15, 16, 19) or different dryness conditions (7, 20).
Limitations of the current study include the inability to standardize the size of dentinal tubules as it varies by the patient’s age, ethnicity, and occlusal forces which will affect the sealer penetration. For future studies, clinical studies could be designed to evaluate the single cone obturation technique and evaluate its influence on the long-term outcome of the root canal treatment.
CONCLUSION
Within the limitations of this in vitro study, it can be concluded that the single cone obturation technique can be used with bioceramic sealers yielding comparable results to the cold lateral compaction technique in dentinal tubule penetration in single-rooted mandibular premolars.
Footnotes
Please cite this article as: Ashri H, Mahran AH, Abuelezz A, Elsewify T. Effect of Obturation Technique on NeoSEALER Flo Bioceramic Sealer Penetration into Dentinal Tubules: A Comparative Confocal Laser Scanning Microscopic Study. Eur Endod J
Disclosures
Ethics Committee Approval
The study was approved by the Misr International University Ethics Committee (no: MIU-IRB-21222223-172, date: 03/10/2022).
Authorship Contributions
Concept – T.E., A.H.M., A.A.; Design – T.E., A.H.M., A.A.; Supervision – T.E., A.H.M., A.A.; Materials – H.A.; Data collection and/or processing – H.A., A.H.M., A.A.; Data analysis and/or interpretation – T.E., A.H.M., A.A., H.A.; Literature search – T.E., A.H.M., H.A.; Writing – T.E., A.H.M., A.A., H.A.; Critical review – T.E., A.H.M., A.A.
Conflict of Interest
All authors declared no conflict of interest.
Use of AI for Writing Assistance
The authors declared that they did not use any of the artificial intelligence–assisted technologies (such as Large Language Models [LLMs], chatbots, or image creators) in the production of this manuscript.
Financial Disclosure
The authors declared that this study received no financial support.
Peer-review
Externally peer-reviewed.
References
- 1.Mahfouze AL, El Gendy AA, Elsewify TM. Bacterial reduction of mature Enterococcus faecalis biofilm by different irrigants and activation techniques using confocal laser scanning microscopy. An in vitro study. Saudi Endod J. 2020;10(3):247–53. doi: 10.4103/sej.sej_135_19. [DOI] [Google Scholar]
- 2.Shalabi M, Saber S, Elsewify T. Influence of blood contamination on the bond strength and biointeractivity of Biodentine used as root-end filling. Saudi Dent J. 2020;32(8):373–81. doi: 10.1016/j.sdentj.2019.11.005. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Emam SA, Mahran AH, Elshafei MM. Evaluation of cytotoxicity and adaptability of a novel bioceramic root canal sealer: an in vitro and scanning electron microscope study. J Conser Dent Endod. 2024;27(3):326–30. doi: 10.4103/JCDE.JCDE_40_24. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Souza LC de, Neves GST, Kirkpatrick T, Letra A, Silva R. Physicochemical and biological properties of AH Plus bioceramic. J Endod. 2023;49(1):69–76. doi: 10.1016/j.joen.2022.10.009. [DOI] [PubMed] [Google Scholar]
- 5.Tanomaru-Filho M, Andrade AS, Rodrigues EM, Viola KS, Faria G, Camilleri J, et al. Biocompatibility and mineralized nodule formation of Neo MTA Plus and an experimental tricalcium silicate cement containing tantalum oxide. Int Endod J. 2017;50:e31–9. doi: 10.1111/iej.12780. [DOI] [PubMed] [Google Scholar]
- 6.Koutroulis A, Kuehne SA, Cooper PR, Camilleri J. The role of calcium ion release on biocompatibility and antimicrobial properties of hydraulic cements. Sci Rep. 2019;9:19019. doi: 10.1038/s41598-019-55288-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Singh AM, Elsewify TM, El-Sayed WS, Nuawafleh HH, Elemam RF, Eid BM. Influence of root canal moisture on the penetration of TotalFill bioceramic sealer into the dentinal tubules: a confocal laser scanning microscopy study. Saudi Endod J. 2024;14(2):187–92. doi: 10.4103/sej.sej_179_23. [DOI] [Google Scholar]
- 8.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(3):387–93. doi: 10.1111/aej.12425. [DOI] [PubMed] [Google Scholar]
- 9.Sebastian S, El-Sayed W, Adtani P, Zaarour RF, Nandakumar A, Elemam RF, et al. Evaluation of the antibacterial and cytotoxic properties of TotalFill and NeoSEALER flo bioceramic sealers. J Conser Dent Endod. 2024;27(5):491–7. doi: 10.4103/JCDE.JCDE_103_24. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Nouroloyouni A, Samadi V, Salem Milani A, Noorolouny S, Valizadeh-Haghi H. Single cone obturation versus cold lateral compaction techniques with bioceramic and resin sealers: quality of obturation and push-out bond strength. Int J Dent. 2023;2023:3427151. doi: 10.1155/2023/3427151. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Soros C, Zinelis S, Lambrianidis T, Palaghias G. Spreader load required for vertical root fracture during lateral compaction ex vivo evaluation of periodontal simulation and fracture load information. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(2):e64–70. doi: 10.1016/j.tripleo.2008.03.027. [DOI] [PubMed] [Google Scholar]
- 12.Kandemir Demirci G, Çalişkan MK. A prospective randomized comparative study of cold lateral condensation versus Core/Gutta-percha in teeth with periapical lesions. J Endod. 2016;42(2):206–10. doi: 10.1016/j.joen.2015.10.022. [DOI] [PubMed] [Google Scholar]
- 13.Elzanaty TK, Elashiry MM, Mahran AH. Retreatability of NeoSEALER Flo obturated with warm vertical compaction versus single-cone technique using two different retreatment systems. J Conser Dent Endod. 2024;27(3):286–92. doi: 10.4103/JCDE.JCDE_314_23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Celikten B, Uzuntas CF, Orhan AI, Orhan K, Tufenkci P, Kursun S, et al. Evaluation of root canal sealer filling quality using a single-cone technique in oval shaped canals: an in vitro Micro-CT study. Scanning. 2016;38(2):133–40. doi: 10.1002/sca.21249. [DOI] [PubMed] [Google Scholar]
- 15.Casino Alegre A, Aranda Verdú S, Zarzosa López JI, Plasencia Alcina E, Rubio Climent J, Pallarés Sabater A. Intratubular penetration capacity of HiFlow bioceramic sealer used with warm obturation techniques and single cone: a confocal laser scanning microscopic study. Heliyon. 2022;8(9):e10388. doi: 10.1016/j.heliyon.2022.e10388. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.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 Conser Dent. 2020;23(5):505–11. doi: 10.4103/JCD.JCD_450_20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Coronas VS, Villa N, Nascimento AL, Duarte PHM, Rosa RAD, Só MVR. Dentinal tubule penetration of a calcium silicate-based root canal sealer using a specific calcium fluorophore. Braz Dent J. 2020;31(2):109–15. doi: 10.1590/0103-6440202002829. [DOI] [PubMed] [Google Scholar]
- 18.Majumdar T, Mukherjee S, Mazumdar P. Microscopic evaluation of sealer penetration and interfacial adaptation of three different endodontic sealers: an in vitro study. J Conser Dent. 2021;24(5):435–9. doi: 10.4103/jcd.jcd_392_21. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Song D, Yang SE. Comparison of dentinal tubule penetration between a calcium silicate-based sealer with ultrasonic activation and an epoxy resin-based sealer: a study using confocal laser scanning microscopy. Eur J Dent. 2022;16(1):195–201. doi: 10.1055/s-0041-1735429. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Chandra SS, Shankar P, Indira R. Depth of penetration of four resin sealers into radicular dentinal tubules: a confocal microscopic study. J Endod. 2012;38(10):1412–6. doi: 10.1016/j.joen.2012.05.017. [DOI] [PubMed] [Google Scholar]
- 21.Ferreira EHRG, Rosas CAP, Limoeiro AG da S, Lima SN, Silva RA, Seckler INB, et al. Effect of obturation technique on dentinal tubule penetration of two tricalcium silicate-based sealers: ex vivo study. Aust Endod J. 2024;50(1):148–56. doi: 10.1111/aej.12825. [DOI] [PubMed] [Google Scholar]
- 22.Eğemen A, Belli S. The effect of primary root canal treatment on dentinal tubule penetration of calcium silicate-based sealers during endodontic retreatment. J Endod. 2022;48(9):1169–77. doi: 10.1016/j.joen.2022.05.008. [DOI] [PubMed] [Google Scholar]
- 23.Faris GH, Alhashimi RA. Effectiveness of four different obturation techniques on the penetration depth of bioceramic sealers into the dentin tubules: an in vitro study. Dent Hypotheses. 2023;14(4):107–10. doi: 10.4103/denthyp.denthyp_69_23. [DOI] [Google Scholar]
- 24.Hassan R, Roshdy NN. Effect of continuous chelation on the dentinal tubule penetration of a calcium silicate-based root canal sealer: a confocal laser microscopy study. BMC Oral Health. 2023;23(1):377. doi: 10.1186/s12903-023-02995-z. [DOI] [PMC free article] [PubMed] [Google Scholar]