ABSTRACT
Objective:
The objective of this in vitro study is to evaluate and compare the antibacterial effectiveness of different root canal sealers against Enterococcus faecalis.
Materials and Methods:
The antibacterial efficacy of four root canal sealers—three bioceramic materials (TotalFill Bioceramic Sealer, BioRoot Root Canal Sealer, and MTA Fillapex) and one epoxy resin-based sealer (AH Plus)—against E. faecalis (ATCC 29212) was assessed using a modified direct contact test. Every sealer was made under the manufacturer’s instructions, and its antibacterial activity was evaluated against newly mixed and set sealers (1 and 3 days) at various intervals (2, 5, 20, and 60 min). Mitis salivarius agar was used to plate the bacterial suspension, and one-way ANOVA was used for statistical analysis.
Results:
TotalFill Bioceramic Sealer showed the highest antibacterial efficacy, followed by BioRoot Root Canal Sealer, MTA Fillapex, and AH Plus.
Conclusion:
Bioceramic root canal sealers, particularly TotalFill, demonstrate superior antibacterial efficacy against E. faecalis compared to epoxy resin-based sealers such as AH Plus.
KEYWORDS: Antibacterial efficacy, endodontic treatment, Enterococcus faecalis, root canal sealers
INTRODUCTION
Successful endodontic treatment requires complete chemomechanical preparation, irrigation, obturation, and postendodontic restoration to eliminate bacteria from the root canal and promote the healing of periapical tissues.[1] Despite thorough cleaning and the use of intracanal medicaments, completely eradicating microorganisms, particularly Enterococcus faecalis, which is resistant to endodontic therapy and often found in failed treatments, remains challenging. This bacterium is difficult to remove from dentinal tubules, contributing to persistent infections. Effective root canal sealing, including mechanical cleaning, antibacterial irrigants, and antimicrobial dressings, plays a key role in treatment success.[2] Root canal sealers, which should be bacteriostatic, tissue-compatible, and capable of providing an airtight seal, are often incorporated with antimicrobial agents to prevent residual infection.[3] Sealers are classified based on their chemical composition, including zinc oxide-eugenol-based, calcium hydroxide-containing, glass ionomer-based, epoxy resin-based, and mineral trioxide aggregate-based types.[4] However, a gap exists in the comparative understanding of the in vitro antibacterial efficacy of various root canal sealers against E. faecalis. Hence, the objective of this study is to evaluate and compare the antibacterial effectiveness of different root canal sealers against E. faecalis.
MATERIALS AND METHODS
Four root canal sealers, including three bioceramic materials and one epoxy resin-based sealer, were evaluated for antibacterial efficacy against E. faecalis (ATCC 29212) using a modified direct contact test (DCT). The materials tested were: TotalFill Bioceramic Sealer (FKG, Switzerland), BioRoot Root Canal Sealer (Septodont, France), MTA Fillapex (Angelus, Brazil), and AH Plus (Dentsply, Germany). Each sealer was prepared according to the manufacturer’s instructions, with 20 μL of freshly prepared sealer placed in 96-microtiter plate wells. The antibacterial activity was tested against freshly mixed sealers, as well as sealers set for 1 and 3 days, under a humid atmosphere at 37°C. A bacterial suspension of E. faecalis was prepared in Tryptic Soy Broth and adjusted to a concentration of 3 × 108 CFU/ml. The modified DCT involved placing 10 μL of bacterial suspension on the surface of each sealer and incubating the plates at 37°C for time intervals of 2, 5, 20, and 60 min. After incubation, the bacterial suspension was mixed and serially diluted before plating onto Mitis salivarius agar. Statistical analysis was performed using one-way ANOVA with a 95% confidence level, using SPSS v. 11.0 (SPSS Inc., Chicago) and Microsoft Office Excel 2016.
RESULTS
Group IV (TotalFill) exhibited the highest mean (8.89 mm), followed by Group II (BioRoot Root Canal Sealer) (4.43 mm), Group I (mineral trioxide aggregate [MTA] Fillapex) (1.96 mm), and Group III (AH Plus) (1.05 mm). Tukey’s post-hoc analysis revealed that Group I had significantly lower antibacterial efficacy compared to all other groups, with mean differences of -2.47 mm (Group II), 0.913 mm (Group III), and- 6.93 mm (Group IV), all with P < 0.001 [Figure 1 and Table 1].
Figure 1.
Antibacterial efficacy of various root canal sealers
Table 1.
Tukey post hoc test
| Group I (mm) | Group II (mm) | Group III (mm) | Group IV (mm) | |
|---|---|---|---|---|
| Group I (mm) | ||||
| Mean difference | — | −2.47 | 0.913 | −6.93 |
| P | — | <0.001 | <0.001 | <0.001 |
| Group II (mm) | ||||
| Mean difference | — | 3.380 | −4.47 | |
| P | — | <0.001 | <0.001 | |
| Group III (mm) | ||||
| Mean difference | — | −7.85 | ||
| P | — | <0.001 | ||
| Group IV (mm) | ||||
| Mean difference | — | |||
| P | — |
DISCUSSION
This study evaluated the antibacterial efficacy of four root canal sealers: TotalFill Bioceramic Sealer, BioRoot Root Canal Sealer, MTA Fillapex, and AH Plus. The results showed that bioceramic sealers demonstrated better antibacterial activity compared to the epoxy resin-based AH Plus. The superior antibacterial efficacy of bioceramic sealers can be attributed to their high pH, hydrophilicity, and the calcium hydroxide released during setting.[5,6] This finding aligns with a study where TotalFill BC eradicated all bacteria in the DCT.[7] The results also agree with similar studies that found that TotalFill BC and Endosequence BC showed better antibacterial efficacy against E. faecalis compared to AH Plus.[8,9] Studies also found no significant antibacterial advantage of EndoSequence BC Sealer over epoxy resin-based sealers, which could be attributed to differences in microbiological methodology.[10,11] There have been only limited studies on the antibacterial efficacy of BioRoot RCS reporting similar efficacy to MTA Fillapex but lower than TotalFill BC.[7] Previous research also found that BioRoot RCS and TotalFill BC showed similar antibacterial efficacy,[12] while a study reported the superiority of BioRoot RCS over MTA Fillapex and AH Plus.[13] These studies, along with the current results, suggest that BioRoot RCS has significant antibacterial efficacy, particularly when compared to AH Plus and MTA Fillapex. In this study, MTA Fillapex exhibited the lowest efficacy compared to other bioceramic sealers but was still more effective than AH Plus. Similar findings have been reported in previous studies,[13,14,15] while some studies using ADT have suggested its lower efficacy compared to AH Plus.[16,17,18] The lower efficacy of MTA Fillapex could be attributed to its lower pH, as it contains a smaller percentage of available calcium hydroxide.
CONCLUSION
Bioceramic root canal sealers such as TotalFill, demonstrate superior antibacterial efficacy against E. faecalis compared to epoxy resin-based sealers (AH Plus), supporting their use for improved endodontic outcomes. Further studies are needed to explore the long-term clinical implications of these findings.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
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