Comparison of Apical Sealing Ability of Different Endodontic Sealers – An In Vitro Study

ABSTRACT

Objective:

This study compares the apical sealing ability of Apexit Plus, Diaproseal, and AH Plus when used with lateral compaction of gutta-percha.

Materials and Methods:

Forty-five extracted human teeth were divided into three groups (n = 15 each) and obturated with Apexit Plus, Diaproseal, and AH Plus. After root canal preparation, apical leakage was assessed using a dye penetration test, followed by longitudinal sectioning and microscopic evaluation.

Results:

There was no significant difference in apical dye leakage between the three groups. Group I (Apexit Plus) had a mean leakage of 0.502 mm, Group II (Diaproseal) had 0.499 mm, and Group III (AH Plus) had 0.504 mm (P = 0.987).

Conclusion:

All the groups demonstrated comparable apical sealing abilities, suggesting that each is an effective choice for root canal obturation.

INTRODUCTION

Proper cleaning, shaping, and obturation with biologically inert, dimensionally stable materials are crucial for the success of root canal therapy.[1] Achieving a complete seal at both the apical and coronal ends is vital to prevent bacterial reinfection and the entry of harmful substances, particularly in the challenging apical third with its complex anatomy.[2] Studies showed that Bio-C Sealer demonstrated superior sealing ability with the least dye penetration and minimal gaps in SEM analysis, outperforming other sealers.[3] AH Plus showed minimal leakage compared to MTA Fillapex and zinc oxide eugenol.[4] Various obturation techniques, such as cold lateral condensation, have been widely used but may lead to issues like voids and poor surface adaptation.[5] To address these, newer sealers like Apexit Plus, Diaproseal, and AH Plus have been introduced, each offering unique benefits. Despite their advantages, resin-based sealers like AH Plus still face challenges such as polymerization shrinkage. This study aimed to compare the sealing effectiveness of various root canal sealers in endodontics.

MATERIALS AND METHODS

Forty-five human teeth with fully formed apices were extracted for periodontal reasons and disinfected with 1% sodium hypochlorite before undergoing root canal treatment. The crowns were removed, and the root canals were accessed and confirmed for apical patency. The teeth were divided into three groups (15 teeth per group), each receiving a different obturation material: Group I used Apexit Plus sealer with lateral compaction of gutta-percha, Group II used Diaproseal sealer with lateral compaction of gutta-percha, and Group III used AH Plus sealer with lateral compaction of gutta-percha. After root canal preparation, including irrigation with sodium hypochlorite and EDTA, the teeth were sealed and incubated for 7 days. Apical leakage was tested by immersing the teeth in 2% methylene blue dye for 48 hours, followed by sectioning and evaluating dye penetration under a stereomicroscope. The results were analyzed using one-way ANOVA (Kruskal–Wallis) to compare leakage among the groups, with statistical parameters including mean, median, standard deviation, and P value.

RESULTS

Group I exhibited a mean leakage of 0.502 mm, group II showed a mean leakage of 0.499 mm, and group III had a mean leakage of 0.504 mm. Statistical analysis revealed no significant differences in apical leakage between the three groups (P = 0.987) [Table 1 and Figure 1].

Table 1.

One-way ANOVA showing apical leakage (mm)

Obturation material	n	Mean	Median	SD	P
Group 1	15	0.502	0.550	0.260	0.987
Group 2	15	0.499	0.500	0.244
Group 3	15	0.504	0.360	0.319

Figure 1.

Apical leakage in the sealers

DISCUSSION

Our study demonstrated similar apical leakage across all three groups. Dia-ProSeal demonstrated significantly lower dye penetration compared to others. Its excellent sealing ability in complex root canal anatomies can be attributed to its good flow, fast setting time, dual syringe mixing system, and long-term storage stability.[6] Previous studies, such as Song YS et al.,[7] highlighted Dia-ProSeal’s favorable properties, including biocompatibility, a pH range of 6.7–7.2, low solubility, and dimensional stability.[8] These features, along with its ability to bond chemically to root dentin through epoxy resin, form covalent bonds.[9] Apexit Plus, a calcium hydroxide-based sealer, showed less dye penetration than AH Plus, possibly due to its alkaline pH that stimulates hard tissue deposition.[10] However, its sealing ability may be compromised over time due to dissolution and volumetric expansion during setting and post-setting periods.[11] Studies have suggested that while Apexit Plus provides a good seal compared to other sealers like ZOE, it still exhibits higher leakage than resin-based sealers.[12]

Our study showed less dye leakage with Apexit Plus, but the difference was not statistically significant among the groups. Kocak et al.[13] and Bodrumlu et al.[14] both reported that gutta-percha does not chemically bond with AH Plus sealer, although the sealer bonds well to dentin. In addition, the presence of silicone oils in AH Plus may negatively impact its sealing ability.[15] These findings align with Ballullaya et al.,[16] who also found no significant difference in dye leakage between Apexit Plus and AH Plus. A similar study by Salz et al.[17] suggests that Apexit Plus may offer superior sealing ability.

The study effectively compared the apical sealing ability of three experimental groups using a controlled design and precise leakage assessment, offering valuable clinical insights. However, its small sample size, in vitro design, short incubation period, and focus on a single irrigation protocol limit generalizability. Additionally, it only evaluated dye penetration, without assessing other important properties like biocompatibility or long-term performance.

CONCLUSION

All the tested sealers provided similar levels of apical leakage, indicating that they are all effective options for root canal obturation. Further studies, incorporating long-term evaluations and alternative obturation techniques, are needed to confirm these findings.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.