Comparative Evaluation of Apical Leakage in Root Canal Obturation Using AH Plus Sealer, Bioceramic Sealer, and Bioceramic Sealer Incorporated With Chitosan Nanoparticles: An In Vitro Study

Abstract

Introduction Endodontic re-infections primarily occur due to the ingress of bacteria and their toxins through an incomplete seal following obturation. A variety of sealers have been developed to achieve effective integration with the different obturation materials and dentinal tubules. To choose the right endodontic sealer and application for each clinical instance, one must be aware of the attributes of the various sealers commonly used in clinical practice. The utility of chitosan nanoparticles in endodontics requires exploration to understand the faring of this material in comparison to the existing gold standards. This study aims to compare the apical leakage after obturation using AH Plus sealer and bioceramic sealer with and without chitosan nanoparticles. Materials and methods Forty single-rooted, single-canal extracted teeth were selected and decoronated to standardize the root length to 14 mm. Root canals were prepared using Protaper rotary files and irrigated with sodium hypochlorite, EDTA (ethylenediaminetetraacetic acid), and saline. The samples were randomly divided into four groups (n=10): group I (gutta percha), group II (gutta percha + AH Plus sealer), group III (gutta percha + bioceramic sealer), and group IV (gutta percha + chitosan nanoparticles in bioceramic sealer). The sealers were applied, and obturation was performed using the cold lateral condensation technique. Post-obturation, the samples were sealed with Cavit-G, coated with nail varnish, and immersed in 2% methylene blue dye for 72 hours. The teeth were then sectioned longitudinally and inspected for dye penetration using a stereomicroscope. Results The mean dye penetration values were as follows: 4.77 ± 2.08 mm in group I, 2.93 ± 0.40 mm in group II, 2.34 ± 1.46 mm in group III, and 1.93 ± 1.68 mm in group IV. Statistical analysis using one-way ANOVA showed significant differences (p < 0.05) between the groups. Tukey's post hoc test revealed the least microleakage in group IV, indicating superior sealing ability of bioceramic sealer with chitosan nanoparticles. Conclusion Incorporation of chitosan nanoparticles in bioceramic sealer significantly enhances its sealing ability, reducing apical microleakage more effectively than gutta percha (2.5 times), AH Plus sealer (1.5 times), and bioceramic sealer alone (1.2 times). This suggests that chitosan nanoparticles could be a promising addition to endodontic sealers to improve treatment outcomes.

Keywords: apical leakage; bioceramic sealer; chitosan nanoparticles; endodontic re-infections; microleakage; obturation; resin sealer; root canal sealers.

Figure 1. (A) Decoronation of the tooth at the CEJ level. (B) Determination of working length. (C) Preparation of the canals with Protaper rotary files. (D) Selection of appropriate master cone (inset: radiographic confirmation).

CEJ, cementoenamel junction

Figure 2. Stereomicroscopic images of the samples of (A) group I, (B) group II, (C) group III, and (D) group IV.

Figure 3. Comparative presentation of mean microleakage across the four groups

Figure 4. Certificate of analysis of the characteristics of chitosan particles