Bioactivity and Element Composition of Three Endodontic Root Canal Sealers

Abstract

Background: This study aimed to evaluate the bioactivity and depth of penetration of three endodontic root canal sealers: AH Plus (AH), Endosequence Bioceramic Sealer BC, and Endosequence Bioceramic HiFlow Sealer (HiFlow).

Materials and methods: Thirty extracted mandibular premolars with single canals were randomly divided into three groups (n = 10) based on the sealer used for root canal obturation. Ten teeth were obturated with AH Plus (AH) sealer and warm vertical compaction (WVC), 10 teeth were obturated with bioceramic root canal sealer (BC), and single cone obturation, and 10 teeth were obturated with bioceramic high flow (HiFlow) sealer and WVC. The groups were further divided into two subgroups (n = 5) for immersion in phosphate-buffered saline (PBS) or deionized water (DIW) for 28 days. Scanning electron microscopy (SEM) and energy-dispersive X-ray (EDX) analysis were used to assess the depth of sealer penetration and elemental composition, respectively. Statistical analyses were conducted using one-way ANOVA, Tukey's HSD, and paired t-tests.

Results: HiFlow exhibited the highest depth of penetration (103.2 ± 42.2 μm), followed by AH (94.6 ± 36.3 μm) and BC (88.6 ± 43.3 μm), with no statistically significant differences between the groups (p = 0.510). Elemental analysis revealed significant differences in Ca/P ratios in AH between PBS (1.8 ± 0.14) and DIW (3.0 ± 0.07) (p < 0.05). Hydroxyapatite crystal formation was observed in PBS-immersed samples from the HiFlow sealer group, indicating the bioactivity of bioceramic sealers.

Conclusion: All three sealers show some form of bioactivity represented by the release of different elements. HiFlow demonstrated superior penetration depth, particularly when used with WVC.

Clinical significance: Based on the results of the study, the use of HiFlow root canal sealer combined with WVC results in better sealer-dentin interaction and improves the quality of obturation. How to cite this article: Alsofi L. Bioactivity and Element Composition of Three Endodontic Root Canal Sealers. J Contemp Dent Pract 2025;26(1):62-70.

Keywords: Bioactivity; Calcium silicate; Endodontics; Root canal sealers Scanning electron microscopy..