Dentinal Tubule Penetration of Various Root Canal Sealers after Removal of Calcium Hydroxide Intracanal Medicament: An In Vitro Confocal Laser Scanning Microscopic Study

Abstract

Objectives: This study compared the penetration depth of three different root canal sealers—AH Plus resin-based, Apexit Plus calcium hydroxide (CH)-based, and BioRoot RCS bioceramic-based sealers—into dentin after removal of CH intracanal medicament. Materials and Methods: In this in vitro study, 60 extracted single-rooted mandibular premolars were decoronated with a diamond disc under water cooling to a standard length of 16mm; 12 samples were selected as control, and the rest received CH mixed with rhodamine dye as an intracanal medicament. Two weeks later, CH was removed by manual filing and irrigant activation using EndoActivator. Samples were then divided into 3 groups (n=12) depending upon the sealer used as AH Plus, Apexit Plus, and Bioroot RCS sealer. All sealers were combined with fluorescein dye, and obturation was performed using F3 gutta-percha with lateral compaction technique. After 2 weeks, the teeth were transversally sectioned into coronal, middle, and apical thirds. The penetration depth of sealers was measured via an imaging software. Statistical analysis was performed using ANOVA followed by the Tukey’s post-hoc test (alpha=0.05). Results: A statistically significant difference was observed among the groups (P<0.05). The penetration depth of sealers was the lowest in the apical third, and the highest in the coronal third in all three groups. BioRoot RCS showed the highest penetration depth at all three levels, despite CH medicament remnants. Conclusion: Bioroot RCS bioceramic sealer was superior to AH Plus resin-based and Apexit Plus CH-based sealers regarding penetration depth into dentin after removal of CH intracanal medicament.