The Use of Premixed Calcium Silicate Bioceramic Sealer with Warm Carrier-Based Technique: A 2-Year Study for Patients Treated in a Master Program

Abstract

Background: Recently several calcium silicate flowable sealers have been introduced as endodontic materials for the root canal. This clinical study tested the use of a new premixed calcium silicate bioceramic sealer in association with the Thermafil warm carrier-based technique (TF). Epoxy-resin-based sealer with the warm carrier-based technique was the control group. Methodology: Healthy consecutive patients (n = 85) requiring 94 root canal treatments were enrolled in this study and assigned to one filling group (Ceraseal-TF n = 47, AH Plus-TF n = 47) in accordance with operator training and best clinical practice. Periapical X-rays were taken preoperatively, after root canal filling and after 6, 12 and 24 months. Two evaluators blindly assessed the periapical index (PAI) and sealer extrusion in the groups (k = 0.90). Healing rate and survival rate were also evaluated. Chi-square tests was used to analyze significant differences between the groups. Multilevel analysis was performed to evaluate the factors associated with healing status. Results: A total of 89 root canal treatments in 82 patients were analyzed at the end-line (24 months). The total drop-out was 3.6% (3 patients; 5 teeth). A total of 91.1% of healed teeth (PAI 1-2) was observed in Ceraseal-TF, with 88.6% in AH Plus-TF. No significant difference was observed on healing outcome and survival among the two filling groups (p > 0.05). Apical extrusion of the sealers occurred in 17 cases (19.0%). Of these, 6 occurred in Ceraseal-TF (13.3%) and 11 in AH Plus-TF (25.0%). Three Ceraseal extrusions were radiographically undetectable after 24 months. All the AH Plus extrusions did not change during the evaluation time. Conclusions: The combined use of the carrier-based technique and premixed CaSi-based bioceramic sealer showed clinical results comparable with carrier-based technique and epoxy-resin-based sealer. The radiographical disappearance of apically extruded Ceraseal is a possible event in the first 24 months.

Premixed calcium silicate‐based ceramic sealers promote osteogenic/cementogenic differentiation of human periodontal ligament stem cells: A microscopy study

“…This discrepancy may be due to the fact that the cell viability experiments were only performed at 24-48 h, which does not allow sufficient exposure time to observe the cellular response to this treatment. Another reason could be attributed to the non-complete set of materials, also confirmed in recent clinical studies, which highlighted the occurrence of a not stable seal in the periapical area (Zamparini et al, 2023). In agreement with our results, another study reported that Endosequence BC Sealer and TFbc had better cell viability rates at 72 h than AHPbc using human periodontal cells (Kwak et al, 2023).…”

Clinical Evaluation of a Novel Premixed Tricalcium Silicate Containing Bioceramic Sealer Used with Warm Carrier-Based Technique: A 12-Month Prospective Pilot Study

“…Recent studies confirmed that warmcarrier-based systems may induce a great percentage of extrusion, ranging from approx. 25% to 58% of the cases [23,29]. A conventional gold-standard sealer (AH Plus), mainly composed of epoxy-resin components, offered a high percentage of radiographic extrusion (30%) [23], likely attributable to the higher flow when heating is applied [34].…”

“…Despite their promising characteristics and considering the recent introduction on the market, a limited number of short-term clinical investigations have been conducted [9,[22][23][24]. Further research is needed to fully understand their performance, clinical outcomes, and occurrence of post-operative pain after filling.…”

Heat-Induced Changes in the Physical Properties of a New Premixed Calcium Silicate-Containing Root Canal Sealer: An In Vitro Study

“…In another study, 82% of cases obturated with AHB using a carrier-based technique (Thermafil; Dentsply, Konstanz, Germany) exhibited complete healing after 1 year [28]. Comparable success rates have been reported for premixed CSCSs and an epoxy resin-based sealer (AH Plus, Dentsply Sirona) when used in warm vertical compaction using the SuperEndo System (B&L Biotech, Ansan, Republic of Korea) at 150 • C [26] or the Thermafil technique [29]. Further investigation is still warranted due to the paucity of well-controlled long-term studies.…”

“…Regarding the clinical impact of heat application to premixed CSCSs, a few studies have reported favorable short-term outcomes [26][27][28][29]. In one study, a 1-year success rate of 99% was reported when four brands of premixed CSCSs were used with either the continuous wave of condensation technique or the carrier-based technique [27].…”