The ability of three different protocols in removing Bioceramic- and Resin-Based sealers from simulated internal resorption cavities: an in vitro study

Aim: this study aims to to compare two sealers removability (bioceramic based and resin based) using three approaches (XP-endo shaper, XP-endo finisher, and Passive Ultrasonic Irrigation) in internal root resorption simulated teeth. Methodology: 132 extracted mandibular premolars were prepared and split, artificial cavities were placed on both teeth segments 5 mm from root apex then teeth segments were brought back together and fixed in epoxy resin model. Models were randomly assigned to six groups (n=22) according to the root canal filling and retreatment protocol. Group 1: (filled with GP + BC sealer and retreated using XP-endo Finisher). Group 2: (filled with GP + Resin sealer and retreated using XP-endo Finisher). Group 3: (filled with GP + BC sealer and retreated using XP-endo Shaper). Group 4: (filled with GP + Resin sealer and retreated using XP-endo Shaper). Group 5: (filled with GP + BC sealer and retreated using PUI). Group 6: (filled with GP + Resin sealer and retreated using PUI). Samples were incubated for 4 weeks then teeth were extracted from epoxy model and split again to evaluate sealer removability under digital light microscope. Results: No significant difference were found between the six groups when it comes to sealer removability Van der Sluis score (p = 0.013). Group 5 showed the highest Van der Sluis score followed by groups 1, 2, 4 and 6 without significant difference between them. Group 3 showed a significantly lower Van der Sluis score than group 5. There was no significant difference between group 3 and groups 1, 2, 4 and 6 in the Van der Sluis score. Conclusion: No treatment protocol was able to eliminate all sealer remnant effectively. Resin based sealer showed no significant difference when compared to Bioceramic based sealer when it comes to sealer removability, the exception was that XP-endo shaper showed significantly better results when compared to passive ultrasonic activation which has failed to remove Bioceramic remnants compared to XP-endo shaper.