Root canal cleanliness and debris extrusion following retreatment of thermoplastic injection technique and bioceramic-based root canal sealer.

Objectives: To evaluate the amount of apically extruded debris and to determine the remaining filling material on the root canal walls by microcomputed tomography (micro-CT), following the root canal retreatment of root canals filled with different obturation techniques (single cone technique, thermoplasticised injection technique) and the different root canal sealers [bioceramic-based, epoxy resin-based root canal sealer].

Materials and methods: 60 single rooted human premolar teeth were prepared with the ProTaper Gold system (Dentsply Maillefer) up to the F4 file and the samples were divided into 4 groups according to obturation procedures: Single cone technique + AH Plus sealer(epoxy resin-based root canal sealer, Dentsply International Inc., York, PA, USA); Single cone technique + Sure-Seal Root(bioceramic-based root canal sealer, Sure Dent Corporation, Gyeonggi-do, South Korea); thermoplastic injection technique[Calamus Dual Obturation System(Dentsply-Tulsa Dental, Tulsa, OK, USA)] + AH Plus(Dentsply International Inc.); Sure-Seal Root(Sure Dent Corporation) + Calamus Dual Obturation System (Dentsply-Tulsa Dental). The teeth were inserted into preweighed Eppendorf tubes and retreatment was performed. The tubes were kept in an incubator at 37 °C for 14 days to obtain the dry debris weight. Following the removal of the root canal fillings, the samples were scanned with a micro-CT device to analyse the volume of filling residues.

Results: Retreatment of samples obturated with epoxy-resin or bioceramic based root sealers combined with Calamus system resulted in higher amount of apical extrusion compared to their combination with single cone technique (p = 0.026 for Single cone technique + AH Plus sealer vs Calamus + AH Plus sealer and p = 0.005 for Single cone technique + Sure-Seal root sealer vs Calamus + Sure-Seal root sealer). The most debris was observed in the Calamus + Sure-Seal root sealer group, the least debris was observed in the Single cone technique + AH Plus sealer group. The percentage of residues was the highest in the Single cone technique + Sure-Seal root sealer and the lowest in the Calamus + AH Plus sealer group, but there were no significant differences between groups (p = 0.463).

Conclusions: No correlation was observed among the groups in terms of extruded debris and remnants inside the root canal. When combined with bioceramic based sealer, thermoplasticised injection technique did not affect the cleanliness of root canal walls; however, it increased its apical extrusion potential during retreatment.

Clinical relevance: The obturation method does not play a role in the removability of bioceramic based root canal sealer, however the use of bioceramic-based root canal sealers with cold obturation techniques may be beneficial in preventing apical extrusion.