Push-Out Bond Strenght of four different bioceramic sealers tested with three different obturating systems: an In Vitro study

Aim The purpose of the current study was to evaluate the bond strength to root canal walls of four different bioceramic sealers used in combination with three different obturation techniques by push-out test.

Materials and Methods 120 monoradicular roots were selected and used for this study. After being endodontically instrumented, the roots were randomly divided in 12 groups of 10 samples each and then obturated with 4 different bioceramic sealers (Ceraseal, Meta Biomed; AH Plus, Dentsply Sirona; BIO-C Sealer Ion+, Angelus; and BioRoot RCS, Septodont) in combination with three obturation techniques (“Continuous Wave of Condensation" technique, "Domino system" carrier-based technique and "Single-Cone" obturation technique). Then the wide majority of roots were cut in slides and each of them was tested under a push out device. Loading was performed at a speed of 0,5mm/min in an apical-coronal direction, and the obtained values were analyzed statistically. Few roots were cut along their long axis to observe the bio ceramic sealers’ penetration into the tubules by an optical microscope.

Results The “Continuous Wave of Condensation” technique showed a media among the four sealers used of 3,36 MPa, “Domino” technique 3,10 MPa and “Single-Cone”  3,28 MPa. However, Kruskal-Wallis one-way analysis of variance revealed the absence of statistically significant differences between sealers in all obturation techniques (p = 0.174, p = 0.667, p = 0.148 for 'Continuous Wave of Condensation', ' Domino' and 'Single-Cone ' respectively). The bond strenght recorded for Ceraseal was 3,15 MPa, AH Plus showed 3,11 MPa, Bio-C Ion+ 3,35 MPa and Bioroot 3,38 MPa. However, Kruskal-Wallis one-way analysis of variance revealed the absence of statistically significant differences between the obturation techniques for all materials (p = 0.714, p = 0.63, p = 0.114, p = 0.655 for 'Ceraseal', 'AH Plus', 'Bio-C Ion +' and 'BioRoot' respectively). Microscopic analysis reveals that Ceraseal, AH Plus, BIO-C Ion+ and BioRoot RCS are able to perform a three-dimensional seal of the root canal and they are able to penetrate the dentinal tubules.

Conclusions It can be concluded that if the endodontic procedure is properly performed and follows protocols based on scientific evidence, clinical success can be achieved regardless of the different materials used and the different techniques.