Effect of delivery method on periapical extrusion of a hydraulic calcium silicate cement-based sealer during single-cone root canal filling technique: An in vitro study
Yasmina Andreani, Ryan David Butler, Paul V. Abbott, Mostafa M. A. ElkholyAbstract
Background:
Hydraulic calcium silicate cement-based sealers (HCSCSs) have become increasingly popular in single-cone obturation techniques due to their superior biocompatibility and flowability. However, the inherent flowability of these materials may predispose them to periapical extrusion. Despite the clinical significance of sealer extrusion, there is limited evidence regarding the optimal delivery method to minimize this complication.
Aim:
To compare three delivery methods for a ready-to-use HCSCS during single-cone root canal filling in mandibular molars and evaluate their effect on periapical extrusion.
Materials and Methods:
Forty-eight human mandibular molars with single distal canals were instrumented to a standardized apical size and filled using EndoSequence BC sealer with three delivery methods: syringe injection (SI), cone coating (CC), and injection followed by sonic agitation with an EndoActivator (EA). Each group contained 16 samples (n = 16). A closed-system model was established using polyvinyl siloxane and blueberry as a biological barrier to simulate periapical resistance. Periapical extrusion was assessed radiographically using two projections immediately after root canal filling.
Results:
The SI group displayed periapical extrusion in 62.5% of samples, compared to 31.25% in both the CC and EA groups. However, this difference was not statistically significant (P = 0.151).
Conclusion:
The delivery method did not significantly influence the frequency of periapical extrusion when using HCSCS with the single-cone technique. Nevertheless, the numerical trend toward reduced extrusion with passive CC and sonic agitation warrants further investigation to optimize sealer placement and reduce the risk of complications associated with periapical extrusion.