Basic Research—Technology

Evaluation of Effects on the Adhesion of Various Root Canal Sealers after Er:YAG Laser and Irrigants Are Used on the Dentin Surface Ismail Ozkocak, DDS, PhD,* and Bade Sonat, DDS, PhD† Abstract Introduction: The aim of this study was to evaluate the bond strength of various root canal sealers after various irrigation solutions and Er:YAG laser irradiation were used on root canal dentin. Methods: One hundred fifty freshly extracted human maxillary singlerooted teeth were used in this study. Teeth were sectioned transversally 4 mm below the cementoenamel junction. The root canal of each specimen was prepared using a tapered bur. Teeth were divided into 3 main groups by sealer (AH Plus Jet [Dentsply DeTrey, Konstanz, Germany], EndoSequence BC Sealer [Brasseler, Savannah, GA], and Real Seal [SybronEndo, Orange, CA]) and then divided into 5 subgroups by dentin treatment (distilled water, calcium hydroxide, sodium hypochlorite, EDTA, and Er:YAG laser). The specimens were placed immediately at 37 C and 100% humidity for 1 week. Then, the push-out test was applied. The maximum failure load was recorded in newtons and was used to calculate the push-out bond strength in MPa. Then, 3 random specimens from each group were examined under scanning electron microscopy. Results: The resin root canal sealers had higher push-out bond strength than the bioceramic sealer, and the differences were statistically significant (P < .05) except in the sodium hypochlorite groups. The EDTA and Er:YAG laser applications removed the smear layer and increased the bond strength. The highest adhesion was observed in EDTA groups when each sealer was evaluated in itself. Conclusions: The bonding strength of root canal sealers is influenced by their properties and various dentin surface treatments. The scanning electron microscopic study showed that although the dentinal tubules were open, at the profile examination the sealers did not penetrate into the dentin canals in all specimens. (J Endod 2015;-:1–6)

Key Words Adhesion, AH Plus Jet, EndoSequence BC sealer, Er:YAG laser, irrigation, push-out test, RealSeal

S

uccess in endodontic treatment depends on obturation of the root canal space in 3 dimensions with stable and nontoxic materials after carefully chemomechanically cleaning and shaping the space to prevent bacteria, bacterial products, and movement of the tissue fluid (1–3). The most important factor in the failure of endodontic treatment is leakage of periapical exudates into canals that are not completely packed. Approximately 60% of failed cases are caused by fully unfilled root canals. Therefore, selection of the chemomechanical instrumentation and irrigation methods is significant in root canal obturation (4). For many years, many canal obturation materials and obturation methods have been developed to eliminate failure factors. Core materials and root canal sealers are used together in many techniques. Sealers are basic elements for all techniques independent of core material and are expected to provide tight sealing (5). AH Plus Jet (Dentsply DeTrey, Konstanz, Germany), RealSeal (SybronEndo, Orange, CA), and EndoSequence BC Sealer (Brasseler, Savannah, GA) are recently developed root canal sealers. EndoSequence BC Sealer was placed on the market as a new bioceramicbased sealer in a syringe mixed and ready to use. Root canal obturation materials should eliminate the remaining microorganisms in the canal and must show good adaptation to root canal dentin to block the passage of microorganisms and their products (6). Irregularities in the anatomy of the root canal, amount of root canal preparation, types of irrigation solution, root canal oburation technique, and types of root canal sealers also affect microleakage (7–11). There is a strong association between apical periodontitis and poor technical quality of root canal treatment. Inadequate or incomplete primary root canal treatment is a risk factor for the development of apical periodontitis and local abscess formation (12–14). Ideal endodontic root canal sealers should completely coat the root canal space and adhere to the canal wall and gutta-percha (3). This feature is influenced by the treatment (irrigation type and preparation methods) and can be affected by the type of root canal sealer. The presence of the smear layer on dentin surfaces is another important factor. According to researchers, the smear layer is a negative factor for root canal obturation. Authors have claimed that the smear layer creates space between the material and the root canal wall, and the smear layer reduces the adhesion of root canal sealers (15–17). Many methods and chemical solutions including lasers have been used to remove the smear layer (18–21).

From the *Department of Endodontics, Faculty of Dentistry, University of Gaziosmanpasa, Tokat, Turkey; and †Department of Endodontics, Faculty of Dentistry, University of Ankara, Ankara, Turkey. Address requests for reprints to Dr Ismail Ozkocak, Department of Endodontics, Faculty of Dentistry, Gaziosmanpas¸a University, Tokat, Turkey. E-mail address: [email protected] 0099-2399/$ - see front matter Copyright ª 2015 American Association of Endodontists. http://dx.doi.org/10.1016/j.joen.2015.03.004

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Various Root Canal Sealers and Er:YAG Laser

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Basic Research—Technology TABLE 1. Multiple Statistical Comparisons between Root Canal Sealers

Distilled water Calcium hydroxide NaOCl EDTA Er:YAG laser

AH Plus Jet vs BC Sealer

AH Plus Jet vs RealSeal

BC Sealer vs RealSeal

P < .01* P < .01* P > .05 P < .01* P < .01*

P = .838 P = .024 P > .05 P < .01* P = .299

P < .01* P < .01* P > .05 P < .01* P < .01*

NaOCl, sodium hypochlorite. *Significant difference between groups (according to the Bonferroni correction, P < .01 was considered statistically significant for the results).

Figure 1. The experimental design and application of push-out force.

According to the literature, differences in the dentin surface affect adhesion to the dentin of the root canal sealers, which seems obvious (22, 23). The aim of this study was to assess the effects on the adhesion of various root canal sealers after the Er:YAG laser and irrigants are used on the dentin surface by using the push-out method and scanning electron microscopy.

Materials and Methods One hundred fifty freshly extracted human maxillary single-rooted teeth were used in this study. The teeth were sectioned transversally 4 mm below the cementoenamel junction to provide 4-mm-thick dentin discs that were centered inside aluminum rings (16-mm diameter and 4-mm high) and embedded in acrylic resin. The root canal of each specimen was prepared using a tapered diamond bur attached to a lowspeed handpiece, and space for sealer placement was created with the following dimensions: larger diameter = 2 mm, smaller diameter = 1.5 mm, and length = 4 mm. Next, the specimens were randomly assigned to 3 experimental groups according to the type of root canal sealer (n = 50). Each main group was further subdivided into 5 subgroups (n = 10) according to the irrigation regimen. Groups 1a, 2a, and 3a were irrigated with distilled water (Erdogmus Kimya, Sivas, Turkey); groups 1b, 2b, and 3b were irrigated with calcium hydroxide solution (Calxyl; OCO Praparate, Dirmstein, Germany); groups 1c, 2c, and 3c were irrigated with 5% sodium hypochlorite (NaOCl) solution (Whitedentmed, Erhan Kimya, Turkey); groups 1d, 2d, and 3d were irrigated with 17% EDTA solution (Whitedentmed); and groups 1e, 2e, and 3e were irradiated with the Er:YAG laser (VersaWave;

HOYA ConBio, Fremont, CA) for 1 minute under water cooling; the laser parameters were 20 Hz and 50 mJ. Thereafter, the specimens in group 1 were obturated with AH Plus Jet, the specimens in group 2 were obturated with EndoSequence BC Sealer, and the specimens in group 3 were obturated with RealSeal root canal sealer. The specimens were placed immediately into the incubator at 37 C and 100% humidity for 1 week. The push-out force was applied in an apicocoronal direction until bond failure occurred by using a universal testing machine (LIoyd LRXplus; LIoyd Instruments Ltd, Fareham, UK), which was manifested by extrusion of the obturation material and a sudden drop along the load deflection (Fig. 1). The force was recorded with Nexygen data analysis software (LIyod Instruments Ltd). The maximum failure load was recorded in newtons and was used to calculate the push-out bond strength in MPa. Then, 3 random specimens from each group were prepared for scanning electron microscopic (SEM) examination. Longitudinal grooves were made on the 2 root surfaces with diamond disks symmetrically without penetrating the canal. Fracture of the specimens was completed by using a chisel and hammer. Data analysis was performed with SPSS for Windows 11.5 statistical software package (SPSS Inc, Chicago, IL) using 2-way analysis of variance and post hoc Tukey tests. In the statistical analysis, P < .05 was considered statistically significant. The Bonferroni correction was applied in order to take control of type I errors in all possible multiple comparisons.

Results Results obtained from the study are summarized in Figure 2 and Tables 1 and 2. AH Plus Jet and RealSeal showed similar adhesion TABLE 2. Multiple Statistical Comparisons between Irrigation Solutions and Er:YAG Laser When Each Sealer Was Evaluated by Itself AH Plus Jet BC Sealer RealSeal Distilled water and calcium hydroxide Distilled water and NaOCl Distilled water and EDTA Distilled water and Er:YAG laser Calcium hydroxide and NaOCl Calcium hydroxide and EDTA Calcium hydroxide and Er:YAG laser NaOCl and EDTA NaOCl and Er:YAG laser EDTA and Er:YAG laser

Figure 2. A graphic view of the results.

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P < .017*

P = .175

P < .017*

P = .033 P < .017* P < .017*

P < .017* P < .017* P < .017*

P = .052 P < .017* P < .017*

P < .017*

P < .017*

P < .017*

P < .017*

P < .017*

P < .017*

P < .017*

P < .017*

P < .017*

P < .017* P = .927 P < .017*

P = .966 P < .017* P < .017*

P < .017* P = .292 P < .017*

NaOCl, sodium hypochlorite. *Significant difference between groups (according to the Bonferroni correction, P < .017 was considered statistically significant for the results).

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Basic Research—Technology properties in the distilled water, calcium hydroxide, NaOCl, and Er:YAG laser groups, and there was no statistical difference. However, when EDTA was used, RealSeal had the highest adhesion values, and the difference was significant. BC Sealer showed lower adhesion values than resin-based sealers in all dentin surface applications, and the differences were statistically significant (P < .01) except in the NaOCl groups. There was no statistically significance (P > .01) between the 3 sealers with NaOCl irrigation in terms of adhesion (Table 1). NaOCl, EDTA irrigation, and Er:YAG laser irradiation increased adhesion values, and the differences were significant (P < .017) when compared with the distilled water and calcium hydroxide (Calxyl) groups. The adhesion values decreased when calcium hydroxide was used as an irrigant, and the difference was statistically significant (P < .017) when compared with all groups except the BC Sealer– distilled water group (Table 2). SEM examination showed EDTA and Er:YAG laser irradiation were effective in removing the smear layer. In the other groups, a smear layer was observed. In cases in which the smear layer was removed, penetration of sealers in the dentinal tubules was observed generally. RealSeal could not penetrate into all dentinal tubules, especially in the laserRealSeal group. Laser irradiation increased microretentive areas (Figs. 3A–L, 4A–L, and 5A–I).

Discussion Adhesion is a very important feature for root canal sealers (22, 24). In recent years, researchers have developed fillers and root canal sealers depending on the dentin adhesion technology to provide more effective filling of the root canal (25). In addition, studies on the bond strength to the dentin of the root canal filling materials

showed that apical dentin adhesion significantly reduces leakage and improves the fracture resistance of root canal–filled teeth (26–29). Zinc oxide–eugenol–, glass ionomer–, and calcium hydroxide– based sealers showed lower adhesion values than resins, which was reported in previous studies (30–32, 33). Therefore, in the present study, 2 actual resin-based sealers were used with bioceramic-based EndoSequence BC Sealer to determine adhesion after the Er:YAG laser and various irrigation agents were applied to the dentin surface. In addition, changes in the fractured surfaces of the specimens were examined with scanning electron microscopy in order to determine the penetration of the sealers into the dentinal tubules. Researchers’ findings support the results of our study. Resin-based sealers showed higher push-out bond strength values than bioceramic-based sealer. Since 1984, the American Dental Association has tested the physical properties of root canal sealers. However, there is no consensus among researchers regarding standardized adhesion tests (34). Orstavik et al (35) recommended the use of a universal testing machine to determine the adhesion of root canal sealers. This method has been used by many researchers (3, 25,35–38, 39). Goracci et al (38) reported that the push-out test is more reliable than other tests, and the push-out method better reflects the clinical status of the fracture. The experimental model used in this study has been used in many recent studies (35,39–42). Adhesion is a desirable property for root canal filling materials (3). Adhesion may be affected by factors such as surface tension, surface wettability, and connected surface cleaning (43) and may be affected by the physical and chemical properties of the paste, type of irrigation solution, and the presence of the smear layer (44). Previous studies have shown that sealer adhesion increased when the smear layer was removed from the canal (41, 45). In the present study, cleaning the

Figure 3. SEM photomicrographs of the distilled water and calcium hydroxide groups. A heavy smear layer and residues of sealers were observed; the dentin canals appeared empty. (A and B) AH Plus Jet and distilled water, (C and D) EndoSequence BC Sealer and distilled water, (E and F) RealSeal and distilled water, (G and H) AH Plus Jet and calcium hydroxide, (I and J) EndoSequence BC Sealer and calcium hydroxide, and (K and L) RealSeal and calcium hydroxide.

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Figure 4. SEM photomicrographs of NaOCl groups and EDTA groups; the dentin canals appeared empty in the NaOCl groups. The smear layer was removed, and dentin canals were penetrated by sealers in EDTA groups. (A and B) AH Plus Jet and NaOCl, (C and D) EndoSequence BC Sealer and NaOCl, (E and F) RealSeal and NaOCl, (G and H) AH Plus Jet and EDTA, (I and J) EndoSequence BC Sealer and EDTA, and (K and L) RealSeal and EDTA.

connected surface was affected by each irrigation solution and laser application differently. For example, according to the values obtained from the study, the presence of the smear layer has a negative effect on the adhesion of all 3 root canal sealers. The smear layer is a structure that connects weakly to the dentin, creating a barrier between sealers and the dentin surface. This may be the reason for the increase in adhesion values when the smear layer was removed. Many chemical solutions affect the biomechanical characteristics of the dentin layer during biomechanical preparation of the root canal system. In addition, routine chemical solutions and other technologies such as laser irradiation have been investigated in root canal dentin applications (39). NaOCl has a high surface tension. Although the organic tissue solving feature of NaOCl is very powerful, solvent properties of NaOCl in inorganic tissue is insufficient so it does not completely remove the smear layer (46). We suggest that these are the reasons why NaOCl did not affect the adhesion values more positively like EDTA. Calcium hydroxide had a negative impact on adhesion in the present study. Contardo et al (47) reported that the apical sealing of the RoekoSeal (Coltene/Whaledent, Langenau, Germany) silicon-based root canal sealer was negatively affected, and leakage increased after calcium hydroxide was used, which must be removed before the canal is filled. Barbizam et al (48) reported that the use of calcium hydroxide before obturation caused a statistically significant decrease in the dentin adhesion of Epiphany (Pentron Clinical Technologies, Wallingford, CT). Bottcher et al (49) reported that calcium hydroxide negatively affected the sealing ability of RealSeal and Endofill (Produits Dentaires SA, Vevey, Switzerland) sealers; the leakage increased, and calcium hydroxide must be removed before the canal fillings are completed. The present study results are consistent with other researchers’ reports. When calcium hydroxide was used as an irrigation solution, adhesion was affected in a negative direction in each of the 3 sealers groups; calcium 4

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hydroxide has a high surface tension and adversely affects the adhesion. Calcium hydroxide has no ability to remove the smear layer and has no tissue solving properties in a short time (50). Also, calcium hydroxide residues remaining in the root canal walls connect weakly to the dentin surface and may be a barrier for a strong bond between the surface and sealer. The results of the present study may connect to these factors regarding the fact that irrigated groups with calcium hydroxide showed lower adhesion values. The absence of the smear layer and the formation of microretentive areas were observed in the laser-treated teeth during SEM examination. Pecora et al (34) concluded that laser applications increased the adhesion of sealers that contained epoxy resin and had no impact on Fillcanal’s (TechNew, Campo Grande, RJ, Brazil) adhesion. Researchers used the occlusal surfaces of molars and the vertical tensile test in experiments. Sousa-Neto et al (36) examined the impact of Er:YAG laser irradiation on the adhesion of Sealer 26 (Dentsply, Petropolis, RJ, Brazil), Grossman (FORP-USP, Ribeir~ao Preto, SP, Brazil), N-Rickert (Inodon, Porto Alegre, RS, Brazil), and Endomethasone (Septodont, Saint-Maur, France) sealer. The Er:YAG laser application increased the bond strength of Sealer 26 root canal sealer and did not affect the adhesion of the other sealers. Picoli et al (33) evaluated the bonding strength of Sealer 26, Apexit (Vivadent, Schaan, Liechtenstein), Sealapex (Kerr, Romulus, MI), and CRCS (Hygenic, Mahwah, NJ) sealers and found that Er:YAG laser irradiation and EDTAC solution application increased the adhesion of Sealer 26 and Apexit. The other calcium hydroxide sealers were not affected. Our study findings are consistent with the results of previous researchers. Laser irradiation increased the adhesion values of sealers when compared with the distilled water and calcium hydroxide groups. Sousa-Neto et al (37) assessed the dentin adhesion of the epoxy resin content of Sealer 26 after Er:YAG and Nd:YAG laser irradiation by using the push-out test. They

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Figure 5. SEM photomicrographs of the Er:YAG laser groups; the laser removed the smear layer, and the sealers penetrated into the dentinal tubules locally. (A and B) AH Plus Jet and Er:YAG laser; (C and D) EndoSequence BC Sealer and Er:YAG laser; (E and F) RealSeal and Er:YAG laser; (G) heavy smear layer, calcium hydroxide, and sealer remnants; and (H and I)effectiveness of Er:YAG laser in removing the smear and microretentive areas after laser irradiation.

reported that the use of Er:YAG and Nd:YAG lasers provided higher values compared with 17% ethylenediaminetetraacetic acid plus Cetavlon (EDTAC); raising the laser parameters increased the adhesion. Alfredo et al (39) examined the effect of 980-nm wavelength diode laser irradiation on the dentin surface on the adhesion of Epiphany and AH Plus root canal sealers. Even when not used in a laser application, AH Plus sealer showed higher bond strength than the Epiphany root canal sealer. The laser application increased the dentin bond strength of the AH Plus root canal sealer while increasing the adhesion of Epiphany although the increase was not statistically significant. There are contrasts between other researchers’ findings and our results. Other authors attributed their results to the residual monomer in the Epiphany root canal sealer, the presence of oxygen, lack of photopolymerization, and disruption of polymerization by-products formed after chemomechanic preparation. In the present study, no differences were found between the AH Plus Jet and RealSeal groups except for the EDTA group. When EDTA was used with RealSeal, the highest adhesion was obtained. A long waiting time (ie, up to a week), which is much longer than the setting time of sealers, may have affected the results for the adhesion of dual cure sealer (RealSeal). In the present study, Er:YAG laser application increased the adhesion of bioceramic- and resinbased root canal sealers, and there was a statistically significant difference compared with the distilled water and calcium hydroxide groups. AH Plus Jet is in the hydrophobic structures, whereas BC Sealer and RealSeal show hydrophilic characteristics. BC sealer requires the presence of water to set (51, 52). The evaporation of liquid in the dentinal tubules during laser application may affect the adhesion of hydrophilic sealers. Laser irradiation increased the adhesion values of BC Sealer even though it could be the reason why it did not affect NaOCl and EDTA as significantly. Saleh et al (53) reported that all root canal sealers did not show penetration in the exposed dentinal tubules after the smear layer was JOE — Volume -, Number -, - 2015

removed, bond strength was not high in all sealers that showed tubular penetration, and the type of irrigation must be chosen according to the different structures of root canal sealer for optimal adhesion. Our study results are consistent with the findings of these researchers. In the present study, dentinal tubules were penetrated by root canal sealers generally when the smear layer was removed, but penetration did not occur in all specimens, especially in the laser-RealSeal groups, according to SEM analysis. For the BC Sealer groups, higher values were found when NaOCl and EDTA were used. When the laser was used, there were more rough and retentive areas and increased adhesion although this difference was not as large as the NaOCl and EDTA effects. Lateral condensation or vertical condensation techniques were not used when obturation of the root canal was performed in the present study; root canals were obturated only with passive pressure of the sealer’s syringe. Fluidity, viscosity of the sealers, and obturation technique may have affected the penetration depth and adhesion because rougher surfaces were obtained by laser applications.

Conclusion According to the results, before root canal obturation, the properties of the sealers and irrigation solutions should be considered. Therefore, the materials should be chosen based on their interaction. EDTA and the Er:YAG laser are very effective in removing the smear layer. Calcium hydroxide and the smear layer should be removed, and the surface of the dentin should be prepared for obturation. Although bioceramicbased sealers exhibited lower adhesion values in the present study, the use of bioceramics should be considered by clinicians with regard to their positive biological (biocompatible feature and bone formation stimulating effect) and antibacterial properties according to the case. Er:YAG laser systems are quite expensive, and the effects on adhesion did not provide a major advantage when compared with traditional irrigants used in endodontics (NaOCl and EDTA). Besides, laser systems

Various Root Canal Sealers and Er:YAG Laser

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Basic Research—Technology have no cytotoxic or allergic properties; clinicians may benefit from the antimicrobial and smear removal effects of lasers. Developments on laser systems are ongoing, and improvements are promising.

Acknowledgments The authors deny any conflicts of interest related to this study.

References 1. Sundqvist G, Figdor D. Endodontic treatment of apical periodontitis. In: Qrstavik D, Pitt Ford TR, editors. Essential Endodontology. Oxford: Blackwell Science. pp. 242–7. 2. Depraet FJ, De Bruyne MA, De Moor RJ. The sealing ability of an epoxy resin root canal sealer after Nd:YAG laser irradiation of the root canal. Int Endod J 2005;38:302–9. 3. Hashem AA, Ghoneim AG, Lutfy RA, Fouda MY. The effect of different irrigating solutions on bond strength of two root canal-filling systems. J Endod 2009;35: 537–40. 4. Ingle JI, Luebke RG, Zidell JD, et al. Obturation of the radicular space. In: Ingle F, Taintor JF, eds. Endodontics, 3rd ed. Philadelphia: Lee & Febiger; 1985:223–307. 5. Johnson WT, Gutmann JL. Obturation of the cleaned and shaped root canal system. In: Cohen S, Hargreaves MK, eds. Pathways of the Pulp, 9th ed. St Louis: Mosby; 2006:358–99. 6. Stock CJR, Walker RT, Gulabivala K, Goodman JR. Endodontics, 2nd ed. London: Mosby-Wolfe; 1997:151–76. 7. Torabinejad M, Ung B, Kettering JD. In vitro bacterial penetration of coronally unsealed endodontically treated teeth. J Endod 1990;16:566–9. 8. Vivacqua-Gomes N, Ferraz CC, Gomes BP, et al. Influence of irrigants on the coronal microleakage of laterally condensed gutta-percha root fillings. Int Endod J 2002;35: 791–5. 9. Pamir T, Turkun M, Kaya AD, Sevgican F. Effect of antioxidant on coronal seal of dentin following sodium-hypochlorite and hydrogen-peroxide irrigation. Am J Dent 2006;19:348–52. 10. Ghoddusi J, Dibaji F, Marandi S. Correlation between sealer penetration and microleakage following the use of MTAD as a final irrigant. Aust Endod J 2010;36:109–13. 11. Rosales-Leal JI, Olmedo-Gaya V, Vallecillo-Capilla M, Luna-del Castillo JD. Influence of cavity preparation technique (rotary vs. ultrasonic) on microleakage and marginal fit of six end-root filling materials. Med Oral Patol Oral Cir Bucal 2011;16:e185–9. 12. Gronholm L, Lemberg KK, Tjaderhane L, et al. The role of unfinished root canal treatment in odontogenic maxillofacial infections requiring hospital care. Clin Oral Investig 2013;17:113–21. 13. Di Filippo G, Sidhu SK, Chong BS. Apical periodontitis and the technical quality of root canal treatment in an adult sub-population in London. Br Dent J 2014;216:E22. 14. Nur BG, Ok E, Altunsoy M, et al. Evaluation of technical quality and periapical health of root-filled teeth by using cone-beam CT. J Appl Oral Sci 2014;22:502–8. 15. Saleh IM, Ruyter IE, Haapasalo M, Orstavik D. The effects of dentine pretreatment on the adhesion of root-canal sealers. Int Endod J 2002;35:859–66. 16. Forough Reyhani M, Ghasemi N, Rahimi S, et al. Push-out bond strength of Dorifill, Epiphany and MTA-Fillapex sealers to root canal dentin with and without smear layer. Iran Endod J 2014;9:246–50. 17. do Prado M, de Assis DF, Gomes BP, Simao RA. Adhesion of resin-based sealers to dentine: an atomic force microscopy study. Int Endod J 2014;47:1052–7. 18. Bolhari B, Ehsani S, Etemadi A, et al. Efficacy of Er,Cr:YSGG laser in removing smear layer and debris with two different output powers. Photomed Laser Surg 2014;32:527–32. 19. Arslan H, Ayranci LB, Karatas E, et al. Effect of agitation of EDTA with 808-nanometer diode laser on removal of smear layer. J Endod 2013;39:1589–92. 20. Mancini M, Cerroni L, Iorio L, et al. Smear layer removal and canal cleanliness using different irrigation systems (EndoActivator, EndoVac, and passive ultrasonic irrigation): field emission scanning electron microscopic evaluation in an in vitro study. J Endod 2013;39:1456–60. 21. Prado M, Gusman H, Gomes BP, Simao RA. Scanning electron microscopic investigation of the effectiveness of phosphoric acid in smear layer removal when compared with EDTA and citric acid. J Endod 2011;37:255–8. 22. Goncalves L, Silva-Sousa YT, Raucci Neto W, et al. Effect of different irrigation protocols on the radicular dentin interface and bond strength with a metacrylate-based endodontic sealer. Microsc Res Tech 2014;77:446–52. 23. Ayranci LB, Koseoglu M. The evalution of the effects of different irrigating solutions and laser systems on adhesion of resin-based root canal sealers. Photomed Laser Surg 2014;32:152–9. 24. Nagas E, Uyanik MO, Eymirli A, et al. Dentin moisture conditions affect the adhesion of root canal sealers. J Endod 2012;38:240–4.

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25. Stiegemeier D, Baumgartner JC, Ferracane J. Comparison of push-out bond strengths of Resilon with three different sealers. J Endod 2010;36:318–21. 26. Britto LR, Borer RE, Vertucci FJ, et al. Comparison of the apical seal obtained by a dual-cure resin based cement or an epoxy resin sealer with or without the use of an acidic primer. J Endod 2002;28:721–3. 27. Shipper G, Orstavik D, Teixeira FB, Trope M. An evaluation of microbial leakage in roots filled with a thermoplastic synthetic polymer-based root canal filling material (Resilon). J Endod 2004;30:342–7. 28. Teixeira FB, Teixeira EC, Thompson JY, Trope M. Fracture resistance of roots endodontically treated with a new resin filling material. J Am Dent Assoc 2004; 135:646–52. 29. Hammad M, Qualtrough A, Silikas N. Effect of new obturating materials on vertical root fracture resistance of endodontically treated teeth. J Endod 2007;33:732–6. 30. Lee KW, Williams MC, Camps JJ, Pashley DH. Adhesion of endodontic sealers to dentin and gutta-percha. J Endod 2002;28:684–8. 31. Tagger M, Tagger E, Tjan AH, Bakland LK. Measurement of adhesion of endodontic sealers to dentin. J Endod 2002;28:351–4. 32. Najar AL, Saquy PC, Vansan LP, Sousa-Neto MD. Adhesion of a glass-ionomer root canal sealer to human dentine. Aust Endod J 2003;29:20–2. 33. Picoli F, Brugnera-Junior A, Saquy PC, et al. Effect of Er:YAG laser and EDTAC on the adhesiveness to dentine of different sealers containing calcium hydroxide. Int Endod J 2003;36:472–5. 34. Pecora JD, Cussioli AL, Guerisoli DM, et al. Evaluation of Er:YAG laser and EDTAC on dentin adhesion of six endodontic sealers. Braz Dent J 2001;12:27–30. 35. Orstavik D, Eriksen HM, Beyer-Olsen EM. Adhesive properties and leakage of root canal sealers in vitro. Int Endod J 1983;16:59–63. 36. Sousa-Neto MD, Marchesan MA, Pecora JD, et al. Effect of Er:YAG laser on adhesion of root canal sealers. J Endod 2002;28:185–7. 37. Sousa-Neto MD, Silva Coelho FI, Marchesan MA, et al. Ex vivo study of the adhesion of an epoxy-based sealer to human dentine submitted to irradiation with Er : YAG and Nd : YAG lasers. Int Endod J 2005;38:866–70. 38. Goracci C, Tavares AU, Fabianelli A, et al. The adhesion between fiber posts and root canal walls: comparison between microtensile and push-out bond strength measurements. Eur J Oral Sci 2004;112:353–61. 39. Alfredo E, Silva SR, Ozorio JE, et al. Bond strength of AH Plus and Epiphany sealers on root dentine irradiated with 980 nm diode laser. Int Endod J 2008;41:733–40. 40. Gettleman BH, Messer HH, ElDeeb ME. Adhesion of sealer cements to dentin with and without the smear layer. J Endod 1991;17:15–20. 41. Nunes VH, Silva RG, Alfredo E, et al. Adhesion of Epiphany and AH Plus sealers to human root dentin treated with different solutions. Braz Dent J 2008;19:46–50. 42. Teixeira CS, Alfredo E, Thome LH, et al. Adhesion of an endodontic sealer to dentin and gutta-percha: shear and push-out bond strength measurements and SEM analysis. J Appl Oral Sci 2009;17:129–35. 43. Bayne S. Bonding to dental substrates. In: Craig RG, Powers JM, eds. Restorative Dental Materials, 11th ed. St. Louis: Mosby; 2001:260–2. 44. Goldman LB, Goldman M, Kronman JH, Lin PS. The efficacy of several irrigating solutions for endodontics: a scanning electron microscopic study. Oral Surg Oral Med Oral Pathol 1981;52:197–204. 45. Vilanova WV, Carvalho-Junior JR, Alfredo E, et al. Effect of intracanal irrigants on the bond strength of epoxy resin-based and methacrylate resin-based sealers to root canal walls. Int Endod J 2012;45:42–8. 46. Estrela C, Estrela CR, Barbin EL, et al. Mechanism of action of sodium hypochlorite. Braz Dent J 2002;13:113–7. 47. Contardo L, De Luca M, Bevilacqua L, et al. Influence of calcium hydroxide debris on the quality of endodontic apical seal. Minerva Stomatol 2007;56:509–17. 48. Barbizam JV, Trope M, Teixeira EC, et al. Effect of calcium hydroxide intracanal dressing on the bond strength of a resin-based endodontic sealer. Braz Dent J 2008;19:224–7. 49. Bottcher DE, Hirai VH, Da Silva Neto UX, Grecca FS. Effect of calcium hydroxide dressing on the long-term sealing ability of two different endodontic sealers: an in vitro study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:386–9. 50. Estrela C, Estrela CR, Guimar~aes LF, et al. Surface tension of calcium hydroxide associated with different substances. J Appl Oral Sci 2005;13:152–6. 51. Zoufan K, Jiang J, Komabayashi T, et al. Cytotoxicity evaluation of Gutta Flow and Endo Sequence BC sealers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:657–61. 52. Moura-Netto C, Palo RM, Camargo SE, et al. Influence of prior 810-nm-diode intracanal laser irradiation on hydrophilic resin-based sealer obturation. Braz Oral Res 2012;26:323–9. 53. Saleh IM, Ruyter IE, Haapasalo MP, Orstavik D. Adhesion of endodontic sealers: scanning electron microscopy and energy dispersive spectroscopy. J Endod 2003;29:595–601.

JOE — Volume -, Number -, - 2015

Evaluation of Effects on the Adhesion of Various Root Canal Sealers after Er:YAG Laser and Irrigants Are Used on the Dentin Surface.

The aim of this study was to evaluate the bond strength of various root canal sealers after various irrigation solutions and Er:YAG laser irradiation ...
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