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Objective: Reuse of endodontic files remains an open issue in clinical practice. This study was designed to evaluate the fracture strength of WaveOne Gold (Dentsply Maillefer, Ballaigues, Switzerland) and Reciproc Blue (VDW, Munich, Germany) files with successive reuse for root canal shaping in up to three molars. Material and Methods: Prospective clinical study carried out by five calibrated endodontists who treated 384 molars (1291 canals) with a curvature

Calcium silicate-based root canal sealers have been developed in powder/liquid or premixed ready-to-use forms. The evaluation of the physico-chemical properties of a prototype powder/liquid MTApex Sealer (Ultradent) in comparison to a ready-to-use material EndoSequence BC Sealer (Brasseler) was performed. The paste/paste epoxy resin-based AH Plus (Dentsply) served as control for comparisons. The sealers were evaluated (n = 6) regarding setting time (in dry and moist environments), flow and radiopacity, following the ISO-6876/2012 standard. Also, the pH was assessed. Material’s surface and chemical characterization was evaluated using scanning-electron-microscopy (SEM) and energy-dispersive-spectrometry (EDS). Mixed ANOVA, Shapiro-Wilk, Levene, and post-hoc analysis with Bonferroni correction were performed at a significance level of 5%. MTApex Sealer exhibited the highest flow and EndoSequence BC Sealer had a significantly longer setting time in dry compared to the moist environment; however, for MTApex Sealer and AH Plus no significant changes occurred when additional moisture was provided. All materials exceeded 7 mm Al of radiopacity and showed a decreasing alkalinity over the 21 day-analysis. SEM/EDS evaluation resulted in peaks of calcium, silicon, and the respective radiopacifier. The prototype powder/liquid MTApex Sealer had the highest flow and similar setting time in both dry and moist environments; opposingly, EndoSequence BC Sealer was crucially influenced by external moisture. This suggests that the powder/liquid materials’ setting seems to be more predictable.

Objective: Evaluate the cytotoxicity in human osteoblastic cells and antimicrobial activity in different root canal sealers in vitro. Methods: BioRoot RCS, TotalFill BC Sealer, and Bio-C Sealer were used in experimental groups, and AH Plus was used as a control. Human osteoblast-like cells and MTT quantitative colorimetric assay were used to evaluate cytotoxicity. Saos-2 cells were exposed to undiluted sealer extracts for 24 h. The supernatant was then collected and the formazan crystals resulting from MTT reduction were dissolved in pure dimethyl sulfoxide. Absorbance was measured in an automated spectrophotometer at a wavelength of 540 nm. Antimicrobial activity was analyzed by the direct contact test using a polymicrobial biofilm composed of Enterococcus faecalis, Candida albicans, and Streptococcus mutans. At 24, 48, and 72 h, colony-forming units were counted on agar plates. A nonparametric Kruskal-Wallis test was used for the statistical analysis. The level of significance was set at 5%. Results: AH Plus showed the lowest cytotoxicity after 24 h, with a significant difference in relation to BioRoot RCS and Bio-C Sealer (p ≤ 0.01). There was no significant difference in cytotoxicity between TotalFill BC Sealer and Bio-C Sealer (p > 0.05). At 24 h, TotalFill BC Sealer and AH Plus showed the least microbial growth compared to Bio-C Sealer (p 0.05). Conclusions: AH Plus had the lowest cytotoxicity. TotalFill BC Sealer and AH Plus yielded greater reductions in microbial counts in the first 24 h compared to Bio-C Sealer. Clinical Relevance: 2c. Objetivo: Evaluar in vitro la citotoxicidad en células osteoblásticas humanas y la actividad antimicrobiana de diferentes cementos obturadores de conductos radiculares. Materiales y métodos: BioRoot RCS, TotalFill BC Sealer y Bio-C Sealer se utilizaron como grupos experimentales y AH Plus se utilizó como control. Se usaron células similares a osteoblastos humanos y ensayo colorimétrico cuantitativo MTT para evaluar la citotoxicidad. Las células Saos-2 se expusieron a extractos de cementos sin diluir durante 24 h. A continuación, se recogió el sobrenadante y los cristales de formazán resultantes de la reducción de MTT se disolvieron en sulfóxido de dimetilo puro. La absorbancia se midió en un espectrofotómetro automático con una longitud de onda de 540 nm. La actividad antimicrobiana se analizó mediante la prueba de contacto directo, utilizando una biopelícula polimicrobiana compuesta por Enterococcus faecalis, Candida albicans y Streptococcus mutans. A las 24, 48 y 72 h, se contabilizaron las unidades formadoras de colonias en placas de agar. Para el análisis estadístico se utilizó la prueba no paramétrica de Kruskal-Wallis. El nivel de significación se fijó en el 5%. Resultados: AH Plus mostró la menor citotoxicidad después de 24 h, con una diferencia significativa en relación con BioRoot RCS y Bio-C Sealer (p ≤ 0.01). No hubo diferencias significativas en la citotoxicidad entre TotalFill BC Sealer y Bio-C Sealer (p > 0.05). A las 24 h, TotalFill BC Sealer y AH Plus mostraron el menor crecimiento microbiano en comparación con Bio-C Sealer (p 0.05). Conclusiones: AH Plus presentó la menor citotoxicidad. TotalFill BC Sealer y AH Plus produjeron mayores reducciones en los recuentos microbianos en las primeras 24 h en comparación con Bio-C Sealer. Relevancia Clínica: 2c. Objetivo: Avaliar a citotoxicidade em células osteoblásticas humanas e a atividade antimicrobiana em diferentes cimentos endodônticos in vitro. Métodos: BioRoot RCS, TotalFill BC Sealer e Bio-C Sealer foram usados nos grupos experimentais e o AH Plus foi usado como controle. Células semelhantes a osteoblastos humanos e ensaio colorimétrico quantitativo de MTT foram usados para avaliar a citotoxicidade. As células Saos-2 foram expostas a extratos de cimento não diluídos por 24 h. O sobrenadante foi então recolhido e os cristais de formazan resultantes da redução do MTT foram dissolvidos em dimetilsulfóxido puro. A absorbância foi medida em um espectrofotômetro automatizado em um comprimento de onda de 540 nm. A atividade antimicrobiana foi analisada pelo teste de contato direto utilizando um biofilme polimicrobiano composto por Enterococcus faecalis, Candida albicans e Streptococcus mutans. Em 24, 48 e 72 h, as unidades formadoras de colônias foram contadas em placas de ágar. O teste não paramétrico de Kruskal-Wallis foi utilizado para a análise estatística. O nível de significância foi estabelecido em 5%. Resultados: AH Plus apresentou a menor citotoxicidade após 24 h, com diferença significativa em relação ao BioRoot RCS e Bio-C Sealer (p ≤ 0,01). Não houve diferença significativa na citotoxicidade entre TotalFill BC Sealer e Bio-C Sealer (p > 0,05). Às 24 h, TotalFill BC Sealer e AH Plus apresentaram o menor crescimento microbiano em comparação com Bio-C Sealer (p 0,05). Conclusões: AH Plus apresentou a menor citotoxicidade. TotalFill BC Sealer e AH Plus produziram maiores reduções na contagem microbiana nas primeiras 24 h em comparação com o Bio-C Sealer. Relevância Clínica: 2c.

Endodontic biomaterials have significantly improved dental treatment techniques in several aspects now that they can be used for vital pulp treatments, as temporary intracanal medication, in definitive fillings, in apical surgeries, and for regenerative procedures. Calcium silicate-based cement is a class of dental material that is used in endodontics in direct contact with the dental structures, connective tissue, and bone. Because the material interacts with biological tissues and stimulates biomineralization processes, its properties are of major importance. The main challenge in endodontic treatments is the elimination of biofilms that are present in the root canal system anatomical complexities, as it remains even after chemical-mechanical preparation and disinfection procedures. Thus, an additional challenge for these biomaterials is to exert antimicrobial activity while maintaining their biological properties in parallel. This article reviews the literature for studies considering the antimicrobial properties of calcium silicate-based dental biomaterials used in endodontic practice. Considering the reviewed studies, it can be affirmed that the reduced antimicrobial effect exhibited by calcium silicate-based endodontic materials clearly emphasizes that all clinical procedures prior to their use must be carefully performed. Future studies for the evaluation of these materials, and especially newly proposed materials, under poly-microbial biofilms associated with endodontic diseases will be necessary.