Odontology

https://doi.org/10.1007/s10266-020-00535-7

ORIGINAL ARTICLE

Dislodgement resistance and adhesive pattern of different endodontic

sealers to dentine wall after artificial ageing: an in‑vitro study
Galvin Sim Siang Lin1 · Nik Rozainah Nik Abdul Ghani1   · Tahir Yusuf Noorani1 · Noor Huda Ismail2 ·
Noraida Mamat3

Received: 12 May 2020 / Accepted: 26 June 2020

© The Society of The Nippon Dental University 2020

Abstract
To compare the dislodgement resistance and the adhesive pattern of four different endodontic sealers to root dentine walls.
Ninety lower premolars were assigned to five groups (n = 18), Group 1: no sealer (control); Group 2: EndoRez (ERZ); Group
3: Sealapex (SPX); Group 4: EndoSeal MTA (ESA) and Group 5: BioRoot RCS (BRS). They were instrumented up to size
30 taper 0.06 and obturated using single cone technique with matched-taper gutta-percha cones and one of the mentioned
sealers. Six teeth from each group were then randomly subjected to 100, 1000 and 10,000 thermocycles, respectively. 1 mm
slice of mid root region, measuring 6 mm from the apical foramen was prepared and subjected to push-out test under a
Universal Testing Machine. Adhesive patterns of sealers were assessed using a stereomicroscope at 20 × magnification and
classified using a new system. Statistical analyses were performed using two-way ANOVA, complemented by Tukey HSD
and Chi-square tests. ESA and BRS showed significantly higher (p < 0.05) push-out bond strength, followed by SPX, ERZ
and lastly the control, but no significant difference was noted between ESA and BRS (p > 0.05) at 100, 1000 and 10,000
thermocycles, respectively. Both ESA and BRS exhibited a significant higher rate (p < 0.05) of Type 3 and Type 4 adhesive
patterns as the thermocycles increased. ESA and BRS demonstrated higher bond strength and better adhesive pattern to root
dentine wall than SPX and ERZ, especially after artificial ageing.

Keywords  Dislodgement resistance · EndoRez · Mineral trioxide aggregate · Sealapex · Tricalcium silicate

Introduction
Successful endodontic treatment includes adequate three-
dimensional sealing of the prepared root canal space to
prevent bacterial reinvasion through microleakage [1].
Gutta-percha is still one of the most used root canal fill-
ing materials in endodontic treatment. However, it does not
completely fill the root canal system without the use of an
* Nik Rozainah Nik Abdul Ghani
rozainah@usm.my
1
Conservative Dentistry Unit, School of Dental Sciences,
Universiti Sains Malaysia, Health campusKubang Kerian,
16150 Kota Bharu, Kelantan, Malaysia
2
Prosthodontics Unit, School of Dental Sciences,
Universiti Sains Malaysia, Health campusKubang Kerian,
16150 Kota Bharu, Kelantan, Malaysia
3
Paediatric Dentistry Unit, School of Dental Sciences,
Universiti Sains Malaysia, Health campusKubang Kerian,
16150 Kota Bharu, Kelantan, Malaysia
endodontic sealer due to the fact that gutta-percha itself does
not promote bonding to the dentine wall and eventually this
reduces its ability to form a complete seal in the root canal
system [2]. In this context, an endodontic sealer is used to
establish a fluid-tight seal at the dentin-sealer and gutta-per-
cha core-sealer interfaces [3]. Such adaptation is important
to enhance the bond strength of the materials and prevent
dislodgement under high occlusal loads [4].
Several types of endodontic sealer have been introduced
in the past few decades such as resin-based, calcium hydrox-
ide-based, glass ionomer cement-based, zinc oxide eugenol-
based, mineral trioxide aggregate (MTA)-based and pure
tricalcium silicate-based which is also known as bioceramic-
based sealer [5]. One of the biggest challenges among all
these sealers is their ability to bond to the dentine wall and
to maintain the integrity of the seal in the root canals [3, 4].
EndoRez (Ultradent Products, Inc., South Jordan, UT), a
second-generation methacrylate resin-based bondable sealer
was introduced to fill the canal using single cone technique
[6]. It is hydrophilic and exhibits excellent flowability which

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 Odontology
allows it to flow into accessory canals and dentinal tubules,
thus, promoting resin tag formation for better adhesion to
the root dentine wall [7]. Calcium hydroxide, a popular and
promising component of a root canal sealer is still widely
available in the market owing to its antibacterial properties.
Besides, calcium hydroxide-based sealers, such as Sealapex
(Kerr Corporation, Orange, California, USA), also have the
ability to stimulate the healing of periapical tissues [8].
Lately, endodontic sealers based on MTA were intro-
duced. It is a material derived from Portland cement and
was first introduced in the field of dentistry around 1993 [9].
MTA is also claimed to exhibit excellent physical, mechani-
cal, and biological properties [10]. Recently, EndoSeal MTA
(Maruchi, Gangwon-do, South Korea), a pozzolan-based
MTA sealer, has been commercialized and is available in
the form of a premixed and preloaded paste stored in an air-
tight syringe, which can be used in various clinical applica-
tions, including root canal obturation [4]. A previous study
also reported that such material demonstrated good sealing
ability in the root canal [11]. In 2016, a new pure tricalcium-
silicate-based endodontic sealer, BioRoot RCS (Septodont,
Saint-Maur-des-Fossés Cedex, France) was introduced into
the market. The powder consists of tricalcium silicate, cal-
cium phosphate, povidone, and zirconium dioxide, whereas
the liquid part consists of calcium chloride with polycar-
boxylate [3]. Unlike other MTA products, pure tricalcium
silicate materials consist of a lesser amount of heavy metals
such as lead, chromium, and arsenic [12]. This is of prime
importance in using biomaterials during endodontic treat-
ment to provide a highly predictable result.
Resistance to the dislodgement of endodontic sealers
to root dentine wall is usually evaluated by push-out bond
strength test [3, 4, 6]. It is a mechanical test that uses a
tensile load which is applied longitudinally to the long axis
of the root sample until the core material and sealer are
dislodged or pushed out. The push-out bond strength test
is reproducible and fracture occurs parallel to the dentine-
bonding interface which make it applicable to assess paral-
lel-sided samples even if the bond strength is minimal [13,
14]. Another advantage of push-out test is its ability to test
materials within the root canal and it does not require highly
sophisticated equipment, which allow push-out test to be
more favourable than other bond strength tests, such as shear
and tensile tests [15]. Several studies have been conducted to
determine the dislodgement resistance of various endodontic
sealers using push-out test, but, the published results vary
notably [3, 4, 16, 17]. Furthermore, information regarding
the use of thermocycling process to simulate the physiolog-
ical ageing of endodontic sealers especially for EndoSeal
MTA and BioRoot RCS is still sparse in the literature.
Therefore, the purpose of this in-vitro study was to deter-
mine the dislodgement resistance of different endodontic
sealers to dentine walls of endodontically treated teeth using
13
push-out test and to assess their adhesive pattern using a
new, simple and systematic classification after artificial age-
ing. Hence, the first null hypothesis was that there is no
significant difference among all four endodontic sealers in
terms of the push-out bond strength and adhesive pattern.
The second null hypothesis was that there is no significant
difference in terms of the push-out bond strength after 100,
1000, and 10,000 thermocycles, respectively.
Materials and methods
Sample size calculation
Bivariate normal distribution model and correlation
(G*Power 3.1.9 for Windows) was used to calculate the sam-
ple size and a minimum sample of 16 teeth for each group
was generated. Another 15% of the samples for each group
were added to account for possible drop-out. Thus, the final
sample size was 90 samples.
Preparation of the samples
This was an in-vitro experimental study involving recently
extracted lower premolars and ethical approval was obtained
from the Human Research Ethics Committee USM (Ref.
USM/JEPeM/18100482). Ninety mature human lower pre-
molars recently extracted due to orthodontic and periodontal
purposes with patients’ age ranging from 20 to 40 years old
were collected. All teeth were inspected to ensure that they
were free from any restoration, fracture, abrasion, resorption
defect, and root caries under a microscope (Leica Microsys-
tem Imaging Solutions, Cambridge, UK) at a 20 × magnifica-
tion by two blinded examiners. The teeth were then meas-
ured using a metal ruler (CLR6, Hu-Friedy Mfg. Co. Inc.,
Chicago, USA) to include teeth with total tooth length of
21 mm (± 1 mm) and root length of 12 mm (± 1 mm). The
tooth samples were also subjected to radiographic examina-
tion (Planmeca, Helsinki, Finland) to confirm the presence
of single canal, mature apical foramen, and root canal with
Vertucci’s Type 1 classification. All teeth were immersed
in 2.5% sodium hypochlorite (NaOCl) solution (Lenntech,
Delfgauw, Netherlands) for 24 h to remove remaining tis-
sue debris. Subsequently, access cavities were prepared
using a diamond Endo-Access bur, 21 mm, size 4 (Dentsply
Maillefer, Switzerland) and canal patency was checked using
size 10 K-file (FlexOFiles; Dentsply Maillefer, Switzerland).
The working length was established at the apical foramen.
The canals were instrumented with NiTi rotary files (S5 Sen-
doline, Tillverkarvägen 6, SE-187 66 TÄBY, Sweden) using
crown-down technique until size 30, taper 0.06. Copious
irrigation using 2.5% NaOCl solution was carried out during
instrumentation and 5 ml of 17% ethylenediaminetetraacetic
Odontology

acid (EDTA) solution (Promega Corporation, Wisconsin,
USA) was used to remove the smear layer. Next, 10 ml of
normal saline solution (RMBIO, Missoula, Montana) was
used as final irrigation to wash out remnants of EDTA in
the canals. Paper points size 30 (Dentsply, Maillefer, USA)
were used to dry the canals. The samples were then ran-
domly divided into five different groups with 18 samples
each. They were categorized as:
Group 1—gutta-percha (GP) only (control).
Group 2—GP + EndoRez (ERZ).
Group 3—GP + Sealapex (SPX).
Group 4—GP + EndoSeal MTA (ESA).
Group 5—GP + BioRoot RCS (BRS).
The master GP size 30 tapered 0.06 (Meta Dental Corp,
Glendale, New York, US) were checked in the canals to
ensure the presence of ‘tug-back’ before obturation and
the sealers were prepared according to the manufacturer’s
instructions. Obturation was then carried out using single-
cone technique. The sealer was coated around the canal walls
using matched-taper GP cone before placing the GP into the
respective canal. Following obturation, the access cavities
were acid etched with 37% phosphoric acid (Kerr Corpora-
tion, Orange, CA) for 15 s followed by washing, drying and
bonding agent (Kerr Corporation, Orange, CA) application.
Light curing was performed for 15 s and the cavities were
restored with microhybrid resin composite (Zmack Comp,
Zhermack, Italy) incrementally with each 2 mm increment
light-cured for 40 s. The final restorations were polished
with a composite polishing kit (PN 0310BB, Composite Pol-
ishing Kit CA, Shofu, CA, USA). All experimental proce-
dures were performed by a single expert operator to reduce
the internal bias of the study. The teeth were then placed in
an incubator (Memmert GmbH + Co. KG, Schwabach) at
37 °C, 100% humidity for 72 h to allow complete chemi-
cal setting of the sealers. Six teeth from each group were
randomly selected and subjected to 100, 1000, 10,000 ther-
mocycles, respectively. The samples were placed in a ther-
mocycling machine (TS Series Liquid, Weiss Technik, North
America) with water bath sequence of 5, 37 and 55 °C; dwell
time of 30 s and transfer time of 5 s.
diameter to prevent it from hitting the dentine walls caus-
ing an unreliable outcome. The speed was set at 1 mm/min,
and the push-out test was performed using a Universal Test-
ing Machine (Shimadzu, Japan) until the gutta-percha was
pushed out. The push-out force was applied from apical to
coronal direction due to the tapering shape of the root canals
which might affect the validity of the results if placed from
coronal to apical direction [18]. The maximum force needed
to cause dislodgement of the core materials was recorded in
Newton (N).
The push-out bond strength was calculated as follows:
Push-out strength (MPa) = Maximum loading force (N)/
surface area of dentine walls ­(mm2).
The surface area (­ mm2) was calculated using the conical
frustum surface area formula:
√
𝜋x r1 + r2 x (r1 − r2 )2 + h2
( )
whereby r1 is the radius at the coronal part, r2 is the radius
at the apical part and h is the thickness of the sample which
is 1 mm.
Adhesive pattern assessment
The remaining sealer adhering to the dentine walls was
examined and analyzed under a stereomicroscope (Wild
M3B; Leica; Heerbrugg, Switzerland) at 20 × magnification
as shown in Fig. 1. The adhesive patterns were recorded
using a new simple and systematic classification by two
blinded operators. The samples were divided into four

Dislodgment resistance assessment using push‑out

test

After thermal cyclic process, a 1 mm thick horizontal root

slice was cut from the mid-root region of each tooth, meas-
uring 6 mm from the apical foramen using a hard tissue
cutter (EXAKT 312, EXAKT Technologies, Inc., Oklahoma
City, USA). The specimens were microscopically examined
before push-out testing to confirm a circular canal shape and
ensure that the specimens were free from defects such as
Fig. 1  Representative image showing root section viewed under a
void and crack. Samples were then subjected to increasing stereomicroscope at 20 × magnification. (arrow) indicates the sealer
occlusal push-out force with spherical steel tip of 0.6 mm adhered to root dentine wall

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 Odontology

quadrants, if sealer was noted in one quadrant, it will be
classified as Type 1 adhesive pattern; two quadrants, Type 2
adhesive pattern; three quadrants, Type 3 adhesive pattern
and if sealer was noted all over the four quadrants, it will
be classified as Type 4 adhesive pattern, which is the most
favourable one. However, if there was no sealer noted on the
dentine wall, it will be classified as ‘non-adhesive’.
Statistical analysis
Data analysis were carried out using SPSS version 24.0 for
Windows (SPSS Inc., Chicago, IL, USA). Normality test for
data distribution was checked with Kolmogorov–Smirnov
test. Since data were normally distributed, the dislodgement
resistance was analyzed using two-way ANOVA comple-
mented by post hoc Tukey HSD test. Chi-square test was
used to analyze the differences in adhesive pattern among
all four endodontic sealers. Significance level was set at
p = 0.05.
Results
The results of push-out bond strength are tabulated in
Table 1 and illustrated in Fig. 2. A significant difference
in bond strength was observed (p < 0.05) with BRS dem-
onstrating the highest mean push-out bond strength fol-
lowed by ESA, SPX, ERZ, and lastly, the control group at
100 thermocycles and 1000 thermocycles, respectively.
However, at 10,000 thermocycles, ESA showed the high-
est mean value (p < 0.05) followed by BRS, SPX, ERZ
and lastly, the control. No significant difference (p > 0.05)

Table 1  Mean push-out bond Number of Type of sealer (SD) p value

strength ­(Nmm−2) of all thermocycles
endodontic sealers tested control ERZ SPX ESA BRS

100 0.648 (0.095) 1.192 (0.073) 1.401 (0.084) 1.846 (0.093)a 1.882 (0.102)a 0.001*
1000 0.568 (0.065)A 1.068 (0.043) 1.201 (0.055) 2.088 (0.069)b 2.123 (0.095)b 0.001*
10,000 0.564 0.912 0.990 2.372 2.338 0.001*
(0.054)A (0.057) (0.064) (0.104)c (0.078)c
*
 Significant at 0.05; SD indicates standard deviation
Same superscript lowercase letters within row indicate no statistical difference (p > 0.05); same superscript
capital letters within column indicate no statistical difference (p > 0.05)

Fig.2  Mean push-out bond strength ­(Nmm−2) of different endodontic sealers

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Odontology

was observed between ESA and BRS at 100, 1000 and
10,000 thermocycles, respectively. Furthermore, no signif-
icant difference (p > 0.05) was found in the control group
between 1000 and 10,000 thermocycles. As the number of
thermocycle increased, the bond strength of the ERZ and
SPX decreased significantly (p < 0.05), whereas a statisti-
cally significant (p < 0.05) increase in the bond strength of
ESA and BRS was noted as the thermocycles increased.
The adhesive pattern of each endodontic sealer is
demonstrated in Table 2. At 100 thermocycles, most of
the specimens fall in Type 1 adhesive pattern with only
one specimen in BRS showed Type 3 adhesive pattern
and no specimen demonstrated Type 4 adhesive pattern.
Chi-square test did not reveal any significant difference
between the groups at 100 thermocycles (p > 0.05). At
1000 thermocycles, the adhesive pattern of ERZ remained
static, whereas a slight improvement was found in SPX.
A significant difference (p < 0.05) was observed among
the groups in which most of the specimens fell in Type 1
and Type 2 adhesive patterns, whereas only one specimen
each in ESA and BRS, exhibited Type 4 adhesive pattern.
At 10,000 thermocycles, the adhesive pattern of ERZ and
SPX remained unchanged. Majority of the specimens dem-
onstrated Type 2 adhesive pattern, but most of the speci-
mens obturated with ESA and BRS exhibited Type 3 and
Type 4 adhesive patterns. Overall, these two sealers exhib-
ited significantly better adhesive property (p < 0.05) than
ERZ and SPX as the number of thermocycles increased.
Discussion
The present study evaluated and compared the dislodgement
resistance and the adhesive pattern of four different endo-
dontic sealers to root dentine walls after artificial ageing.
The first null hypothesis was partially rejected, because sig-
nificant differences in terms of the push-out bond strength
and adhesive pattern were noted. Although EndoRez can
form a monoblock system in the root canal and create long
resin tags that penetrate dentinal tubules to provide a close
adaptation to the dentine walls, low bond strength was still
reported in the present study which is in accordance with
the results found in the literature [16, 17]. The monoblock
concept aims at achieving a single homogenous unit in the
root canal system but such entrepreneurial concept has been
hampered by the lack of chemical bond between EndoRez
and gutta-percha [7]. Moreover, intrinsic volumetric shrink-
age and the conversion of carbon–carbon double bonds to
single bond are among the major problems whereby resin
materials will experience interfacial stress during polymeri-
zation that reduces their bond strength [19]. Also, C-factor is
extremely high in the root canal, which will cause debonding
of the material when subjected to huge polymerization stress
[20]. These could be the plausible reasons for inferior bond
strength of EndoRez in the present study.
Sealapex in the present study showed slightly higher bond
strength than resin sealer probably due to the interaction
between isobutyl salicylate which is found in the material
itself and also calcium in the tooth that formed a chemical

Table 2  Adhesive pattern of all Type of sealer Type of adhesive pattern, η p value

endodontic sealers tested
non-adhesive Adhesive
1 2 3 4

100 Thermocycles
 ERZ 3 3 0.131
 SPX 3 2 1
 ESA 3 3
 BRS 2 3 1
1000 Thermocycles
 ERZ 3 3 0.049*
 SPX 2 2 2
 ESA 2 2 1 1
 BRS 3 2 1
10,000 Thermocycles
 ERZ 3 3 0.028*
 SPX 2 2 2
 ESA 2 3 1
 BRS 2 2 2
*
 Significant at 0.05

13
 Odontology
barrier [21]. Despite this, calcium hydroxide sealer will
degrade and dissolve over time [22]. This elucidates the
decreased bond strength of Sealapex as the thermocycles
increased. Bioceramic sealers, (EndoSeal MTA and BioRoot
RCS) on the other hand, showed higher bond strength than
other sealers due to the formation of apatite layer, intrafi-
brillar apatite deposition and also tag-like structures that
form mineral plugs along with the dentine bonding interface,
known as the mineral infiltration zone [4, 12, 23]. Addi-
tionally, bioceramic sealers undergo bioactivity process that
results in apatite nucleation, which prevents dislodgement
of the gutta-percha from the canal and provides a tight seal
in the root canal system [24]. Howbeit, a direct comparison
with other push-out bond strength studies is not pertinent as
the compared materials are greatly different and huge design
variability occurred in the methodology among studies.
It has been claimed that push-out bond strength test is not
advisable for gutta-percha as it will undergo plastic deforma-
tion during testing [15]. Suggested solutions to this problem
included the filling of canals entirely with sealer without any
core material [6]. However, the interest of simulating clinical
conditions in a natural root canal is lost. Since the present
study aimed to compare the dislodgement resistance of vari-
ous endodontic sealers in a clinically orientated setup, thus,
the sealers were used with gutta-percha cone that is recom-
mended by the manufacturer. Notwithstanding, the push-out
test is still a significant tool to rank the bonding ability of
different endodontic sealers and the rankings are reported to
be similar when comparing canals filled with gutta-percha
with those filled with sealer alone [6]. Other variables such
as the punch diameter, root canal preparation, obturation
technique, specimen thickness and specimen orientation
should be addressed systematically to avoid internal bias
[15]. In the present study, the punch diameter used was set
at 0.6 mm which is within the acceptable range as a punch
diameter between 70 and 90% of the canal diameter will not
cause significant effect on the results [15]. Besides, a taper
of 0.06 was used in the present study, because such taper will
create an angulation of only 3.5° to allow very small effect
on the frictional resistance during the push-out test [15]. In
addition, single cone technique was used as lateral conden-
sation and warm vertical techniques were found to cause a
negative impact on the push-out force [3]. Thus, these test-
ing protocols should be performed appropriately to provide
better standardization of the push-out test.
The current study highlights the importance of adhesive
properties of endodontic sealers to improve the bonding abil-
ity, and to maintain the integrity of the seal in the root canal
in both static and dynamic states [14]. Previous studies clas-
sified the failure mode of endodontic sealers into adhesive,
cohesive or combination of both adhesive and cohesive pat-
terns, but none of them could correlate these failure modes
with the bond strength of various endodontic sealers [3, 4, 6,
13
14]. Moreover, it is also challenging to assess the cohesive-
ness of an endodontic sealer in push-out test as the loading
jig-covered part of the sealer in which internal validity is
questionable. Currently, very limited studies focus on the
adhesive pattern of these sealers to dentine walls. A new sys-
tematic classification is introduced in this study to identify
the type of adhesive pattern of sealer to root canal dentinal
wall, which provides a more applicable and simple method
to assess the adhesiveness of the materials. To the best of
our knowledge, there is yet no standardization in assessing
the adhesive pattern of endodontic sealers, because no con-
sensus on evaluation parameters has been reached among
researchers. It is important to emphasize that the adhesive
property of sealers is somewhat correlated to the bond
strength which is shown in the results of the present study.
Thermocycling process has been introduced as one of
the most widely used and valid in-vitro tests to simulate and
accelerate the physiological ageing of material in a clinical
setting [25]. The thermal test will stress the bond between
the materials and the dentinal walls which will further impair
the bond strength of the materials itself [26]. However, the
use of thermocycling for endodontic sealers remains con-
troversial, as several authors questioned the use of thermal
test on materials in the root canals. Studies have shown that
cement material will be affected by thermal changes due
to difference in coefficient of thermal expansion, and lead
to a decrease in bond strength causing microleakage and
bonding failure [27, 28]. Even though the root is embedded
in the bone, but due to the thermophysical properties of a
tooth [29], the temperature experienced by the crown will be
transferred to the root as well [30]. This provides concrete
evidence that thermal test is a reliable method to simulate
ageing of root canal materials.
The second null hypothesis was partially rejected since
all sealers demonstrated significant changes as the thermo-
cycles increased except for the control group. EndoRez and
Sealapex showed decreased bond strength with increased
thermocycles, but EndoSeal MTA and BioRoot RCS showed
a contrasting result which is inconsistent with a previous
study [28]. From a clinical standpoint, the biomineraliza-
tion process of bioceramic sealers enhances the dislodge-
ment resistance to root dentine walls by forming a colloi-
dal calcium silicate hydrate gel that will harden and create
a micromechanical interaction by tag-like structures over
time [3, 12]. Therefore, one may hypothesize that the bond
strength of bioceramic sealers will not deteriorate even after
being subjected to a series of thermocycling processes due
to the continuous hardening and improved adhesion from the
hydration reaction which make them difficult to dislodge.
Such observation also corroborates another clinical finding,
that the retreatment of bioceramic sealing material is more
difficult and requires more time to be removed since the
sealer remnants adhered strongly to the root dentine walls
Odontology
even after a period of 2 weeks [31]. Nonetheless, the expla-
nation for the improved bond strength of bioceramic sealers
after artificial ageing merely based on their setting reaction
alone is questionable as the exact mechanism for bonding
of such sealers to dentine wall is still unclear. Hence, more
in-vitro studies evaluating the bond strength of bioceramic
sealers after artificial ageing are warranted to determine its
clinical significance. Furthermore, the differences in dwell
time and the number of cycles could also possibly affect the
dislodgement resistance of endodontic sealers. In the present
study, 10,000 cycles were used which corresponds to one
service year of physiological ageing of a material in clinical
condition. This theory was first proposed in 1999 [32], and
has been supported by other researchers [25, 33]. Taking all
these into consideration, the samples were subjected to dif-
ferent thermocycling regimes in the present study to provide
a more valid and accurate representation of the effects of
ageing on the tested materials.
Since there was no stimulated periodontal ligament in this
study, therefore, the results may not be fully appropriate to
be extrapolated to a clinical setting. However, this laboratory
experimental study does provide reliable and reproducible
results which can be used to compare new endodontic seal-
ers and establish international standards for further testing.
Besides, the adhesive strength of the root canal sealer to
dentine walls is only one of the ideal qualities of endodontic
sealer. Thus, further investigation of other properties of root
canal sealers is needed to give a more valid result.
Conclusion
Within the limitations of this study, Bioceramic sealers (Bio-
Root RCS and EndoSeal MTA) demonstrated higher bond
strength and excellent adhesive pattern especially after age-
ing as compared to resin (EndoRez) and calcium hydroxide-
based sealers (Sealapex). A new classification introduced in
this study to identify the type of adhesive pattern of sealer
to dentine wall provides an applicable and simple method to
assess their adhesiveness.
Acknowledgements  The authors received financial support from
Universiti Sains Malaysia under the short-term grant scheme 304/
PPSG/6315195 and 304/PPSG/6316456. The authors thank Mr Mohd
Yusof Soon Abdullah for helping in thermal cycle procedures and Miss
Ng Wen Yun for assistance in photo-taking during the project. Further-
more, we acknowledge the management of Hospital Universiti Sains
Malaysia (USM), Kubang Kerian, Kelantan, during the process of con-
ducting this research and Septodont for providing the BioRoot RCS.
Compliance with ethical standards  73. https​://doi.org/10.1016/j.joen.2012.12.032.
Conflict of interest  The authors declare no conflict of interest in this
study.
References
1. Donnermeyer D, Vahdat-Pajouh N, Schafer E, Dammaschke T.
Influence of the final irrigation solution on the push-out bond
strength of calcium silicate-based, epoxy resin-based and silicone-
based endodontic sealers. Odontology. 2019;107(2):231–6. https​
://doi.org/10.1007/s1026​6-018-0392-z.
2. Raina R, Loushine RJ, Weller RN, Tay FR, Pashley DH. Evalu-
ation of the quality of the apical seal in Resilon/Epiphany and
Gutta-Percha/AH Plus-filled root canals by using a fluid filtration
approach. J Endod. 2007;33(8):944–7. https​://doi.org/10.1016/j.
joen.2007.05.003.
3. Donnermeyer D, Dornseifer P, Schafer E, Dammaschke T. The
push-out bond strength of calcium silicate-based endodontic seal-
ers. Head Face Med. 2018;14(1):13. https:​ //doi.org/10.1186/s1300​
5-018-0170-8.
4. Silva EJ, Carvalho NK, Prado MC, Zanon M, Senna PM, Souza
EM, et al. Push-out bond strength of injectable pozzolan-based
root canal sealer. J Endod. 2016;42(11):1656–9. https​://doi.
org/10.1016/j.joen.2016.08.009.
5. Tomson RM, Polycarpou N, Tomson PL. Contemporary obtura-
tion of the root canal system. Br Dent J. 2014;216(6):315–22.
https​://doi.org/10.1038/sj.bdj.2014.205.
6. Jainaen A, Palamara JE, Messer HH. Push-out bond strengths
of the dentine-sealer interface with and without a main cone.
Int Endod J. 2007;40(11):882–90. https ​ : //doi.org/10.111
1/j.1365-2591.2007.01308​.x.
7. Kim YK, Grandini S, Ames JM, Gu LS, Kim SK, Pashley DH,
et  al. Critical review on methacrylate resin-based root canal
sealers. J Endod. 2010;36(3):383–99. https​://doi.org/10.1016/j.
joen.2009.10.023.
8. Mohammadi Z, Karim Soltani M, Shalavi S, Yazdizadeh M, Jafar-
zadeh M. Calcium hydroxide-based root canal sealers: an updated
literature review. Compend Contin Educ Dent. 2014;35(5):334–9
(quiz 40).
9. Lee SJ, Monsef M, Torabinejad M. Sealing ability of a min-
eral trioxide aggregate for repair of lateral root perforations.
J Endod. 1993;19(11):541–4. https​://doi.org/10.1016/S0099​
-2399(06)81282​-3.
10. Ha WN, Nicholson T, Kahler B, Walsh LJ. Mineral trioxide aggre-
gate-a review of properties and testing methodologies. Materials
(Basel). 2017. https​://doi.org/10.3390/ma101​11261​.
11. Lin GSS, Ghani NRNA, Noorani TY. Apical sealing ability of dif-
ferent endodontic sealers using glucose penetration test: a stand-
ardized methodological approach. Cumhuriyet Dent J. 2020. https​
://doi.org/10.7126/cumud​j.70410​7.
12. Al-Haddad A, Che Ab Aziz ZA. Bioceramic-based root canal
sealers: a review. Int J Biomater. 2016;2016:9753210. https​://doi.
org/10.1155/2016/97532​10.
13. Goracci C, Tavares AU, Fabianelli A, Monticelli F, Raffaelli O,
Cardoso PC, 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(4):353–61. https​
://doi.org/10.1111/j.1600-0722.2004.00146​.x.
14. Ungor M, Onay EO, Orucoglu H. Push-out bond strengths: the
Epiphany-Resilon endodontic obturation system compared with
different pairings of Epiphany, Resilon, AH Plus and gutta-
percha. Int Endod J. 2006;39(8):643–7. https​://doi.org/10.111
1/j.1365-2591.2006.01132​.x.
15. Pane ES, Palamara JE, Messer HH. Critical evaluation of the push-
out test for root canal filling materials. J Endod. 2013;39(5):669–
16. Patil SA, Dodwad PK, Patil AA. An in vitro comparison of bond
strengths of Gutta-percha/AH Plus, Resilon/Epiphany self-etch
and EndoREZ obturation system to intraradicular dentin using a
13
 Odontology
push-out test design. J Conserv Dent. 2013;16(3):238–42. https​
://doi.org/10.4103/0972-0707.11132​3.
17. Fisher MA, Berzins DW, Bahcall JK. An in vitro comparison of
bond strength of various obturation materials to root canal dentin
using a push-out test design. J Endod. 2007;33(7):856–8. https​://
doi.org/10.1016/j.joen.2007.02.011.
18. Nagas E, Cehreli ZC, Durmaz V, Vallittu PK, Lassila LV. Regional
push-out bond strength and coronal microleakage of Resilon after
different light-curing methods. J Endod. 2007;33(12):1464–8.
https​://doi.org/10.1016/j.joen.2007.07.028.
19. Carvalho RM, Pereira JC, Yoshiyama M, Pashley DH. A review
of polymerization contraction: the influence of stress development
versus stress relief. Oper Dent. 1996;21(1):17–24.
20. Tay FR, Loushine RJ, Lambrechts P, Weller RN, Pashley DH.
Geometric factors affecting dentin bonding in root canals: a theo-
retical modeling approach. J Endod. 2005;31(8):584–9.
21. Caicedo R, Alongi DJ, Sarkar NK. Treatment-dependent calcium
diffusion from two sealers through radicular dentine. Gen Dent.
2006;54(3):178–81.
22. Ersahan S, Aydin C. Solubility and apical sealing characteristics
of a new calcium silicate-based root canal sealer in comparison
to calcium hydroxide-, methacrylate resin- and epoxy resin-based
sealers. Acta Odontol Scand. 2013;71(3–4):857–62. https​://doi.
org/10.3109/00016​357.2012.73441​0.
23. Tay FR, Pashley DH, Rueggeberg FA, Loushine RJ, Weller
RN. Calcium phosphate phase transformation produced by the
interaction of the portland cement component of white mineral
trioxide aggregate with a phosphate-containing fluid. J Endod.
2007;33(11):1347–51. https:​ //doi.org/10.1016/j.joen.2007.07.008.
24. Reyes-Carmona JF, Felippe MS, Felippe WT. The biomineraliza-
tion ability of mineral trioxide aggregate and portland cement on
dentin enhances the push-out strength. J Endod. 2010;36(2):286–
91. https​://doi.org/10.1016/j.joen.2009.10.009.
25. Amaral FL, Colucci V, Palma-Dibb RG, Corona SA. Assessment of
in vitro methods used to promote adhesive interface degradation:
13
a critical review. J Esthet Restor Dent. 2007;19(6):340–54. https​
://doi.org/10.1111/j.1708-8240.2007.00134​.x.
26. Korkmaz Y, Gurgan S, Firat E, Nathanson D. Effect of adhesives
and thermocycling on the shear bond strength of a nano-composite
to coronal and root dentin. Oper Dent. 2010;35(5):522–9. https​://
doi.org/10.2341/09-185-L.
27. Luthy H, Loeffel O, Hammerle CH. Effect of thermocycling
on bond strength of luting cements to zirconia ceramic. Dent
Mater. 2006;22(2):195–200. https​: //doi.org/10.1016/j.denta​
l.2005.04.016.
28. Saghiri MA, Asatourian A, Garcia-Godoy F, Gutmann JL,
Sheibani N. The impact of thermocycling process on the dis-
lodgement force of different endodontic cements. Biomed Res
Int. 2013;2013:317185. https​://doi.org/10.1155/2013/31718​5.
29. Brown WS, Dewey WA, Jacobs HR. Thermal properties of teeth. J
Dent Res. 1970;49(4):752–5. https:​ //doi.org/10.1177/002203​ 4570​
04900​40701​.
30. Lancaster P, Brettle D, Carmichael F, Clerehugh V. In-vitro ther-
mal maps to characterize human dental enamel and dentin. Front
Physiol. 2017;8:461. https​://doi.org/10.3389/fphys​.2017.00461​.
31. Hess D, Solomon E, Spears R, He J. Retreatability of a bioceramic
root canal sealing material. J Endod. 2011;37(11):1547–9. https​
://doi.org/10.1016/j.joen.2011.08.016.
32. Gale MS, Darvell BW. Thermal cycling procedures for laboratory
testing of dental restorations. J Dent. 1999;27(2):89–99.
33. Xie C, Han Y, Zhao XY, Wang ZY, He HM. Microtensile bond
strength of one- and two-step self-etching adhesives on sclerotic
dentin: the effects of thermocycling. Oper Dent. 2010;35(5):547–
55. https​://doi.org/10.2341/10-025-L.
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