Original Article

Comparison of Sealing Ability of Bioceramic Sealer, AH Plus, and

GuttaFlow in Conservatively Prepared Curved Root Canals Obturated
with Single‑Cone Technique: An In vitro Study
Shalan Kaul1, Ajay Kumar2, Bhumika Kamal Badiyani3, Laxmi Sukhtankar4, M. Madhumitha5, Amit Kumar3
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1
Department of Pedodontics Background: Inadequate obturation techniques of the root canal system have been

Abstract
and Preventive Dentistry,
Indira Gandhi Government
found to be the most frequent reason of failure post root canal treatment. An ideal
Dental College and Hospital, endodontic sealer should fulfill all ideal requisites. The present study aimed to
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 05/30/2024

Jammu, India, 2Conservative compare apical sealing ability between bioceramic (BC) sealer, GuttaFlow, and AH
Dentistry and Endodontics, Plus. Methodology: One hundred and twenty‑five curved roots of maxillary and
Indira Gandhi Government mandibular third molar teeth with fully formed apex were collected for this study.
Dental College and Hospital, The root canals were cleaned and shaped using a standard single‑cone preparation
Jammu, Jammu and Kashmir,
India, 3Department of
to file at the established working length and divided into five groups of 25 each.
Public Health Dentistry, Dye leakage was carried out. Group A: with GP, using EndoSequence BC sealer
Clinical Practitioner, with conventional with 4% gutta‑percha (Brasseler USA, Savannah, Georgia,
Mumbai, Maharashtra, India, USA); Group B: with ceramic coated with 4% gutta‑percha (Brasseler USA,
4
Metropolitan Dental Center, Savannah, Georgia, USA); Group C: with GP, using AH Plus sealer (Dentsply,
Troy, MI, USA, 5Department De‑Trey Konstanz, Germany) with 4% gutta‑percha; Group D: with GuttaFlow
of Pedodontics and
Preventive Dentistry, RVS
bioseal (Roeko‑Coltène/Whaledent, Langenau, Germany) with 4% Gutta‑percha;
Dental College and Hospital, and Group E is a negative control group. Statistical analysis was done using
Coimbatore, the Statistical Package for the Social Sciences software and Student’s unpaired
Tamil Nadu, India t‑test. Results: The group AH Plus showed more leakage values than the
GuttaFlow group and of two groups of BC sealer and negative control. Student’s
unpaired t‑test disclosed no significant difference (P < 0.05) between the groups.
Conclusion: None of the sealers used in the study could completely seal the apical
Submitted: 03‑Feb‑2021
Revised: 10-Feb-2021 foramen to have a fluid‑tight seal.
Accepted: 15‑Feb‑2021
Published: 30‑Apr‑2021 Keywords: AH Plus, apical leakage, bioceramic sealer, GuttaFlow, sealer

Introduction requisites. The tight seal at the apex can be enhanced,

T he scientific and biological pillar of endodontics
is well rooted and highlights the dominant role
of microorganisms in the initiation, development,
and persistence of periapical disease and apical
periodontitis.[1‑5] Therefore, the main principle for
successful root canal treatment (RCT) is the prevention
of oral flora and toxins from entering through the
root canal system into the periapical tissues. This is
obtained by obturating the root canal system completely,
including the coronal and apical seal.[6‑8] Inadequate
obturation techniques of the root canal system have been
found to be the most frequent reason of failure post
RCT. An ideal endodontic sealer should fulfill all ideal
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DOI: 10.4103/jpbs.jpbs_52_21
sealer bonds chemically to the dentinal wall of root
canal, and mild expansion of the sealer improves its
adaptation to the canal walls. The three‑dimensional
obturation is the primary objective of root canal
therapy; the purpose of obturation, in turn, is to seal
all “portals of exit.”[9‑15] Obturation impedes any sort
Address for correspondence: Dr. Ajay Kumar,
Department of Conservative Dentistry and Endodontics,
Indira Gandhi Government Dental College and Hospital, Jammu,
Jammu and Kashmir, India.
E‑mail: drajaygupta123@gmail.com
This is an open access article distributed under the terms of the Creative Commons
Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to remix, tweak,
and build upon the work non‑commercially, as long as the author is credited and the new
creations are licensed under the identical terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
How to cite this article: Kaul S, Kumar A, Badiyani BK, Sukhtankar L,
Madhumitha M, Kumar A. Comparison of sealing ability of bioceramic
sealer, AH plus, and guttaflow in conservatively prepared curved root
canals obturated with single-cone technique: An In vitro study. J Pharm
Bioall Sci 2021;13:S857-60.

© 2021 Journal of Pharmacy and Bioallied Sciences | Published by Wolters Kluwer - Medknow S857
 Kaul, et al.: Comparison of sealing ability of bioceramic sealer, AH Plus, and GuttaFlow
of communication between periapex, periodontal space,
and root canal, thus entombing the microorganisms
and preventing reinfection by spread of microbial
toxins. Conventionally, sealers can be a cause of root
canal failure due to microleakage at sealer–dentin or
sealer–core material interface. Bonding of the sealer to
the root canal dentin wall and formation of a monoblock
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can eliminate this drawback. It should be antibacterial
and resistant to dissolution. The present study was
undertaken to compare and evaluate the apical sealing
ability of bioceramic (BC) sealer, AH Plus, and
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 05/30/2024
GuttaFlow in conservatively prepared narrow canals
obturated with single‑cone technique in an in vitro study.
Methodology
The study was conducted on 125 extracted human
curved roots of maxillary and mandibular third molar
teeth. Seventy‑five extracted human single‑rooted
permanent teeth with fully developed root apices,
straight roots, free of cracks, caries, resorptive defects,
and fractures were selected for the study. After removal
of the external debris, teeth were placed in 2.5% sodium
hypochlorite (NaOCl) solution for 2 h and stored in
normal saline. Teeth were decoronated 12 mm from
the apex; canals were accessed. Instrumentation was
done with 4% and up to 11 mm working length using
neo‑endo endodontic Ni‑Ti rotary files and keeping
Schilder’s technique in mind. Canals were irrigated with
10 mL of a freshly prepared solution of 5.25% NaOCl
and 17% ethylenediaminetetraacetic acid solution
alternatively between files, and the final irrigation was
done with normal saline. The canals were then dried with
sterile paper points. Single‑cone method of obturation
was performed with size 30 as the master cone.
Obturation of canals
The specimens were randomly divided into five groups
of 25 samples each.
1. Group A: With GP, using EndoSequence BC sealer
with conventional with 4% gutta‑percha (Brasseler
USA, Savannah, Georgia, USA)
2. Group B: With ceramic coated with 4%
gutta‑percha (Brasseler USA, Savannah, Georgia,
USA)
3. Group C: Using AH Plus sealer (Dentsply, De‑Trey
Konstanz, Germany) with 4% gutta‑percha
4. Group D: With GuttaFlow bioseal (Roeko‑Coltène/
Whaledent, Langenau, Germany) with 4%
gutta‑percha
5. Group E is a negative control group.
Following obturation of each group, gutta‑percha was
removed from the coronal 2 mm of the obturated root
canals with a warm instrument after the sealer had
S858 Journal of Pharmacy and Bioallied Sciences ¦ Volume 13 ¦ Supplement 1 ¦ June 2021
hardened and the coronal end of all canals was sealed
with glass‑ionomer cement. The teeth were stored in an
incubator in 100% humidity at 37°C for 48 h to ensure
the complete setting of the sealers. Root surfaces of all
the samples except negative control were coated with
two coats of nail varnish except apical 2 mm. Numerous
studies have evaluated the apical sealing ability of root
canal fillings using methods such as dye leakage,[8]
electrochemical techniques,[9,10] bacterial penetration
measurement,[11] radioisotope techniques,[12] and fluid
filtration[13] techniques. Although there are many studies
of the apical sealing abilities of different root obturation
techniques, studies that compare leakage evaluation
methods are less common and their results conflict with
each other. All the root surfaces of all the teeth were
thoroughly dried and coated with two coats of nail
varnish, except at the apical 2 mm of the root, with each
coat being allowed to dry before the subsequent one was
applied.
These samples were suspended in dye, i.e., 1%
methylene blue in a glass container for 72 h at 37°C
in the incubator. One percent methylene blue has been
shown to have a better result than other dyes used in
dentistry.[8] The samples were suspended in the dye in a
vertical direction with the help of a sticky wax so that
the dye can penetrate by capillary action. After removal
from the dye, the teeth were washed under running
tap water to remove excess dye and nail varnish was
removed using Bard‑Parker blade.
A demineralization and clearing process was carried out.
The teeth were demineralized by placing in 5% nitric
acid solution; the acid was changed daily for 5 days. The
teeth were dehydrated in 70%, 80%, 90%, and absolute
alcohol for 1 h in each concentration. By immersing the
teeth in methyl salicylate solution, clearing process was
completed.
The samples were then examined under
stereomicroscope (magnification: ×4–40) for the
evaluation of dye penetration. A single examiner
measured the extent of microleakage. The dye
penetration scores were recorded and tabulated, and
statistical analysis was carried out. The dye used has
multiple advantages such as dissolution during the
demineralization and clearing processes, and hence, the
teeth were demineralized and cleared.
Results
The efficacy was evaluated based on the dye penetration
test. This in vitro study was conducted to evaluate
the apical sealing ability between two types of BC
sealer, AH Plus, and GuttaFlow. The original values
of apical microleakage for all three sealers were
 Kaul, et al.: Comparison of sealing ability of bioceramic sealer, AH Plus, and GuttaFlow
recorded [Table 1]. The group AH Plus showed more
leakage values than the GuttaFlow group and two types
of BC sealer. The results showed that both the BC sealer
groups had had a mean leakage of 0.89 mm whereas
the GuttaFlow group had a mean leakage of 1.42 mm
whereas AH Plus had a mean of 1.73 mm. The standard
deviation of BC sealer, GuttaFlow, and AH Plus was
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0.3002, 0.2998, and 0.2721, respectively.
Statistical analysis was done using the Statistical Package
for the Social Sciences software, and Student’s unpaired
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t‑test disclosed no significant difference (P > 0.05)
between the groups [Table 2].
Discussion
The goal of root canal filling is always to prevent the
ingress of microorganisms and their by‑products along
the root canal. Among all the tested groups used in this
study, TotalFill BC sealer with BC gutta‑percha was
the best group which showed the least leakage. Better
performance of TotalFill BC can be explained on the
basis of its small particle size, hydrophilicity, and
low contact angle which enable the cement to spread
easily over the dentin walls of the root canal and get
inside and fill the lateral microcanals. BC root canal
sealers also exhibit chemical bonding to root canal
dentin walls as well as its corresponding BC particle
impregnated gutta‑percha. It also exhibits a significant
expansion of 0.20%. These features result in gap–
free chemical bond between the sealer and dentinal
walls, thus making it an effective sealer.[11‑13] A
silicone‑based sealer (GuttaFlow) has been introduced
as one of various root filling materials. GuttaFlow
is 2 in 1 cold, fluid obturation system that mixes
sealer and gutta‑percha together. It consists of a
polymer matrix, which is filled with very finely
ground gutta‑percha. Polydimethylsiloxane has been
utilized in the dental field for many years, especially
in prosthodontics, as an impression material with
only limited dimensional change in setting expansion.
The finely ground gutta‑percha powder and the
silicone‑based matrix are dispensed homogeneously
after mixing. Laboratory investigations indicate setting
expansion of 0.2% biocompatibility.[8,9,16‑20] GuttaFlow
contains nanosilver. Nanosilver is metallic silver that
is uniformly dispersed on the surface of the filling.
Table 1: Descriptive table of dye leakage
Summary Bioceramic (conventional with Bioceramic ceramic coated with
4% gutta‑percha)
Sample size 25
Mean (mm) 0.89
SD 0.3002
SD: Standard deviation
Journal of Pharmacy and Bioallied Sciences ¦ Volume 13 ¦ Supplement 1 ¦ June 2021
The corrosion or color changes in GuttaFlow are not
caused by the chemical type and concentration of the
nanosilver. There is adequate nanosilver in the material
to avert further spread of bacteria, and nanosilver
is highly biocompatible.[10] AH Plus (Dentsply
Maillefer, Ballaigues, Switzerland) is an epoxy‑based
endodontic sealer that is used with gutta‑percha. It
consists of a paste‑to‑paste system, supplied in two
tubes in a double‑barrel syringe. AH Plus contains
silicone oils along with other ingredients. AH Plus
has a film thickness of approximately 25 mm, which
is clearly below the value of <50 mm required by the
ISO standard for root canal sealing materials.[11] In
this dye leakage study, methylene blue dye was used
because it shows a high sensitivity and its particles are
of a similar dimension to microorganisms and their
metabolites.[12,13] In the present study, dye penetration
was observed in all specimens. Statistical analysis
revealed that the lowest dye penetration was in
Group 1 (BC sealer) followed by Group 2 (GuttaFlow)
followed by (in ascending order of dye penetration)
Group 3 (AH Plus). Leakage of AH Plus may be
rippled from inadequate bonding between the sealer
and the gutta‑percha point, allowing fluid to pass at
the interface. This possibility is in agreement with the
results of Bouillaguet S et al.[18] One in vitro study
compared the microleakage of three sealers, namely
EndoSequence BC sealer, AH Plus, and Epiphany,
suggesting that newly introduced BC and Epiphany
sealers sealed better compared to AH Plus sealer.[19]
In one comparative study of apical sealing ability of
a new resin‑based obturation system (Resilion) with
AH 26, it was found that there was no significant
difference between both the materials.[20]
Conclusion
Dye penetration was observed in all the specimens.
This shows that none of the sealers used in the study
could completely seal the apical foramen to have a
fluid‑tight seal. Although BC sealer, GuttaFlow, and
AH Plus showed no statistically significant difference in
microleakage, the better result was shown by BC sealer.
BC sealer seems to be a promising filling material
because of the good sealing ability, ease of handling,
and application of the material. The results of dye
GuttaFlow AH Plus Negative control
4% gutta‑percha
25 25 25 25
0.89 1.42 1.73 ‑
0.3002 0.2998 0.2721 ‑
S859
 Kaul, et al.: Comparison of sealing ability of bioceramic sealer, AH Plus, and GuttaFlow

in round‑shaped canals obturated with bioceramic cone and

Table 2: Comparison of all three groups with respect to
sealer using matched single cone technique. Restor Dent Endod
Student’s unpaired t‑test 2018;43:e30.
Type of sealer Mean (mm) SD P Significance 7. Petschelt A, Ebert J, Hickel R. The tightness of root fillings in
Bioceramic 0.89 0.3002 0.6621 Not significant smear‑free root canals. Dtsch Zahnarztl Z 1988;43:884‑6.
(conventional) 8. Cambruzzi JV, Marshall FJ, Pappin JB. Methylene blue dye: An
Bioceramic 0.89 0.3002 aid to endodontic surgery. J Endod 1985;11:311‑4.
(ceramic coated)
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9. Bouillaguet S, Wataha JC, Lockwood PE, Galgano C, Golay A,

GuttaFlow 1.42 0.2998 Krejci I. Cytotoxicity and sealing properties of four classes
AH Plus 1.73 0.2721 of endodontic sealers evaluated by succinic dehydrogenase
Negative control ‑ ‑ ‑ ‑ activity and confocal laser scanning microscopy. Eur J Oral Sci
SD: Standard deviation 2004;112:182‑7.
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 05/30/2024

penetration studies only indicate the comparative sealing
ability of root canal fillings in vitro, and they do not
indicate their ability to prevent the ingress of bacteria
into filled root canals in vivo. Further, in vivo studies
need to be done to correlate with the present study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Lee SH, Oh S, Al‑Ghamdi AS, Mandorah AO, Kum KY,
Chang SW. Sealing ability of AH Plus and GuttaFlow Bioseal.
Bioinorg Chem Appl 2020;2020:1-8.
2. Anantula K, Ganta AK. Evaluation and comparison of sealing
ability of three different obturation techniques ‑ Lateral
condensation, Obtura II, and GuttaFlow: An in vitro study.
J Conserv Dent 2011;14:57‑61.
3. Schilder H. Filling root canals in three dimensions. 1967.
J Endod 2006;32:281‑90.
4. Dem K, Wu Y, Kaminga AC, Dai Z, Cao X, Zhu B. The push
out bond strength of polydimethylsiloxane endodontic sealers to
dentin. BMC Oral Health 2019;19:181.
5. Patil P, Rathore VP, Hotkar C, Savgave SS, Raghavendra K,
Ingale P. A comparison of apical sealing ability between
GuttaFlow and AH plus: An in vitro study. J Int Soc Prev
Community Dent 2016;6:377‑82.
6. Yanpiset K, Banomyong D, Chotvorrarak K, Srisatjaluk RL.
Bacterial leakage and micro‑computed tomography evaluation
10. De‑Deus G, Brandão MC, Fidel RA, Fidel SR. The sealing
ability of GuttaFlow in oval‑shaped canals: An ex vivo study
using a polymicrobial leakage model. Int Endod J 2007;40:794‑9.
11. Tyagi S, Mishra P, Tyagi P. Evolution of root canal sealers: An
insight story. Eur J Gen Dent 2013;2:199‑218.
12. Matloff IR, Jensen JR, Singer L, Tabibi A. A comparison of
methods used in root canal sealability studies. Oral Surg Oral
Med Oral Pathol 1982;53:203‑8.
13. Kersten HW, Moorer WR. Particles and molecules in endodontic
leakage. Int Endod J 1989;22:118‑24.
14. Ørstavik D, Nordahl I, Tibballs JE. Dimensional change
following setting of root canal sealer materials. Dent Mater
2001;17:512‑9.
15. Elayouti A, Achleithner C, Löst C, Weiger R. Homogeneity
and adaptation of a new gutta‑percha paste to root canal walls.
J Endod 2005;31:687‑90.
16. Gernhardt CR, Krüger T, Bekes K, Schaller HG. Apical sealing
ability of 2 epoxy resin‑based sealers used with root canal
obturation techniques based on warm gutta‑percha compared to
cold lateral condensation. Quintessence Int 2007;38:229‑34.
17. Punia SK, Nadig P, Punia V. An in vitro assessment of apical
microleakage in root canals obturated with gutta‑flow, resilon,
thermafil and lateral condensation: A stereomicroscopic study.
J Conserv Dent 2011;14:173‑7.
18. Bouillaguet S, Shaw L, Barthelemy J, Krejci I, Wataha JC.
Long‑term sealing ability of Pulp Canal Sealer, AH‑Plus,
GuttaFlow and Epiphany. Int Endod J 2008;41:219‑26.
19. Pawar SS, Pujar MA, Makandar SD. Evaluation of the apical
sealing ability of bioceramic sealer, AH plus & epiphany: An
in vitro study. J Conserv Dent 2014;17:579‑82.
20. Kishan KV, Hegde V. Comparative analysis of sealing ability
of a new resin based obturation system using two different
techniques: An in vitro study. Indian J Dent Sci 2015;7:28‑30.

S860 Journal of Pharmacy and Bioallied Sciences ¦ Volume 13 ¦ Supplement 1 ¦ June 2021