Root Canal Filling Quality of a Premixed Calcium Silicate Endodontic Sealer Applied Using Gutta-percha Cone-mediated Ultrasonic Activation

Introduction The aim of this study was to investigate the filling quality of a recently developed premixed calcium silicate–based endodontic sealer (Endoseal MTA) with a single gutta-percha (GP) cone technique compared with a resin-based sealer (AH plus) with warm vertical compaction. We also explored the effect of GP cone-mediated ultrasonic activation on the filling quality of Endoseal MTA. Methods Thirty human single-rooted maxillary premolars with ribbon-shaped canals were prepared and assigned to 3 experimental groups according to filling method: EMS group was Endoseal MTA + single-cone; EMSU group was Endoseal MTA + single-cone with ultrasonic activation; and the APW group was AH plus + warm vertical compaction. Each tooth was scanned using micro–computed tomography (μ-CT), and the proportions of sections with void and the volume percentages of void were calculated. Then, the tooth was sectioned transversely, and the presence of void in the slices was scored under a stereomicroscope. The data were statistically analyzed using 1-way analysis of variance and Tukey tests to detect any significance (α = 0.05). Results In the μ-CT assessment, there was no significant difference among the groups regarding the proportion of sections with void and the void volume percentage (P >.05). However, in the stereomicroscopic evaluation, the EMS group showed a higher number of voids and a higher void score compared with the other groups (P <.05). Conclusion Endoseal MTA performs best when used with GP cone-mediated ultrasonic activation. Furthermore, stereomicroscopic observation of sections of the specimens should be performed when evaluating root canal filling quality.