Retreatability of root canals obturated using a bioceramic sealer and gutta percha



micro-organisms, obturation


The use of bioceramic sealers may, on occasion, complicate endodontic retreatment. This is due to their hard setting nature as well as adherence to root dentine which makes them more challenging to dislodge from root canals. The aim of this in vitro study was to determine the retreatability of root canals sealed with a bioceramic calcium silicate-based sealer cement. Materials and Methods 120 permanent human single rooted teeth were selected for the study. After working length and apical patency determination, the teeth were prepared using iRace™ Ni-Ti rotary files. Teeth were divided into four groups (n=30) and obturated as follows: • Group 1: TotalFill BC™ points and TotalFill BC™ sealer with the master GP at WL using basic hydraulic technique • Group 2: TotalFill BC™ points and TotalFill BC™ sealer with the master GP 3mm short of WL using basic hydraulic technique • Group 3: GP and AH Plus™ with the master GP at WL using lateral condensation technique • Group 4: GP and AH Plus™ with the master GP 3mm short of WL using lateral condensation technique• D-Race™ retreatment files and Endosolv™ was used to remove obturation material. The Kruskal-Wallis H test, pairwise and comparison between groups showed that the type of sealer cement and the working length influenced both the retreatability of the canal and retreatment time. The differences were statistically significant (p < 0.005) at a 95% CI. Fully extended GP will guarantee a passage for retreatment instruments to the apical area of the canal. The sealer and GP application technique during obturation should allow for full extension of the GP within the canal. Improper use of bioceramic sealers diminishes the chances of successful retreatment


Download data is not yet available.


Metrics Loading ...


Torabinejad M & White SN. Evaluation of Endodontic Outcomes. In: Principles and Practice of endodontics. 5th ed. St. Louis, Missouri: Elsevier Saunders, 2015: 397-411.

Tabassum S, Khan FR. Failure of endodontic treatment: The usual suspects. Eur J Dent. 2016; 10(1):144-147

Trope M, Bunes A, Debelian G. Root filling materials and techniques: bioceramics a new hope? Endod Topics. 2015; 32(1):86-96.

Flores DS, Rached‐Júnior FJ, Versiani MA, Guedes DF, Sousa‐Neto MD, Pécora JD. Evaluation of physicochemical properties of four root canal sealers. Int Endod J. 2011; 44(2):126-35.

Debelian G, Trope M. The use of premixed bioceramic materials in endodontics. G Ital Endod. 2016; 30(2):70-80.

Mickel AK, Wright ER. Growth inhibition of Streptococcus anginosus (milleri) by three calcium hydroxide sealers and one zinc oxide-eugenol sealer. J. Endod. 1999; 25(1):34-7.

Zmener O, Spielberg C, Lamberghini F, Rucci M. Sealing properties of a new epoxy resin‐based root‐canal sealer. Int Endod J. 1997; 30(5):332-4.

Jitaru S, Hodisan I, Timis L, Lucian A, Bud M. The use of bioceramics in endodontics-literature review. Clujul

Med. 2016; 89(4):470-473

Duarte MA, Marciano MA, Vivan RR, Tanomaru Filho M, Tanomaru JM, Camilleri J. Tricalcium silicate-based

cements: properties and modifications. Braz Oral Res. 2018; 32(1):111-118

Colombo M, Poggio C, Dagna A, Meravini MV, Riva P, Trovati F, Pietrocola G. Biological and physico-chemical

properties of new root canal sealers. J Clin Exp Dent. 2018; 10(2):120-126

FKG Dentaire, B.U. Premixed Bioceramic Endodontic Materials 2013

Al-Haddad A, Che Ab Aziz ZA. Bioceramic-based root canal sealers: a review. Int. J. Biomater. 2016.

Zhou HM, Du TF, Shen Y, Wang ZJ, Zheng YF, Haapasalo M. In vitro cytotoxicity of calcium silicate–containing endodontic sealers. J. Endod. 2015; 41(1):56-61.

AlAnezi AZ, Jiang J, Safavi KE, Spangberg LS, Zhu Q. Cytotoxicity evaluation of endosequence root repair

material. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 109(3):122-125.

Ma J, Shen Y, Stojicic S, Haapasalo M. Biocompatibility of two novel root repair materials. J. Endod. 2011;


Ciasca M, Aminoshariae A, Jin G, Montagnese T, Mickel A. A comparison of the cytotoxicity and proinflammatory cytokine production of EndoSequence root repair material and ProRoot mineral trioxide aggregate in human osteoblast cell culture using reverse-transcriptase polymerase chain reaction. J. Endod. 2012; 38(4):486-489.

Chen I, Karabucak B, Wang C, Wang HG, Koyama E, Kohli MR, Nah HD, Kim S. Healing after root-end

microsurgery by using mineral trioxide aggregate and a new calcium silicate–based bioceramic material as rootend filling materials in dogs. J. Endod. 2015; 41(3):389-99.

Lovato KF, Sedgley CM. Antibacterial activity of endosequence root repair material and proroot MTA

against clinical isolates of Enterococcus faecalis. J. Endod. 2011; 37(11):1542-1546.

Zhang H, Shen Y, Ruse ND, Haapasalo M. Antibacterial activity of endodontic sealers by modified direct

contact test against Enterococcus faecalis. J. Endod. 2009; 35(7):1051-1055.

Wang Z, Shen Y, Haapasalo M. Dentin extends the antibacterial effect of endodontic sealers against

Enterococcus faecalis biofilms. J. Endod. 2014; 40(4):505-508.

Zhou HM, Shen Y, Zheng W, Li LI, Zheng YF, Haapasalo M. Physical properties of 5 root canal sealers. J. Endod. 2013; 39(10):1281-1286.

Zoufan K, Jiang J, Komabayashi T, Wang YH, Safavi KE, Zhu Q. Cytotoxicity evaluation of Gutta flow and

endo sequence BC sealers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112(5):657-661.

Charland T, Hartwell GR, Hirschberg C, Patel R. An evaluation of setting time of mineral trioxide aggregate

and EndoSequence root repair material in the presence of human blood and minimal essential media. J. Endod.

; 39(8):1071-2.

Gandolfi MG, Siboni F, Prati C. Properties of a novel polysiloxane-guttapercha calcium silicate-bioglasscontaining root canal sealer. Dent Mater. 2016; 32(5): 113-126

Candeiro, G.T.D.M., Correia, F.C., Duarte, M.A.H., Ribeiro-Siqueira, D.C. & Gavin, G. (2012) Evaluation of radiopacity, pH, release of calcium ions, and flow of a bioceramic root canal sealer. J. Endod. 2012; 38(6):842–845.

Nagas E, Uyanik MO, Eymirli A, Cehreli ZC, Vallittu PK, Lassila LV, Durmaz V. Dentin moisture conditions affect

the adhesion of root canal sealers. J. Endod. 2012; 38(2):240-4.

Shokouhinejad N, Gorjestani H, Nasseh AA, Hoseini A, Mohammadi M, Shamshiri AR. Push‐out bond strength of gutta‐percha with a new bioceramic sealer in the presence or absence of smear layer. Aust. Dent.

J. 2013; 39(3):102-6.

Madhuri GV, Varri S, Bolla N, Mandava P, Akkala LS, Shaik J. Comparison of bond strength of different endodontic sealers to root dentin: An in vitro pushout test. Journal of conservative dentistry: J. Conserv. Dent. 2016; 19(5):461-464

Ghabraei S, Bolhari B, Yaghoobnejad F, Meraji N. Effect of intra-canal calcium hydroxide remnants on the push-out bond strength of two endodontic sealers. Iran Endod J. 2017; 12(2):168.

Wang Z. Bioceramic materials in endodontics. Endod Topics. 2015; 32(1):3-30.

Ioannidis K, Mistakidis I, Beltes P, Karagiannis V. Spectrophotometric analysis of crown discoloration

induced by MTA-and ZnOE-based sealers. J. Appl. Oral Sci. 2013; 21(2):138-144.

Virdee SS, Thomas MB. A practitioner's guide to gutta-percha removal during endodontic retreatment. Br. Dent. J. 2017; 222(4):251-257.

Ng YL, Mann V, Rahbaran S, Lewsey J, Gulabivala K. Outcome of primary root canal treatment: systematic

review of the literature–part 1. Effects of study characteristics on probability of success. Int Endod J.

; 40(12):921-939.

Só MV, Saran C, Magro ML, Vier-Pelisser FV, Munhoz M. Efficacy of ProTaper retreatment system in root

canals filled with gutta-percha and two endodontic sealers. J. Endod. 2008; 34(10):1223-1225.


Alves FR, Marceliano-Alves MF, Sousa JC, Silveira SB, Provenzano JC, Siqueira Jr JF. Removal of root canal fillings in curved canals using either reciprocating single-or rotary multi-instrument systems and a supplementary step with the XP-Endo Finisher. J. Endod. 2016; 42(7):1114-1119.

Silva EJ, Belladonna FG, Zuolo AS, Rodrigues E, Ehrhardt IC, Souza EM, De-Deus G. Effectiveness of XP-endo Finisher and XP-endo Finisher R in removing root filling remnants: a micro-CT study. Int Endod J. 2018; 51(1):86-91.

Versiani MA, Carvalho KK, Mazzi-Chaves JF, SousaNeto MD. Micro–computed tomographic evaluation

of the shaping ability of XP-endo Shaper, iRaCe, and EdgeFile systems in long oval-shaped canals. J.

Endod. 2018; 44(3):489-495.

Torabinejad M., Ashraf F. & Walton R. Endodontics: Principles and Practice. Elsevier Health Sciences. 5th ed. St. Louis, Missouri: Elsevier Health Sciences, 2014:7,49

Hess D, Solomon E, Spears R, He J. Retreatability of a bioceramic root canal sealing material. J. Endod. 2011;


Agrafioti A, Koursoumis AD, Kontakiotis EG. Reestablishing apical patency after obturation with Guttapercha and two novel calcium silicate-based sealers. Eur J Dent. 2015; 9(4):457-461

Obeid MF, Nagy MM. Retreatability of different endodontic sealers using chemical solvents. Tanta Dent J. 2015; 12(4):286-291.

Oltra E, Cox TC, LaCourse MR, Johnson JD, Paranjpe A. Retreatability of two endodontic sealers, EndoSequence BC Sealer and AH Plus: a microcomputed tomographic comparison. Restor Dent Endo.d 2017; 42(1):19-26.

Bhagavaldas MC, Diwan A, Kusumvalli S, Pasha S, Devale M, Chava DC. Efficacy of two rotary retreatment

systems in removing Gutta-percha and sealer during endodontic retreatment with or without solvent: A

comparative in vitro study. J. Conserv. Dent. 2017; 20(1):12.

Hülsmann M, Stotz S. Efficacy, cleaning ability and safety of different devices for gutta-percha removal in

root canal retreatment. Int Endod J. 1997; 30(4):227-33.

Ersev H, Yılmaz B, Dinçol ME, Da-laro-lu R. The efficacy of ProTaper Universal rotary retreatment

instrumentation to remove single gutta-percha cones cemented with several endodontic sealers. Int Endod

J. 2012; 45(8):756-762.

Chutich MJ, Kaminski EJ, Miller DA, Lautenschlager EP. Risk assessment of the toxicity of solvents of guttapercha used in endodontic retreatment. J. Endod. 1998; 24(4):213-216.

Wourms DJ, Campbell AD, Hicks ML, Pelleu GB. Alternative solvents to chloroform for gutta-percha

removal. J. Endod. 1990; 16(5):224-226.

Ng YL, Mann V, Gulabivala K. A prospective study of the factors affecting outcomes of nonsurgical root

canal treatment: part 1: periapical health. Int Endod J. 2011; 44(7):583-609.




How to Cite

Maronga, G. O. ., Ahmed, S. ., Saayman, C. M., & Irari, K. W. (2022). Retreatability of root canals obturated using a bioceramic sealer and gutta percha. South African Dental Journal, 77(02), 77–84. Retrieved from