Advancements in bio-ceramic technology has revolutionised endodontic material science by enhancing the treatment outcome for patients. This class of dental materials conciliates excellent biocompatibility with high osseoconductivity that render them ideal for endodontic care. Few recently introduced bio-ceramic materials have shown considerable clinical success over their early generations in terms of good handling characteristics. Calcium enriched mixture (CEM) cement, Endosequence sealer, and root repair materials, Biodentine and BioAggregate are the new classes of bio-ceramic materials. The aim of this literature review is to present investigations regarding properties and applications of CEM cement in endodontics. A review of the existing literature was performed by using electronic and hand searching methods for CEM cement from January 2006 to December 2013. CEM cement has a different chemical composition from that of mineral trioxide aggregate (MTA) but has similar clinical applications. It combines the biocompatibility of MTA with more efficient characteristics, such as significantly shorter setting time, good handling characteristics, no staining of tooth and effective seal against bacterial leakage.

During a composite resin restoration, an anticipating contraction gap is usually tried to seal with low-viscosity resin after successive polishing, etching, rinsing and drying steps, which as a whole is called rebonding procedure. However, the gap might already have been filled with water or debris before applying the sealing resin. We hypothesized that microleakage would decrease if the rebonding agent was applied before the polishing step, i.e., immediately after curing composite resin. On the buccal and lingual surfaces of 35 extracted human molar teeth, class V cavities were prepared withthe occlusal margin in enamel and the gingival margin in dentin. They were restored with a hybrid composite resin Z250 (3M ESPE, USA) using an adhesive AdperTM Single Bond 2 (3M ESPE). As rebonding agents, BisCover LV (Bisco, USA), ScotchBond Multi-Purpose adhesive (3M ESPE) and an experimental adhesive were applied on the restoration margins before polishing step or after successive polishing and etching steps. The infiltration depth of 2% methylene blue into the margin was measured using an optical stereomicroscope. The correlation between viscosity of rebonding agents and mciroleakage was also evaluated. There were no statistically significant differences in the microleakage within the rebonding procedures, within the rebonding agents, and within the margins. However, when the restorations were not rebonded, the microleakage at gingival margin was significantly higher than those groups rebonded with 3 agents (p < 0.05). The difference was not observed at the occlusal margin. No significant correlation was found between viscosity of rebonding agents and microleakage, except very weak correlation in case of rebonding after polishing and etching at gingival margin (r = -0.326, p = 0.041).

The purpose of this study was to evaluate the effect of soft chelating irrigant on the sealing ability of root fillings by using a glucose leakage test.

A total of 45 single-rooted teeth were selected for the study. The teeth were decoronated leaving a total length of 13mm. The root canals prepared using K3 NiTi rotary instruments to an apical dimension of size 45(0.06 taper). The specimens were then randomly divided into 3 experimental groups of 13 roots each and 2 control groups of 3 roots each. Specimen in each group were prepared with different irrigation protocols : group 1, 2.5% NaOCl; group 2, 2.5% NaOCl and 17% EDTA; group 3, 2.5% NaOCl and 15% HEBP. The root canals were filled with gutta-percha and AH Plus sealer using lateral condensation. After 7 days in 37℃, 100% humidity, the coronal-to-apical microleakage was evaluated quantitatively using a glucose leakage model. The leaked glucose concentration was measured with spectrophotometry at 1, 4, 7, 14, 21 and 28 days.

There was a tendency of increase in leakage in all experimental groups during experimental period. HEBP-treated dentin showed no significant difference with EDTA-treated dentin during experimental period. From the 21th day onward, HEBP-treated dentin showed significantly lower leakage than smear-covered dentin. HEBP-treated dentin displayed a similar sealing pattern to EDTA-treated dentin and a better sealing ability than smear-covered dentin. Consequently, a soft chelator(HEBP) could be considered as the possible alternative to EDTA.

The purpose of this study was to compare the microleakage of low and high viscosity flowable resins in class V cavities applied with 1-step adhesives.

Forty class V cavities were prepared on the cervices of buccal and lingual surfaces of extracted molar teeth and divided into four groups (n=8). Cavities were restored with AQ Bond Plus/Metafil Flo α, G-Bond/UniFil LoFlo Plus (Low flow groups), AQ Bond Plus/Metafil Flo and G-Bond/UniFil Flow (High flow group), respectively.

Specimens were immersed in a 2% methylene blue solution for 24 hours, and bisected longitudinally. They were observed microleakages at the enamel and dentinal margins.

In conclusion, the low viscosity flowable resins showed lower marginal microleakage than do the high viscosity flowable resins in class V cavities.

We evaluated in vitro microleakage of Mineral Trioxide Aggregate (MTA) powder with 4-methacryloxyethyl trimellitate anhydride (4-META) / methyl methacrylate (MMA) & tri-n-butylborane (TBB) resin as a retrograde filling material by using methylene blue dye method.

Fifty-two single rooted, extracted teeth were instrumented and obturated with gutta percha and AH plus sealer. The apical 3mm of each root was resected and 3mm deep ultrasonic root end preparation was done. External surface of roots was coated with nail varnish. Prepared teeth were randomly divided into five groups; Negative control: completely covered with nail varnish; Positive control: coated with nail varnish except for apical foramen; Group 1 (retrofilled with Portland cement); Group 2 (retrofilled with MTA); Group 3 (retrofilled with MTA powder mixed with 4-META/MMA & TBB resin). Immediately after completion of root-end filling, all specimens were submerged in methylene blue dye for 72 hours in 37℃ incubator. The roots were longitudinally sectioned and measured for extent of dye penetration by three different examiners under microscope (×10). The results were statistically analyzed using one way ANOVA and Turkey's HSD test. No leakage was evident in negative control and complete leakage in positive control group. Group 3 showed significantly less leakage than group 1 and 2 (p < 0.01). There was no significant difference between group 1 and 2 (p > 0.01).

It was concluded that MTA powder with 4-META/MMA & TBB resin was excellent in reducing initial apical microleakage.

This study was done to determine if there is any difference in microleakage between experimental composite resins, in which various proportions of three component photoinitiators (Camphoroquinone, OPPI, Amine) were included.

Four kinds of experimental composite resin were made by mixing 3.2% silanated barium glass (78 wt.%, average size; 1 µm) with each monomer system including variously proportioned photoinitiator systems used for photoinitiating BisGMA/BisEMA/TEGDMA monomer blend (37.5:37.5:25 wt.%). The weight percentage of each component were as follows (in sequence Camphoroquinone, OPPI, Amine): Group A - 0.5%, 0%, 1% / Group B - 2%, 0.2%, 2% / Group C - 0.2%, 1%, 0.2% / Group D - 1%, 1%, 2%.

Each composite resin was used as a filling material for round class V cavities (diameter: 2/3 of mesiodistal width; depth: 1.5 mm) made on extracted human premolars and they were polymerized using curing light unit (XL 2500, 3M ESPE) for 40 s with an intensity of 600 mW/cm². Teeth were thermocycled five-hundred times between 50℃ and 550℃ for 30s at each temperature.

Electrical conductivity (µA) was recorded two times (just after thermocycling and after three-month storage in saline solution) by electrochemical method.

Microleakage scores of each group according to evaluation time were as follows [Group: at first record / at second record; unit (µA)]: A: 3.80 (0.69) / 13.22 (4.48), B: 3.42 (1.33) / 18.84 (5.53), C: 4.18 (2.55) / 28.08 (7.75), D: 4.12 (1.86) / 7.41 (3.41).

Just after thermocycling, there was no difference in microleakage between groups, however, group C showed the largest score after three-month storage. Although there seems to be no difference in microleakage between groups just after thermocycling, composite resin with highly concentrated initiation system or classical design (Camphoroquinone and Amine system) would be more desirable for minimizing microleakage after three-month storage.

The purpose of this study was to evaluate the effects of MTAD, EDTA and sodium hypochlorite(NaOCl) as final irrigants on coronal leakage resistance to Enterococcus faecalis. Forty extracted human maxillary molars were used in this experiment. The teeth were randomly divided into positive control group (Group 1; n = 5), negative control group (Group 2; n = 5) and three experimental groups (n = 30). In Group 3 (n = 10), the root canals were irrigated with sodium hypochlorite. In Group 4 (n = 10) and 5 (n = 10), the root canals were irrigated with sodium hypochlorite and rinsed with EDTA and MTAD, respectively. The teeth in each group were cleaned and shaped to #40 profile with .04 taper, and obturated with gutta-percha and AH-26 root canal sealer. The coronal portion of each tooth was placed in contact with inoculum of Enterococcus faecalis in Brain Heart Infusion (BHI) culture media. Each root tip was placed in a vial containing sterile culture media. The vials were placed in anaerobic chamber and observed everyday for turbidity for 180 days. Statistical analysis was performed using Fisher's Exact Test. After 180 days, Group 3, 4, and 5 showed 7, 4 and 5 leaking samples respectively. The differences in leakage resistance were not statistically significant among Group 3, 4 and 5.

The purpose of this study was to compare the apical microleakage in root canal filled with Resilon by methacrylate-based root canal sealer or 2 different self-adhesive resin cements. Seventy single-rooted extracted human teeth were sectioned at the CEJ perpendicular to the long axis of the roots with diamond disk. Canal preparation was performed with crown-down technique using Profile NiTi rotary instruments and GG drill. Each canal was prepared to ISO size 40, .04 taper and 1 mm short from the apex. The prepared roots were randomly divided into 4 experimental groups of 15 roots each and 5 roots each for positive and negative control group. The root canals were filled by lateral condensation as follows. Group 1: Guttapercha with AH-26, Group 2: Resilon with RealSeal primer & sealer, Group 3: Resilon with Rely-X Unicem, Group 4: Resilon with BisCem. After stored in 37℃, 100% humidity chamber for 7 days, the roots were coated with 2 layers of nail varnish except apical 3 mm. The roots were then immersed in 1% methylene blue dye for 7 days. Apical microleakage was measured by a maximum length of linear dye penetration after roots were separated longitudinally. One way ANOVA and Scheffe's post-hoc test were performed for statistical analysis. Group 1 showed the least apical leakage and there was no statistical significance between Group 2, 3, 4. According to the results, the self adhesive resin cement is possible to use as sealer instead of primer & sealant when root canal filled by Resilon.

The purpose of this study was to compare the sealing abilities of four endodontic temporary restorative materials using a methylene blue dye penetration test under dynamic loading. Standardized access cavities were prepared in forty-four intact human permanent molar teeth, and the cavities were restored with Caviton, MD-Temp, IRM, or ZOE. After thermocycling, an intermittent load of 98 N at 1 Hz was applied for 1,000 cycles to the long axis of the functional cusp of each of the teeth, which were immersed in a 1% methylene blue solution. The teeth were split in half, and the linear depth of dye penetration was evaluated according to the criteria. The results were analyzed using one-way ANOVA (p = 0.05) and Duncan's multiple range test. The results demonstrated that Caviton and MD-Temp showed significantly lower microleakage than IRM and ZOE. It was concluded that Caviton and MD-Temp exhibited better sealing ability than IRM and ZOE under dynamic loading.

The purpose of this study was to compare the apical microleakage in root canal filled with Resilon by several self-etching primers and methacrylate-based root canal sealer. Seventy single-rooted human teeth were used in this study. The canals were instrumented by a crown-down manner with Gate-Glidden drills and .04 Taper Profile to ISO #40. The teeth were randomly divided into four experimental groups of 15 teeth each according to root canal filling material and self-etching primers and two control groups (positive and negative) of 5 teeth each as follows: group 1 - gutta percha and AH26® sealer; group 2 - Resilon, RealSeal™ primer and RealSeal™ sealer; group 3 - Resilon, Clearfil SE Bond® primer and RealSeal™ sealer group 4 - Resilon, AdheSe® primer and RealSeal™ sealer. Apical leakage was measured by a maximum length of linear dye penetration of roots sectioned longitudinally by diamond disk. Statistical analysis was performed using the One-way ANOVA followed by Scheffe's test. There were no statistical differences in the mean apical dye penetration among the groups 2, 3 and 4 of self-etching primers. And group 1, 2 and 3 had also no statistical difference in apical dye penetration. But, there was statistical difference between group 1 and 4 (p < 0.05). The group 1 showed the least dye penetration. According to the results of this study, Resilon with self-etching primer was not sealed root canal better than gutta precha with AH26® at sealing root canals. And there was no significant difference in apical leakage among the three self-etching primers.

The purpose of this study was to measure the polymerization shrinkage and hygroscopic expansion of resin-based temporary filling materials and to evaluate microleakage at the interface between the materials and cavity wall.

Five resin-based temporary filing materials were investigated: Fermit (Vivadent), Quicks (Dentkist), Provifil (Promedica), Spacer (Vericom), Clip (Voco). Caviton (GC) was also included for comparison. Polymerization shrinkage of five resin-based temporary filling materials was measured using the bonded disc method. For the measurement of hygroscopic expansion, the discs of six cured temporary filling materials were immersed in saline and a LVDT displacement sensor was used to measure the expansion for 7 days. For estimating of microleakage, Class I cavities were prepared on 120 extracted human molars and randomly assigned to 6 groups of 20 each. The cavities in each group were filled with six temporary filling materials. All specimens were submitted to 1000 thermo-cycles, with temperature varying from 5℃/55℃. Microleakage was determined using a dye penetration test.

The results were as follows:

Fermit had significantly less polymerization shrinkage than the other resin-based temporary filling materials. Fermit (0.22 %) < Spacer (0.38 %) < Quicks (0.64 %), Provifil (0.67 %), Clip (0.67 %)

This study examined the influence of the apical sizes on the sealing ability of a root canal filling.

Thirty-six single rooted teeth with a single canal were divided into 3 groups (n = 12) and instrumented with either the Profile® or LightSpeed® system to achieve three different apical sizes (master apical file [MAF] of #25, #40, or #60). The teeth were filled with gutta percha using a modified continuous wave technique. The level of microleakage was determined by immersing ten teeth from each group into India ink for 1 week followed by clearing with nitric acid, ethyl-alcohol, and methylsalicylate. The microleakage was measured using vernier calipers. The data was analyzed statistically using Kruskal-Wallis one-way ANOVA and a Student-Newman-Keuls Method. Two teeth from each group were sectioned horizontally at 1, 2, 3 and 4 mm from the apex in order to observe a cross section.

The apical size was significantly (p < .05) influenced the level of microleakage. In the Student-Newman-Deuls Method, MAF sizes of #25 and #40; and MAF sizes of #25 and #60, respectively showed a statistically significant difference. There was no significant difference between #40 and #60. In most cross sections, oval-shaped canals were observed, and the irregularity of the internal surface increased with decreasing apical size. There was also an increase in the area of recess, which is the area where the canal space is not filled with either gutta-percha or sealer.

When the root canals are filled using a modified continuous wave technique, canal filling with more consistent and predictable outcome may be expected as the apical preparation size is increased.

The purpose of this study was: (1) to compare nanoleakage patterns of a conventional 3-step etch and rinse adhesive system and two experimental hydrophobic adhesive systems and (2) to investigate the change of the nanoleakage patterns after load cycling. Two kinds of hydrophobic experimental adhesives, ethanol containing adhesive (EA) and methanol containing adhesive (MA), were prepared. Thirty extracted human molars were embedded in resin blocks and occlusal thirds of the crowns were removed. The polished dentin surfaces were etched with a 35% phosphoric acid etching gel and rinsed with water. Scotchbond Multi-Purpose (MP), EA and MA were used for bonding procedure. Z-250 composite resin was built-up on the adhesive-treated surfaces. Five teeth of each dentin adhesive group were subjected to mechanical load cycling. The teeth were sectioned into 2 mm thick slabs and then stained with 50% ammoniacal silver nitrate. Ten specimens for each group were examined under scanning electron microscope in backscattering electron mode. All photographs were analyzed using image analysis software. Three regions of each specimen were used for evaluation of the silver uptake within the hybrid layer. The area of silver deposition was calculated and expressed in gray value. Data were statistically analyzed by two-way ANOVA and post-hoc testing of multiple comparisons was done with the Scheffe's test. Silver particles were observed in all the groups. However, silver particles were more sparsely distributed in the EA group and the MA group than in the MP group (p < .0001). There were no changes in nanoleakage patterns after load cycling.

The purpose of this study was to compare the apical leakage of the root canal filled with the System B and the EndoTwinn (the combined application of heat and ultrasonic vibration).

Sixty extracted premolars with straight root were cleaned and shaped to size 35. Group SB was obturated using System B and Group ET was filled with EndoTwinn. A size 35 of 0.06 tapered gutta-percha and Adseal were used and the plugger which could be introduced to 4 mm short of working length was selected in the obturation procedure. As the positive control, Group PC was not filled. In Group SB, ET and PC, all external surfaces of each tooth were coated with nail varnish leaving only 1 mm area around the apical foramen. In the negative control of Group NSB and Group NET, all of external tooth surface including apical foramen was coated with the nail varnish. The specimens were immersed in methylene blue dye solution for 2 days. Then the specimens were sectioned at each 1 mm from apex to 5 mm level. The final score of one specimen was given by summing up of the points at all levels.

The dye leakage of Group ET was significantly less than that observed in Group SB (p < 0.05). And the frequency of gutta-percha pulling out from root canal when the plugger was removed was more often with the System B than with EndoTwinn but there was no significant difference.

The purpose of this study was to compare apical sealing ability of continuous wave canal filling technique according to various heat source plugging depths.

Eighty one extracted human premolars with straight root were cleaned and shaped to size 35 using .06 taper rotary NiTi file. After cleansing and shaping, the teeth were divided into 5 groups following the heat source probing depths from the apex; 3, 4, 5, 6 and 7 mm. All specimens were filled using E&Q plus with #35 / .06 tapered gutta-percha cone. The positive control teeth were not filled. All teeth were coated with nail varnish except the apical 1 mm around the apical foramen. Negative control teeth were completely sealed include the apical foramen. All specimens were immersed in 1% methylene blue solution for 72 hours. Then the specimens were sectioned horizontally at 1, 2 and 3 mm from the root apex. Each sectioned surface was photographed using a digital camera attached to the stereomicroscope at 12.5 × 2.5 fold magnification. All points at 1, 2 and 3 mm were summed as final score of one specimen. Statistical analysis of the collected data was performed.

Under the condition of this study, there was no significant difference between the heat source plugging depths of 3, 4, 5, 6 and 7 mm in apical sealing ability. All of apical heat source plugging depth from 3 to 7 mm including Buchanan's protocol -from 5 to 7 mm- seems to be acceptable in clinical application.

The purpose of this study was to evaluate the effect of a new resin monomer on the microleakage of composite resin restorations. By adding new methoxylated Bis-GMA (Bis-M-GMA, 2,2-bis[4-(2-methoxy-3-methacryloyloxy propoxy) phenyl] propane) having low viscosity, the content of TEGDMA which has adverse effects on polymerization shrinkage might be decreased. As a result, microleakage might be improved.

2 mm × 2 mm × 2 mm cavities with occlusal margins in enamel and gingival margins in dentin were prepared on buccal and lingual surfaces of 40 extracted human premolars. Prepared teeth were randomly divided into four groups and restored with Clearfil SE bond (Kuraray, Japan) and one of experimental composite resins; EX1, Experimental composite resin1 (Bis-M-GMA/TEGDMA = 95/5 wt%, 40 nm nanofillers); EX2, Experimental composite resin2 (Bis-M-GMA/TEGDMA = 95/5 wt%, 20 nm nanofillers); EX3, Experimental composite resin3 (Bis-GMA/TEGDMA = 70/30 wt%, 40 nm nanofillers); and Filtek Z250 (3M ESPE, USA) was filled as a control group. The restored teeth were thermocycled, and immersed in 2% methylene blue solution for 24 hours. The teeth were sectioned buccolingually with a low speed diamond saw and evaluated for microleakage under stereomicroscope. The data were statistically analyzed by Pearson Chi-Square test and Fisher Exact test (p = 0.05).

The microleakage scores seen at the enamel margin were significantly lower than those of dentin margin (p = 0.007). There were no significant differences among the composite resins in the microleakage scores within each margin (p > 0.05). Bis-M-GMA, a new resin monomer having low viscosity, might in part replace high viscous Bis-GMA and might improve the quality of composite resin.

The purpose of this study was to compare the marginal microleakage of different 2-step adhesive systems in Class V cavities prepared with different diamond points.

Forty Class V cavities were prepared with two different (coarse or fine) diamond points on cervical third of extracted molars. The occlusal and gingival margin of cavities was located in enamel and dentin, respectively. They were divided into one of four equal groups (n = 10) and ; Group 1-prepared with coarse diamond point (EX-41), restored with Single Bond and Z 250, Group 2-prepared with fine diamond piont (TF-21F), restored with Single Bond and Z 250, Group 3-prepared with coarse diamond point (EX-41), restored with Clearfil SE Bond and Clearfil AP-X, Group 4-prepared with fine diamond point (TF-21F), restored with Clearfil SE Bond and Clearfil AP-X.

Specimens were thermocycled, immersed in a 2% methylene blue solution for 24 hours, and bisected longitudinally. They were observed leakages at enamel and dentinal margins. Data were analyzed using Mann-Whitney and Wilcoxon signed ranked test.

In this study, marginal microleakage of Single Bond was not affected by type of diamond points. But Clearfil SE Bond showed higher marginal microleakage at both enamel and dentinal margin when Class V cavity was prepared with coarse diamond point.

The objective of this study is to evaluate the effect of an additional application of bonding resin on the bond strength of resin luting cements in both the light-cure (LC) and self-cure (SC) modes by means of the µTBS tests.

Three combinations of One-Step Plus with Choice, Single Bond with Rely X ARC, and One-Up Bond F with Bistite II were used. D/E resin and Pre-Bond resin were used for the additional application. Twelve experimental groups were made. Three mandibular 3^rd molars were used in each group. Indirect composite blocks were cemented on the tooth surface. 1 × 1 mm² dentin-composite beam for µTBS testing were made and tested.

When total-etching dentin adhesives were used, an additional application of the bonding resin increased the bond strength (P < 0.05). However, this additional application didn't influence the bond strength of self-etching dentin adhesives (P > 0.05).

In conclusion, the results suggest that an additional application of the bonding resin increases bond strength and enhances quality of bonding when using total-etching dentin adhesives.