Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 84907

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : ZC45 - ZC49 Full Version

Comparison of Residual Bioceramic and Epoxy Resin Sealers Following Retreatment with Reciprocating File System in Oval Root Canals: A Micro-computed Tomography Study

Published: June 1, 2022 | DOI:
Sonal Agrawal, Sheetal Mali, Ashish Jain, Rahul Rao, Amit Patil, Himmat Jaiswal

1. Postgraduate, Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai, Maharashtra, India. 2. Reader, PG Guide, Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai, Maharashtra, India. 3. Professor and Head, Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai, Maharashtra, India. 4. Professor, PG Guide, Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai, Maharashta, India. 5. Reader, PG Guide, Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai, Maharashtra, India. 6. Assistant Professor, Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Dental College and Hospital, Navi Mumbai, Maharashtra, India.

Correspondence Address :
Sonal Agrawal,
Sai Pride A1701 Sector 18 Sanpada, Navi Mumbai, Maharashtra, India.


Introduction: When endodontic treatment has failed, non surgical retreatment is often the first choice. This procedure includes removal of previous obturating material followed by chemomechanical preparation, disinfection and refilling of the root canals. However, residual sealer during retreatment remains a concern when such bioceramic sealers are utilised for obturation and this can affect the prognosis.

Aim: To evaluate and compare the amount of residual filling material after retreatment in straight and oval root canals filled with iRoot SP and AH Plus sealer using V-Blue file system using Micro-Computed Tomography (micro-CT).

Materials and Methods: This in-vitro study was conducted at Bharati Vidyapeeth (deemed to be) Dental College and Hospital, Navi Mumbai, Maharashtra, India, between November 2020 to December 2021. Sixty freshly extracted human mandibular premolar with straight and oval canals standardised with Cone Beam Computed Tomography (CBCT) were prepared with ProTaper next files and were assigned to two groups for obturation with gutta-percha using AH Plus and iRoot SP sealer respectively. Quality of obturation was confirmed with CBCT. After one month, retreatment was carried with V-Blue files and percentage of remaining obturating material was were evaluated before and after retreatment through micro-CT imaging. Two sample means and Kolmogorov Smirnov test were used to analyse data.

Results: Data of all the samples from the micro-CT evaluation indicated that the mean volume of the initial filling material did not differ significantly among AH Plus sealer and iRoot SP sealer group (p>0.05). Percentage of residual volume of AH Plus sealer (0.02%) was lower than that of iRoot SP sealer group (0.06%) and this difference was statistically significant (p<0.05).

Conclusion: Considerable amount of iRoot SP sealer remained after retreatment using V-Blue file as compared with AH Plus sealer.


Chemomechanical preparation, Cone beam computed tomography, Obturation, Root canal

Endodontic failures are no exception and such teeth often require retreatment. Persistent and secondary intra-radicular infection are the main cause of endodontic failure (1). Other two factors responsible for root canal failure are insufficient cleaning and incomplete root canal obturation. When endodontic treatment has failed, non surgical retreatment is the first choice. It includes removal of the previous obturating material followed by biomechanical preparation, disinfection, and refilling of root canals with proper coronal restoration (2). Various reasons are listed for a lower success rate for retreatment such as development of intratubular infection, long term intracanal infection with resistant persistent bacteria and difficulty in removal of the previous filling material in order to access the bacteria. Removal of obturating material from root canal system is mandatory as it may act as mechanical barrier for irrigating solution and intracanal medicament to reach the root canal wall and apex (2). Post-treatment pathosis could occur due to presence of bacteria in these materials (3). Therefore, in order to improve chances of success, it is imperative to completely remove the obturating material.

Gutta-percha along with root canal sealer aim to produce a hermetic seal (4). Recently different types of sealers have been introduced in dentistry (5). Root canal sealers are essential to fill the irregularities and minor discrepancies between gutta-percha and canal wall (2). AH Plus sealer (epoxy resin based) is considered the gold standard of endodontic sealers because of its optimum radiopacity, high bond strength to dentine, dimensional stability, flow, low solubility (6).

Yendrembam B et al. stated that bioceramic sealer offers highest fracture resistance than AH Plus sealer and MTA Fillapex in endodontically treated extracted teeth (7).

Bioceramic root canal sealers are among the next generation and revolutionary materials in endodontics (8). Various rotary, reciprocating, ultrasonic or hand instruments have been introduced for removal of gutta-percha and sealers from root canals in retreatment procedures.

The V-Blue file system is a single file reciprocating system and its potential for retreatment efficacy has not been studied extensively (9). Few studies have investigated the retreatability of bioceramic sealers and no studies could be found which studied the residual AH Plus and iRoot SP sealer with V-Blue file using micro-CT (7),(10). Therefore the aim of this in-vitro study was to evaluate and compare the amount of residual filling material after retreatment in straight and oval root canals filled with iRoot SP and AH Plus Sealer using V-Blue file system using micro-CT. The null hypothesis stated that there was no difference in percentage of residual filling material with AH Plus and iRoot SP sealer.

Material and Methods

This in-vitro study was conducted at Bharati Vidyapeeth (deemed to be) Dental College and Hospital, Navi Mumbai, Maharashtra, India, between November 2020 to December 2021. Ethical clearance was obtained by the Institutional Ethics Committee (IEC) with protocol no. IEC297022021 Version No. 001.

Inclusion criteria: Freshly extracted caries free human mandibular premolars with single, straight and oval canals was selected on basis of CBCT (Kodak CS 9000) evaluation.

Exclusion criteria: Teeth with previous root canal treatment, calci?cations in canal, caries, dilacerated roots, external resorption and/or internal resorption were excluded from the study.

Sample size calculation: Sample size was based on statistical calculations and assumptions of earlier reported data for % residual filing material with AH Plus and BC sealer which is 13.5 (2.3) and 17.8 (3.2) (10). It was assumed that the BC sealer is similar to iRoot SP sealer. Using a two-sample test for independent means, the sample size required per group was 30 at alpha 0.05 at 90% power (two-sided test).

Study Procedure

About 60 extracted mandibular premolars with a single oval, straight canal constituted the study sample.

30 teeth were included in each of the study groups. Teeth were considered oval only when buccolingual diameter was 2.5 times than mesiodistal diameter of teeth on basis of cone beam computed tomography (11). Samples were arranged in modelling wax and mounted to CBCT imaging system (Table/Fig 1). They were disinfected with 0.1% thymol solution at 37°C for five days and stored in normal saline until use. The tooth crown was sectioned with diamond disks C12/190 (0.2 mm) to maintain uniform working length of 15 mm. Initial exploration of canal (canal patency) was carried out by with size 10 k file (Mani, Japan). The specimen was prepared using the ProTaper Next (PTN) (Dentsply Mallifer, Switzerland) rotary system up to X3 (size 30,.07 taper). Root canal were irrigated with a total of 10 mL of 5.2% Sodium Hypochlorite (NaOCl) (Prime Dental, India) using 30 gauge side vented needle (Ultradent) followed by 1 mL of 17% ethylenediamine tetra-acetic acid (EDTA) (Prime Dental, India) for one minute. Then canals were dried with paper points (Dentsply Mallifer, Switzerland). ProTaper Next gutta-percha cones (Dentsply Mallifer, Switzerland) were used in accordance with master apical file size of prepared canals and were evaluated by checking the tug back sensation. The prepared samples were coded and randomly assigned to two groups (n=30).

Group 1: Epoxy resin based sealer (AH Plus)

Group 2: Bioceramic sealer (iRoot SP )

Manufacturer’s instructions were followed to mix the sealers. Root canals obturation was done using the cold lateral compaction technique and root canals were obturated 0.5 mm short of the apex. Temporary restoration Cavit G (3M ESPE, Germany) was used to filled access cavities and CBCT imaging was done to confirm the status of obturation (Table/Fig 2). To allow complete setting of sealer, all specimens was stored at 37°C for one month in 100% relative humidity.

Root canal retreatment procedure: After 30 days, retreatment procedure was initiated using V-Blue files to remove the canal filling materials, root canals were instrumented. These reciprocating files were used in continuous pecking motion with gentle inward pressure until the file reached full working length as stated by Bernardes RA et al (12). R25 file (size 25, .08) was used with X Smart Plus (Dentsply Mallifer, Switzerland) at 300 rpm. 15 mL of NaOCl was constantly used after using each file. Every file was used for only three root canals. When each instrument reached up to working length, retreatment was considered to be complete. Root canals were flushed with 1 mL of 5.2% NaOCl using 30 gauge side vented needle, filled with 1 mL of 17% EDTA for three minutes in the canal, finally 1 mL of 5.2% NaOCl was used and were dried with paper points.

Laboratory micro-CT imaging for measurement of filling material and remaining filling material: All specimens before and after retreatment procedures was scanned by Xradia 520 Versa 3D micro-CT (Table/Fig 3). Samples were measured at 75 kV and 55 μA using 400 projections. The geometrical magni?cation was 80. The percentage of volume and density of the remaining ?lling material was calculated from the data obtained through micro-CT (Table/Fig 4). All procedures were performed by a Single Operator (SA) to maintain uniformity. Formula used for the calculation of percentage of residual filling material used was (13):

Percentage (%) of residual filling material = (Residual filling material/ Initial filling material)×100.

Statistical Analysis

The percentage of volume of obturating material after retreatment was analysed using a two sample test for independent means. Windows based ‘MedCalc Statistical Software version 19.1. was used for data analysis. Data for mean resistance was analyzed for normality using the Kolmogorov Smirnov test. Level of significance was set at 95%.


Data of all the samples from the micro-CT evaluation indicated that the mean volume of the initial filling material did not differ significantly among AH Plus sealer and iRoot SP sealer group (p>0.05) (Table/Fig 5). Standard volume and percentage (%) of residual filling material of AH Plus sealer and iRoot SP sealer group was shown in (Table/Fig 6). There was significant difference in residual volume of filling material (p=0.0003) between the two groups. It may be inferred that there was significantly less remnants of residual filling material in AH Plus group as compared to iRoot SP group, whereas radiographic density of iRoot SP group was found to be more than AH Plus group but the difference was non-significant (p>0.05) (Table/Fig 7).


The percentage of residual filling material and states that percentage of residual volume of AH Plus sealer (0.02%) is less than iRoot SP sealer group (0.06%) (p<0.0003) is shown in (Table/Fig 5). Thus, the null hypothesis was rejected. The retreatment protocol adopted for this study was successful in eliminating most of the previous filling material. However none of the groups showed complete removal of obturating material. The percentage of residual filling material for AH Plus sealer group was less than iRoot SP sealer group after retreatment with V-Blue file system. Root canal retreatment can be accomplished only after thorough removal of existing filling materials from root canals in order to facilitate disinfection and three dimensional obturation (10). Many studies have confirmed that it is difficult to completely remove the filling material (10),(14). Sealers are an integral part of endodontic obturation. The evolution of endodontic sealers from zinc oxide eugenol based sealers to epoxy based resin sealers which serves as a gold standard, to recently introduced bioceramic sealer reflects the changing perception of role and performance of endodontic sealer. Hence epoxy based resin sealer and bioceramic sealer was used in the study. Since bioceramic sealers have the property to induce formation of hydroxyapatite tags and better sealing abilities than epoxy based resin sealer they are more difficult to remove from the canal (5). iRoot SP (Innovative Bioceramic, Vancouver, Canada) recently introduced bioceramic sealer was used in the present study. It was launched in 2018, and is trending in the market in recent years and is composed of calcium phosphate, calcium silicates, calcium hydroxide and thickening agents (15),(16). It is highly biocompatible, hydrophilic, aluminium-free, non-toxic and hydrophilic as claimed by the manufacturers. iRoot SP sealer is applied using the disposable tips into the root canal. It complete its reaction by utilizing the moisture present in the dentinal tubules (17).

The amount of residual sealers in the root canal can be assessed by various methods such as digital radiography, confocal microscopy, optical microscopy, scanning electron microscope and micro-CT. In the present study micro-CT was used to evaluate residual filling material in a root canal before and after retreatment (18). The volume, and mean density of initial and residual filling material was calculated through micro-CT. It is used to generate multi slice image without requiring the sectioning of samples. The micro-CT is a non destructive and non invasive method to obtain two and three dimensional images (19). CBCT has been used for determining the oval shape of canals. In oval shaped canals particularly, obturating material fills the polar areas of canal hampering its removal and may end in perforation. CBCT has also been used for conforming the status of obturation (20). CBCT scan is an important tool for detecting post endodontic complications or difficulties such as complex anatomy, root resorptions, perforations and for diagnosis, to overcome limitations of radiographs (21).

Bernardes RA et al., reported that reciprocating systems are more efficient than rotary system for removal of residual filling material (12). Comparison of the finding of present study with previously published similar studies have been done in (Table/Fig 8) (6),(7),(10),(15),(17),(22),(23),(24),(25),(26),(27). V-Blue file system has s-shaped cross section with more positive cutting angle and larger chip space hence facilitates more efficient removal of dentinal chips (22).

The present study focused on micro-CT evaluation which shows that iRoot SP sealer are difficult to remove from the canal than AH Plus sealer through V-Blue file system in retreatment. Microhardness of iRoot SP is more which results in formation of interlocking between its crystal. This property creates a resistance to removal during retreatment procedures. Calcium silicate crystals of iRoot SP sealer react with dentin to form mineral infiltration zone which results in deposition of intrafibrillar apatite crystals. This zone is absent in AH Plus sealer. Density of the residual root canal sealer was the additional parameter studied. Bioceramic sealer expands and hardens on setting thus the density of iRoot SP sealer is more as compared to AH Plus sealer (23). It was assumed that increase in density of iRoot SP sealer creates resistance in removal of residual filling material.


This is an in-vitro study in single rooted straight mandibular premolar with oval shaped canals so the results in molars may differ in clinical scenario. Limitations of this study is that anatomical complexity may interfere with the results obtained thorough micro-CT evaluations and not using chloroform in retreatment. During nonsurgical endodontic retreatment, solvents like eucalyptol oil, chloroform, xylene, turpentine oil, halothane, and pine needle oil are generally used for softening the gutta-percha. These solvents were not used in the present study as they are toxic to the periapical tissue and more residual filling material can be seen in root canal walls and dentinal tubules. In this study only iRoot SP and AH Plus sealers are compared so further studies are required to compare other endodontic sealers.


Within limitation of this in-vitro study it may be inferred that it is more difficult to completely remove iRoot SP bioceramic sealer as compared with AH Plus epoxy resin based sealer using V-Blue reciprocating file system in retreatment cases. Clinical trials with larger sample sizes are required for thorough assessment in future.


Yamaguchi M, Noiri Y, Itoh Y, Komichi S, Yagi K, Uemura R, et al. Factors that cause endodontic failures in general practices in Japan. BMC Oral Health. 2018;18:70. [crossref] [PubMed]
Tabassum S, Khan FR. Failure of endodontic treatment: The usual suspects. European Journal of Dentistry.2016;10(1):144-47. [crossref] [PubMed]
Silva BSF, Bueno MR, Yamamoto-Silva FP, Gomez RS, Peters OA, Estrela C. Differential diagnosis and clinical management of periapical radiopaque/hyperdense jaw lesions. Brazilian Oral Research. 2017;31:01-52. [crossref] [PubMed]
Somani R, Jaidka S, Singh DJ, Kaur N. Hermetic Seal in Obturation: An Achievable Goal with Recently Introduced C point. Int J Clin Pediatr Dent. 2019;12(5):410-13. [crossref] [PubMed]
Lim M, Jung C, Shin DH, Cho YB, Song M. Calcium silicate-based root canal sealers: A literature review. Restor Dent Endod. 2020;45(3):e35. [crossref] [PubMed]
Garikapati S, Kalyan Satish R, Sajjan GS, Madhu Varma K, Kolla VB, Rajashekar Ch. Comparison of push-out bond strength of bioceramic sealer with bioceramic coated and non-bioceramic coated Gutta-percha: An in vitro study. Int J Dent Mater. 2020;2(3):98-102. [crossref]
Yendrembam B, Mittal A, Sharma N, Dhaundiyal A, Kumari S, Abraham A. Relative assessment of fracture resistance of endodontically treated teeth with epoxy resin-based sealers, AH Plus, MTA Fillapex, and Bioceramic Sealer: An In vitro study. Indian J Dent Sci. 2019;11:46-50. [crossref]
Washio A, Morotomi T, Yoshii S, Kitamura C. Bioactive Glass-Based Endodontic Sealer as a Promising Root Canal Filling Material without Semisolid Core Materials. Materials (Basel). 2019;12(23):3967. [crossref] [PubMed]
Bago I, Suk M, Katić M, Gabrić D, Anić I. Comparison of the effectiveness of various rotary and reciprocating systems with different surface treatments to remove gutta-percha and an epoxy resin-based sealer from straight root canals. Int Endod J. 2019;52(1):105-13. [crossref] [PubMed]
Oltra E, Cox TC, LaCourse MR, Johnson JD, Paranjpe A. Retreatability of two endodontic sealers, Endosequence BC sealer and AHplus: A micro-computed tomographic comparison. Restor Dent Endod. 2017;42(1):19-26. [crossref] [PubMed]
De-Deus G, Barino B, Zamolyi RQ, Souza E, Fonseca A Jr, Fidel S, et al. Suboptimal debridement quality produced by the single-file F2 ProTaper technique in oval-shaped canals. J Endod. 2010;36(11):1897-900. [crossref] [PubMed]
Bernardes RA, Duarte MAH, Vivan RR, Alcalde MP, Vasconcelos BC, Bramante CM. Comparison of three retreatment techniques with ultrasonic activation in flattened canals using micro-computed tomography and scanning electron microscopy. Int Endod J. 2016;49(9):890-97. [crossref] [PubMed]
Kim K, Kim DV, Kim SY, Yang S. A micro-computed tomographic study of remaining filling materials of two bioceramic sealers and epoxy resin sealer after retreatment. Restor Dent Endod. 2019;44(2). [crossref] [PubMed]
Rossi-Fedele G, Ahmed HM. Assessment of root canal filling removal effectiveness using micro-computed tomography: A systematic review. J Endod. 2017;43:520-26. [crossref] [PubMed]
Pedrinha VF, Alencar CM, Jassé FA, Zaniboni JF, Dantas AA, de Andrade FB, et al. Effect of the several epoxy resin-based sealer compositions on adhesion interface in radicular dentin after calcium hydroxide intracanal medication removal. J Clin Exp Dent. 2021;13(9):e913-e919. [crossref] [PubMed]
Zordan-Bronzel CL, Esteves Torres FF, Tanomaru-Filho M, Chávez-Andrade GM, Bosso-Martelo R, Guerreiro-Tanomaru JM. Evaluation of physicochemical properties of a new calcium silicate-based sealer, Bio-C sealer. J Endod. 2019;45:1248-52. [crossref] [PubMed]
Yaman Y, Gulsahi K. Evaluation of the Effect of Different Root Canal Obturation Materials on the Fracture Resistance of Endodontically Treated Roots. Austin J Dent. 2018;5(2):1100.
Yilmaz F, Koç C, Kamburoğlu K, Ocak M, Geneci F, Uzuner MB, et al. Evaluation of 3 different retreatment techniques in maxillary molar teeth by using micro-computed tomography. J Endod. 2018;44(3):480-84. [crossref] [PubMed]
Aksoy U, Küçük M, Versiani MA, Orhan K. Publication trends in micro-CT endodontic research: A bibliometric analysis over a 25-year period. Int Endod J. 2021;54(3):343-53. [crossref] [PubMed]
Yilmaz F, Sonmez G, Kamburoglu K, Koc C, Ocak M, Celik HH. Accuracy of CBCT images in the volumetric assessment of residual root canal filling material: Effect of voxel size. Niger J Clin Pract. 2019;22(8):1091-98.
Patel S. Cone beam computed tomography in Endodontics-a review of the literature. Int Endod J. 2019;52:1138-152. [crossref] [PubMed]
Khallaf ME. Effect of two contemporary root canal sealers on root canal dentin microhardness. J Clin Exp Dent. 2017;9:67-70. [crossref] [PubMed]
Almohaimede A, Almanie D, Alaathy S, Almadi E. Fracture Resistance of Roots Filled With Bio-Ceramic and Epoxy Resin-Based Sealers: In Vitro Study. Eur Endod J. 2020;5(2):134-37. [crossref] [PubMed]
Hess D, Solomon E, Spears R, He J. Retreatability of bioceramic root canal sealing material. J Endod. 2011;37(11):1547-49. [crossref] [PubMed]
Rajda M, Miletić I, Baršić G, Krmek SJ, Å njarić D, Baraba A. Efficacy of Reciprocating Instruments in the Removal of Bioceramic and Epoxy Resin-Based Sealers: Micro-CT Analysis. Materials (Basel). 2021;14(21):6670. [crossref] [PubMed]
Kim H, Kim E, Lee SJ, Shin SJ. Comparisons of the Retreatment Efficacy of Calcium Silicate and Epoxy Resin-based Sealers and Residual Sealer in Dentinal Tubules. J Endod. 2015;41(12):2025-30. [crossref] [PubMed]
Sherif DA, Farag AM, Darrag AM, Shaheen NA. Evaluation of root canals filled with bioceramic sealer after retreatment with two different techniques. Tanta Dent. J 2017;14:76-82. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2022/55228.16510

Date of Submission: Jan 25, 2022
Date of Peer Review: Feb 25, 2022
Date of Acceptance: Apr 13, 2022
Date of Publishing: Jun 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Jan 31, 2022
• Manual Googling: Feb 24, 2022
• iThenticate Software: Apr 14, 2022 (25%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)