Influence of endodontic access cavity design on the effectiveness of different retreatment protocols in mandibular molars obturated with bioceramic or epoxy resin-based sealer: a micro-CT analysis
Autores
Laila Gonzales Freire, Manuela Gimenes Lupi, Carla Regina do Carmo Della Libera, Samara Daher Teixeira Castro, Giulio GaviniDocumentos
Key Information
Revista
Published in v. 6 n. 1 (2026) of Brazilian Endodontic Journal.
Sobre a RevistaResumo
Objetivo: Avaliar a influência do desenho da cavidade de acesso sobre a porcentagem de material obturador remanescente após diferentes protocolos de retratamento em molares inferiores. Metodologia: Sessenta e quatro molares inferiores preparados e obturados com AH Plus ou Bio-C Sealer foram distribuídos de acordo com o tipo de cavidade de acesso: tradicional (n = 32) ou conservadora (n = 32), sendo posteriormente subdivididos conforme o cimento obturador e o protocolo complementar de retratamento: ProTaper Retreatment + XP-Endo Finisher R ou ProTaper Retreatment + inserto ultrassônico Clearsonic. Varreduras por micro-CT foram realizadas após a obturação, a remoção inicial do material obturador e a remoção complementar do material obturador. As porcentagens de material obturador foram calculadas para cada raiz e para cada terço. Os dados foram analisados por ANOVA e teste de Tukey (α = 0,05). Resultados: O grupo TAC apresentou remoção inicial significativamente maior do material obturador em comparação ao grupo CAC nos terços cervical e médio das raízes mesiais e distais (p < 0,05). O AH Plus demonstrou maior retratabilidade do que o Bio-C Sealer em todos os grupos (p < 0,05). O inserto Clearsonic apresentou desempenho superior ao XPFR de forma geral, especialmente nos canais distais (p < 0,05). O terço apical apresentou a menor eficiência de remoção, independentemente do protocolo utilizado. Conclusões: A eficiência inicial do retratamento foi favorecida pelo acesso tradicional. O AH Plus apresentou maior retratabilidade em comparação ao Bio-C Sealer. O inserto Clearsonic foi particularmente eficaz na remoção do material obturador, especialmente nos canais distais.
Referências
1. Zuolo AS, Mello JE Jr, Cunha RS, Zuolo ML, Bueno CE. Efficacy of reciprocating and rotary techniques for removing filling material during root canal retreatment. Int Endod J. 2013;46(10):947-53. doi:10.1111/iej.12085
2. Crozeta BM, Lopes FC, Menezes Silva R, Silva-Sousa YTC, Moretti LF, Sousa-Neto MD. Retreatability of BC Sealer and AH Plus root canal sealers using new supplementary instrumentation protocol during non-surgical endodontic retreatment. Clin Oral Investig. 2021;25(3):891-9. doi:10.1007/s00784-020-03376-4
3. Fischer BV, Goulart TS, Vitali FC, de Souza DL, Teixeira CDS, Garcia LDFR. Supplementary methods for filling material removal: A systematic review and meta-analysis of micro-CT imaging studies. J Dent. 2024;151:105445. doi:10.1016/j.jdent.2024.105445
4. Clark D, Khademi J. Modern molar endodontic access and directed dentin conservation. Dent Clin North Am. 2010;54(2):249-73. doi:10.1016/j.cden.2010.01.004
5. Shabbir J, Zehra T, Najmi N, Hasan A, Naz M, Piasecki L, et al. Access cavity preparations: classification and literature review of traditional and minimally invasive endodontic access cavity designs. J Endod. 2021;47(8):1229-44. doi:10.1016/j.joen.2021.04.018
6. Rover G, Belladonna FG, Bortoluzzi EA, De-Deus G, Silva EJNL, Teixeira CDS. Influence of access cavity design on root canal detection, instrumentation efficacy, and fracture resistance assessed in maxillary molars. J Endod. 2017;43(10):1657-62. doi:10.1016/j.joen.2017.06.013
7. Fatima K, Nair R, Khasnis S, Vallabhaneni S, Patil JD. Efficacy of rotary and reciprocating single-file systems on different access outlines for gutta-percha removal in retreatment: an in vitro study. J Conserv Dent. 2018;21(4):354-8. doi:10.4103/JCD.JCD_46_18
8. Odabaşı Tezer E, Kırmızı D, Abduljalil M, Basmacı F, Buyuksungur A, Dartar Öztan M. Comparative retreatment efficacy of two multi-file systems with different access cavity designs: a micro-computed tomography study. Medicina. 2024;60(12):1980. doi:10.3390/medicina60121980
9. Candeiro GT, Correia FC, Duarte MA, Ribeiro-Siqueira DC, Gavini G. Evaluation of radiopacity, pH, release of calcium ions, and flow of a bioceramic root canal sealer. J Endod. 2012;38(6):842-5. doi:10.1016/j.joen.2012.02.029
10. Pinto JC, Torres FFE, Santos-Junior AO, Tavares KIMC, Guerreiro-Tanomaru JM, Tanomaru-Filho M. Influence of sealer and supplementary approach on filling material removal during endodontic retreatment. Braz Oral Res. 2024;38:e022. doi:10.1590/1807-3107bor-2024.vol38.0022
11. Oltra E, Cox TC, LaCourse MR, Johnson JD, Paranjpe A. Retreatability of two endodontic sealers, EndoSequence BC Sealer and AH Plus: a micro-computed tomographic comparison. Restor Dent Endod. 2017;42(1):19-26. doi:10.5395/rde.2017.42.1.19
12. Silva EJNL, Belladonna FG, Zuolo AS, Rodrigues E, Ehrhardt IC, Souza EM, et al. 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. doi:10.1111/iej.12788
13. Tavares SJO, Gomes CC, Marceliano-Alves MF, Guimarães LC, Provenzano JC, Amoroso-Silva P, et al. Supplementing filling material removal with XP-Endo Finisher R or R1-Clearsonic ultrasonic insert during retreatment of oval canals from contralateral teeth. Aust Endod J. 2021;47(2):188-94. doi:10.1111/aej.12451
14. Rossi-Fedele G, Ahmed HM. Assessment of root canal filling removal effectiveness using micro-computed tomography: a systematic review. J Endod. 2017;43(4):520-6. doi:10.1016/j.joen.2016.12.008
15. Bukhary SM. Retreatability of calcium silicate-based sealers based on micro-computed tomographic evaluation: a systematic review. Saudi Dent J. 2024;36(10):1278-94. doi:10.1016/j.sdentj.2024.09.011
16. Crozeta BM, Silva-Sousa YTC, Leoni GB, Mazzi-Chaves JF, Fantinato T, Baratto-Filho F, et al. Micro-computed tomography study of filling material removal from oval-shaped canals by using rotary, reciprocating, and adaptive motion systems. J Endod. 2016;42(5):793-7. doi:10.1016/j.joen.2016.02.005
17. Bis BM, Silva-Sousa YTC, Macedo LMD, Oliveira OP, Alfredo E, Leoni GB, et al. Removal of filling material using rotating or reciprocating systems with or without solvent: microCT analysis. Braz Oral Res. 2021;35:e117. doi:10.1590/1807-3107bor-2021.vol35.0117
18. 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-CT and SEM. Int Endod J. 2016;49(9):890-7. doi:10.1111/iej.12522
19. Liu H, Zaghwan A, Wang X, Alexander A, Tay F, Shen Y. Efficacy of root filling removal from aged, minimally instrumented mandibular molars using a retreatment system combination. J Dent. 2025;152:105454. doi:10.1016/j.jdent.2024.105454
20. Keskin NB, Özyürek T, Uğur Aydın Z, Uslu G, Kurşun Çakmak EŞ, Helvacioglu-Yigit D. Comparative evaluation of supplementary techniques for filling material removal in oval root canals: a micro-CT analysis. Odontology. 2025. doi:10.1007/s10266-025-01246-7
21. Lyngdoh D, Alam S, Iftekhar H, Mishra SK. Evaluation of canal patency and cleanliness following retreatment of bioceramic sealer-obturated root canals using three different irrigant activation protocols. Aust Endod J. 2024;50(3):475-85. doi:10.1111/aej.12855
22. Rivera-Peña ME, Duarte MAH, Alcalde MP, Andrade FB, Vivan RR. A novel ultrasonic tip for removal of filling material in flattened/oval-shaped root canals: a microCT study. Braz Oral Res. 2018;32:e88. doi:10.1590/1807-3107bor-2018.vol32.0088
23. Campos Fruchi L, Alcalde MP, Amoroso-Silva P, Vivan RR, Bramante CM, Húngaro Duarte MA. Micro-CT assessment of filling removal effectiveness in the apical third of curved canals with different anatomy. Iran Endod J. 2024;19(1):22-7. doi:10.22037/iej.v19i1.27511
24. Cıkrık BN, İnce Yusufoğlu S. Efficacy of irrigation activation methods in removal of bioceramic-based sealer in retreatment. Odontology. 2025;113(3):1119-27. doi:10.1007/s10266-025-01054-z
25. Peña-Bengoa F, Abarca J, Cáceres C, Steinfort K, Niklander SE, Silva EJNL. Evaluation of the retreatability and different supplementary cleaning techniques for removing bioceramic sealers in oval-shaped canals. Aust Endod J. 2025. doi:10.1111/aej.70011
26. Bincelli Seckler IN, Pelegrine RA, Stringheta CP, Lopes RT, de Sá Silva AS, da Silveira Bueno CE. Comparative evaluation of supplementary cleaning techniques for removal of Bio-C Sealer and AH-Plus from oval root canals: a micro-CT analysis. Iran Endod J. 2024;19(3):199-207. doi:10.22037/iej.v19i3.43580
27. Sutharoj T, Dewi A, Phumpatrakom P, Sastraruji T. Comparative evaluation of root canal retreatment techniques and the effect of supplementary cleaning on curved canals obturated with premixed bioceramic sealer. J Endod. 2025. doi:10.1016/j.joen.2025.06.012
28. Volponi A, Pelegrine RA, Kato AS, Stringheta CP, Lopes RT, Silva ASS, et al. Micro-computed tomographic assessment of supplementary cleaning techniques for removing bioceramic sealer and gutta-percha in oval canals. J Endod. 2020;46(12):1901-6. doi:10.1016/j.joen.2020.09.010
29. Colombo JA, Rocha DG, Limoeiro AS, Nascimento WM, Fontana CE, Pelegrine RA, et al. Micro-CT evaluation of sealers removal by reciprocal instrumentation followed by continuous ultrasonic irrigation in teeth with oval root canals. J Clin Exp Dent. 2023;15(3):e233-8. doi:10.4317/jced.60013
Detalhes
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Copyright (c) 2026 Laila Gonzales Freire, Manuela Gimenes Lupi, Carla Regina do Carmo Della Libera, Samara Daher Teixeira Castro, Giulio Gavini
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Articles published in the Brazilian Endodontic Journal — BEJ are licensed under the Creative Commons Attribution 4.0 International License — CC BY 4.0.
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