JIOH on LinkedIn JIOH on Facebook
  • Users Online: 370
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL RESEARCH
Year : 2020  |  Volume : 12  |  Issue : 5  |  Page : 476-484

Assessment of physical properties of a ZnO/E sealer modified by adding moringa oleifera: An experimental in-vitro study


Restorative and Dental Materials Department, National Research Centre, Cairo, Egypt

Date of Submission22-Dec-2019
Date of Decision13-Apr-2020
Date of Acceptance14-Apr-2020
Date of Web Publication21-Oct-2020

Correspondence Address:
Prof. Engy M Kataia
Restorative and Dental Materials Department, National Research Centre, Cairo.
Egypt
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_347_19

Rights and Permissions
  Abstract 

Aim: In an attempt to move toward exploration of the antibacterial properties of herbal products, this study evaluated the effect of how the addition of Moringa would affect the physical properties of the commercial Endofil sealer. Materials and Methods: An experimental in vitro study was performed using three experimental sealers. There were four groups in this study: Group A (ZnO/E sealer alone), Group B (ZnO/E and Moringa root), Group C (ZnO/E and Moringa leaf), and Group D (ZnO/E and Moringa leaf extract liquid). Measurements were carried out according to International Organization for Standardization (ISO) standardization 6876:2012. Moringa oleifera was added to Endofil’s powder and liquid and the physical properties of the new sealer were tested according to ISO 6876:2012 and compared to those of Endofil alone. One-way analysis of variance (ANOVA) followed by Tukey post hoc test was used to compare between more than two groups in non-related samples. Results: All groups showed varying degrees of shrinkage with Group B having the lowest shrinkage and setting time, whereas Groups A and D experienced the highest shrinkage. All groups experienced solubility; Group B had the highest mass loss and Group D showed the lowest. Group A showed the lowest film thickness. Radiopacity of all groups satisfies the ISO recommendations for root canal sealers. Conclusion: Moringa added to ZnO/E sealer showed acceptable physical properties of the commercial Endofil sealer.

Keywords: Herbal, Moringa Oleifera, Physical Properties, Sealer, Zinc Oxide Eugenol


How to cite this article:
Kataia EM, Khallaf ME, Omar N, Aly Y, ElShafei N. Assessment of physical properties of a ZnO/E sealer modified by adding moringa oleifera: An experimental in-vitro study. J Int Oral Health 2020;12:476-84

How to cite this URL:
Kataia EM, Khallaf ME, Omar N, Aly Y, ElShafei N. Assessment of physical properties of a ZnO/E sealer modified by adding moringa oleifera: An experimental in-vitro study. J Int Oral Health [serial online] 2020 [cited 2020 Nov 29];12:476-84. Available from: https://www.jioh.org/text.asp?2020/12/5/476/298796




  Introduction Top


Various techniques have been advocated to fill root canals.[1] The most commonly used is filling with gutta-percha as the core material, combined with root canal sealers or pastes.[2] Because gutta-percha alone is not appropriate for ideal root canal filling due to absence of flow and adhesion to canal walls, using sealers is mandatory to obtain a satisfactory seal.[2],[3] The principle functions of the root canal filling and sealers are sealing off the root canal, entombment of remaining bacteria, and filling irregularities in prepared canals. Root canal sealers must be biocompatible,[4],[5] antimicrobial,[6] and present satisfactory physiochemical properties,[7],[8] dimensional stability, slow setting time, and insolubility.[9]

The main causes of failed endodontic treatments are the persistence of intraradicular infections.[10] Even if the eradication of microorganisms from the canal space, or at least reducing their levels to be appropriate to the periapical tissue health are the objectives of endodontic treatment, the presence of bacteria in dentinal tubules after treatment was recorded.[11]

Knowing that complete elimination of microorganisms from the endodontic space is not predictable, sealers’ antimicrobial action may help get rid of residual microorganisms unaffected by the chemo-mechanical preparation.[12] Accordingly, endodontic sealers with good antimicrobial activity help to minimize or stop the growth of microorganisms and aid in the repairing of periapical tissues.[13]

Although during routine endodontic therapy, it is desired that the endodontic sealers remain inside the root canal, sometimes they are accidentally pushed beyond the apical constriction. In fact, they remain in intimate contact with the surrounding soft and hard tissues for an extended period.

Zinc oxide eugenol (ZnO/E) sealers were successfully used in obturation for over 100 years. They possess antimicrobial activity and are the most common among clinicians, especially when used with thermos-plasticized obturation technique.[14] But moderate to severe cytotoxicity and localized inflammation were observed both in soft tissue and in bone if extruded periapically.[2] Lindqvist and Otteskog[15] suggested that cytotoxicity is due to free eugenol liberated from the set material. Moreover, another study showed that ZnO/E sealers also released formaldehyde after setting.[16]

In an attempt to decrease the cytotoxic effect and add to the antimicrobial property of the ZnO/E sealer, the thought of adding herbal antimicrobial was suggested.

Moringa oleifera is an amazing nutritious tree to the extent that it is also called “Tree of Life or Miracle Tree.” It has been widely used for treating bacterial,[17] fungal infections, and inflammation.[17],[18] The reported antibiotic activity of this tree was a subject of serious scientific research.[19]

Moreover, the recently proven antibacterial effect against Enterococcus faecalis without any cytotoxicity,[20] encouraged us to undergo this attempt of adding of Moringa oleifera to Endofil (ZnO/E) sealer, in a trial to decrease its inflammatory and cytotoxic effect and to take the advantage of the antibacterial and anti-inflammatory properties of Moringa. The physical properties of this new sealer were evaluated.


  Materials and Methods Top


Setting and design

An experimental in vitro study was carried out in the National Research Centre (Dokki, Giza, Egypt) in 2019, for 3 months. Three experimental sealers were prepared by adding M. oleifera to ZnO/E sealer. M. oleifera powder and liquid extracts were obtained from Egyptian Scientific Society of the Moringa Trees, National Research Centre (Dokki, Giza, Egypt). Physical properties (measured according to International Organization for Standardization [ISO] 6876:2012) of the experimental sealers were compared to those of the ZnO/E sealer alone as control.

Grouping of the samples

The study was conducted on the following four groups: Group A: Endofil (Promedica, Neumuenster, Germany) (ZnO/E) sealer alone, Group B: The sealer powder was prepared by adding Moringa leaf powder to ZnO powder in the ratio 2:1 (ZnO and Moringa leaf respectively), Group C: Moringa root powder was added to ZnO powder in the ratio of 2:1, ZnO and Moringa Root, respectively, and Group D: Moringa eugenol liquid was mixed with leaf extract liquid in the ratio 2:1, respectively. For measuring the physical properties of each sealer, the powders and liquids were mixed till required consistency was reached.

Setting time, dimensional stability, solubility, film thickness, and radiopacity were measured according to ISO 6876:2012 as follows[21],[22]:

Setting time: Test was performed under controlled temperature and humidity: 37°C ± 1°C and 95% ± 5% relative humidity. Molds of dimensions 10 mm diameter × 2 mm thickness were filled with the mixed sealers. For each sealer, three specimens were prepared. After initial cement setting time, a Gilmore needle with an active tip of 1.0 mm diameter and 110g weight was used at 5-min intervals to determine the final setting time. The setting times of a sealer was the time that elapsed from the beginning of mixing to the time when no indentation was detected on specimen surface.

Dimensional stability: Molds made of teflon (dimensions 6 mm diameter × 12 mm height) were used. They were backed up with a glass plate, filled with the mixed sealer, then the other side was also backed with another glass plate. This assembly was then placed in an incubator for three times the setting time. The ends of the molds were ground using 600-grit sandpaper after complete setting. The specimens were then removed from the mold, and their length was measured by a digital caliper (L0). Specimens were stored in distilled water, and the container was stored in incubator for 30 days. At the end of the period, samples were dried using tissue paper and their length was remeasured (L1). This was done three times for each sealer, and the difference in length was recorded as the dimensional change (D) in the following formula: (%) = (L1L0)/L0 × 100.

Teflon ring molds with dimensions 20 mm diameter × 1.5 mm height were used for Solubility measurements. Three specimens were prepared for each sealer. Before setting of the sealer, a nylon thread was inserted in it. The specimens were kept in an incubator (at 37°C and 95%) for three times their setting times. After setting, the samples were removed from the molds, and any loose material particles were removed from the surface, using a soft brush. Samples were weighed in an analytical balance with 0.0001g (UMark 210; Bel Engineering, Monza, Italy) precision. The samples were suspended by the nylon thread inside a glassware containing 50 mL of distilled water. Each container was then kept in an incubator for 24h. Samples were then removed and gently washed with distilled water, dried with filter paper, placed in oven for 24h, and then reweighed. This was repeated three times for each sealer. Solubility was determined by calculating the weight loss.

Film thickness: Two glasses of 5-mm thickness were used; 0.5 mL of sealer was placed in the center of one of them and the other was placed centrally over the sealer. After 180 ± 10s post mixing, a load of 150N was applied centrally and vertically on top of the plates. Ten minutes after commencement of mixing, the load was removed, and total thickness of the two plates and the sealer film was measured with a digital caliper. The difference between two measurements showed the film thickness of the materials. This test was repeated three times, and the mean of the three readings was recorded.

Radiopacity: Six specimens were prepared for each material. Specimens with no visible defects were positioned on photo-stimulable phosphor plate (Soredex, Digora, Helsinki, Finland) with the aluminum step wedge of thickness 2–16 mm in 2 mm increments. A dental X-ray system (Progeny, Midmark, Versailles, Ohio), operating at 60kV, 10 mA for exposure time 0.3s with a 30-cm focus-film distance, was used. X-ray images were analyzed using the Digora 1.51 software (Orion Corporation Soredex, Helsinki, Finland). Equal-density areas in the radiographs were identified by the equal-density tool to compare the radiographic density of cements and the radiopacity of the different aluminum step wedge thicknesses. Readings for each sample were recorded and their averages were calculated. Radiopacity values were determined according to the following equation:



where A = radiographic density of the material (RDM) – radiographic density of the aluminum step wedge increments immediately below RDM; B = radiographic density of the aluminum step wedge increments immediately above the RDM – radiographic density of the aluminum step wedge increment immediately below the RDM; 2 = 2 mm increments of the aluminum step wedge.

Statistical analysis

The data were statistically analyzed with IBM Statistical Package for the Social Sciences (SPSS) Statistics software, version 20.0, for Windows. One-way analysis of variance (ANOVA) followed by Tukey post hoc test was used to compare between more than two groups in non-related samples. The significance level was set at P ≤ 0.05 [Table 1],[Table 2],[Table 3],[Table 4].
Table 1: The mean, standard deviation (SD) values of physical properties.

Click here to view
Table 2: The descriptive data of analysis of variance test for each method of evaluation

Click here to view
Table 3: The descriptive data of post-hoc test and CI for mean difference between each pair for each method of evaluation.

Click here to view
Table 4: The descriptive data and CI for mean of each group for each method of evaluation.

Click here to view



  Results Top


Setting time results

There was a statistically significant difference between Group A, Group B, Group C, and Group D, where P < 0.001. A statistically significant difference was found between Group A and each of Group B, Group C, and Group D, where P < 0.001, P = 0.022, and P < 0.001, respectively. Also, a statistically significant difference was found between Group B and each of Group C and Group D, where P < 0.001. A statistically significant difference was found between Group C and Group D, where P < 0.001.

The highest mean value was found in Group B, followed by Group C and Group A, whereas the least mean value was found in Group D [Table 1].

Dimensional stability results

There was a statistically significant difference between Group A, Group B, Group C, and Group D, where P < 0.001. A statistically significant difference was found between Group A and each of Group B and Group C, where P < 0.001 and P = 0.003, respectively, whereas no statistically significant difference was found between Group A and Group D, where P = 1. No statistically significant difference was found between Group B and Group C, where P = 0.192, whereas a statistically significant difference was found between Group B and Group D, where P < 0.001. A statistically significant difference was found between Group C and Group D, where P = 0.003.

The highest mean value of shrinkage was found in Group A and Group D, followed by Group C, whereas the least mean value of shrinkage was found in Group B [Table 1].

Solubility results

There was a statistically significant difference between Group A, Group B, Group C, and Group D, where P = 0.002. A statistically significant difference was found between Group A and Group B, where P = 0.014, whereas no statistically significant difference was found between Group A and each of Group C and Group D, where P = 0.070 and P = 0.611, respectively. No statistically significant difference was found between Group B and Group C, where P = 0.649, whereas a statistically significant difference was found between Group B and Group D, where P = 0.003. A statistically significant difference was found between Group C and Group D, where P = 0.012.

The highest mean value was found in Group B, followed by Group C and Group A, whereas the least mean value was found in Group D [Table 1].

Film thickness results

There was a statistically significant difference between Group A, Group B, Group C, and Group D, where P = 0.001. A statistically significant difference was found between Group A and each of Group B and Group C, where P = 0.002, whereas no statistically significant difference was found between Group A and Group D, where P = 0.624. No statistically significant difference was found between Group B and Group C, where P = 0.999, whereas a statistically significant difference was found between Group B and Group D, where P = 0.007. A statistically significant difference was found between Group C and Group D, where P = 0.009.

The highest mean value was found in Group B, followed by Group C and Group D, whereas the least mean value was found in Group A [Table 1].

Radiopacity

A statistically significant difference was found between Group A, Group B, Group C, and Group D, where P < 0.001. A statistically significant difference was found between Group C and each of Group A and Group D, where P = 0.001 and P < 0.001, respectively, whereas no statistically significant difference was found between Group C and Group B, where P = 0.173. No statistically significant difference was found between Group B and Group A, where P = 0.066, whereas a statistically significant difference was found between Group B and Group D, where P = 0.007. No statistically significant difference was found between Group A and Group D, where P = 0.606.

The highest mean value was found in Group D, followed by Group A and Group B, whereas the lowest mean value was found in Group C [Table 1].


  Discussion Top


Proper root canal system disinfection is important for successfulness of endodontic treatment.[23] In spite of the several enhancements attained recently, endodontic chemo-mechanical disinfection techniques used today cannot provide complete canal sterility.[24]

It was sighted that after canal preparation chemo-mechanically, the antimicrobial properties of sealers could control infections and prevent penetration of fluids, which provide nutrition to the remaining microorganisms.[25] Therefore, endodontic sealers are used in root canal therapy to eliminate microorganisms still remaining in canal systems after chemo-mechanical preparation and to prevent their recolonization. Sealers have to be biologically compatible and with dimensional stability, as well as possess a long-lasting antibacterial effect.[26] Sealers containing eugenol are well-known for their antibacterial property, which was higher against E. faecalis than resin and calcium hydroxide–based sealers.[27]

Due to the proven antimicrobial and anti-inflammatory activity of the M. oleifera against oral and root canal bacteria,[28],[29] and its recently proved antibacterial effect against E. faecalis without any toxicity, this made the authors[20] suggest its safe used as an alternative antimicrobial agent in the root canal therapy; in this study, it was added to ZnO/E sealer in an attempt to dilute its cytotoxic and inflammatory effect on host cells, without weakening its antimicrobial effect on microorganisms.

The importance of using root canal sealers and their essential requirements was reported.[30] Grossman[9] and other authors[31] inspected different properties, including solubility, flow, setting time, and radiopacity of the root canal sealers. That is why in this research, the physical properties (setting time, dimensional stability, solubility, film thickness, and radiopacity) of ZnO/E sealer modified by adding Moringa powder and liquid were evaluated and compared to the ZnO/E sealer alone as a control. The procedures were performed as outlined in the ISO standard 6876:2012.[21]

The amount of Moringa powder or liquid added to the ZnO/E was kept half the amount of the Endofil powder or the liquid, to avoid adversely affecting the physical properties of the original sealer.

According to ISO specifications, sealer’s setting time should differ no more than 10% of what is stated by the manufacturer. Setting time of Endofil was not mentioned by the manufacturer.

Setting time depends on particle size, room temperature, and relative humidity of the sealer.[32] Setting time is clinically important, where it is desirable to have a setting time that is neither too fast nor too slow. The advantages of a slow setting time are that it allows sealer placement in more than one canal as well as the ability to recover gutta-percha from a canal directly after obturation (if correction is necessary). On the contrary, too slow setting time is a disadvantage, because coronal leakage may take place shortly after the completion of root canal treatment.[33] Unset or partially set sealers may allow more rapid diffusion of bacteria or bacterial byproducts, through the obturation.[34]

The results showed that Group B, where the Moringa root powder was added to the powder of ZnO/E took the longest time to set, which was nearly 24h compared to Group A (ZnO/E sealer alone), which was nearly 5h. The shorter setting time of Endofil, was probably because of the absence of calcium hydroxide in its composition, where calcium hydroxide when contacts water delays the setting process.[35] Moringa has vast quantities of calcium, which may be the cause of prolonging the setting time.[36]

Dimensional change determines the percent of shrinkage or expansion of a material after setting. The maximum allowed linear shrinkage is 1%, whereas the maximum allowed expansion is 0.1%.[21] Both shrinkage and expansion are not favorable for a root canal filling material after setting. Shrinkage creates slits and passageways for bacteria and their products, whereas expansion might produce threatening forces, which could cause infractions, leading to dentin fracture.[37] All sealers showed shrinkage more than that considered acceptable by the ISO specification. Group B had the lowest shrinkage of 2.78%, and Groups A and D experienced the highest shrinkage of 9.63%. The contraction presented by the ZnO/E sealer maybe due to the loss of zinc in the immersion solution, which could be related to the continued loss of eugenol from the matrix,[38] these results agreed with the work of Marín-Bauza et al.[39] To the contrary of our results, some literature reported expansion of ZnO/E sealer.[40] From this, we can conclude that the lesser degree of shrinkage occurring with Groups B and C may be due to the lesser percentage of ZnO powder in the mix (where the Moringa powder was added), so decreasing the amount of zinc lost in the immersion solution.

Solubility is an unsatisfactory characteristic for an endodontic sealer because it leads to the release of constituents that may show biological incompatibility and may lead to gap formations that can negatively affect the hermetic seal of the endodontic filling.[41] Solubility and disintegration of endodontic sealers must be as minimal as possible to allow for the creation of a hermetic seal, thus promoting clinical success, because microleakage may occur from the apical third—cervically or vice versa.[42]

ISO 6876:2012 stated that solubility of sealers should not exceed 3% by mass. Solubility results of Groups A and D showed mass loss of 1.45% and 0.65%, respectively, and were within the range approved by the ISO recommendations. On the contrary, Group B showed the highest solubility, which may be due to its delayed setting time, leading to leaching out of its unset components.

On studying the solubilization of different sealers,[8] it was found that the highest solubility was presented by the ZnO/E-based sealer (Endofil) due to the continuously losing eugenol from sealer matrix.[43] It noted that the presence of sodium borate in Endofil aids in increasing its solubility because it is very soluble.[44] The hydrolysis reaction of the hardened zinc eugenolate also contributes to its solubility.[45] Wilson and Batchelor,[46] described the disintegration mechanism of ZnO/E cements as a sequence of continuous loss of eugenol from cement matrix by decomposing the balance between this matrix and eugenol. This may also clarify why group D had the lowest solubility results because the liquid used in mixing was a combination of Moringa extract liquid and eugenol, so the percentage of eugenol in the final mix was less than that in the other three groups. The weight loss of Endofil sealer coincides with the finding of other studies.[39],[47]

Adequate film thickness is mandatory for a satisfying distribution of the sealer into lateral canals, narrow irregularities, and the apical foramina.[48] According to ISO specification, sealers should have a film thickness not more than 50 μm. Greater film thicknesses are undesirable due to the possibility of interfering with proper gutta-percha cones seating inside root canals during the filling procedures.[49] Thin film thickness sealers are expected to better wet the surface than thick film thickness sealers, providing a better seal.[50] Group A, showed the lowest film thickness of 30 μm, followed by Group D of 50 μm film thickness, with no significant difference between them. Both groups had values that complied with what the ISO specification required. Groups B and C, where the Moringa root and leaf powders were added to the ZnO powder, had the highest film thickness of 150 μm. This could possibly be due to different particle sizes of Moringa powder than those of the ZnO powder.

Radiopacity of endodontic filling materials is important as it makes it possible to distinguish between tooth and surrounding structures.[50] It also aids in the assessment of the root canal filling.[51]

The radiopacity for a root canal sealer should not be less than 3 mmAl.[21] All sealers examined showed radiopacity values above the minimum recommendation of the ISO standards. The high radiopacity of the ZnO/E sealer (Endofil) used in this study is due to its content of barium sulfate, zinc oxide, and bismuth subcarbonate in its powder.[37] That explains the high radiopacity of both Groups A and D in comparison to Groups B and C, which have a significantly lower radiopacity, due to incorporation of Moringa powder to the ZnO/E powder, decreasing the amounts of radiopacifiers in the final mix. This agrees with several studies,[52] stating that the degree of radiopacity of Endofil sealers is affected by the amount of ZnO powder in the final sealer mix.[52],[53]

In this study, we recommend that the concentration used was 2:1 (ZnO/E to Moringa either powder or liquid, respectively), maybe future studies could investigate the effect of different concentrations of Moringa. The use of Moringa powder with nano-sized particles when combined with a sealer should be considered in future studies. These tests measuring the physical properties of the experimental sealers do not assure that the material is suitable for its purpose, which is why more tests on clinical and biological performances are being carried out now for a full assessment.

ZnO/E sealer modified with moringa showed acceptable physical properties.

Acknowledgement

None.

Financial support and sponsorship

This work was conducted as a part of a project fundedfrom the National Research Centre, Giza, Egypt.

Conflict of Interest

There are no conflicts of interest.

Data availability Statement

Data can be available on valid request on contacting to corresponding author mail.



 
  References Top

1.
Sadr S, Golmoradizadeh A, Raoof M, Tabanfar MJ Microleakage of single-cone gutta-percha obturation technique in combination with different types of sealers. Iran Endod J 2015;10:199-203.  Back to cited text no. 1
    
2.
Kaur A, Shah N, Logani A, Mishra N Biotoxicity of commonly used root canal sealers: A meta-analysis. J Conserv Dent 2015;18:83-8.  Back to cited text no. 2
    
3.
Razmi H, Bolhari B, Karamzadeh Dashti N, Fazlyab M The effect of canal dryness on bond strength of bioceramic and epoxy-resin sealers after irrigation with sodium hypochlorite or chlorhexidine. Iran Endod J 2016;11:129-33.  Back to cited text no. 3
    
4.
Kim Y, Kim BS, Kim YM, Lee D, Kim SY The penetration ability of calcium silicate root canal sealers into dentinal tubules compared to conventional resin-based sealer: A confocal laser scanning microscopy study. Materials (Basel) 2019;12:531.  Back to cited text no. 4
    
5.
Scarparo RK, Grecca FS, Fachin EV Analysis of tissue reactions to methacrylate resin-based, epoxy resin-based, and zinc oxide-eugenol endodontic sealers. J Endod 2009;35:229-32.  Back to cited text no. 5
    
6.
Radwan MM, Khallaf ME, Kataia EM Formulation and characterization of a calcium silicate/calcium phosphate root end filling material; part II: Adaptability and in-vivo biocompatibility study. Res J Pharm Biol Chem Sci 2016;7:2474-80.  Back to cited text no. 6
    
7.
Radwan MM, Kataia EM, Khallaf ME Formulation and characterization of a calcium silicate/calcium phosphate root end filling material; part I: Synthesis and physico-mechanical properties. Res J Pharm Biol Chem Sci 2016;7:2465-73.  Back to cited text no. 7
    
8.
Resende LM, Rached-Junior FJ, Versiani MA, Souza-Gabriel AE, Miranda CE, Silva-Sousa YT, et al. A comparative study of physicochemical properties of AH plus, epiphany, and epiphany SE root canal sealers. Int Endod J 2009;42:785-93.  Back to cited text no. 8
    
9.
Grossman LI Endodontic Practice. 10th ed. Philadelphia, PA: Henry Kimpton Publishers; 1981. p. 297.  Back to cited text no. 9
    
10.
Tabassum S, Khan FR Failure of endodontic treatment: The usual suspects. Eur J Dent 2016;10:144-7.  Back to cited text no. 10
    
11.
Narayanan LL, Vaishnavi C Endodontic microbiology. J Conserv Dent 2010;13:233-9.  Back to cited text no. 11
    
12.
Poggio C, Trovati F, Ceci M, Colombo M, Pietrocola G Antibacterial activity of different root canal sealers against Enterococcus faecalis. J Clin Exp Dent 2017;9:e743-8.  Back to cited text no. 12
    
13.
Poggio C, Lombardini M, Colombo M, Dagna A, Saino E, Arciola CR, et al. Antibacterial effects of six endodontic sealers. Int J Artif Organs 2011;34:908-13.  Back to cited text no. 13
    
14.
Berman LH, Hargreaves KM, Cohen SR, editors. Cohen's Pathways of the Pulp Expert Consult—E-Book. Mosby. Maryland Heights, Missour United States. 2011. p. 263.  Back to cited text no. 14
    
15.
Lindqvist L, Otteskog P Eugenol: Liberation from dental materials and effect on human diploid fibroblast cells. Scand J Dent Res 1980;88:552-6.  Back to cited text no. 15
    
16.
Bergenholtz G, Horsted-Bindslev P, Reit C, editors. Textbook of Endodontology. 2nd ed. USA: Wiley-Blackwell; 2013. p. 261.  Back to cited text no. 16
    
17.
Das N, Sikder K, Ghosh S, Fromenty B, Dey S Moringa oleifera Lam. leaf extract prevents early liver injury and restores antioxidant status in mice fed with high-fat diet. Indian J Exp Biol 2012;50:404-12.  Back to cited text no. 17
    
18.
Cheenpracha S, Park EJ, Yoshida WY, Barit C, Wall M, Pezzuto JM, et al. Potential anti-inflammatory phenolic glycosides from the medicinal plant Moringa oleifera fruits. Bioorg Med Chem 2010;18:6598-602.  Back to cited text no. 18
    
19.
Zaffer M, Ahmad S, Sharma R, Mahajan S, Gupta A, Agnihotri RK Antibacterial activity of bark extracts of Moringa oleifera Lam. against some selected bacteria. Pak J Pharm Sci 2014;27:1857-62.  Back to cited text no. 19
    
20.
Arevalo-Hıjar L, Aguilar-Luis MA, Caballero-Garcıa S, Gonzales-Soto N, Valle-Mendoza JD Antibacterial and cytotoxic effects of Moringa oleifera (Moringa) and Azadirachta indica (Neem) methanolic extracts against strains of Enterococcus faecalis. Int J Dent2018;25:1071676.  Back to cited text no. 20
    
21.
International Standard ISO 6876:2012. Dentistry Root Canal Sealing Materials. 3rd ed. Vernier, Geneva, Switzerland: International Organization for StandardizationISO Central SecretariatChemin de Blandonnet;2012.  Back to cited text no. 21
    
22.
Lee JK, Kwak SW, Ha JH, Lee W, Kim HC Physicochemical properties of epoxy resin-based and bioceramic-based root canal sealers. Bioinorg Chem Appl 2017;2017:2582849.  Back to cited text no. 22
    
23.
Roshdy NN, Kataia EM, Helmy NA Assessment of antibacterial activity of 2.5% NaOCl, chitosan nano-particles against Enterococcus faecalis contaminating root canals with and without diode laser irradiation: An in vitro study. Acta Odontol Scandinav 2019;77:39-43.  Back to cited text no. 23
    
24.
Haapasalo M, Endal U, Zandi H, Coil JM Eradication of endodontic infection by instrumentation and irrigation solutions. Endodontic Topics 2005;10:77-102.  Back to cited text no. 24
    
25.
Poggio C, Trovati F, Ceci M, Colombo M, Pietrocola G Antibacterial activity of different root canal sealers against Enterococcus faecalis. J Clin Exp Dent 2017;9:e743-8.  Back to cited text no. 25
    
26.
Shourgashti Z, Keshvari H, Torabzadeh H, Rostami M, Bonakdar S, Asgary S Physical properties, cytocompatibility and sealability of Healapex (a novel premixed biosealer). Iran Endod J 2018;13:299-304.  Back to cited text no. 26
    
27.
Hoelscher AA, Bahcall JK, Maki JS In vitro evaluation of the antimicrobial effects of a root canal sealer-antibiotic combination against Enterococcus faecalis. J Endod 2006;32:145-7.  Back to cited text no. 27
    
28.
Alsaraf KM, Abd ST, Husain NS An antimicrobial activity of Moringa oleifera extract in comparison to chlorhexidine gluconate (in vitro study). J Bagh College Dent 2016:28:183-7.  Back to cited text no. 28
    
29.
Mathew T, Shetty A, Hegde MN Comparison of antimicrobial activities of Moringa oleifera leaf, propolis, 2% chlorhexidine gluconate and MTAD on E. faecalis—an in-vitro study. RJPBCS 2014;5:163-73.  Back to cited text no. 29
    
30.
Ruddle C Filling root canals. In: Cohen S, Burns R, editors. Path Ways of the Pulp. 7th ed. St. Louis, Missouri: Mosby; 1994. p. 285-7.  Back to cited text no. 30
    
31.
Walton RE, Torabinejad M Principles and Practice of Endodontics. 2nd ed. Philadelphia, PA: Saunders; 1996.  Back to cited text no. 31
    
32.
Ashraf H, Najafi F, Heidari S, Mohammadian M, Zadsirjan S Physical properties and chemical characterization of two experimental epoxy resin root canal sealers. Iran Endod J 2017;12:149-56.  Back to cited text no. 32
    
33.
Tomson RM, Polycarpou N, Tomson PL Contemporary obturation of the root canal system. Br Dent J 2014;216:315-22.  Back to cited text no. 33
    
34.
Rangappa, KG, Hegde J, Chikkamallaiah C, Rashmi K. Comparative evaluation of the sealing ability of different obturation systems used over apically separated rotary nickel-titanium files: An in vitro study. J Conservative Dent 2013;16:408-12.  Back to cited text no. 34
    
35.
Amabye TG Chemical compositions and nutritional value of Moringa oleifera available in the market of Mekelle. J Food Nutr Sci 2015;3:187-90.  Back to cited text no. 35
    
36.
Thapa K, Poudel M, Adhikari P Moringa oleifera: A review article on nutritional properties and its prospect in the context of Nepal. Acta Sci Agriculture 2019;3:47-54.  Back to cited text no. 36
    
37.
AL-Haddad A, Che Ab Aziz ZA Bioceramic-based root canal sealers: A review. Int J Biomat2016;2016:9753210. p. 1-10.  Back to cited text no. 37
    
38.
Nunes VH, Silva RG, Alfredo E, Sousa-Neto MD, Silva-Sousa YT Adhesion of epiphany and AH plus sealers to human root dentin treated with different solutions. Braz Dent J 2008;19:46-50.  Back to cited text no. 38
    
39.
Marín-Bauza GA, Silva-Sousa YTC, da Cunha SA, Abi Rached-Junior FJ, Bonetti-Filho I, Sousa-Neto MD, et al. Physicochemical properties of endodontic sealers of different bases. J Appl Oral Sci 2012;20:455-61.  Back to cited text no. 39
    
40.
Chandrasekhar V, Morishetty PK, Metla SL, Raju RVSC Expansion of gutta-percha in contact with various concentrations of zinc oxide–eugenol sealer: A three-dimensional volumetric study. JOE 2011;37:697-700.  Back to cited text no. 40
    
41.
Yigit DH, Gencoglu N Evaluation of resin/silicone based root canal sealers. Part I: Physical properties. Dig J Nanomater Bios 2012;7:107-15.  Back to cited text no. 41
    
42.
Zhou HM, Shen Y, Zheng W, Li L, Zheng YF, Haapasalo M Physical properties of 5 root canal sealers. J Endod 2013;39:1281-6.  Back to cited text no. 42
    
43.
Hemed SJ, Waleed M, Khalil WM, Mohammed AA The solubility of a zinc oxide eugenol root canal sealer (Endofil) in normal saline solution at different time intervals. J Bagh College Dent 2005;17:4-7.  Back to cited text no. 43
    
44.
Pécora JD, Silva RG, Savioli RN, Vansan LP Effect of particle size of Grossman's cement powder on setting time. Rev Odontol Univ São Paulo 1998;12:1-4.  Back to cited text no. 44
    
45.
Schäfer E, Zandbiglari T Solubility of root-canal sealers in water and artificial saliva. Int Endod J 2003;36:660-9.  Back to cited text no. 45
    
46.
Wilson AD, Batchelor RF Zinc oxide-eugenol cements: II. Study of erosion and disintegration. J Dent Res 1970;49:593-8.  Back to cited text no. 46
    
47.
Fadhil NH, Al-Hashimi MK An evaluation of the solubility of four endodontic sealers in different solvents (an in vitro study). J Bagh College Dent 2015;27:15-20.  Back to cited text no. 47
    
48.
Said HM, Bakar WZ, Farea M, Husein A The effect of different sealer placement techniques on sealing ability: An in vitro study. J Conserv Dent 2012;15:257-60.  Back to cited text no. 48
    
49.
Tyagi S, Mishra P, Tyagi P Evolution of root canal sealers: An insight story. 2013;2:199-218.  Back to cited text no. 49
    
50.
Bortoluzzi EA, Guerreiro-Tanomaru JM, Tanomaru-Filho M, Duarte MA Radiographic effect of different radiopacifiers on a potential retrograde filling material. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;108:628-32.  Back to cited text no. 50
    
51.
Kielbassa AM, Frank W, Madaus T Radiologic assessment of quality of root canal fillings and periapical status in an Austrian subpopulation—an observational study. PLoS One 2017;12:e0176724.  Back to cited text no. 51
    
52.
Moraes IG, Bramante CM, Moraes FG, Gonçalves SB, Mori GG Radiopacity evaluation of Sealer 26, Endofil endodontic cements and an experimental cement. J Bras Endod 2006;6:8-12.  Back to cited text no. 52
    
53.
Tanomaru JM, Cezare L, Gonçalves M, Tanomaru Filho M Evaluation of the radiopacity of root canal sealers by digitization of radiographic images. J Appl Oral Sci 2004;12:355-7.  Back to cited text no. 53
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
References
Article Tables

 Article Access Statistics
    Viewed181    
    Printed2    
    Emailed0    
    PDF Downloaded20    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]