The Effect of Bioceramic HiFlow and EndoSequence Bioceramic Sealers on Increasing the Fracture Resistance of Endodontically Treated Teeth: An In Vitro Study

Background/purpose Root fractures after endodontic treatment are a serious complication, and it often causes tooth loss, several studies have found a correlation between root canal preparation and filling, and the possibility of root fracture. Therefore, this study aimed to evaluate the root fracture resistance of the endodontically treated mandibular premolars after preparing and filling by EndoSequence Bioceramic (BC), EndoSequence BC HiFlow, and AH Plus (AHP). Materials and methods The study sample consisted of 75 single-rooted and single-canal mandibular premolars, they were randomly distributed into five groups: Group I: root canals preparation and fillings with AHP sealer; Group II: root canals preparation and fillings with EndoSequence BC sealer; Group III: root canals preparation and fillings with BC HiFlow sealer; Group IV (Negative Control): without root canals preparation; and Group V (Positive Control): canals preparation without root canals filling. A glide path was established by #10 hand K-file, then the crowns were cut, and the canals were prepared and filled. All teeth were restored with glass ionomer cement and kept in an incubator at 37°C for a week. All samples were placed within acrylic bases and a vertical force was applied using a Testometric machine and the fracture resistance force was recorded. Results EndoSequence BC and BC HiFlow groups showed slightly better fracture resistance (494.440, 496.960 N respectively) than AHP group (492.680 N). However, no statistically significant difference was found between the two groups (P-value >0.05). The greatest mean fracture force was observed in the positive control group (736.040 N) with statistically significant difference between the other groups (P-value <0.01) and the least mean fracture force was shown in the negative control group (318.040 N) with statistically significant difference between the other groups (P-value <0.01). Conclusion Based on this in vitro study, the use of EndoSequence BC, BC HiFlow, and AHP enhanced the fracture resistance in root-filled single-rooted premolar teeth. While, the application of EndoSequence BC, BC HiFlow, and AHP did not increase the fracture resistance of roots compared to that of unprepared root canals.