Effect of citric acid and chitosan chelators on dentinal tubule penetration depth of bioseramic based root canal sealers: a confocal microscope study

The success of root canal treatment depends on achieving effective disinfection through irrigation followed by a hermetically sealed filling in the root canal. The penetration of the root canal sealer into dentinal tubules is an important parameter indicating the quality of the filling. Tubular penetration is influenced by the irrigation solution and the physical properties of the sealer used. Therefore, the effect on penetration should be considered when selecting the irrigation solution and root canal sealer in endodontic treatment. The aim of this study is to evaluate the effects of different irrigation solutions on the penetration depth, area, and percentage of bioceramic-based sealers in dentinal tubules. In this study, 63 extracted teeth were divided into nine groups: for irrigation solutions, the control group used EDTA, and the experimental groups used chitosan and citric acid; for sealers, the control group used AH Plus, and the experimental groups used Bio-C Sealer and MTA Fillapex. The sealers were stained with rhodamine B to be visualized under a CLSM (Confocal Laser Scanning Microscope). From the filled teeth, two 1-mm-thick horizontal sections were obtained from the middle and apical thirds using a precision sectioning device (Minitom). Statistical analyses were performed using IBM SPSS Statistics 22, and penetration depth, area, and percentage were evaluated using a Three-Way ANOVA and post hoc Tukey HSD test. According to the study's findings, chitosan significantly improved the penetration of the sealer compared to citric acid and EDTA, while no significant difference was observed between citric acid and EDTA. Bio-C Sealer demonstrated statistically significantly better penetration than MTA Fillapex and AH Plus, while no significant difference was found between MTA Fillapex and AH Plus. Keywords: Penetration, laser scanning confocal microscope, EDTA, chitosan, citric acid, AH Plus, Bio-C Sealer, MTA Fillapex