May 24, 2026
Impact of different drying techniques on bonding strength of bioceramic sealers: An In Vitro Study
- Mohand Saad Mohamed Saeed1,
- Professor. Dr. Manar Fouda2,
- Dr. Nermine Hassan3
- 1Master degree candidate, Department of Endodontics, BDS, Faculty of Dentistry, Cairo University;
- 2Professor of Endodontics, Faculty of Dentistry, Cairo University;
- 3Lecturer of Endodontics, Faculty of Dentistry, Cairo University
Protocol Citation: Mohand Saad Mohamed Saeed, Professor. Dr. Manar Fouda, Dr. Nermine Hassan 2026. Impact of different drying techniques on bonding strength of bioceramic sealers: An In Vitro Study. protocols.io https://dx.doi.org/10.17504/protocols.io.14egn5d26g5d/v1
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: May 05, 2026
Last Modified: May 24, 2026
Protocol Integer ID: 316351
Keywords: Endo-aspirator, Endo-aspirator pro, Well-root ST, Bio-C sealer, Drying techniques, Intra-canal aspirating device, Bonding strength, Paper points, Bio ceramic sealer, bio ceramic sealer, bioceramic sealer, resin sealer, drying technique, ideal moisture condition, ideal residual moisture, techniques on bonding strength, contact with moisture, based sealer, bonding strength, residual moisture, variable perception of residual moisture, formation of hydroxyapatite crystal, hydroxyapatite crystal, releasing calcium, moisture, biocompatible property, calcium, root canal, tight seal, mineral content
Abstract
Compared to resin sealers, calcium-silicate based sealers are better not only due to their biocompatible properties related to their high alkalinity and mineral content. But also, due to their physical advantages having great dimensional stability and their hygroscopic abilities by expansion when in contact with moisture and releasing calcium and hydroxyl ions which help in formation of hydroxyapatite crystals so minimize voids and provide tight seal (Zhou H.M et al, 2013). Operators have variable perception of residual moisture recommended for bio ceramic sealers to initiate the setting mechanism of them properly and evenly along the root canal (Tanomaru-Filho et al, 2017). There is no clear instruction for obtaining the ideal residual moisture when different drying techniques are used such as paper points and endo-aspirator devices or combination between them. Aiming to find the ideal moisture condition for two bio ceramic sealers, this study will compare using an aspirator device alone, paper point alone and combination between both of them to test the bonding strength and the interfacial failure mode.
Materials
- Endo-aspirator pro (CEREKAMED, Poland)
- Bio-C sealer (Angelus, Brazil)
- Well-root ST (Vericom, Korea)
Introduction:
Obturation is the last step done in endodontic treatment and supposed to provide tight, hermetic seal of the canals preventing re-infection and stimulating peri-apical tissue healing (Dotto et al,2020). Obturation is done using gutta percha as the core material of obturation and sealer acting as binder that bonds the gutta percha to radicular dentine and fills areas of the root canal complex anatomy where gutta percha can’t reach (Goldman M et al,1988).
Sealers have been on continuous development and different types have been developing starting form Zinc Oxide and eugenol-based sealers that are not used nowadays due to their disadvantages, followed by Resin sealers that have been gold standard for obturation as AH-Plus (DENTSPLY, Sirona) and currently calcium silicate-based sealers known as bioceramic sealers (Komabayashi T et al, 2020).
Grossman identified requirements needed for an ideal endodontic sealer as follow, it should form tight hermetic seal, should flow properly after mixing, have proper working time, have proper setting time, doesn’t cause tooth discoloration, can set in dry environment or when slight moisture is available, maintain its dimensions upon setting and better expand on setting to provide further sealing, non-irritant to periapical tissues and better enhance healing, bacteriostatic and bactericidal to a limit, insoluble in oral fluid, and should be soluble in most of the recommended solvents in case if retreatment needed (Velayuthamet al , 2014. Grossman's Endodontic Practice - 13th edition.)
Compared to resin sealers, calcium-silicate based sealers are better not only due to their biocompatible properties related to their high alkalinity and mineral content. But also, due to their physical advantages having great dimensional stability and their hygroscopic abilities by expansion when in contact with moisture and releasing calcium and hydroxyl ions which help in formation of hydroxyapatite crystals so minimize voids and provide tight seal (Zhou H.M et al, 2013).
Operators have variable perception of residual moisture recommended for bioceramic sealers to initiate the setting mechanism of them properly and evenly along the root canal (Tanomaru-Filho et al, 2017). There is no clear instruction for obtaining the ideal residual moisture when different techniques are used such as paper points and endo-aspirator devices or combination between them.
Rationale for conducting the research
Successful endodontic treatment is multifactorial and depends on several factors starting from chemo mechanical preparation and different irrigation techniques and protocols and ending by obturation which prevent further reinfections and prevent any pathogen to proceed form the coronal part of the canal to the apex allowing the periapical are to heal properly and relief of pain leading to regression of signs and symptoms of infection (Goldman M. et al, 1988).
It is reported that endodontic treatment failure is due apical leakage of pathogens to the periapical area of the tooth leading to infection and causing irritation in the periapical area. And bioceramic sealers have been known for their ability to set in humid environment. Having a great ability to seal and form chemical bond with radicular dentine. However, for decades drying the canal have been known to increase sealer penetration and better bonding with radicular dentine (Pommel L, et al. 2003).
Residual moisture and environmental factors can alter the sealer setting time either by decreasing setting time as in case of acidic pH it can accelerate the setting time of the sealer and lead to dissociation of its released ions quickly and may even alter its composition and lead to incomplete setting of the sealer that negatively affect the obturation quality leading to voids and causing re-infections (Huang et al. 2017).
Given these information, ideal balance between residual moisture and complete dry situations of the root canal is needed to allow for proper environment of the sealer to set and allow it to do its bioactive and bio-inductive functions after obturating the canals.
Aiming to find the ideal moisture condition for two bio-ceramic sealers, this study will compare using an aspirator device alone, paper point alone and combination between both of them to test the bonding strength and the interface failure mode.
Review of literature
Al-Hiyasat and Alfirjani (2019), conducted an in vitro study to assess the bonding strength of bioceramic sealer (Totalfill BCS) compared to resin sealer (AH-Plus sealer), using different obturating techniques using Push-out test was used to evaluate the bond strength. Teeth were divided according to the obturation technique used into three groups, group one with cold lateral compaction technique, group two with single cone, and group three with warm vertical compaction obturation technique. Results of the push-out evaluation showed that the bioceramic sealer (Totalfill BCS) was significantly higher compared to that of AH-Plus sealer regardless the obturation technique used. On other hand, AH-Plus sealer was
impacted directly by the obturation technique, showing least bonding strength in warm vertical compaction groups and single cone groups, and had the highest bonding strength in cold lateral compaction group. They concluded that bioceramic sealer showed higher bonding strength compared to resin sealers as they have the ability to chemical bond to radicular dentine.
Nishant Khurana et al (2019), conducted an in vitro study to evaluate the bond strength of bioceramic sealer (Endosequence BC, BC Sealer, Brasseler USA, Savannah, GA, USA), MTA based sealer (MTA Fillapex, Angelus, Londrina, Paraná, Brazil), and Resin-based sealer (AH plus ,DENTSPLY, Sirona)) and impact of different drying techniques on them using Push-out test and stereomicroscope for visualizing the tested sections. Teeth were grouped according to the sealer used and sub-grouped according to
the final drying method where, sub-group I was dried using paper points until it was confirmed visually dry, and sub-group II iso-propyl alcohol of 70% concentration was left for 5 seconds and aspirated using low-vacuum endo-aspirator. On final assessment groups dried with 70% iso-propyl alcohol showed higher bonding strength compared to groups dried by paper points were Endosequence BC was the highest followed by AH-Plus sealer, and lastly MTA Fillapex with least bonding strength among them. And on visualizing failure types, AH-Plus showed cohesive failure indicating better bonding ability, Endosequence BC showing adhesive failure at the interface denoting an affection of the chemical adhesion with radicular dentine, and MTA Fillapex showed both adhesive and cohesive failures equally along different slices.
Ozlek E et al (2020), conducted an in vitro study to evaluate the effect of residual moisture in dentine on bioceramic sealers comparing MTA Fillapex (Angelus, Londrina, Paraná, Brazil) and Guttaflow Bioseal (Coltène/Whaledent, Altstätten/Switzerland) using push out test as dislocation evaluating test and observed the failure modes under stereomicroscope. Teeth were divided into three groups according to
moisture level group I wet dentine, group II moist dentine and group III dry dentine then sub-grouped according to the sealer used within obturation Evaluation was done to detect bonding strength at 3 weeks and at 3 months post-obturation. Results showed that Guttaflow Bioseal had higher bonding strength compared to MTA Fillapex at 3 weeks and at 3 months, when comparing all results at 3 weeks to the 3 months results, the 3 months groups showed higher bonding strength compared with the 3 weeks results. Upon inspection, in group I (wet dentine) all specimens showed adhesive failure, while the other two groups showed cohesive failure in the sealer itself. Meaning that residual moisture level has great impact on the setting reaction, interactions and bio-active functions of the calcium silicate-based sealer. So, maintaining the radicular dentine moisture level being not totally dry nor totally wet can have great advantage on the final setting of the bioceramic sealers as it allows for the biomineralization of the sealer-dentine interface.
Frasqueitti Ks et al (2023), conducted an in vitro study to evaluate the bond strength of two bioceramic sealers; Sealer plus BC (MK Life, Porto Alegre, Brazil) and Bio-C (Angelus, Londrina, PR, Brazil) sealer by using different drying techniques on, and used push out test as universal testing device for the bond strength on different sections of the root along the groups. In this study they used the aspirator cannula to eliminate the residual moisture inside the canal after irrigation protocol was done. They concluded that Sealer plus BC showed higher bond strength compared to Bio-C sealer, but the aspiration cannula affected negatively the results in both the coronal and middle thirds. Both sealers showed the same results of bonding strength when compared in the apical part regardless the drying technique used.
Pooja, R. et al (2025), conducted an in vitro study to evaluate the effect of different levels of residual moisture and its effect on two sealers Resin based AH-Plus (DENTSPLY, Sirona) and calcium-silicate based Ceraseal (Meta biomed, Korea). Teeth were divided into four groups according to the
drying technique; among them paper point, alcohol followed by Paper point drying, Alcohol and vacuum cannula, and completely wet group. Push-out test was used to evaluate the bonding strength of both sealers. And then evaluated under stereomicroscope. In conclusion, AH-plus groups showed the highest bonding strength when canals were dried by 95% Ethanol followed by vacuum cannula. On other hand, Ceraseal showed the highest bonding strength when canals were dried using paper points only and showed the least bonding strength with 95% Ethanol group. They concluded that the residual moisture act as point of favor for the calcium-silicate based sealers as it leads to better bonding with radicular dentine and help calcium-silicate based sealers to set properly.
Specific objectives
Research question
In extracted human lower premolar teeth, Does the use of Endo-aspirator pro (CEREKAMED,
Poland) alone or combined with paper points affect the sealing ability of bioceramic Sealers; Bio-C sealer
(Angelus, Brazil) and Well-root ST (Vericom, Korea) when assessed using Push-out test ?
Specific objectives
Aim of the study
To evaluate, the sealing ability of different Bio-ceramic Sealers such as Bio-C sealer (Angelus,
Brazil) and Well-root ST (Vericom, Korea) when canals are dried by Endo-aspirator pro (CEREKAMED,
Poland) alone or combined with paper points using push out test, in an In Vitro study.
Specific objectives
PICO approach:
P: Population - Human extracted Single canal teeth.
I: Intervention I - Drying the canal using Endo-aspirator pro (CEREKAMED, Poland) alone.
I: Intervention II - Drying the canal using Endo-aspirator pro (CEREKAMED, Poland) combined with paper points.
C: Control - Drying the canal using paper points alone with Bio-C sealer (Angelus, Brazil). (Frasquetti et al., 2022)
O: Outcome -
Primary Outcome: To evaluate the apical seal of different bioceramic sealers using push out test in order to test sealing ability of the bioceramic sealers in different levels of residual moisture in the canals.
Secondary Outcome: To detect the failure mode that occurs after push out testing and determine its type using stereomicroscope.
| Prioritization of Outcome | Outcome | Method of Measurement | Unit of Measurement | |
| Primary outcome | Bonding strength at apical part of teeth | Push out test(Reddy et al., 2018) | MPa | |
| Secondary outcome | Failure mode at the interface between sealer and radicular dentine. | Stereomicroscope (Khurana et al., 2019) | Adhesive failure Cohesive failure Mixed failures |
Specific objectives
Prioritization of Outcome:
- Primary outcome: Bonding strength at apical part of teeth measured by Push out test (Reddy et al., 2018) in MPa.
- Secondary outcome: Failure mode at the interface between sealer and radicular dentine measured by Stereomicroscope (Khurana et al., 2019) with outcomes classified as Adhesive failure, Cohesive failure, or Mixed failures.
Specific objectives
Hypothesis:
The null hypothesis is that there is no difference between using endo-aspirator pro alone or combined with paper points for drying the canals on the apical seal of human extracted single canal teeth when used for drying the canals before obturating the canals using one of the three bio ceramic sealers.
Type of the study:
An in vitro comparative study.
Methods
Sample size
Sample size calculation:
A power analysis was conducted to ensure adequate power to detect a significant effect of the tested variables on push-out bond strength. Using an alpha (α) level of (0.05), a beta (β) level of (0.2) corresponding to (80%) statistical power and effect size (Cohen’s f) of (0.450) derived from the results of a previous study (Nishant Khurana et al 2019), the total required sample size (n) was found to be (54) samples. Sample size was increased to account for possible procedural errors during testing to be (66) samples (i.e., 33 samples per group and 11 samples per subgroup). The sample size was calculated using G*Power version 3.1.9.7.
Statistical methods:
Categorical data will be presented as frequencies and percentages and analyzed using a chi-square test. Numerical data will be assessed for normality by examining the distribution and using the Shapiro-Wilk test. If the data are normally distributed, they will be presented as mean and standard deviation values, and a two-way ANOVA test will be used for the analysis. If the normality assumption is violated, the data will be presented as median and range values and analyzed using the Kruskal-Wallis and Friedman’s tests. The significance level will be set at p 3c0.05 for all tests. Statistical analysis will be performed with R statistical analysis software version 4.5.2 for Windows.
Description of study sample:
Sample selection:
Extracted single rooted and single canal mandibular premolar teeth, with completely formed apices, will be collected. All collected teeth will be examined to exclude those with previous root canal treatment, root caries, root resorption, fractures, or cracks.
Inclusion criteria:
- Extracted human single rooted and single canal mandibular premolar permanent teeth.
- Teeth free from caries, fractures, or cracks.
- Teeth with straight canals (curvature <10º based on Schneider’s method).
- Teeth with similar lengths.
- Non endodontically treated teeth.
Exclusion criteria:
- Teeth showing external or internal resorption.
- Teeth with open apices or immature roots.
- Teeth with calcified canals or obstructed pathways.
- Teeth stored in formalin or any chemical that may alter dentin properties.
Groups are divided according to the intervention as following:
Group (1): - Endo-Aspirator Pro (Cerkamed, Poland). (n=22)
- Sub-group 1a Bio-C sealer and Endo-aspirator pro (n=11)
- Sub-group 1b Well-root ST and Endo-aspirator pro (n=11)
Group (2): - Endo-Aspirator Pro (Cerkamed, Poland) and Paper Point drying. (n=22)
- Sub-group 2a Bio-C sealer and Endo-aspirator pro and paper point drying (n=11)
- Sub-group 2b Well-root ST and Endo-aspirator pro and paper point drying (n=11)
Group (3): - Paper Point Drying. (n=22)
- Sub-group 3a Bio-C sealer and paper point drying. (n=11)
- Sub-group 3b Well-root ST and paper point drying. (n=11)
Disinfection and storage
Teeth are disinfected with 5.25% sodium hypochlorite for 5 minutes (Clorox, Egypt), then stored in sterile saline solution.
Sample preparation:
- Collect extracted human mandibular premolar teeth with single canal from the university clinics extracted for orthodontic, prosthodontic and periodontal reasons. And Ethical approval was obtained in accordance with institutional guidelines and Declaration of Helsinki.
- Remove residual soft tissue and calculus, then store teeth in sterile saline until use after disinfected by immersion in 5.25% NaOCl for 5 minutes.
- Pre-operative digital radiographs will be taken in both bucco-lingual and mesio-distal directions to confirm a single patent canal.
- Samples are cut under water cooling using low-speed saw (Isomet 4000 Buehler USA) to obtain uniform 12mm.
- A #10 K-file (MANI, Inc. 25 mm, Japan.) will be used to confirm canal patency, and the working length will be determined using a #15 K-file, inserted until it is visible at the apex, then subtracting 1 mm to obtain a standardized working length.
- Root canal instrumentation will be performed using ROGIN Dental VARI-TAPER FILES Ni-Ti rotary files (SHENZHEN ROGIN MEDICAL CO.LTD, China) supplied in following sizes of Orifice opener and sequential files ISO #15/04, #20/04, #25/04, #30/04, #35/04 and teeth are shaped up to #40/04. In accordance to manufacturer instructions of speed 250 rpm and torque not exceeding 1.5 N.cm.
- Irrigation will be performed using 2 ml of freshly prepared 5% NaOCl (JK Dental. Sodium hypochlorite solution 5% (250 ml). Egypt.), after each rotary file, delivered with a 30 gauge side vented needle 26 mm, double lateral vents , closed front-end.(Fanta Dental Material Co. (n.d.) Shanghai, China) inserted 1 mm short of the working length. Apical patency will be maintained with a #10 K-file between each successive file. Upon completion of instrumentation, 2ml of EDTA 17% (JK Dental) are used followed by 5 ml of saline will be used as a final rinse, followed by drying with sterile paper points or Endo-aspirator Pro according to the group.
- Obturation is done using Gutta percha (Meta Biomed, China) and sub-group sealer using Warm Vertical Compaction technique done by Fast-Fill and Fast-Pack system (Eighteeth, Changzhou Sifary Medical Technology Co.Ltd)
Methods of evaluation:
Dislocation resistance test by push-out bond strength:
Cut samples are cut horizontally using an Isomet saw under water cooling, to obtain 3 horizontal root sections of 1 ± 0.2mm Thickness sections and checked using caliber. The bond-strength is determined by Push-Out test. Push-out test will be done using stainless steel plunger in a universal testing machine (Instron model 3345 universal testing machine, USA) at crosshead speed of 1mm/min to apply push-out force in apico-coronal direction. (Reddy et al., 2018)
The push-out force will be applied in an apico-coronal direction until failure occur. The force will be recorded with its data as Newton and recorded using computer software BlueHill universal Instron England. It will be converted to MPa by applying the following formula.
Push-out bond strength (MPa) = N/A; N = maximum failure load, A = adhesion area (mm^2). The bonding surface area of each slice will be calculated as: [π (r1 + r2)] x [(r1 – r2)^2 + h^2 ]^1/2; π is the constant 3.14, r1, and r2 are the smaller and larger radii, and h is the thickness of the section in mm^3(Gancedo-Caravia and Garcia-Barbero, 2006)
Failure mode analysis:
The failure will be analyzed under a stereomicroscope (XCAM 1080P8MPB Stereomicroscope, ToupTek Photonics, Zhejiang, China.). All samples will be classified into i) adhesive failure between dentin and sealer (no sealer visible on dentine wall), ii) Cohesive failure in sealer (dentine wall covered with sealer), iii) Mixed failure when both adhesive and cohesive failure are observed (seen in both sealer and dentine). Samples representing the failure mode for each group will be evaluated.
Data analysis:
Categorical data will be presented as frequencies and percentages and analyzed using a chi-square test. Numerical data will be assessed for normality by examining the distribution and using the Shapiro-Wilk test. If the data are normally distributed, they will be presented as mean and standard deviation values, and a two-way ANOVA test will be used for the analysis. If the normality assumption is violated, the data will be presented as median and range values and analyzed using the Kruskal-Wallis and Friedman’s tests. The significance level will be set at p 3c0.05 for all tests. Statistical analysis will be performed with R statistical analysis software version 4.5.2 for Windows.
Sequence generation
Random allocation and sequence generation will be performed using a computer random sequence generator program which will be formulated into three columns.
Allocation concealment
To prevent the selection bias in the interventions, the allocated sequence will be protected and concealed until assignment using sequentially numbered opaque sealed envelopes in which the teeth will be placed.
Implementation:
Random allocation, sequence generation and the allocation concealment will be performed by the co-supervisor. The technical procedures will be carried out by the investigator.
Blinding:
Blinding is done for the statistician and the outcome assessor as the researcher can distinguish the groups according to which intervention is done along the groups.
Ethics
The research will be admitted to the ethics committee for review. After receiving the results and finishing the experiment all instruments and teeth samples will be sterilized and discarded in special incinerator under supervision of Microbiology department- Cairo university.
References
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Protocol references
Ahmad S. Al-Hiyasat, Suha A. Alfirjani, The effect of obturation techniques on the push-out bond
strength of a premixed bioceramic root canal sealer, Journal of Dentistry, Volume 89, 2019, 103169,
ISSN 0300-5712, https://doi.org/10.1016/j.jdent.2019.07.007.
• B, Sureshchandra & Gopikrishna, Velayutham. (2014). Grossman's Endodontic Practice - 13th
edition.
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Acknowledgements
Supervisors: Prof. Dr. Manar Fouda, Dr. Nermine Hassan
Funding: Self - Funded
Roles and Responsibilities:
- Mohand Saad Mohamed Saeed: Researcher and principal investigator. Responsibilities include collection of data, preparation, screening and conduction of the practical work and the research results, writing the protocol, producing the final report of the research and writing the article to be published. E-mail: [email protected]
- Professor. Dr. Manar Fouda: Chief supervisor. Responsibilities include monitoring and editing the data and the whole process of the study, accessing the final results and data collected from the study. E-mail: [email protected]
- Dr. Nermine Hassan: Co-supervisor. Responsibilities include sequence generation, allocation concealment, randomization and data management. E-mail: [email protected]