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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Effect of 2% Chlorhexidine Gel Medicament on Push-out Bond Strength of Epoxy Resin and Bioceramic Sealers in teeth extracted from Diabetics: An In-vitro Study
Correspondence Address :
Dr. Naveena Thalabhakthula,
Postgraduate Student, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Takkellapadu, Guntur-522509, Andhra Pradesh, India.
E-mail: drnaveenatpg2022@sids.ac.in
Introduction: Diabetes Mellitus (DM) impairs healing, immune function and dentin metabolism, potentially affecting adhesion. Chlorhexidine (CHX) gel is widely used as an intracanal medicament due to its sustained antimicrobial action; however, its influence on sealer bonding in diabetes-altered dentin is unclear. AH Plus® and BioRoot Root Canal Sealer (RCS) sealers are commonly used, yet their adhesion following 2% CHX application requires evaluation.
Aim: To evaluate the effect of 2% CHX gel on the Push-Out Bond Strength (POBS) of AH Plus® and BioRoot RCS in teeth from diabetics.
Materials and Methods: This in-vitro study was conducted at the Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India. The study duration was three months, from June 2024 to August 2024. A total of 52 single-rooted teeth were prepared up to size 35/06 using Sodium Hypochlorite (NaOCl), sonic activation and Ethylenediaminetetraacetic Acid (EDTA). Specimens were divided into two groups: without 2% CHX (Group-1) and with 2% CHX (Group-2) gel applied for two weeks, followed by obturation using AH Plus® and BioRoot RCS. After two weeks, 2-mm mid-root slices were subjected to POBS testing and bond failure mode analysis.
Results: One-way Analysis of Variance (ANOVA) showed a significant difference in POBS among the groups (F value 9.36, p-value <0.001). AH Plus® with 2% CHX showed the highest mean POBS (2.44±0.59 MPa), followed by AH Plus® without CHX (1.81±0.80 MPa). BioRoot RCS without CHX showed 1.27±0.59 MPa, while BioRoot RCS with 2% CHX showed 1.41±0.44 MPa. CHX increased Bond Strength (BS) for AH Plus®, while only a minimal increase was observed for BioRoot RCS. Post-hoc test illustrated that AH Plus® with 2% CHX (Group-2A: 2.44±0.58) demonstrated a significantly greater POBS compared to BioRoot RCS with 2% CHX (Group-2B: 1.41±0.44) (p-value <0.05).
Conclusion: The AH Plus® showed higher POBS than BioRoot RCS, with 2% CHX significantly enhancing AH Plus® adhesion but not BioRoot RCS.
Adhesion, Matrix metalloproteinase inhibitors, Substantivity, Systemic health influence
The DM is a metabolic disorder characterised by impaired insulin secretion or reduced insulin action (1). It induces structural and functional alterations in the dental pulp by disrupting circadian rhythms, inhibiting dentin bridge formation and compromising vascularity, thereby adversely affecting tissue nourishment, healing and regeneration (2). DM also interferes with calcification, enamel-dentin development and collagen integrity. Advanced glycation leads to increased dentin brittleness, altered mechanical properties and enlargement of dentinal tubule diameter and density, particularly in areas adjacent to the pulp (1). Since peritubular dentin is highly mineralised, diabetes-related changes in calcification may significantly influence its structural characteristics (1).
The success of endodontic treatment relies on effective debridement and disinfection of the root canal system (3). Mechanical instrumentation alone is insufficient, as it leaves residual debris and microorganisms, necessitating chemomechanical preparation (4). Sodium Hypochlorite (NaOCl), Ethylenediaminetetraacetic Acid (EDTA), and CHX are commonly employed irrigants (3), although their antimicrobial efficacy depends on microbial resistance patterns. CHX exhibits substantivity (5), broad-spectrum antimicrobial activity and low toxicity (6); however, it lacks tissue-dissolving ability (6). Intracanal medicaments enhance antimicrobial efficacy, especially in cases of trauma, abscesses, perforations, resorptive defects and immature teeth (7). Among commonly used medicaments, CHX is effective against Enterococcus faecalis (8) and 2% CHX is recommended for persistent endodontic infections (9). CHX gel also facilitates instrumentation and reduces smear layer formation (10). As DM accelerates collagen degradation through increased Matrix Metalloproteinase (MMP) activity (1), CHX, an MMP inhibitor, may enhance dentin-sealer BS (11),(12). Conversely, inadequate removal of intracanal medicaments may hinder sealer penetration and compromise BS (9).
Bioceramic sealers have gained popularity due to their bioactivity and osteoinductive potential (13). BioRoot RCS, composed of tricalcium silicate, zirconium oxide and mineral fillers (14), demonstrates low cytotoxicity, antibacterial properties and sustained calcium ion release that supports tissue regeneration (15). Its hydrophilic nature improves sealing through apatite formation along dentinal walls (15). Epoxy resin–based sealers such as AH Plus® are widely used owing to their low solubility, favourable sealing ability, strong adhesion to dentin and biocompatibility (3). Effective adhesion between the sealer, gutta-percha and dentin is essential to prevent microleakage and ensure long-term treatment success (7).
The POBS testing is a reliable method for assessing interfacial adhesion, although stress distribution may influence results. POBS testing is commonly used to evaluate the adhesion between root canal sealers and dentinal walls. It measures the resistance of the obturation material to dislodgement under compressive forces, thereby reflecting the integrity and stability of the sealer-dentin interface. Adequate BS is essential for maintaining a hermetic seal, preventing microleakage and improving the long-term success of endodontic treatment. Although variations in stress distribution may affect the results, the push-out test is considered a reliable and widely accepted method for assessing the bonding performance of endodontic sealers (16). The use of 2-mm-thick root slices minimises these limitations (17),(18). Cold Lateral Compaction (CLC) was selected due to its safety, cost-effectiveness and ability to promote sealer penetration, despite inherent technique sensitivity and the possibility of void formation (19).
Although CHX has been shown to enhance the BS of resin-based sealers (7), diabetic dentin exhibits altered physicochemical properties that may affect sealer adhesion (1). Furthermore, evidence regarding the influence of CHX as an intracanal medicament on sealer-dentin bonding in diabetic teeth is limited (1),(2).
Therefore, the present study aimed to evaluate the effect of 2% CHX gel on the POBS of root canal sealers in teeth obtained from diabetic patients.
The present in-vitro investigation was carried out in the Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India, over a period of three months from June 2024 to August 2024. Ethical approval for the study was obtained from the Institutional Ethics Committee (Approval No.: Pr.196/IEC/SIBAR/2023). Informed consent was obtained from patients.
Sample size calculation: Sample size was calculated using G*power 3.1.9.2 software with effect size of 0.8, Type 1 (α error): 0.05, power of the study (β error-80%). A total of 52 teeth were required for the study, which were allocated into two primary groups of 26 specimens each. These groups were further divided into four subgroups consisting of 13 samples per subgroup. Allocation concealment was ensured using sealed opaque envelopes prepared by an independent investigator.
A total of 52 freshly extracted permanent single-rooted teeth with a single canal which were extracted due to periodontal reasons were obtained from patients with a documented history of DM for a duration exceeding five years. Samples were collected from department of Oral and Maxillofacial surgery in SIBAR institute of dental sciences, Guntur.
Inclusion criteria: Teeth that were non carious, single-rooted, exhibited a single canal and had completely formed apices were selected.
Exclusion criteria: Teeth with multiple canals, root caries, developmental anomalies, cracks, fractures, previous endodontic treatment, or existing restorations were excluded from the study.
Study Procedure
Root Canal Instrumentation and Preparation: With the required armamentarium as shown in (Table/Fig 1). Following extraction, all the samples (Table/Fig 2) were debrided using an ultrasonic scaler (Coltene Biosonic S1L Portable Scaler, Switzerland) to eliminate surface contaminants and were subsequently stored in 0.1% thymol solution until use. Radiographic examination using a dental X-ray unit (Acteon, X-Mind, England) confirmed the presence of a single canal (Table/Fig 3). Access cavity preparation was performed using Endo Access burs (Dentsply Sirona, USA) (Table/Fig 4) (9). Canal patency was established with size 10 and 15 K-files (Table/Fig 5) (9). The working length was determined and standardised at 1 mm short of the apical foramen. Rotary instrumentation was completed up to size #35/.06 (Table/Fig 6) (9).
Irrigation was carried out using 2 mL of 3% NaOCl (PRIME Dental Products Pvt., Ltd., India) for one minute, followed by sonic activation using an EndoActivator (Super Endo Sonic Flush Endo Irrigator) equipped with a 25/.04 tip for 30 seconds (19). After each irrigation cycle, the canals were flushed with 1 mL of distilled water for one minute. Upon completion of instrumentation, the canals were irrigated with 2 mL of 17% EDTA (Waldent Alchem, India) for one minute, followed by a final rinse using 5 mL of distilled water for one minute (20).
Grouping and medicament application: Extracted human teeth specimens were randomly allocated into two groups (n=26 each) using a computer-generated randomisation sequence created in IBM SPSS Statistics (Version 21, IBM Corp., Armonk, NY, USA). Allocation concealment was maintained by an independent researcher who prepared the randomisation list and assigned specimens using sequentially numbered, opaque, sealed envelopes to ensure unbiased group distribution.
• Group-1 (n=26): No application of 2% CHX gel;
• Group-2 (n=26): Application of 2% CHX gel.
In Group-2, 2% CHX gel (Waldent Alchem, India) (Table/Fig 7) was delivered into the root canals using a size #25 lentulospiral (Table/Fig 8) (Waldent Alchem, India). The access cavities were temporarily sealed with Cavitemp {Amrit Chemicals & Minerals Agency (AMMDENT), India}, and all samples were incubated in a humidity-controlled oven {Rajendra Electric Motor Industries (REMI), India} at 37°C with 95% relative humidity for a period of two weeks (Table/Fig 9) (9).
After the incubation period, the intracanal medicament in Group-2 was removed using hand K-files in conjunction with distilled water irrigation and sonic activation (Table/Fig 10) (9). This was followed by irrigation with 2 mL of 3% NaOCl for one minute, sonic activation for 30 seconds using a 25/.04 EndoActivator tip, rinsing with 1 mL of distilled water for one minute, irrigation with 2 mL of 17% EDTA for one minute and a final rinse with 5 mL of distilled water for one minute (20).
The specimens were further categorised into four subgroups:
• Group-1A: AH Plus® sealer without CHX medicament;
• Group-1B: BioRoot RCS sealer without CHX medicament;
• Group-2A: AH Plus® sealer following CHX medicament application;
• Group-2B: BioRoot RCS sealer following CHX medicament application.
Obturation procedure: The root canals were dried using absorbent paper points prior to obturation. AH Plus® (Dentsply, Konstanz, Germany) and BioRoot RCS (Septodont, France) sealers were prepared in accordance with the manufacturers’ guidelines. Obturation was performed using the CLC technique. A size 35/02 master gutta-percha cone coated with sealer was placed to the predetermined working length. Lateral compaction was achieved using a size #25 finger spreader (Mani, Tochigi, Japan) along with accessory gutta-percha cones. Excess gutta-percha was removed at the canal orifice level (21).
Subsequently, the access cavities were restored using a composite resin (Beautifil II, Shofu Inc.) and all specimens were stored under humid conditions for two weeks to ensure complete setting of the sealers.
Push-Out Bond Strength (POBS) evaluation: Total tooth samples were mounted on acrylic Moulds (Table/Fig 11). Using microtome (Baincut LSS) (Table/Fig 12), each specimen was sectioned to obtain 2-mm-thick slices from the middle third of the root using a microtome (Baincut LSS) (Table/Fig 13) (9).
The POBS testing was conducted using a universal testing machine (Instron E3000) (Table/Fig 14)). A cylindrical plunger with a diameter of 0.5 mm was employed. The slices were positioned with the apical surface facing the plunger to facilitate loading in an apico-coronal direction. A crosshead speed of 1 mm/min was applied until debonding occurred (9).
Failure mode assessment: Following BS testing, the mode of failure was analysed under a stereomicroscope (Magnus, Olympus India Pvt., Ltd.). The observed failure patterns were documented and subjected to statistical analysis (9).
STATISTICAL ANALYSIS
Data analysis was performed using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY, USA). One-way Analysis of Variance (ANOVA) was applied to compare POBS among groups, followed by Tukey’s post-hoc test for pair-wise comparisons. Chi-square test was used to evaluate differences in failure modes. A p-value<0.05 was considered statistically significant.
As presented in (Table/Fig 15) (One-way analysis of variance), the overall trend in BS values was observed as follows: AH Plus® with 2% CHX > AH Plus® > BioRoot RCS with 2% CHX > BioRoot RCS. One-way ANOVA revealed statistically significant difference in POBS among the four groups (F=9.36, p value< 0.001). The mean POBS of AH Plus® without CHX (Group-1A: 1.81±0.802) was higher than that of BioRoot RCS without CHX (Group-1B: 1.27±0.58); while AH Plus® with CHX application (Group-2A: 2.44±0.58) demonstrated a greater POBS compared to BioRoot RCS with CHX (Group-2B: 1.41±0.44).
As presented in (Table/Fig 16) the overall trend in BS values was observed as follows: AH Plus® with 2% CHX > AH Plus® > BioRoot RCS with 2% CHX > BioRoot RCS.
The Tukey’s post-hoc test to identify intergroup differences showing the mean POBS of AH Plus® without CHX (Group-1A: 1.81±0.802) was higher than that of BioRoot RCS without CHX (Group-1B: 1.27±0.58); however, the difference was not statistically significant (p-value ≥0.05). In contrast, AH Plus® used following CHX application (Group-2A: 2.44±0.58) demonstrated a significantly greater POBS compared to BioRoot RCS with CHX (Group-2B: 1.41±0.44) (p-value ≤0.05) as presented in (Table/Fig 17).
The pair-wise comparisons to study the effect of CHX on push out BS of sealers which show that CHX tends to increase BS of Epoxy Resin sealer, but the improvement was not statistically significant (p-value >0.05) (Table/Fig 18)a. CHX showed no statistically significant effect on bioceramic sealers (p-value >0.05) has been presented in (Table/Fig 18)b. However, while comparing effect of CHX on both the sealers, with CHX Push out BS of AH Plus® significantly increased compared to BioRoot RCS (p-value ≤0.05) (Table/Fig 18)c.
The variation in failure patterns among the experimental groups showing statistically significant difference between the experimental groups (p-value <0.001 as represented in (Table/Fig 19). Group-1A predominantly exhibited mixed failures, whereas adhesive failures were more frequently observed in Group-1B. Group-2A showed mainly cohesive failures, while mixed failure modes were most commonly noted in Group-2B.
The distribution of bond failure modes among the experimental groups is depicted in (Table/Fig 20). Group-1A predominantly exhibited mixed failures, whereas adhesive failures were more frequently observed in Group-1B. Group-2A demonstrated mainly cohesive failures, while Group-2B showed a higher incidence of mixed failure patterns.
The POBS values observed in the present study followed the order: AH Plus® with 2% CHX > AH Plus® without 2% CHX > BioRoot RCS with 2% CHX > BioRoot RCS without 2% CHX. In the absence of CHX, AH Plus® exhibited superior BS compared to BioRoot RCS.
One-way ANOVA revealed a statistically significant overall difference (F value 9.36, p-value <0.001), pair-wise comparisons indicated that AH Plus® with CHX demonstrated superior BS compared to BioRoot RCS groups. This suggests a material-specific enhancement rather than a generalised effect.
In the present study, the mean POBS of AH Plus® without CHX {Group-1A (1.81±0.802)} was reported to be higher than BioRoot RCS without CHX {Group-1B (1.27±0.58)} without any significant difference (p value >0.05). AH Plus® sealer with CHX {Group-2A (2.44±0.58)} demonstrated significantly higher mean POBS values compared to the BioRoot RCS with CHX {Group-2B (1.41±0.44)} with p-value ≤0.05 (Tukey post-hoc). There was a positive effect of CHX on POBS of AH Plus® {(Group-1A (1.81±0.802) and Group-2A (2.44±0.58)} but without significant difference with p-value >0.05. There was no significant effect of CHX on POBS of BioRoot RCS {Group-1B: 1.27±0.58 and Group-2B: 1.41±0.44} with (p-value >0.05).
The CLC was selected to evaluate POBS due to its safety, cost-effectiveness and ability to promote sealer penetration, despite inherent technique sensitivity and the possibility of void formation (19).
This finding was in agreement with Donnermeyer D et al., who attributed the enhanced adhesion of AH Plus® to its ability to form covalent bonds with dentinal collagen, whereas calcium silicate-based sealers rely primarily on mineral infiltration–mediated micromechanical retention (22).
Neelakantan P et al., demonstrated improved BS of AH Plus® following EDTA and NaOCl irrigation, which was attributed to effective smear layer removal facilitating deeper sealer penetration (23). In contrast, NaOCl used alone may negatively affect resin bonding by degrading the collagen or organic matrix of dentin (23),(24),(25). Kurup D et al., also reported enhanced bonding performance of AH Plus®, attributing it to its dimensional stability and minimal polymerisation shrinkage (26). Conversely, Saleh IM et al., suggested that retention of the smear layer may improve calcium silicate–based sealers marginal adaptation, which could explain the reduced BS of BioRoot RCS following smear layer removal (27).
Contradictory findings have been reported in the literature. Nouroloyouni A et al. and Navjot SM et al., observed higher BS values for calcium silicate-based sealers, attributing this to compromised resin-dentin bonding after NaOCl-induced collagen degradation and to hydroxyapatite formation during the setting reaction of calcium silicate sealers, which enhances their adhesion (19),(28).
In the present study, mean POBS of AH Plus® sealer has been significantly improved with CHX intracanal medicament (Group-2A). For BioRoot RCS the mean BS has increased but there was no significant effect of CHX on BS. Similar results were obtained by Maan S et al., where AH Plus® showed considerably more POBS than MTA Fillapex following administration of CHX intracanal medication (7). They claimed that CHX might improve resin-based sealer BS which may account for increased POBS of AH Plus®. Additionally, they noted that AH Plus® superior BS might be influenced by its capacity to form covalent bond with collagen amino groups, its reduced shrinkage, intrinsic volumetric expansion and long-term dimensional stability (7).
Comparable to the results of present research, AH Plus® had better BS than MTA Fillapex with CHX as a final irrigant mentioned by Gupta PR et al., CHX strengthens resin-based sealer bond to dentine as it acts as an MMP inhibitor and prevents collagen degradation, thus allows better penetration of resin sealers into collagen network (11). The irrigation protocol used to remove smear layer i.e., 17% EDTA results in demineralisation and exposes collagen matrix with which AH Plus® sealer bonds. This might be the reason for improved BS of Resin sealer (11). The stable BS achieved by AH Plus® after application of 2% CHX medicament in this study might also be due to above mentioned properties of CHX.
Although BioRoot RCS demonstrated an increase in BS after CHX application, the difference was not statistically significant. Similar findings were reported by Roy D et al., who suggested that while CHX may improve dentin wettability, residual medicament may restrict sealer penetration into dentinal tubules (9).
The comparatively lower BS of BioRoot RCS in the present study may also be attributed to alterations in diabetic dentin. Although CHX has been shown to enhance the BS of resin-based sealers (7), diabetic dentin exhibits altered physicochemical properties that may affect sealer adhesion (1). Abbassy MA et al., reported reduced mineralisation and impaired collagen maturation in teeth affected by DM (29). Additionally, Saghiri MA et al., observed reduced POBS values for mineral trioxide aggregate in diabetic dentin due to increased dentinal tubule density and reduced peritubular mineralisation, factors that adversely affect sealers dependent on mineral-based bonding mechanisms (1). Hyperglycaemia-associated increases in MMP and Advanced Glycation End-product (AGE) activity further compromise the organic dentinal matrix (30). CHX may partially counteract these effects by inhibiting dentinal MMPs and cathepsins, thereby favouring improved adhesion of epoxy resin–based sealers such as AH Plus® (11).
Failure mode analysis revealed variations based on sealer type and CHX application. In the absence of CHX, AH Plus® predominantly exhibited mixed failure patterns, whereas BioRoot RCS showed mainly adhesive failures, indicating weaker sealer-dentin interaction. Following CHX application, AH Plus® demonstrated predominantly cohesive failures, which is consistent with findings reported by Gupta H et al., Vilanova WV et al. and Albino Souza M et al., reflecting improved bonding and mechanical integrity (3),(4),(5). BioRoot RCS with CHX showed mainly mixed failures, while adhesive failures were more frequent without CHX. This may be attributed to reduced calcium availability and mineralisation in diabetic dentin, which adversely affects the inorganic-phase-dependent bonding mechanism of calcium silicate-based sealers. Although Roy D et al., reported cohesive failures for both sealers following intracanal medicament use, the altered characteristics of diabetic dentin may explain the differences observed in the present study (9).
Overall, AH Plus® demonstrated superior POBS owing to its chemical bonding potential and favourable physical properties, with CHX application further enhancing its adhesion. Although BioRoot RCS showed improvement following CHX application, its bonding effectiveness appeared limited by diabetes-induced dentinal alterations. Further investigations are warranted to substantiate these findings.
Limitation(s)
The present in-vitro study utilised teeth obtained from diabetic patients, which may limit direct extrapolation of the results to clinical scenarios. The use of single-rooted teeth with straight canals restricts the applicability of the findings to more complex root canal anatomies. POBS was evaluated after a two-week period of CHX application; longer evaluation periods may be necessary to assess long-term bond durability. Minor variations in sealer manipulation could have influenced the outcomes. Additionally, BS assessment was limited to the middle third of the root, which may not represent variations along the entire canal length. The findings may not be applicable to healthy dentin, underscoring the need for comparative studies.
Within the limitations of the present study, AH Plus® exhibited significantly higher POBS than BioRoot RCS in teeth obtained from diabetic patients. The application of 2% CHX enhanced the adhesion of AH Plus®, while BioRoot RCS also demonstrated an increase in BS following CHX application, although this improvement was not statistically significant. Considering the altered bonding behaviour of sealers in diabetic dentin, the use of 2% CHX as an intracanal medicament may contribute to improved obturation quality, especially when epoxy resin-based sealers are employed. Further in-vivo and comparative studies are required to validate these findings under clinical conditions.
DOI: 10.7860/JCDR/2026/87650.24373
Date of Submission: Jan 22, 2026
Date of Peer Review: Mar 06, 2026
Date of Acceptance: May 04, 2026
Date of Publishing: Sep 01, 2026
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
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ETYMOLOGY: Author Origin
EMENDATIONS: 6
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