ORIGINAL RESEARCH

https://doi.org/10.5005/jp-journals-10015-2565
World Journal of Dentistry
Volume 16 | Issue 1 | Year 2025

Effect of Different Irrigation Protocols on Push-out Bond Strength of Calcium Silicate-based Root Canal Sealer to Dentin

Aysath Aphiya¹, Moksha Nayak², Aishwarya M U³

¹Department of Conservative Dentistry and Endodontics, Yenepoya Dental College and Hospital, Mangaluru, Karnataka, India

²Department of Conservative Dentistry and Endodontics, KVG Dental College and Hospital, Mangaluru, Karnataka, India

³Department of Oral and Maxillofacial Surgery, A B Shetty Memorial Institute of Dental Sciences, Mangaluru, Karnataka, India

Corresponding Author: Aysath Aphiya, Department of Conservative Dentistry and Endodontics, Yenepoya Dental College and Hospital, Mangaluru, Karnataka, India, Phone: +91 9731832476, e-mail: aphiya8aysha@gmail.com

Received: 02 January 2025; Accepted: 29 January 2025; Published on: 13 March 2025

ABSTRACT

Aim: To investigate the effect of different irrigation protocols on the push-out bond strength of calcium silicate-based root canal sealer to radicular dentin.

Materials and methods: The root canals of 32 single-rooted premolars were instrumented and randomly allocated into two groups (n = 16) according to the irrigation regimen: group I—irrigation with 17% ethylenediaminetetraacetic acid (EDTA), and group II—irrigation with 3 mL of QMix. Root canals were obturated with CeraSeal bioceramic root canal sealer and gutta-percha. Two-millimeter-thick horizontal sections from the coronal and middle thirds of each root were sliced for push-out bond strength measurement and evaluated using a universal testing machine. Data were statistically analyzed using analysis of variance (ANOVA), and comparisons between the groups were performed using Tukey’s post hoc test in R Commander software.

Results: Statistically significant differences were observed between the two groups (p < 0.05). Samples irrigated with QMix solution showed increased push-out bond strength of calcium silicate-based root canal sealer to dentin compared to 17% EDTA solution.

Conclusion: The irrigation protocol with QMix resulted in higher push-out bond strength compared to irrigation with EDTA. Hence, the QMix irrigation protocol may be more beneficial in clinical scenarios to prevent endodontic failure related to obturation.

Clinical significance: Using QMix as an irrigation protocol may enhance endodontic success by improving sealer adhesion and minimizing obturation failure.

Keywords: Ethylenediaminetetraacetic acid, Obturation, Push-out bond strength, QMix, Root canal irrigant, Sodium hypochlorite

How to cite this article: A A, Nayak M, U AM. Effect of Different Irrigation Protocols on Push-out Bond Strength of Calcium Silicate-based Root Canal Sealer to Dentin. World J Dent 2025;16(1):45–50.

Source of support: Nil

Conflict of interest: None

INTRODUCTION

The success of endodontic therapy relies heavily on thorough chemomechanical preparation of the root canal system and effective three-dimensional obturation, ensuring that the root canal space previously occupied by the canal contents is adequately filled.¹^,² Mechanical instrumentation of the root canal inevitably creates an amorphous smear layer on the dentin surface. This smear layer consists of organic and inorganic debris that obstructs dentinal tubule openings, promotes microbial colonization, and impairs the effectiveness of root canal irrigants and medicaments.³ Additionally, it hinders sealer bonding and penetration, thereby compromising the integrity of the postobturation seal. Therefore, the removal of the smear layer is critical to achieving successful root canal treatment.³^,⁴

During chemomechanical preparation, chemical irrigants play a vital role in disinfecting the root canal space and removing the smear layer. Sodium hypochlorite (NaOCl) is the most commonly used irrigant due to its ability to dissolve organic tissue and its excellent antibacterial properties.⁵^,⁷ However, NaOCl alone cannot remove the smear layer, necessitating the use of additional chelating agents or acids. Ethylenediaminetetraacetic acid (EDTA), a widely used chelating agent, acts on the inorganic component of the dentin, reacting with calcium ions to cause decalcification.⁸^,⁹ While EDTA is effective at smear layer removal, it has significant limitations, including dentin erosion, which depends on its concentration and duration of application. Prolonged exposure to EDTA can lead to damage to the periapical tissues, raising concerns about its use.

To address the limitations of EDTA, a novel EDTA-based formulation, QMix, was introduced. QMix is a final rinse solution containing EDTA, chlorhexidine, and a surfactant, offering a less toxic alternative to 17% EDTA. It combines the ability to remove the smear layer with antibacterial properties and enhanced wettability, facilitating better penetration into the root canal system.¹⁰^,¹³ Additionally, QMix has demonstrated reduced dentin erosion compared to EDTA and provides improved adhesion of sealers to dentin walls. Despite its potential advantages, the diffusion of irrigants into dentinal tubules and lateral canals during manual syringe irrigation remains a challenge.¹⁴^,¹⁵ Agitated irrigation techniques can further enhance the efficacy of irrigants by physically and chemically modifying the dentin surface, thereby promoting the retention of filling materials.

The smear layer removal exposes dentinal tubules, allowing the sealer to interlock with tubular dentin and aiding in the displacement of obturating materials.¹⁶ Achieving and maintaining the integrity of the dentin-sealer interface requires enhanced bond strength, facilitated by either micromechanical retention or frictional resistance.¹⁷ CeraSeal, a modern bioceramic sealer, was selected for this study due to its superior bioactive properties and excellent sealing ability. According to the manufacturer, CeraSeal remains dimensionally stable, with no shrinkage or expansion, and is suitable for single-cone obturation techniques. These properties make it a promising material for achieving a durable seal within the root canal system.¹⁸

The push-out bond strength test is widely used to evaluate the adhesion between root canal sealers and dentin.¹⁹ It involves applying a tensile load perpendicular to the long axis of the root until the filling material is dislodged, providing insights into the sealer’s performance. The present study aimed to compare the influence of two irrigation protocols—EDTA and QMix—on the push-out bond strength of CeraSeal to dentin walls using a manual syringe irrigation technique.

This investigation is essential to determine whether QMix, as an advanced irrigant, offers significant advantages over traditional EDTA in enhancing the sealer-dentin bond strength. The null hypothesis tested in this study was that the irrigation protocols employed have no influence on the push-out bond strength of the sealer-dentin interface. The results of this study are anticipated to guide clinicians in selecting optimal irrigation protocols for improved endodontic outcomes.

MATERIALS AND METHODS

Study Design and Sample Size Calculation

This study was an in vitro experimental study designed to evaluate the push-out bond strength of a bioceramic sealer (Ceraseal) in root canals irrigated with different endodontic irrigants. The required sample size was calculated using the formula:

n= [2 × SD² × (Zα/2 + Zβ)²] / d²

Where:

SD = 0.79 (standard deviation based on previous studies)

Zα/2 = 1.96 (at 5% error)

Zβ = 0.84 (at 80% power)

d = 0.56 (effect size)

The estimated sample size was 31. To account for variability, 32 single-rooted human premolar teeth were included in the study.

Ethical Approval

The study was approved by the Institutional Ethics Committee under approval number IECKVGDCH/SS06/2020-21.

Study Duration

The study was conducted over a 4-month period from December 2021 to March 2022.

Study Groups and Sample Size

Thirty-two single-rooted premolar teeth were selected based on the following inclusion and exclusion criteria.

Inclusion Criteria

Single-rooted premolar teeth extracted for orthodontic or periodontal reasons.
Intact roots without fractures or resorptions.
Mature apices.

Exclusion Criteria

Teeth with visible cracks, fractures, or previous root canal treatments.
Roots with curved canals.
Teeth with calcified canals.

The samples were divided into two groups of 16 teeth each based on the irrigation protocol. Group I (n = 16): Irrigation with 3 mL of 3% sodium hypochlorite (NaOCl), followed by 1 mL of normal saline and 3 mL of 17% EDTA for 1 minute. Group II (n = 16): Irrigation with 3 mL of 3% NaOCl, followed by 1 mL of normal saline and 3 mL of QMix 2-in-1 for 3 minutes.

Sample Preparation

The teeth were cleaned, stored, sterilized, and handled according to OSHA and CDC guidelines. The access cavity was prepared, and canal patency was confirmed using a K-file of ISO size 08 (Figs 1A and B). Root canals were prepared to an apical preparation size F3 using the ProTaper Gold rotary system (Fig. 1C). Between each instrumentation step, canals were irrigated with 1 mL of 3% NaOCl.

Figs 1A to D: (A) Access opening, (B) Biomechanical preparation, (C) Working length determination, (D) Irrigation with 17% EDTA/QMix

Irrigation

Following instrumentation, canals were irrigated based on the respective group protocols. Group I was irrigated with 3 mL of 3% NaOCl, followed by 1 mL of normal saline and 3 mL of 17% EDTA for 1 minute (Fig 1D). Group II was irrigated with 3 mL of 3% NaOCl, followed by 1 mL of normal saline and 3 mL of QMix 2-in-1 for 3 minutes (Fig 1D). All irrigations were performed using NaviTip side-vented needles to ensure uniform delivery of irrigants. Canals were finally flushed with 3 mL of normal saline and dried with sterile paper points (Fig 1D).

Sealer Placement and Obturation

Ceraseal was introduced into the canals using the provided syringe tip. Excess sealer was removed using water-soaked cotton pellets. A gutta-percha point (F3) was inserted into the canal, and the coronal region was sealed with Gian. Samples were incubated at 37°C and 95% relative humidity for 1 week to allow sealer setting.

Push-out Bond Strength Test

Teeth were decoronated at the cementoenamel junction to standardize root length to 15 mm (Fig. 2A). Each root was sectioned horizontally into 2 mm thick slices from the coronal and middle thirds using a hard tissue microtome (Fig 2B). Slices were embedded in chemically cured acrylic resin. The push-out bond strength test was conducted using a universal testing machine equipped with a 0.8 mm diameter stainless-steel plunger. The crosshead speed was set at 1 mm/minute, and the maximum force (N) was recorded. Bond strength (MPa) was calculated using the formula:

Figs 2A to B: (A) Coronal third, (B) Middle third

Bond strength (MPa) = Force (N) / Bonded area (mm²)

The primary outcome was the push-out bond strength of the sealer to radicular dentin. Mean values and standard deviations were calculated for each group and tooth section (coronal and middle thirds).

Data were analyzed using one-way analysis of variance (ANOVA) to compare the bond strength across groups and tooth sections. Tukey’s post hoc tests were employed for pairwise comparisons when significant differences were identified. Statistical significance was set at p < 0.05. Analyses were performed using R Commander software (version 4.0).

RESULTS

The push-out bond strength varied significantly across groups and tooth sections, indicating that the choice of irrigant and the location within the tooth strongly influence the adhesion of sealers to dentin.

In both group I and group II, statistically significant differences were observed between the coronal and middle thirds (p < 0.05) (Table 1 and Fig. 3). For both groups, the coronal third consistently exhibited higher mean bond strength values compared to the middle third:

**Table 1:** Intergroup comparison between irrigants for push-out bond strength (MPa) at coronal and middle third of the root canal
Groups	I. EDTA			II. QMix
Groups	n	Mean ± SD	Median	n	Mean ± SD	Median
Coronal third	16	3.29 ± 0.52	3.37^Aa	16	4.17 ±0.38	4.23^Aa
Middle third	16	2.66 ±0.28	2.72^Ba	16	3.83 ± 0.33	3.78^Ba

Different uppercase letters indicate significant differences between groups in the same column, and different lowercase letters indicate significant differences between groups in the same row (p < 0.05) according to ANOVA; SD, standard deviation

Fig. 3: The mean values of push-out bond strength (MPa) of two irrigants at different thirds of the tooth.

Group I: The coronal third demonstrated a greater mean value compared to the middle third (p < 0.05) (Table 1 and Fig. 3).
Group II: Similarly, the coronal third recorded a significantly higher mean bond strength value than the middle third (p < 0.05) (Table 1 and Fig. 3).

Comparison between Groups

Coronal third: A statistically significant difference was found between group II and group I (p < 0.05). Group II showed the highest mean bond strength value (4.17 ± 0.38 MPa), while group I recorded a lower mean value (3.29 ± 0.52 MPa) (Table 1 and Fig. 3).
Middle third: The middle third of group II exhibited a significantly higher mean bond strength value (3.83 ± 0.33 MPa) compared to group I (2.66 ± 0.28 MPa) (p < 0.05) (Table 1 and Fig. 3).

Bar graphs (Fig. 3) were utilized to illustrate the mean values of push-out bond strength (MPa) for each irrigant group at the coronal and middle thirds. The graphs visually emphasize the superior performance of group II compared to group I at both thirds of the tooth.

The results indicate that the choice of irrigant significantly affects the bond strength of sealers to dentin, with group II outperforming group I in both the coronal and middle thirds. Additionally, the coronal third demonstrated consistently higher bond strength compared to the middle third across both groups. These findings underline the importance of irrigation protocols in enhancing the adhesive properties of root canal sealers.

DISCUSSION

This study was conducted to evaluate the impact of different irrigation protocols on the push-out bond strength of bioceramic sealers to radicular dentin. The primary objective was to determine the efficacy of QMix as a final irrigant in comparison to other commonly used agents. The ability to achieve effective smear layer removal while enhancing sealer penetration and adhesion is critical for the long-term success of root canal therapy.²⁰^,²⁴ Additionally, this study sought to assess the influence of dentinal tubule structure on bonding performance across different root canal sections.

Bioceramic sealer (Ceraseal) was selected over resin-based sealers like AH Plus due to its superior bioactivity, including hydroxyapatite formation, better penetration into dentinal tubules, and ability to form chemical bonds with dentin. These properties were highlighted in studies by Singh et al. (2024) and Verma et al. (2018).²²^,²⁴ QMix was chosen as the final irrigant based on prior findings by Reddy et al. (2022) and Singh et al. (2024), which demonstrated its ability to remove smear layers more effectively than EDTA, NaOCl, or chitosan-based solutions.²⁰^,²² The push-out bond strength test was utilized for its reliability in quantifying sealer adhesion to dentin.

The results of the current study revealed that the QMix irrigation protocol achieved the highest push-out bond strength among the tested groups. This finding aligns with Reddy et al. (2022), who reported that QMix outperformed EDTA/NaOCl and chitosan-based irrigants in enhancing bond strength.²⁰ Similarly, Singh et al. (2024) confirmed that QMix had greater efficacy in smear layer removal compared to other agents.²²

In agreement with Choudhary et al. (2024), the current study observed that Ceraseal demonstrated higher dentinal tubule penetration compared to Bio-C and MTA Fillapex.²³ The detergent and surfactant components in QMix likely improved dentin wettability, facilitating better sealer penetration.²⁵^,³⁷ These findings are supported by earlier research indicating that QMix enhances dentin wettability and adhesion properties (Ballal et al., 2013).³⁶

However, contrasting results were noted in the study by Dudulwar et al. (2024), which reported the highest push-out bond strength at the apical region, followed by the middle and coronal sections.²⁹ In contrast, the current study observed the highest bond strength in the coronal section, attributed to the higher dentinal tubule density and branching in this region. The reduced tubule density and less predictable smear layer removal in the apical third likely contributed to lower bond strength in that region. Aman Verma et al. (2024) also reported similar findings, with the coronal third showing higher push-out bond strength than the middle and apical thirds.³⁰

Regarding EDTA, the current study utilized 1 mL of 17% EDTA for 1 minute, based on findings by Sayin et al. (2007), who demonstrated that this protocol effectively removes smear layers without excessive erosion.¹⁰ Prolonged exposure or larger volumes of EDTA have been shown to cause dentinal erosion, reducing bond strength.³⁸^,⁴⁰ This limitation underscores the need for further research on biocompatible irrigants that minimize adverse effects.

This discrepancy may be attributed to differences in methodology, including variations in root canal preparation techniques and irrigation protocols. Additionally, the chemical composition of the irrigants and their interaction with the sealer play a crucial role in determining bond strength.

This study was conducted in vitro, which limits the direct applicability of results to clinical settings. Variations in dentinal tubule density across individuals and root canal sections may have influenced the outcomes. The apical third, with its lower tubule density, presents challenges in achieving effective smear layer removal, as also noted by Aranda-Garcia et al. (2013).²⁷ Future studies should include larger sample sizes, clinical evaluations, and assessments of agitation techniques, as highlighted by Da Silva Trandafilov et al. (2024), which may significantly enhance the bond strength of sealers.²⁶

The findings of this study suggest that QMix is a superior irrigant for improving sealer-dentin adhesion while reducing dentinal erosion compared to EDTA. Its detergent and surfactant components improve dentin wettability, enhancing sealer penetration and bond strength. Bioceramic sealers like Ceraseal are recommended for their bioactive properties, including the formation of a mineral infiltration zone and chemical bonding with dentin. This ensures better adaptation, hermetic sealing, and long-term success in endodontic treatments.

The superior performance of QMix can be attributed to its multifaceted composition, which combines the smear layer removal capability of EDTA with the antimicrobial properties of chlorhexidine and the enhanced wettability provided by its surfactant component. These attributes likely contributed to improved sealer-dentin interaction and higher bond strength values in the QMix group. Furthermore, the reduced dentin erosion observed with QMix compared to EDTA could help maintain the structural integrity of dentin, which is vital for long-term adhesion and sealing.

The results highlight the superior performance of QMix in enhancing the adhesion of Ceraseal to radicular dentin. The apical third consistently exhibited lower bond strength values compared to the middle and coronal thirds. This discrepancy may be attributed to differences in methodology, including variations in root canal preparation techniques and irrigation protocols. Additionally, the chemical composition of the irrigants and their interaction with the sealer play a crucial role in determining bond strength.

The study findings reinforce the significance of choosing an appropriate irrigation protocol to optimize the adhesion of bioceramic sealers to dentin. Clinicians are encouraged to adopt QMix as part of their irrigation protocols to optimize bonding outcomes, particularly in the coronal and middle thirds. In the apical third, additional agitation techniques or adjunctive methods may be required to enhance smear layer removal and improve bonding. Further research on alternative biocompatible irrigants and their long-term effects on sealer performance is warranted to address existing challenges.

CONCLUSION

The results of this study demonstrated that the irrigation protocol utilizing QMix, a premixed solution of EDTA and chlorhexidine, achieved significantly higher push-out bond strength of the calcium silicate-based bioceramic sealer (CeraSeal BC Sealer) to radicular dentin compared to the conventional EDTA irrigation protocol.

From these findings, it can be concluded that QMix enhances the bonding of bioceramic sealers to radicular dentin, likely due to its ability to effectively remove the smear layer, improve dentin wettability, and promote better sealer penetration into dentinal tubules. This improved bonding may reduce microleakage, thus enhancing the overall success of root canal treatment.

In a clinical setting, the QMix irrigation protocol offers a practical and effective solution for improving the retention of root canal sealers and preventing endodontic failure due to inadequate obturation. Its integration into routine endodontic practice is strongly recommended for achieving superior treatment outcomes.

REFERENCES

1. Shipper G, Ørstavik D, Teixeria FB, et al. An evaluation of microbial leakage in roots filled with a thermoplastic synthetic polymer-based root canal filling material (Resilon). J Endod 2004;30:342. DOI: 10.1097/00004770-200405000-00009

2. McComb D, Smith DC. A preliminary scanning electron microscopic study of root canals after endodontic procedures. J Endod 1975;1:238. DOI: 10.1016/S0099-2399(75)80226-3

3. Pimenta JA, Zaparolli D, Pecora JD, et al. Chitosan: effect of a new chelating agent on the micro hardness of root dentin. Braz Dent J 2012;23(3):212. DOI: 10.1590/s0103-64402012000300005

4. Shokouhinejad N, Hoseini A, Gorjestani H, et al. The effect of different irrigation protocols for smear layer removal on bond strength of a new bioceramic sealer. Iran Endod J. 2013;8(1):10. DOI: 10.22037/iej.v8i1.2750

5. Beltz RE, Torabinejad M, Pouresmail M. Quantitative analysis of the solubilizing action of MTAD, sodium hypochlorite, and EDTA on bovine pulp and dentin. J Endod 2003;29:334. DOI: 10.1097/00004770-200305000-00004

6. Zehnder M, Kosicki D, Luder H, et al. Tissue-dissolving capacity and antibacterial effect of buffered and unbuffered hypochlorite solutions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:756. DOI: 10.1067/moe.2002.128961

7. Siqueira JF Jr, Rôças IN, Favieri A, et al. Chemomechanical reduction of the bacterial population in the root canal after instrumentation and irrigation with 1%, 2.5%, and 5.25% sodium hypochlorite. J Endod 2000;26:331. DOI: 10.1097/00004770-200006000-00006

8. Zehnder M. Root canal irrigants. J Endod 2006;32:389. DOI: 10.1016/j.joen.2005.09.014

9. Leal F, Simão RA, Fidel SR, et al. Effect of final irrigation protocols on push-out bond strength of an epoxy resin root canal sealer to dentin. Aust Endod J 2015;41(3):135. DOI: 10.1111/aej.12114

10. Sayin TC, Serper A, Cehreli ZC, et al. The effect of EDTA, EGTA, EDTAC and tetracycline-HCl with and without subsequent NaOCl treatment on the micro hardness of root canal dentin. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104(3):418. DOI: 10.1016/j.tripleo.2007.03.021

11. Fernández ML, Pérez GG, Villagómez II, et al. In vitro study of erosion caused by EDTA on root canal dentin. J Appl Oral Sci. 2012;16(1):8. DOI: 10.1590/S1678-77572012000100002

12. Saghiri MA, Garcia-Godoy F, Asgar K, et al. The effect of Morinda citrifolia juice as an endodontic irrigant on smear layer and micro hardness of root canal dentin. Oral Sci Int 2013;10(2):53. DOI: 10.1016/S1348-8643(12)00073-0

13. Zhang J, Xia W, Liu P, et al. Chitosan modification and pharmaceutical/biomedical applications. Mar Drugs 2010;8(7):1962. DOI: 10.3390/md8071962

14. Saricam E, Küçük M, Akyol M. Evaluation of EDTA, QMix, and Irritrol solutions activated with Er, Cr: YSGG and diode lasers on the push-out bond strength of filling material. Microsc Res Tech 2021;84(4):584. DOI: 10.1002/jemt.23616

15. Van der Sluis LW, Gambarini G, Wu MK, et al. The influence of volume, type of irrigant and flushing method on removing artificially placed dentine debris from the apical root canal during passive ultrasonic irrigation. Int Endod J 2006;39(6):472. DOI: 10.1111/j.1365-2591.2006.01108.x

16. Choudhury S, Shivanand S, Patil AC, et al. Evaluation of push-out bond strength of a resin sealer to dentin after a final flush of three irrigants. J Contemp Dent Pract 2020;21(9):982. DOI: 10.5005/jp-journals-10024-2906

17. Meta Biomed Co., Ltd. CeraSeal pamphlet. Korea, Republic; 2019.

18. Pane ES, Palamara JE, Messer HH. Critical evaluation of the push-out test for root canal filling materials. J Endod 2013;39(5):669. DOI: 10.1016/j.joen.2012.12.032

19. Montcelli F, Sword J, Martin RL, et al. Sealing properties of two contemporary single cone obturation systems. Int Endod J 2007;40:374. DOI: 10.1111/j.1365-2591.2007.01231.x

20. Reddy BN, Murugesan S, Subramani SK, et al. Comparative assessment of QMix as endodontic irrigant on reversal of bond strength in teeth subjected to irradiation: a scanning electron microscope study. J Contemp Dent Pract. 2022;23(3):331. DOI: 10.5005/jp-journals-10024-3221

21. Nouroloyouni A, Samadi V, Salem Milani A, et al. Single cone obturation versus cold lateral compaction techniques with bioceramic and resin sealers: quality of obturation and push-out bond strength. Int J Dent 2023;2023:3427151. DOI: 10.1155/2023/3427151

22. Singh DK, Raj BS, Soans CR, et al. Assessment of the smear layer removal efficacy of three different agents on periodontally compromised teeth: an in vitro study. J Contemp Dent Pract 2024;25(2):156. DOI: 10.5005/jp-journals-10024-3618

23. Choudhary D, Gupta A, Bharti N. Comparative evaluation of penetrability of various bioceramic sealers into the tubules of radicular dentin. J Adv Oral Res 2024;15(1):79–85. DOI: 10.1177/23202068241237329

24. Verma D, Taneja S, Kumari M. Efficacy of different irrigation regimes on the push-out bond strength of various resin-based sealers at different root levels: an in vitro study. J Conserv Dent 2018;21(2):125. DOI: 10.4103/JCD.JCD_337_16

25. Tartari T, Wichnieski C, Silva RM, et al. Final irrigation protocols can be used to promote stable long-term bond strength of AH Plus to dentin. J Appl Oral Sci 2023;31:e20230005. DOI: 10.1590/1678-7757-2023-0005

26. da Silva Trandafilov AA, Grazziotin-Soares R, Nogueira APA, et al. Filling material bond strength to dentin is positively influenced by the agitation of endodontic final irrigating solutions. Iran Endod J 2024;19(2):112. DOI: 10.22037/iej.v19i2.43108

27. Aranda-Garcia AJ, Kuga MC, Vitorino KR, et al. Effect of the root canal final rinse protocols on the debris and smear layer removal and on the push-out strength of an epoxy-based sealer. Microsc Res Tech 2013;76:533. DOI: 10.1002/jemt.22196

28. Fisher MA, Berzins DW, Bahcall JK. An in vitro comparison of bond strength of various obturation materials to root canal dentin using a push-out test design. J Endod 2007;33:856. DOI: 10.1016/j.joen.2007.02.011

29. Dudulwar D, Patil S, Bandekar S, et al. A comparative evaluation of push-out bond strength of six different root canal sealers: an in-vitro study. Cureus 2024;16(3):e56481. DOI: 10.7759/cureus.56481

30. Verma A, Arora A, Taneja S. Comparative evaluation of dentinal tubule penetration and push-out bond strength of new injectable hydraulic calcium disilicate based root canal sealer: a single blinded in vitro study. J Oral Biol Craniofac Res 2024;14(2):143–51. DOI: 10.1016/j.jobcr.2024.01.009

31. Crumpton BJ, Godell GG, McClanahan SB. Effects on smear layer and debris removal with varying volumes of 17% REDTA after rotary instrumentation. J Endod. 2005;31(7):536. DOI: 10.1097/01.don.0000148871.72896.1d

32. Aksel H, Serper A, Kalayci S, et al. Effects of QMix and ethylenediaminetetraacetic acid on decalcification and erosion of root canal dentin. Microsc Res Tech 2016;79(11):1056. DOI: 10.1002/jemt.2274

33. Albino Souza M, Dalla Lana D, Gabrielli E, et al. Effectiveness of final decontamination protocols against Enterococcus faecalis and its influence on bond strength of filling material to root canal dentin. Photodiagnosis Photodyn Ther 2017;17:92. DOI: 10.1016/j.pdpdt.2016.11.004

34. Gundogar M, Sezgin GP, Erkan E, et al. The influence of the irrigant QMix on the push-out bond strength of a bioceramic endodontic sealer. Eur Oral Res 2018;52(2):64. DOI: 10.26650/eor.2018.446

35. Uzunoglu E, Turker SA, Karahan S. The effect of increased temperatures of QMix and EDTA on the push-out bond strength of an epoxy resin-based sealer. J Clin Diagn Res 2015;9(7):ZC98–ZC101. DOI: 10.7860/JCDR/2015/13402.6262.

36. Ballal NV, Tweeny A, Khechen K, et al. Wettability of root canal sealers on intraradicular dentine treated with different irrigating solutions. J Dent 2013;41(6):556. DOI: 10.1016/j.jdent.2013.04.005

37. Zhang W, Li Z, Peng B. Assessment of a new root canal sealer’s apical sealing ability. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107(6):e79. DOI: 10.1016/j.tripleo.2009.02.024

38. Sarkar NK, Caicedo R, Ritwik P, et al. Physicochemical basis of the biologic properties of mineral trioxide aggregate. J Endod 2005;31(2):97. DOI: 10.1097/01.don.0000133155.04468.41

39. Torabinejad M. Calcium silicate-based cements. In: Torabinejad M, editor. Mineral Trioxide Aggregate: Properties and Clinical Applications. Ames: Wiley Blackwell; 2014. pp. 281–332.

40. Atmeh AR, Chong EZ, Richard G, et al. Dentin-cement interfacial interaction: calcium silicates and polyalkenoates. J Dent Res 2012;91(5):454. DOI: 10.1177/0022034512443068

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