Influence of Intracanal Endodontic Medicaments on the Push-Out bond Strength of Bioceramic Types of Cement: An ex vivo Study

The study evaluated the impact of Intracanal Medicaments (IMs) on the Push-out Bond Strength (PBS) of MTA and TotalFill Bioceramic (BC) Root Repair Material (RRM). The study randomly divided 88 human single-canaled premolars into four subcategories each in TotalFill BC RRM and Mineral Trioxide Aggregate (MTA) groups. Cement was compressed until bond failure occurred to evaluate PBS in a universal testing machine. The failure mode was assessed. Analyses included Chi-square, one-way ANOVA and Tukey’s post hoc tests at a 5% significance level. The PBS was substantially stronger with Totalfill BC RRM compared to MTA, regardless of IM employed. After placing calcium hydroxide IM, Totalfill BC RRM had the strongest PBS (87.21±64.49 MPa). There were statistically highly significant variations between the PBS of IM across the two bioceramic cements (p<0.01). Similarly, statistically significant variances were documented between the PBS of control groups (p<0.05) and modified Triple Antibiotic Paste (mTAP) groups between the two bioceramic cements (p<0.01). The overall material failure difference rates of the evaluated types of cement were statistically significant (p<0.01). MTA caused 36.4% adhesive and 40.9% of mixed failure modes, while Total fill BC RRM caused 65.9% cohesive failures. There were significant variances in the failure mode of calcium hydroxide IM between the two bioceramic cements (p=0.03). BC RRM strengthened the bond better than MTA regardless of IM. Further, BC RRM could replace MTA after IM disinfects the root canal in regenerative endodontic treatment methods or apexification.