Evaluation of the Single-Tip Bioceramic Filling Procedure in Root Canal Treatment of Maxillary First Molars: A Clinical Study

Summary

This study compared the single-tip bioceramic filling and AH-Plus hot vertical compaction methods in treating second mesiobuccal canal root canals of maxillary first molars. The single-tip group showed higher optimal filling rates, shorter procedure time, and reduced postoperative pain, confirming it as a safe, effective, and efficient treatment option.

Abstract

This study aimed to assess the clinical efficacy of the single-tip bioceramic filling method in treating the second mesiobuccal canal (MB2) of maxillary first molars. Ninety-four patients requiring MB2 root canal therapy were randomly allocated to either an experimental group (n = 47) or a control group (n = 47) between January 2023 and December 2024. The experimental group was treated using the single-tip bioceramic technique, whereas the control group received AH-Plus hot vertical compaction. The primary outcome measures included filling quality, procedure time, postoperative pain at 24 hours and 7 days, and clinical efficacy at 6 months. The experimental group demonstrated a significantly higher optimal filling rate (P < 0.05) and shorter mean procedure duration, with comparable clinical success between both groups at 6 months. Additionally, patients in the experimental group experienced lower postoperative discomfort within 24 hours (P < 0.001). Overall, the single-tip bioceramic filling technique achieved equivalent clinical outcomes with improved procedural efficiency and patient comfort compared with the conventional AH Plus vertical compaction method. This simplified technique may represent a safe, effective, and time-efficient approach for MB2 canal obturation in maxillary first molars.

Introduction

Root canal therapy serves as the primary treatment approach for periapical diseases affecting the pulp¹, with the goal of thoroughly cleaning the root canal system and performing a three-dimensional hermetic seal to prevent reinfection². Maxillary first molars are the earliest permanent molars to erupt in the mouth³, which play a key role in maintaining a normal occlusal relationship, and root canal treatment is often required clinically due to caries, defects, and fissures.

The second mesiobuccal (MB2) canal is highly prevalent in maxillary first molars

Protocol

This study was approved by the Medical Ethics Committee of the Second People’s Hospital of Yibin City. Written informed consent was obtained from all participants prior to enrollment in accordance with the Declaration of Helsinki. This work was supported by the 2023 Scientific Research Project of the Yibin Municipal Health Commission (Grant No. 2023YW014) and the Natural Science Foundation of Sichuan Province (Grant No. 2023NSFSC0546).

1. Study design and participants

This randomized controlled study involved 94 patients who received microscope-assisted root canal treatment for MB2 periapical disease affectin....

Results

Filling quality comparison

As shown in Table 1 and Figure 1, the overall filling quality differed significantly between the two groups. In the experimental group, 93.62% (95% CI: 88.2–97.0) of canals achieved an optimal fill, compared with 85.11% (95% CI: 78.0–90.6) in the control group. Overfilled canals were fewer in the experimental group (6.38% [95% CI: 3.0–11.8]) than in the control group (14.89% [95% CI: 9.4–22.0]). Statisti.......

Discussion

The morphology of root canals in maxillary first permanent molars is notably intricate, especially within the MB roots, where the occurrence of MB2 canals exhibits significant variability across studies, with reported rates between 51% and 90%^11,13,14,15. This variability can be attributed to differences in race, age, detection methods, sample size, and the absence of a standardized definition .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Apex Locator	J. Morita, Japan	Root ZX II	Determines working length of canals
Bioceramic Sealer (iRoot SP)	Innovate Biotech, China	IS-001	Root canal sealer for experimental group
Calcium Hydroxide Paste	Voco, Germany	2016	Used as intracanal medicament
Dental Operating Microscope	Zeiss, Germany	OPMI Pico	Used for enhanced visualization during MB2 canal location
Digital Radiography System	Carestream Dental, USA	CS 2100	Used for postoperative radiographs
Disposable Paper Points	Meta Biomed, Korea	DPP-30	For canal drying
Epoxy Resin-Based Sealer (AH Plus)	Dentsply Sirona, Germany	606.46.531	Sealer used in control group
Gutta-Percha Cones	Dentsply Sirona, Germany	GP-55	Used for obturation
Heat Carrier Tip	B&L Biotech, South Korea	Beta Mini	Used for vertical compaction at 180 °C
Hot Vertical Compaction Device	B&L Biotech, South Korea	Alpha II	For gutta-percha compaction
Image Analysis Software	National Institutes of Health (NIH), USA	ImageJ 1.53t	Used for radiographic evaluation
Intraoral Sensor	Carestream Dental, USA	RVG 5200	For digital image acquisition
Nickel–Titanium Rotary Files	Dentsply Sirona, Switzerland	ProTaper Gold	For canal preparation
Rotary Endodontic Motor	NSK, Japan	Endo-Mate DT	Used for NiTi rotary file operation
Rubber Dam Kit	Kerr, USA	1600	Isolation of operative field
Saline Solution (0.9%)	Baxter, China	07S060	Used as final irrigant
Sodium Hypochlorite Solution (1%)	Sigma-Aldrich, USA	425044	Irrigant used during instrumentation
Statistical Software	IBM Corp., USA	SPSS 26.0	Used for statistical analysis
Ultrasonic Scaler Unit	Dentsply Sirona, USA	Cavitron Select SPS	Used for ultrasonic cleaning of canals
Ultrasonic Tips	Dentsply Sirona, USA	Start-X #3	For canal debridement and MB2 troughing