Post-obturation tooth discoloration: a scoping review of endodontic sealer choices for aesthetic success
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Abstract
Background: Post obturation discoloration, is an undesirable outcome of endodontic treatment and is particularly burdensome on clinicians managing anterior teeth. Objectives: This review examines the discoloration potential of a plethora of historical and currently used endodontic sealers with the aim of providing clinicians with a guide on material selection, with the most minimal esthetic impact. Method: A PICO framework was employed to identify relevant data, focusing on discoloration associated with different sealers. A literature search was conducted across PubMed, ScienceDirect, and Google Scholar. Relevant studies published between January 2000 and January 2024 were selected based on pre-defined inclusion and exclusion criteria. The findings revealed that most of the included studies were ex vivo and in vitro, with limited in vivo evidence available. Insufficient long-term follow-up was noted and direct comparisons between the various sealer brands was limited. Conclusion: Zinc oxide-based sealers should be avoided by the clinician in areas of high esthetic concern. The strict confinement of the sealers to the canal space, is the best strategy to minimize discoloration. There is a need for improved materials, and more robust long-term studies to generate evidence-based guidelines as it relates to sealers.
Received date: 01-08-2024
Accepted date: 12-10-2024
Published date: 15-06-2025
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References
Caicedo R, von Fraunhofer JA. The properties of endodontic sealer cements. J Endod 1988:14:527-34.
Komabayashi T, Colmenar D, Cvach N, Bhat A, Primus C, Imai Y. Comprehensive review of current endodontic sealers. Dent Mater J 2020:39:703-20.
Tour Savadkouhi S, Fazlyab M. Discoloration Potential of Endodontic Sealers: A Brief Review. Iran Endod J 2016:11:250-4.
Kahler B. Present status and future directions - Managing discoloured teeth. Int Endod J 2022:55 Suppl 4:922-50.
Eliyas S, Jalili J, Martin N. Restoration of the root canal treated tooth. Br Dent J 2015:218:53-62.
Kelleher M. Ethical issues, dilemmas and controversies in 'cosmetic' or aesthetic dentistry. A personal opinion. Br Dent J. 2012:212:365-7.
Forde K. Harty's Endodontics in clinical practice, 6th edition. Br Dent J 2011:210:192.
Bosenbecker J, Barbon FJ, de Souza Ferreira N, Morgental RD, Boscato N. Tooth discoloration caused by endodontic treatment: A cross-sectional study. J Esthet Restor Dent. 2020:32:569-74.
Alotaibi R, Altuwaijri S, Ahmed D. The degree of crown discoloration induced by a bioceramic and other conventional endodontic sealers. Saudi Endo J 2019:9:192-7.
Ekici MA, Ekici A, Kaskatı T, Helvacıoğlu Kıvanç B. Tooth crown discoloration induced by endodontic sealers: a 3-year ex vivo evaluation. Clin Oral Investig 2019:23:2097-102.
Chahande RK, Patil SS, Gade V, Meshram R, Chandhok DJ, Thakur DA. Spectrophotometric analysis of crown discoloration induced by two different sealers: An In vitro study. Indian J Dent Res 2017:28:71-5.
Zarei M, Javidi M, Jafari M, Gharechahi M, Javidi P, Shayani Rad M. Tooth Discoloration Resulting from a Nano Zinc Oxide-Eugenol Sealer. Iran Endod J 2017:12:74-7.
Forghani M, Gharechahi M, Karimpour S. In vitro evaluation of tooth discolouration induced by mineral trioxide aggregate Fillapex and iRoot SP endodontic sealers. Aust Endod J 2016:42:99-103.
Gürel MA, Kivanç BH, Ekici A, Alaçam T. Evaluation of crown discoloration induced by endodontic sealers and colour change ratio determination after bleaching. Aust Endod J 2016:42:119-23.
Shokouhinejad N, Nekoofar MH, Pirmoazen S, Shamshiri AR, Dummer PM. Evaluation and Comparison of Occurrence of Tooth Discoloration after the Application of Various Calcium Silicate-based Cements: An Ex Vivo Study. J Endod 2016:42:140-4.
Suciu I, Ionescu E, Dimitriu BA, Bartok RI, Moldoveanu GF, Gheorghiu IM, et al. An optical investigation of dentinal discoloration due to commonly endodontic sealers, using the transmitted light polarizing microscopy and spectrophotometry. Rom J Morphol Embryol 2016:57:153-9.
Kohli MR, Yamaguchi M, Setzer FC, Karabucak B. Spectrophotometric Analysis of Coronal Tooth Discoloration Induced by Various Bioceramic Cements and Other Endodontic Materials. J Endod 2015:41:1862-6.
Shahrami F, Zaree M, Mir APB, Abdollahi-Armani M, Mesgarani A. Comparison of tooth crown discoloration with Epiphany and AH26 sealer in terms of chroma and value: an in vitro study. Brazilian J Oral Sci. 2015:10:171-4.
El Sayed MA, Etemadi H. Coronal discoloration effect of three endodontic sealers: An in vitro spectrophotometric analysis. J Conserv Dent 2013:16:347-51.
Ioannidis K, Beltes P, Lambrianidis T, Kapagiannidis D, Karagiannis V. Crown discoloration induced by endodontic sealers: spectrophotometric measurement of Commission International de I'Eclairage's L*, a*, b* chromatic parameters. Oper Dent 2013:38:E1-12.
Ioannidis K, Mistakidis I, Beltes P, Karagiannis V. Spectrophotometric analysis of crown discoloration induced by MTA- and ZnOE-based sealers. J Appl Oral Sci 2013:21:138-44.
Ioannidis K, Beltes P, Lambrianidis T, Kapagiannidis D, Karagiannis V. Validation and spectrophotometric analysis of crown discoloration induced by root canal sealers. Clin Oral Investig 2013:17:1525-33.
Jang JH, Kang M, Ahn S, Kim S, Kim W, Kim Y, et al. Tooth discoloration after the use of new pozzolan cement (Endocem) and mineral trioxide aggregate and the effects of internal bleaching. J Endod 2013:39:1598-602.
Meincke DK, Prado M, Gomes BP, Bona AD, Sousa EL. Effect of endodontic sealers on tooth color. J Dent 2013:41 Suppl 3:e93-6.
Thomson AD, Athanassiadis B, Kahler B, Walsh L. Tooth discolouration: staining effects of various sealers and medicaments. Aust Endod J 2012:38:2-9.
Zare Jahromi M, Navabi AA, Ekhtiari M. Comparing Coronal Discoloration Between AH26 and ZOE Sealers. Iran Endod J 2011:6:146-9.
Partovi M, Al-Havvaz AH, Soleimani B. In vitro computer analysis of crown discolouration from commonly used endodontic sealers. Aust Endod J 2006:32:116-9.
Parsons JR, Walton RE, Ricks-Williamson L. In vitro longitudinal assessment of coronal discoloration from endodontic sealers. J Endod 2001:27:699-702.
Llena C, Herrero A, Lloret S, Barraza M, Sanz JL. Effect of calcium silicate-based endodontic sealers on tooth color: A 3-year in vitro experimental study. Heliyon 2023:9:e13237.
Wilson AD, Mesley RJ. Chemical nature of cementing matrixes of cements formed from zinc oxide and 2-ethoxybenzoic acid-eugenol liquids. J Dent Res 1974:53:146.
Hume WR. Effect of eugenol on respiration and division in human pulp, mouse fibroblasts, and liver cells in vitro. J Dent Res 1984:63:1262-5.
Jafari F, Jafari S, Etesamnia P. Genotoxicity, Bioactivity and Clinical Properties of Calcium Silicate Based Sealers: A Literature Review. Iran Endod J 2017:12:407-13.
Babb BR, Loushine RJ, Bryan TE, Ames JM, Causey MS, Kim J, et al. Bonding of self-adhesive (self-etching) root canal sealers to radicular dentin. J Endod 2009:35:578-82.
Mohebbi P, Tour Savadkouhi S. Tooth discoloration induced by calcium-silicate based materials: a literature review. Minerva Stomatol 2016:65:378-84.
Marciano MA, Duarte MA, Camilleri J. Dental discoloration caused by bismuth oxide in MTA in the presence of sodium hypochlorite. Clin Oral Investig 2015:19:2201-9.
Da Silva JD, Park SE, Weber HP, Ishikawa-Nagai S. Clinical performance of a newly developed spectrophotometric system on tooth color reproduction. J Prosthet Dent 2008:99:361-8.
Paul S, Peter A, Pietrobon N, Hämmerle CH. Visual and spectrophotometric shade analysis of human teeth. J Dent Res 2002:81:578-82.
CIE Recommendations on Uniform Color Spaces, Color-Difference Equations, and Metric Color Terms. Color Research & Application 1977:2:5-6.
Chu SJ, Trushkowsky RD, Paravina RD. Dental color matching instruments and systems. Review of clinical and research aspects. J Dent 2010:38 Suppl 2:e2-16.