Actual problems in dentistry Actual problems in dentistry Проблемы стоматологии 2077-7566 2412-9461 106469 10.18481/2077-7566-2025-21-4-138-147 ХИРУРГИЧЕСКАЯ СТОМАТОЛОГИЯ И ИМПЛАНТОЛОГИЯ SURGICAL DENTISTRY AND IMPLANTOLOGY ХИРУРГИЧЕСКАЯ СТОМАТОЛОГИЯ И ИМПЛАНТОЛОГИЯ PATHOHISTOLOGICAL CHANGES IN THE MAXILLARY SINUS TISSUES DURING LONG-TERM CONTACT WITH AH PLUS EPOXY SEALANT ПАТОГИСТОЛОГИЧЕСКИЕ ИЗМЕНЕНИЯ В ТКАНЯХ ВЕРХНЕЧЕЛЮСТНОГО СИНУСА ПРИ ДЛИТЕЛЬНОМ КОНТАКТЕ С ЭПОКСИДНЫМ ГЕРМЕТИКОМ AH PLUS Сирак Сергей Владимирович Sirak Sergey V. sergejsirak@yandex.ru

доктор медицинских наук;

doctor of medical sciences;

 Гатило Ирина Анатольевна Gatilo Irina A. chijgay@yandex.ru

кандидат медицинских наук;

candidate of medical sciences;

 Переверзева Екатерина Сергеевна Pereverzeva Ekaterina Sergeevna sirakekaterina2204@yandex.ru Ставропольский государственный медицинский университет Ставрополь Россия Stavropol State Medical University Stavropol Russian Federation Ставропольский государственный медицинский университет Stavropol State Medical University Кубанский государственный медицинский университет Краснодар Россия Kuban State Medical University Krasnodar Russian Federation 29 01 2026 29 01 2026 21 4 138 147 11 11 2025 https://dental-press.ru/en/nauka/article/106469/view

Введение корневых герметиков на основе эпоксидной смолы (например, AH Plus) за пределы корня зуба в верхнечелюстной синус является частым осложнением эндодонтического лечения, приводящим к хроническому воспалению, фиброзу и некрозу тканей. Несмотря на клинические наблюдения, патогистологические механизмы этих изменений при длительном контакте остаются недостаточно изученными. Цель исследования — анализ маркеров воспаления, фиброза и токсических эффектов в тканях верхнечелюстного синуса при экспериментальном моделировании контакта с эпоксидным герметиком на овцах. Материалы и методы. Эксперимент проведен на 16 овцах северокавказской породы. Под общим наркозом в передней стенке верхнечелюстного синуса создавался доступ к шнейдеровой мембране, на которую наносился герметик AH Plus; противоположная сторона служила контролем. Сроки наблюдения – 1 и 2 года. Проводился гистологический анализ (окраска гематоксилином и эозином, по Ван-Гизон и Маллори) и иммуногистохимия (маркеры Ki-67+, NSE+, EMA+, виментина). Статистическая обработка включала сравнение экспериментальных и контрольных групп с использованием корреляционного анализа. Результаты. Через 1 год отмечены некроз соединительной ткани вокруг герметика, миграция его фрагментов, нарушения в микрососудистом русле (тромбоз, некроз), вакуолярная дистрофия эпителия и фрагментация стромы. Через 2 года – интенсивный фиброз с хаотичной ориентацией коллагеновых волокон, полный некроз сосудов, резорбция костных трабекул с деминерализацией и десквамация эпителия. Иммуногистохимия выявила умеренную экспрессию маркеров, указывающую на активацию пролиферации, неоваскулогенеза и мезенхимальной дифференцировки, но с преобладанием деструктивных процессов (p < 0,05). Выводы. Длительный контакт с эпоксидным герметиком вызывает прогрессирующие патогистологические изменения, включая некроз, фиброз и сосудистые нарушения, с частичной активацией репаративных механизмов. Результаты подчеркивают необходимость разработки более биосовместимых материалов и протоколов для снижения рисков осложнений в эндодонтии, что может улучшить исходы лечения и снизить экономические потери.

The insertion of epoxy resin-based root sealants (e.g., AH Plus) beyond the tooth root into the maxillary sinus is a common complication of endodontic treatment, leading to chronic inflammation, fibrosis, and tissue necrosis. Despite clinical observations, the pathohistological mechanisms of these changes during prolonged contact remain poorly understood. The aim of this study was to analyze markers of inflammation, fibrosis, and toxic effects in maxillary sinus tissue during an experimental model of contact with an epoxy sealant in sheep. Materials and Methods: The experiment was conducted on 16 North Caucasian sheep. Under general anesthesia, access to the Schneiderian membrane was created in the anterior wall of the maxillary sinus, onto which AH Plus sealant was applied; the contralateral side served as a control. Follow-up periods were 1 and 2 years. Histological analysis (hematoxylin and eosin staining, van Gieson and Mallory staining) and immunohistochemistry (markers Ki-67+, NSE+, EMA+, vimentin) were performed. Statistical analysis included group comparisons and correlation analysis. Results: After 1 year, necrosis of connective tissue around the sealant, migration of its fragments, microvascular disturbances (thrombosis, necrosis), vacuolar degeneration of the epithelium, and stromal fragmentation were noted. After 2 years, intense fibrosis with chaotic collagen fiber orientation, complete vascular necrosis, bone trabecular resorption with demineralization, and epithelial desquamation were observed. Immunohistochemistry revealed moderate expression of markers indicating activation of proliferation, neovasculogenesis, and mesenchymal differentiation, but with a predominance of destructive processes (p < 0.05). Conclusions: Long-term exposure to epoxy sealant causes progressive pathohistological changes, including necrosis, fibrosis, and vascular disruption, with partial activation of reparative mechanisms. The results emphasize the need for developing more biocompatible materials and protocols to reduce complication risks in endodontics, which can improve treatment outcomes and reduce economic losses.

 эксперимент верхнечелюстной синус корневые герметики Шнейдерова мембрана некроз иммуногистохимия фиброз неоангиогенез experiment maxillary sinus root sealants Schneiderian membrane necrosis immunohistochemistry fibrosis angiogenesis

Григорьянц Л.А., Сирак С.В. Лечение травм нижнеальвеолярного нерва, вызванных выведением пломбировочного материала в нижнечелюстной канал. Клиническая стоматология. 2006;(1):52-57. [Grigoryanz L.A., Sirak S.V. Treatment of inferior alveolar nerve injuries, induced by insertion of filling material in mandibular canal. Clinical Dentistry. 2006;(1):52-57. (In Russ.)]. Grigor'yanc L.A., Sirak S.V. Lechenie travm nizhneal'veolyarnogo nerva, vyzvannyh vyvedeniem plombirovochnogo materiala v nizhnechelyustnoy kanal. Klinicheskaya stomatologiya. 2006;(1):52-57. [Grigoryanz L.A., Sirak S.V. Treatment of inferior alveolar nerve injuries, induced by insertion of filling material in mandibular canal. Clinical Dentistry. 2006;(1):52-57. (In Russ.)]. Сирак С.В., Шаповалова И.А., Копылова И.А. Осложнения, возникающие на этапе пломбирования корневых каналов зубов, их прогнозирование и профилактика. Эндодонтия Today. 2009;(1):23-25. [Sirak S.V., Shapovalova I.A., Kopylova I.A. The complications arising at the stage of sealing of root channels of teeth, their forecasting and preventive maintenance. Endodontics Today. 2009;(1):23-25. (In Russ.)]. https://elibrary.ru/item.asp?id=12158346 Sirak S.V., Shapovalova I.A., Kopylova I.A. Oslozhneniya, voznikayuschie na etape plombirovaniya kornevyh kanalov zubov, ih prognozirovanie i profilaktika. Endodontiya Today. 2009;(1):23-25. [Sirak S.V., Shapovalova I.A., Kopylova I.A. The complications arising at the stage of sealing of root channels of teeth, their forecasting and preventive maintenance. Endodontics Today. 2009;(1):23-25. (In Russ.)]. https://elibrary.ru/item.asp?id=12158346 Giacomino C.M., Wealleans J.A., Kuhn N., Diogenes A. Comparative Biocompatibility and Osteogenic Potential of Two Bioceramic Sealers. Journal of Endodontics. 2019;45(1):51–56. https://doi.org/10.1016/j.joen.2018.08.007 Giacomino C.M., Wealleans J.A., Kuhn N., Diogenes A. Comparative Biocompatibility and Osteogenic Potential of Two Bioceramic Sealers. Journal of Endodontics. 2019;45(1):51–56. https://doi.org/10.1016/j.joen.2018.08.007 Jo S.B., Kim H.K., Lee H.N., Kim Y.-J., Patel K.D., Knowles J.C. et al. Physical Properties and Biofunctionalities of Bioactive Root Canal Sealers In Vitro. Nanomaterials. 2020;10(9):1750. https://doi.org/10.3390/nano10091750 Jo S.B., Kim H.K., Lee H.N., Kim Y.-J., Patel K.D., Knowles J.C. et al. Physical Properties and Biofunctionalities of Bioactive Root Canal Sealers In Vitro. Nanomaterials. 2020;10(9):1750. https://doi.org/10.3390/nano10091750 Edanami N., Ibn Belal R.S., Yoshiba K., Yoshiba N., Ohkura N., Takenaka S. et al. Effect of a resin-modified calcium silicate cement on inflammatory cell infiltration and reparative dentin formation after pulpotomy in rat molars. Australian Endodontic Journal. 2021;48(2):297–304. https://doi.org/10.1111/aej.12568 Edanami N., Ibn Belal R.S., Yoshiba K., Yoshiba N., Ohkura N., Takenaka S. et al. Effect of a resin-modified calcium silicate cement on inflammatory cell infiltration and reparative dentin formation after pulpotomy in rat molars. Australian Endodontic Journal. 2021;48(2):297–304. https://doi.org/10.1111/aej.12568 Xiong B., Shirai K., Matsumoto K., Abiko Y., Furuichi Y. The potential of a surface pre-reacted glass root canal dressing for treating apical periodontitis in rats. International Endodontic Journal. 2021;54(2):255–267. https://doi.org/10.1111/iej.13414 Xiong B., Shirai K., Matsumoto K., Abiko Y., Furuichi Y. The potential of a surface pre-reacted glass root canal dressing for treating apical periodontitis in rats. International Endodontic Journal. 2021;54(2):255–267. https://doi.org/10.1111/iej.13414 Li J., Chen L., Zeng C., Liu Y., Gong Q., Jiang H. Clinical outcome of bioceramic sealer iRoot SP extrusion in root canal treatment: A retrospective analysis. Head & face medicine. 2022;18(1):28. https://doi.org/10.1186/s13005-022-00332-3 Li J., Chen L., Zeng C., Liu Y., Gong Q., Jiang H. Clinical outcome of bioceramic sealer iRoot SP extrusion in root canal treatment: A retrospective analysis. Head & face medicine. 2022;18(1):28. https://doi.org/10.1186/s13005-022-00332-3 Zamparini F., Prati C., Taddei P., Spinelli A., Di Foggia M., Gandolfi M.G. Chemical-Physical Properties and Bioactivity of New Premixed Calcium Silicate-Bioceramic Root Canal Sealers. International Journal of Molecular Sciences. 2022;23(22):13914. https://doi.org/10.3390/ijms232213914 Zamparini F., Prati C., Taddei P., Spinelli A., Di Foggia M., Gandolfi M.G. Chemical-Physical Properties and Bioactivity of New Premixed Calcium Silicate-Bioceramic Root Canal Sealers. International Journal of Molecular Sciences. 2022;23(22):13914. https://doi.org/10.3390/ijms232213914 Simsek N., Akinci L., Gecor O., Alan H., Ahmetoglu F., Taslidere E. Biocompatibility of a new epoxy resin-based root canal sealer in subcutaneous tissue of rat. European Journal of Dentistry. 2015;9(1):31-35. https://doi.org/10.4103/1305-7456.149635 Simsek N., Akinci L., Gecor O., Alan H., Ahmetoglu F., Taslidere E. Biocompatibility of a new epoxy resin-based root canal sealer in subcutaneous tissue of rat. European Journal of Dentistry. 2015;9(1):31-35. https://doi.org/10.4103/1305-7456.149635 Somngam C., Samartkit S., Kanchanasurakit S., Strietzel F.P., Khongkhunthian P. New bone formation of biphasic calcium phosphate bone substitute material: a systematic review and network meta-analysis of randomized controlled trials (RCTs). International Journal of Implant Dentistry. 2025;11(1):47. https://doi.org/10.1186/s40729-025-00636-4 Somngam C., Samartkit S., Kanchanasurakit S., Strietzel F.P., Khongkhunthian P. New bone formation of biphasic calcium phosphate bone substitute material: a systematic review and network meta-analysis of randomized controlled trials (RCTs). International Journal of Implant Dentistry. 2025;11(1):47. https://doi.org/10.1186/s40729-025-00636-4 Molnár B., Jung A.K., Papp Z., Martin A., Orbán K., Pröhl A. et al. Comparative analysis of lateral maxillary sinus augmentation with a xenogeneic bone substitute material in combination with piezosurgical preparation and bony wall repositioning or rotary instrumentation and membrane coverage: a prospective randomized clinical and histological study. Clinical Oral Investigations. 2022;26(8):5261-5272. https://doi.org/10.1007/s00784-022-04494-x Molnár B., Jung A.K., Papp Z., Martin A., Orbán K., Pröhl A. et al. Comparative analysis of lateral maxillary sinus augmentation with a xenogeneic bone substitute material in combination with piezosurgical preparation and bony wall repositioning or rotary instrumentation and membrane coverage: a prospective randomized clinical and histological study. Clinical Oral Investigations. 2022;26(8):5261-5272. https://doi.org/10.1007/s00784-022-04494-x Kraus R.D., Stricker A., Thoma D.S., Jung R.E. Sinus Floor Elevation with Biphasic Calcium Phosphate or Deproteinized Bovine Bone Mineral: Clinical and Histomorphometric Outcomes of a Randomized Controlled Clinical Trial. International Journal of Oral and Maxillofacial Implants. 2020;35(5):1005-1012. https://doi.org/10.11607/jomi.8211 Kraus R.D., Stricker A., Thoma D.S., Jung R.E. Sinus Floor Elevation with Biphasic Calcium Phosphate or Deproteinized Bovine Bone Mineral: Clinical and Histomorphometric Outcomes of a Randomized Controlled Clinical Trial. International Journal of Oral and Maxillofacial Implants. 2020;35(5):1005-1012. https://doi.org/10.11607/jomi.8211 Pereira R.D.S, Bonardi J.P., Ouverney F.R.F., Campos A.B., Griza G.L., Okamoto R. et al. The new bone formation in human maxillary sinuses using two bone substitutes with different resorption types associated or not with autogenous bone graft: a comparative histomorphometric, immunohistochemical and randomized clinical study. Journal of Applied Oral Science. 2020;29:e20200568. https://doi.org/10.1590/1678-7757-2020-0568 Pereira R.D.S, Bonardi J.P., Ouverney F.R.F., Campos A.B., Griza G.L., Okamoto R. et al. The new bone formation in human maxillary sinuses using two bone substitutes with different resorption types associated or not with autogenous bone graft: a comparative histomorphometric, immunohistochemical and randomized clinical study. Journal of Applied Oral Science. 2020;29:e20200568. https://doi.org/10.1590/1678-7757-2020-0568 Komabayashi T., Colmenar D., Cvach N., Bhat A., Primus C., Imai Y. Comprehensive review of current endodontic sealers. Dental Materials Journal. 2020;39(5):703-720. https://doi.org/10.4012/dmj.2019-288 Komabayashi T., Colmenar D., Cvach N., Bhat A., Primus C., Imai Y. Comprehensive review of current endodontic sealers. Dental Materials Journal. 2020;39(5):703-720. https://doi.org/10.4012/dmj.2019-288 Stanley E., Strother K.K., Kirkpatrick T., Jeong J.W. Calcium Silicate–based Sealer Extrusion into the Mandibular Canal: 3 Different Recovery Outcomes-A Report of 3 Cases. Journal of Endodontics. 2023;49(6):735–741. https://doi.org/10.1016/j.joen.2023.04.006 Stanley E., Strother K.K., Kirkpatrick T., Jeong J.W. Calcium Silicate–based Sealer Extrusion into the Mandibular Canal: 3 Different Recovery Outcomes-A Report of 3 Cases. Journal of Endodontics. 2023;49(6):735–741. https://doi.org/10.1016/j.joen.2023.04.006 Martins J.B., Scheeren B., van der Waal S. The Effect of Unintentional AH-Plus Sealer Extrusion on Resolution of Apical Periodontitis After Root Canal Treatment and Retreatment—A Retrospective Case-control Study. Journal of Endodontics. 2023;49(10):1262–1268. https://doi.org/10.1016/j.joen.2023.07.021 Martins J.B., Scheeren B., van der Waal S. The Effect of Unintentional AH-Plus Sealer Extrusion on Resolution of Apical Periodontitis After Root Canal Treatment and Retreatment—A Retrospective Case-control Study. Journal of Endodontics. 2023;49(10):1262–1268. https://doi.org/10.1016/j.joen.2023.07.021 Takahara S., Edanami N., Ibn Belal R.S., Yoshiba K., Takenaka S., Ohkura N. et al. An Evaluation of the Biocompatibility and Chemical Properties of Two Bioceramic Root Canal Sealers in a Sealer Extrusion Model of Rat Molars. Journal of Functional Biomaterials. 2025;16(1):14. https://doi.org/10.3390/jfb16010014 Takahara S., Edanami N., Ibn Belal R.S., Yoshiba K., Takenaka S., Ohkura N. et al. An Evaluation of the Biocompatibility and Chemical Properties of Two Bioceramic Root Canal Sealers in a Sealer Extrusion Model of Rat Molars. Journal of Functional Biomaterials. 2025;16(1):14. https://doi.org/10.3390/jfb16010014 Kwak S.W., Koo J., Song M., Jang I.H., Gambarini G., Kim H.-C. Physicochemical Properties and Biocompatibility of Various Bioceramic Root Canal Sealers: In Vitro Study. Journal of Endodontics. 2023;49(7):871–879. https://doi.org/10.1016/j.joen.2023.05.013 Kwak S.W., Koo J., Song M., Jang I.H., Gambarini G., Kim H.-C. Physicochemical Properties and Biocompatibility of Various Bioceramic Root Canal Sealers: In Vitro Study. Journal of Endodontics. 2023;49(7):871–879. https://doi.org/10.1016/j.joen.2023.05.013 Guo J., Peters O.A., Hosseinpour S. Immunomodulatory Effects of Endodontic Sealers: A Systematic Review. Dental Journal. 2023;11(2):54. https://doi.org/10.3390/dj11020054 Guo J., Peters O.A., Hosseinpour S. Immunomodulatory Effects of Endodontic Sealers: A Systematic Review. Dental Journal. 2023;11(2):54. https://doi.org/10.3390/dj11020054 Ricucci D., Grande N.M., Plotino G., Tay F.R. Histologic Response of Human Pulp and Periapical Tissues to Tricalcium Silicate–based Materials: A Series of Successfully Treated Cases. Journal of Endodontics. 2020;46(2):307–317. https://doi.org/10.1016/j.joen.2019.10.032 Ricucci D., Grande N.M., Plotino G., Tay F.R. Histologic Response of Human Pulp and Periapical Tissues to Tricalcium Silicate–based Materials: A Series of Successfully Treated Cases. Journal of Endodontics. 2020;46(2):307–317. https://doi.org/10.1016/j.joen.2019.10.032 Donnermeyer D., Bürklein S., Dammaschke T., Schäfer E. Endodontic sealers based on calcium silicates: A systematic review. Odontology. 2018;107(4):421–436. https://doi.org/10.1007/s10266-018-0400-3 Donnermeyer D., Bürklein S., Dammaschke T., Schäfer E. Endodontic sealers based on calcium silicates: A systematic review. Odontology. 2018;107(4):421–436. https://doi.org/10.1007/s10266-018-0400-3 Silva E., Tanomaru-Filho M., Silva G., Lopes C., Cerri P., Tanomaru J.G. Evaluation of the biological properties of two experimental calcium silicate sealers: An in vivo study in rats. International Endodontic Journal. 2021;54(1):100–111. https://doi.org/10.1111/iej.13398 Silva E., Tanomaru-Filho M., Silva G., Lopes C., Cerri P., Tanomaru J.G. Evaluation of the biological properties of two experimental calcium silicate sealers: An in vivo study in rats. International Endodontic Journal. 2021;54(1):100–111. https://doi.org/10.1111/iej.13398 Kato A., Miyaji H., Yoshino Y., Kanemoto Y., Hamamoto A., Nishida E. et al. In Vivo Inflammatory Effects and Surface Composition Changes in Implanted Root Canal Sealer Containing Bioactive Glass. The Japanese Journal of Conservative Dentistry. 2022;65(2):145–153. Japanese. https://doi.org/10.11471/SHIKAHOZON.65.145 Kato A., Miyaji H., Yoshino Y., Kanemoto Y., Hamamoto A., Nishida E. et al. In Vivo Inflammatory Effects and Surface Composition Changes in Implanted Root Canal Sealer Containing Bioactive Glass. The Japanese Journal of Conservative Dentistry. 2022;65(2):145–153. Japanese. https://doi.org/10.11471/SHIKAHOZON.65.145 López-García S., Myong-Hyun B., Lozano A., García-Bernal D., Forner L., Llena C. et al. Cytocompatibility, bioactivity potential, and ion release of three premixed calcium silicate-based sealers. Clinical Oral Investigations. 2019;24(5):1749–1759. https://doi.org/10.1007/s00784-019-03036-2 López-García S., Myong-Hyun B., Lozano A., García-Bernal D., Forner L., Llena C. et al. Cytocompatibility, bioactivity potential, and ion release of three premixed calcium silicate-based sealers. Clinical Oral Investigations. 2019;24(5):1749–1759. https://doi.org/10.1007/s00784-019-03036-2 Sleman N., Khalil A. A Comprehensive Review of Biomaterials for Maxillary Sinus Floor Augmentation: Exploring Diverse Bone Graft Options. The Open Dentistry Journal. 2025;19:e18742106378788. https://doi.org/10.2174/0118742106378788250715114923 Sleman N., Khalil A. A Comprehensive Review of Biomaterials for Maxillary Sinus Floor Augmentation: Exploring Diverse Bone Graft Options. The Open Dentistry Journal. 2025;19:e18742106378788. https://doi.org/10.2174/0118742106378788250715114923