employee
Stavropol, Stavropol, Russian Federation
employee from 01.01.2008 to 01.01.2025
Stavropol, Stavropol, Russian Federation
Krasnodar, Krasnodar, Russian Federation
UDC 616.31
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.
experiment, maxillary sinus, root sealants, Schneiderian membrane, necrosis, immunohistochemistry, fibrosis, angiogenesis
1. 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.)].
2. 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
3. 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
4. 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
5. 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
6. 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
7. 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
8. 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
9. 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
10. 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
11. 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
12. 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
13. 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
14. 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
15. 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
16. 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
17. 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
18. 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
19. 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
20. 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
21. 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
22. 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
23. 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
24. 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
25. 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
