Periapical reactions to calcium hydroxide-containing sealers and AH 26 in monkeys

The long-term effect on periapical healing (8-14 months) of CRCS and Sealapex was compared with that of AH 26. Vital pulpectomy and root canal filling by the hybrid thermomechanical method were performed in teeth of 3 young monkeys. Ten roots with CRCS, 10 with Sealapex and 7 roots with AH 26 were examined after demineralization and routine histological processing. Hematoxylin and eosin and Brown & Brenn staining for micro-organisms were employed. Mild to severe inflammatory lesions were found at the apical foramina of the roots filled with AH 26 and CRCS. Most of the Sealapex specimens showed no inflammatory cells, except macrophages with sealer particles. A striking finding was a tendency towards apical obliteration with calcified tissue in roots filled with Sealapex, apparently following resorption of the sealer. Such a tendency was seldom observed with the other sealers. However, both AH 26 and Sealapex were irritating for a long time when pushed into bone. Despite the interesting results with Sealapex, additional research is needed before its use can be unconditionally recommended. This sealer has not yet been tested in infected cases and its ability to be resorbed, which is an advantage when it precedes replacement by calcified tissue, may become a disadvantage if it is not followed by apical obliteration.