Dental Journal of Advance Studies
Volume 12 | Issue 1 | Year 2024

Comparative Evaluation of Sealing Ability and Pushout Strength of Four Different Furcation Repair Materials: An In Vitro Study

Suman Sharma1, Purshottam Jasuja2, Heena Khurana3, Shveta Munjal4, Ekta Gakhar5, Gurkiran Kaur6

1–6Department of Pediatric and Preventive Dentistry, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India

Corresponding Author: Suman Sharma, Department of Pediatric and Preventive Dentistry, Genesis Institute of Dental Sciences and Research, Ferozepur, Punjab, India, Phone: +91 7011572954, e-mail: sumananchriya@gmail.com

How to cite this article: Sharma S, Jasuja P, Khurana H, et al. Comparative Evaluation of Sealing Ability and Pushout Strength of Four Different Furcation Repair Materials: An In Vitro Study. Dent J Adv Stud 2024;12(1):21–28.

Source of support: Nil

Conflict of interest: None

Received on: 04 March 2024; Accepted on: 02 April 2024; Published on: 30 April 2024


Introduction: In endodontic practice, technical accidents are commonly encountered such as furcation perforation. For everlasting success, furcation perforations shall be corrected rapidly with an ideal perforation sealing material. For an ideal perforation sealing material, the desirable properties include an adequate seal, minimal microleakage, good biocompatibility, high pushout strength, stability in blood-contaminated areas, bactericidal, induction of mineralization, osteogenesis, and cementogenesis, radio-opacity and ease of clinical manipulation. Mineral trioxide aggregate (MTA) is the commonly used furcation repair material, but it presents sundry clinical shortfalls for instance prolonged setting time, difficulty in handling, and tooth discoloration. To remodel the attributions of MTA, new materials have been introduced which include Biodentine, calcium-enriched material (CEM) cement, and Cention N (CN). Biodentine is used as a dentin substitute because of its excellent sealing potential, high compressive strength, high pushout strength, less setting time, good biocompatibility, and biomineralization properties. Calcium-enriched material cement is a water-based tooth-colored material that yields a biological glue, is biocompatible, and ability to induce osteogenesis and cementogenesis. Cention N is an “alkasite” restorative material, like compomer or ormocer materials. It is radiopaque and releases ions such as fluoride, calcium, and hydroxyl.

Objectives: To evaluate and equate the sealing capability and pushout strength of ProRoot MTA, CEM cement, CN, and Biodentine as furcation perforation repair materials.

Materials and methods: A total of 60 extracted permanent mandibular molars were collected, and furcation perforations were made between the roots in a standardized manner. Based on kind of perforation repair material, samples were arbitrarily categorized into four discrete groups having 15 teeth each. In group I, samples were restored with ProRoot MTA. In group II, samples were restored with CEM Cement. In group III, samples were repaired with CN, and in group IV, samples were revived with Biodentine. After which, five samples from each group were selected for sealing ability testing using the dye extraction method by spectrophotometer, five samples from each group were selected for microleakage testing using the dye infiltration method followed by sectioning and evaluation of the sectioned samples by stereomicroscope, and five samples from each group were selected for Pushout strength evaluation by embedding them in acrylic using polyvinyl chloride (PVC) molds and subjecting them to universal testing machine. The data collected was statistically analyzed.

Results: The mean spectrophotometric dye absorbance was significantly higher in CN followed by CEM cement and dye absorbance was least in ProRoot MTA and Biodentine. Infiltration loss was significantly higher among ProRoot MTA and Biodentine compared to CEM cement and CN. The mean pushout strength was significantly higher in Biodentine followed by ProRoot MTA and CN and it was the least in CEM cement.

Conclusion: Biodentine showed the best sealing ability and highest pushout strength among the four materials used, that is, MTA, CEM cement, and CN. Therefore, Biodentine can be used as a replacement for MTA, CEM cement, and CN as a furcation perforation repair material.

Keywords: Biodentine, Calcium-enriched material cement, Cention N, Dye extraction, Furcation repair, Perforation, Pushout strength, Spectrophotometer, Stereomicroscope.


The prime focus of endodontic therapy is to preserve the coherence of the natural dentition inappropriate function, form, and esthetics. The major goals of endodontic treatment are as follows: (A) Elimination of organic debris, toxic compounds, and irritation/troubling agents from the root canal system; (B) cleaning and shaping of canals; (C) to stuff or obdurate the cleaned and shaped architecture; and (D) to limit further in future recontamination of sealed root canals.1

Seldom, during endodontic treatment, accidental issues like furcation perforation come. Accidental mechanical furcal perforation can be induced by the misdirection of bur and depth of bur during the preparation of the access cavity. Furcation perforation may lead to an inflammatory response in periodontal tissues. Consequently, the diagnosis of the tooth is affected in the long run. The overall clinical prognosis of furcation perforation is governed by the following factorials: (A) Size of perforation; (B) Duration of exposure to the oral cavity; (C) Level of inflammation in the periodontium; and (D) The shorter time interval between the perforation and repair favors a good prognosis. In pediatric patients, perforation has been reported as the second leading cause of endodontic failure following obturation and this constitutes up to 9.6% of all unsuccessful cases.2 Furcation perforation repair materials should have the following ideal characteristics:

The conglomeration of mineral trioxide is the most popularly used material due to its profound usage. Mineral trioxide aggregate (MTA) was introduced by Torabinejad et al.,4 which has good sealing ability, is biocompatible, and is bioactive hydrophilic cement (sets in the presence of water).5 The composition of MTA is powdery having Portland cement clinker, bismuth oxide, and gypsum. The working mechanism of MTA lies in the hydration cascade, so the byproducts of insoluble calcium silicate hydrate and alkaline calcium hydroxide render a peculiar capability, and due to its strengthening, it boosts hard tissue regeneration. MTA is an exclusive material that fosters the overgrowth of cementum and formation of bone having both dentinogenic and osteogenic potential.6 Mineral trioxide aggregate has many drawbacks, such as handling difficulty, prolonged setting time, and high cost. Mineral trioxide aggregate by chemistry is a derivative of Portland cement, and Portland cement contains the same principal chemical elements except for bismuth oxide.5

Several utilitarian uses of the calcium-enriched mixture (CEM) are there in endodontics, it is a cementing biomaterial that is hydropowered and widely used in tooth coloring.

As demonstrated by several studies in the literature, CEM cement has antifungal as well as antibacterial properties, it imparts excellent physical and biological gluing effects, that have biocompatibility, and is nontoxic.7

Cention N (CN) is commonly known as an “alkasite” reparative material. These composite obturative materials are chemically copolymers and ormocers. They employ an alkaline filler and can discharge acid-neutralizing ions. Furthermore, CN is a self-healing material with elective added light curing. Cention N by its chemistry is radiologically opaque and it frees up fluoride, calcium, and hydroxide ions.8

By chemical formulation Biodentine (Septodont, Saint-Maur-des-Fosses, France) has tricalcium silicate, zirconium dioxide, and calcium carbonate. It has a liquid state which contains calcium chloride as a setting catalyst. Biodentine has tremendous strengthening potential which imparts marked bioactivity, reciprocity, and a small setting time of 12 minutes.9 As a proven endodontic repair material, Biodentine is endorsed as an excellent dentin substitute.10



By the due course of periodontal causations 60 (n = 60), human permanent mandibular molars were extracted and selected for the study. With the help of hand scalers, the teeth were cleaned of any organic surface debris afterward calculus was polished with prophylaxis paste and polishing rubber cup. Extracted teeth were further stored in 3% sodium hypochlorite until used in the next stages.

Armamentarium Used for the Study

Hand scalers (Hu-Friedy Manufacturing Company, Chicago, Illinois, USA), 3% NaOCl (Septodont Health Care India Pvt. Ltd), normal saline (Beryl Drugs Ltd, India), Diamond disc (Contiene) and mandrel, Bard Parker (BP) blade (GLASSVAN) and handle (Premium GDC Marketing Company, India), tweezer (API), Williams’s probe (API), applicator tips (3M ESPE), sterile gloves (Surgicare Kanam Latex Industries Pvt. Ltd, Ghaziabad, Uttar Pradesh, India), disposable face mask (Prime Surgicals, Whitefield Limited, Bengaluru, Karnataka, India), disposable syringe and needle (DISPOVAN), sticky wax (PYRAX), nail varnish, black marker pen, air rotor handpiece (NSK, Nakanishi, Inc., Japan), burs–round bur No. 40 (Mani, Inc., Japan), taper fissure No. 12 (Mani, Inc., Japan), endo access bur (Densply, Maillefer, Ballaiguas, Switzerland) and No. 2 round carbide bur, micromotor control box (Supreme Laboratories), micromotor (Marathon) and straight handpiece (NSK, Nakanishi, Inc., Japan), contra-angle hand piece (NSK, Nakanishi, Inc., Japan), rubber cup, prophylaxis paste (Spectra, Prevest DenPro), PVC moulds, 37% phosphoric acid etchant (DPI, Dental Products of India), bonding agent (Primedent), glass slab and metal spatula (Premium GDC Marketing Company, India), glass beaker, test tubes and test tube stand, cold cure acrylic resin (Pyrax), MTA carrier (Waldent), plastic disposable containers, Petri dishes, kidney tray, composite filling instrument (Premium GDC Marketing Company, India), plastic filling instrument (Premium GDC Marketing Company, India), mixing pad and plastic spatula, 2% methylene blue (MB) dye, nitric acid (65 wt%), composite (Ivoclar vivadent), MTA (ProRoot MTA, Dentsply Tulsa, Tulsa, Oklahoma, USA), Biodentine (Septodont, France), CEM cement (Neoendo Neocem), and CN (Ivoclar Vivadent).

Equipment Used

Ultraviolet (UV) spectrophotometer (Labtronics) (Fig. 1A), stereomicroscope (Nikon Trinocular Stereozoom SMZ-745T) (Fig. 1C), universal testing machine (Hi-Tech, Model-5k) (Fig. 1D), centrifuge machine (Fig. 1B), and incubator.

Figs 1A to D: (A) Ultraviolet spectrophotometer; (B) Centrifuge machine; (C) Stereomicroscope; (D) Universal testing machine

Inclusion Criterion

  • Permanent molars with well-developed and complete roots.

Exclusion Criteria

  • Teeth with cracks

  • Teeth with root caries

  • Teeth with fused roots

  • Teeth with root resorption

  • Teeth with developmental defects


Preparation of Teeth before Testing

The decoronation of all 60 (n = 60) teeth was done above 3 mm to the cementoenamel junction (CEJ) and subsequent roots were amputated below 3 mm to the furcation. A standardized endodontic access cavity was prepared in all 60 samples. After that, the orifices of each canal were sealed with sticky wax.

A total of 60 molars which were used for the evaluation of sealing ability were then double coated with discrete layers of nail varnish. The defect location is marked using a black marker.

By employing high-speed handpiece No. 2 round carbide bur mounted and on the external surface of the tooth a defect of 1-mm diameter was made employing a water coolant. Subsequently, the chamber and perforations were cleaned with water and pat dried. The dried teeth were then shifted to an incubator maintained at 37°C for 24 hours to mimic clinical environments.

Perforation Repair

The following materials were used to repair the perforations:

  • ProRoot MTA

  • Calcium-enriched material cement

  • CN

  • Biodentine

Prepared samples were categorized into four groups of 15 teeth each, every group was divided on the basis of type of perforation repair material.

  • Group I (n = 15): Restoration with ProRoot MTA

  • Group II (n = 15): Restoration with CEM Cement

  • Group III (n = 15): Restoration with CN

  • Group IV (n = 15): Restoration with Biodentine

Specimens in each group were restored with respective restorative materials according to the manufacturer’s guidelines. All the teeth samples in peripherals of aforesaid groups were incubated to rest to achieve proper setting for 24 hours having 100% humidity at 37°C. Each group was further subdivided into three subgroups of five teeth each according to the procedure.

  • Subgroup IA (n = 5): Sealing ability was evaluated by spectrophotometer

  • Subgroup IB (n = 5): Sealing ability was evaluated by Stereomicroscope

  • Subgroup IC (n = 5): Samples were evaluated for pushout strength

  • Subgroup IIA (n = 5): Sealing ability was evaluated by spectrophotometer

  • Subgroup IIB (n = 5): Sealing ability was evaluated by stereomicroscope

  • Subgroup IIC (n = 5): Samples were evaluated for pushout strength

  • Subgroup IIIA (n = 5): Sealing ability was evaluated by spectrophotometer

  • Subgroup IIIB (n = 5): Sealing ability was evaluated by stereomicroscope

  • Subgroup IIIC (n = 5): Samples were evaluated for pushout strength

  • Subgroup IVA (n = 5): Sealing ability was evaluated by spectrophotometer

  • Subgroup IVB (n = 5): Sealing ability was evaluated by stereomicroscope

  • Subgroup IVC (n = 5): Samples were evaluated for pushout strength

Dye Extraction Microleakage Evaluation by Spectrophotometer

The samples in subgroups IA, IIA, IIIA, and IVA were kept in separate Petri dishes having 2% MB to allow teeth to be dipped in dye up to the CEJ for an inverted dye challenge and by this procedure, the dye can reach the chamber of each tooth so that orthograde dye penetration. In the next step, the teeth samples were stored for 48 hours. Subsequently, teeth were removed from the dye solution and rinsed in running tap water for a period of 30 minutes. By using a sterile BP blade, the varnish was removed from the teeth. Separate vials having 5 mL of conc nitric acid (65 wt%) are used for storing teeth for a sum period of 3 days. The dye solution thus obtained is then made to centrifuge at 3500 rpm for 5 minutes. In a UV spectrophotometer at 550-nm wavelength, supernatant (4 mL) was analyzed and recorded, conc. nitric acid to be used as blank, absorbance was recorded units.11

Dye Infiltration by Stereomicroscope

The access opening of the teeth in subgroups IB, IIB, IIIB, and IVB were filled with lightcure composite filling material (IVOCLAR). A coating of two layers of nail varnish was done after passage of 24 hours, whereas 1–2 mm around the perforation site was left open to air. Afterward, all teeth were then dipped in 2% MB in 100% humidity at 37°C for 24 hours. Subsequently, the teeth were rinsed in running tap water and dried at room temperature for 24 hours. Longitudinal sections of each tooth in a buccolingual direction, were made crossing the site of perforation using a diamond disk (0.3 mm in thickness) employing a low-speed handpiece and a water coolant. The maximum apical extent of dye leakage at the interfacial surface between tooth structure and repair material was calculated using a stereomicroscope at 25× magnification. To investigate the sealing ability in this in vitro study, we used mean values of apical dye leakage at the perforation site, and Escobar’s criteria was employed to measure the infiltration ratios as follows:12

0: Infiltration loss (dye penetration <1.5 mm) (Figs 2A and D).

1: Simple infiltration (dye penetration 1.5–3 mm) (Fig. 2B).

Figs 2A to D: (A) Infiltration loss in ProRoot MTA; (B) Simple infiltration in CEM cement; (C) Medium infiltration in CN; (D) Infiltration loss in biodentine

2: Medium infiltration (dye penetration >3 mm) (Fig. 2C).13

Pushout Strength Evaluation

After the repair of perforations, subgroups IC, IIC, IIIC, and IVC were encased in a piece of wet gauze and thereafter taken to an incubator at 37°C and 100% relative humidity for 72 hours to establish the hardening of the tested materials. The samples were then embedded in PVC mold using cold cure acrylic resin, in a straight position over the sponge to prevent acrylic from flowing over and under the area of perforation. The specimens were then subjected to load using the universal testing machine at a crosshead speed of 1 mm/minute using a metal stylus of 1-mm diameter to check the pushout bond strength. The plunger tip was positioned to contact the test material touching only the filling material without stressing the surrounding dentin, in a coronal-apical direction. The test was completed until total bond failure. The highest force applied to materials at the time of dislodgement was recorded in megapascals (MPa). Bond strength was calculated from the following equation: Bond strength = Fdh, where F is the compressive force applied to the specimen, d is the diameter of the plunger, h is the thickness of the specimen, and π is constant (3.14).

The data collected was then put into statistical analysis to compare the sealing ability for each type of furcation perforation repair material and pushout strength for each subgroup.


The mean spectrophotometer reading was calculated by employing one-way analysis of variance (ANOVA). The recordings of groups having ProRoot MTA, CEM cement, CN, and Biodentine were compared and correlated. There were noteworthy differences in mean Spectrophotometer readings in-between ProRoot MTA, CEM cement, CN, and Biodentine groups (Table 1).

Table 1: Distribution of study population according to mean spectrophotometric dye absorbance values
  Spectrophotometer reading
Mean SD F-value p-value
ProRoot MTA 0.11 0.02 144.265 0.001*
CEM cement 0.20 0.02    
CN 0.28 0.02    
Biodentine 0.08 0.00    
*Significant difference; One-way ANOVA test; SD, standard deviation

To test intergroup mean significant correlations, the post hoc Bonferroni method is employed. As per results, the mean spectrophotometric dye absorbance was significantly higher in CN followed by CEM cement, and dye absorbance was least in ProRoot MTA and Biodentine (Fig. 3) and there was no significant difference in the dye absorbance between ProRoot MTA and Biodentine (Table 2).

Table 2: Intergroup comparison according to mean spectrophotometric dye absorbance values
    Mean difference p-value
ProRoot MTA CEM cement –0.09 0.001*
ProRoot MTA CN –0.17 0.001*
ProRoot MTA Biodentine 0.03 0.111
CEM cement CN –0.08 0.001*
CEM cement Biodentine 0.12 0.001*
CN Biodentine 0.19 0.001*
*Significant difference; Post hoc Bonferroni test

Fig. 3: Graphical representation of mean spectrophotometric dye absorbance values between four groups

The sealing capability was compared between ProRoot MTA, CEM cement, CN, and Biodentine using the Chi-square test. There were notable differences in sealing ability between ProRoot MTA, CEM cement, CN, and Biodentine (Table 3).

Table 3: Distribution of study population according to stereomicroscopic findings
Sealing ability Material
ProRoot MTA CEM cement CN Biodentine
Infiltration loss 4 2 1 4
80.0% 40.0% 20.0% 80.0%
Simple infiltration 1 2 1 1
20.0% 40.0% 20.0% 20.0%
Medium infiltration 0 1 3 0
0.0% 20.0% 60.0% 0.0%
p-value 0.017*      
*Significant difference; Chi-square test

The relative assessment between the groups for sealing ability was done using the Chi-square test. Infiltration loss was significantly higher among ProRoot MTA and Biodentine compared to CEM cement and CN (Fig. 4) and there were no significant alterations between the sealing ability of ProRoot MTA, Biodentine, and CEM cement (Table 4).

Table 4: Intergroup comparison of sealing ability according to stereomicroscopic findings
ProRoot MTA CEM cement CN Biodentine
ProRoot MTA 0.368 0.091 1.000
CEM cement 0.368 0.435 0.368
CN 0.049* 0.435 0.049*
Biodentine 1.000 0.368 0.049
*Significant difference; Chi-square test

Fig. 4: Graphical representation of mean dye infiltration between four groups

One-way ANOVA is also used to investigate the mean pushout strength and further compared in ProRoot MTA, CEM cement, CN, and Biodentine groups. The statistical findings indicate significant alterations in mean pushout strength between ProRoot MTA, CEM cement, CN, and biodentine (Table 5).

Table 5: Distribution of study population according to pushout strength
  Pushout strength
Mean SD F-value p-value
ProRoot MTA 194.60 32.71 21.611 0.001*
CEM cement 143.20 21.08    
CN 174.20 8.29    
Biodentine 264.20 29.24    
*Significant difference; One-way ANOVA test

The intergroup comparison of mean pushout strength was done using the post hoc Bonferroni test. The mean pushout strength was significantly higher in Biodentine followed by ProRoot MTA and CN and it was least in CEM cement (Fig. 5) and there was no noticeable variation in the pushout strength of ProRoot MTA and CN (Table 6).

Table 6: Intergroup comparison according to pushout strength
    Mean difference p-value
ProRoot MTA CEM cement 51.40 0.028*
ProRoot MTA CN 20.40 1.000
ProRoot MTA Biodentine –69.60 0.002*
CEM cement CN –31.00 0.047*
CEM cement Biodentine –121.00 0.001*
CN Biodentine –90.00 0.001*
*Significant difference; Post hoc Bonferroni test

Fig. 5: Graphical representation of mean pushout strength values between four groups


Accidental problems may occur occasionally during endodontic treatment such as furcation perforation.14 Furcation perforation may lead to an inflammatory response in periodontal tissues. This can impact the long-term prognosis of the tooth.2 This mechanical communication needs to be gathered with a biocompatible material promptly.15

Permanent and primary teeth present clear anatomical, structural, and physiological differences. Thus, dental morphology is a remarkable concept in reducing the risk of perforations. Primary teeth have wider pulp chambers, thinner enamel, and smaller root trunks than permanent teeth.16 These anatomical aspects increase the risk of perforation in primary teeth. Preoperative radiographs, and the use of appropriate dental instruments, with the prior knowledge of accurate dental anatomy, can demote the furcation perforation risks in primary teeth.17,18

In the present study, MTA was used in group I as a perforation repair material. Also, MTA has the property to induce cementogenesis which can produce a matrix for cementum formation and is biocompatible with the periradicular tissues, thus it shows improved sealing ability.15 Cention N being in group III, which is established as an artistic option to combine, is an “alkasite” restorative material such as compomer or ormocer (a subgroup of the composite resins) and its compressive strength is evaluated to conjoin.19 The calcium-based CEM cementing material which used in group II, is a hydrophilic tooth-colored biomaterial with manifold merits in endodontics. Due to its chemistry, CEM as a cementing material has inhibitory properties for the growth of fungus and bacteria, furnishes excellent sealing functional biological manifestations, is nonhazardous, and biologically compatible.7 Biodentine was used in group IV as a furcation perforation repair material. Biodentine is known as a favorable perforation repair material as it has easy material handling, easy logistics, and a short and supportive time scheduling (12 minutes). It has a high alkaline pH and is biocompatible.15

Microleakage assays provide useful information on the restorative material’s performance.20 In this study, the dye penetration method for evaluation of sealing ability was used as it has an advantage of technique simplicity and low cost. On the contrary, the dye penetration test has some drawbacks including the small molecular size of the dye compared to bacteria.21 However, on the contrary, Torabinejad et al.4 stated that if the material can prevent small dye molecules from penetrating, then it can also be used to circumvent bacteria (large substances) and their sequels from penetration.

A dye penetration test can read the application as well as the longevity of restorative material. Appraisal of marginal microleakage for any restorative material is significant as it has a direct impact on the overall performance of the restorations. The dye penetration assay has many advantages, such as no use of reactive chemicals and radiations and the availability of different dye solutions, therefore, this technique is viable and can be easily reproducible.20 About 2% MB dye was selected for this study because of its low molecular size which allows for the detection of minutest leakage where even bacteria cannot penetrate and is a more sensitive indicator of leakage.19,20,2224 The dye–penetration studies are popularly employed due to their low cost and simplicity of technique and do not necessitate sophisticated materials, but they give questionable results. In the present study, the fluid–filtration and dye extraction techniques allowed the scaling of four perforation repair materials and presented corresponding results. The dye–extraction technique is propitious, fast, and can be performed with ease.25

For better analysis of dye penetration most of the studies used stereomicroscope but with different magnification power as Nikoloudaki et al. used 20× and Mohan et al. used 10×.12,26 In the present study, 25× was used in agreement with Yahya et al.27 for better and more accurate analysis on a bigger scale with a clear image to detect the leakage and the gaps between the material and the dentin walls.21

The Biodentine group showed the highest sealing ability among all the groups, followed by MTA and CEM cement. Cention N shows the least sealing ability. This is in synchronous with the study performed by Yahya27 and Samuel et al.28

Dye penetrations in MTA-placed cavities were less than those of CEM cement and CN. This is due to its superior marginal sealing ability.23 It also shows excellent biological sealing of furcation perforation as it induces the formation of periradicular cement.29

The pushout bond strength test, which was utilized in this investigation, was proved to be effective, practical, and accurate.21 To assess bond strength, the pushout test is a reliable method, where a gradually increasing pressure is applied to the material until debonding occurs and it mimics clinical situations.14,15

The Biodentine group showed the highest pushout strength among the groups, followed by MTA and CN, and the least pushout strength was seen in CEM cement. These results are in accordance with the study conducted by Guneser et al.,30 Tomer et al.,31 and Aggarwal et al.32 The biomineralization capacity of Biodentine can be attributed to the small particle size of Biodentine that can improve the cement penetration and the formation of tags that enhances the dislodgment resistance.3032

All the factors mentioned above justify the results of this study, which shows the excellent sealing property and pushout strength of Biodentine compared to MTA, CEM cement, and CN. The present study was performed under in vitro conditions, although the best simulation of intraoral conditions was created with available resources, but the oral cavity is a complex structure, thus exact simulation of conditions could not be reproduced, which might have affected the results.

Because of these limitations, a realistic sealing ability and pushout strength for in vivo environment may not be summarized in the study. However, because all groups were tested in a similar fashion, relative sealing ability and pushout strength among the groups are coherent presumptions that should hold true in the in vivo situations. Hence, based on observations from the current study, this knowledge can be applied to our daily clinical practice. Further long-term studies should be conducted in the field of furcation repair materials in the future so that data on a large scale will be available before a decisive outcome can be made for the best furcation repair material.


From the results of our study and after comparing them with literature data, we can conclude that Biodentine can be used as a furcation perforation repair material. Biodentine showed the best sealing ability and highest pushout strength among the four materials used that is, MTA, CEM cement, and CN. Consequently, Biodentine can be employed to substitute MTA, CEM cement and CN as a furcation perforation repair material. However, multicentric in-vivo/vitro studies may relinquish further correlation in clinical setup.


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