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Comparative in vitro analysis of the antifungal activity of different calcium silicate-based endodontic sealers


Candida albicans
Root canal filling materials

How to Cite

Moreira LFN, Peña-Bengoa F, Niklander SE, Bueno CE da S, Martin AS de, Rocha DGP. Comparative in vitro analysis of the antifungal activity of different calcium silicate-based endodontic sealers. Braz. J. Oral Sci. [Internet]. 2024 Apr. 8 [cited 2024 Jun. 14];23(00):e243355. Available from:


Aim: This study aimed to perform an in vitro comparative analysis of the antifungal activity of different calcium silicate-based endodontic sealers against three fungal species. Methods: The antifungal properties of three calcium silicate-based sealers were tested: Bio-C Sealer, Cambiar a Sealer Plus BC, and MTA-Fillapex. Two commonly used sealers were used as controls: AH Plus and Endomethasone. An agar diffusion test was performed to analyze the antifungal activity of the sealers against Candida albicans, Candida glabrata, Candida tropicalis, and a mixed microbial culture medium. The results were analyzed using ANOVA (p <0.05). Results: Endomethasone exhibited the highest inhibition against all strains examined, maintaining a consistent level of inhibition throughout 7 days. MTA-Fillapex demonstrated the best performance among the calcium silicate-based sealers for the three fungal species (p < 0.05), maintaining stable values over the 7 days, surpassing that of Endomethasone. Nevertheless, MTA-Fillapex only exhibited antimicrobial effect against the mixed culture for the first 24 hours, and no antimicrobial activity was observed at 48 hours, being surpassed by all tested sealers (p < 0.05). Conclusion: Of all silicate-based sealers tested, only MTA-Fillapex exhibited promising antifungal activity. Nevertheless, care must be taken when extrapolating these results, as MTA-Fillapex exhibited poor antimicrobial activity when tested in mixed microbial cultures.


Tzanetakis GN, Koletsi D, Tsakris A, Vrioni G. Prevalence of fungi in primary endodontic infections of a greek-living population through real-time polymerase chain reaction and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. J Endod. 2022 feb;48(2):200-7. doi: 10.1016/j.joen.2021.11.003.

Tabassum S, Khan FR. Failure of endodontic treatment: The usual suspects. Eur J Dent. 2016 Jan-Mar;10(1):144-7. doi: 10.4103/1305-7456.175682.

Siqueira JF, Rôças IN. Present status and future directions: Microbiology of endodontic infections. Int Endod J. 2022 May;55 Suppl 3:512-30. doi: 10.1111/iej.13677.

Lacerda MFLS, Coutinho TM, Barrocas D, Rodrigues JT, Vidal F. [The relationship between secondary and persistent infections and failure of endodontic treatments]. Rev Bras Odontol. 2016;73(3):212-7. Portuguese.

Persoon IF, Buijs MJ, Özok AR, Crielaard W, Krom BP, Zaura E, et al. The mycobiome of root canal infections is correlated to the bacteriome. Clin Oral Investig. 2017 Jun;21(5):1871-81. doi: 10.1007/s00784-016-1980-3.

Lydia Rajakumari M, Saravana Kumari P. Prevalence of Candida species in the buccal cavity of diabetic and non-diabetic individuals in and around Pondicherry. J Mycol Med. 2016 Dec;26(4):359-67. doi: 10.1016/j.mycmed.2016.08.002.

Mergoni G, Percudani D, Lodi G, Bertani P, Manfredi M. Prevalence of candida species in endodontic infections: systematic review and meta-analysis. J Endod. 2018 Nov;44(11):1616-25.e9. doi: 10.1016/j.joen.2018.07.016.

Siqueira JF, Sen BH. Fungi in endodontic infections. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 May;97(5):632-41. doi: 10.1016/S1079210404000046.

Siqueira Jr JF, Rôças IN. Distinctive features of the microbiota associated with different forms of apical periodontitis. J Oral Microbiol. 2009 Aug 10:1. doi: 10.3402/jom.v1i0.2009.

Yang X, Tian J, Li M, Chen W, Liu H, Wang Z, et al. Biocompatibility of a new calcium silicate-based root canal sealer mediated via the modulation of macrophage polarization in a rat model. Materials (Basel). 2022 Mar;15(5):1962. doi: 10.3390/ma15051962.

Alves Silva EC, Tanomaru-Filho M, da Silva GF, Delfino MM, Cerri PS, Guerreiro-Tanomaru JM. Biocompatibility and bioactive potential of new calcium silicate–based endodontic sealers: Bio-C Sealer and Sealer Plus BC. J Endod. 2020 Oct;46(10):1470-7. doi: 10.1016/j.joen.2020.07.011.

Utneja S, Nawal RR, Talwar S, Verma M. Current perspectives of bio-ceramic technology in endodontics: calcium enriched mixture cement - review of its composition, properties and applications. Restor Dent Endod. 2015 Feb;40(1):1-13. doi: 10.5395/rde.2015.40.1.1.

Koch DK. Bioceramic technology – the game changer in endodontics. Endodontic Pract. 2009 Apr:13-7.

Lima NFF, Dos Santos PRN, Pedrosa MDS, Delboni MG. [Bioceramic sealers in endodontics: a literature review]. RFO. 2017;22(2):248-54. Portuguese. doi: 10.5335/rfo.v22i2.7398.

Bosaid F, Aksel H, Azim AA. Influence of acidic pH on antimicrobial activity of different calcium silicate based–endodontic sealers. Clin Oral Investig. 2022 Aug;26(8):5369-76. doi: 10.1007/s00784-022-04504-y.

Ashofteh Yazdi K, Ghabraei Sh, Bolhari B, Kafili M, Meraji N, Nekoofar MH, et al. Microstructure and chemical analysis of four calcium silicate-based cements in different environmental conditions. Clin Oral Investig. 2019 Jan;23(1):43-52. doi: 10.1007/s00784-018-2394-1.

Damasceno FMB, Moreira EJ, Abad EC, Siqueira Junior JF. [Comparative study of the antifungal activity of endodontic sealers and mineral trioxide aggregate (MTA)]. Rev Bras Odontol. 2008; 65(1):66-71. Portuguese. doi: 10.18363/rbo.v65n1.p.66.

Gomes BPF de A, Pedroso JA, Jacinto RC, Vianna ME, Ferraz CCR, Zaia AA, et al. In vitro evaluation of the antimicrobial activity of five root canal sealers. Braz Dent J. 2004;15(1):30-5. doi: 10.1590/s0103-64402004000100006.

Rahman H, Chandra R, Chowdhary D, Singh S, Tripathi S, Anwar SZ. Antimicrobial activity of mta fillapex, real seal se, acroseal and zinc oxide eugenol sealers against enterococcus faecalis and candida albicans. IOSR J Dent Med Sci. 2017;16(1):66–9. doi: 10.9790/0853-1601046669.

Xie Q, Johnson BR, Wenckus CS, Fayad MI, Wu CD. Efficacy of berberine, an antimicrobial plant alkaloid, as an endodontic irrigant against a mixed-culture biofilm in an in vitro tooth model. J Endod. 2012 Aug;38(8):1114-7. doi: 10.1016/j.joen.2012.04.023.

Tanomaru-Filho M, Tanomaru JMG, Barros DB, Watanabe E, Ito IY. In vitro antimicrobial activity of endodontic sealers, MTA-based cements and Portland cement. J Oral Sci. 2007 Mar;49(1):41-5. doi: 10.2334/josnusd.49.41.

Athanassiadis B, George GA, Abbott PV, Wash LJ. A review of the effects of formaldehyde release from endodontic materials. Int Endod J. 2015 Sep;48(9):829-38. doi: 10.1111/iej.12389.

Phukan AH, Mathur S, Sandhu M, Sachdev V. The effect of different root canal sealers on the fracture resistance of endodontically treated teeth-in vitro study. Dent Res J (Isfahan). 2017 Nov-Dec;14(6):382-8. doi: 10.4103/1735-3327.218558.

Al-Hezaimi K, Naghshbandi J, Oglesby S, Simon JH, Rotstein I. Comparison of antifungal activity of white-colored and gray-colored mineral trioxide aggregate (MTA) at similar concentrations against Candida albicans. J Endod. 2006 Apr;32(4):365-7. doi: 10.1016/j.joen.2005.08.014.

Morgental RD, Vier-Pelisser FV, Oliveira SD, Antunes FC, Cogo DM, Kopper PM. Antibacterial activity of two MTA-based root canal sealers. Int Endod J. 2011 Dec;44(12):1128-33. doi: 10.1111/j.1365-2591.2011.01931.x.

Sfeir G, Zogheib C, Patel S, Giraud T, Nagendrababu V, Bukiet F. Calcium silicate-based root canal sealers: a narrative review and clinical perspectives. Materials (Basel). 2021 Jul;14(14):3965. doi: 10.3390/ma14143965.

Camilleri J, Arias Moliz T, Bettencourt A, Costa J, Martins F, Rabadijeva D, et al. Standardization of antimicrobial testing of dental devices. Dent Mater. 2020 Mar;36(3):e59-e73. doi: 10.1016/

El Sayed M, Ghanerad N, Rahimi F, Shabanpoor M, Shabanpour Z. Antibacterial activity of sodium hypochlorite gel versus different types of root canal medicaments using agar diffusion test: an in vitro comparative study. Int J Dent. 2020 Nov:2020:6483026. doi: 10.1155/2020/6483026. eCollection 2020.

Siqueira JF Jr, Favieri A, Gahyva SM, Moraes SR, Lima KC, Lopes HP. Antimicrobial activity and flow rate of newer and established root canal sealers. J Endod. 2000 May;26(5):274-7. doi: 10.1097/00004770-200005000-00005.

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Copyright (c) 2024 Luiz Felipe Nunes Moreira, Fernando Peña-Bengoa, Sven Eric Niklander, Carlos Eduardo da Silveira Bueno, Alexandre Sigrist de Martin, Daniel Guimarães Pedro Rocha


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