Marginal Adaptation and Porosity of Calcium Silicate Cements in Furcation Perforations: A Micro-CT Comparative Study

Marginal Adaptation and Porosity of Calcium Silicate Cements in Furcation Perforations: A Micro-CT Comparative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Marginal Adaptation and Porosity of Calcium Silicate Cements in Furcation Perforations: A Micro-CT Comparative Study María Rojo Carpintero, Ana Martín Díaz, Juan Miraglia Cantarini, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6315576/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 02 Jun, 2025 Read the published version in Scientific Reports → Version 1 posted 12 You are reading this latest preprint version Abstract This study compares the adaptation, porosity, and sealing performance of ProRoot MTA, NeoPutty, and Biodentine. Thirty-six mandibular molars with furcation perforations were randomly assigned to three groups (n = 12). Clinical evaluation assessed adaptation, porosity, and overfilling, while micro-computed tomography (micro-CT) provided quantitative data on voids and gaps. Statistical analysis used chi-square, Kruskal-Wallis, and Mann-Whitney U tests. NeoPutty and ProRoot MTA showed superior adaptation compared to Biodentine (p < 0.05). Biodentine showed higher porosity (28.44%) than ProRoot MTA (0%) and NeoPutty (8.3%) (p < 0.001). Biodentine also had the highest void volume (1.05 mm³) and gap volume (1.37 mm³), while ProRoot MTA recorded the lowest void volume (0.59 mm³), and NeoPutty had the smallest gap volume (0.85 mm³). No significant differences were observed in overfilling rates. ProRoot MTA offered the best sealing ability, while NeoPutty provided easier application. In contrast, Biodentine showed the worst performance. Health sciences/Health care/Dentistry/Endodontics Health sciences/Health care/Dentistry/Dental materials/Dental biomaterials Health sciences/Health care/Dentistry/Dental materials/Mineral trioxide aggregate Calcium silicate cement Dental porosity Furcal perforations Mandibular molars Marginal adaptation Micro-computed tomography Perforation sealing Figures Figure 1 Figure 2 Figure 3 Introduction Furcation perforations are pathological connections between the root canal system and the surrounding periodontium. They can be caused by extensive caries, resorption processes, or iatrogenic factors during endodontic treatment [ 1 ]. These perforations compromise the tooth's integrity and often lead to periodontal inflammation due to bacterial colonization of the perforation site. If left untreated ​, furcation perforations worsen over time [ 2 ]. Due to their proximity to critical periodontal structures and the increased risk of contamination from the oral environment, they pose a significant challenge to successful endodontic treatment [ 1 , 2 ]. The prognosis of teeth with furcation perforations is strongly influenced by several factors, including the size and location of the perforation, the time elapsed until repair, and the type of material used for sealing [ 3 ]. Larger perforations and those located close to the bone crest pose a greater risk of bacterial infiltration and contamination with fluid from the gingival sulcus, leading to compromised healing outcomes [ 4 ]​. In addition, untreated perforations can lead to a series of complications, which increase the likelihood of tooth extraction, such as persistent inflammation, damage to the periodontal attachment, epithelial tissue overgrowth, ongoing bone deterioration, and extensive bone resorption [ 2 ]. It has been reported as the second leading cause of endodontic failures following obturation, accounting for 9.6% of cases [ 5 ]. An effective repair material should provide an adequate seal with minimal setting time, be biocompatible, non-toxic, non-carcinogenic, affordable, bacteriostatic, readily available, easy to handle, and capable of promoting osteogenesis and cementogenesis [ 6 ]. Additionally, it should function effectively as a barrier or matrix between the root canal filling and surrounding tissues, guaranteeing a hermetic seal [ 5 , 7 , 8 ]. This can be accomplished by reducing the formation of gaps between the dentin walls and the material and minimizing voids within the material itself to decrease bacterial microleakage [ 8 , 9 ]. Recent advances in calcium silicate-based cements such as mineral trioxide aggregate (MTA) and Biodentine (Septodont, Saint Maur des Fosse’s, France) [ 10 ] have revolutionized the treatment of furcation perforations. These highly biocompatible materials promote complex tissue regeneration and provide a hermetic seal that prevents bacterial recontamination [ 11 ]​. MTA, introduced in the 1990s, became the gold standard due to its ability to induce cementogenesis and its excellent sealing properties [ 6 ]. However, its disadvantages include long setting times [ 6 ], complex handling, and possible discoloration due to the inclusion of bismuth oxide [ 12 , 13 ]. In response to these limitations, second-generation calcium silicate cements such as Biodentine have been developed, offering shorter setting times and improved handling properties [ 14 ]. Biodentine, which incorporates zirconium oxide as a radiopacifier instead of bismuth oxide, has been shown to avoid staining while maintaining similar mechanical properties to dentin​ [ 15 ]. More recently, pre-mixed putty-like repaired materials such as NeoPutty (Avalon Biomed, Houston, Texas, USA) have come onto the market, eliminating mixing variability and facilitating application. These materials have demonstrated satisfying outcomes in several clinical situations besides furcation perforations such as root resorptions, vital pulp therapies, and microsurgeries [ 8 , 16 , 17 ]. Advanced imaging techniques such as micro-computed tomography (micro-CT) are frequently used to investigate the efficacy of these materials in sealing furcation perforations [ 18 ]. This technique enables a thorough examination of marginal adaptation, porosity, and the integration of the material into the surrounding dentin. In a recent study [ 8 ], using micro-CT imaging, the adaptation of three calcium silicate-based cements in mandibular molar furcation perforations. The materials evaluated included Endosequence BC RRM-Fast Set Condensable Putty (Brasseler USA, Savannah, GA, USA), ProRoot MTA (Dentsply Maillefer, Ballaigues, Switzerland), and Biodentine. Results indicated that the Endosequence BC putty exhibited the least gap volume among the three materials, signifying superior adaptation to the dentin walls in this context. However, the study's methodology involved assessments conducted by the same operator, which limited the potential for blinded results. The absence of a blinded assessment introduces potential bias, as the operator may unconsciously favor one material over the others during testing. Furthermore, in addition to the previously mentioned study, there is a noticeable lack of research focused on assessing gaps and voids in cases of furcal perforation using micro-CT analysis. Considering this gap in the literature, the current study aims to evaluate the marginal adaptation of different calcium silicate-based cements in repairing simulated furcation perforations in mandibular molars using clinical assessment and micro-CT imaging. Materials and Methods Sample Size Calculation The present study is reported according to the Preferred Reporting Items for Laboratory studies in Endodontology (PRILE) 2021 guidelines [ 19 ]. The research protocol was approved by the Rey Juan Carlos institutional ethics committee (Madrid, Spain) under registration no. 1301202302823. The study was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all subjects and/or their legal guardians. The sample size calculation was based on the percentage values of gaps and voids reported in a previous study [ 8 ]. The results indicated that a minimum of eight samples would be required in each group to achieve a power of 95%, given an alpha error of 0.05. Twelve samples per group were included to enhance the robustness and reliability of the study findings. Sample Selection and Grouping An initial sample of 125 extracted inferior mandibular molars were collected for this ex-vivo study. After assessing eligibility based on inclusion and exclusion criteria, only 36 extracted mandibular molars were selected. All were free of root caries, previous endodontic treatment, or cracks and had intact furcation. The teeth were randomly assigned to three experimental groups (n = 12 per group), each assigned to one of three commercially available calcium silicate-based cements: ProRoot MTA (Dentsply Maillefer, Ballaigues, Switzerland), NeoPutty, and Biodentine. Before the experimental procedures, the samples were standardized using Cone Beam Computed Tomography (CBCT) to measure the distance from the chamber floor to the furcation, ensuring consistent anatomical conditions across the samples. This step aimed to create a more homogeneous sample set and decrease the chances of furcation perforations having greater depth and a higher presence of material. The samples were grouped in sets of three based on similar volume, and then the three matched samples were randomly assigned to one of the three bioceramic materials. Furcation Perforation Standardization and Placement of Sealing Material The molars were first immersed in a 4.25% sodium hypochlorite solution for 15 minutes to eliminate organic matter from the root surfaces. They were then thoroughly rinsed with a saline solution to remove residual sodium hypochlorite. A coronal access cavity was prepared using a round bur (801LG.FG.016, Meisinger, Neuss, Germany), ensuring the bottom of the pulp chamber remained untouched. Subsequently, standardized furcal perforations were created in the center of the pulp chamber floor using the same round bur (with a diameter of 1.6 mm and an active part length of 1.6 mm) under constant irrigation to prevent overheating. The crown was sectioned 4 mm above the cementoenamel junction, and the roots were sectioned 4 mm below the furcation area using a lance bur (859 LF.FG.014, Komet, Lemgo, Germany). Each tooth was mounted in heavy-body silicone, leaving a gap between the specimen and the mold. A sterile cotton pellet moistened with saline solution was placed under the furcation perforation to simulate the moisture present in the periodontal ligament under clinical conditions. The furcation perforations were sealed using the bioceramic repair materials: ProRoot MTA, NeoPutty, and Biodentine. ProRoot MTA was mixed according to the manufacturer's guidelines by combining the powder with sterile water at a 3:1 ratio. A spatula blended the mixture on a glass slab until it reached a putty-like consistency. Similarly, Biodentine was prepared by mixing the liquid with the powder in the capsule and blending them in a triturator for 30 seconds, following the manufacturer’s directions. NeoPutty, a premixed bioceramic material, was used immediately without additional preparation. Each material was loaded into an amalgam carrier, applied to the perforation site, and compacted with an inverted size 30 paper point to ensure proper fit against the cavity walls. After application, the samples were kept in a 100% humidity chamber at 37°C for a week to mimic oral conditions during the setting process. Qualitative and Quantitative Evaluation After sealing, radiographs were taken to assess the adaptation of the repair materials. Each sample was examined under a dental microscope (OPMI PICO, Carl Zeiss, Göttingen, Germany) at 10x magnification, and images were captured. Each clinical photograph was paired with its corresponding radiograph and compiled into a PowerPoint presentation, and each specimen was assigned a random letter (uppercase/lowercase). A table cross-referencing the letters with specific samples was created and made available only to one operator (M.R.C.) to ensure that the other three operators involved in the evaluation (J.M.C., N.N., and D.R.F.) remained blinded. These operators were calibrated and unaware of the material of the samples. A PDF file containing clinical and radiographic images of each specimen and the corresponding assigned letter was provided to the three operators, who were asked to complete a questionnaire evaluating four clinical parameters: adaptation of the material to the cavity, presence of porosity, overfilling, and overall adequacy of the sealing. Responses were assessed as either "yes" or "no." This double-blind approach helped to reduce bias and enhance the quality of the assessment. Micro-CT scans were performed using a Phoenix V|tome|x S240 system (General Electric, Boston, MA, USA) with an isotropic resolution of 20 µm. Scanning was conducted at 155 kV and 190 mA, utilizing a 0.2-mm-thick aluminum filter and completing a full 360° rotation around the vertical axis, resulting in approximately 1300 images per tooth after reconstruction with Phoenix Datos|x 3D software (General Electric, Boston, MA, USA), which included ring artifact correction of 5, beam hardening correction of 50%, and smoothing of 8. Each scan took about 60 minutes. The volumetric data (mm³) were subsequently analyzed using a combination of ImageJ (National Institutes of Health, Bethesda, MD) for quantitative analysis, 3D Slicer ( http://www.slicer.org ) for image binarization, and Meshmixer (Autodesk Inc.) for generating three-dimensional models to visualize the perforations. For each sample, the data associated with the calcium-silicate-based materials within the cavities, as well as the voids and gaps between the dentin wall and the repair material, were calculated by creating binary images (by subtracting the filled perforation from the total volume) and assessing porosity through segmentation to identify regions of lower density (Fig. 1 ). Gaps are dark voids between the dentin wall and the repair material, indicating inadequate adaptation or sealing. Conversely, voids refer to dark spaces within the repair material, suggesting internal porosity or incomplete filling. These factors were measured quantitatively to evaluate the integrity and sealing performance of the materials examined. Statistical Analysis The statistical analysis was conducted using SPSS (Statistical Package for the Social Sciences 21.0; IBM Corp, Armonk, NY). The qualitative data, including adaptation, overfilling, porosity, and overall quality of obturation, were analyzed using the chi-square test. In contrast, the quantitative data from the micro-CT scans, such as voids and porosity, were first assessed for normality using the Shapiro-Wilk test. Since the data did not follow a normal distribution, the Kruskal-Wallis test was employed to compare the three experimental groups, followed by the Mann-Whitney U test for pairwise comparisons, with an appropriate adjustment for multiple comparisons. The statistical significance level was set at p < 0.05. Results Qualitative analysis Results from the qualitative analysis are shown in Table 1 . The qualitative analysis of furcal perforation repair using various calcium silicate cements focused on four key aspects: adaptation, overfilling, porosity, and overall obturation quality. Table 1 Qualitative analysis of adaptation, overfilling, porosity, and the overall quality of obturation. Material Adaptation Overfilling Porosity Obturation quality N % N % N % N % Biodentine Yes 8 ac 66.7 4 33.3 6 b,c 50.0 8 e 66.7 No 4 33.3 8 66.7 6 50.0 4 33.3 Neoputty Yes 12 a 100 4 33.3 1 b 8.3 11 91.7 No 0 0 8 66.7 11 9.7 1 8.3 ProRoot Yes 12 c 100 3 25 0 c 0 12 e 100 No 0 0 9 75 12 100 0 0 a,b,c,d,e In each column, data with the same letter are related by a statistically significant difference (P < 0.05). Before testing the materials' sealing ability, the volumes of the initial perforation were compared between groups to verify homogeneity among the samples. The analysis confirmed that no statistically significant differences were observed in the initial perforation volumes across the groups, validating the comparability of the results obtained after treatment. ProRoot MTA and NeoPutty demonstrated 100% adaptation to the cavity, while Biodentine achieved only 66.7%. This difference was statistically significant ( p < 0.05) when comparing Biodentine with ProRoot MTA and NeoPutty. No significant differences were observed between ProRoot MTA and NeoPutty. The proportion of cases showing porosity in the material was significantly higher with Biodentine (50%) compared to NeoPutty (8.3%) and ProRoot MTA (0%). The difference between Biodentine and the other two materials was statistically significant ( p < 0.05), while no significant difference was found between NeoPutty® and ProRoot MTA. The best qualitative results regarding overfilling were obtained with ProRoot MTA (25%), followed by NeoPutty and Biodentine (33.3%). However, this difference was not statistically significant. ProRoot MTA demonstrated the highest performance, with 100% of cases achieving proper obturation. NeoPutty followed with 91.7%, while Biodentine recorded the lowest success rate at 66.7%. Significant differences were noted when comparing NeoPutty to Biodentine® and ProRoot MTA to Biodentine ( p < 0.05). Quantitative evaluation Table 2 presents the results of a quantitative evaluation conducted with micro-CT imaging. The evaluation focused on voids, gaps, and porosity within the material (Fig. 2 , 3 ). Table 2 Quantitative analysis of voids, gaps, and porosity of the samples in microCT. Characteristic Biodentine Mean (Min-Max)* NeoPutty Mean (Min-Max) ProRoot Mean (Min-Max) Perforation volume (mm 3 ) 5.57 (4.06–7.90) 5.29 (3.04–10.97) 4.44 (3.88–5.07) Voids Volume (mm 3 ) 1.05 (0.00-0.82) 0.347 (0.01–2.93) 0.06 (0.01–0.20) Voids Percentage (%) 2.38 (0.00-20.20) 4.20 (0.20-26.71) 1.29 (0.21–4.37) Gaps Volume (mm 3 ) 0.14 (0.00-0.53) 0.09 (0.00-0.82) 0.03 (0.01–0.10) Gap Percentage (%) 2.40 (0.00-9.93) 1.04 (0.00-7.47) 0.65 (0.20–2.22) Porosity (mm 3 ) 1.35 (0.00-3.21) 0.00 (0.00–0.00) 0.49 (0.00-3.18) Porosity Percentage (%) 28 (0.00-76.43) ab 0.00 (0.00–0.00) b 11.46 (0.00-78.52) b a,b In each column, data with the same letter are related by a statistically significant difference (P < 0.05). * Abbreviations: Min, minimum value; Max, Maximum value. NeoPutty had the highest percentage of voids (4.20%), whereas ProRoot MTA had the lowest (1.28%). Biodentine exhibited an average void volume of 1.05 mm³ (2.38%), which was higher than NeoPutty (0.70 mm³, 1.65%) and ProRoot MTA (0.59 mm³, 1.29%). These differences highlight the superior material density of ProRoot MTA and NeoPutty compared to Biodentine. Gaps, referring to the spaces between the dentinal wall and the sealing material, were largest in ProRoot MTA (6.48%), followed by Biodentine (2.40%), and smallest in NeoPutty (1.03%). In terms of gap volume, Biodentine had the highest value (1.37 mm³), followed by NeoPutty (0.85 mm³) and ProRoot MTA (0.29 mm³). Biodentine exhibited the highest porosity at 28.44%, whereas NeoPutty demonstrated no measurable porosity at 0.0%. The differences between Biodentine and ProRoot MTA and between Biodentine and NeoPutty were statistically significant (p < 0.001); however, no significant differences were observed between ProRoot MTA and NeoPutty. Discussion The present study evaluated the sealing ability of three calcium silicate cements—ProRoot MTA, NeoPutty, and Biodentine—to repair furcal perforations in mandibular molars. Both qualitative (adaptation, overfilling, porosity, and obturation quality) and quantitative micro-CT assessments (voids, gaps, and porosity) were employed to compare these materials. The findings indicate significant differences in material performance, especially regarding adaptation, porosity, and obturation quality, which are critical factors for the success of furcation perforation repairs. To the authors’ knowledge, this is the first study to perform a qualitative clinical assessment of bioceramic sealer adaptation in furcal perforations. Since micro-CT imaging cannot be performed in vivo , this study provides a controlled experimental setting that closely replicates real clinical situations. Indeed, micro-CT is a highly reliable technique commonly employed to evaluate 3D microstructures in ex vivo models [ 20 ]. Its precision in image analysis arises from its ability to distinguish the dentinal wall, furcal repair materials, and empty spaces using various grayscale thresholds. These results are consistent with a recent study emphasizing calcium silicate cements' superior sealing ability and biocompatibility, especially MTA [ 8 ]. Overall, the current findings indicate that both ProRoot MTA and NeoPutty achieved perfect adaptation to the dentinal walls, significantly exceeding the performance of Biodentine. This variation in adaptation is linked to the materials' handling characteristics. Specifically, NeoPutty, with its pre-mixed, putty-like texture, appears to offer enhanced ease of use and improved conformity to the irregularities of the perforation site. In contrast, Biodentine, while it sets relatively quickly [ 21 ], demonstrated a statistically significant inability to adapt as well as the other two materials. As shown in Table 1 , one of the most critical findings of this study is the difference in porosity among the materials. Biodentine exhibited significantly higher porosity (28.44%) compared to both ProRoot MTA (0%) and NeoPutty (8.3%). This increased porosity in Biodentine could be attributed to its mixing process, which involves mechanical vibration and automatic agitation. These mixing methods may introduce air bubbles into the material, producing higher porosity. In contrast, NeoPutty comes in a pre-mixed formula that effectively minimizes the incorporation of air during handling, resulting in its lower porosity and improved overall performance.. Indeed, a key factor influencing the performance of bioceramic cements is the mixing process [ 22 , 23 ], which is eliminated in NeoPutty due to its pre-mixed formulation. This ensures consistent material properties and reduces operator-dependent variability. Previous studies highlighted this aspect, demonstrating that factors such as the powder-to-liquid ratio, temperature, and porosity can significantly affect the mechanical properties of cements [ 22 – 24 ]. As a result, any variables related to mixing ( e.g. , the powder-to-liquid ratio and the operator’s mixing technique) and material placement play a crucial role in the outcome [ 22 ]. Furthermore, the porosity of endodontic sealers plays a crucial role in their effectiveness. Exposure to periradicular fluids can negatively impact the durability of the endodontic filling. Sealers with high porosity are more prone to microleakage, potentially causing periradicular fluids to infiltrate the root canal system. This infiltration can compromise the success of the root canal treatment, posing a risk to long-term clinical outcomes [ 8 , 25 ]. Biodentine's markedly higher porosity appears inconsistent with findings from a recent study (29) comparing the porosity of Biodentine and ProRoot MTA against a pre-mixed bioceramic, iRoot BP Plus (Innovative BioCeramix Inc., Vancouver, BC, Canada), and Ceramicrete. The study found no statistically significant differences in porosity among the materials tested. Nevertheless, despite the lack of significance, these earlier results indicated that Biodentine was more porous than ProRoot MTA, aligning with the current findings. Meanwhile, the pre-mixed bioceramic sealer exhibited the highest porosity. The differences observed in the current data might be attributed to using plastic molds instead of actual mandibular molars in that study and a small sample size per group (n = 4). Furthermore, the results obtained in the current study do not align with those reported by Guerrero et al. [ 18 ], who found significant differences in the porosity of Biodentine compared to White ProRoot MTA, with Biodentine demonstrating superior porosity properties in terms of both the number and volume of pores. However, it is important to note that their study did not use human molars, but rather 5 mm high silicone tubes, and the samples were not placed in a humidity chamber to simulate oral conditions. Additionally, the materials were let to set only 24 hours, a detail that could influence the results. On the contrary, the present study demonstrated that ProRoot MTA and NeoPutty are effective materials for sealing furcal perforations, particularly in porosity control. The current investigation also evaluated overfilling, which was observed across all groups, with ProRoot MTA exhibiting the lowest rate (25%), while NeoPutty and Biodentine both showed a higher overfilling rate of 33.3%. Overfilling can be particularly relevant in cases where the perforation site is close to critical anatomical structures, as it could cause inflammation, delayed healing, or potential interference with periradicular tissue regeneration. The presence of extruded material in crucial areas such as the furcal region may also jeopardize periodontal reattachment and raise the risk of treatment failure [ 26 ]. Interestingly, ProRoot MTA showed a lower overfilling rate, which may be attributed to its thicker consistency, allowing a more controlled application. On the contrary, NeoPutty, despite its pre-mixed formulation, may exhibit slightly lower viscosity, making it more prone to extrusion beyond the perforation site. Similarly, Biodentine presents a higher overfilling rate, probably due to its lower viscosity and faster setting time, which could make the materials harder to manipulate precisely before setting. This study highlighted that pre-mixed bioceramic cements achieved better gap reduction results regarding quantitative parameters. This is consistent with the findings of a recent study [ 8 ], where Endosequence Fast Set Putty achieved significantly better outcomes. Both studies followed a similar clinical protocol, performing micro-CT assessments in extracted teeth. In this study, ProRoot MTA exhibited the highest gap percentage (6.48%), followed by Biodentine (2.40%) and NeoPutty, which showed the smallest gap percentage (1.03%). However, when considering the absolute gap volume, Biodentine showed the highest value (1.37 mm³), followed by NeoPutty (0.85 mm³), with ProRoot MTA showing the lowest value (0.29 mm³). These findings indicate that despite having the highest gap percentage, ProRoot MTA had the smallest actual gap volume; this is probably explained by its higher adaptation and material density that compensate for its marginal gap presence. Conversely, Biodentine showed higher gap volume, supporting its lower adaptation performance, as observed in qualitative analyses. On the contrary, NeoPutty, with both a low gap percentage and moderate gap volume, demonstrated consistent adaptation, probably explained by its putty-like consistency, which allows for better flow and adaptation to the dentinal surface. From a clinical perspective, these results highlight that adaptation and porosity are critical factors when choosing a repair material for furcation perforations. While all materials showed some voids and gaps, ProRoot MTA remains the most reliable, while NeoPutty offers a strong alternative. Indeed, NeoPutty emerged as the superior material in terms of both handling and porosity. Its pre-mixed nature eliminates the variability associated with on-site material mixing, which can introduce inconsistencies in performance, as seen with Biodentine, which requires careful handling due to its limitations. [ 8 ]​ Indeed, despite its shorter setting time, bioactivity, and ease of use in some clinical scenarios, Biodentine shows significantly higher porosity and lower adaptation rate, which limits its reliability for furcal perforation repair. This suggests that it might be better suited for other clinical applications, such as dentin replacement in non-load-bearing areas, where its shortcomings in adaptation and porosity are less critical​ [ 27 ]. While this study provides valuable insights into the performance of different calcium silicate cements, several limitations should be acknowledged. Although adequate for detecting significant differences, the sample size could be expanded in future studies to increase the generalizability of the findings. Additionally, the ex-vivo nature of the study does not fully replicate the complexities of in vivo conditions, such as blood and saliva contamination, which could affect the materials' performance. Future research should also explore the long-term outcomes of furcal perforation repairs using these materials, focusing on their performance under masticatory loads and their resistance to bacterial infiltration over time. In conclusion, this study's findings suggest that NeoPutty is the most reliable material for furcal perforation repair, offering superior adaptation and the lowest porosity. ProRoot MTA remains a strong option, although its handling properties may present challenges in clinical settings. Biodentine, while advantageous in setting time, exhibits significant porosity and suboptimal adaptation, making it a less favorable choice for critical repair cases such as furcation perforations. Declarations Authorship Declaration: All authors contributed to the study's conception and design. M.R: Investigation, Methodology, Data curation, Software. A.M.D : Investigation. J.M.C : Conceptualization, Methodology, Data curation, Investigation. N.N : Conceptualization, Investigation, Supervision. A.R.P: Writing- Reviewing and Editing, Conceptualization, Supervision. G.M. : Writing-Reviewing and Editing, Data curation J.A : Investigation, Supervision. D.R.F : Conceptualization, Investigation, Reviewing and Editing, Supervision. Acknowledgments : The authors do not want to thank anyone in particular. Ethics Approval and Consent to Participate: The Rey Juan Carlos institutional ethics committee approved the study (protocol 1301202302823). Funding: No funding was obtained for this study. Data Availability Statement: The data supporting this study's findings are available from the corresponding author upon reasonable request. Disclosure statement: José Aranguren and Alejandro R. Pérez are the opinion leaders of ZARC (Zarc4endo, Gijón, Asturias, Spain), and Juan Miraglia Cantarini is the opinion leader of Dentsply (Dentsply-Sirona, Baillagues, Switzerland). The other authors deny any conflicts of interest. 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Madani, Z., Alvandifar, S. & Bizhani, A. Evaluation of tooth discoloration after treatment with mineral trioxide aggregate, calcium-enriched mixture, and Biodentine(®) in the presence and absence of blood. Dent Res J (Isfahan) 16 , 377-383 (2019). Howait, M., Shaker, M., Aljuhani, H. & AlMohnna, M. External Cervical Resorption: A Case Report and Brief Review of the Literature, and Treatment Algorithms. J Contemp Dent Pract 22 , 298-303 (2021). Moinzadeh, A.T., Aznar Portoles, C., Schembri Wismayer, P. & Camilleri, J. Bioactivity Potential of EndoSequence BC RRM Putty. J Endod 42 , 615-621 (2016). Guerrero, F. & Berástegui, E. Porosity analysis of MTA and Biodentine cements for use in endodontics by using micro-computed tomography. J Clin Exp Dent 10 , e237-e240 (2018). Nagendrababu, V. , et al. PRILE 2021 guidelines for reporting laboratory studies in Endodontology: A consensus-based development. Int Endod J 54 , 1482-1490 (2021). Huang, Y. , et al. Evaluation of the sealing ability of different root canal sealers: a combined SEM and micro-CT study. J Appl Oral Sci 26 , e20160584 (2018). Bilvinaite, G., Drukteinis, S., Brukiene, V. & Rajasekharan, S. Immediate and Long-Term Radiopacity and Surface Morphology of Hydraulic Calcium Silicate-Based Materials. Materials (Basel) 15 (2022). Ghasemi, N., Janani, M., Razi, T. & Atharmoghaddam, F. Effect of different mixing and placement methods on the quality of MTA apical plug in simulated apexification model. J Clin Exp Dent 9 , e351-e355 (2017). Basturk, F.B., Nekoofar, M.H., Gunday, M. & Dummer, P.M. Effect of varying water-to-powder ratios and ultrasonic placement on the compressive strength of mineral trioxide aggregate. J Endod 41 , 531-534 (2015). Sharifi, R., Araghid, A., Ghanem, S. & Fatahi, A. Effect of temperature on the setting time of Mineral Trioxide Aggregate (MTA). J Med Life 8 , 88-91 (2015). De Souza, E.T. , et al. Tridimensional quantitative porosity characterization of three set calcium silicate-based repair cements for endodontic use. Microsc Res Tech 76 , 1093-1098 (2013). Asgary, S. & Fayazi, S. Endodontic Surgery of a Symptomatic Overfilled MTA Apical Plug: A Histological and Clinical Case Report. Iran Endod J 12 , 376-380 (2017). Askerbeyli Örs, S., Aksel, H., Küçükkaya Eren, S. & Serper, A. Effect of perforation size and furcal lesion on stress distribution in mandibular molars: a finite element analysis. Int Endod J 52 , 377-384 (2019). Additional Declarations Competing interest reported. José Aranguren and Alejandro R. Pérez are the opinion leaders of ZARC (Zarc4endo, Gijón, Asturias, Spain), and Juan Miraglia Cantarini is the opinion leader of Dentsply (Dentsply-Sirona, Baillagues, Switzerland). The other authors deny any conflicts of interest Supplementary Files PRILEFlowchart.docx Cite Share Download PDF Status: Published Journal Publication published 02 Jun, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 10 Apr, 2025 Reviews received at journal 09 Apr, 2025 Reviews received at journal 09 Apr, 2025 Reviews received at journal 07 Apr, 2025 Reviewers agreed at journal 30 Mar, 2025 Reviewers agreed at journal 30 Mar, 2025 Reviewers agreed at journal 29 Mar, 2025 Reviewers invited by journal 28 Mar, 2025 Editor assigned by journal 28 Mar, 2025 Editor invited by journal 28 Mar, 2025 Submission checks completed at journal 28 Mar, 2025 First submitted to journal 26 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6315576","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":440982054,"identity":"bfc162a7-1acb-4413-997a-250248ca54c5","order_by":0,"name":"María Rojo Carpintero","email":"","orcid":"","institution":"Rey Juan Carlos University","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"Rojo","lastName":"Carpintero","suffix":""},{"id":440982057,"identity":"1b39b8a3-c08d-4a8e-9170-e59af57df8bd","order_by":1,"name":"Ana Martín Díaz","email":"","orcid":"","institution":"Rey Juan Carlos University","correspondingAuthor":false,"prefix":"","firstName":"Ana","middleName":"Martín","lastName":"Díaz","suffix":""},{"id":440982058,"identity":"73c3f6ec-68ac-46b3-83fb-9c6bdda2963e","order_by":2,"name":"Juan Miraglia Cantarini","email":"","orcid":"","institution":"Private Practice in Microscopic Endodontics and Apical Microsurgery, Málaga","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"Miraglia","lastName":"Cantarini","suffix":""},{"id":440982059,"identity":"c4913f9b-548e-4c03-af4b-2fd4e77f58d4","order_by":3,"name":"Natalia Navarrete","email":"","orcid":"","institution":"Rey Juan Carlos University","correspondingAuthor":false,"prefix":"","firstName":"Natalia","middleName":"","lastName":"Navarrete","suffix":""},{"id":440982060,"identity":"0a2f92b4-c76a-45e5-a1af-90d006f05877","order_by":4,"name":"Alejandro R. Pérez","email":"","orcid":"","institution":"Rey Juan Carlos University","correspondingAuthor":false,"prefix":"","firstName":"Alejandro","middleName":"R.","lastName":"Pérez","suffix":""},{"id":440982061,"identity":"13d0483a-f07c-4327-a5ef-16377ad87059","order_by":5,"name":"Giulia Malvicini","email":"","orcid":"","institution":"University of Siena","correspondingAuthor":false,"prefix":"","firstName":"Giulia","middleName":"","lastName":"Malvicini","suffix":""},{"id":440982062,"identity":"f67ec619-32e7-4c7b-9ab5-231effe0fbda","order_by":6,"name":"José Aranguren","email":"","orcid":"","institution":"Rey Juan Carlos University","correspondingAuthor":false,"prefix":"","firstName":"José","middleName":"","lastName":"Aranguren","suffix":""},{"id":440982063,"identity":"36e8fdfe-3047-466e-9147-3381fca99b96","order_by":7,"name":"David Rubio Flores","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsklEQVRIiWNgGAWjYDCCA4wPD4BofhK0MBuAtUg2kKwFQhID+G4fZjjwcY+NvfGN5KcbGCrqCGuRPJfMcHDGs7TEbTfSzG4wnDlMWIvBGf4Dh3kOHE4wu5HDdoOxjQjnGZxhZgBq+W9vPAOk5R8RDoNqOcC4QQKkpYGZsBZJoJaDMw4kJ84488zsRsIxIvzCd4aZ8cGHA3b2/O3Jz258qCHCYagggVQNo2AUjIJRMAqwAwAE4EAg48vFsgAAAABJRU5ErkJggg==","orcid":"","institution":"Rey Juan Carlos University","correspondingAuthor":true,"prefix":"","firstName":"David","middleName":"Rubio","lastName":"Flores","suffix":""}],"badges":[],"createdAt":"2025-03-26 23:08:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6315576/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6315576/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-03729-7","type":"published","date":"2025-06-02T15:57:01+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":80827417,"identity":"81db7f93-d33c-4e1d-84d5-92cc35f7be12","added_by":"auto","created_at":"2025-04-17 13:26:19","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33996,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative\u003cstrong\u003e \u003c/strong\u003emicro-CT\u003cstrong\u003e \u003c/strong\u003escans of the variables evaluated during quantitative evaluation: (A) voids (red arrow), (B) gaps (green arrow), (C) porosity (blue arrow).\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6315576/v1/00daa0f87cfe48c78ac14d39.jpg"},{"id":80827415,"identity":"c18e4b2f-6605-43a2-a73a-1900474b0f59","added_by":"auto","created_at":"2025-04-17 13:26:19","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":52435,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative 3D figures before perforation repair (A, D, G). Post-repair 3D images with B) Neoputty; E) Biodentine; H) ProRoot. Axial images of micro-CT scans after repair with C) Neoputty; F) Biodentine I) Biodentine.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6315576/v1/34fb5cbf80867728587405bc.jpg"},{"id":80827416,"identity":"bee138dd-c6a7-4009-8d5e-552830604b3c","added_by":"auto","created_at":"2025-04-17 13:26:19","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":43962,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative 3D sagittal images illustrating pre (A, C, E), and post perforation repair with B) Neoputty; D) Biodentine; F) ProRoot.\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6315576/v1/45d04fb0121bbcb6ac2a84d6.jpg"},{"id":84242376,"identity":"24e3ba37-2030-4eec-871a-d89bd2ce0e35","added_by":"auto","created_at":"2025-06-09 16:06:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":953021,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6315576/v1/33d88437-6a39-4170-8d3d-4a6961ca96f1.pdf"},{"id":80827420,"identity":"57c735f8-4ef6-461c-9571-1d967a29b959","added_by":"auto","created_at":"2025-04-17 13:26:19","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":28657,"visible":true,"origin":"","legend":"","description":"","filename":"PRILEFlowchart.docx","url":"https://assets-eu.researchsquare.com/files/rs-6315576/v1/044115366ab19fde65ee5681.docx"}],"financialInterests":"Competing interest reported. José Aranguren and Alejandro R. Pérez are the opinion leaders of ZARC (Zarc4endo, Gijón, Asturias, Spain), and Juan Miraglia Cantarini is the opinion leader of Dentsply (Dentsply-Sirona, Baillagues, Switzerland). The other authors deny any conflicts of interest","formattedTitle":"Marginal Adaptation and Porosity of Calcium Silicate Cements in Furcation Perforations: A Micro-CT Comparative Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eFurcation perforations are pathological connections between the root canal system and the surrounding periodontium. They can be caused by extensive caries, resorption processes, or iatrogenic factors during endodontic treatment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These perforations compromise the tooth's integrity and often lead to periodontal inflammation due to bacterial colonization of the perforation site. If left untreated ​, furcation perforations worsen over time [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Due to their proximity to critical periodontal structures and the increased risk of contamination from the oral environment, they pose a significant challenge to successful endodontic treatment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe prognosis of teeth with furcation perforations is strongly influenced by several factors, including the size and location of the perforation, the time elapsed until repair, and the type of material used for sealing [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Larger perforations and those located close to the bone crest pose a greater risk of bacterial infiltration and contamination with fluid from the gingival sulcus, leading to compromised healing outcomes [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]​. In addition, untreated perforations can lead to a series of complications, which increase the likelihood of tooth extraction, such as persistent inflammation, damage to the periodontal attachment, epithelial tissue overgrowth, ongoing bone deterioration, and extensive bone resorption [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It has been reported as the second leading cause of endodontic failures following obturation, accounting for 9.6% of cases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAn effective repair material should provide an adequate seal with minimal setting time, be biocompatible, non-toxic, non-carcinogenic, affordable, bacteriostatic, readily available, easy to handle, and capable of promoting osteogenesis and cementogenesis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Additionally, it should function effectively as a barrier or matrix between the root canal filling and surrounding tissues, guaranteeing a hermetic seal [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This can be accomplished by reducing the formation of gaps between the dentin walls and the material and minimizing voids within the material itself to decrease bacterial microleakage [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecent advances in calcium silicate-based cements such as mineral trioxide aggregate (MTA) and Biodentine (Septodont, Saint Maur des Fosse\u0026rsquo;s, France) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] have revolutionized the treatment of furcation perforations. These highly biocompatible materials promote complex tissue regeneration and provide a hermetic seal that prevents bacterial recontamination [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]​. MTA, introduced in the 1990s, became the gold standard due to its ability to induce cementogenesis and its excellent sealing properties [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, its disadvantages include long setting times [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], complex handling, and possible discoloration due to the inclusion of bismuth oxide [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn response to these limitations, second-generation calcium silicate cements such as Biodentine have been developed, offering shorter setting times and improved handling properties [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Biodentine, which incorporates zirconium oxide as a radiopacifier instead of bismuth oxide, has been shown to avoid staining while maintaining similar mechanical properties to dentin​ [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. More recently, pre-mixed putty-like repaired materials such as NeoPutty (Avalon Biomed, Houston, Texas, USA) have come onto the market, eliminating mixing variability and facilitating application. These materials have demonstrated satisfying outcomes in several clinical situations besides furcation perforations such as root resorptions, vital pulp therapies, and microsurgeries [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdvanced imaging techniques such as micro-computed tomography (micro-CT) are frequently used to investigate the efficacy of these materials in sealing furcation perforations [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. This technique enables a thorough examination of marginal adaptation, porosity, and the integration of the material into the surrounding dentin.\u003c/p\u003e \u003cp\u003eIn a recent study [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], using micro-CT imaging, the adaptation of three calcium silicate-based cements in mandibular molar furcation perforations. The materials evaluated included Endosequence BC RRM-Fast Set Condensable Putty (Brasseler USA, Savannah, GA, USA), ProRoot MTA (Dentsply Maillefer, Ballaigues, Switzerland), and Biodentine. Results indicated that the Endosequence BC putty exhibited the least gap volume among the three materials, signifying superior adaptation to the dentin walls in this context. However, the study's methodology involved assessments conducted by the same operator, which limited the potential for blinded results.\u003c/p\u003e \u003cp\u003eThe absence of a blinded assessment introduces potential bias, as the operator may unconsciously favor one material over the others during testing. Furthermore, in addition to the previously mentioned study, there is a noticeable lack of research focused on assessing gaps and voids in cases of furcal perforation using micro-CT analysis.\u003c/p\u003e \u003cp\u003eConsidering this gap in the literature, the current study aims to evaluate the marginal adaptation of different calcium silicate-based cements in repairing simulated furcation perforations in mandibular molars using clinical assessment and micro-CT imaging.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSample Size Calculation\u003c/h2\u003e \u003cp\u003eThe present study is reported according to the Preferred Reporting Items for Laboratory studies in Endodontology (PRILE) 2021 guidelines [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The research protocol was approved by the Rey Juan Carlos institutional ethics committee (Madrid, Spain) under registration no. 1301202302823. The study was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all subjects and/or their legal guardians.\u003c/p\u003e \u003cp\u003eThe sample size calculation was based on the percentage values of gaps and voids reported in a previous study [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The results indicated that a minimum of eight samples would be required in each group to achieve a power of 95%, given an alpha error of 0.05. Twelve samples per group were included to enhance the robustness and reliability of the study findings.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample Selection and Grouping\u003c/h3\u003e\n\u003cp\u003eAn initial sample of 125 extracted inferior mandibular molars were collected for this \u003cem\u003eex-vivo\u003c/em\u003e study.\u003c/p\u003e \u003cp\u003eAfter assessing eligibility based on inclusion and exclusion criteria, only 36 extracted mandibular molars were selected. All were free of root caries, previous endodontic treatment, or cracks and had intact furcation. The teeth were randomly assigned to three experimental groups (n\u0026thinsp;=\u0026thinsp;12 per group), each assigned to one of three commercially available calcium silicate-based cements: ProRoot MTA (Dentsply Maillefer, Ballaigues, Switzerland), NeoPutty, and Biodentine.\u003c/p\u003e \u003cp\u003eBefore the experimental procedures, the samples were standardized using Cone Beam Computed Tomography (CBCT) to measure the distance from the chamber floor to the furcation, ensuring consistent anatomical conditions across the samples. This step aimed to create a more homogeneous sample set and decrease the chances of furcation perforations having greater depth and a higher presence of material. The samples were grouped in sets of three based on similar volume, and then the three matched samples were randomly assigned to one of the three bioceramic materials.\u003c/p\u003e\n\u003ch3\u003eFurcation Perforation Standardization and Placement of Sealing Material\u003c/h3\u003e\n\u003cp\u003eThe molars were first immersed in a 4.25% sodium hypochlorite solution for 15 minutes to eliminate organic matter from the root surfaces. They were then thoroughly rinsed with a saline solution to remove residual sodium hypochlorite. A coronal access cavity was prepared using a round bur (801LG.FG.016, Meisinger, Neuss, Germany), ensuring the bottom of the pulp chamber remained untouched. Subsequently, standardized furcal perforations were created in the center of the pulp chamber floor using the same round bur (with a diameter of 1.6 mm and an active part length of 1.6 mm) under constant irrigation to prevent overheating.\u003c/p\u003e \u003cp\u003eThe crown was sectioned 4 mm above the cementoenamel junction, and the roots were sectioned 4 mm below the furcation area using a lance bur (859 LF.FG.014, Komet, Lemgo, Germany). Each tooth was mounted in heavy-body silicone, leaving a gap between the specimen and the mold. A sterile cotton pellet moistened with saline solution was placed under the furcation perforation to simulate the moisture present in the periodontal ligament under clinical conditions.\u003c/p\u003e \u003cp\u003eThe furcation perforations were sealed using the bioceramic repair materials: ProRoot MTA, NeoPutty, and Biodentine.\u003c/p\u003e \u003cp\u003e ProRoot MTA was mixed according to the manufacturer's guidelines by combining the powder with sterile water at a 3:1 ratio. A spatula blended the mixture on a glass slab until it reached a putty-like consistency. Similarly, Biodentine was prepared by mixing the liquid with the powder in the capsule and blending them in a triturator for 30 seconds, following the manufacturer\u0026rsquo;s directions. NeoPutty, a premixed bioceramic material, was used immediately without additional preparation.\u003c/p\u003e \u003cp\u003eEach material was loaded into an amalgam carrier, applied to the perforation site, and compacted with an inverted size 30 paper point to ensure proper fit against the cavity walls. After application, the samples were kept in a 100% humidity chamber at 37\u0026deg;C for a week to mimic oral conditions during the setting process.\u003c/p\u003e\n\u003ch3\u003eQualitative and Quantitative Evaluation\u003c/h3\u003e\n\u003cp\u003eAfter sealing, radiographs were taken to assess the adaptation of the repair materials. Each sample was examined under a dental microscope (OPMI PICO, Carl Zeiss, G\u0026ouml;ttingen, Germany) at 10x magnification, and images were captured. Each clinical photograph was paired with its corresponding \u0026ensp;radiograph and compiled into a PowerPoint presentation, and each specimen was assigned a random letter (uppercase/lowercase).\u003c/p\u003e \u003cp\u003eA table cross-referencing the letters with specific samples was created and made available only to one operator (M.R.C.) to ensure that the other three operators involved in the evaluation (J.M.C., N.N., and D.R.F.) remained blinded. These operators were calibrated and unaware of the material of the samples. A PDF file containing clinical and radiographic images of each specimen and the corresponding assigned letter was provided to the three operators, who were asked to complete a questionnaire evaluating four clinical parameters: adaptation of the material to the cavity, presence of porosity, overfilling, and overall adequacy of the sealing. Responses were assessed as either \"yes\" or \"no.\" This double-blind approach helped to reduce bias and enhance the quality of the assessment.\u003c/p\u003e \u003cp\u003eMicro-CT scans were performed using a Phoenix V|tome|x S240 system (General Electric, Boston, MA, USA) with an isotropic resolution of 20 \u0026micro;m. Scanning was conducted at 155 kV and 190 mA, utilizing a 0.2-mm-thick aluminum filter and completing a full 360\u0026deg; rotation around the vertical axis, resulting in approximately 1300 images per tooth after reconstruction with Phoenix Datos|x 3D software (General Electric, Boston, MA, USA), which included ring artifact correction of 5, beam hardening correction of 50%, and smoothing of 8. Each scan took about 60 minutes.\u003c/p\u003e \u003cp\u003eThe volumetric data (mm\u0026sup3;) were subsequently analyzed using a combination of ImageJ (National Institutes of Health, Bethesda, MD) for quantitative analysis, 3D Slicer (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.slicer.org\u003c/span\u003e\u003cspan address=\"http://www.slicer.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) for image binarization, and Meshmixer (Autodesk Inc.) for generating three-dimensional models to visualize the perforations. For each sample, the data associated with the calcium-silicate-based materials within the cavities, as well as the voids and gaps between the dentin wall and the repair material, were calculated by creating binary images (by subtracting the filled perforation from the total volume) and assessing porosity through segmentation to identify regions of lower density (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eGaps are dark voids between the dentin wall and the repair material, indicating inadequate adaptation or sealing. Conversely, voids refer to dark spaces within the repair material, suggesting internal porosity or incomplete filling. These factors were measured quantitatively to evaluate the integrity and sealing performance of the materials examined.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe statistical analysis was conducted using SPSS (Statistical Package for the Social Sciences 21.0; IBM Corp, Armonk, NY). The qualitative data, including adaptation, overfilling, porosity, and overall quality of obturation, were analyzed using the chi-square test. In contrast, the quantitative data from the micro-CT scans, such as voids and porosity, were first assessed for normality using the Shapiro-Wilk test. Since the data did not follow a normal distribution, the Kruskal-Wallis test was employed to compare the three experimental groups, followed by the Mann-Whitney U test for pairwise comparisons, with an appropriate adjustment for multiple comparisons. The statistical significance level was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eQualitative analysis\u003c/h2\u003e \u003cp\u003eResults from the qualitative analysis are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The qualitative analysis of furcal perforation repair using various calcium silicate cements focused on four key aspects: adaptation, overfilling, porosity, and overall obturation quality.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQualitative analysis of adaptation, overfilling, porosity, and the overall quality of obturation.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eMaterial\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eAdaptation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eOverfilling\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003ePorosity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eObturation quality\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBiodentine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003csup\u003eac\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003csup\u003eb,c\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeoputty\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e91.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProRoot\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12\u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003csup\u003e\u003cb\u003ea,b,c,d,e\u003c/b\u003e\u003c/sup\u003e In each column, data with the same letter are related by a statistically significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBefore testing the materials' sealing ability, the volumes of the initial perforation were compared between groups to verify homogeneity among the\u0026ensp; samples. The analysis confirmed that no statistically significant differences were observed in the initial perforation volumes across the groups, validating the comparability of the results obtained after treatment.\u003c/p\u003e \u003cp\u003eProRoot MTA and NeoPutty demonstrated 100% adaptation to the cavity, while Biodentine achieved only 66.7%. This difference was statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) when comparing Biodentine with ProRoot MTA and NeoPutty. No significant differences were observed between ProRoot MTA and NeoPutty.\u003c/p\u003e \u003cp\u003eThe proportion of cases showing porosity in the material was significantly higher with Biodentine (50%) compared to NeoPutty (8.3%) and ProRoot MTA (0%). The difference between Biodentine and the other two materials was statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while no significant difference was found between NeoPutty\u0026reg; and ProRoot MTA.\u003c/p\u003e \u003cp\u003eThe best qualitative results regarding overfilling were obtained with ProRoot MTA (25%), followed by NeoPutty and Biodentine (33.3%). However, this difference was not statistically significant.\u003c/p\u003e \u003cp\u003eProRoot MTA demonstrated the highest performance, with 100% of cases achieving proper obturation. NeoPutty followed with 91.7%, while Biodentine recorded the lowest success rate at 66.7%. Significant differences were noted when comparing NeoPutty to Biodentine\u0026reg; and ProRoot MTA to Biodentine (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQuantitative evaluation\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the results of a quantitative evaluation conducted with micro-CT imaging. The evaluation focused on voids, gaps, and porosity within the material (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuantitative analysis of voids, gaps, and porosity of the samples in microCT.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBiodentine\u003c/p\u003e \u003cp\u003eMean (Min-Max)*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeoPutty\u003c/p\u003e \u003cp\u003eMean (Min-Max)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eProRoot\u003c/p\u003e \u003cp\u003eMean (Min-Max)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerforation volume (mm\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.57 (4.06\u0026ndash;7.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.29 (3.04\u0026ndash;10.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.44 (3.88\u0026ndash;5.07)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVoids Volume (mm\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.05 (0.00-0.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.347 (0.01\u0026ndash;2.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06 (0.01\u0026ndash;0.20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVoids Percentage (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.38 (0.00-20.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.20 (0.20-26.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.29 (0.21\u0026ndash;4.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGaps Volume (mm\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.14 (0.00-0.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.09 (0.00-0.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.03 (0.01\u0026ndash;0.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGap Percentage (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.40 (0.00-9.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.04 (0.00-7.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.65 (0.20\u0026ndash;2.22)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePorosity (mm\u003c/b\u003e\u003csup\u003e\u003cb\u003e3\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.35 (0.00-3.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00 (0.00\u0026ndash;0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.49 (0.00-3.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePorosity Percentage (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (0.00-76.43)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00 (0.00\u0026ndash;0.00)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.46 (0.00-78.52)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cb\u003ea,b\u003c/b\u003e\u003c/sup\u003e In each column, data with the same letter are related by a statistically significant difference (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003eAbbreviations: Min, minimum value; Max, Maximum value.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eNeoPutty had the highest percentage of voids (4.20%), whereas ProRoot MTA had the lowest (1.28%). Biodentine exhibited an average void volume of 1.05 mm\u0026sup3; (2.38%), which was higher than NeoPutty (0.70 mm\u0026sup3;, 1.65%) and ProRoot MTA (0.59 mm\u0026sup3;, 1.29%). These differences highlight the superior material density of ProRoot MTA and NeoPutty compared to Biodentine.\u003c/p\u003e \u003cp\u003eGaps, referring to the spaces between the dentinal wall and the sealing material, were largest in ProRoot MTA (6.48%), followed by Biodentine (2.40%), and smallest in NeoPutty (1.03%). In terms of gap volume, Biodentine had the highest value (1.37 mm\u0026sup3;), followed by NeoPutty (0.85 mm\u0026sup3;) and ProRoot MTA (0.29 mm\u0026sup3;).\u003c/p\u003e \u003cp\u003eBiodentine exhibited the highest porosity at 28.44%, whereas NeoPutty demonstrated no measurable porosity at 0.0%. The differences between Biodentine and ProRoot MTA and between Biodentine and NeoPutty were statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001); however, no significant differences were observed between ProRoot MTA and NeoPutty.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study evaluated the sealing ability of three calcium silicate cements\u0026mdash;ProRoot MTA, NeoPutty, and Biodentine\u0026mdash;to repair furcal perforations in mandibular molars. Both qualitative (adaptation, overfilling, porosity, and obturation quality) and quantitative micro-CT assessments (voids, gaps, and porosity) were employed to compare these materials. The findings indicate significant differences in material performance, especially regarding adaptation, porosity, and obturation quality, which are critical factors for the success of furcation perforation repairs.\u003c/p\u003e \u003cp\u003eTo the authors\u0026rsquo; knowledge, this is the first study to perform a qualitative clinical assessment of bioceramic sealer adaptation in furcal perforations. Since micro-CT imaging cannot be performed \u003cem\u003ein vivo\u003c/em\u003e, this study provides a controlled experimental setting that closely replicates real clinical situations. Indeed, micro-CT is a highly reliable technique commonly employed to evaluate 3D microstructures in \u003cem\u003eex vivo\u003c/em\u003e models [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Its precision in image analysis arises from its ability to distinguish the dentinal wall, furcal repair materials, and empty spaces using various grayscale thresholds.\u003c/p\u003e \u003cp\u003eThese results are consistent with a recent study emphasizing calcium silicate cements' superior sealing ability and biocompatibility, especially MTA [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Overall, the current findings indicate that both ProRoot MTA and NeoPutty achieved perfect adaptation to the dentinal walls, significantly exceeding the performance of Biodentine. This variation in adaptation is linked to the materials' handling characteristics. Specifically, NeoPutty, with its pre-mixed, putty-like texture, appears to offer enhanced ease of use and improved conformity to the irregularities of the perforation site. In contrast, Biodentine, while it sets relatively quickly [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], demonstrated a statistically significant inability to adapt as well as the other two materials.\u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, one of the most critical findings of this study is the difference in porosity among the materials. Biodentine exhibited significantly higher porosity (28.44%) compared to both ProRoot MTA (0%) and NeoPutty (8.3%). This increased porosity in Biodentine could be attributed to its mixing process, which involves mechanical vibration and automatic agitation. These mixing methods may introduce air bubbles into the material, producing higher porosity. In contrast, NeoPutty comes in a pre-mixed formula that effectively minimizes the incorporation of air during handling, resulting in its lower porosity and improved overall performance..\u003c/p\u003e \u003cp\u003eIndeed, a key factor influencing the performance of bioceramic cements is the mixing process [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], which is eliminated in NeoPutty due to its pre-mixed formulation. This ensures consistent material properties and reduces operator-dependent variability. Previous studies highlighted this aspect, demonstrating that factors such as the powder-to-liquid ratio, temperature, and porosity can significantly affect the mechanical properties of cements [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. As a result, any variables related to mixing (\u003cem\u003ee.g.\u003c/em\u003e, the powder-to-liquid ratio and the operator\u0026rsquo;s mixing technique) and material placement play a crucial role in the outcome [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, the porosity of endodontic sealers plays a crucial role in their effectiveness. Exposure to periradicular fluids can negatively impact the durability of the endodontic filling. Sealers with high porosity are more prone to microleakage, potentially causing periradicular fluids to infiltrate the root canal system. This infiltration can compromise the success of the root canal treatment, posing a risk to long-term clinical outcomes [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBiodentine's markedly higher porosity appears inconsistent with findings from a recent study (29) comparing the porosity of Biodentine and ProRoot MTA against a pre-mixed bioceramic, iRoot BP Plus (Innovative BioCeramix Inc., Vancouver, BC, Canada), and Ceramicrete. The study found no statistically significant differences in porosity among the materials tested. Nevertheless, despite the lack of significance, these earlier results indicated that Biodentine was more porous than ProRoot MTA, aligning with the current findings. Meanwhile, the pre-mixed bioceramic sealer exhibited the highest porosity. The differences observed in the current data might be attributed to using plastic molds instead of actual mandibular molars in that study and a small sample size per group (n\u0026thinsp;=\u0026thinsp;4).\u003c/p\u003e \u003cp\u003eFurthermore, the results obtained in the current study do not align with those reported by Guerrero \u003cem\u003eet al.\u003c/em\u003e [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], who found significant differences in the porosity of Biodentine compared to White ProRoot MTA, with Biodentine demonstrating superior porosity properties in terms of both the number and volume of pores. However, it is important to note that their study did not use human molars, but rather 5 mm high silicone tubes, and the samples were not placed in a humidity chamber to simulate oral conditions. Additionally, the materials were let to set only 24 hours, a detail that could influence the results. On the contrary, the present study demonstrated that ProRoot MTA and NeoPutty are effective materials for sealing furcal perforations, particularly in porosity control.\u003c/p\u003e \u003cp\u003eThe current investigation also evaluated overfilling, which was observed across all groups, with ProRoot MTA exhibiting the lowest rate (25%), while NeoPutty and Biodentine both showed a higher overfilling rate of 33.3%. Overfilling can be particularly relevant in cases where the perforation site is close to critical anatomical structures, as it could cause inflammation, delayed healing, or potential interference with periradicular tissue regeneration. The presence of extruded material in crucial areas such as the furcal region may also jeopardize periodontal reattachment and raise the risk of treatment failure [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Interestingly, ProRoot MTA showed a lower overfilling rate, which may be attributed to its thicker consistency, allowing a more controlled application. On the contrary, NeoPutty, despite its pre-mixed formulation, may exhibit slightly lower viscosity, making it more prone to extrusion beyond the perforation site. Similarly, Biodentine presents a higher overfilling rate, probably due to its lower viscosity and faster setting time, which could make the materials harder to manipulate precisely before setting.\u003c/p\u003e \u003cp\u003eThis study highlighted that pre-mixed bioceramic cements achieved better gap reduction results regarding quantitative parameters. This is consistent with the findings of a recent study [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], where Endosequence Fast Set Putty achieved significantly better outcomes. Both studies followed a similar clinical protocol, performing micro-CT assessments in extracted teeth. In this study, ProRoot MTA exhibited the highest gap percentage (6.48%), followed by Biodentine (2.40%) and NeoPutty, which showed the smallest gap percentage (1.03%).\u003c/p\u003e \u003cp\u003eHowever, when considering the absolute gap volume, Biodentine showed the highest value (1.37 mm\u0026sup3;), followed by NeoPutty (0.85 mm\u0026sup3;), with ProRoot MTA showing the lowest value (0.29 mm\u0026sup3;). These findings indicate that despite having the highest gap percentage, ProRoot MTA had the smallest actual gap volume; this is probably explained by its higher adaptation and material density that compensate for its marginal gap presence. Conversely, Biodentine showed higher gap volume, supporting its lower adaptation performance, as observed in qualitative analyses. On the contrary, NeoPutty, with both a low gap percentage and moderate gap volume, demonstrated consistent adaptation, probably explained by its putty-like consistency, which allows for better flow and adaptation to the dentinal surface.\u003c/p\u003e \u003cp\u003eFrom a clinical perspective, these results highlight that adaptation and porosity are critical factors when choosing a repair material for furcation perforations. While all materials showed some voids and gaps, ProRoot MTA remains the most reliable, while NeoPutty offers a strong alternative. Indeed, NeoPutty emerged as the superior material in terms of both handling and porosity. Its pre-mixed nature eliminates the variability associated with on-site material mixing, which can introduce inconsistencies in performance, as seen with Biodentine, which requires careful handling due to its limitations. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]​\u003c/p\u003e \u003cp\u003eIndeed, despite its shorter setting time, bioactivity, and ease of use in some clinical scenarios, Biodentine shows significantly higher porosity and lower adaptation rate, which limits its reliability for furcal perforation repair. This suggests that it might be better suited for other clinical applications, such as dentin replacement in non-load-bearing areas, where its shortcomings in adaptation and porosity are less critical​ [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile this study provides valuable insights into the performance of different calcium silicate cements, several limitations should be acknowledged. Although adequate for detecting significant differences, the sample size could be expanded in future studies to increase the generalizability of the findings. Additionally, the \u003cem\u003eex-vivo\u003c/em\u003e nature of the study does not fully replicate the complexities of \u003cem\u003ein vivo\u003c/em\u003e conditions, such as blood and saliva contamination, which could affect the materials' performance. Future research should also explore the long-term outcomes of furcal perforation repairs using these materials, focusing on their performance under masticatory loads and their resistance to bacterial infiltration over time.\u003c/p\u003e \u003cp\u003eIn conclusion, this study's findings suggest that NeoPutty is the most reliable material for furcal perforation repair, offering superior adaptation and the lowest porosity. ProRoot MTA remains a strong option, although its handling properties may present challenges in clinical settings. Biodentine, while advantageous in setting time, exhibits significant porosity and suboptimal adaptation, making it a less favorable choice for critical repair cases such as furcation perforations.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthorship Declaration:\u003c/strong\u003e All authors contributed to the study's conception and design. \u003cstrong\u003eM.R:\u003c/strong\u003e Investigation, Methodology, Data curation, Software. \u003cstrong\u003eA.M.D\u003c/strong\u003e: Investigation. \u003cstrong\u003eJ.M.C\u003c/strong\u003e: Conceptualization, Methodology, Data curation, Investigation. \u0026nbsp;\u003cstrong\u003eN.N\u003c/strong\u003e\u003cem\u003e:\u003c/em\u003e Conceptualization,\u0026nbsp;Investigation, Supervision.\u0026nbsp;\u003cstrong\u003eA.R.P:\u003c/strong\u003e Writing- Reviewing and Editing, Conceptualization, Supervision.\u0026nbsp;\u003cstrong\u003eG.M.\u003c/strong\u003e: Writing-Reviewing and Editing, Data curation\u0026nbsp;\u003cstrong\u003eJ.A\u003c/strong\u003e: Investigation, Supervision.\u0026nbsp;\u003cstrong\u003eD.R.F\u003c/strong\u003e: Conceptualization,\u0026nbsp;Investigation, Reviewing and Editing, Supervision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e: The authors do not want to thank anyone in particular.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate:\u003c/strong\u003e The Rey Juan Carlos institutional ethics committee approved the study (protocol 1301202302823).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e The data supporting this study's findings are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure statement:\u0026nbsp;\u003c/strong\u003eJosé Aranguren and Alejandro R. Pérez are the opinion leaders of ZARC (Zarc4endo, Gijón, Asturias, Spain), and Juan Miraglia Cantarini is the opinion leader of Dentsply (Dentsply-Sirona, Baillagues, Switzerland). The other authors deny any conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCardoso, M., Catr\u0026eacute;, D., Noites, R., Paulo, M. \u0026amp; Viegas, C. Animal models used in furcation perforation studies: A systematic review and comprehensive synthesis of model characteristics. \u003cem\u003eAust Endod J\u003c/em\u003e \u003cstrong\u003e44\u003c/strong\u003e, 273-280 (2018).\u003c/li\u003e\n\u003cli\u003eSilva, L.A.B.\u003cem\u003e, et al.\u003c/em\u003e Furcation Perforation: Periradicular Tissue Response to Biodentine as a Repair Material by Histopathologic and Indirect Immunofluorescence Analyses. \u003cem\u003eJ Endod\u003c/em\u003e \u003cstrong\u003e43\u003c/strong\u003e, 1137-1142 (2017).\u003c/li\u003e\n\u003cli\u003eMente, J., Leo, M., Panagidis, D., Saure, D. \u0026amp; Pfefferle, T. Treatment outcome of mineral trioxide aggregate: repair of root perforations-long-term results. \u003cem\u003eJ Endod\u003c/em\u003e \u003cstrong\u003e40\u003c/strong\u003e, 790-796 (2014).\u003c/li\u003e\n\u003cli\u003eGorni, F.G., Andreano, A., Ambrogi, F., Brambilla, E. \u0026amp; Gagliani, M. 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Evaluation of sealing ability of Biodentine\u0026trade; and mineral trioxide aggregate in primary molars using scanning electron microscope: A randomized controlled in vitro trial. \u003cem\u003eContemp Clin Dent\u003c/em\u003e \u003cstrong\u003e7\u003c/strong\u003e, 322-325 (2016).\u003c/li\u003e\n\u003cli\u003eToia, C.C., Teixeira, F.B., Cucco, C., Valera, M.C. \u0026amp; Cavalcanti, B.N. Volumetric Evaluation of Voids and Gaps of Different Calcium-Silicate Based Materials Used in Furcal Perforations: A Micro-CT Study. \u003cem\u003eDent J (Basel)\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e(2022).\u003c/li\u003e\n\u003cli\u003eSiew, K., Lee, A.H. \u0026amp; Cheung, G.S. Treatment Outcome of Repaired Root Perforation: A Systematic Review and Meta-analysis. \u003cem\u003eJ Endod\u003c/em\u003e \u003cstrong\u003e41\u003c/strong\u003e, 1795-1804 (2015).\u003c/li\u003e\n\u003cli\u003eDawood, A.E., Parashos, P., Wong, R.H.K., Reynolds, E.C. \u0026amp; Manton, D.J. 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Effect of perforation size and furcal lesion on stress distribution in mandibular molars: a finite element analysis. \u003cem\u003eInt Endod J\u003c/em\u003e \u003cstrong\u003e52\u003c/strong\u003e, 377-384 (2019).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Calcium silicate cement, Dental porosity, Furcal perforations, Mandibular molars, Marginal adaptation, Micro-computed tomography, Perforation sealing","lastPublishedDoi":"10.21203/rs.3.rs-6315576/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6315576/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study compares the adaptation, porosity, and sealing performance of ProRoot MTA, NeoPutty, and Biodentine. Thirty-six mandibular molars with furcation perforations were randomly assigned to three groups (n\u0026thinsp;=\u0026thinsp;12). Clinical evaluation assessed adaptation, porosity, and overfilling, while micro-computed tomography (micro-CT) provided quantitative data on voids and gaps. Statistical analysis used chi-square, Kruskal-Wallis, and Mann-Whitney U tests. NeoPutty and ProRoot MTA showed superior adaptation compared to Biodentine (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Biodentine showed higher porosity (28.44%) than ProRoot MTA (0%) and NeoPutty (8.3%) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Biodentine also had the highest void volume (1.05 mm\u0026sup3;) and gap volume (1.37 mm\u0026sup3;), while ProRoot MTA recorded the lowest void volume (0.59 mm\u0026sup3;), and NeoPutty had the smallest gap volume (0.85 mm\u0026sup3;). No significant differences were observed in overfilling rates. ProRoot MTA offered the best sealing ability, while NeoPutty provided easier application. In contrast, Biodentine showed the worst performance.\u003c/p\u003e","manuscriptTitle":"Marginal Adaptation and Porosity of Calcium Silicate Cements in Furcation Perforations: A Micro-CT Comparative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-17 13:26:14","doi":"10.21203/rs.3.rs-6315576/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-10T06:42:48+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-10T00:00:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-09T21:22:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-07T18:28:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"319217764637731352409093437784831383648","date":"2025-03-30T15:41:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181538437080647697268395685368527800609","date":"2025-03-30T14:51:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80153455721736588829061496215243466182","date":"2025-03-29T13:35:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-28T14:31:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-28T14:09:57+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-03-28T08:48:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-28T04:35:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-03-26T22:52:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7ebc9fbd-4bec-46a5-a8a4-18ce4eef0f94","owner":[],"postedDate":"April 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":46951777,"name":"Health sciences/Health care/Dentistry/Endodontics"},{"id":46951778,"name":"Health sciences/Health care/Dentistry/Dental materials/Dental biomaterials"},{"id":46951779,"name":"Health sciences/Health care/Dentistry/Dental materials/Mineral trioxide aggregate"}],"tags":[],"updatedAt":"2025-06-09T15:59:04+00:00","versionOfRecord":{"articleIdentity":"rs-6315576","link":"https://doi.org/10.1038/s41598-025-03729-7","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-06-02 15:57:01","publishedOnDateReadable":"June 2nd, 2025"},"versionCreatedAt":"2025-04-17 13:26:14","video":"","vorDoi":"10.1038/s41598-025-03729-7","vorDoiUrl":"https://doi.org/10.1038/s41598-025-03729-7","workflowStages":[]},"version":"v1","identity":"rs-6315576","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6315576","identity":"rs-6315576","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}