An in vitro comparative evaluation of the effect of three intracanal medicaments – Chlorhexidine gel, triple antibiotic paste, and calcium hydroxide paste on the push-out bond strength of MTA Plus, Biodentine, and calcium-enriched mixture

Aim: Caries or traumatic injuries affecting young permanent teeth during root development usually result in an open apex which is highly challenging to treat. The aim of this study was to evaluate the push-out bond strength of apical plugs of Mineral Trioxide Aggregate (MTA) Plus, Biodentine, and calcium-enriched mixture (CEM) after premedication with chlorhexidine, triple antibiotic paste (TAP), and calcium hydroxide. Methods: Fifty-four extracted intact anterior teeth were decoronated and 3 mm was sectioned from the apex. The canals were rendered parallel using #80 K-files and #3, #4 Peeso reamers to mimic an open apex situation. The samples were divided into 3 groups containing 18 samples each for the three intracanal medicaments. After premedication, the samples were stored for 2 weeks at 37°C, following which the canals were cleaned using #80 K-file along with ethylenediaminetetraacetic acid and sodium hypochlorite irrigation. The samples were further divided into three subgroups, each containing six samples for the three calcium silicate cement used in this study. They were later subjected to push-out bond strength testing. Results: Regardless of the type of intracanal medicament used, Biodentine had significantly higher bond strength than MTA Plus and CEM. The highest push-out bond strength results were obtained in samples premedicated with chlorhexidine. Compared to TAP and calcium hydroxide (Ca(OH) 2), this value was statistically significant (P < 0.001). Conclusion: Within the limitations of this study, Biodentine showed the highest push-out bond strength as compared to MTA Plus and CEM. Chlorhexidine may be superior to calcium hydroxide and TAP medicaments when used for apexification procedures with calcium silicate cement