The comparison of strip perforation repair using proroot MTA and calcium silicate-based sealer with cold hydraulic technique; bacterial leakage and micro-CT studies

Background: Strip perforations present a significant challenge in endodontic treatment due to the complexity of achieving an efficient seal, which can directly impact treatment outcomes. While bioceramic materials are commonly used for root repair, limited evidence exists regarding their effectiveness in sealing strip perforations. This study aims to investigate the sealing ability of ProRoot MTA, AH Plus, and iRoot SP in strip perforation repair using a bacterial leakage model, as well as to evaluate the presence of gaps and voids using micro-computed tomography (micro-CT). Methods: Forty human mandibular molars were used in this study. A strip perforation was created on the distal surface of the mesial root, between the coronal and middle thirds, using a Gate Glidden drill size #3. Tooth specimens were divided into three experimental groups (n = 12) and two control groups (positive and negative control groups, n = 2 each). The perforations in the experimental groups were repaired with ProRoot MTA, AH Plus using the lateral compaction technique, and iRoot SP using the cold hydraulic obturation technique. The sealing performance of the repair materials was assessed using a bacterial leakage model with Enterococcus faecalis (ATCC 29212). Leakage was monitored over 45 days, and statistical analysis was conducted using Kaplan-Meier survival curve analysis. Gaps and voids at the perforation sites were evaluated with micro-CT analysis, and statistical comparisons were made using one-way ANOVA. Results: The ProRoot MTA group exhibited the highest percentage of non-leakage samples (75.0%), followed by the iRoot SP group (66.7%) and the AH Plus group (41.7%). However, no statistically significant differences were detected among the groups. The micro-CT analysis demonstrated that the mean percentage of gaps and voids was significantly higher in the AH Plus group compared to both the ProRoot MTA and iRoot SP groups (p < 0.05). Conclusion: ProRoot MTA showed the highest proportion of non-leakage samples, followed by iRoot SP and AH Plus, with no significant differences in leakage time. Micro-CT analysis revealed significantly more voids in the AH Plus group. Within the study’s limitations, bioceramic sealers showed comparable sealing performance to MTA. Further studies are needed to confirm these findings.