Comparative Evaluation of the Effect of Calcium Silicate–Based, Metapex, and Triple Antibiotic Paste Intracanal Medicaments on the Push-Out Bond Strength of a Bio ceramic Root Canal Sealer: An In Vitro Study

Introduction: Effective endodontic treatment requires thorough microbial control and three-dimensional obturation. Intracanal medicaments are used as adjuncts to reduce residual microorganisms; however, their effects on dentin properties and subsequent sealer adhesion may vary. Conventional medicaments such as calcium hydroxide-based Metapex and Triple Antibiotic Paste (TAP) have demonstrated antimicrobial efficacy but may adversely affect dentin characteristics and sealer bonding. Calcium silicate–based medicaments such as Bio-C Temp have recently gained attention due to their bioactivity, biomineralization potential, and favourable interaction with dentin. However, limited evidence exists regarding their influence on the push-out bond strength of bio ceramic sealers. Therefore, this study comparatively evaluated the effect of calcium silicate–based intracanal medicament, Metapex, and TAP on the push-out bond strength of a bio ceramic root canal sealer. Objectives. To evaluate the push-out bond strength of the bioceramic root canal sealer following the use of a calcium silicate–based intracanal medicament.To evaluate the push-out bond strength following the use of Metapex.To evaluate the push-out bond strength following the use of Triple Antibiotic Paste.To compare the push-out bond strength values among the three intracanal medicament groups. Methods: Forty extracted single-rooted human teeth were decoronated and biomechanically prepared. Samples were randomly divided into four groups (n = 10): Control, Bio ceramic medicament, Metapex, and TAP. After placement of intracanal medicaments for 7 days, canals were obturated using a bio ceramic root canal sealer. Push-out bond strength was evaluated using a universal testing machine. Statistical analysis was performed using one-way ANOVA and Tukey HSD post hoc test. Results: The Bio ceramic group demonstrated the highest mean push-out bond strength (0.4416 ± 0.1893 MPa), followed by Metapex (0.3189 ± 0.1320 MPa), Control (0.2865 ± 0.1612 MPa), and TAP (0.2835 ± 0.0575 MPa). One-way ANOVA showed no statistically significant difference among groups (F = 2.682, p = 0.061). Pairwise comparisons also showed no statistically significant differences, although the Bio ceramic group demonstrated a near-significant trend compared with Control and TAP groups. Conclusions: Calcium silicate–based intracanal medicament exhibited superior push-out bond strength compared to Metapex and TAP. However, differences among groups were statistically non-significant