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| Assessment of sealing ability of two root-end filling materials at different depths: A comparative study |
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Anupama Ahirwar1, J John2, Midhun Paul2, Allu Baby2, Bilu Sara3, Sapna C Kambiranda4
1 Department of Dentistry, Gandhi Medical College, Bhopal, Madhya Pradesh, India
2 Department of Conservative Dentistry and Endodontics, St. Gregorios Dental College, Ernakulam, Kerala, India
3 Department of Orthodontics and Dentofacial Orthopaedics, Mar Baselios Dental College, Ernakulam, Kerala, India
4 Department of Prosthodontics, Coorg Institute of Dental Sciences, Virajpet, Karnataka, India
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| Date of Submission | 28-Sep-2019 |
| Date of Acceptance | 29-Sep-2019 |
| Date of Web Publication | 25-Oct-2019 |
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Background: Most biocompatible and least microleakage of root-end filling material helps the clinician to provide a proper apical seal that prevents the movement of bacteria and the spreading of their remnants from the root canal system into the periapical tissues. The aim of this study was to compare the sealing ability of biodentine and mineral trioxide aggregate (MTA) as root-end filling material at different depths. Materials and Methods: For this study, 100 freshly extracted maxillary central and lateral incisor teeth were taken and stored in normal saline. All teeth were divided into four experimental groups: Group 1––filled with biodentine; Group 2––filled with MTA; Group 3––positive control group; and Group 4––negative control group. Groups 1–3 were divided into three subgroups, which comprised 10 teeth each. The teeth were immersed in methylene blue dye (Thermo Fisher Scientific, Mumbai, India) for 72h. The depth of dye penetration was examined under a stereomicroscope (Magnus, Olympus, Noida, India) with a ×10 eyepiece magnification and ×2 zoom to evaluate the roots for the extent of microleakage. Results: On biodentine filling, at 3mm showed the least mean (126.72 ± 111.87) followed by 4mm (137.28 ± 111.87) and 2mm (195.36 ± 182.99) deep cavities, respectively. On MTA filling, at 4mm showed the least mean (902.88 ± 321.12) followed by 3mm (924.00 ± 303.06) and 2mm (1404.48 ± 539.72) deep cavities, respectively. Conclusion: On conclusion, both the materials tested showed dye penetration but there was significantly less dye penetration in biodentine, which may be because of its smaller particle size and formation of mineral tags, which may offer more resistance to microleakage than MTA at a similar depth. Keywords: Biocompatible, biodentine, mineral trioxide aggregate, root-end filling
How to cite this URL:
Ahirwar A, John J, Paul M, Baby A, Sara B, Kambiranda SC. Assessment of sealing ability of two root-end filling materials at different depths: A comparative study. Int J Oral Care Res [Epub ahead of print] [cited 2023 Mar 28]. Available from: https://www.ijocr.org/preprintarticle.asp?id=269957 |
| Introduction | |  |
The primary aim of root canal treatment is the elimination and exclusion of all the microorganisms from the root canal system.[1] The most important factor for a successful endodontic treatment is the complete obliteration of the root canal system and development of fluid tight seal.[2],[3]
Despite of new endodontic techniques, development of more effective materials, and instruments, the resolution of periapical pathosis is not achieved in certain cases.[4] In cases where conventional endodontic treatment is unsuccessful, surgical endodontic intervention is needed to save the involved tooth.[5] This procedure includes exposure of involved apex, resection of the apical end of the root, preparation of root-end cavity, and insertion of root-end filling material.[6] The main objective of a root-end filling material is to provide an apical seal that prevents the movement of bacteria and the diffusion of their products from the root canal system into the periapical tissues.[7],[8],[9]
There are limited data on the microleakage of mineral trioxide aggregate (MTA) and biodentine at different thicknesses. Therefore, the aim of this study was to compare the microleakage of ProRoot MTA and biodentine as a root-end filling material at three different thicknesses.
Null hypotheses. There is no difference in microleakage between 2-mm, 3-mm, 4-mm-deep cavities of biodentine, MTA, positive control, and negative control.
| Materials and Methods | | |
This in vitro study was conducted in the Department of Conservative Dentistry and Endodontics at Peoples College of Dental Sciences and Research Centre, Bhopal after the approval from the ethical committee.
For this study, 100 freshly extracted maxillary central and lateral incisor teeth were taken and stored in normal saline. Access cavities were prepared with an Endo Access Bur (Dentsply Maillefer, Ballaigues, Switzerland). Then, a #10 no. K-file (Dentsply Maillefer, Ballaigues, Switzerland) was introduced into the canal until the tip was visible at the apical foramen and by subtracting 0.5mm from this measurement, the working length was determined. The biomechanical preparation was carried out using step-back technique until reaching a master apical file of size #45. The canals were irrigated between each file with 2mL of 3% sodium hypochlorite, followed by irrigation with 5mL of 3% NaOCl and 15% ethylenediaminetetraacetic acid (EDTA). Final irrigation with 5 mL of NaOCl was done. Canals were obturated with guttapercha. The AH plus sealer (Dentsply, Konstanz, Germany) using a lateral compaction technique Guttapercha was vertically condensed 1mm below cementoenamel junction (CEJ) and canal orifices were sealed with glass ionomer cement (GC Corporation, Tokyo, Japan). All samples were stored at 37 ± 1°C and 100% relative humidity for seven days. All teeth were decoronated at CEJ using a diamond disk (DFS, Germany). The apical 3mm of the obturated roots will be resected at the apical end at 90° to the long axis using a crosscut fissure bur (SS White FG 558) under continuous sterile distilled water irrigation.
All teeth were divided into four experimental groups.
Group 1: This group comprised 30 teeth that were divided into three subgroups comprising 10 teeth each. Standardized bur length was measured by using a Digital Vernier caliper.
Subgroup I: A standardized 2-mm-deep and 0.8-mm-wide retrograde cavity was prepared using a straight fissure diamond bur (SF 41, Mani, Japan).
Subgroup II: A standardized 3-mm-deep and 0.8-mm-wide retrograde cavity was prepared using a straight fissure diamond bur (SF 41, Mani, Japan).
Subgroup III: A standardized 4-mm-deep and 0.8-mm-wide retrograde cavity was prepared using a straight fissure diamond bur (SF 41, Mani, Japan).
All cavities were irrigated with 17% EDTA followed by saline, and then the cavity dried and filled with biodentine (Septodont, Saint-Maur-des-Fossés, France).
Group 2: This group comprised 30 teeth that were divided into three subgroups comprising 10 teeth each. Standardized bur length was measured by using a Digital Vernier caliper.
Subgroup I: A standardized 2-mm-deep and 0.8-mm-wide retrograde cavity was prepared using a straight fissure diamond bur (SF 41, Mani, Japan).
Subgroup II: A standardized 3-mm-deep and 0.8-mm-wide retrograde cavity was prepared using a straight fissure diamond bur (SF 41, Mani, Japan).
Subgroup III: A standardized 4-mm-deep and 0.8-mm-wide retrograde cavity was prepared using a straight fissure diamond bur (SF 41, Mani, Japan).
All the cavities were irrigated with 17% EDTA followed by saline and then the cavity dried and filled with MTA.
Group 3: This group comprised 30 teeth that were divided into three subgroups comprising 10 teeth each. Standardized bur length was measured by using a Digital Vernier caliper.
Subgroup I: A standardized 2-mm-deep and 0.8-mm-wide retrograde cavity was prepared using a straight fissure diamond bur (SF 41, Mani, Japan).
Subgroup II: A standardized 3-mm-deep and 0.8-mm-wide retrograde cavity was prepared using a straight fissure diamond bur (SF 41, Mani, Japan).
Subgroup III: A standardized 4-mm-deep and 0.8-mm-wide retrograde cavity was prepared using a straight fissure diamond bur (SF 41, Mani, Japan).
All the cavities were irrigated with 17% EDTA followed by saline and then the cavity dried and remained empty.
Group 4: This group comprised 10 teeth.
In the negative control group, no further preparation was carried out and the entire specimen including the root canal orifice and the apical foramen completely coated with three layers of nail varnish to inhibit the dye leakage to the canal system.
The external surfaces of all other specimens were then coated with three layers of nail varnish (Lakme, India) except at the apical end of the resected root and were then allowed to dry. The teeth were immersed in methylene blue dye (Thermo Fisher Scientific, Mumbai, India) for 72h. Following this procedure, the roots were rinsed for 15min under tap water and allowed to dry; nail varnish were removed with acetone and split longitudinally with a diamond disk using a water coolant. The depth of dye penetration was examined under a stereomicroscope (Magnus, Olympus, India) with a ×10 eyepiece magnification and ×2 zoom to evaluate the roots for the extent of microleakage. The greatest depth of dye penetration along one of the cavity walls has been taken and measured in micrometers meters.
| Statistical Analysis | | |
The Statistical Package for the Social Sciences software version 21.0 for windows was used for data analysis. The results were analyzed using the Kruskal–Wallis test and Mann–Whitney U test. Significance was assessed at 5% level of significance.
| Results | | |
[Table 1] depicts the dye leakage values (µm) of samples. Less dye penetration was found in biodentine followed by MTA and positive control.
A significant difference was found in microleakage between 2-mm, 3-mm, and 4-mm-deep cavities of biodentine, MTA, positive control, and negative control. Microleakage was maximum in positive control (2mm = 3 mm= 4mm) and minimum in negative control. In MTA (2 mm = 3 mm = 4 mm) microleakage was higher than biodentine (2 mm = 3 mm = 4 mm) but less than positive control (2 mm = 3 mm = 4 mm). In biodentine (2 mm = 3 mm = 4 mm) microleakage was more than negative control [Table 2]. | Table 2: Comparison of microleakage between 2-mm, 3-mm, and 4-mm deep cavities of biodentine, MTA, positive control, and negative control
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| Discussion | | |
The preparation of the cavity in the resected root end that is dimensionally sufficient for placement of a root-end filling material is of great clinical significance. The ideal root-end filling materials should prevent leakage of microorganisms and their products into the surrounding tissues.[10] Chong and Pitt Ford[11] state that the function of the root-end filling is to provide an ideally fluid impervious seal of the root canal and to inhibit coronal leakage of pathogens.
Rahimi et al.[12] and Torabinejad et al.[13] compared the microleakage at three different thicknesses of MTA as a root-end filling material. In the first, second, and third experimental groups, 1mm, 2mm, and 3mm thickness of MTA, respectively, were filled as a root-end filling material. India ink and a stereomicroscope dye penetration methods were used to check the leakage. The microleakage in the 3-mm and 2-mm root-end cavities was less than at 1-mm depth, but there were no significant differences found among the three different thicknesses. Roberts et al.[14] explained MTA materials solidify similar to other mineral cements, in which the anhydrous material dissolves, followed by the crystallization of hydrates in an interlocking mass. Laurent et al.[15] tested biodentine to evaluate its genotoxicity, cytotoxicity, and effects on the target cells specific functions. The study concluded that the material is biocompatible. The material was not found to affect the specific functions of target cells and thus could safely be used in the clinic.
In this study, microleakage was evaluated using dye leakage method and the methylene blue dye was selected for the study because it is inexpensive and easy to manipulate, as well as it has high degree of staining and a molecular weight even lower than that of bacterial toxins. Similar study was conducted by Kontakiotis et al.[16]
| Conclusion | | |
On conclusion both the material tested showed dye penetration but there was significantly less dye penetration in biodentine, which may be because of its smaller particle size and formation of mineral tags, which may offer more resistance to microleakage than MTA at a similar depth. Given the low cost and short setting time and better sealing ability at lesser depth, it is reasonable to consider biodentine as a possible substitute for MTA as a root-end restorative material.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Chong BS, Pitt Ford TR, Watson TF, Wilson RF Sealing ability of potential retrograde root filling materials. Endod Dent Traumatol 1995;11:264-9.  |
| 2. | Ozata F, Erdilek N, Tezel H A comparative sealability study of different retrofilling materials. Int Endod J 1993;26:241-5. |
| 3. | Wu MK, Wesselink PR Endodontic leakage studies reconsidered. Part I. Methodology, application and relevance. Int Endod J 1993;26:37-43. |
| 4. | Sousa CJ, Loyola AM, Versiani MA, Biffi JC, Oliveira RP, Pascon EA A comparative histological evaluation of the biocompatibility of materials used in apical surgery. Int Endod J 2004;37:738-48. |
| 5. | Holt GM, Dumsha TC Leakage of amalgam, composite, and super-EBA, compared with a new retrofill material: Bone cement. J Endod 2000;26:29-31. |
| 6. | Torabinejad M, Higa RK, McKendry DJ, Pitt Ford TR Dye leakage of four root end filling materials: Effects of blood contamination. J Endod 1994;20:159-63. |
| 7. | El Sayed M, Saeed M In vitro comparative study of sealing ability of diadent bioaggregate and other root-end filling materials. J Conserv Dent 2012;15:249-52. |
| 8. | Hasheminia SM, Nejad SL, Dianat O, Modaresi J, Mahjour F Comparing the sealing properties of mineral trioxide aggregate and an experimental ceramic based root end filling material in different environments. Indian J Dent Res 2013;24:474-7. |
| 9. | Kokate SR, Pawar AM An in vitro comparative stereomicroscopic evaluation of marginal seal between MTA, glass ionomer cement & biodentine as root end filling materials using 1% methylene blue as tracer. Endodontology 2012;24:36-42. |
| 10. | Gartner AH, Dorn SO Advances in endodontic surgery. Dent Clin North Am 1992;36:357-78. |
| 11. | Chong BS, Pitt Ford TR Root-end filling materials: Rationale and tissue response. Endodontic Topics 2005;11:114-30. |
| 12. | Rahimi S, Shahi S, Lotfi M, Yavari HR, Charehjoo ME Comparison of microleakage with three different thicknesses of mineral trioxide aggregate as root-end filling material. J Oral Sci 2008;50:273-7. |
| 13. | Torabinejad M, Parirokh M Mineral trioxide aggregate: A comprehensive literature review––part II: Leakage and biocompatibility investigations. J Endod 2010;36:190-202. |
| 14. | Roberts HW, Toth JM, Berzins DW, Charlton DG Mineral trioxide aggregate material use in endodontic treatment: A review of the literature. Dent Mater 2008;24:149-64. |
| 15. | Laurent P, Camps J, About I Biodentine™ induces TGF-β1 release from human pulp cells and early dental pulp mineralization. Int Endod J 2012;45:439-48. |
| 16. | Kontakiotis EG, Georgopoulou MK, Morfis AS Dye penetration in dry and water-filled gaps along root fillings. Int Endod J 2001;34:133-6. |
Correspondence Address:
Anupama Ahirwar,
Department of Dentistry, Gandhi Medical College, Bhopal 462016, Madhya Pradesh.
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/INJO.INJO_31_19
[Table 1], [Table 2] |
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