Comparative Evaluation of the Apical Leakage of Different Bioceramic Retrofilling Materials with and without Smear Layer: A Stereomicroscopic Study

Objective: Present in?vitro study aimed to evaluate the apical leakage of different bioceramic retrofilling materials with and without smear layer. Materials and Methods: Sixty human single?rooted teeth were decoronated at a standardized root length of 13 mm, chemo?mechanically prepared and obturated. After obturation, root?end resection was done and root?end cavities were prepared using ultrasonic tips. The specimens with prepared retro cavities were randomly assigned into 2 groups (n = 30) based on the smear layer removal protocol used. Each group was further subdivided into 3 subgroups (n = 10) based on the bioceramic retrofilling material MTA (Mineral Trioxide Aggregate; Proroot Dentsply/Tulsa), CEM (Calcium?Enriched Mixture; Bionique Dent, Tehran) and ERRM (EndoSequence® Root Repair Material; Brasseler USA, Savannah, GA). The extension of dye (2% Rhodamine B) penetration was measured in millimetre using a stereomicroscope at 10× zoom. Results were statistically analysed using one?way ANOVA (analysis of variance) test and unpaired Student’s t test. Results: In the presence of smear layer, MTA demonstrated maximum mean apical leakage value (1.70 ± 0.30), followed by CEM (1.40 ± 0.37) and ERRM (1.40 ± 0.23), which was statistically not significant. Without the smear layer, ERRM demonstrated the least mean apical leakage value, which was statistically significant as compared with CEM (P <.05) and MTA ( P <.01). Conclusion(s): All bioceramic retrofilling materials demonstrated apical leakage irrespective of the presence or absence of the smear layer. The presence of a smear layer is beneficial for the sealing ab

Microfiltración Apical de Dos Cementos Selladores: Un Estudio in vitro / Apical Microfiltration of Two Cement Sealers: An in vitro Study

Se ha propuesto que una de las causas de fracaso del tratamiento de canales es el paso de bacterias a través del foramen apical, las que por acción directa o por activación del sistema inmune generan una respuesta inflamatoria. El sellado apical con conos de gutapercha y cemento sellador es lo que impide el paso de estas bacterias, pero en presencia de humedad sufre de solubilidad y permite la filtración bacteriana. El objetivo de este estudio fue comparar la filtración bacteriana apical que se produce después de la obturación radicular con cementos Topseal® y Tubliseal®, para lo cual se realizó un estudio de tipo experimental en que se seleccionaron 26 dientes unirradiculares recientemente extraídos, que se instrumentaron con limas Protaper Universal® hasta F3, finalizando con un ajuste apical con lima K#45, siendo irrigados permanente y abundantemente con hipoclorito de sodio al 5%. Los dientes se dividieron aleatoriamente en dos grupos que se obturaron por compactación lateral y cemento Topseal®, G1 (n=12), y cemento Tubliseal®, G2 (n=12). Las superficies externas se sellaron con esmalte para uñas, excepto los 2 mm apicales y se montaron en un dispositivo para filtración bacteriana de doble cámara, dejando sumergidos los ápices en un caldo agar bilis esculina con Enterococcus faecalis. Se incubaron a 37C por 10 semanas y se determinó la filtración bacteriana mediante la aparición de turbidez en el medio en la cámara con caldo estéril. Se determinaron los días transcurridos para verificar el crecimiento bacteriano y la cantidad de especímenes positivos, valores que se registraron y analizaron mediante la prueba estadística de X2. Las muestras obturadas con Topseal® presentaron mayor filtración bacteriana (66,64%) que las obturadas con Tubliseal® (58,31%), sin diferencias significativas (X2= 0,16), mostrando ambos altos niveles de filtración apical.

It has been proposed that one of the causes for endodontic failure is the passing of bacteria through the apical foramen, which produces an inflammatory response, either by direct action or by activating the immune system. The apical seal with gutta-percha points and sealant is what stops these bacteria from passing, but in the presence of humidity, this seal is subject to solubility and it allows bacterial leakage. The aim of this study was to compare the apical bacterial leakage that occurs after root filling using Topseal® and Tubliseal® sealers, for which an experimental study was conducted and 26 single-rooted freshly extracted teeth were selected, that were then instrumented with Protaper ® Universal until the F3 file, ending with an apical stop using a # 45 K-type file, under permanent and abundant irrigation with 5% sodium hypochlorite. The teeth were randomly divided into two groups that were filled by Lateral Condensation and Topseal®, G1 (n=12, and Tubliseal®, G2 (n=12) sealers. The external surface of the roots was covered with nail polish except the apical 2 mm and mounted in a dual chamber device for bacterial filtration, leaving the apexes immersed in bile esculin agar broth with Enterococcus faecalis obtained from clinical specimens. They were incubated at 37°C for 10 weeks and bacterial filtration was determined by the appearance of turbidity in the medium of the chamber with sterile broth. The elapsed days were measured to verify the presence of bacterial growth and the number of positive specimens, values that were recorded and analyzed using the X2 test statistic. The samples filled using Topseal® had higher bacterial filtration (66.64%) than the ones filled using Tubliseal® (58.31%), showing no significant difference ( X2=0.16), showing both high levels of apical filtration.

Effect of four different intracanal medicaments on the apical seal of the root canal system: A dye extraction study.

Aim: The aim was to determine the effect of four different intracanal medicaments on the apical seal of the root canal system in vitro. Methodology: Fifty freshly extracted intact human permanent maxillary central incisors were collected, stored and disinfected. The root canals were prepared to a master apical size of number 50 using step back technique. Depending upon the intracanal medicament used, the teeth were divided randomly into five groups of 10 teeth each including one control group and four experimental groups. Group A: No intracanal medicament. Group B: Calcium hydroxide powder mixed with distilled water. Group C: Calcium hydroxide gutta percha points (calcium hydroxide points). Group D: 1% chlorhexidine gel (hexigel). Group E: Chlorhexidine gutta percha points (Roeko Activ Points). The medication was left in canals for 14 days. Following removal of the intracanal medicament, all the groups were obturated with lateral compaction technique. The apical leakage was then evaluated using dye extraction method with the help of a spectrophotometer. Results: Results were statistically analyzed using Kruskal-Wallis and Mann-Whitney U-test, which showed statistically significant difference among the five groups tested. Conclusion: It can be concluded from this study that the control group showed least amount of leakage, whereas the 1% chlorhexidine gel group showed maximum amount of leakage. Apical leakage was observed with all the experimental groups with little variations in between them. Under the parameters of this study, it can be concluded that use of intracanal medicaments during endodontic treatment has a definite impact on the apical seal of the root canal system.

Nerve Injury from Overfilled Calcium Hydroxide Root Canal Filling Paste for Maxillary Lateral Incisor Endodontic Treatment

Evaluation of apical leakage in root canals filled with different sealers / Avaliação do desempenho de diferentes cimentos obturadores no selamento apical de canais radiculares

Objective: To evaluate the apical leakage exhibited by root canals filled with gutta-percha points and three different endodontic sealers. Material and Methods: Thirty-five human molars were used and had their palatal (maxillary molars) and distal roots (mandibular molars) sectioned, standardized and instrumented with Mtwo rotary system. The roots were filled through active lateral condensation technique and divided into three groups (n=10), according to the endodontic sealer employed: G1- AH Plus, G2- Fill Canal, G3- MTA Fillapex. All groups were filled by gutta-percha points and endodontic sealer. Gutta-percha points were immersed into sodium hypochlorite for 24 h to achieve disinfection. After the filling procedure, the roots were immersed into Indian ink for posterior diaphanization and obtainment of the images through stereomicroscopy. By analyzing the images in Adobe Illustrator CS5 software, the level of apical leakage was determined. The data obtained were submitted to Kruskal Wallis and Dunn tests, with level of significance set at 5%. Results: Statistically significant differences were found between G1 and G3. G2 did not show statistically significant differences. G1 exhibited the smallest apical leakage mean (12.85), followed by G2 (109.84) and G3 (101.15). Conclusions: Root canal obturation with gutta-percha points and AH plus sealer through lateral condensation technique provided lower apical leakage rates than the other endodontic sealers evaluated

Objetivo: Avaliar a infiltração apical apresentada em canais radiculares obturados com guta-percha e três diferentes cimentos obturadores. Material e Métodos: Foram utilizados 35 molares humanos, os quais tiveram suas raízes linguais (molares superiores) e distais (molares inferiores) seccionadas, padronizadas e instrumentadas com o sistema rotatório Mtwo. As raízes foram obturadas através da técnica de condensação lateral ativa e divididas em 3 grupos (n=10), de acordo com o cimento obturador utilizado: G1- AH Plus, G2- Fill Canal, G3- MTA Fillapex. Todos os grupos foram obturados com o conjunto guta-percha e cimento obturador, sendo que a guta-percha utilizada permaneceu 24 h imersa em hipoclorito de sódio, para sua desinfecção. Após a obturação, as raízes foram imersas em corante tinta da Índia, para posterior diafanização e obtenção de imagens através de estereomicroscópio. Através da análise das imagens no programa Adobe Illustrator CS5 foi determinado o nível de infiltração apical. Os dados obtidos foram submetidos aos testes estatísticos de Kruskal Wallis e Dunn, com nível de significância 5%. Resultados: Verificou-se presença de diferença estatística significante entre o G1 e G3, sendo que G2 não diferiu estatisticamente dos demais grupos. O G1 apresentou a menor média de infiltração apical (12.85), seguida pelo G2 (109.84) e G3 (101.15). Conclusões: A obturação de canais radiculares com cones de guta-percha e cimento AH plus através da técnica de condensação lateral proporciona baixos índices de infiltração apical, quando comparada aos demais cimentos obturadores avaliados

Nd:YAG laser irradiation effect on apical intracanal dentin - a microleakage and SEM evaluation

The purpose of this in vitro study was to evaluate the effect of neodymium:yttrium-aluminum-garnet (Nd:YAG) laser irradiation on intracanal dentin surface by SEM analysis and its interference in the apical seal of filled canals. After endodontic treatment procedures, 34 maxillary human incisors were randomly assigned to 2 groups. In the negative control group (n=17), no additional treatment was performed and teeth were filled with vertically condensed gutta-percha; in the laser-treated group (n=17), the root canals were irradiated with Nd:YAG laser (1.5 W, 100 mJ, 15 Hz) before filling as described for the control group. Two specimens of each group were prepared for SEM analysis to evaluate the presence and extent of morphological changes and removal of debris; the other specimens were immersed in 0.5 percent methylene blue dye (pH 7.2) for 24 h for evaluation of the linear dye leakage at the apical third. SEM analysis of the laser-treated group showed dentin fusion and resolidification without smear layer or debris. The Student’s t-test showed that the laser-treated group had significantly less leakage in apical third than the control group. Within the limitations of this study, it may be concluded that the morphological changes on the apical intraradicular dentin surface caused by Nd:YAG laser resulted in less linear dye apical leakage.

Influência do alargamento do canal sobre o selamento apical da obturação dos canais radiculares / Influence of root canal enlargement on the apical seal of root-filled teeth

Avaliou-se a relação do alargamento do canal com a qualidadedo selamento da obturação. No grupo I (n=17) os canaisforam preparados utilizando-se a regra do 1+4, ou seja, um instrumentoinicial que se ajustava no comprimento de trabalho emais quatro em ordem crescente de calibre. No Grupo II (n=17)a instrumentação foi feita da mesma forma que no grupo I, seguidado uso das brocas Gates-Glidden # 2, 3 e 4 nos terços cervicale médio e do escalonamento ápice-coroa com três limassubsequentes à última usada no comprimento de trabalho. Osdois grupos foram obturados pela técnica da condensação lateral,com cimento à base de óxido de zinco e eugenol, e colocadosem azul de metileno durante 72 horas, após o que se avaliou aqualidade do selamento através da infiltração linear do coranteno sentido ápice-coroa. A análise estatística dos resultados mostrouque não houve diferença na infiltração entre os grupos. Aconclusão a que se pode chegar é que o alargamento do canalnão melhora o selamento apical da obturação.

It was evaluated the relationship between root canal enlargementand root canal seal. In group I (n=17) canals were preparedwith the binded initial instrument and four more with increasedsize caliber. In group II (n=17) instrumentation was done as ingroup I and Gates-Glidden bur # 2, 3 and 4 in cervical and mediumthirds and step back with three k-files besides the last oneused in working length. Both groups were obturated by lateralcondensation technique and zinc oxide based sealer. They were put in methylene blue dye for 72 hours and root canal filling wasanalyzed for linear apical dye infiltration. Statistical analysis ofresults showed that there were no differences between groups.It was concluded that root canal enlargement does not improveroot apical seal.

Ex vivo evaluation of coronal and apical microbial leakage of root canal - Filled with gutta-percha or Resilon/Epiphany root canal filling material.

Objective: This ex vivo study compared coronal and apical microleakage of root canals filled with Resilon/Epiphany (RE) or gutta-percha/Grossman sealer (GP), using either lateral condensation (LC) or System B (SB) technique. Materials and Methods: Specimens in eight experimental groups were obturated using the following materials and techniques: Groups 1 and 3 - GP and LC; groups 2 and 4 - GP and SB; groups 5 and 7 - RE and LC; groups 6 and 8 - RE and SB. Apical and coronal leakages were tested using bacterial methods. For coronal analysis, the number of days required for complete contamination of the root canals was recorded according to observation of the brain heart infusion broth turbidity for 15 weeks. For apical analysis, the teeth were cleaved and the leakage was measured at 30 days. Data were collected for each sample and analyzed statistically with the Chi-square and ANOVA tests. Results: Leakage was found in all groups. The difference between filling materials, obturation techniques, and median time of leakage was not statistically significant for coronal ( P=0.847) and apical ( P=0.5789) leakages. Conclusion: There were no differences between the different filling materials (gutta-percha/Grossman sealer and Resilon/Epiphany) and obturation techniques (lateral condensation and system B technique) in coronal or apical leakages.

Comparação da infiltração apical entre os cimentos Obturadores ah plus, sealapex, sealer 26 e endofill, Através da diafanização / Comparison of apical leakage of endodontic sealers Ah plus, saelapex, sealer 26 e endofill through cleared teeth

Introdução e Objetivo: Analisar a infiltração dos cimentos AH Plus®, Sealapex®, Sealer 26® e Endofill® através da diafanização. Material e Métodos: 50 dentes humanos unirradiculares tiveram suas coroas removidas e canais preparados pela técnica de Oregon modificada. Após o preparo químico-mecânico os dentes foram obturados com cone de Guta-Percha e quatro diferentes tipos de cimentos endodônticos: Grupo I: AH Plus®; Grupo II: Sealapex®; Grupo III: Sealer 26® e Grupo IV: Endofill®. Os outros dois grupos serviram para os controle positivo (5 dentes) e negativo (5 dentes). Após a obturação, os dentes permaneceram em soro fisiológico a 0,9% por 60 dias, simulando a situação de umidade bucal. Passado esse período, os dentes foram impermeabilizados com três camadas de esmalte de unha e, depois de secos, foram imersos em tinta Nanquim e colocados na estufa a 37°C por 48 horas. Após esse período, as unidades de estudo foram lavadas em água corrente por 24 horas, as camadas de esmalte removidas com lâmina de bisturi e os dentes diafanizados. Resultados e Conclusão: Os resultados mostraram diferenças insignificantes entre os materiais testados, tendo assim, um comportamento semelhante na infiltração marginal apical.

Introduction and Objective: The aim of this study was to analyze the infiltration from sealers: AH Plus®, Sealapex®, Sealer 26® and Endofill®, using clearing teeth technique. Material and Methods: The present work makes an analysis of infiltration using the clearing technique of 50 single-rooted teeth that had crowns removed and canals prepared by the Oregon Modified Technique. The root canals were filled with Gutta-Percha and for different sealers: Group I: AH Plus®; Group II: Sealapex®; Group III: Sealer 26® and Group IV: Endofill®. The others two groups of five teeth each served as positive and negative control groups. After filling, teeth remained for 60 days in saline solution 0,9% simulating oral conditions. Following this stage, teeth were covered by three layers of nail polish, immersed in Nanquin ink and stored in a stove under 37º for 2 days. The samples were washed in current water for 24 hours, had the nail varnish removed with bistouries blades and the clearing technique was applied to evaluation to results. Results and Conclusion: The Mann-Whitney test was used and statistical analysis of the results showed insignificant differences between the materials tested and so a similar behavior in the apical marginal infiltration.Key words: cleared teeth; apical leakage; obturation.

Evaluation of the influence of apical sizes on the apical sealing ability of the modified continuous wave technique / 대한치과보존학회지

This study examined the influence of the apical sizes on the sealing ability of a root canal filling. Thirty-six single rooted teeth with a single canal were divided into 3 groups (n = 12) and instrumented with either the Profile(R) or LightSpeed(R) system to achieve three different apical sizes (master apical file [MAF] of #25, #40, or #60). The teeth were filled with gutta percha using a modified continuous wave technique. The level of microleakage was determined by immersing ten teeth from each group into India ink for 1 week followed by clearing with nitric acid, ethyl-alcohol, and methylsalicylate. The microleakage was measured using vernier calipers. The data was analyzed statistically using Kruskal-Wallis one-way ANOVA and a Student-Newman-Keuls Method. Two teeth from each group were sectioned horizontally at 1, 2, 3 and 4 mm from the apex in order to observe a cross section. The apical size was significantly (p < .05) influenced the level of microleakage. In the Student-Newman-Deuls Method, MAF sizes of #25 and #40; and MAF sizes of #25 and #60, respectively showed a statistically significant difference. There was no significant difference between #40 and #60. In most cross sections, oval-shaped canals were observed, and the irregularity of the internal surface increased with decreasing apical size. There was also an increase in the area of recess, which is the area where the canal space is not filled with either gutta-percha or sealer. When the root canals are filled using a modified continuous wave technique, canal filling with more consistent and predictable outcome may be expected as the apical preparation size is increased.

Effect of two different calcium hydroxide paste removal techniques on apical leakage: an electrochemical study / 대한치과보존학회지

This study evaluated the effect of two different calcium hydroxide (Ca(OH)2) paste removal techniques on the apical leakage of canals obturated with gutta percha cones and sealer after removing a Ca(OH)2 dressing using an electrochemical method. Seventy extracted single-rooted teeth were instrumented on with Profile rotary files under NaOCl irrigation. Fifty-eight canals were filled with calcium hydroxide paste, which was then removed using one of the following two techniques. In group A, calcium hydroxide was removed using only NaOCl irrigation, and in group B, the canals were re-prepared with a Profile rotary files-one size larger than the previous instrument and were irrigated with NaOCl. In both groups, the root surfaces were coated twice with nail varnish from CEJ to an area 4 mm away from the apex after canal obturation. Apical leakage was measured using an electrochemical method for 24 days. All the specimens showed leakage that increased markedly in the first three days. There was no significant difference between the two groups (p > 0.05). The effect of two calcium hydroxide paste removal techniques on the apical leakage was not different during a short period.

The effect of MTAD on the apical leakage of obturated root canals: an electrochemical study / 대한치과보존학회지

The purpose of this study was to evaluate the effect of newly developed endodontic root canal cleanser (MTAD) on the apical leakage of obturated root canal using an electrochemical method. Canals of 60 extracted single-rooted human teeth were prepared by using a crown-down technique with rotary nickel-titanium files. In Group 1 (positive control group) and 2 (negative control group), 5.25% NaOCl was used as a canal irrigant and no canal wall treatment was done. In group 3, only 5.25% NaOCl were used as canal irrigant, canal wall treatment and final rinse. In group 4, specimens were irrigated with 5.25% NaOCl, treated with 5 ml of 17% EDTA for 5 minutes and final rinsed with 5.25% NaOCl. Specimens of group 5 were irrigated with 1.3% NaOCl and treated with 5 ml of MTAD for 5 minutes. All root canals are dried with paper points and obtuated with gutta-percha and AH plus as a sealer using a continuous wave of condensation technique except in the group 1. The electrical resistance between the standard and experimental electrodes in canals was measured over a period of 10 days. Rising of apical leakage with time was observed for all the groups. Group 4 and 5 showed lower apical leakage than group 3 but differences between the group 3, 4 and 5 were no statistical significance at any measurement time.

An electrochemical study of the sealing ability of three retrofilling materials / 대한치과보존학회지

The purpose of this study was to evaluate the apical sealing ability of Super-EBA, MTA and Dyract-flow as retrofilling materials. Forty-eight extracted human teeth with straight and single root canal were used in this study. The root canals were prepared to a #40 apical canal size and obturated with gutter-percha. Apicoectomies were performed and root end cavities were prepared to a depth of 3mm using an ultrasonic device. The root end cavities were filled with Super-EBA, MTA or Dyract-flow. Leakage was measured using an electrochemical technique for 4 weeks. According to this study, the results were as follows. 1. Increasing leakage with time was observed in all groups. 2. No significant difference was noted among the 3 groups with time (p = 0.216). 3. No significant difference was noted among the 3 groups when measured within the same time interval (p = 0.814). The results of this study suggest that the sealing ability of Dyract-flow is equal to that of Super-EBA and MTA, and Dyract-flow may be an alternative to other materials for root-end filling.