Evaluación de la citotoxicidad de tres cementos selladores endodóncicos utilizados en cirugía periapical: estudio in vitro / Cytotoxicity assessment of three endodontic sealing cements used in periapical surgery. In vitro study

Introducción: Existen diversos materiales de retroobturación, pero poco se sabe de su toxicidad sobre fibroblastos gingivales. Objetivo: Evaluar la citotoxicidad de tres materiales de retroobturación sobre fibroblastos gingivales humanos y fibroblastos de la línea L929. Material y métodos: Los medios condicionados de los materiales de retroobturación EndoSequence® BC RRMTM (ERRM), trióxido mineral agregado MTA Angelus® blanco (MTA) y material de restauración intermedia (IRM®) se obtuvieron en fresco, al tiempo de fraguado, y después de 1, 24 y 72 horas del tiempo de fraguado. La morfología celular fue evaluada por microscopia de luz y la viabilidad celular fue evaluada a través de la actividad metabólica mitocondrial con 3-(4,5-dimetiltiazol-2-il)-2,5-difenil bromuro de tetrazolio (MTT). El análisis estadístico se realizó por ANOVA. Resultados: El material ERRM no mostró efectos citotóxicos sobre los fibroblastos. Sin embargo, el MTA y el IRM® mostraron citotoxicidad moderada y alta, respectivamente. Esto revela que el MTA y el IRM® no son completamente inocuos. Conclusión: Los materiales biocerámicos como el ERRM pueden ser considerados los materiales de retroobturación más biocompatibles.

Introduction: Presently there are many retrofilling materials in themarket, nevertheless, little is known about their toxicity on gingival fibroblasts. Objective: To assess cytotoxicity of three materials tohuman gingival fibroblasts and L929 mouse fibroblasts cell line. Material and methods: EndoSequence® BC RRMTM (ERRM; rootrepair material), white MTA Angelus® (MTA) and intermediaterestoration material (IRM®) conditioned media were obtained whenmaterials were freshly mixed, at setting time and after 1, 24 and72 hours of setting time. Cell morphology was assessed with lightmicroscopy and cell viability was assessed through mitochondrialmetabolic activity with 3-(4,5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide (MTT). Statistical analysis was conducted withANOVA. Results: We found that ERRM material did not exhibitcytotoxic effects on used fibroblast, nevertheless, MTA and IRM® respectively exhibited moderate and severe cytotoxicity, thusindicating the materials were not fully harmless. Conclusion: Bioceramic cements like ERRM could be considered the mostcompatible retrofilling-materials.

Análise comparativa da adaptação marginal, infiltração microbiana e da citotoxicidade em ápices retrobturados com os cimentos Palacos-R e MTA / Comparative analysis of marginal adaptation, microbial leakage and cytotoxicity in apices in retrofills with cements Palacos-R and MTA

O sucesso do tratamento endodôntico está relacionado com uma adequada limpeza, modelagem e um bom selamento do sistema de canais radiculares. A cirurgia parendodôntica é um procedimento que tem como finalidade resolver problemas que não puderam ser solucionados pelo tratamento endodôntico convencional nem pelo retratamento. Essas cirurgias são realizadas através da exposição e remoção dos ápices radiculares, confecção de retrocavitações no longo eixo dos canais radiculares e retrobturações com materiais seladores específicos. Sendo assim, o presente trabalho teve o objetivo de realizar um estudo comparativo dos cimentos MTA (Agregado Trióxido Mineral) e Palacos-R (cimento ósseo) nas retrobturações endodônticas através da avaliação da adaptação marginal, da infiltração microbiana e da citotoxicidade. Para avaliação da adaptação marginal e da capacidade seladora pelo método da infiltração microbiana, foram selecionados 48 caninos superiores permanentes humanos extraídos, instrumentados e obturados. As apicetomias para a remoção dos 3mm apicais das raízes foram realizadas com a utilização da ponta ultrassônica diamantada CVD DENTUS 8.1117. Os retropreparos foram confeccionados com pontas ultrassônicas diamantadas CVD DENTUS 6.1107-E, com 4mm de profundidade. As 28 amostras foram retrobturadas com o cimento ósseo Palacos-R (HERAEUS KULZER) e o cimento MTA cinza (ANGELUS), num total de 14 espécimes para cada cimento testado. A avaliação da adaptação marginal foi realizada pela microscopia eletrônica de varredura (MEV) com 8 dentes (4 para cada cimento retrobturador). A capacidade seladora foi analisada através de ensaios de infiltração bacteriana com Enterococcus faecalis (ATCC 29212), com 10 dentes para o grupo do Palacos-R, 10 dentes para o grupo do MTA cinza, 10 dentes para o grupo controle positivo e 10 dentes para o grupo controle negativo. A avaliação da citotoxicidade foi feita com os eluatos dos cimentos pelo teste MTT, com fibroblastos gengivais de camundongos (células L929). A análise ao MEV mostrou uma melhor adaptação do Palacos-R aos retropreparos do que o MTA cinza. Apesar do Palacos-R ter obtido os menores índices numéricos de infiltração bacteriana, não houve diferença estatisticamente significativa entre ambos. Os dois cimentos não demonstraram atividade citotóxica sobre células L929, contudo nos extratos duplamente concentrados o cimento Palacos-R foi menos citotóxico do que o MTA cinza (P< 0.0001). Pôde-se concluir que o Palacos-R apresentou uma melhor adaptação marginal do que o MTA cinza ao MEV, que não houve diferença entre o Palacos-R e o MTA quanto à infiltracao microbiana e a citotoxicidade tornando-o um material retrobturador promissor a ser utilizado em Endodontia

The success of endodontic treatment is related to a proper cleaning, and a good seal of root canal system. Paraendodôntic surgery is a procedure that aims to solve problems that couldn't be solved by conventional endodontic treatment. These surgeries are performed by exposing and removing the root tips, making retrocavitations on the long axis of the root canals, and retrofilling with specific sealant materials Thus, the present work had the objective of performing a comparative study of MTA (Mineral Trioxide Aggregate) and Palacos-R (bone cement) cements in endodontic retrofillings through the evaluation of marginal adaptation, microbial infiltration and cytotoxicity. To evaluate the marginal adaptation and the sealing ability by the microbial infiltration method, 48 human permanent upper canines were selected, instrumented and obturated. The apicetomies for removal of the apical 3mm from the roots were performed using the diamond ultrasound tip CVD DENTUS 8.1117. The retroprepares were made with ultrasonic CVD DENTUS 6.1107-E diamond tips, 4mm deep. The 28 samples were retrobured with the Palacos-R (HERAEUS KULZER) cement and the gray MTA cement (ANGELUS), in a total of 14 specimens for each cement tested. The evaluation of the marginal adaptation was performed by scanning electron microscopy (SEM) with 8 teeth (4 for each retroburst cement). Sealing capacity was analyzed through bacterial infiltration assays with Enterococcus faecalis (ATCC 29212), with 10 teeth for the Palacos-R group, 10 teeth for the gray MTA group, 10 teeth for the positive control group and 10 teeth for the the negative control group. Cytotoxicity evaluation was performed with the eluates of the cements by the MTT test, with mouse gingival fibroblasts (L929 cells). The SEM analysis showed a better adaptation of the Palacos-R to the retroprepares than the gray MTA. Although Palacos-R had the lowest numerical rates of bacterial infiltration, there was no statistically significant difference between the two. The two cements did not demonstrate cytotoxic activity on L929 cells, however in the doubly concentrated extracts the Palacos-R cement was less cytotoxic than the gray MTA (P <0.0001). It was concluded that the Palacos-R presented a better marginal adaptation than the gray MTA to the SEM, that there was no difference between the Palacos-R and the MTA in terms of microbial infiltration and cytotoxicity, making it a promising retrofilling material to be used in Endodontics

Root - End Filling Materials - A Review.

When non-surgical root canal treatment fails to resolve periradicular lesions of endodontic origin or if retreatment is not feasible surgical intervention is recommended. Management of root end during endodontic surgery involves apical resection,retropreparation and retrofilling to seal the root canal. Numerous materials have been suggested and the newer ones like MTA, Castor Oil Polymer and calcium phosphate have shown promising results . This article is a review of literature on the suitability of various root end filling materials based on their leakage assessment, marginal adaptation, cytotoxicity and usage tests in experimental animals and humans.

Potencial do MTA e sealapex agregado ao MTA no selamento apical / Potential of the MTA and sealapex added to the MTA in the apical sealing

Objetivo: O objetivo deste trabalho foi avaliar a capacidade de selamento apical do MTA- Angelus® e a combinação do Sealapex agregado ao pó do MTA- Ângelus® em retrobturações. Metodologia: Os canais de incisivos centrais de humanos foram instrumentados e em seguida obturados pela técnica da condensação lateral usando o cimento endodôntico Sealer 26. Os dentes foram divididos aleatoriamente em 2 grupos experimentais (n= 40) e dois controles (n= 4). Em seguida foram realizados apicectomia das raízes a 3 mm do ápice e preparo da cavidade com pontas lisas de ultrassom com 3 mm de profundidade, seguindo-se a obturação retrógrada da seguinte maneira: grupo 1, as retrocavidades foram preenchidas com MTA-Angelus® e o grupo 2, as retrocavidades foram preenchidas com Sealapex agregado ao pó do MTA- Angelus®. Depois de serem corados com solução de azul de metileno 1% por 24 horas, lavados por 24 horas, os dentes foram seccionados longitudinalmente no sentido vestíbulo-palatino, com um disco diamantado em duas metades, e analisados com uma lupa esteroscópica. Resultados: Os resultados obtidos foram submetidos à análise estatística e mostraram que, o grupo 2 apresentou menor infiltração que o grupo 1 (p<0,01). Conclusão: Concluiu-se então, que o pó MTA agregado ao Sealapex apresenta potencial para serem usados como materiais retrobturadores.

The purpose of this study was to examine the ability of sealing the root end cavities filled with MTA- Angelus® or Sealapex increased a powder MTA- Angelus®. Forty single-rooted extracted human teeth were cleaned, shaped and filled by the lateral condensation technique using Sealer 26. The specimens were divided randomly into two groups of 20. Folowing root-end resection and cavity preparation with ultrassonic, the root-end cavities were filled with: Group 1: MTA- Angelus® and group 2: Sealapex plus power MTA- Angelus®. The teeth were then submerged in solution methilene blue 1% dye for 24 hours, washed for 24 hours, and using a slow-speed diamond saw, the teeth were longitudinally sectioned into two halves and the quantitative analysis of leakage was performed using light microscopy. The results showed that the specimens of group 2 had significantley less leakage than group 1 (p< 0,01). The results of this study indicated that Sealapex plus power MTA presents the potential to be used as a root end filling material.

Sealing ability of MTA and amalgam in different root-end preparations and resection bevel angles: an in vitro evaluation using marginal dye leakage

This in vitro study evaluated the effect of different apicoectomy angles, instruments used in root-end preparation, and dental materials used in retrofilling on apical sealing. Root ends were resected at 45 or 90 degrees in 80 single-rooted teeth. For each type of apicoectomy, root-end cavities were prepared with either a round carbide #2 bur or an S12/90D ultrasonic tip. The root-end cavities in each subgroup (apicoectomy + root-end preparation) were filled with silver amalgam without zinc (Am) or with gray mineral trioxide aggregate -Angelus (MTA), and the specimens were immediately immersed in 0.2 percent rhodamine B for 24 h. Sealing was evaluated based on the dyed cross-sectional dentin area. Data were analyzed statistically by the Kruskal-Wallis test at 5 percent significance level. No group showed complete sealing of root-end areas. The only significant factor affecting microleakage was dental material, with MTA exhibiting less leakage.

Este estudo in vitro avaliou o efeito de diferentes ângulos de apicectomia, instrumentos utilizados na retrocavitação e materiais odontológicos usados na retrobturação sobre selamento apical. Oitenta dentes unirradiculares, tratados endodonticamente, foram apicectomizados. Quarenta raízes tiveram seu ápice radicular seccionado com angulação de 45º e a outra metade com angulação de 90º. Para cada tipo de apicectomia realizou-se retrocavidades com broca esférica carbide nº 2 ou com retroponta ultra-sônica S12/90D. Cada subgrupo (apicectomia/retrocavidade) foi retrobturado com MTA ou amálgama, sendo os espécimes imediatamente imersos no corante Rodamina B a 0,2 por cento por 24 h. O selamento apical foi avaliado com base na área transversal de dentina corada ao redor da retrobturação. Os dados foram submetidos á análise estatística utilizando os testes de Kruskal-Wallis e Mann-Whitney. Nenhum grupo foi capaz de selar totalmente a região apical. O tipo de material utilizado na retrobturação foi o único fator que mostrou significativa diferença no selamento apical em relação à infiltração de corante.

Physical properties of novel composite using Portland cement for retro-filling material / 대한치과보존학회지

OBJECTIVES: The aim of this study was to compare apical sealing ability and physical properties of MTA, MTA - AH-plus mixture (AMTA) and experimental Portland cement - Epoxy resin mixture (EPPC) for a development of a novel retro-filling material. MATERIALS AND METHODS: Forty-nine extracted roots were instrumented and filled with gutta-percha. Apical root was resected at 3 mm and the retro-filling cavity was prepared for 3 mm depth. Roots were randomly divided into 3 groups of 15 roots each. The retro-filling was done using MTA, AMTA, and EPPC as the groups divided. Four roots were used as control groups. After setting in humid condition for 24 hours, the roots were immersed in 1% methylene blue dye solution for 72 hours to test the apical leakage. After immersion, the roots were vertically sectioned and photos were taken to evaluate microleakage. Setting times were measured with Vicat apparatus and digital radiographs were taken to evaluate aluminum equivalent thickness using aluminum step wedge. The results of microleakage and setting time were compared between groups using one-way ANOVA and Scheffe's post-hoc comparison at the significance level of 95%. RESULTS: AMTA and EPPC showed less microleakage than MTA group (p < 0.05). AMTA showed the highest radio-opacity than other groups and the novel EPPC showed 5 mm aluminum thickness radio-opacity. EPPC showed the shortest initial and final setting times than other groups while the MTA showed the longest (p < 0.05). CONCLUSIONS: Under the condition of this study, the novel composite using Portland cement-Epoxy resin mixture may useful for retro-filling with the properties of favorable leakage resistance, radio-opacity and short setting 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.