Push-out bond strength of three calcium silicate cements to root canal dentine after two different irrigation regimes

Effect of different chelators on the push-out bond strength of hydraulic cements in retrograde obturation

Background

This study examined the effect of ethylenediaminetetraacetic acid (EDTA) and etidronic acid (HEDP) in retrograde cavities on the bond strength of MTA Angelus and NeoPutty.

Methods

Sixty-six teeth with single roots and canals were decoronated and enlarged up to F3 using the ProTaper Universal file system. After removing the apical 3 mm within the scope of endodontic surgery procedures, retrograde cavities were prepared with ultrasonic tips. The teeth were divided into three main groups according to the irrigation solution used: saline, 17% EDTA, and 9% HEDP. Following the irrigation of retrograde cavities, each main group was further divided into two subgroups in terms of using MTA Angelus and NeoPutty as retrograde filling materials. Bond strength values of hydraulic cements were measured by the push-out test. Fracture modes were examined under a stereo microscope. Two dentin sections from each group were examined under scanning electron microscopy (SEM) to observe dentinal tubules. Two-way ANOVA and post hoc Tukey tests were used to analyze the data.

Results

Irrigation solutions similarly affected the bond strength values of hydraulic cements (P=0.115). MTA Angelus showed significantly higher values than NeoPutty in all the solution groups (P=0.34). Adhesive and cohesive fracture modes were mostly observed in the MTA Angelus and NeoPutty groups, respectively.

Conclusion

EDTA, HEDP, and saline had a similar effect on the bond strength of hydraulic cements. The higher bond values of MTA Angelus compared to NeoPutty could support its safe use in endodontic surgery procedures.

Dislodgement pushout resistance of five bioceramic root-end filling materials

This study evaluated the dislodgement push-out resistance of five bioceramic materials. One hundred single-rooted teeth with one canal had the apical 3 mm and crown resected to create a 14 mm standardized length. The canals were instrumented to an apical size 80 with a 3 mm root-end preparation made with ultrasonic diamonds. The prepared roots were randomly divided into 5 root-end restorative groups (n=20). ProRoot MTA, Biodentine, EndoSequence Root Repair Material, EndoSequence Fast Set Putty, and EndoSequence BC Sealer with each material placed following manufacturer's instructions and stored at 100% humidity for 2 weeks. An apical-to-coronal static testing load with the identified dislodgement force converted into MPa with mean results analyzed with Kruskal-Wallis and Dunn's post hoc tests (α=0.05). ProRoot MTA and Biodentine displayed similar push-out stress resistance and exhibited significantly greater stress resistance than the similar Endosequence materials. However, all materials failed cohesively and were not dislodged from the root canal surface.

Comparative analysis of bond strength to root dentin and compression of bioceramic cements used in regenerative endodontic procedures

Objectives

This study compared the Biodentine, MTA Repair HP, and Bio-C Repair bioceramics in terms of bond strength to dentin, failure mode, and compression.

Materials and Methods

Fifty-four slices obtained from the cervical third of 18 single-rooted human mandibular premolars were randomly distributed (n = 18). After insertion of the bioceramic materials, the push-out test was performed. The failure mode was analyzed using stereomicroscopy. Another set of cylindrically-shaped bioceramic samples (n = 10) was prepared for compressive strength testing. The normality of data distribution was analyzed using the Shapiro-Wilk test. The Kruskal-Wallis and Friedman tests were used for the push-out test data, while compressive strength was analyzed with analysis of variance and the Tukey test, considering a significance level of 0.05.

Results

Biodentine presented a higher median bond strength value (14.79 MPa) than MTA Repair HP (8.84 MPa) and Bio-C Repair (3.48 MPa), with a significant difference only between Biodentine and Bio-C Repair. In the Biodentine group, the most frequent failure mode was mixed (61%), while in the MTA Repair HP and Bio-C Repair groups, it was adhesive (94% and 72%, respectively). Biodentine showed greater resistance to compression (29.59 ± 8.47 MPa) than MTA Repair HP (18.68 ± 7.40 MPa) and Bio-C Repair (19.96 ± 3.96 MPa) (p < 0.05).

Conclusions

Biodentine showed greater compressive strength than MTA Repair HP and Bio-C Repair, and greater bond strength than Bio-C Repair. The most frequent failure mode of Biodentine was mixed, while that of MTA Repair HP and Bio-C Repair was adhesive.

Effect of Irrigants on the Push-Out Bond Strength of Two Bioceramic Root Repair Materials

The purpose of this study was to compare different irrigants’ effect on two EndoSequence root repair materials’ push-out bond strength. Sixty root slices were filled either with EndoSequence premixed fast-set putty or regular-set paste, and then immersed either in sodium hypochlorite, chlorhexidine gluconate, or saline (as control) for 30 min, after which the slices were subjected to the push-out test. The surface structures were evaluated with Scanning Electron Microscopy and Fourier Transform Infrared. Fast-set putty exhibited greater displacement resistance when immersed in saline and subjected to adhesive failure mode, while regular-set paste showed greater resistance when immersed in chlorhexidine and subjected to cohesive failure mode. Infrared analysis showed changes in organic filler, and carbonate and phosphate bands after using irrigants. The lowest carbonate/phosphate ratio was found for chlorhexidine in both materials. Therefore, sodium hypochlorite reduced EndoSequence root repair materials’ displacement resistance markedly.

Effect of root canal irrigation protocols on the dislocation resistance of mineral trioxide aggregate-based materials: A systematic review of laboratory studies

The aim of this systematic review was to address the question: Do different irrigating protocols have an impact on the dislocation resistance of mineral trioxide aggregate (MTA)-based materials? The review was performed using a well-defined search strategy in three databases (PubMed, Scopus, Web of Science) to include laboratory studies performed between January 1995 and May 2017, in accordance with PRISMA guidelines. Two reviewers analysed the papers, assessed the risk of bias and extracted data on teeth used, sample size, size of root canal preparation, type of MTA-based material, irrigants, canal filling method, storage method and duration, region of roots and the parameters of push-out testing (slice thickness, plunger dimensions and plunger loading direction), the main results and dislocation resistance values (in MPa). From 255 studies, 27 were included for full-text analysis. Eight papers that met the inclusion criteria were included in this review. There was a wide variation in dislocation resistance due to differences in irrigation sequence, time and concentration of irrigants, storage method and duration, and the parameters of push-out bond strength testing. A meta-analysis was not done but qualitative synthesis of the included studies was performed. No definitive conclusion could be drawn to evaluate the effect of irrigation protocols on dislocation resistance of MTA-based materials. Recommendations have been provided for standardized testing methods and reporting of future studies, so as to obtain clinically relevant information and to understand the effects of irrigating protocols on root canal sealers and their interactions with the dentine walls of root canals.

Design Variability of the Push-out Bond Test in Endodontic Research: A Systematic Review

INTRODUCTION

There is limited literature on the impact of testing variables on the push-out bond test (POBT). This review identified designs of the POBT used in the endodontic literature and aimed to determine which experimental variables may influence the push-out bond strength (POBS).

METHODS

A systematic review based on PRISMA guidelines was performed by searching the PubMed, SCOPUS, and Cochrane library databases using terms including push-out and dislocation resistance and descriptions of endodontic materials. Test variables assessed included method of root preparation, timing of sectioning compared with filling, thickness, diameter and taper of sections, and plunger size and velocity. The POBS of 3 common materials (gutta-percha and AH Plus, mineral trioxide aggregate, and Biodentine) were collected from investigations, and a comparison was attempted.

RESULTS

One hundred thirty-three studies assessed the POBS of root-filling materials, 68 assessed root repair cements/root-end filling materials, and 16 assessed orifice barrier materials other than mineral trioxide aggregate. There was significant variation in all of the assessed variables, resulting in a large range of reported values for the POBS of the various materials. Because of this heterogeneity in study design, no further statistical analysis of the impact of the test variables on POBS was possible.

CONCLUSIONS

There was considerable variation in the POBT design used in endodontic research. Greater standardization is required for future research as well as accurate reporting for all test variables to assess the impact of specific design variables on POBS.

Push-out bond strength of three different calcium silicate-based root-end filling materials after ultrasonic retrograde cavity preparation

OBJECTIVE

The aim of this study was to evaluate the bond strength of three calcium silicate-based root-end filling materials.

MATERIALS AND METHODS

The root canals of 30 single-rooted teeth were endodontically treated; their root ends were resected and root-end cavities were prepared using ultrasonic tip. The teeth were randomly divided into three groups according to the material: (1) Micro-Mega mineral trioxide aggregate (MM-MTA), (2) Biodentine, and (3) TotalFill root repair material (RRM). Push-out test was performed using universal testing machine, and failure mode was analyzed by stereomicroscope. The data were statistically analyzed using Kruskal-Wallis and Man-Whitney post hoc tests. All p values < 0.05 were considered significant.

RESULTS

TotalFill RRM exhibited significantly higher bond strength (12.69 MPa) than Biodentine (9.34 MPa, p = 0.023) and MM-MTA (7.89 MPa, p = 0.002). The difference between Biodentine and MM-MTA was not significant (p = 0.447). Mixed failures were the most noted in all three groups. MM-MTA had more adhesive failures than Biodentine and TotalFill, and no cohesive failures, but without statistical significance (p = 0.591).

CONCLUSION

The bond strength was the highest for TotalFill RRM.

CLINICAL RELEVANCE

In order to provide a persistent apical seal, root-end filling materials should resist dislodgement under static conditions, during function and operative procedures. TotalFill RRM exhibited higher bond strength to dentin than MM-MTA and Biodentine.

Effect of Smear Clear and Some Other Commonly Used Irrigants on dislodgement resistance of Mineral Trioxide Aggregate to Root Dentin

Background

This study aimed to assess the push-out bond strength of mineral trioxide aggregate (MTA) to root canal dentin after irrigation with Smear Clear in comparison with 2.5% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX) and saline as commonly used root canal irrigants.

Material and Methods

The coronal and mid-root areas of maxillary anterior teeth were horizontally sectioned into one-millimeter thick slices. The root canal lumen of dentinal slices was dilated using a diamond bur with 1.3 mm diameter. After the application of MTA, the samples were incubated in 100% humidity for 10 minutes and were then randomly divided into four groups (n=20) and immersed in Smear Clear, 2.5% NaOCl, 2% CHX and saline for 30 minutes. No irrigant was used for the control group (n=20). A wet cotton pellet was placed on the samples and after 48 hours of incubation, push-out bond strength was measured using a universal testing machine. The samples were evaluated under a stereomicroscope to determine the mode of failure. One-way ANOVA was used to assess statistical differences among the groups.

Results

The control group showed the highest bond strength with significant differences with other groups (P<0.05). Among the experimental groups, the saline group had no significant difference with CHX (P=0.09) but it had significant differences with Smear Clear and NaOCl groups (P<0.05). No significant difference in bond strength to MTA was noted after irrigation with Smear Clear, CHX and NaOCl (P>0.05). Other pairwise comparisons showed no significant difference (P>0.05).

Conclusions

Irrigation with Smear Clear, CHX and NaOCl did not cause a significant change in bond strength of MTA to dentin.

Key words:Root Canal Irrigants, push-out, Mineral Trioxide Aggregate, dentin.

Effect of the TiO2 nanoparticles on the selected physical properties of mineral trioxide aggregate

Background

Some of the efforts to improve the properties of Mineral Trioxide Aggregate (MTA) include incorporation of some nanoparticles such as Titanium dioxide (TiO2). The aim of this study was to evaluate the effect of TiO2 nanoparticles on the setting time, working time, push-out bond strength and compressive strength of MTA.

Material and Methods

The physical properties to be evaluated were determined using the ISO 6786:2001 and 9917 specifications. Fifteen samples of each material (MTA or MTA with 1% weight ratio of TiO2 Nanoparticles) were prepared for any evaluated physical property. Data were analyzed using descriptive statistics and T-test. Statistical significance was set at P<0.05.

Results

There was the significant effect of the material type (presence and absence of TiO2 nanoparticles) on the push-out bond strength, compressive strength, working time and setting time, with significantly higher values achieved in the group with TiO2 nanoparticles than the group without these particles (P=0.01 for the setting time and compressive strength, P=0.03 for the working time and P=0.001 for the bond strength).

Conclusions

Based on the findings of this in vitro study, incorporation of the TiO2 nanoparticles with weight ratio of 1% increased the setting time, working time, compressive strength and push out bond strength of MTA.

Key words:Mineral trioxide aggregate, nanoparticles, physical properties, titanium dioxide.

Effect of double antibiotic and calcium hydroxide pastes on dislodgement resistance of an epoxy resin-based and two calcium silicate-based root canal sealers

OBJECTIVES

The purpose of the present study was to determine the dislodgement resistance of AH Plus, MTA Fillapex, and Total Fill BC sealer to root canal dentin walls following placement of calcium hydroxide (CH) or double antibiotic paste (DAP) medicaments.

MATERIALS AND METHODS

Root canals of 90 single-rooted human mandibular premolar teeth were instrumented with Reciproc rotary instruments to a size R50. The teeth were randomly divided into two experimental groups: those receiving an intracanal medicament with either CH or DAP and a control group (n = 30). After 3 weeks, the medicaments were removed by irrigation with 5 mL of 2.5 % NaOCl, 5 mL 17 % EDTA, and 5 mL distilled water under sonic agitation. Each group was then subdivided into three subgroups (n = 10), and the canals were filled with either AH Plus, MTA Fillapex, or Total Fill BC sealer. After 1 week, a push-out test was applied to the specimens and the results were analyzed using one-way analysis of variance (ANOVA) and post hoc Tamhane's tests.

RESULTS

Regardless of the type of intracanal medicament used, Total Fill BC Sealer and MTA Fillapex showed the highest and lowest bond strength, respectively (P < 0.05). The use or absence of medicaments did not significantly affect the dislodgment resistance of root canal fillings (P > 0.05). Prior CH placement improved dislodgement resistance of all sealers without statistical difference (P > 0.05). Adhesive failure between core and sealer was the most frequent failure mode.

CONCLUSIONS

Prior application of CH or DAP did not significantly affect the adhesion of the AH Plus, MTA Fillapex, and Total Fill BC Sealers.

CLINICAL RELEVANCE

There is a little information about the influence of antibiotic medicaments on the bond strength of root canal sealer. These findings suggest that the use of DAP does not affect the adhesion strength of AH Plus, MTA Fillapex, and Total Fill BC Sealers.

Push-out Bond Strength of Root-end Filling Materials

The aim of this study was to evaluate the bond strength of root-end filling materials. Forty 2-mm-thick slices were obtained from human single-rooted teeth. After root canal preparation using a 1.5 mm diameter cylindrical drill, the dentinal walls were prepared by diamond ultrasonic tip (CVD T0F-2). The specimens were divided according the material (n=10): MTA Angelus (MTAA), MTA Sealer (MTAS, experimental), Sealer 26 (S26) and zinc oxide and eugenol cement (ZOE). The push-out test was performed in a mechanical test machine (EMIC DL 2000) at 1 mm/min speed. The failure type was evaluated by stereomicroscopy. The results were subjected to ANOVA and Tukey test, at 5% significance level. MTAA (19.18 MPa), MTAS (19.13 MPa) and S26 (15.91 MPa) showed higher bond strength (p<0.05). ZOE (9.50 MPa) showed the least bond strength values (p<0.05). Adhesive failure was prevalent in all groups, except for ZOE, which showed mixed failures. It was concluded that root-end filling materials MTA Angelus, MTA Sealer and Sealer 26 showed higher bond strength to dentinal walls than zinc oxide and eugenol cement after retrograde preparation.

Fracture resistance of immature teeth filled with mineral trioxide aggregate, bioaggregate, and biodentine

Objective:

The purpose of this study was to evaluate fracture resistance of teeth with immature apices treated with coronal placement of mineral trioxide aggregate (MTA), bioaggregate (BA), and Biodentine.

Materials and Methods:

Forty-one freshly extracted, single-rooted human premolar teeth were used for the study. At first, the root length was standardized to 9 mm. The crown-down technique was used for the preparation of the root canals using the rotary ProTaper system (Dentsply Maillefer, Ballaigues, Switzerland) of F3 (30). Peeso reamer no. 6 was stepped out from the apex to simulate an incompletely formed root. The prepared roots were randomly assigned to one control (n = 5) and three experimental (n = 12) groups, as described below. Group 1: White MTA (Angelus, Londrina, Brazil) was prepared as per the manufacturer's instructions and compacted into the root canal using MAP system (Dentsply Maillefer, Ballaigues, Switzerland) and condensed by pluggers (Angelus, Londrina, Brazil). Group 2: The canals were filled with DiaRoot-BA (DiaDent Group International, Canada). Group 3: Biodentine (Septodont, Saint Maur des Fosses, France) solution was mixed with the capsule powder and condensed using pluggers. Instron was used to determine the maximum horizontal load to fracture the tooth, placing the tip 3 mm incisal to the cementoenamel junction. Mean values of the fracture strength were compared by ANOVA followed by a post hoc test. P < 0.05 was considered statistically significant.

Results:

No significant difference was observed among the MTA, BA, and biodentine experimental groups.

Conclusion:

All the three materials tested, may be used as effective strengthening agents for immature teeth.

Assessment of the biocompatibility of mineral trioxide aggregate, bioaggregate, and biodentine in the subcutaneous tissue of rats

OBJECTIVE

The objective of this study was to evaluate the tissue inflammation caused by three endodontic repair materials.

MATERIALS AND METHODS

The materials included micro mega-mineral trioxide aggregate (MM-MTA), bioaggregate (BA), and biodentine (BD), which were implanted into the subcutaneous tissue of rats. The tissue samples for histological examination were prepared. The infiltration of lymphocytes and macrophages into the tissue was examined to assess the inflammatory response.

RESULTS

Lymphocyte infiltration: A significant increase was detected in the MM-MTA and BA groups on the 7th and 14th days as compared with the control (7th day P=0.0001, 14th day P=0.0176). There was no difference between the groups on the 45th day (P=0.1730). Lymphocyte infiltration had decreased over time in all groups. Macrophage infiltration: There was a significant increase by the 7th day in the test groups as compared to the control group (P=0.007). However, there was no difference between the experimental groups on the 14th (P=0.2708) and 45th (P=0.1291) days.

CONCLUSION

While MM-MTA and BA showed a similar biocompatibility, BD was more biocompatible than MM-MTA and BA in the 1 st week of the experiment. However, there was no difference between the materials at the end of the 45th day. MM-MTA, BA, and BD can be considered suitable endodontic repair materials.

Calcium silicate-based cements: composition, properties, and clinical applications

Mineral trioxide aggregate (MTA) is a calcium silicate-based cement (CSC) commonly used in endodontic procedures involving pulpal regeneration and hard tissue repair, such as pulp capping, pulpotomy, apexogenesis, apexification, perforation repair, and root-end filling. Despite the superior laboratory and clinical performance of MTA in comparison with previous endodontic repair cements, such as Ca(OH)₂ , MTA has poor handling properties and a long setting time. New CSC have been commercially launched and marketed to overcome the limitations of MTA. The aim of the present review was to explore the available literature on new CSC products, and to give evidence-based recommendations for the clinical use of these materials. Within the limitations of the available data in the literature regarding the properties and performance of the new CSC, the newer products could be promising alternatives to MTA; however, further research is required to support this assumption.

Effects of dentin surface treatments including Er,Cr:YSGG laser irradiation with different intensities on the push-out bond strength of the glass fiber posts to root dentin

OBJECTIVE

Intra-canal post systems are commonly used to restore root-filled teeth. Bond strengths of the posts can be affected by various surface treatments of the post or the dentin. The aim of this study was to evaluate the effects of dentin surface treatments including erbium-chromium; yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser irradiation with different intensities on the push-out bond strength of the glass fiber posts to root dentin.

MATERIALS AND METHODS

Forty single-rooted human maxillary incisors were filled and post spaces were prepared. After these procedures, the specimens were divided randomly into four groups according to the dentin surface treatments, as follows: (i) untreated surface (control), (ii) 1W Er,Cr:YSGG laser application, (iii) 2W Er,Cr:YSGG laser application and (iv) 3W Er,Cr:YSGG laser application. Then the posts were cemented into the root canals using dual-cured resin cement. Bonded specimens were cut into 1-mm-thick slices and push-out tests were performed using a universal testing device. All specimens were loaded until fracture and the failure modes were evaluated with a stereomicroscope at 32× magnification. Representative specimens were analyzed by scanning electron microscopy. Data were analyzed using a one-way ANOVA, Tukey and Wilcoxon tests.

RESULTS

The bond strength values ranged from 3.22-4.68 MPa. There were no statistically significant differences among the groups, regardless of the different levels. The coronal and middle levels of the post space had significantly higher bond strength values compared with the apical level (p < 0.05).

CONCLUSION

Er,Cr:YSGG laser irradiation with different intensities did not increase the bond strength of the fiber posts to the root canal dentin walls.