Expansion of gutta-percha in contact with various concentrations of zinc oxide-eugenol sealer: a three-dimensional volumetric study

The Effect of Sealer Application Methods on Voids Volume after Aging of Three Calcium Silicate-Based Sealers: A Micro-Computed Tomography Study

During obturation, air voids are undesirable as they may provide shelter for microorganisms or passage for fluids. This study aimed to compare the occurrence of voids between three calcium silicate-based sealers (CSBSs) (MTA-Fillapex, BioRoot-RCS, Bio-C) and the change in their volume after aging. In addition, we aimed to compare voids when using two sealer application methods: lentulo-spiral (LS) and gutta-percha (GP) cone. Thirty extracted mandibular premolars (n = 30) were endodontically prepared and obturated using single GP cone (SGPC) technique. Each sealer was applied to 10 teeth (n = 10) using LS or GP. Micro-computed tomography (micro-CT) was used to quantify the volume of root filling and voids before and after 8-week storage in a phosphate-rich medium. The percentage of root filling and voids were compared between the groups using a Mann–Whitney U test and Kruskal–Wallis test with a Bonferroni correction. Before aging, the percentages of root filling volume after obturation were comparable with no significant differences between sealers (p = 0.325) or application methods (p = 0.950). After aging, the voids’ volume increased significantly in all sealers (p ≤ 0.05). However, no significant differences were found between sealers (p = 0.302). In conclusion, voids in CSBSs may not reduce in size with aging; hence, SGPC should be carefully selected for suitable cases.

A critical analysis of research methods and experimental models to study root canal fillings

Canal filling materials and techniques have been one of the most studied topics in Endodontics. A simple search using the mesh term "root canal filling" in PubMed revealed more than 11,000 articles, an impressive number that is much higher than "root canal disinfection" (5,544 articles) or even the popular "root canal preparation" (8,527 articles). The overriding importance attributed to root filling procedures is not merely intuitive. It derived from the appealing relevance given by the appearance of the white lines in common radiographs grounded on retrospective clinical data that had identified the quality of a root filling as one of the major causes of treatment failure (lack of healing). Since the publication of the Washington study, impressive efforts have been made for the release of new materials and techniques, as well as, for the development of a plethora of laboratory methods to assess the quality of root filling procedures. This narrative review aims to address and discuss the most relevant laboratory methods to assess the root canal filling. Since filling quality improvements have not translated into higher success rates, as reported in longitudinal clinical studies, more than to deliver a simple methodology-based review, this paper aims to present an in-depth critical view on the assessment of laboratory methods used to study the filling materials and techniques. Recent data indicate that the long-term dimensional stability/degradation over time of endodontic sealers plays a central role in the treatment outcome. In this context, laboratory methods should be developed focusing on predicting, at least to some degree, the long-term clinical behaviour of root canal fillings, rather than simply ranking different materials or techniques.

Alkaline conditions can affect the volume and chemical characteristics of dental gutta-percha

The effects of alkaline pH on the size and surface characteristics of gutta-percha were studied. Forty ProTaper Universal-F2 gutta-percha cones (GPC) were stored individually for 8-weeks. GPC were distributed into 2 groups (n = 20) based on the storage solutions' pH (pH7, pH12). The GPC volume was measured after 1,2,3,4 and 8-weeks using water displacement method and compared to the baseline volume. The surfaces of representative GPCs were analysed using Raman spectroscopy and assessed later using Scanning Electron Microscopy with Energy-Dispersive X-Ray Spectroscopy (EDS). Samples t test was used to compare the change in volume of GPC and a repeated measures Analysis of Variance (ANOVA) was used to compare the effects of storage durations. After 8-weeks, GPCs aged in high-pH exhibited significant drop in their volume (16%) compared with GPCs aged in water (2.5%). The surface of GPCs stored in water or high-pH both demonstrated structural and chemical alterations in comparison with non-aged GPCs.

The evaluation of physical properties of a polyurethane expandable endodontic sealer: a preliminary study

Endodontic sealers play a vital role in providing 3-dimensional (3D) filling of complex root canal system (RCS). This study intended to compare the physical properties of a Polyurethane Expandable Sealer (PES), AH Plus and EndoSequence. Three properties including setting time, radiopacity and flow (rheology) were evaluated based on ISO 6876 standard. For evaluation of each of these physical properties, five samples from experimental groups: AH Plus, EndoSequence, PES (controlled expansion) and PES (high expansion) were used (n = 5). Data were analysed by one-way ANOVA and Post Hoc Tukey tests (a = 0.05). EndoSequence showed the longest setting time (P < 0.000); AH Plus showed that highest radiopacity (P < 0.000); and PES (high expansion) showed the highest flow (diameter and surface area) (P < 0.000). EndoSequence and PES (controlled expansion) showed promising and comparable physical properties to the AH Plus sealer in terms of flow, setting time and radiopacity.

An In vitro Comparison and Evaluation of Sealing Ability of Newly Introduced C-point System, Cold Lateral Condensation, and Thermoplasticized Gutta-Percha Obturating Technique: A Dye Extraction Study

Aim

The aim of this study is to compare and to evaluate sealing ability of newly introduced C-point system, cold lateral condensation, and thermoplasticized gutta-percha obturating technique using a dye extraction method.

Materials and Methodology

Sixty extracted maxillary central incisors were decoronated below the cementoenamel junction. Working length was established, and biomechanical preparation was done using K3 rotary files with standard irrigation protocol. Teeth were divided into three groups according to the obturation protocol; Group I-Cold lateral condensation, Group II-Thermoplasticized gutta-percha, and Group III-C-Point obturating system. After obturation all samples were subjected to microleakage assessment using dye extraction method. Obtained scores will be statistical analyzed using ANOVA test and post hoc Tukey's test.

Results

One-way analysis of variance revealed that there is significant difference among the three groups with P value (0.000 < 0.05). Tukey's HSD post hoc tests for multiple comparisons test shows that the Group II and III perform significantly better than Group I. Group III performs better than Group II with no significant difference.

Conclusion

All the obturating technique showed some degree of microleakage. Root canals filled with C-point system showed least microleakage followed by thermoplasticized obturating technique with no significant difference among them. C-point obturation system could be an alternative to the cold lateral condensation technique.

Expansion of Gutta-percha in contact with various concentrations of zinc oxide-eugenol sealer: A three-dimensional volumetric study using spiral computed tomography

Aim:

The purpose of this study was to evaluate the three-dimensional expansion of Gutta-percha (GP), at various powder/liquid ratios, of a zinc oxide-eugenol (ZOE)-based sealer using spiral computed tomography (SCT).

Materials and Methods:

Thirty-five freshly extracted human mandibular premolars were selected for this study. Cleaning and shaping were performed in all the teeth initially with hand K-files up to #25 and finally with RaCe rotary instruments (25/06). Teeth were randomly divided into five groups of 7 teeth each. Specimens were scanned using SCT. They were then viewed both cross-sectionally and longitudinally, with a constant thickness of 1 mm/slice. The volume of root canal in each tooth was estimated. Obturation was performed by GP points (25/04) and ZOE-based root canal sealer in all groups with different powder-liquid ratio. Groups 1, 2, 3, and 4, had powder/liquid ratio of 1:1, 1:2, 1:3, and 1:4, respectively, while in the control group, no sealer was used. The obturation was performed by sealer coated single cone GP. A second SCT scan was performed to determine the volume of GP and sealer in all four groups 1 day after obturation. The third and fourth SCT scans were taken 7 and 30 days after obturation, respectively. The mean volume of GP per group was calculated. Data were statistically analyzed using one-way ANOVA. Inter-group comparisons were done using Scheffe post hoc multiple comparisons test.

Results:

All groups with sealer showed expansion of GP at both 7^th day and 30^th day, which was statistically significant from the GP volume at 1^st day. Groups 2 and 3 with powder/liquid ratio of 1:2 and 1:3 gave the highest mean volume values during 30 days period and showed significant expansion in comparison with Groups 1 and 4 with powder/liquid ratio of 1:1 and 1:4, respectively.

Conclusion:

Increasing the ratio of eugenol in sealer resulted in the volumetric expansion of GP. However, further studies should be performed to confirm the expansion of GP, leading to the achievement of fluid impervious seal.

Volume of sealer in the apical region of teeth filled by different techniques: a micro-CT analysis

The volume of sealer in the apical 1 mm of teeth filled using different techniques was evaluated by micro-commuted tomography (micro-CT). Sixty-four maxillary central incisors were prepared using NiTi rotary instruments. Teeth were randomly distributed into four groups according to root canal sealers (AH Plus, Endofill, Sealapex, and Sealer 26) and subdivided into two subgroups according to the filling techniques (active and passive lateral condensation; n = 8 each). Subsequently, teeth were examined using the 1174 SkyScan micro-CT device. Images were reconstructed using the NRecon software, and the sealer volume (mm3) in the apical region was analyzed using the two-way ANOVA and post-hoc Student-Newman-Keuls test (α = 0.05). The lowest volume of sealer was observed in teeth filled with Sealapex (0.100 ± 0.009) and Endofill (0.103 ± 0.010). The highest volume was observed in teeth filled with AH Plus (0.112 ± 0.008) and Sealer 26 (0.109 ± 0.018) (p > 0.05). Regarding the filling technique, a lower sealer volume was observed using the active lateral condensation technique compared with that using the passive lateral condensation technique (0.100 ± 0.010 vs. 0.111 ± 0.012) (p < 0.05). Therefore, the lowest volume of sealer was observed in teeth filled with Sealapex and Endofill using the active lateral condensation technique.

A microcomputed tomography-based comparison of root canal filling quality following different instrumentation and obturation techniques

OBJECTIVE

With a microcomputed tomography (microCT) imaging device, we aimed to quantitatively evaluate root canal fillings after commonly used endodontic procedures and also tested the suitability of microCT for this purpose.

MATERIALS AND METHODS

Eighty single roots were instrumented and obturated with gutta-percha and Tubli-Seal. They were divided into 4 groups of 20. The Hand groups were instrumented with hand files and filled with thermoplastic (Th) compaction and cold lateral (CL) condensation, i.e. Hand-Th and Hand-CL, respectively. The Rot groups, i.e. Rot-Th and Rot-CL, were instrumented with a rotary ProFile system and filled as above. The roots were scanned and 3-dimensional (3D) visualization was obtained. The number, size, percentage of volume and distribution of voids at the filling/dentine interface (i-voids) and voids surrounded by filling material (s-voids) were measured.

RESULTS

Canal fillings differed significantly with regard to the size of both types of voids and the average number of i-voids. All canals presented a low volume of voids. The highest percentage (0.69%) was found for i-voids in the Hand-CL group, while the lowest volume (0.11% for s-voids and 0.14% for i-voids) was in the Hand-Th canals. Apically, in the last 3 mm, i-voids were observed mainly in the Th groups, and s-voids occurred mostly in the coronal part of the canal filling in all cases.

CONCLUSION

MicroCT was a useful tool for 3D quantitative evaluations of these root canal fillings. None of the root canal instrumentation and filling methods ensured void-free obturation. CL condensation produced mainly i-voids. With Th compaction, internal s-voids were particularly common, but there were mainly i-voids in the apical part.

Ability of new obturation materials to improve the seal of the root canal system: a review

New obturation biomaterials have been introduced over the past decade to improve the seal of the root canal system. However, it is not clear whether they have really produced a three-dimensional impervious seal that is important for reducing diseases associated with root canal treatment. A review of the literature was performed to identify models that have been employed for evaluating the seal of the root canal system. In vitro and in vivo models are not totally adept at quantifying the seal of root canals obturated with classic materials. Thus, one has to resort to clinical outcomes to examine whether there are real benefits associated with the use of recently introduced materials for obturating root canals. However, there is no simple answer because endodontic treatment outcomes are influenced by a host of other predictors that are more likely to take precedence over the influence of obturation materials. From the perspective of clinical performance, classic root filling materials have stood the test of time. Because many of the recently introduced materials are so new, there is not enough evidence yet to support their ability to improve clinical performance. This emphasizes the need to translate anecdotal information into clinically relevant research data on new biomaterials.

Fabrication and characterization of polymer composites for endodontic use

AIM

To develop a low-density polyethylene-hydroxyapatite (HA-PE) composite with properties tailored to function as a potential root canal filling material.

METHODOLOGY

Hydroxyapatite and polyethylene mixed with strontium oxide as a radiopacifier were extruded from a single screw extruder fitted with an appropriate die to form fibres. The composition of the composite was optimized with clinical handling and placement in the canal being the prime consideration. The fibres were characterized using infrared spectroscopy (FTIR), and their thermal properties determined using differential scanning calorimetry (DSC). The tensile strength and elastic modulus of the composite fibres and gutta-percha were compared, dry and after 1 month storage in simulated body fluid (SBF), using a universal testing machine. The radiopacity of the fibres was determined using digital radiography. The interaction of the composites with eugenol was evaluated and compared with gutta-percha. Data of the tensile test were submitted to two-way anova and Bonferroni tests (P < 0.05).

RESULTS

The endothermic peaks obtained from the DSC studies showed that the melting point of the HA/PE composites ranged between 110.5 and 111.2 °C, whereas gutta-percha exhibited a melting point at 52 °C. The tensile strength and elastic modulus of the silanated HA/PE composites were significantly higher than those of gutta-percha (P < 0.0001) under dry conditions and 1 month storage in SBF. The gutta-percha in eugenol showed a significant increase in the polymer molar mass, whereas the silanated HA/PE composites were unchanged. Radiological evaluations demonstrated that silanated HA/PE fibres were sufficiently radiopaque.

CONCLUSION

Promising materials for endodontic applications have been developed, offering relevant benefits over the traditional materials in terms of mechanical and chemical properties.

Evaluation of the sealing ability of resin cement used as a root canal sealer: An in vitro study

AIM

This study was designed to evaluate the apical seal of root canals obturated with resin cement as a root canal sealer and compare with that of the glass ionomer and zinc oxide eugenol sealers using a cold lateral condensation gutta-percha technique.

BACKGROUND

Successful root canal treatment requires three-dimensional obturation of the root canal system with nonirritating biomaterials. None of the available materials are capable of providing a fluid tight seal.

MATERIALS AND METHODS

The prepared teeth were randomly divided into three groups of 15 each to be obturated using three different sealers. Group I: zinc oxide eugenol (Tubliseal), Group II: Glass ionomer (Ketac Endo), and Group III: resin cement (C & B Superbond). All the specimens were stored in 100% relative humidity at 37° for 24 h. The specimens were placed in 2% methylene blue dye for 48 h and sectioned. The dye penetration was evaluated under a stereomicroscope.

RESULTS

The "Kruskal" Wallis test was carried out to test the equality of mean. All the specimens showed dye leakage, and there was a statistically significant difference (P < 0.0001) among the groups. The specimens in Group III showed a minimal leakage and the specimens in Group I showed a maximum leakage.

CONCLUSION

Resin cement sealed the root canals significantly better when compared with zinc oxide eugenol and glass ionomer sealers.