Scanning electron microscopic evaluation of finishing techniques on IRM and EBA retrofillings

Ex vivo microscopic assessment of factors affecting the quality of apical seal created by root-end fillings

AIM

(i) To evaluate the incidence of microcracks around root-end preparations completed with ultrasonic tips and their relationship with the root filling technique and thickness of surrounding dentine. (ii) To investigate the effect of rapid exposure to a water-soluble dye of Intermediate Restorative Material (IRM), Super Ethoxybenzoic Acid (sEBA) and Mineral Trioxide Aggregate (MTA), on the marginal adaptation and microleakage of root-end fillings. (iii) To describe the microstructure of the surface of root-end filling materials.

METHODOLOGY

Ninety-two single-rooted teeth were divided into two groups (n = 46) according to the root canal instrumentation/filling techniques. Group 1 consisted of specimens in which canal preparation was completed using a crown-down technique and then filled with the Thermafil system (TF group); Group 2 consisted of specimens in which canal preparation was completed using a step-back technique and lateral condensation (LC group). Following root-end resection and ultrasonic cavity preparation, the samples were further divided into three subgroups (n = 24) for root-end filling with IRM, sEBA or MTA. The ultrasonic preparation time was recorded. Eight teeth were kept as positive and 12 as negative controls. Following immersion in Indian ink for 7 days, all resected root surfaces were evaluated for the presence of microcracks and the cross-sectional area of root-end surface and root-end filling were measured to evaluate the thickness of the dentinal walls. Thereafter, the samples were sectioned longitudinally so as to assess the depth of dye penetration and marginal adaptation of root-end fillings. Negative controls longitudinally sectioned were used to describe microstructural characteristics of the root-end filling materials using scanning electron microscopic (SEM) techniques.

RESULTS

Although the thickness of dentinal walls between groups 1 and 2 was similar, the ultrasonic preparation time and number of microcracks were significantly higher (P < 0.001) in the TF group. Both groups had a significant correlation between microcracks and ultrasonic preparation time (P < 0.001). sEBA and IRM had better adaptation and less leakage compared with MTA. A SEM analysis displayed microstructural differences between the root-end filling materials.

CONCLUSION

Microcracks can occur independently of the thickness of dentinal walls and may be associated with the prolonged ultrasonic preparation time required for the removal of the root filling during root-end cavity preparation. Although sEBA and IRM had better behaviour than MTA regarding microleakage and marginal adaptation, it is possible that exposure of MTA to a water-soluble dye before achieving full set and its porous microstructure contributed to the results.

Comparative study of MTA and other materials in retrofilling of pulpless dogs' teeth

This in vivo study compared the effect of mineral trioxide aggregate (MTA), IRM, Super EBA and ZOE in a puttylike consistency, used as retrofilling materials, in the healing process of periapical tissue of pulpless dogs' teeth submitted to a conventional retrofilling technique. Twenty-four premolars obtained from three dogs were used. At the first intervention, the animals were anesthetized, coronal access was obtained and pulpectomy was done. Root canals were kept open to the oral environment for 180 days to induce the formation of apical lesions. After surgical removal of the lesions with curettes, 2 mm of the apical root was cut out perpendicular to the long axis of the teeth, and root-end cavities were shaped with a low-speed round bur. The bone cavities were irrigated and dried, and the root-end cavities were filled with MTA, IRM, Super EBA and ZOE in a puttylike consistency. The bone cavities were passively filled with blood and flaps were sutured. The coronal access openings were cleaned and double-sealed with ZOE and amalgam. After 180 days, the animals were killed by anesthetic overdose, maxilla and mandible were removed and the pieces were processed for histomorphologic analysis. Data were evaluated blindly on the basis of several histopathologic events and the scores obtained were analyzed statistically using the Kruskal Wallis test. No significant differences were observed among MTA, Super EBA and IRM (p>0.05). However, ZOE had a significantly more negative influence on the apical healing (p<0.05). In conclusion, MTA, Super EBA and IRM had similar histopathologic effects among each other and better performance than ZOE used in a puttylike consistency. Furthermore, only MTA stimulated hard tissue deposition in direct contact with the retrofilling material, even when it was inserted under critical conditions.

A Systematic Review of In Vitro Retrograde Obturation Materials

The purpose of this review was two-fold: (a) to determine which retrograde obturation material(s) best prevents dye/ink penetration in vitro; and (b) to determine whether in vitro results agree with in vivo results. A MEDLINE search was conducted to identify in vitro studies published between January 1966 and October, week 4, 2003, conducted on human teeth, and published in English, German, or French language, testing the resistance to retrograde penetration of retrograde filling materials. The MEDLINE search identified 278 published articles. Of those, 115 studies examined the resistance to penetration of various retrograde filling materials, in vitro. Thirty-four studies met all the inclusion and validity criteria. The results indicate that, beyond 10 days in vitro, the most effective retrofilling materials, when measured by dye/ink penetration are: composites>glass ionomer cement>amalgam>orthograde gutta-percha>EBA. The results of these in vitro studies are not congruent with in vivo study results, suggesting a need to re-evaluate the clinical validity and importance of in vitro studies.

Investigation of the marginal adaptation of root-end filling materials in root-end cavities prepared with ultrasonic tips

AIM

To compare the surface topography of root apices following ultrasonic root-end preparation, and again after root-end fillings submitted to three different finishing techniques.

METHODOLOGY

Eighty-one root-end cavities prepared ultrasonically in human canines, were divided at random into three test groups of 27 each. The cavities were filled with Super-EBA, IRM, or ProRoot-MTA and finished by ball burnishing. Eighteen roots from each group received a final finish with either a 30-fluted tungsten carbide finishing bur, or a Zekrya carbide 28 mm bur after storage in water at 37 degrees C for 24 h. The root-end surface topographies were reproduced by means of polyvinylsiloxane impressions and epoxy resin replicas. Scanning electron micrography (SEM) images of each replica were taken prior to and after root-end filling. An image analysis system was used to compare the alteration of the marginal chipping areas and to calculate the gaps located in the dentine/root-end filling interface.

RESULTS

When a bur was used to finish the set materials, a significant (P < 0.05) area of marginal chipping was eliminated. The finishing technique did not significantly (P > 0.05) affect the incidence of gaps in groups root-end filled with MTA or IRM. Super-EBA and IRM retrofillings finished with a ball burnisher or a Zekrya bur displayed a significantly (P < 0.05) larger calculated gap area than roots filled with MTA.

CONCLUSION

Under this in vitro study, the marginal adaptation of MTA was good with or without finishing procedures. Applying a finishing bur over the condensed and set IRM and Super-EBA created better marginal adaptation.

Transition element contained partial-stabilized cement (PSC) as a dental retrograde-filling material

A modified silicate cement has previously been developed as a dental retrograde filling; it has great sealing ability, good biocompatibility, and anti-bacterial properties. However, its clinical application is limited by a long setting time and poor handling property. In the present study, the setting time has been shortened by raising the preparation temperature of the cement and adding transition elements into the partial-stabilized cement (PSC) to increase the rate of hydration reaction of the cement. The rate of the hydration was evaluated by micro-hardness measurement. Phase transformation and micro-structure were examined by an X-ray diffractometer and a scanning electron microscope, respectively.When the preparation temperature increased (1400 degrees C), the phase content of Ca(2)SiO(5)(C(2)S) and Ca(3)SiO(6)(C(3)S) increased but the CaO decreased. The setting time was shortened and the micro-hardness increased because the increased amplitude of vibration of the atoms about their equilibrium resting positions increased by increasing the heating temperature. When the transition elements were added to PSC, crystal defects were effectively created and monoclinic structure of C(3)S was favored to form, which would increase the hydrated reaction of PSC and shorten the setting time. Co addition is the most effective due to its ability to create more defects and stabilize the monoclinic structure. The micro-hardness of the PSC with Co 5 wt% addition was about 66 in the Vickers scale. It also exhibited an early setting within 20 min. We believe that the modified PSC will have a great potential in its application to perforation repair and retrograde filling in endodontic surgery.

Finishing of glass ionomer retroseals

Various techniques have been suggested for the finishing of retrosealing materials. By measuring marginal leakage and by the use of scanning electronic microscopy, this study evaluated the use of bone files, burnishers, and Shofu points for the finishing of 60 retrosealings done with glass ionomer. With each of the three finishing agents, one group of teeth was polished with movements directed from the palatal toward the buccal, and in another group it was done from the center of the retroseal toward the margins of the cavity. ANOVA showed significant differences among the groups according to the way the finishing was done. The use of instruments from the center to the margins of the cavity rather than in just one direction always caused less leakage. The Shofu stone and the burnisher caused equivalent leakage which was significantly less than that caused by bone files. Scanning electron microscopic photos show that the use of the instrument in only one direction caused the material to shift away from the palatal side. This shift always led to greater leakage of dyes on that side.

Considerations in the selection of a root-end filling material

Surgical root canal treatment often includes the placement of a root-end filling material. New materials have recently emerged to challenge the long-standing position of amalgam as the root-end filling material of choice. This review discusses several of the commonly used root-end filling materials, with emphasis on indications and contraindications for the use of each.

Microleakage of super-EBA with and without finishing as determined by the fluid filtration method

Super-EBA (SEBA) has been used as a root-end filling material because of its superior sealing properties and clinical success. The purpose of this study was to evaluate whether finishing SEBA after it had set would affect the apical seal. Sixty-five extracted maxillary anterior teeth were instrumented and obturated with a single gutta-percha master cone. The root end was resected, and a 3 mm deep root-end preparation was made using ultrasonic tips. Teeth were randomly divided into three groups. Group 1 received SEBA and was finished with a 30-flute high-speed finishing bur. Group 2 received SEBA, which was cold-burnished with a ball burnisher. Temporary Endodontic Restorative Material was used as the negative control in group 3. Microleakage (microliter/min) was measured under 10 psi using the fluid filtration method at days 1, 7, 30, 90, and 180. SEBA/finished exhibited significant microleakage at day 1 when compared with the burnished group. The differences in leakage were not significant at any other time period.