Effect of root resection on the apical sealing ability of mineral trioxide aggregate

Comparison of the sealing ability amongst orthograde apical plugs of mineral trioxide aggregate plus, mineral trioxide aggregate repair HP, and Biodentine after root resection: a bacterial leakage study

This study aimed to analyse the effect of root-end resection on the sealing ability of orthograde apical plugs of three root-end filling materials (MTA Repair HP, Biodentine, MTA Plus) using the bacterial leakage method and compare it with the retrograde root-end filling technique. Eighty-four extracted mandibular premolar teeth with single root and single straight canals were selected and randomly divided into two main experimental groups (n = 36) depending on the apical plug placement technique and a control: Group I: orthograde technique, followed by root-end resection; Group II: retrograde root-end filling technique; one control Group III (n = 12): obturation with gutta-percha, followed by root-end resection. Experimental groups were further subdivided into three subgroups A, B, and C (n = 12) depending on the three different root-end filling materials used. An apical plug of 3 mm thickness was obtained in both the experimental groups. The apical sealing ability was evaluated with the dual-chamber bacterial leakage method. Statistical analysis was performed using the Kaplan-Meier survival analysis test. By the end of 30 days, the occurrence of turbidity indicating bacterial leakage was 75% in MTA Repair HP, 83.3% in Biodentine, and 91.7% in MTA Plus samples. This trend of turbidity was similar in both orthograde and retrograde technique. The control group showed turbidity in all the samples (100%). More MTA Repair HP samples (25%) survived the 30 days observation period with no bacterial leakage compared to Biodentine (16.7%) and MTA Plus (8.3%). The sealing ability of already set root-end filling materials placed through the orthograde technique did not deteriorate after root-end resection. Also among three root-end filling materials, MTA Repair HP presented the lowest bacterial microleakage followed by Biodentine and MTA Plus, respectively.

Push out bond strength of hydraulic cements used at different thicknesses

BACKGROUND

The aim of this study was to compare the pushout bond strength (POBS) of three hydraulic cements, when used at thicknesses of 3 and 5 mm.

METHODS

78 root slices of 3 and 5 mm of thickness were obtained from human teeth. Cylindrical cavities of 1.4 mm of diameter were drilled and filled with Biodentine (BD), Totalfill Root Repair paste (TF) or ProRoot MTA White (PMTA). Pushout tests were performed 21 days later. The fracture pattern of each sample was also analyzed. POBS data were analyzed with Welch and Brown-Forsythe and Tamhane's post hoc tests and a Weibull analysis was also performed.

RESULTS

In the 3 mm group, TF showed significantly lower bond strength than BD and PMTA. In the 5 mm group, BD showed significantly higher bond strength than TF. Both BD and TF showed higher bond strength when the thickness of the sample increased, while PMTA did not.

CONCLUSIONS

TF and BD achieve higher pushout bond strength resistance when used at a thickness of 5 mm than at 3 mm, while the mean resistance of PMTA is less influenced by the thickness. At 5 mm of thickness, BD and PMTA exhibit similar resistance to displacement. However, the behavior of BD is more predictable than that of its predecessor. BD is a reliable hydraulic cement for clinical situations where thick cavities need to be filled and displacement resistance plays an important role. Clinicians need to consider choosing specific hydraulic cements according to the thickness of material to be used.

Sealing ability of three different materials to repair furcation perforations using computerized fluid filtration method

Background. The present study aimed to evaluate the sealing ability of three different calcium silicate-based materials in furcation perforations.

Methods. Seventy-six human mandibular molar teeth were selected. Perforations were created in the center of the pulp chamber floor. The experimental teeth were randomly divided into three groups (n=22). Perforations were repaired with MTA Angelus, Endocem MTA, or EndoSequence BioCeramic Root Repair Material Fast Set Putty (BC-RRM Putty). Microleakage of the different repair materials to be tested was measured by computerized fluid filtration method at 24- and 72-hour intervals.

Results. For each time interval, no statistically significant difference was observed between the groups. For Endocem MTA and BC-RRM Putty groups, the difference between the leakage values measured at both periods was not statistically significant (P > 0.05). However, there was a significant difference for the MTA Angelus group (P < 0.05).

Conclusion. All the calcium silicate-based materials used in the present study showed similar performance in repairing furcation perforations at 24- and 72-hour intervals.

Surgical Sealing of Laterally Localized Accessory Root Canal with Resin Containing S-PRG Filler in Combination with Non-Surgical Endodontic Treatment: A Case Report

The spread of root canal infection to surrounding periodontal tissue through accessory root canals reduces the success rate of endodontic treatment. In this case, cone-beam computed tomography revealed a lesion (4 mm from the apex) resulting from an accessory root canal of the maxillary left central incisor. First, non-surgical endodontic treatment was conducted but the sinus tract remained. Surgical preparation of the root cavity was then conducted to remove potentially infected dentin surrounding the accessory root canal. The cavity was filled and the foramen was sealed with resin containing bioactive surface pre-reacted glass (S-PRG) filler. The photopolymerized resin was then contoured and polished. In combination with subsequent supportive non-surgical endodontic treatment, a good clinical outcome with the disappearance of the sinus tract and clinical symptoms such as discomfort and pressure pain and the regeneration of the alveolar bone hanging over the cavity was obtained. In this case, the good clinical outcome may have been due to the dentin-adhesive property and durability of the pre-adhesive system and composite resin. The better biocompatibility of S-PRG fillers presumably facilitated periodontal tissue healing.

New Approach in the Management of Vertical Root Fracture with the Help of Biodentine and CBCT

Introduction

Vertical root fracture is a big challenge to dentists for its diagnosis and treatment. As the tooth presents poor prognosis, the most common treatment modality is extraction. One can save the tooth from extraction by the reconstruction of fracture fragments followed by intentional reimplantation. New treatment options have arrived for healing of the fracture site by hard tissue barrier formation with the help of bioceramic materials. Case Report. The present case report describes successful management of complete vertical root fracture of a maxillary left central incisor by trauma in a 35-year-old male with the help of Biodentine, a bonding agent, a fiber post, and dual-cure resin cement without tooth extraction, followed by all ceramic crowns. Up to two years of follow-up, there is no problem in the tooth, and radiographically, there is no radiolucency along the fracture line. Periodontal status and probing depth were within a normal physiological limit.

Conclusion

Functional and aesthetic outcomes are achieved by combined therapy in the present case report.

Crack Formation Following Root-End Preparation in Roots with the Butterfly Effect

Objective:

To investigate apical cracks in roots that exhibit the butterfly effect and that have undergone apical resection and ultrasonic root-end cavity preparation. The effect of the obturation material was also studied.

Methods:

Forty extracted single-rooted teeth were decoronated at the cemento-enamel junction. Roots were viewed under a light microscope and coded according to the presence or absence of the butterfly effect. Canals were prepared using ProTaper Next instruments to size X3 and assigned to two obturation groups (gutta-percha and AH Plus, and ProRoot MTA alone). Each contained twenty roots (10 with the butterfly effect and 10 without the butterfly effect). Roots were resected perpendicular to their long axis, 3 mm from the apex, and cavities were cut using ultrasonic retrotips. Resin replicas were used for crack imaging from scanning electron micrographs. Statistical analyses were performed using Stata 13.1 (StataCorp, College Station, TX, USA).

Results:

Cracks occurred more frequently in teeth with the butterfly effect (80%), with this difference being significant (P=0.001). Most cracks (73%) ran buccolingually. Teeth obturated with MTA developed fewer cracks compared to those obturated with GP and sealer.

Conclusion:

Root-ends with the butterfly effect had a significantly higher number of buccolingual cracks following resection and ultrasonic root-end preparation. This might explain the development of some vertical root fractures, which usually run buccolingually. Canal obturation with MTA may be protective.

The physical properties and ion release of CPP-ACP-modified calcium silicate-based cements

BACKGROUND

This study investigated the physical properties and ion release of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-modified calcium silicate-based cements (CSCs) and compared the properties of a trial mineral trioxide aggregate (MTA) with two commercially available CSCs, Biodentine(™) and Angelus(®) MTA.

METHODS

The setting time, solubility, compressive strength and Vickers surface microhardness of the three CSCs incorporated with 0%, 0.5%, 1.0%, 2.0% and 3.0% (w/w) CPP-ACP were investigated. Release of calcium (Ca(2+) ), phosphate ions (Pi ) and pH of the test cements were measured after 24, 72, 168 and 336 h of storage.

RESULTS

The addition of up to 1.0% CPP-ACP into Biodentine(™) and 0.5% into the other cements did not adversely affect their physical properties except for the setting time. The addition of 0.5% CPP-ACP increased Ca(2+) released from Biodentine(™) (after 168 and 336 h), Angelus(®) MTA (after 168 h) and the trial MTA (after 72 h). The addition of 1.0-3.0% CPP-ACP increased Ca(2+) and Pi released from all the cements. Biodentine(™) released more Ca(2+) particularly in the early stages and showed shorter setting time and higher mechanical properties than the other cements. The mechanical properties of Angelus(®) MTA and the trial MTA were similar. All the cements produced highly alkaline storage solutions.

CONCLUSIONS

Up to 1.0% CPP-ACP in Biodentine(™) improves Ca(2+) and Pi release and 0.5% CPP-ACP in Angelus(®) MTA and the trial MTA improves Ca(2+) release without altering the mechanical properties and solubility. The addition of CPP-ACP into CSCs prolonged the setting time.

Behavior of mineral trioxide aggregate apical plugs and root fillings under cyclic loading

AIM

The aim of the present study was to develop a methodology for constant monitoring of the resistance to fluid flow during functional loading and to then compare the efficacy of 4-mm mineral trioxide aggregate (MTA) apical plugs and full-length MTA root fillings.

METHODS

The root canals of 24 single-rooted teeth were instrumented and assigned into two groups: group 1 (filled with a 4-mm MTA apical plug and gutta percha) and group 2 (filled with MTA to cementoenamel junction level). All teeth were subjected to stepwise cyclic loading with a constant simulated interstitial pressure of 25 cm H₂ O applied apically. A Flodec machine (De Marco Engineering, Geneva, Switzerland) constantly monitored the rate and direction of fluid flow. Student's t-test, Kruskal-Wallis test, Fisher's exact test, and Newcombe-Wilson test were used for statistical analysis, with P < 0.05.

RESULTS

Crown fractures occurred in 21 teeth with no change in the rate of fluid flow. Three teeth (filled with full-length MTA) showed sudden change in the rate of fluid flow through the root canal after cyclic loading.

CONCLUSIONS

The methodology reliably monitored fluid flow during cyclic loading. There was no difference between a 4-mm MTA apical plug and full-length MTA root filling after cyclic loading using a dynamic fluid-flow monitoring technique.

Similar sealability between bioceramic putty ready-to-use repair cement and white MTA

This study was designed to assess the ability to prevent glucose penetration of a bioceramic putty ready-to-use repair cement comparing to white mineral trioxide aggregate (WMTA). After root canal instrumentation, the apical 3 mm of maxillary incisors were resected and root-end cavities with depth of 3 mm were prepared with ultrasound and filled with the tested materials (15 roots per group). All roots were mounted in a double chamber system to assess glucose penetration using 15 psi pressure application. After 1 h, glucose concentrations in the lower chamber were measured following an enzymatic reaction. Four roots were used as controls. The Mann-Whitney test verified differences in glucose leakage between groups and the Tukey's test was used for multiple comparisons. Significance level was set at 5%. There was no significant difference in glucose leakage between iRoot BP Plus and White MTA groups. iRoot BP Plus had a similar ability to that of white MTA in preventing glucose leakage as a root-end filling material.

Effect of post space preparation on the sealing ability of mineral trioxide aggregate and Gutta-percha: A bacterial leakage study

Aim:

The purpose of this study was to evaluate the effect of post space preparation on the sealing ability of teeth obturated with mineral trioxide aggregate (MTA) and Gutta-percha.

Materials and Methods:

Fifty intact human mandibular premolars, after decoronation and biomechanical preparation, were randomly divided into three experimental groups. In Group A (n = 10), the canals were obturated with Gutta-percha using cold lateral compaction technique, followed by immediate post space preparation. In Group B (n = 10), the canals were obturated with 8 mm of MTA and in Group C (n = 10), sectional obturation with 4 mm of MTA was done, followed by delayed post space preparation. All specimens were subjected to bacterial leakage analysis, and the occurrence of turbidity was checked.

Results:

All specimens in the lateral compaction group leaked. The mean number of days at which leakage was observed in Groups A, B and C were 18.5 days, 93.6 days and 95.5 days.

Conclusions:

MTA can be considered as an alternative to Gutta-percha as an apical third restorative material for teeth indicated for post and core, as it demonstrates better-sealing ability compared with Gutta-percha. Further, the removal of set MTA for post space preparation does not disrupt the integrity of the remaining apical MTA.

An in vitro study of different material properties of Biodentine compared to ProRoot MTA

Introduction

The aim of this study was to compare solubility, microhardness, radiopacity, and setting time of Biodentine with ProRoot MTA.

Methods

Solubility in distilled water, radioopacity, and setting time were evaluated in accordance with International Standard ISO 6876:2001. In addition, the solubility in Phosphate Buffered Saline (PBS) buffer was determined. For microhardness-testing, ten samples of each cement were produced. All samples were loaded with a diamond indenter point with a weight of 100 g for 30s.

All data were analysed using the Student-t-test.

Results

Both materials fulfilled the requirements of the International Standard ISO 6876:2001 and showed a solubility of <3% after 24 h. At all exposure times Biodentine was significantly more soluble than ProRoot MTA (p < 0.0001). After immersion in PBS-buffer a precipitation of hydroxyapatite was visible.

The Vickers microhardness for Biodentine was significantly higher (62.35 ± 11.55HV) compared with ProRoot MTA (26.93 ± 4.66HV) (p < 0.0001).

ProRoot MTA was significantly more radiopaque (6.40 ± 0.06 mm Al) than Biodentine (1.50 ± 0.10 mm Al) (p < 0.0001).

The setting time for Biodentine (85.66 ± 6.03 min) was significantly lower than for ProRoot MTA (228.33 ± 2.88 min) (p < 0.0001).

Conclusions

Biodentine and ProRoot MTA displayed different material properties. The solubility of both cements was in accordance with the International Standard ISO 6876:2001, whereas ProRoot MTA showed a significantly lower solubility. With regard to microhardness, Biodentine may be used to replace dentine. The radioopacity of Biodentine did not fulfil the requirements laid down in the International Standard ISO 6876:2001. The setting time for ProRoot MTA is significantly higher. Both materials can be used in different indications where specific material properties may be favourable. Hence, the here tested material properties are of clinical relevance.

A Randomized Controlled Study of the Use of ProRoot Mineral Trioxide Aggregate and Endocem as Direct Pulp Capping Materials: 3-month versus 1-year Outcomes

INTRODUCTION

The purpose of this study was to assess the long-term clinical outcomes of direct pulp capping (DPC) with ProRoot MTA (Dentsply, Tulsa, OK) and Endocem (Maruchi, Wonju, Korea) as pulp capping materials. To this end, the 1-year cumulative successes of both materials were evaluated and compared with those of the 3-month outcomes in a prospective, randomized controlled trial.

METHODS

Patients were recruited from the Department of Conservative Dentistry of the Yonsei University Dental Hospital, Seoul, South Korea, from January to May 2013. Of the 48 teeth that met the inclusion criteria, 46 teeth were randomly allocated to either ProRoot MTA or Endocem groups (n = 23). Direct pulp capping was performed, and clinical and radiographic examinations were conducted over 1 year after the treatment. Survival analyses were conducted to compare the cumulative successes between ProRoot MTA and Endocem and to evaluate other clinical variables.

RESULTS

Forty-one teeth were recalled 1 year after the treatments (recall rate = 89.13%). There were no significant differences between the cumulative successes of ProRoot MTA and Endocem in either log-rank or Cox proportional hazard regression analyses (P > .05). Among the other clinical variables, cavity type (class I, II, III vs class V) was determined to be significant in both the log-rank test (P = .001) and Cox regression analysis (P = .006).

CONCLUSIONS

Both ProRoot MTA and Endocem exhibited similar cumulative successes as direct pulp capping materials up to 1 year. The teeth restored with class V cavities exhibited significantly lower cumulative success rates after direct pulp capping compared with the teeth restored with other types of cavities.

Comparing the Coronal Seal of Different Thicknesses of MTA with Gutta-Percha after Post Space Preparation

INTRODUCTION

The aim of this study was to compare the coronal seal of different thicknesses of MTA with gutta-percha after post space preparation.

MATERIALS AND METHODS

A total of 50 maxillary central incisors randomly divided into 5 experimental groups (n = 8). After preparation of the root canals with step back technique, in groups 1 and 2, post spaces were prepared and 4 or 5 mm gutta-percha remained in the apical, respectively. In groups 3, 4, and 5, there was 1-2 and 3 mm MTA in the apical, respectively. The ten teeth serve as control groups. The teeth were connected to a bacterial microleakage evaluation system. The study period was 120 days and the samples were evaluated on ten-day intervals; Meier-Kaplan technique was used for estimation of the mean time of microleakage to occur. Log-rank test was used for comparison of microleakage.

RESULTS

Number of samples exhibiting microleakage in MTA was less than those of gutta-percha at all intervals. Means of days with no microleakage were maximum and minimum with 3 mm MTA and 4 mm gutta-percha, respectively.

CONCLUSION

Obturation of root canals using the MTA technique provides a proper seal with the minimum thickness of MTA in teeth requiring post space preparation.

Marginal adaptation of mineral trioxide aggregate (MTA) to root dentin surface with orthograde/retrograde application techniques: A microcomputed tomographic analysis

Background:

Achieving a good apical seal for root canals is known to be associated with good mineral trioxide aggregate (MTA) adaptation to dentin.

Aims:

This study aims to compare the marginal adaptation of MTA with root dentin between orthograde and retrograde application techniques using microcomputed tomography (micro-CT) analysis.

Settings and Design:

Fifty-two single-rooted human teeth were divided into four equal groups: (Group 1) Retrograde MTA (RMTA), (Group 2) Orthograde MTA (OMTA), (Group 3) Etched RMTA (ERMTA), and (Group 4) Etched OMTA (EOMTA).

Materials and Methods:

For Group 1, 3-mm retrograde cavities were prepared and filled with MTA. For Group 2, the apical 6 mm of the canals were filled with MTA and sealed with sealer cement and warm gutta-percha. In Groups 3 and 4, canals were treated the same as Groups 1 and 2, respectively, except that before placing the MTA, canals were irrigated with 17% ethylenediaminetetraacetic acid (EDTA). After 48 hours, all the teeth were analyzed using a micro-CT scanner.

Statistical Analysis:

Mean dentin-MTA contact and the mean length and width of each gap was analysed using one-way analysis of variance (ANOVA). Statistical significance was set at an α level of 5%.

Results:

No significant difference in gap volumes was observed in the dentin-MTA adaptation in both orthograde and retrograde application techniques. However, significant difference in the gap volumes was observed between RMTA and ERMTA (P = 0.045). Etching significantly improved the MTA-Dentin adaptation (P < 0.05). The type of application technique did not significantly improve the dentin-MTA adaptation, instead with the use of 17% EDTA, a significant improvement could be achieved.

Conclusion:

Within the limitations of the present study, it concludes that MTA adaptation to dentin tooth structure is not significantly different between an orthograde and retrograde approach. However, the use of EDTA significantly improved the MTA-Dentin adaptation.

Resistance to leakage of various thicknesses of apical plugs of Bioaggregate using liquid filtration model

AIM

The aim of this study was to compare the resistance to leakage of different thicknesses of Bioaggregate (BA) and 4-mm-thick white mineral trioxide aggregate (WMTA) in an apexification model using liquid filtration.

METHODS

32 extracted mandibular premolar teeth were sectioned at the cemento-enamel junction and 3-4 mm from the tooth apex to obtain 12-mm-long root segments. The apical and coronal thirds were prepared with size two through six Gates Glidden burs. The teeth were divided into four groups according to material and thickness, as follows: Group 1: 2-mm BA; Group 2: 4-mm BA; Group 3: 12-mm (total length) BA; Group 4: 4-mm WMTA (control). The empty parts of the roots in Groups 1, 2, and 4 were filled with gutta-percha and root canal sealer, and leakage was measured using fluid filtration. The data were analyzed using the Kruskal-Wallis H-test.

RESULTS

No statistical differences in microleakage were observed between Groups 1, 2, and 4 (P > 0.05). Group 3 (roots filled completely with BA) showed significantly less leakage than the other groups tested (P < 0.01).

CONCLUSIONS

The findings of this study showed that 12 mm of BA exhibited the best resistance to leakage. At the same time, 2-4 mm of BA showed similar results when compared to 4-mm MTA. In light of these results, this study suggests that BA may be a good candidate for further clinical studies when used as an apical barrier for apexification.

Sealing Ability of Orthograde MTA and CEM Cement in Apically Resected Roots Using Bacterial Leakage Method

INTRODUCTION

The aim of this in vitro study was to determine the sealing ability of orthograde ProRoot mineral trioxide aggregate (MTA) and calcium enriched mixture (CEM) cement as root-end filling materials.

MATERIALS AND METHODS

Fifty four extracted single-rooted human teeth were used. The samples were randomly divided into 3 experimental groups. In group A and B, 4 mm of WMTA and CEM cement were placed in an orthograde manner and 3 mm of apices were resected after 24 hours. In group C the apical 3 mm of each root was resected and the root-end prepared with ultrasonic tips to a depth of 3 mm and subsequently, then filled with MTA. The apical sealing ability was performed with bacterial leakage method. Statistical analysis was carried out with Chi-square test.

RESULTS

There were no significant differences in the extent of bacterial leakage between the three experimental groups (P>0.05).

CONCLUSION

Based on the limitations of this in vitro study, we concluded that MTA and CEM cement can be placed in an orthograde manner when there is a potential need for root-end surgery.

Biocompatibility of mineral trioxide aggregate and three new endodontic cements: An animal study

Background:

Introducing new endodontic cements should await comprehensive investigations and new formulations have to be tested in vivo before applying in human beings. So, the purpose of this study was to compare the biocompatibility of new endodontic cements, calcium aluminate α-aluminate cement (CAAC), calcium aluminate α-aluminate plus cement (CAAC plus), and a mixture of wollastonite and CAAC cement (WOLCA) and mineral trioxide aggregate (MTA), in subcutaneous connective tissue of rats.

Materials and Methods:

Twenty-seven Wistar rats were divided into three groups of 7, 14, and 30 experimental days. Sterile polyethylene tubes were filled with MTA, CAAC, CAAC Plus, and WOLCA cement and implanted subcutaneously. Empty tubes were implanted as negative control. After the experimental periods, animals were sacrificed by anesthetic overdosing. The occurrence of inflammatory responses was scored according to the previously established scores. Data were statistically analyzed using Friedman, Wilcoxon, Kruskal-Wallis, and Mann-Whitney tests. The level of significance was 5% (P<0.05).

Results:

There was a statistically significant difference between experimental and negative control sites in each group (P<0.05). CAAC Plus showed the highest mean scores of inflammation, compared with MTA, CAAC, and WOLCA cement sits at the end of all periods (P<0.05). There were no statistically significant differences between inflammatory scores of each site in different experimental groups, except CAAC plus sites, in which inflammation increased significantly with time (P<0.05).

Conclusion:

According to the results of the current study, biocompatibility of CAAC and WOLCA cement were comparable with that of MTA, but CAAC Plus induced an inflammatory response higher than MTA, therefore is not biocompatible.

Surface changes of mineral trioxide aggregate after the application of bleaching agents: electron microscopy and an energy-dispersive X-ray microanalysis

INTRODUCTION

The aim of this study was to investigate the changes in the surface structure and chemical composition after applying bleaching agents to completely hardened mineral trioxide aggregate.

METHODS

A total of 12 samples of MTA blocks were divided into three groups, two different bleaching agents, and a control group. The surface structure was observed using a scanning electron microscope. The changes in elemental composition were analyzed by an energy-dispersive x-ray microanalysis (EDX) system.

RESULTS

The surface of the MTA covered with each bleaching agent changed in terms of both color and structure compared with the control. EDX showed that both bleaching agents affected the elemental distribution. A decrease in Ca and an increase in Si were shown, and this tendency was especially pronounced in the higher hydrogen peroxide concentration group.

CONCLUSIONS

The acidic conditions induced by bleaching agents brought about the deterioration of the MTA surface. These findings suggest that MTA is an insufficient barrier against tooth bleaching.

Apical limit of root canal filling and its relationship with success on endodontic treatment of a mandibular molar: 11-year follow-up

OBJECTIVE

This article discusses the relationship between apical limit of root canal filling and success on endodontic treatment of a mandibular molar.

STUDY DESIGN

A mandibular right first molar with vital pulp was endodontically treated, and 3 years later periapical lesions on mesial and distal roots were detected. The canals were retreated and obturated to the same levels as in the previous treatment.

RESULTS

An 8-year radiographic follow-up showed repair of the periapical lesions on both roots.

CONCLUSIONS

Results suggest that the apical limit of obturation seems to have no influence in the repair of periapical tissues in mandibular molars.

The effect of post space preparation in teeth obturated with Mineral Trioxide Aggregate evaluated using a fluid filtration system

The aim of this study was to evaluate the seal of a 4-mm Mineral Trioxide Aggregate (MTA) filling after post space preparation. Forty single-rooted premolar teeth without curved root anatomy and fractures were selected. The root length was standardized to 12 mm by removing excess from the apical end. The roots were instrumented to a 50 K-file by the step-back technique. The roots were randomly divided into groups A and B, of fifteen each. In group A, the canals were obturated with 7 mm of white MTA. After 24 h, 3 mm of MTA was removed to simulate post space preparation using a long shank diamond round bur. In group B, the canals were filled with 4 mm of white MTA. All samples were attached to a fluid filtration device. Measurements (µl min⁻¹ cm H₂O⁻¹) were taken every 2 min, for 10 min and data were analyzed by an independent t-test (P > 0.05). Fluid transport averaged in groups A and B at 9.2 × 10⁻⁴, and 11.8 × 10⁻⁴ µl min⁻¹ cm H₂O⁻¹, respectively. Independent t-test showed no significant difference between the groups (P < 0.05). Removing set MTA using a round bur for post space preparation does not affect its sealing ability, when 4 mm of MTA remains.

Sealing ability, marginal adaptation and their correlation using three root-end filling materials as apical plugs

Objective

This study used dye leakage assay and scanning electron microscopy to evaluate, respectively, the sealing ability and marginal adaptation of three root-end filling materials used as apical plugs, as well as the possible correlation between these properties.

Material and Methods

Ninety-eight single-rooted human teeth were prepared to simulate an open apex. The teeth were allocated to three experimental groups (n = 30), which received a 5-mm thick apical plug of (1) gray MTA Angelus^TM, (2) CPM^TM and (3) MBPc, and two controls groups (n = 4). After immersion in 0.2% Rhodamine B solution for 48 h, the teeth were sectioned longitudinally and analyzed by Image Tool 3.0 software. The marginal adaptation between apical plugs and the root canal walls were analyzed by SEM.

Results

MBPc had significantly less (p<0.05) apical leakage than the other materials. Regarding marginal adaptation, CPM^TM showed the best numerical results, though without statistical significance from the other materials (p<0.05). There was no correlation between the two properties.

Conclusions

When used as apical plugs, the tested root-end filling materials had similar marginal adaptation to the dentin walls, but MBPc had the best sealing ability, as demonstrated by the least apical leakage from all tested materials.

MTA and F-doped MTA cements used as sealers with warm gutta-percha. Long-term study of sealing ability

AIM

To evaluate the long-term sealing ability (up to 6 months) of two experimental calcium silicate MTA cements used as root canal sealers in association with warm gutta-percha.

METHODOLOGY

Calcium silicate (MTA) and calcium-fluoro-silicate powders were prepared. Sodium fluoride was included in FMTA (Fluoride-doped Mineral Trioxide Aggregate) as an expansive and retardant agent. Single-rooted teeth were instrumented with NiTi rotary instruments, filled with warm gutta-percha in association with one of the experimental sealers or with AH Plus as a control (n = 20 for each sealer) and stored at 37 °C. Sealing was assessed at 24, 48 h, 1, 2 weeks and 1, 3, 6 months by a fluid filtration method. Scanning electron microscopy with energy dispersive analysis (SEM/EDX) was used to study the dentine/sealer interface of roots stored for 6 months and the surface of cement disks stored for 24 h.

RESULTS

All sealers revealed a statistically significant reduction (P < 0.05) in fluid filtration after the first 2 weeks. No statistically significant differences were observed between FMTA and AH Plus at all analysis times. At short times (24, 48-h), no statistically significant differences were found between the experimental cements and AH Plus. At long-term evaluations (1, 3, 6 months), FMTA and AH Plus sealed significantly better (P < 0.05) than MTA. FMTA was associated with lower fluid filtration rates, and the seal was stable from 48 h to 6 months, thus proving the most effective material. Scanning electron microscopy with energy dispersive analysis of root sections filled with calcium silicate sealers revealed the formation of a blend layer of gutta-percha and cement consequent to the warm gutta-percha condensation technique. Scanning electron microscopy with energy dispersive analysis of 24-h-stored disks identified a Ca-rich coating on the outer surface consisting of globular particles (calcium hydroxide and calcium carbonate), and a deeper internal Ca- and Si-rich region consisting of needle-like ettringite crystals and round formations of calcium silicate hydrate gel.

CONCLUSION

Fluoride-doped MTA demonstrated stable sealing during a period of up to 6 months and significantly better than conventional calcium silicate MTA cements and comparable to AH Plus. The study supports the suitability of calcium silicate MTA cements as sealers in association with warm gutta-percha for root filling.

In vitro sealing ability of white and gray mineral trioxide aggregate (MTA) and white Portland cement used as apical plugs

This study evaluated the sealing ability of apical plugs made of white and gray MTA-Angelus and white Portland cement placed via the root canal and having different thicknesses (2, 5 and 7 mm). Ninety extracted human single-rooted teeth were instrumented using a size 40 K-file to standardize the foraminal opening by the stepback technique. The teeth were assigned to 3 groups (n=30), according to the material used for fabrication of the apical plugs: A = gray MTA; B = white MTA; C = white Portland cement. The groups were subdivided into groups of 10 teeth each according to the apical plug thickness (2, 5 and 7 mm). Marginal apical dye leakage was assessed using 0.2% Rhodamine B solution in which the specimens were immersed for 72 hours at 37 degrees C. The roots were sectioned longitudinally in a buccolingual direction for apical plug exposure, and digital photographs were taken and analyzed by Image Tool image-analysis software. Data were analyzed statistically by Kruskal-Wallis and Dunn's tests. Significance level was set at 5%. The least percent leakage was observed for 5- and 7-mm-thick plugs (p<0.05). No significant difference (p>0.05) was found between gray MTA and white Portland cement. Among the three materials analyzed, white MTA presented the highest marginal leakage (p<0.05). The findings of the present study showed that gray MTA and Portland cement had better sealing ability than white MTA when used as apical plugs. Dye leakage was smaller for 5- and 7-mm-thick plugs compared to 2-mm-thick plugs.

Sealing ability of grar MTA AngelusTM, CPM TM and MBPc used as apical plugs

This study evaluated the sealing ability of apical plugs fabricated with gray MTA Angelus™ sealer, CPM™ sealer and MBPc sealer. The root canals of 98 extracted single-rooted human teeth were instrumented with #5 to #1 Gates Glidden drills according to the crown-down technique until the #1 drill could pass through the apical foramen. The specimens were then prepared with K-files, starting with an ISO 50 until an ISO 90 could be visualized 1 mm beyond the apex. After root canal preparation, the external surface of each root was rendered impermeable and roots were assigned to 3 experimental groups (n = 30), which received a 5-mm thick apical plug of gray MTA Angelus™, CPM ™ and MBPc, and two control groups (n=4). The remaining portion of the canal in the experimental groups was filled by the lateral condensation technique. The teeth of each group, properly identified, were fixed on utility wax by their crowns and were placed in plastic flasks, leaving the apex free and facing upward. The flasks were filled with 0.2% Rhodamine B solution, pH 7.0, so as to completely cover the root apex of all teeth. The sealing ability was analyzed by measuring 0.2% Rhodamine B leakage after all groups had been maintained in this solution for 48 hours. Data were analyzed statistically by Kruskal-Wallis test and Dunn test with a=5%. The results showed that, among the tested materials used for fabrication of apical plugs, MBPc sealer had the least amount of leakage with statistically significant difference (p<0.05).

A prospective clinical study of periradicular surgery using mineral trioxide aggregate as a root-end filling

A prospective outcome study of periradicular surgery using microsurgical techniques and root-end filling with mineral trioxide aggregate (MTA) was performed. Nonhealing endodontically treated teeth (n = 321) were included in the study. Surgery was completed under local anesthesia using a standardized clinical protocol. Patients were recalled periodically and examined for signs and symptoms of failure. Thirty-nine teeth were lost from recall. Of the 276 teeth examined, 163 showed complete healing radiographically with no other signs and symptoms; 82 teeth had no symptoms but incomplete or uncertain healing, and 31 teeth showed nonhealing (three had persistent pain despite evidence of complete radiologic healing and eight teeth did not heal for reasons unrelated to the surgical treatment). The overall success rate was 88.8%, including all teeth with no clinical symptoms. In this study, the use of MTA as a root-end filling, following microsurgical techniques, showed a high success rate.

A comparative study of selected properties of ProRoot mineral trioxide aggregate and two Portland cements

AIM

To compare solubility, microhardness and radiopacity of ProRoot mineral trioxide aggregate (MTA) with two Portland cements (PC: CEM I and CEM II).

METHODOLOGY

Solubility: for standardized samples (n = 12/group) ring moulds were filled with the cements. These samples were immersed in double-distilled water for 1 min, 10 min, 1 h, 24 h, 72 h, and 28 days. Mean loss of weight was determined. Microhardness: five samples of each cement were produced. All samples were loaded with a diamond indenter point with a weight of 100 g for 30 s. Radiopacity: five samples per cement were produced. These samples were tested according to the ISO standards to compare their radiodensity to that of an aluminium step wedge (1-9 mm). Differences between the three materials with respect to their solubility, microhardness and radiopacity were analysed using ANOVA and Student-Newman-Keuls.

RESULTS

After 28 days MTA was of low solubility (0.78%) compared with CEM I (31.38%) and CEM II (33.33%). At exposure times >1 min the two PCs were significantly more soluble than MTA (P < 0.05). The microhardness for MTA was significantly higher (39.99 HV; P < 0.001) compared with the two PC (CEM I: 16.32 HV; CEM II: 13.51 HV). MTA was significantly more radiopaque (5.34 mm Al) than CEM I (3.32 mm Al) and CEM II (2.52 mm Al) (P < 0.05), whereas CEM I was significantly more radiopaque than CEM II (P < 0.05).

CONCLUSIONS

Mineral trioxide aggregate displayed superior material properties than both Portland cements.

Ex vivo biocompatibility tests of regular and white forms of mineral trioxide aggregate

AIM

To examine the genotoxicity and cytotoxicity of regular and white mineral trioxide aggregate (MTA) ex vivo by the single-cell gel (comet) assay and trypan blue exclusion test, respectively.

METHODOLOGY

Aliquots of 1 x 10(4) Chinese hamster ovary cells were incubated at 37 degrees C for 3 h with grey and white forms of MTA at final concentrations ranging from 1 to 1,000 microg mL(-1). The negative control group was treated with vehicle control phosphate buffer solution for 3 h at 37 degrees C and the positive control group was treated with methyl metasulfonate (at 1 microg mL(-1)) for 1 h at 37 degrees C. After incubation, the cells were centrifuged at 180 g for 5 min and washed twice with fresh medium and resuspended with fresh medium. Each individual treatment was repeated three times consecutively to ensure reproducibility. Parameters from single-cell gel (comet) and cytotoxicity assays were assessed by the Kruskal-Wallis nonparametric test.

RESULTS

Neither compounds produced genotoxic effects with respect to the single-cell gel (comet) assay in all concentrations evaluated. In the same way, the dose-response relationships of all compounds tested at concentrations ranging from 1 to 1,000 microg mL(-1) on cell viability assessed by the trypan blue assay displayed no statistically significant differences (P > 0.05) for either endodontic material.

CONCLUSIONS

Regular (grey) and white MTA are not genotoxins and do not induce cellular death.

Human Saliva Penetration of Root Canals Obturated with Two Types of Mineral Trioxide Aggregate Cements

The sealing ability of orthograde mineral trioxide aggregate (MTA) root canal filling against human saliva was assessed in vitro. Leakage of gray-colored MTA, white-colored MTA and vertically condensed gutta-percha and sealer were compared. Forty-three extracted single-rooted human teeth were serially instrumented to a file size 40/0.06 at the apex and obturated with either gray-colored MTA (group A), white-colored MTA (group B), or gutta-percha and Kerr Canal Sealer EWT (group C). The teeth were then mounted in a model to test for saliva leakage. After 42 days, one root in group A (9.1%), four roots in group B (36.4%), and nine roots in group C (81.8%) showed saliva leakage. Statistically, a significant difference was found between group A and group C (p < 0.001). No statistical difference was found between group A and group B. Out of the root samples that leaked, the one sample in group A leaked after 36 days. Of the four samples in group B, one sample leaked after 32 days, one sample after 33 days, and two samples after 39 days. All nine samples in group C had leaked after 19 days. It appears that under the conditions of this study both MTA preparations may be more resistant to human saliva leakage than vertically condensed gutta-percha and sealer.