A comparative evaluation of three root-end filling materials: an in vitro leakage study using Prevotella nigrescens

Comparative Evaluation of Sealing Ability of Different Type of MTA as Root-End Filling Materials Using Dye Penetration Technique - An In Vitro Study

Introduction

The main goal of the root-end filling material is to create a hermetic seal to protect against microbes and their by-products. Excellent biocompatibility and sealing ability are characteristics of MTA developed by Torabinejad et al. This study aimed to compare the sealing ability of different type MTA as root-end filling material using dye penetration technique.

Material and Method

One-twenty (N = 120) extracted human maxillary anterior teeth were decontaminated, cleaned, and decoronated. Endodontic treatment and root-end resection were done. Then root-end cavity was prepared and filled with tested materials (N = 30). A calibrated stereomicroscope was used to evaluate linear measurement. All data were tabulated and statistically analyzed with a level of significance set at P < .05.

Result

This order of increasing microleaks was observed: MTA Angelus < MTA Plus < PRO-Root MTA < Control group. There was a statistically significant difference in mean microleakage in MTA Angelus and MTA Plus groups (P = 0.040). MTA Angelus shows the least microleakage among all the bioceramic material groups.

Conclusion

Although the sealing ability of MTA Angelus is superior to MTA Plus, PRO-Root MTA. MTA Plus, PRO-Root MTA could be considered an acceptable alternative to MTA Angelus in peri-radicular surgeries.

Marginal gaps and internal voids after root-end filling using three calcium silicate-based materials: A Micro-CT analysis

This study evaluated the 3D quality of root-end filling, assessing the presence (volume and percentage) of marginal gaps and internal voids formed after retro-filling with three calcium silicate-based materials: MTA Angelus (Angelus Soluçoes Odontologicas, Londrina, PR, Brazil), Biodentine (Septodont Ltd., Saint Maur-des-Faussés, France) and Neo MTA Plus (Avalon Biomed Inc., Bradenton, Florida, US). Thirty human, extracted, single rooted teeth were used. Orthograde root canal treatment, root resection (3mm shorter than the apex) and retrograde cavity preparation with ultrasonic tips were performed. Teeth were divided into 3 groups (n =10 each) following a stratified randomization according to the initial volume of the root-end cavity. After retrofilling, samples were stored for 7 days. Then, two rounds of micro-CT scans were performed: soon after root-end preparation (with the cavity still empty) and 7 days after root-end filling. Marginal gaps, internal voids volume (mm3 and %), as well as, the overall defects (sum of gaps and voids) were evaluated. Statistics compared the three groups in relation to those defects. There was not statistical difference between groups regarding the marginal gaps (P≥ 0.05), the internal voids (P≥ 0.05), and the overall defects (P≥ 0.05). Median (mm3) and % of overall air-entrapment defects (gaps and/or voids) was: 0.004mm3 and 1.749% for MTA Angelus, 0.018mm3 and 6.660% for Biodentine, and 0.012mm3 and 4.079% for Neo MTA Plus. All materials had gaps and/or voids. No differences were found between MTA Angelus, Biodentine and Neo MTA Plus.

Innovative root-end filling materials based on calcium-silicates and calcium-phosphates

This in vitro study evaluated the apical sealing ability, bioactivity and biocompatibility of an experimental calcium silicate-based and two light-curing calcium silicate/calcium-phosphate cements as potential root end filling materials. A calcium silicate Portland-based (Control PC), an experimental calcium silicate (Exp. PC) and two light-curing cements (LC-CaP; LC-Si/CaP) were assessed for their alkalinising activity (pH) and biocompatibility. Single-rooted human canines were endodontically treated, filled with gutta-percha and finally submitted to apicoectomy. Root end fillings were performed using all tested cements, and their apical sealing ability was evaluated up to 4 weeks of immersion in simulated body fluid (SBF). The mineral precipitation at the apical region and the cement adaptation to root dentine were also evaluated through non-destructive optical microscopy both at 24 h and after prolonged water storage (four week). LC-CaP and LC-Si/CaP had neutral pH, the greatest sealing ability (24 h) and excellent cytocompatibility. The Exp. PC cement presented sealing ability after two and four weeks, as well as biocompatibility after four and seven days, similar to LC-CaP and LC-Si/CaP. The control PC cement showed the lowest sealing ability and the greatest cytotoxicity. Mineral precipitation was observed in all groups, while some differences were seen in terms of cement adaptation along the root canal dentine walls. The experimental light-curable cements as well as the experimental PC might be suitable root end filling materials with appropriate (in vitro) sealing ability, biocompatibility and aptitude to induce mineral precipitation.

The use of bioceramics in endodontics - literature review

BACKGROUND AND AIM

Bioceramics are ceramic compounds obtained both in situ and in vivo, by various chemical processes. Bioceramics exhibit excellent biocompatibility due to their similarity with biological materials, like hydroxyapatite. Bioceramics and multi-substituted hydroxyapatite or similar compounds have the ability to induce a regenerative response in the organism. The aim of this paper is to make a literature review on the main bioceramic materials currently used in endodontics and on their specific characteristics.

METHODS

We conducted a search in the international databases (PubMed), to identify publications in the last 10 years, using the following key words: "bioceramics endodontics", "bioceramic endodontic cement", "bioceramic sealer" and "direct pulp capping bioceramic".

RESULTS

Commonly used endodontic sealers (e.g., containing zinc oxide, calcium hydroxide and a resin) have a long tradition in scientific research and clinical use in endodontics. For specific cases, like root resorptions, perforations, apexification, and retrograde fillings, new biocompatible materials were developed in order to improve the clinical outcome: ProRooT MTA (Dentsply Company, Germany); Biodentine (Septodont, France); Endosequence BC sealer (Brassler, SUA); Bioaggregate (IBC, Canada); Generex A (Dentsply Tulsa Dental Specialties, USA).

CONCLUSION

The studies are generally in favor of bioceramic materials even if there are not many products available on the market for endodontic use. As more products are launched and more research is performed regarding these materials, we will provide more reliable data on clinical outcome.

Sealing ability of root-end filling materials

BACKGROUND

The aim of this research was to compare the apical sealing ability of different root-end filling materials (SuperEBA(®), ProRoot MTA(®), thermoplasticized gutta-percha + AH-Plus(®), thermoplasticized RealSeal(®)), by means of microbial indicators.

MATERIALS AND METHODS

Thus, 50 human single-rooted teeth were employed, which were shaped until size 5 0, retro - prepared with ultrasonic tips and assigned to 4 groups, retro-filled with each material or controls. A platform was employed, which was split in two halves: upper chamber-where the microbial suspension containing the biological indicators was introduced (E. faecalis + S. aureus + P. aeruginosa + B. subtilis + C. albicans); and a lower chamber containing the culture medium brain, heart influsion, where 3 mm of the apical region of teeth were kept immersed. Lectures were made daily for 60 days, using the turbidity of the culture medium as indicative of microbial contamination. Statistical analyses were carried out at 5% level of significance.

RESULTS

The results showed microbial leakage at least in some specimens in all of the groups. RealSeal(®) has more microbial leakage, statistically significant, compared to ProRoot(®) MTA and SuperEBA(®). No significant differences were observed when compared ProRoot(®) MTA and SuperEBA(®). The gutta-percha + AH Plus results showed no statistically significant differences when compared with the other groups.

CONCLUSIONS

All the tested materials showed microbial leakage. Root-end fillings with Super-EBA or MTA had the lowest bacterial filtration and RealSeal shows highest bacterial filtration.

The sealing ability of MTA apical plugs exposed to a phosphate-buffered saline

OBJECTIVE

The aim of this study was to evaluate the influence of exposure of the mineral trioxide aggregate (MTA) - with and without calcium chloride (CaCl2) - to phosphate-buffered saline (PBS) on the apical microleakage using a glucose leakage system.

MATERIAL AND METHODS

Sixty root segments were randomly divided into 4 experimental groups (n=15). After resecting the apical segments and enlarging the canals with Gates-Glidden drills, the apical cavities were filled with MTA with or without CaCl2 and the root canals were dressed with a moistened cotton pellet or PBS, as follows: 1) MTA/cotton pellet; 2) MTA/PBS; 3) MTA+10%CaCl2/cotton pellet; 4) MTA+10%CaCl2/PBS. All root segments were introduced in floral foams moistened with PBS. After 2 months, all root segments were prepared to evaluate the glucose leakage along the apical plugs. The amount of glucose leakage was measured following an enzymatic reaction and quantified by a spectrophotometer. Four roots were used as controls. The data were analyzed using Kruskal-Wallis and Mann-Whitney tests (p<0.05).

RESULTS

There were no differences between groups 1 and 2 (p>0.05), and 3 and 4 (p>0.05). The addition of CaCl2 to the MTA significantly decreased its sealing ability (p<0.05).

CONCLUSION

The interaction with PBS did not improve the MTA sealing ability. The addition of CaCl2 to the MTA negatively influenced the apical seal.

Endodontic essay

"It has been said that Mineral Trioxide Aggregate is driving an endodontic revolution. Discuss this statement considering the biological and clinical attributes of this innovative material."

The comparison of MTA, Geristore® and Amalgam with or without Bioglass as a matrix in sealing the furcal perforations (in vitro study)

AIM

The objective of this in vitro was to assess the sealing ability of MTA, Geristore®, and amalgam with and without Bioglass as a matrix used to repair furcation perforations in mandibular molars by using dye penetration.

MATERIALS AND METHODS

One hundred mandibular molars were randomly divided into six experimental groups. Five teeth with perforation were used as positive control while five teeth without perforation were used as negative control group. Furcal perforations were made in the teeth. Perforations were repaired with amalgam in group 1, amalgam and Bioglass in group 2, MTA in group 3, MTA and Bioglass in group 4, Geristore® in group 5, and Geristore® and Bioglass in group 6. All repairing materials were allowed to set for 72 h. Leakage at the repaired sites was then evaluated using dye penetration and clearing technique under stereomicroscope.

RESULTS

The perforations repaired with MTA and Geristore® leaked significantly less than amalgam (p = 0.000). Bioglass reduced sealing ability of MTA and Geristore® significantly (p = 0.000, p = 0.019), while reduced the sealing ability of amalgam insignificantly (p = 0.78).

CONCLUSION

MTA and Geristore® have shown acceptable sealing ability in furcal perforation in comparison to amalgam while Bioglass as a matrix beneath them has reduced their sealing ability.

Bioactive materials in endodontics

Endodontic treatment in dentistry is a delicate procedure and many treatment attempts fail. Despite constant development of new root canal filling techniques, the clinician is confronted with both a complex root canal system and the use of filling materials that are harmful for periapical tissues. This paper evaluates reported studies on biomaterials used in endodontics, including calcium hydroxide, mineral trioxide aggregate, calcium phosphate ceramics and calcium phosphate cements. Special emphasis is made on promising new biomaterials, such as injectable bone substitute and injectable calcium phosphate cements. These materials, which combine biocompatibility, bioactivity and rheological properties, could be good alternatives in endodontics as root canal fillers. They could also be used as drug-delivery vehicles (e.g., for antibiotics and growth factors) or as scaffolds in pulp tissue engineering.

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 chemical study of MTA and portland cements

Portland cement has been analyzed and compared to mineral trioxide aggregate (MTA) because of their chemical similarity. The possibility of using this material as a less expensive alternative to MTA in dental practice should be considered. In view of this, the present study compared the components of a Portland cement (Votoran®) to two commercial brands of MTA (Pro-Root™ and MTA-Angelus®). Twelve specimens of each material were fabricated and examined by scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS) to obtain their percentage of chemical elements. The means of the chemical elements found in each material was compared by descriptive statistics. Bismuth was present only in MTA cements to provide radiopacity. In conclusion, the tested cements have similar components, which supports, as far as composition is concerned, the possible clinical use of Portland as an option to MTA.

Apical Leakage of Root-End Placed SuperEBA, MTA, and Geristore Restorations in Human Teeth Previously Stored in 10% Formalin

The purpose of this study was to determine if storage of extracted teeth in 10% formalin affects microleakage of MTA, Geristore, or SuperEBA root-end fillings. There were 130 freshly extracted single-rooted teeth collected, immediately placed in phosphate buffered saline (PBS) and stored for less than 24 hours. Teeth were divided and either placed in 10% formalin for a 4-weeks immersion or immediately prepared. Preparation for all teeth consisted of canal instrumentation, obturation, apical resection, retrograde preparation, and placement of a root-end filling material. After 72 hours, the apical portions were immersed in India ink under vacuum pressure for 30 minutes, and then stored in ink for 1 week. Negative controls and positive controls performed as expected. In general, there was significantly less dye leakage of root-end restorations in teeth stored in 10% formalin when compared to the freshly extracted teeth (p < 0.0001). No difference in dye leakage was observed between Geristore restorations placed in teeth stored in formalin as compared to fresh teeth (p = 0.892). Less dye leakage was noted in teeth restored with Geristore as compared to MTA and SuperEBA, regardless of storage medium (p < 0.0001). No difference was observed between MTA and SuperEBA root-end restorations (p = 0.157). The results of this study provide evidence that storage of teeth in 10% formalin over a 4-week period may significantly influence dye leakage as compared to leakage in freshly extracted teeth.

Leakage of Bovine Serum Albumin in Root Canals Obturated with Super-EBA and IRM

The aim of this study was to determine the leakage of SuperEBA and intermediate restorative material (IRM) in root canal samples, with or without orthograde filling, by evaluating bovine serum albumin (BSA) microleakage using spectrophotometry. Thirty-five single-rooted teeth were divided into five groups, instrumented, and had apices resected. Root-end cavities in groups I and II were filled with SuperEBA and IRM. The samples from the groups III, IV, and V were filled with gutta-percha and sealer. In groups IV and V, root-end cavities were filled with SuperEBA and IRM. After 60 days, the greatest microleakage of BSA was observed in group II (4.1 +/- 0.0011 ng), followed by group III (3.4 +/- 0.0064 ng), and then group I (2.6 +/- 0.0019 ng). Samples from groups IV and V leaked the least (0.7 +/- 0.0014 ng). Significantly less leakage (p < 0.05) occurred in samples filled with orthograde and root-end fillings than did in samples filled only with an orthograde approach and the samples with IRM root-end fillings.

Root-End Filling Materials: Apical Microleakage and Marginal Adaptation

The purpose of this study was to evaluate the root-end sealing ability through dye leakage evaluation and the marginal adaptation through scanning electron microscopy (SEM) of some root-end filling materials. Thirty human uniradicular teeth were used. Teeth were divided into three groups: (1) retrofilled with MTA-Angelus, (2) with SuperEBA, and (3) with Vitremer. The root surfaces were isolated with nail polish and teeth were immersed in silver nitrate. Roots were sectioned transversally at each millimeter, in three sections and evaluated at a stereomicroscope to observe dye penetration. Using SEM the distance between the tested root-end filling materials and the surrounding dentin was measured at four points. The statistical analysis showed significant differences among the three materials in relation to the sealing ability (p < 0.05). Concerning marginal adaptation, MTA-Angelus presented the best results (p < 0.01). Absence of correlation between the two methodologies was clearly observed.

Perforation Repair Comparing Two Types of Mineral Trioxide Aggregate

The purpose of this study was to evaluate the ability of two types of mineral trioxide aggregate (MTA) to seal furcal perforations in extracted human molars using an anaerobic bacterial leakage model. Forty, human, maxillary and mandibular molars were randomly divided into two experimental groups of 18, with two teeth used as positive controls and two teeth without perforations used as negative controls. Experimental group 1 was repaired with gray-colored MTA and group 2 with off-white-colored MTA. A dual-chamber, anaerobic, bacterial-leakage model was assembled. Brain-heart infusion broth with yeast extract, hemin, and menadione was used as the culture broth for Fusobacterium nucleatum. Two of 18 gray-colored MTA samples leaked and three off-white-colored MTA samples leaked. There was no significant difference between the two types of MTA in preventing leakage of F. nucleatum past furcal perforation repairs.

Treatment of a non-vital immature incisor with mineral trioxide aggregate (MTA)

- A case of severe crown fracture and luxation in the upper permanent incisors of a 9-year-old boy is reported. The treatment of one of the injured teeth included apexification with calcium hydroxide and endodontic treatment with gutta-percha obturation. The other incisor was also treated with calcium hydroxide, but as there was no apical stop after 3 years of treatment, it was decided to use a new root-end filling material: mineral trioxide aggregate (MTA). At follow-up 12 months later, the tooth was asymptomatic and radiographically showed the initial repair of the radiolucent apical lesion.