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Sunlakawit C, Chaimanakarn C, Srimaneekarn N, Osiri S. Effect of Calcium Hydroxide as an Intracanal Medication on Dentine Fracture Resistance: A Systematic Review and Network Meta-Analysis. J Endod 2024:S0099-2399(24)00443-6. [PMID: 39168239 DOI: 10.1016/j.joen.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION Bacterial infections necessitate effective root canal disinfection during endodontic therapy. Calcium hydroxide (CH), a widely used intracanal medication, shows conflicting effects on dentine fracture resistance in different studies. This study aimed to perform a comprehensive systematic review and network meta-analysis to evaluate the effects of CH on the fracture resistance of dentine in human teeth across different periods. METHODS PubMed, EMBASE, MEDLINE (EBSCO), Cochrane Library, Scopus, Google Scholar, and ProQuest databases were exhaustively searched to identify studies published until February 29, 2024, with no language restrictions. Laboratory studies that investigated dentine fracture resistance in human permanent teeth following intracanal CH exposure were included. The risk of bias was evaluated using modified criteria derived from previous studies. Network meta-analysis was performed using the frequentist method. Prespecified subgroup analyses focused on simulating immature teeth. RESULTS The search yielded 2,265 studies from all databases, and 27 met the inclusion criteria, involving 3,879 teeth or roots. The overall results from network meta-analysis indicated that CH affected the fracture resistance of human dentine. Subgroup analysis revealed that the duration influencing fracture resistance was ≥4 weeks for mature teeth, but no specific time limitation for immature teeth. The overall quality of the evidence showed a moderate to high risk of bias. CONCLUSIONS Short-term use of CH does not compromise human root dentine strength, supporting its routine application in clinical practice. CH remains a viable treatment strategy for over 4 weeks of medication needs but requires carefully considering the associated risks and benefits emphasizing on preservation and disease resolution. REGISTRATION PROSPERO database (CRD 42024513199).
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Affiliation(s)
- Chayanit Sunlakawit
- Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Chitpol Chaimanakarn
- Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Sittichoke Osiri
- Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
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2
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Sriprasart K, Wimonchit S. Fracture Resistance of Simulated Immature Teeth Filled with Three Types of Calcium Silicate Cement after Intracanal Medication with Ca(OH) 2: An Ex Vivo Study. Int J Dent 2024; 2024:8386533. [PMID: 38707786 PMCID: PMC11068449 DOI: 10.1155/2024/8386533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/21/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives The aim of this study was to evaluate the 1-day fracture resistance of simulated immature teeth with an apical plug with ProRoot MTA, MTA Angelus, and RetroMTA after calcium hydroxide intracanal medication. Materials and Methods Sixty extracted, single-rooted human mandibular premolars were randomly divided into six groups of 10 teeth each. Firstly, to standardize the 9 mm root length, the crowns were cut off at and 9 mm below the cementoenamel junction transversely. Simulations for immature apices were carried out by using No. 1-6 Peeso reamers to pass through the apex to obtain a diameter of 1.7 mm at the apical opening. One group served as a negative control without any treatment, while the other groups received 30 days of calcium hydroxide intracanal medication. Four groups were plugs with 4 mm of ProRoot MTA, MTA Angelus, RetroMTA, and gutta-percha, respectively. The last one was served as a positive control group without filling inside. After 1 day of incubation, specimens were vertically loaded in a universal testing machine at a crosshead speed of 1 mm/min until fracture occurred. The peak load to fracture (Newton) and fracture pattern were recorded. A one-way analysis of variance (ANOVA) followed by Tukey's HSD test was used for data analysis. Results The highest mean load to fracture was shown in the negative control group (543.33 ± 37.17 N), followed by ProRoot MTA (432.82 ± 68.06 N), MTA Angelus (396.92 ± 59.93 N), RetroMTA (389.08 ± 56.25 N), and gutta-percha (283.28 ± 43.40 N), and the lowest belonged to the positive control group (239.98 ± 27.19 N). The significant differences were found between both the control and experimental groups with an apical plug with calcium silicate cement (p < 0.05). There were no significant differences among those three apical plugs (p > 0.05). Conclusion Apical plugs with ProRoot MTA, MTA Angelus, and RetroMTA had an immediate strengthening effect on simulated immature teeth after calcium hydroxide intracanal medication had been used.
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Affiliation(s)
| | - Suwit Wimonchit
- Department of Conservative Dentistry and Prosthodontics, Faculty of Dentistry, Srinakharinwirot University, Bangkok, Thailand
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3
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Joshi S, Gandage D, Thakare E, Mahagaonkar PA, Gadda R, Palekar AU. A Comparative Evaluation of the Fracture Resistance of Mineral Trioxide Aggregate (MTA) Plus and MTA Angelus: An In Vitro Study. Cureus 2023; 15:e40385. [PMID: 37456459 PMCID: PMC10344682 DOI: 10.7759/cureus.40385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2023] [Indexed: 07/18/2023] Open
Abstract
Background Mineral trioxide aggregate (MTA) is a biocompatible dental material used for root-end filling in endodontics. A wide variety of literature has been published on the assessment of fracture resistance of MTA. However, the results were conflicting in the reported studies, and the sample size used was insufficient to conclude the efficacy of materials such as MTA Plus and MTA Angelus. Therefore, this study was designed to compare and evaluate the effectiveness of two commercially available MTAs, namely, MTA Plus (Avalon Biomed Inc. by Prevest Denpro Ltd, Jammu, India) and MTA Angelus (Angelus Dental Solutions, Brazil) in terms of fracture resistance. Methodology To determine fracture resistance, 300 freshly extracted healthy human teeth with single roots and canals were collected by simple random sampling. Teeth were decoronated, the apical third was enlarged, and root canals were prepared to receive MTA as a 5 mm apical filling. The root segments were randomly categorized into two experimental groups of 100 samples each, namely, group A (MTA Plus) and group B (MTA Angelus), and the remaining 100 root segments were used as control (unfilled). Fracture resistance was determined using the Instron Universal testing machine. Results The results of our study showed statistically significant increased fracture resistance for MTA Plus (532.14 ± 5.19 N) than MTA Angelus (540.81 ± 3.56 N) and the control group (460.63 ± 7.91 N). Conclusions The control group showed the least fracture resistance. The composition and structure of MTA Angelus (group B) containing Portland cement, with a 4:1 addition of bismuth oxide, make it more fracture resistant than MTA Plus (group A).
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Affiliation(s)
- Saurabh Joshi
- Department of Pediatric Dentistry, Rural Dental College, Pravara Institute of Medical Sciences, Loni, IND
| | - Dhananjay Gandage
- Department of Prosthodontics, Dr D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, IND
| | - Esha Thakare
- Department of Oral Pathology and Microbiology, SGP Nanded Rural Dental College and Research Centre, Nanded, IND
| | | | - Rohit Gadda
- Department of Oral Medicine and Radiology, Mahatma Gandhi Mission Dental College and Hospital, Navi Mumbai, IND
| | - Aparna U Palekar
- Department of Conservative Dentistry and Endodontics, Rural Dental College, Pravara Institute of Medical Sciences, Loni, IND
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de Souza GL, Freitas GAN, Ribeiro MTH, Lemus NXA, Soares CJ, Moura CCG. Effects of different calcium-silicate based materials on fracture resistance of immature permanent teeth with replacement root resorption and osteoclastogenesis. Restor Dent Endod 2023; 48:e21. [PMID: 37284344 PMCID: PMC10240096 DOI: 10.5395/rde.2023.48.e21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/26/2023] [Accepted: 03/26/2023] [Indexed: 06/08/2023] Open
Abstract
Objectives This study evaluated the effects of Biodentine (BD), Bio-C Repair (BCR), and mineral trioxide aggregate (MTA) plug on the fracture resistance of simulated immature teeth with replacement root resorption (RRR) and in vitro-induced osteoclastogenesis. Materials and Methods Sixty bovine incisors simulating immature teeth and RRR were divided into 5 groups: BD and BCR groups, with samples completely filled with the respective materials; MTA group, which utilized a 3-mm apical MTA plug; RRR group, which received no root canal filling; and normal periodontal ligament (PL) group, which had no RRR and no root canal filling. All the teeth underwent cycling loading, and compression strength testing was performed using a universal testing machine. RAW 264.7 macrophages were treated with 1:16 extracts of BD, BCR, and MTA containing receptor activator of nuclear factor-kappa B ligand (RANKL) for 5 days. RANKL-induced osteoclast differentiation was assessed by staining with tartrate-resistant acid phosphatase. The fracture load and osteoclast number were analyzed using 1-way ANOVA and Tukey's test (α = 0.05). Results No significant difference in fracture resistance was observed among the groups (p > 0.05). All materials similarly inhibited osteoclastogenesis (p > 0.05), except for BCR, which led to a lower percentage of osteoclasts than did MTA (p < 0.0001). Conclusions The treatment options for non-vital immature teeth with RRR did not strengthen the teeth and promoted a similar resistance to fractures in all cases. BD, MTA, and BCR showed inhibitory effects on osteoclast differentiation, with BCR yielding improved results compared to the other materials.
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Affiliation(s)
- Gabriela Leite de Souza
- Department of Endodontics, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | | | - Maria Tereza Hordones Ribeiro
- Department of Operative Dentistry and Dental Materials, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | | | - Carlos José Soares
- Department of Operative Dentistry and Dental Materials, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
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Arıcan B, Sesen Uslu Y, Sarıalioğlu Güngör A. Resistance to fracture of simulated external cervical resorption cavities repaired with different materials. AUST ENDOD J 2022; 49:174-182. [PMID: 36354094 DOI: 10.1111/aej.12714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
The aim of the study was to evaluate the fracture resistance (FR) of teeth with simulated external cervical resorption (ECR) cavities repaired with different materials. Following the shaping of the 80 human permanent maxillary central incisors, standard ECR cavities were prepared and restored with a nanohybrid composite resin; a high viscosity GIC Equia Forte Fill; Biodentine; Biodentine + nanohybrid composite resin; MTA BIOREP; MTA BIOREP + nanohybrid composite resin. Then, the root canals were obturated with AH Plus and gutta-percha. The roots were embedded acrylic resin blocks and fracture strength test was applied. The highest FR was observed in the Biodentine group, while the lowest was in Equia group (p < 0.05). No significant results were observed among composite, Biodentine + composite, MTA BIOREP + composite and MTA BIOREP (p > 0.05). Biodentine may be a preferable material for repairing ECR cavities. Adding a composite layer on MTA BIOREP and Biodentine did not improve the FR of these materials.
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Affiliation(s)
- Burçin Arıcan
- Department of Endodontics, School of Dental MedicineBahçeşehir UniversityIstanbulTurkey
| | - Yesim Sesen Uslu
- Department of Restorative Dentistry, School of Dental MedicineBahçeşehir UniversityIstanbulTurkey
| | - Ayça Sarıalioğlu Güngör
- Department of Restorative Dentistry, Faculty of DentistryBezmialem Vakif UniversityIstanbulTurkey
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6
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Long-term outcome of nonvital immature permanent teeth treated with apexification and corono-radicular adhesive restoration - a case series. J Endod 2022; 48:1191-1199. [PMID: 35750220 DOI: 10.1016/j.joen.2022.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/03/2022] [Accepted: 06/14/2022] [Indexed: 12/26/2022]
Abstract
INTRODUCTION This study aims to evaluate the long-term outcome of sixteen permanent maxillary central incisors with nonvital pulps and open apices treated with apexification and corono-radicular adhesive restorations, within a follow-up span of 5 to 22 years. METHODS Fourteen patients providing a total of sixteen teeth treated with MTA (n = 12), Biodentine (n = 3) or β-tricalcium phosphate (n = 1) apical barrier and corono-radicular restoration, with or without fiberglass post, were included. Clinical and radiographic criteria were defined for assessment at recall. Restoration and periapical tissues' status evaluation were performed according to FDI World Dental Federation's esthetic, functional and biological criteria and Ørstavik Periapical Index (PAI). Outcome was dichotomized in "healed" (PAI ≤ 2, asymptomatic with absence of signs of infection) or "not healed" (PAI ≥ 3, presence of clinical signs and/or symptoms). RESULTS Fourteen out of twenty-four patients were available for the present study (recall rate = 58%). Within a follow-up of 5 to 22 years, ten (62.5%) teeth were considered "healed", fulfilling both strict clinical and radiographic success criteria. Only one tooth was missing due to root resorption and one patient was presenting with clinical signs and symptoms at recall, resulting in a survival rate of 93.8%. CONCLUSIONS Adhesive corono-radicular restoration in nonvital permanent immature teeth treated with apexification allows for favorable long-term outcomes, by ensuring structural reinforcement and coronal microleakage prevention. Teeth sustaining a substantial loss of coronal structure may require post/core placement. In the case of failure, this endodontic-restorative combination assured teeth survival until growth phase conclusion, thus allowing for proper prosthetic rehabilitation approaches.
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7
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Liu H, Lu J, Jiang Q, Haapasalo M, Qian J, Tay FR, Shen Y. Biomaterial scaffolds for clinical procedures in endodontic regeneration. Bioact Mater 2022; 12:257-277. [PMID: 35310382 PMCID: PMC8897058 DOI: 10.1016/j.bioactmat.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 12/14/2022] Open
Abstract
Regenerative endodontic procedures have been rapidly evolving over the past two decades and are employed extensively in clinical endodontics. These procedures have been perceived as valuable adjuvants to conventional strategies in the treatment of necrotic immature permanent teeth that were deemed to have poor prognosis. As a component biological triad of tissue engineering (i.e., stem cells, growth factors and scaffolds), biomaterial scaffolds have demonstrated clinical potential as an armamentarium in regenerative endodontic procedures and achieved remarkable advancements. The aim of the present review is to provide a broad overview of biomaterials employed for scaffolding in regenerative endodontics. The favorable properties and limitations of biomaterials organized in naturally derived, host-derived and synthetic material categories were discussed. Preclinical and clinical studies published over the past five years on the performance of biomaterial scaffolds, as well as current challenges and future perspectives for the application of biomaterials for scaffolding and clinical evaluation of biomaterial scaffolds in regenerative endodontic procedures were addressed in depth. Overview of biomaterials for scaffolding in regenerative endodontics are presented. Findings of preclinical and clinical studies on the performance of biomaterial scaffolds are summarized. Challenges and future prospects in biomaterial scaffolds are discussed.
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8
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Hiremath H, Misar P, Harinkhere C, Sonawane S, Sharma V, Rana K. Reinforcing an immature tooth model using three different restorative materials. Dent Res J (Isfahan) 2022. [DOI: 10.4103/1735-3327.340113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Żuk-Grajewska E, Saunders WP, Chadwick RG. Fracture resistance of human roots filled with mineral trioxide aggregate mixed with phosphate-buffered saline, with and without calcium hydroxide pre-medication. Int Endod J 2020; 54:439-453. [PMID: 33025614 DOI: 10.1111/iej.13426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022]
Abstract
AIM To compare the fracture strength of extracted human roots with apical plugs of mineral trioxide aggregate (MTA) mixed with either Ca- and Mg-free phosphate-buffered saline (PBS) or water, with and without calcium hydroxide (CH) canal pre-medication. METHODOLOGY A total of 180 single-rooted human teeth were prepared to resemble immature roots and divided into groups (n = 20). The negative control received canal irrigation only, and the positive control received intracanal treatment with CH for either two or twelve weeks. MTA mixed with water was used in Group 1: (i) without CH pre-medication - MTA(W); (ii) after 2 weeks CH pre-medication - 2/52CH + MTA(W); and (iii) after 12-week CH pre-medication - 12/52 CH + MTA(W). MTA mixed with PBS was used in Group 2: (i) without CH pre-medication - MTA(PBS); (ii) after 2-week CH pre-medication - 2/52CH + MTA(PBS); and (iii) after 12-week CH pre-medication - 12/52 CH + MTA(PBS). A compressive force was applied to each root until the point of fracture. The results were analysed by the Kruskal-Wallis and Dunn's multiple comparisons tests (P < 0.05). RESULTS There was no significant difference between groups MTA(W), MTA(PBS) and 2/52CH + MTA(PBS), and all three groups were significantly (P < 0.01, P < 0.05 and P < 0.05, respectively) more resistant to fracture than the negative control. Within Group 1, the samples that received two- (P < 0.01) and twelve-week (P < 0.001) CH pre-treatment were more prone to fracture than those which did not. No difference was found amongst the control groups. The roots of the MTA(PBS) group had a higher dependability (P < 0.05) than the MTA(W) group when compared by the Weibull modulus. The difference was also present when a 2-week CH pre-medication was used. CONCLUSIONS Mineral trioxide aggregate mixed with Ca- and Mg-free phosphate-buffered saline had a significant strengthening effect on the fracture resistance of structurally weak roots, even when short-term calcium hydroxide pre-medication had been used. MTA mixed with water lost its strengthening effect on human roots when 2- or 12-week CH pre-treatment had been used. Use of CH dressing for up to 12 weeks had no negative effect on fracture resistance of human roots.
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Affiliation(s)
- E Żuk-Grajewska
- Restorative Department, School of Dentistry, University of Dundee, Dundee, UK
| | - W P Saunders
- Restorative Department, School of Dentistry, University of Dundee, Dundee, UK
| | - R G Chadwick
- Restorative Department, School of Dentistry, University of Dundee, Dundee, UK
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10
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Lee W, Yoo YJ. Effect of apexification on occlusal resistance of immature teeth. BMC Oral Health 2020; 20:325. [PMID: 33183284 PMCID: PMC7664021 DOI: 10.1186/s12903-020-01317-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/05/2020] [Indexed: 11/13/2022] Open
Abstract
Background Strain distribution was investigated to assess the occlusal resistance alterations in immature teeth under different occlusal force. Methods In vitro apexification models of teeth with a funnel-shaped immature apex were obturated with mineral trioxide aggregate (MTA; ProRoot MTA) using different combinations of core materials (10/group): group 1, full-length orthograde obturation of MTA; group 2, a 5-mm MTA apical plug with a composite core; group 3, a 5-mm MTA apical plug and back-filling with warm gutta-percha. Teeth with calcium hydroxide (CH)-medicated canals and untreated teeth with normal apices were tested as controls. The teeth were arranged between two adjacent normal-apex teeth, embedded in a resin mold with a simulated periodontal ligament space. Strain data were recorded from the 3-unit teeth assembly under static compressive occlusal forces (50, 100, 200, and 300 N). Measurements were repeated 20 times for each condition, and the data were statistically analyzed. Results The immature teeth showed altered occlusal force resistance, placing increased strain on adjacent teeth. Teeth with CH-medicated canals showed significantly inferior occlusal resistance under all tested forces (P < 0.05). Application of an MTA plug with deep composite resin core resulted in significantly better stress-bearing capacity especially under forces of 50 and 300 N (P < 0.05). Conclusions The pattern of occlusal force distribution in immature teeth differed according to the canal obturation materials used for apexification. Immature teeth with an MTA apical plug showed more favorable occlusal force resistance than those with CH-medicated canals.
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Affiliation(s)
- WooCheol Lee
- Department of Conservative Dentistry, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Republic of Korea
| | - Yeon-Jee Yoo
- Department of Comprehensive Treatment Center, Seoul National University Dental Hospital, Daehakro 101, Jongno-Gu, Seoul, 03080, Republic of Korea.
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11
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Schürz A, Gehrig H, Schuessler DL, Mente J. Preservation of a Split Tooth: Nonsurgical Clinical Management. J Endod 2020; 46:1002-1008. [DOI: 10.1016/j.joen.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/28/2020] [Accepted: 03/08/2020] [Indexed: 11/29/2022]
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Sarraf P, Nekoofar MH, Sheykhrezae MS, Dummer PMH. Fracture Resistance of Immature Incisors Following Root Filling with Various Bioactive Endodontic Cements Using an Experimental Bovine Tooth Model. Eur J Dent 2019; 13:156-160. [PMID: 31509877 PMCID: PMC6777150 DOI: 10.1055/s-0039-1695654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective
The aim of this study was to compare the fracture resistance of immature bovine roots when using ProRoot MTA, CEM Cement, and Biodentine as root filling materials.
Materials and Methods
An immature bovine tooth model was developed by removing the coronal and apical portions of 70 bovine incisors 8 mm above and 12 mm below the cementoenamel junction (CEJ). The specimens were then divided into five groups: ProRoot MTA, CEM Cement, Biodentine, gutta-percha/AH26 sealer, and control. All groups received a 5-mm apical plug with a temporary restorative material. Then, the remaining root canal space was filled with one of the afore-mentioned materials. After setting, the specimens were mounted in acrylic resin. Then, 3 mm coronal to the CEJ from the buccal side of the teeth and at a 135°angle to the long axis, the specimens were loaded until fracture.
Results
The specimens in the Biodentine (2196 N) and ProRoot MTA (2103 N) groups had significantly greater fracture resistance in comparison to the control group (
p
= 0.01). No significant difference was found between CEM Cement, gutta-percha and sealer AH26, and control groups. No significant differences occurred between the four experimental groups (
p
= 0.45).
Conclusion
Filling the root canal space with ProRoot MTA and Biodentine contributed to higher fracture resistance values.
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Affiliation(s)
- Pegah Sarraf
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Nekoofar
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.,School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
| | | | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, United Kingdom
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13
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Fracture resistance of simulated immature roots using Biodentine and fiber post compared with different canal-filling materials under aging conditions. Clin Oral Investig 2019; 24:1333-1338. [DOI: 10.1007/s00784-019-03014-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/08/2019] [Indexed: 12/27/2022]
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Ali MRW, Mustafa M, Bårdsen A, Bletsa A. Fracture resistance of simulated immature teeth treated with a regenerative endodontic protocol. ACTA BIOMATERIALIA ODONTOLOGICA SCANDINAVICA 2019; 5:30-37. [PMID: 30775411 PMCID: PMC6366405 DOI: 10.1080/23337931.2019.1570822] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/03/2019] [Indexed: 01/20/2023]
Abstract
This study aims to evaluate fracture resistance of simulated immature teeth after treatment with regenerative endodontic procedure (REP) using tricalcium silicate cements (TSCs) as cervical plugs. Bovine incisors were sectioned to standard crown/root ratio. Pulp tissue was removed and canals were enlarged to a standardized diameter. Teeth were then treated with a REP protocol consisting of NaOCl and EDTA irrigation, intracanal medication with triple-antibiotic paste for 14 days followed by a TSC cervical seal and composite restoration. Teeth were divided into groups according to the material used; Mineral-Trioxide-Aggregate (MTA), Biodentine, TotalFill. Teeth filled with guttapercha (GP) and intact teeth served as controls. All teeth subjected to an increasing compressive force (rate of 0.05 mm/s at a 45° angle to the long axis of the tooth) until fracture. All treated teeth exhibited significantly lower resistance to fracture compared to the intact teeth but no difference was found between the TSC groups (Kruskal-Wallis, Dunn’s multiple comparison, p < .05). TSCs applied at the cervical area of simulated immature teeth treated with REP did not reinforce fracture resistance.
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Affiliation(s)
- Mohamed Raouf W Ali
- Department of Clinical Dentistry Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Manal Mustafa
- Oral Health Centre of Expertise in Western Norway, Bergen, Norway
| | - Asgeir Bårdsen
- Department of Clinical Dentistry Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Athanasia Bletsa
- Department of Clinical Dentistry Faculty of Medicine, University of Bergen, Bergen, Norway.,Oral Health Centre of Expertise in Western Norway, Bergen, Norway
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Jamshidi D, Homayouni H, Moradi Majd N, Shahabi S, Arvin A, Ranjbar Omidi B. Impact and Fracture Strength of Simulated Immature Teeth Treated with Mineral Trioxide Aggregate Apical Plug and Fiber Post Versus Revascularization. J Endod 2018; 44:1878-1882. [PMID: 30390973 DOI: 10.1016/j.joen.2018.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/08/2018] [Accepted: 09/11/2018] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Immature necrotic teeth are at a high risk of fracture, especially at the cervical region, after treatment. This study aimed to compare the impact and fracture strength of immature permanent teeth treated with revascularization versus a mineral trioxide aggregate (MTA) plug and fiber post. METHODS This in vitro, experimental study was conducted on 160 maxillary central incisors, which were randomly divided into 10 groups. The groups included a fracture (F) and impact (I) negative control group, F and I positive control groups, F and I MTA groups, F and I revascularizing group, and F and I revascularized groups. Fracture strength was measured using a universal testing machine with a crosshead speed of 1 mm/min. Other tooth samples were then subjected to the Charpy impact test for impact strength measurements, and the amount of energy absorbed by the teeth was determined. Data were analyzed using the Kolmogorov-Smirnov test, analysis of variance, and the Tukey test. RESULTS The mean load to fracture of the negative, positive, MTA, revacularizing, and revascularized groups was 1931.8, 1350.1, 1003.8, 1262.5, and 1100.2 N, respectively, and the mean impact strength was 5.04, 3.6, 3.68, 3.16, and 3.65 J, respectively. The fracture and impact strength of the negative control group was significantly higher than that of the other groups (P < .05), but the other groups were not significantly different in this respect (P > .05). CONCLUSIONS Despite the limitations of this study, the results showed that none of the tested modalities could significantly increase the impact and fracture strength of simulated immature teeth.
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Affiliation(s)
- Davoud Jamshidi
- Department of Endodontics, Dental Caries Prevention Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hamed Homayouni
- Department of Endodontics, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Nima Moradi Majd
- Dental Research Laboratory, Howard University College of Dentistry, Washington, DC
| | - Samaneh Shahabi
- Department of Endodontics, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran.
| | - Armita Arvin
- Department of Endodontics, Faculty of Dentistry, Alborz University of Medical Sciences, Alborz, Iran.
| | - Baharan Ranjbar Omidi
- Department of Operative Dentistry, Faculty of Dentistry, Qazvin University of Medical Sciences, Qazvin, Iran
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Oskoee SS, Bahari M, Daneshpooy M, Ajami AA, Rahbar M. Effect of Different Intraorifice Barriers and Bleaching Agents on the Fracture Resistance of Endodontically Treated Anterior Teeth. J Endod 2018; 44:1731-1735. [PMID: 30266467 DOI: 10.1016/j.joen.2018.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/25/2018] [Accepted: 07/29/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Intraorifice barriers (IOBs) are usually used before internal bleaching for coronal sealing and the prevention of cervical resorption. The aim of this study was to investigate the effect of different IOBs on the fracture resistance (FR) of endodontically treated anterior teeth bleached with various bleaching agents (BAs). METHODS After performing root canal treatment for 72 extracted bovine upper incisors, the coronal 3 mm of gutta-percha was removed, and samples were classified into 3 based on the type of IOB: calcium-enriched mixture, mineral trioxide aggregate, and resin-modified glass ionomer. After applying IOBs, samples of each group were subdivided into 4 based on the BA: carbamide peroxide 45% (CP), hydrogen peroxide 35% (HP), sodium perborate (PB), and distilled water as the control. At the end of bleaching, the access cavities were restored with composite resin. The FR was measured with a universal testing machine at a crosshead speed of 5 mm/min. The data were analyzed using 2-way analysis of variance and least significant difference post hoc tests (P < .05). RESULTS The effect of BAs on the FR was significant (P < .05); however, the effect of the IOB and the interactive effect of these variables were not significant (P > .05). The FR in the HP and PB groups was significantly different from the control (P < .05) but that of CP was not significantly different from the control (P > .05). CONCLUSIONS Mineral trioxide aggregate and calcium-enriched mixture act similarly to resin-modified glass ionomer as an IOB. CP, unlike HP and PB, did not significantly decrease the FR.
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Affiliation(s)
- Siavash Savadi Oskoee
- Dental and Periodontal Research Center, Dentistry Faculty, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Operative and Esthetic Dentistry, Dentistry Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmoud Bahari
- Dental and Periodontal Research Center, Dentistry Faculty, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Operative and Esthetic Dentistry, Dentistry Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Daneshpooy
- Department of Operative and Esthetic Dentistry, Dentistry Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir-Ahmad Ajami
- Department of Operative and Esthetic Dentistry, Dentistry Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdi Rahbar
- Dental and Periodontal Research Center, Dentistry Faculty, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Operative and Esthetic Dentistry, Dentistry Faculty, Tabriz University of Medical Sciences, Tabriz, Iran.
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Aktemur Türker S, Uzunoğlu E, Deniz Sungur D, Tek V. Fracture Resistance of Teeth with Simulated Perforating Internal Resorption Cavities Repaired with Different Calcium Silicate-based Cements and Backfilling Materials. J Endod 2018; 44:860-863. [PMID: 29550008 DOI: 10.1016/j.joen.2018.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/11/2018] [Accepted: 01/31/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This study assessed the fracture resistance (FR) of teeth with simulated perforating internal resorption cavities repaired with different calcium silicate-based cements (CSCs) and backfilling materials. METHODS Ninety-six mandibular premolar teeth were used. Twelve of the teeth were assigned as negative control group. Remaining roots were instrumented with rotary files, and standardized internal resorption cavities were prepared on the middle half of roots with burs. Twelve of the samples were not further interfered and were assigned as a positive control group. The apical 4 mm of the remaining 72 root canals was obturated with single-cone technique and divided into 6 groups according to CSCs used for repairing of cavities and backfilling materials as follows: MTA + MTA, MTA + gutta-percha/sealer, Biodentine + Biodentine, Biodentine + gutta-percha/sealer, MTA Plus + MTA Plus, and MTA Plus + gutta-percha/sealer. Specimens were embedded in acrylic resin and then subjected to fracture testing. The forces when the fracture occurred were analyzed with analysis of variance and Bonferroni tests at P = .05. RESULTS No significant difference was found among CSCs irrespective of backfilling materials (P > .05). Groups MTA + gutta-percha/sealer, Biodentine + gutta-percha/sealer, and MTA Plus + gutta-percha/sealer showed significantly lower FR compared with groups MTA + MTA, Biodentine + Biodentine, and MTA Plus + MTA Plus, respectively (P < .05). The highest FR was observed in group Biodentine + Biodentine, and the lowest was in group MTA Plus + gutta-percha/sealer. FR of positive control group was statistically lower than groups completely filled with CSCs (P < .05), whereas FR of negative control group was statistically higher than the groups combined with gutta-percha and sealer (P < .05). CONCLUSIONS The backfilling with CSCs may be a preferable material rather than gutta-percha/sealer combination for the roots with perforated internal resorptions.
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Affiliation(s)
- Sevinç Aktemur Türker
- Bülent Ecevit University, Faculty of Dentistry, Department of Endodontics, Zonguldak, Turkey.
| | - Emel Uzunoğlu
- Hacettepe University, Faculty of Dentistry, Department of Endodontics, Ankara, Turkey
| | - Derya Deniz Sungur
- Hacettepe University, Faculty of Dentistry, Department of Endodontics, Ankara, Turkey
| | - Vildan Tek
- Bülent Ecevit University, Faculty of Dentistry, Department of Endodontics, Zonguldak, Turkey
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Shetty S, Kahler SL, Kahler B. Alkaline Material Effects on Roots of Teeth. MATERIALS 2017; 10:ma10121412. [PMID: 29232874 PMCID: PMC5744347 DOI: 10.3390/ma10121412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/04/2017] [Accepted: 12/05/2017] [Indexed: 11/16/2022]
Abstract
The aim of this review was to identify and analyse all studies related to the effects of alkaline materials used in dentistry on roots of teeth. The first part of the review focused on mechanical property alterations of root dentine due to sodium hypochlorite (SH) used as an irrigant solution based on MeSH (Medical Subject Heading) terms from a previous study by Pascon et al in 2009. The second part reviewed literature on calcium hydroxide (CH), mineral trioxide aggregate (MTA) and other alkaline materials used as root canal dressings or filling materials. Additional MeSH terms used included "compressive strength", "elastic modulus" "flexural strength", "fracture strength" and "fracture resistance". The language filter was English. Of the initial 205 articles identified, 49 were included in this review, of which 29 were on SH, 21 on CH/MTA, and 1 relating to both. Many in vitro studies indicated a strong link between reduced mechanical properties of roots of teeth or radicular dentine treated with SH, and when sealers or root fillings with CH- or MTA-based materials were placed in contact with roots or radicular dentine. Recent literature indicates that the association between reduced mechanical properties and alkaline sealers and/or root-filling materials is not as straightforward as previously assumed, and requires further investigation using more valid experimental models.
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Affiliation(s)
- Sowmya Shetty
- School of Dentistry, The University of Queensland, Brisbane 4006, Australia.
| | - Sam L Kahler
- School of Biomedical Sciences, The University of Queensland, Brisbane 4006, Australia.
| | - Bill Kahler
- School of Dentistry, The University of Queensland, Brisbane 4006, Australia.
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Yilmaz Z, Küçükkaya Eren S, Uzunoğlu E, Görduysus M, Görduysus MÖ. Interaction of backfilling techniques and MTA plugs with additives: Fracture strength and adaptation analyses. Dent Mater J 2017; 36:809-815. [PMID: 28845036 DOI: 10.4012/dmj.2016-412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aims were to evaluate the effects of different additives on the adaptation of mineral trioxide aggregate (MTA) plugs before and after different backfilling techniques and analyze the interference of filling procedures on the fracture resistance of simulated immature teeth. The apical parts of 60 teeth were filled with MTA mixed with distilled water (DW), propylene glycol (PG) or calcium chloride (CaCl2) and backfilled with cold lateral condensation (CLC) or warm vertical compaction (WVC). The specimens were subjected to adaptation analysis and fracture testing. CaCl2 addition resulted in poor marginal adaptation, while PG addition significantly decreased the fracture values (p<0.05). WVC technique negatively affected the marginal adaptation of MTA-CaCl2 plugs and decreased the fracture values of teeth with MTA-PG plugs (p<0.05). Mixing MTA with DW can be recommended as apical plug when the remaining root canal space is going to be filled with either CLC or WVC techniques.
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Affiliation(s)
- Zeliha Yilmaz
- Department of Endodontics, Faculty of Dentistry, Hacettepe University
| | | | - Emel Uzunoğlu
- Department of Endodontics, Faculty of Dentistry, Hacettepe University
| | - Melahat Görduysus
- Department of Endodontics, Faculty of Dentistry, Hacettepe University.,RAK College of Dental Science, RAK Medical and Health Science University
| | - Mehmet Ömer Görduysus
- Department of Endodontics, Faculty of Dentistry, Hacettepe University.,University of Sharjah, College of Dental Medicine, Department of Preventive and Restorative Dentistry
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Linsuwanont P, Kulvitit S, Santiwong B. Reinforcement of Simulated Immature Permanent Teeth after Mineral Trioxide Aggregate Apexification. J Endod 2017; 44:163-167. [PMID: 29153732 DOI: 10.1016/j.joen.2017.08.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/02/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The objectives of this study were to compare the fracture resistance of simulated human immature teeth that have undergone mineral trioxide aggregate (MTA) apexification and have been root-filled with fiber post, composite resin, MTA, or gutta-percha. METHODS Fifty-six human permanent maxillary incisors were selected. Ten teeth received no treatment (intact teeth group). The root canals of 46 teeth were prepared to an internal diameter of 1.75 mm. Six teeth were used as simulated immature teeth group. The remaining teeth received MTA apexification and were divided into 4 groups: MTA, fiber post, composite resin, and gutta-percha groups. The root canals of each group were filled with each test material. All teeth were thermocycled and received cyclic loading before compression testing by an Instron universal testing machine. The load to fracture was recorded. Data were subjected to statistical analysis by using one-way analysis of variance and Tukey multiple comparison test. RESULTS All teeth fractured at the cervical area of the root. The mean load to fracture of the intact tooth, MTA, fiber post, composite resin, gutta-percha, and the simulated immature tooth groups was 1988 N, 1921 N, 1691 N, 1623 N, 1476 N, and 962 N, respectively. Statistically, load to fracture of the simulated immature tooth group was significantly lower than in the intact tooth, MTA, fiber post, and composite resin groups but was not significantly different from the gutta-percha group. CONCLUSIONS Within the limit of this study, after MTA apexification, intraradicular reinforcement with MTA, fiber post, or composite resin increased the fracture resistance of simulated immature teeth.
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Affiliation(s)
- Pairoj Linsuwanont
- Faculty of Dentistry, Department of Restorative Dentistry, Chulalongkorn University, Bangkok, Thailand.
| | - Sirinya Kulvitit
- Faculty of Dentistry, Department of Restorative Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Busayarat Santiwong
- Faculty of Dentistry, Department of Pediatric Dentistry, Chulalongkorn University, Bangkok, Thailand
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Long-Term Fracture Resistance of Simulated Immature Teeth Filled with Various Calcium Silicate-Based Materials. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2863817. [PMID: 27382564 PMCID: PMC4921621 DOI: 10.1155/2016/2863817] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 04/16/2016] [Accepted: 05/18/2016] [Indexed: 01/20/2023]
Abstract
Objective. The aim of this in vitro study was to evaluate the long-term fracture resistance of simulated human immature permanent teeth filled with BioAggregate™ (BA), mineral trioxide aggregate (MTA), and EndoSequence® Root Repair Material (ERRM). Material and Methods. 40 teeth, simulated to average root length of 13 ± 1 mm (Cvek's stage 3), were included in the study. The teeth were randomly divided into four groups: Group 1: DiaRoot® BA, Group 2: MTA-Plus™ (MTA-P), Group 3: MTA-Angelus (MTA-A), and Group 4: ERRM. The root canal filling materials were applied according to the manufacturers' instructions. After 24 months of incubation, the roots of the teeth were embedded in acrylic blocks and subjected to fracture testing. The resultant data were analyzed statistically by Kruskal-Wallis and Mann-Whitney U tests. Results. Mean (±SD) failure loads (MPa) were 20.46 ± 2.53 for BA, 18.88 ± 5.13 for MTA-P, 14.12 ± 1.99 for MTA-A, and 17.65 ± 4.28 for ERRM groups. BA group exhibited the highest and MTA-A group showed the lowest resistance to fracture. Significant differences in fracture resistance were found between the groups of BA and MTA-A (p < 0.001), MTA-P and MTA-A (p < 0.05), and ERRM and MTA-A (p < 0.05). Conclusion. Within the limitations of this study, data suggests that BA-filled immature teeth demonstrate higher fracture resistance than other groups at 24 months appearing to be the most promising material tested.
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