Apical and coronal seal of roots obturated with a dentine bonding agent and resin

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

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

Coronal and apical leakage among five endodontic sealers

PURPOSE

The aim of this study was to use dye penetration to measure apical and coronal leakage simultaneously in single-canal teeth that had been treated endodontically using a single-cone obturation technique.

METHODS

One hundred single-canal, extracted human teeth were cleaned and shaped with ProTaper NEXT rotary files to size-X5 (50/.06), then randomly assigned to five sealer groups for single-cone gutta-percha obturation. The teeth were soaked in 0.6% rhodamine B at 37°C for seven days, then the roots were ground mesiodistally and the maximum apical and coronal dye penetration was measured. Differences in leakage among the sealer groups were examined using the Kruskal-Wallis test. Pairwise comparisons were made using the Mann-Whitney test with Bonferroni correction.

RESULTS

The mean values (mm) of dye penetration for AH Plus, Pulp Canal Sealer, NeoSEALER Flo, EndoSequence BC, and Super-Bond RC Sealer were 0.200, 0.300, 0.675, 0.850, and 0.900 apically, whereas 1.675, 2.075, 4.800, 6.500, and 4.125 coronally. Pairwise comparisons showed significant apical differences between AH Plus/Super-Bond RC Sealer (P = 0.047) and significant coronal differences between AH Plus/NeoSEALER Flo (P = 0.001), AH Plus/EndoSequence BC (P < 0.01), AH Plus/Super-Bond RC Sealer (P < 0.01), Pulp Canal Sealer/NeoSEALER Flo (P = 0.010), Pulp Canal Sealer/EndoSequence BC (P < 0.01), and Pulp Canal Sealer/Super-Bond RC Sealer (P < 0.01).

CONCLUSION

Coronal leakage was worse than apical leakage for all sealers. AH Plus exhibited the least leakage apically and coronally; Super-Bond RC Sealer showed the most leakage apically, and EndoSequence BC showed the most leakage coronally.

Endodontic Treatment of a Traumatic Tusk Fracture With Exposed Pulp in an Asian Elephant (Elephas maximus)

Tusk fracture in elephants is a common incident often resulting in pulp exposure and pulpitis. Extensive lavage, endodontic therapy, direct pulp capping, or extraction are treatment options. In this report, the successful management of a broken tusk of a juvenile male Asian elephant (Elephas maximus) including morphological analysis of the tusk tip 2 years after surgery are presented. Treatment was carried out under barn conditions and included antimicrobial photodynamic therapy and partial pulpotomy with direct pulp capping. Immediate pain relief was reached. The fractured tusk was preserved and continued to grow. The therapeutic filling material remained intact for over 1 year but was absent 2 years after treatment. The former pulp cavity of the tusk tip was filled with reparative dentin, osteodentin, and bone, but the seal between these hard tissues and pulp chamber dentin was incomplete. Radiographs obtained 3 years after treatment showed no differences in pulp shape, pulp width, and secondary dentin formation between the treated right and the healthy left tusk. It can be concluded that in case of an emergency, the endodontic therapy of a broken elephant tusk can be attempted under improvised conditions with adequate success. Photodynamic therapy might contribute to prevent infection and inflammation of the pulp. The decision tree published by Steenkamp (2019) provides a valuable tool to make quick decisions regarding a suitable therapy of broken tusks.

Development of a novel direct dental pulp-capping material using 4-META/MMA-TBB resin with nano hydroxyapatite

In the case of dental pulp exposure, direct pulp capping is often performed to preserve vital dental pulp tissue. Numerous studies regarding the development of direct pulp-capping materials have been conducted, but materials with an appropriate sealing ability, which induce dense reparative dentin formation, have not been developed. Although nano hydroxyapatite (naHAp) is a bone-filling material with bioactivity and biocompatibility, the inductive effects of naHAp on reparative dentin formation remain unclear. In the present study, the effects of dental adhesive material 4-methacryloxyethyl trimellitate anhydride/methyl methacrylate tri-n-butylborane [4-META/MMA-TBB or Super-bond (SB)], which included 10%, 30%, and 50% naHAp (naHAp/SB) on odontoblastic differentiation of dental pulp stem cells (DPSCs) and reparative dentin formation were investigated. Scanning electron microscopy (SEM) and energy dispersive X-ray spectrometer analysis were performed to verify the existence of naHAp particles on the surface of naHAp/SB discs. The tensile adhesive strength of naHAp/SB was measured using a universal testing machine. As a result, 10% naHAp/SB and 30% naHAp/SB showed almost the same tensile adhesive strength as SB but 50% naHAp/SB showed significantly lower than the other experimental group. WST-1 proliferation assay and SEM analysis revealed that naHAp/SB did not affect the proliferation of DPSCs. Calcium release assay, quantitative RT-PCR, and western blotting analysis demonstrated that naHAp/SB did not release calcium ion but 30% naHAp/SB increased the expression of calcium-sensing receptor (CaSR) in DPSCs. Additionally, quantitative RT-PCR, western blotting analysis, Alizarin Red S- and von Kossa staining revealed that 30% naHAp/SB induced odontoblastic differentiation of DPSCs, which was inhibited by a MEK/ERK inhibitor and CaSR antagonist. Furthermore, 30% naHAp/SB promoted dense reparative dentin formation in an experimentally-formed rat dental pulp exposure model. These findings suggest that 30% naHAp/SB can be used as an ideal direct pulp capping material.

Evaluation of rheological behaviour of flowable dental composites reinforced with low aspect ratio micro-sized glass fibres

OBJECTIVE

Experimental investigation is carried out to determine the flowability and stickiness of the developed composite material for dental restoration containing low aspect ratio (AR ≤ 100) surface treated micro-sized glass fibres.

METHODS

Specimens are manufactured by mixing low AR (50/70/100) micro-sized glass fibres with two different weight fractions (5%/10%) into UDMA/TEGDMA based resin. Particulate filler composite (PFC) containing 55% glass fillers is used as the control group. Dynamic oscillatory strain sweep tests are conducted to analyse the linear viscoelastic behaviour. Solid-to fluidic transition behaviour of dental composites is also calculated in terms of flow and yield stresses. Furthermore, the oscillatory frequency sweep tests are conducted at three different strains (0.5%, 5% and 50%) resembling the positioning of unset paste onto restorations for different real-life clinical situations. Additionally, stickiness of dental composites with handling instrument (steel) and dentine covered with bonding agent is also evaluated.

RESULTS

The results suggested the all the FRC groups exhibited non-Newtonian, shear-thinning behaviour. It is further established that inclusion of 5% of 50/70AR fibres into dental composites does not affect the flowability. Simultaneously, stickiness with dentine covered with bonding agent is more for these two compositions as compared to that of handling instrument (steel).

SIGNIFICANCE

This study suggest that visco-elastic properties of dental composites are greatly affected by the type of filler (spherical shaped particulate fillers or rod-shaped fibres) as well as fibre weight fraction/fibre AR. This phenomenon can be attributed to the varying interactions between micro-sized fibres of different AR/weight fraction, particulate fillers and monomers.

Electrolyzed saline… an alternative to sodium hypochlorite for root canal irrigation

Objectives

The aim of this study is to evaluate electrolyzed saline, produced from a custom-made chair side apparatus for its cleaning effect on root canal walls.

Methods

A chair side apparatus has been designed to produce and dispense electrolytically activated solutions (Electrolyzed saline) for the purpose of root canal irrigation. Two different solutions, one, which is oxidizing in nature, consisting primarily of Chlorine derivatives and another, reducing in nature, consisting primarily of sodium hydroxide, are obtained. A combination of these two solutions was used for root canal irrigation in extracted teeth. Root canals were split and the samples were subjected to Scanning electron microscopic evaluation.

Results

Under the conditions of this study, electrolyzed saline significantly cleaned the root canal surfaces well, opening the dentinal tubules and removing the smear layer.

Significance

There has been a constant search for the ideal root canal irrigant. Sodium hypochlorite has been vastly used but its toxicity and storage risks are of concern. Electrolyzed saline has been produced from saline and the apparatus prepares and dispenses the solution chair side, obviating storage needs.

An assessment of coronal leakage of permanent filling materials in endodontically treated teeth: An in vitro study

Introduction:

The present in vitro study was undertaken to evaluate and compare the sealing ability of hybrid composite, glass ionomer cement type II, silver amalgam and Ketac molar as permanent filling material in root canal treated teeth.

Methodology:

Hundred maxillary central incisors were selected for the study. After cleaning all the teeth, root canal treatment was carried out on all of them. The crown portion was cut-off at the cervical level. Three millimeter of coronal Gutta-percha was replaced by four different restorative materials. Then after thermocycling, samples were immersed in dye for 2 weeks. The amount of dye penetration was measured using stereomicroscope. Data were collected and analyzed statistically with ANOVA test and Student–Newman–Keuls test.

Results:

Coronal leakage was seen in all groups. Composite hybrid showed least amount of microleakage as compared to the other three experimental groups, and Ketac molar showed more leakage compared to other experimental groups.

Conclusion:

This study showed that hybrid composites offer better sealing ability compared to other materials tested in this study.

Comparative evaluation of fracture resistance of root obturated with resilon and gutta-percha using two different techniques: an in vitro study

INTRODUCTION

Present study evaluated the fracture resistance of endodontically treated teeth filled with Gutta percha and a new resin based obturating material (Resilon).

MATERIALS AND METHODS

A total of 150 freshly extracted Mandibular premolar with fully formed apices were selected and decoronated at cemento-enamel junction (CEJ). Teeth were divided into Group A and Group B of 75 teeth each. In Group A canals were prepared up to # no 40 K file and Group B up to #no 80 K file. Both the groups were sub divided into five group of 15 teeth each as control group (unfilled canals), lateral condensation with Gutta-percha using AH 26 sealer, vertical condensation with Gutta-percha using AH 26 sealer, lateral condensation with Resilon using resilon sealer, vertical condensation with Resilon using resilon sealer. Each specimen was subjected to compressive load using Universal testing machine. The force required to fracture was recorded and data were analysed by ANOVA, Duncan's test and student T test.

RESULT

The result showed that there is statistically significant difference among experimental groups (p < 0.05). The groups with the Resilon material displayed higher mean fracture loads than the Gutta percha groups. No statistically significant differences were observed between different preparation techniques.

CONCLUSION

Obturating the canals with the new resin-based obturation material increases the in vitro fracture resistance of endodontically treated teeth when compared with standard Gutta percha techniques.

Bacterial leakage in root canals filled with AH Plus and dentine bonding agents

OBJECTIVE

The aim of this study was to compare the efficacy of different dentine adhesives in delaying the coronal bacterial leakage of Enterococcus faecalis in filled root canals. Materials and methods. Ninety-five lower incisors of patients >65 years of age were instrumented using the ProTaper system and were irrigated with 1 mL of 2.5% sodium hypochlorite (NaOCl) alternated with 1 mL 17% EDTA between each file change. Final irrigation was performed with 5 mL of 17% EDTA and then flushed with 5 mL of distilled water. The teeth were randomly divided into five experimental groups (n = 15/group) and one of the following dentine adhesives was applied: (1) AdheSE; (2) Excite DSC; (3) Clearfil Protect Bond; (4) One Coat 7.0; or (5) Control group without adhesive. After filling the root canals, the samples were mounted on a double chamber device to evaluate the bacterial filtration of E. faecalis during a period of 240 days. The results underwent non-parametric Kaplan-Meier survival analysis and comparisons among groups were done using the Log-Rank test.

RESULTS

At 240 days, E. faecalis was detected in samples of all groups in the lower chamber. The highest survival value was obtained by One Coat 7.0, giving statistically significant differences from the other groups, whereas Clearfil Protect Bond, AdheSE and Excite DSC showed similar behaviours, likewise similar to the Control group.

CONCLUSIONS

One Coat 7.0 adhesive system provides the longest survival value to delay E. faecalis coronal leakage in filled root canals.

Push-out bond strength of a self-adhesive resin cement used as endodontic sealer

OBJECTIVES

The aim of the present study was to investigate the bond strength of RelyX Unicem (3M) to root canal dentin when used as an endodontic sealer.

MATERIALS AND METHODS

Samples of 24 single-rooted teeth were prepared with Gates Glidden drills and K3 files. After that, the roots were randomly assigned to three experimental groups (n = 8) according to the filling material, (1) AH Plus (Dentsply De Trey GmbH)/Gutta-Percha cone; (2) Epiphany SE (Pentron)/Resilon cone; (3) RelyX Unicem/Gutta-Percha cone. All roots were filled using a single cone technique associated to vertical condensation. After the filling procedures, each tooth was prepared for a push-out bond strenght test by cutting 1 mm-thick root slices. Loading was performed on a universal testing machine at a speed of 0.5 mm/min. One-way analysis of variance and Tukey test for multiple comparisons were used to compare the results among the experimental groups.

RESULTS

Epiphany SE/Resilon showed significantly lower push-out bond strength than both AH Plus/Gutta-Percha and RelyX Unicem/Gutta-Percha (p < 0.05). There was no significant difference in bond strength between AH Plus/Gutta-Percha and RelyX Unicem/Gutta-Percha (p > 0.05).

CONCLUSIONS

Under the present in vitro conditions, bond strength to root dentin promoted by RelyX Unicem was similar to AH Plus. Epiphany SE/Resilon resulted in lower bond strength values when compared to both materials.

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

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

Comparative evaluation of intracanal sealing ability of mineral trioxide aggregate and glass ionomer cement: An in vitro study

Aims:

The purpose of this study was to compare the sealing ability of Mineral Trioxide Aggregate (MTA) and Glass Ionomer Cement (GIC) when used over gutta-percha as intracanal sealing materials. The study also evaluated the sealing ability of Zinc oxide eugenol (ZOE) cement and Acroseal sealer.

Materials and Methods:

Teeth were obturated with gutta-percha using sealer ZOE (group A, C, D) and Acroseal (group B). The groups were further divided into 2 subgroups (15 premolars each) on the basis of intracanal sealing material used: GIC subgroups (A1, B1) and MTA in subgroups (A2, B2). The clearing technique was used in this study for leakage evaluation. Seventy mandibular premolars were prepared using step-back technique and divided into experimental groups A and B (30 premolars each) and the positive and negative control groups C and D (5 premolars each).

Statistical analysis used:

Coronal microleakage was determined under stereomicroscope using 15X magnification. Data was statistically analyzed using one-way ANOVA followed by Post-Hoc Multiple comparison (Bonferroni).

Results:

MTA group leaked significantly less than GIC group (P < 0.05). Acroseal exhibited better sealing ability than ZOE sealer. Teeth with no intracanal barrier showed almost complete leakage.

Conclusions:

MTA may be preferred over GIC as an intracanal barrier.

Bond strength to radicular dentin and sealing ability of AH Plus in combination with a bonding agent

OBJECTIVE

To evaluate the sealing ability and bond strength of AH Plus sealer associated with the hybridization protocol of radicular dentin with Scotchbond Multi Purpose (SB).

MATERIALS AND METHODS

Ninety palatal roots of maxillary molars were selected and divided into three groups (n = 30) according to filling protocol (G1, AH Plus/Resilon; G2, SB/AH Plus/Resilon; and G3, AH Plus/Gutta-Percha). In groups in which AH Plus + resin cones were used, dentin was hybridized before applying sealing material. For the bond strength test, 60 roots of bovine teeth were selected. Six holes were made in each root, two in the cervical, middle and apical third of the root. The roles were filled with AH Plus sealer with or without an adhesive system and submitted to push out test and the fracture mode was examined using a stereomicroscope (×32).

RESULTS

Statistical analysis showed that ScotchBond Multi Purpose (SB) + Resilon cone + AH Plus group promoted higher sealing ability than the gutta-percha + AH Plus group (p < 0.05). Bond strength was lower with SB application than without it (p < 0.05). A reverse correlation was found between bond strength and sealing ability. The fracture mode methodology revealed 22.77% of adhesive, 11.67% of cohesive and 65.55% of mixture fractures for SBMP/AH Plus protocol, whereas the AH Plus protocol indicated 86.11% of cohesive and 13.89% of mixed fractures.

CONCLUSION

It was concluded that the use of the adhesive system Scotchbond Multi Purpose improved coronal sealing ability of AH Plus, but bond strength of sealer was reduced when adhesive was applied.

Comparative evaluation of microleakage of various retrograde filling materials: An in vitro study

OBJECTIVE

The present study is envisaged to evaluate and compare the microleakage of mineral trioxide aggregate (MTA) with commonly used retrograde filling materials, like light-cured composite with dentin-bonding agents, light-cured glass ionomer cement (LC GIC) and resin-modified zinc oxide eugenol.

MATERIALS AND METHODS

Ninety freshly extracted non-carious single-rooted human anterior teeth were used in the study. They were randomly divided into four experimental groups and two control groups of 15 each. Following the biomechanical preparation, all teeth were obturated and then the apices of the obturated teeth were resected by removing 3 mm of each apex at 90° to the long axis of the tooth with a straight fissure bur in a high-speed air-rotor handpiece with water coolant. A 3-mm-deep root end cavity was prepared and the root end fillings were placed as per the manufacturer's instructions and according to the groups divided. The samples were then immersed in 1% methylene blue at room temperature for 72 h, 96 h and 1 week and the dye penetration was measured.

RESULTS AND CONCLUSION

All the four materials used in the study showed some microleakage throughout the experimental period. The sealing ability in terms of microleakage can be summarized as: MTA > Composite resin with dentin bonding agent > LC GIC > Resin modified zinc oxide eugenol.

Cytotoxicity evaluation of three resin-based sealers on an L929 cell line

Background:

Endodontic sealers usually come in contact with adjacent tissues and their biocompatibility is key in a successful treatment. The purpose of this study was to assess the cytotoxicity of three resin-based sealers, namely AH Plus, EndoREZ, and Epiphany in set and fresh states on an L929 cell line.

Materials and Methods:

In this in vitro experimental study, the materials were mixed according to the manufacturers’ instructions, and were divided into two groups, fresh and set. The elutes of materials were prepared separately and were incubated with L929 fibroblasts for 1 hour, 24 hours, and 72 hours. Pulp Canal Sealer and Dulbecco's Modified Eagle Medium (DMEM) served as positive and negative controls respectively. Cell viability was evaluated by MTT assay ([3-4,5-dimethyl thiazol-2-yl]-2,5-diphenyltetrazolium bromide succinate), after 1 hour, 24 hours, and 72 hours. The data were analyzed by analysis of variance (ANOVA), and Tukey multiple comparison test.

Results:

After 1 hour, fresh Epiphany and fresh AH Plus were significantly more cytotoxic than their set samples. No significant difference was perceived between cytotoxicity of fresh state of sealers and positive control, or between set state and negative control. After 24 hours, both fresh and set samples of all materials were significantly more cytotoxic than the negative control group, and were less cytotoxic than the positive control group. After 72 hours, the fresh and set samples of all materials were as cytotoxic as the positive control group. At each time point, no significant difference was perceived among different materials in terms of cell viability.

Conclusion:

The observed differences among the cytotoxicity of AH Plus, EndoREZ, and Epiphany did not reach a significant level at comparable time points after exposure.

Qualitative SEM/EDS analysis of microleakage and apical gap formation of adhesive root-filling materials

Objective

The aim of this study was to compare the correspondence between gap formation and apical microleakage in root canals filled with epoxy resin-based (AH Plus) combined or not with resinous primer or with a dimethacrylate-based root canal sealer (Epiphany).

Material and Methods

Thirty-nine lower single-rooted human premolars were filled by the lateral condensation technique (LC) and immersed in a 50-wt% aqueous silver nitrate solution at 37ºC (24 h). After longitudinal sectioning, epoxy resin replicas were made from the tooth specimens. Both the replicas and the specimens were prepared for scanning electron microscopy (SEM). The gaps were observed in the replicas. Apical microleakage was detected in the specimens by SEM/energy dispersive spectroscopy (SEM/EDS). The data were analyzed statistically using an Ordinal Logistic Regression model and Analysis of Correspondence (α=0.05).

Results

Epiphany presented more regions containing gaps between dentin and sealer (p<0.05). There was correspondence between the presence of gaps and microleakage (p<0.05). Microleakage was similar among the root-filling materials (p>0.05).

Conclusions

The resinous primer did not improve the sealing ability of AH Plus sealer and the presence of gaps had an effect on apical microleakage for all materials.

Effect of various endodontic solutions on punch out strength of Resilon under cyclic loading

Background:

Before obturation, various endodontic solutions are used as a final rinse. These solutions might affect the bond strength of Resilon-Epiphany system. The aim of this study was to evaluate the effect of NaOCl (5.25%), chlorhexidine CHX (2%), EDTA solution (17%), and BioPure MTAD on push out bond strength of Resilon-Epiphany system.

Materials and Methods:

Seventy-five human premolar roots were prepared and divided on the basis of final endodontic solution rinse. The canals were obturated with Resilon-Epiphany system. All samples were restored using a fiber post system and indirect composite crown. The samples received 150 000 cycles of mechanical loading. Push out bond strength was performed in the apical third of root having Resilon obturation.

Results and Conclusions:

Different endodontic solutions tested, did not affected the push out bond strength of Resilon-Epiphany obturation system.

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

AIM

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

BACKGROUND

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

Effect of intra-orifice depth on sealing ability of four materials in the orifices of root-filled teeth: an ex-vivo study

Aim. To investigate the effect of orifice cavity depth on the sealing ability of Fusio, Fuji II, Fuji IX, and MTA“G”. Materials and Methods. Ninety-two canals in extracted mandibular premolars were prepared, obturated, and randomly grouped into 4 groups. Each group was subgrouped for a 2 mm and 3 mm orifice cavity depth (n = 10). The remaining roots were divided to serve as positive and negative controls (n = 6). Cavities of the 4 experimental groups were filled with the respective materials and subjected to methylene blue dye leakage. Linear leakage was measured in mm using a stereomicroscope. Statistical Analysis. Kruskall-Wallis test was used at P < 0.05, and t-test was done to compare 2 mm and 3 mm. Results. All tested materials leaked to various degrees. Significantly higher leakage score was found for Fuji IX, Fusio, Fuji II, and MTA “G” in a descending order, when the materials were placed at 3 mm depths. A significant difference was found in the leakage score between the 2 mm and 3 mm depths in all tested materials with the 3 mm depth showing a greater leakage score in all tested materials. Exception was in MTA “G” at 2 mm and 3 mm depths (0.551 mm ± 0.004 mm and 0.308 mm ± 0.08 mm, resp.). Conclusion. The null hypothesis should be partially rejected. Fusio and MTA “G” were affected by orifice cavity depth with regard to their sealing ability. MTA “G” had the least leakage when placed at 2 or 3 mm depths, and Fusio is the next when placed at 2 mm depth. Two millimeters orifice cavity depth is suitable for most adhesive orifice barrier materials.

Influence of different restorative techniques on the strength of endodontically treated weakened roots

Objective. Comparing effect of different restoration techniques on fracture resistance of compromised roots. Methods. Crowns of 100 single-rooted teeth were sectioned and 10 roots were kept as negative control group (Group 1). Remaining roots were instrumented and divided into one and positive control group of 10 samples (Group 2) and 4 experimental groups of 20 samples each. Group 3: roots were obturated with gutta-percha; Group 4: roots were restored with gutta-percha, composite, and glass fiber post; Group 5: roots were obturated with Resilon; Group 6: Roots were restored with Resilon, composite, and glass fiber post. Roots were weakened before obturation in groups 2, 3, and 5 and after obturation in groups 4 and 6. Fracture strengths were measured using Dartec testing machine and fracture load was recorded in kilo-Newton. Statistical analysis was done using ANOVA and Tukeys test. Results. The fractures resistance of restored roots was significantly higher in groups 4, 5, and 6 than in Groups 2 and 3. There were no significant differences between groups 1, 4, 5, and 6. Conclusions. Restoration of weakened roots with Resilon or bonding an intermediate composite resin to coronal radicular dentin and to glass fiber post increased their fracture resistance.

Influence of calcium hydroxide intracanal medication on bond strength of two endodontic resin-based sealers assessed by micropush-out test

AIM

To evaluate the influence of calcium hydroxide (CH) paste used as intracanal medication on the bond strength of AH Plus (AH) and Epiphany (EP) sealers to root dentin.

METHODOLOGY

Sixty palatal canals were prepared in human maxillary first molars, using a rotary system. Half of the specimens received distilled water, and the other ones received intracanal medication with CH for 14 days. Thereafter, the CH was removed and both groups were further divided into two subgroups, filled with either AH or EP. The test specimens were submitted to the micropush-out test at a speed of 0.5 mm min(-1) . Results were statistically analyzed with anova and Tukey's test at a 95% confidence level.

RESULTS

The use of CH had statistically significant (P < 0.05) influence on AH only, increasing its bond strength from 19.7 ± 4.5 to 23.8 ± 2.5 (mean ± SD in MPa). In both EP groups, with (1.8 ± 0.5 MPa) and without (1.5 ± 0.9 MPa) CH, the bond strength values were statistically significantly lower than in either of the AH groups (P < 0.05).

CONCLUSION

Calcium hydroxide used as intracanal medication for 14 days had a positive influence on the bond strength of AH to root dentin whereas the effect on EP was insignificant. Regardless of the intracanal medication used, AH showed considerably higher bond strength values compared with EP sealer.

Fracture resistance of teeth obturated with Gutta percha and Resilon: An in vitro study

Aim:

The aim of this study was to evaluate and compare the fracture resistance of endodontically treated teeth filled with gutta percha and Resilon.

Materials and Methods:

A total of 60 freshly extracted single rooted teeth are selected and their anatomical crown removed at the CEJ. All samples were instrumented with the Step-back technique. Samples were randomly divided into three groups of 20 samples each: Group A obturated by lateral condensation with gutta percha and AH plus sealer, Group B obturated by lateral condensation with Resilon; Group C recieved no filling. Restored teeth were subjected to compressive loading in a universal testing machine. The results of fracture resistance recorded and statistical analysis done.

Results:

The mean and SD values for the groups are as follows: Group A-536.555 ± 128.816, Group B- 885.943 ± 194.410 and Group C- 591.066 ± 68.97. It was seen that samples of Group B showed the highest fracture resistance followed by Group C. Group A showed the least fracture resistance.

Conclusion:

The results of this study showed that filling the canals with Resilon increased the in vitro resistance to fracture of endodontically treated single canal teeth when compared with gutta percha.

Comparative evaluation of the apical sealing ability and adaptation to dentine of three resin-based sealers: An in vitro study

OBJECTIVE

To evaluate the apical sealing ability and adaptation of three resin-based sealers to the dentine.

MATERIALS AND METHODS

A total of 66 recently extracted human maxillary anterior teeth were subjected for the study. The teeth were prepared and obturated with gutta-percha by a lateral condensation using AH Plus, Endorez and Epiphany sealers. Fifteen teeth from each group were used for the apical leakage test and the remaining five teeth from each group were used for examination under the scanning electron microscope. Data were analyzed using one-way ANOVA and the Student Newman-Keuls test.

RESULTS

Epiphany sealer showed better sealing ability and adaptation to dentine.

CONCLUSION

The Epiphany sealer has a better apical sealing ability and adaptation to dentine than the AH Plus and Endorez sealers.

Physicochemical properties, sealing ability, bond strength and cytotoxicity of a new dimethacrylate-based root canal sealer

BACKGROUND/PURPOSE

Resin-based root canal sealer can bond to dentin and establish a hermetic seal. The aim of this study was to evaluate the physicochemical properties, sealing ability, cytotoxicity and bond strength of a new resin-based root canal sealer (NRCS).

METHODS

The physicochemical properties were assessed by the flow, setting time, solubility, film thickness, radiopacity and dimensional changes. Sixty premolar root samples were filled with either Resilon/NRCS or Resilon/Epiphany and sectioned perpendicularly at the long axis at 2 mm below the cemento-enamel junction into 1-mm serial slices. The bond strength was tested by a universal testing machine. The glucose microleakage model was used to test the sealing ability. Elutes of NRCS and Epiphany were co-cultured with human periodontal ligament cells to test the cytotoxicity.

RESULTS

All the physicochemical properties of NRCS conformed to ISO 6876:2001(E). The root samples filled with Resilon/NRCS had significantly less leakage (p < 0.01) and greater bond strength (p < 0.001) than the Resilon/Epiphany group had. Environmental scanning electron microscopy showed that Resilon/NRCS filling material was intimately bonded to the root dentin. Although NRCS was slightly toxic to human periodontal ligament cells, its cytotoxicity was significantly less than that of Epiphany (p < 0.01)

CONCLUSION

NRCS has better physicochemical and sealing properties, as well as lower cytotoxicity and microleakage than Epiphany has.

[Comparative evaluation of sealing ability of different obturation materials]

INTRODUCTION

Root canal filling materials are intended to prevent microleakage and passing of microorganisms and their toxins along the root canal space and into the periradicular tissues.

OBJECTIVE

Objective of this in vitro study was to evaluate and compare apical leakage of root canals obturated using a modified warm vertical condensation technique and different materials.

METHODS

Sixty-five extracted single-root teeth were prepared according to the crown-down/ step-back technique. Each canal was rinsed with 3% NaOCl during and after the preparation. The teeth were divided into 3 groups. Every group was obturated by the same technique, but with different materials: RealSeal system (SybronEndo), gutta-percha with AH Plus (Dentsply Maillefer) and gutta-percha with Acroseal sealer (Septodont). The remaining 20 teeth were in the control group. The teeth were immersed in 1% methylene blue for 72 hours. After that period, the roots were split longitudinally, and dye penetration was measured using a stereomicroscope.

RESULTS

Dye penetration occurred in all groups. The least dye penetration occurred in the RealSeal group (0.33 +/- 0.29 mm), while the highest dye penetration occurred in the Acroseal group (1.11 +/- 0.52 mm). According to the Student's t-test, Acroseal showed significantly more leakage (p < 0.001) than RealSeal and AH Plus materials. The microleakage of RealSeal system was not significantly different (p > 0.05) from that of AH Plus sealer with gutta-percha.

CONCLUSION

The results suggested that new material Resilon (RealSeal) and conventional combination AH Plus with guttapercha had the least apical dye penetration and provided the best sealing.

Resin materials for root canal obturation

With the appearance of more in vivo and ex vivo publications, methacrylate based resin sealers are becoming more popular in endodontics. Their ease of use and favorable clinical performance offer an attractive alternative to conventional endodontics. This article reviews the development of resin-based sealers and biocompatibility tests. The many, mostly opposing views are analyzed to put what has been published thus far in perspective. A critical analysis of the facts leads to the consensus that methacrylate based resin sealers are here to stay and offer a suitable alternative to conventional endodontic treatment.

Evaluation of microleakage following application of a dentin bonding agent as root canal sealer in the presence or absence of smear layer

The aim of this study was to compare the apical leakage of roots obturated with gutta-percha using either an epoxy resin sealer (AH26) or a dual cure dentin binding agent (Excite DSC) as sealer in the presence or absence of smear layer with fluid filtration method. The canals of eighty-six, single-rooted premolars were instrumented until a #40 K-file fit at working length and then randomly divided into four groups (n = 20) with the remaining six used as controls. Groups 1 and 2 were filled with gutta-percha using AH26 as sealer; groups 3 and 4 were filled with gutta-percha and Excite DSC as sealer. Groups 1 and 3 were smear layer-positive, while group 2 and 4 were designated as smear layer-negative. After 3 days and 3 months, the samples were connected to a fluid filtration system. Analysis of data with the paired t-test showed that microleakage in AH26 groups (with and without smear layer) decreased significantly at 3 months compared to 3 days; however, in the DBA groups, the amount of microleakage at 3 days and 3 months was not significantly different. According to the results of this study, DBA (Excite DSC) had better apical sealing ability and could be applied clinically.

Chronologic comparison of root dentin moisture in extracted human teeth stored in formalin, sodium azide, and distilled water

This study quantified in vitro the root dentin moisture when 10% formalin (group A), 3% sodium azide (group B), and distilled water (group C) were used as teeth storage media. The root dentin moisture of 66 extracted human mandibular single-rooted teeth was measured at baseline (day 0) and at 1, 3, 7, and 14 days using a digital grain moisture meter. The baseline dentin moisture value was used as covariate in the generalized estimating equation (GEE) analysis. The mean dentin moisture values (%) +/- SD on days 0, 1, 3, 7, and 14 were, respectively: 10.6 +/- 0.64, 14.3 +/- 0.71, 14.6 +/- 0.84, 14.4 +/- 0.64, and 14.7 +/- 0.75 in group A; 11.4 +/- 0.94, 14.6 +/- 0.95, 14.6 +/- 0.76, 14.6 +/- 0.93, and 14.8 +/- 0.81 in group B; and 10.2 +/- 0.95, 12.8 +/- 0.90, 13.3 +/- 0.95, 13.0 +/- 0.91, and 13.2 +/- 0.89 in group C. The dentin moisture increased in all 3 groups; however, there was no overall significant difference in moisture between the formalin and sodium azide groups.

Root dentin body moisture changes caused by ascorbic acid

OBJECTIVES

To quantify in vitro the root dentin moisture (DM) when soaked in 10% ascorbic acid solution (Group A) and distilled water (Group B) for up to 14 days.

METHODS

Forty-four extracted human mandibular single-rooted teeth were sectioned perpendicular to the long axis at the CEJ to access the root dentin. The samples were divided into Groups A and B. Baseline (day 0) DM was measured using a digital grain moisture meter. One sample was placed in each tube, which was then filled with solution. All tubes were kept at 37 degrees C and 100% humidity. DM was measured after 1, 3, 7, and 14 days. The baseline DM value was used as a covariate in the generalized estimating equation (GEE) analysis to account for the difference in the baseline DM between the two groups.

RESULTS

The mean DM (%) values+/-standard deviation on days 0, 1, 3, 7, and 14 were 11.4+/-1.08, 17.1+/-0.87, 18.2+/-0.76, 18.4+/-0.77, and 17.9+/-0.90 in Group A, and 10.2+/-0.95, 12.8+/-0.90, 13.3+/-0.95, 13.0+/-0.91, and 13.2+/-0.89 in Group B, respectively. Group A had significantly higher baseline DM than Group B (p=0.006). After adjusting for differences in the baseline, the GEE analysis indicated that, on average, Group A had a significantly higher increase in DM than Group B, with means+/-standard deviation of 4.35+/-0.26.

CONCLUSIONS

The moisture increase in the ascorbic acid group was greater than that in the distilled water group. Soaking root dentin in the unreplenished ascorbic acid solution or distilled water beyond 3 days did not further increase DM.

A rapid nondestructive method for root dentin moisture measurements: in vitro pilot study

Dentin moisture content is important in adhesive bonding and structural strength research; however, there is no rapid method available to assess dentin moisture without sample destruction. This study examined the use of a digital grain moisture meter to measure root dentin moisture in vitro. Extracted mandibular single-rooted teeth were sectioned at the CEJ. The moisture of the root dentin was measured at 6 measuring modes for different grains and repeated 5 times. Dentin weight changes before and after drying were measured to obtain control values. The control values were compared with machine readings. In conclusion, (1) each nondestructive measurement took less than 30 seconds, (2) 24 hours of storage at 37 degrees C and 100% humidity did not restore dentin moisture, and (3) 5 grain modes had a high validity and could be used for dentin moisture measurements.

Apical sealing ability of Resilon/Epiphany versus gutta-percha/AH Plus: immediate and 16-months leakage

AIM

To compare the long-term apical sealing ability of gutta-percha/AH Plus and Resilon/Epiphany.

METHODOLOGY

The root canals of 90 single-rooted human mandibular premolars with single narrow root canals were prepared with ProFile 0.4 taper instruments to apical size 40. After each instrument, the canals were irrigated with 1% sodium hypochlorite. Subsequently, the teeth were randomly divided into four groups containing 20 teeth each. Additionally, 10 prepared premolars served as positive and 10 counterparts with intact crowns as negative controls. The root canals were filled with gutta-percha/AH Plus or Resilon/Epiphany using lateral or vertical compaction. Specimens were allowed to set for 7 days at 37 degrees C and 100% humidity. Subsequently, the root fillings were removed down to the apical 4 mm. Fluid movement was then assessed using a fluid transportation model and re-evaluated after 16 months of water storage. Leakage within and between groups was compared using nonparametric tests.

RESULTS

Negative controls revealed no fluid movement and positive controls displayed gross fluid movement at both times of observation. At the immediate measurement, there were no significant differences between the experimental groups (Kruskal-Wallis, P > 0.05). Gutta-percha/AH Plus fillings retained their seal after 16-months storage (Wilcoxon, P > 0.05), whilst the Resilon/Epiphany groups lost their sealing capacity (Wilcoxon, P < 0.001). In these groups, 29 of the 40 specimens exhibited gross leakage similar to positive controls.

CONCLUSION

Initially, Resilon/Epiphany root fillings prevented fluid movement to the same degree as gutta-percha/AH Plus counterparts, but showed more fluid movement when tested at 16 months.

Radiopacity of root filling materials using digital radiography

AIM

To evaluate radiopacity of root filling materials using digital radiography.

METHODOLOGY

The sealers tested were AH Plus, Endofill, EndoREZ and Epiphany. Gutta-percha (Dentsply Maillefer) and Resilon cones were also tested. Acrylic plates, containing six wells, measuring 1 mm in depth and 5 mm in diameter, were prepared for the test, and filled with the materials. The test samples were radiographed together with an aluminium stepwedge calibrated in millimetres, according to ANSI/ADA Specification 57. For the radiographic exposures, digital imaging plates and an X-ray machine at 70 kVp and 8 mA were used. The object-to-focus distance was 30 cm, and the exposure time, 0.2 s. After the laser optic reading process, the software determined the radiopacity of the standardized areas, using grey-scale values, calculating the average radiographic density for each material.

RESULTS

The decreasing values of radiopacity of the studied materials, expressed in millimetres of aluminium equivalent, were: Resilon (13.0), AH Plus(TM) (11.2), gutta-percha (9.8), Epiphany (8.0), Endofill (6.9) and EndoREZ (6.6).

CONCLUSION

All materials had radiopacity values above 3 mm of aluminium recommended by ANSI/ADA Specification 57.

Cytotoxicity of new resin-, calcium hydroxide- and silicone-based root canal sealers on fibroblasts derived from human gingiva and L929 cell lines

AIM

To assess ex vivo the cytotoxic effects of five new root canal sealers (RC Sealer, Epiphany, EndoREZ, GuttaFlow and Acroseal) and three existing products (AH Plus, RoekoSeal and Apexit) using primary human gingival fibroblasts (HGF) and a mouse fibroblast cell line, L929.

METHODOLOGY

Eight samples of each sealer were fabricated in sterile cylindrical Teflon blocks, 4.4 mm diameter and 2 mm height and then divided into two groups, fresh and aged specimens. Extraction of fresh specimens was carried out after setting whilst aged specimens were placed in Petri dishes and kept in a humid chamber at 37 degrees C for 7 days before extraction in cell culture medium using the ratio 1.25 cm(2) mL(-1). Undiluted eluates were used for the dimethylthiazol diphenyltetrazolium bromide (MTT) assay with HGF and L-929. Morphology of HGF cells was also examined by an inverted microscope using undiluted eluates of the sealers. The results were analysed using a two-tailed t-test (alpha = 0.05) between groups.

RESULTS

Resin-based (Epiphany and EndoREZ) and calcium hydroxide-based (Apexit and Acroseal) sealers were significantly more cytotoxic than other sealers (P<0.05). However, L929 cells were more sensitive to Apexit and EndoREZ than HGF cells. RC Sealer showed mild cytotoxicity to HGF at both setting times. AH Plus did not exert any cytotoxic effect to HGF and aged specimens appeared to induce cellular proliferation. RoekoSeal and GuttaFlow also demonstrated mild cytotoxicity. GuttaFlow was slightly more cytotoxic to both cultures, especially when tested fresh.

CONCLUSIONS

Toxicity varied but RC Sealer and GuttaFlow were the least toxic new sealers.

Influence of resin-based adhesive root canal fillings on the resistance to fracture of endodontically treated roots: an in vitro preliminary study

OBJECTIVE

The aim was to investigate the root reinforcing capability of the resin-based RealSeal.

STUDY DESIGN

In two groups (n=36) canals were instrumented with nickel-titanium rotary GTfiles or with hand K-files. Twelve teeth from each group were obturated with lateral compaction using either gutta-percha and AHPlus or RealSeal. The canals of twelve teeth of both groups were instrumented but not filled. Group 3 (n=12) acted as uninstrumented controls. The force required to fracture the roots was measured. ANOVA and Scheffé test were used for statistical analysis.

RESULTS

The intact roots were significantly stronger than both groups with instrumented and unobturated roots (P<.05). Between the roots of both groups obturated with RealSeal and the intact roots there were no significant differences (P>.05). The roots obturated with RealSeal were significantly stronger than those obturated with gutta-percha and AHPlus (P<.05).

CONCLUSIONS

An obturation with RealSeal significantly increases the fracture resistance of instrumented roots.

Sealing Ability of New Adhesive Root Canal Filling Materials Measured by New Dye Penetration Method

The sealing ability of new adhesive root canal filling materials was evaluated using a new dye penetration method. Twenty-eight single-rooted mandibular premolars were randomly divided into four groups of seven teeth each and filled by lateral condensation using one of these combinations: Resilon point with Epiphany sealer (RE); gutta-percha point with Sealapex sealer (GS); gutta-percha point with dentin activator and Superbond sealer (GDS); or gutta-percha point with Accel primer, dentin activator, and Superbond sealer (GADS). Amount of 0.06% methylene blue dye solution (MB) that leaked from the coronal portion to the apical area was measured with a spectrophotometer at one, four, eight, 15, and 30 days in an accumulative manner. The total amount of leaked MB on day 30 was significantly higher for GDS than the other combinations (p < 0.05).

An In Vitro Evaluation of the Apical Sealing Ability of a New Resin-Based Root Canal Obturation System

The purpose of this study was to assess the apical sealing ability of the new resin-based Epiphany-Resilon root canal filling system, and to compare this with the sealing abilities of different pairings of AH plus, gutta-percha, Epiphany, and Resilon. Seventy extracted human single-rooted teeth were used. All teeth were instrumented using a set of ProTaper rotary instruments. The canal spaces were filled with different combinations of core and sealer using lateral condensation, as follows: group 1, AH Plus + gutta-percha; group 2, AH Plus + Resilon; group 3, Epiphany + Resilon; group 4, Epiphany + gutta-percha. Apical leakage quantity was measured with the computerized fluid filtration meter. Statistical analysis indicated that Epiphany gutta-percha combination had the least amount of microleakage than all the other groups; AH Plus gutta-percha combination proved to have second least amount of microleakage among the groups. AH Plus-Resilon combination demonstrated the greatest amount of microleakage. There were a significant difference between Epiphany gutta-percha and AH Plus-Resilon combinations (p < 0.05). It was found that there were no significant differences between Epiphany-Resilon combination and all the other groups (p > 0.05).