Comparative evaluation of a novel smart-seal obturating system and its homogeneity of using cone beam computed tomography: In vitro simulated lateral canal study

A Comparative Evaluation of Push-Out Bond Strength of Six Different Root Canal Sealers: An In-Vitro Study

BACKGROUND

Adhesiveness with radicular dentin is absent with gutta-percha, leading to microleakage and hence re-infection. Root canal sealer helps to achieve an adhesive interface between gutta-percha and root dentin thereby resisting the displacement forces during the functioning of teeth which is evaluated by the push-out test. The aim of this study is to compare the push-out bond strength and to assess the relative bond failure between dentin-sealer, sealer-main cone of (1) epoxy resin, (2) silicon, (3) mineral trioxide aggregate (MTA), (4) calcium hydroxide, (5) bioceramic, (6) zinc oxide eugenol containing root canal sealers.

METHODOLOGY

Sixty human permanent lower premolars with one root were collected, disinfected, and decoronated at cemento-enamel junction. Instrumentation was done with a K3 40,0.06 Ni-Ti rotary file and obturated using the main cone and sealer. Based on the sealer utilized, six groups were created: Group 1: AH-Plus, Group 2: RoekoSeal, Group 3: MTA Fillapex, Group 4: Apexit, Group 5: Smart Paste Bio, and Group 6: Procosol. One slice each was obtained from the coronal, middle, and apicalsections of all the obturated canals. Push-out bond strength and failure modes were studied. Statistics involved analysis of variance (ANOVA) followed by the post hoc Tukey test.

RESULTS

All three sections exhibited the highest strength for Smart Paste Bio sealer and the least was for RoekoSeal. With all the sealers, the apical section had the highest strength followed by the middle and coronal.

CONCLUSION

The smart seal system was superior to all other sealers and displayed a good bond to dentin.

Sealing Ability Comparison of Three Different Obturating Systems to Intraradicular Dentin-An In Vitro Stereomicroscopic Study

Background

Different obturation techniques are being used to improve canal sealing, thereby minimizing marginal leakage.

Aims and Objectives

To evaluate the marginal leakage of three different obturating materials and techniques using stereomicroscope.

Materials and Methods

Thirty freshly extracted maxillary anterior teeth were collected and were divided into three groups of 10 each for which the biomechanical preparation was done. The teeth were divided into three experimental groups according to the obturation material and technique used, Group I: gutta-percha with AH Plus root canal sealer (lateral condensation): Group II: thermoplasticized gutta-percha technique-non-carrier-based (calamus) with AH Plus sealer (backfill): Group III: C point (self-sealing root canal obturating system) with bioceramic sealer (single cone). Each specimen was subjected for testing apical sealing ability. The values of microleakage associated with different root canal sealers were evaluated using a stereomicroscope.

Results

There was no statistically significant difference in the mean scores of apical dye penetration/leakage among all the three groups (P = 0.091), whereas Group I showed a higher degree of apical leakage than the other techniques tested.

Conclusion

None of the tested filling materials provided a gap-free or void-free root canal filling; however, thermoplasticized gutta-percha is used with AH Plus sealer exhibited less voids and gaps when compared to other tested materials.

Be Smart and Active in Conservative Dentistry and Endodontics

Numerous aspects of dentistry have been transformed by smart materials. In recent years, there have been advancements in dental materials that exhibit improved biological compatibility. These materials are specifically designed to interact effectively with the fluids found in the oral cavity, including saliva and gingival crevicular fluids. The search for the optimum restorative material results in the development of a more recent generation of dental materials known as smart materials. Smart materials react to stimuli, including stress, temperature, moisture, pH, electric field, and magnetic field, in a regulated way. Some of them are biomimetic and can imitate the dentin and enamel seen in natural teeth. These resources herald the start of a new era in dentistry known as "Smart Dentistry," and they project a promising future in terms of improved dependability and efficiency. These types of diverse materials can pick up and perform definite functionalities regarding adjustments in the nearby surroundings. Based on their capacity for recognition, analysis, and discrimination, these materials might be able to foresee problems in the near future. The superior biocompatibilities of smart materials, which have brought about a new generation of biosmart dentistry, are a crucial component of their utilization in numerous dental applications. We should use any material with intelligence as we progress in innovation and advanced technology. Additionally, we should purposefully incorporate intelligence into existing materials through design. Smart materials have proven advantageous in the field of dentistry, particularly in restorative applications. Various dental products, including smart composites, resin-modified glass ionomer materials, pit, and fissure sealants releasing amorphous calcium phosphate (ACP), smart ceramics, and compomers have all witnessed positive advancements due to the integration of smart materials.

Can Type of Instrumentation and Activation of the Final Irrigant Improve the Obturation Quality in Oval Root Canals? A Push-Out Bond Strength Study

Simple Summary

The complete instrumentation of oval root canals remains practically unattainable. The majority of studies show that shaping oval, flat, and irregularly shaped canals is challenging, with more than half of the root canal area remaining unaltered. Furthermore, both rotary and reciprocating files compact hard tissue debris into the isthmus areas and buccal and/or lingual recesses of oval canals, impairing debridement and filling. In addition, one of the most essential variables in assessing the success of endodontic therapy is the adhesion of root canal filling material to dentin.

Abstract

To appraise the outcome of file systems and activation of the final irrigant on the push-out bond strength of root fillings in oval canals. Single-rooted mandibular premolars (n = 180) with oval canals were divided into three groups (n = 60) for instrumentation: ProTaper Next (PTN), WaveOne (WO), and Self-adjusting File (SAF). The specimens were further divided into subgroups (n = 20) and subjected to final irrigation with activation by EndoActivator or passive ultrasonic irrigation or without activation. Then, the specimens were again subdivided (n = 10) and obturated with gutta-percha and AH Plus (GP-AH) or C-Point with EndoSequence bioceramic sealer (C-EBC). One-millimeter-thick horizontal slices were cut from the apical third of the root, 5 mm from the apex, and subjected to push-out bond strength (BS) testing. Specimens for which SAF was used exhibited higher BS values than those for which PTN or WO was used (p < 0.05). Activation of the final irrigation did not affect the BS of the root fillings. Root fillings made of C-EBC presented a higher BS than those made of GP-AH (p < 0.05). Adhesive failure was more common with specimens instrumented using PTN and WO. Root canals instrumented with SAF, showed the highest bond strength values for both root filling materials. The C-EBC produced significantly higher bond strength values than those of the GP-AH.

Assessment of Quality of Root Canal Filling with C Point, Guttacore and Lateral Compaction Technique: A Confocal Laser Scanning Microscopy Study

Objective:

The purpose of this in vitro study was to compare the quality of root canal filling of C Point, GuttaCore and lateral compaction using confocal laser scanning microscopy.

Methods:

Ninety recently extracted human mandibular incisors with single canal were selected. Canals were prepared with ProTaper instruments to size F3 and obturated using C Point, GuttaCore or lateral compaction technique. Endosequence BC sealer was labeled with Rhodamine B dye to allow analysis under a confocal microscope. The percentages of gutta-percha filled area (PGFA), sealer filled area (PSFA), voids (POV) and interfacial adaptation (IA) was assessed at 2, 5 and 8 mm from the apex, using image analysis software. Kruskal–Wallis followed by Mann Whitney U tests were used for data analysis, and the P value was set at 0.05 (P=0.05).

Results:

No significant difference was seen among the three groups at 2 mm level for PGFA, PSFA and voids (P>0.05). At 5 and 8 mm levels, canals filled with GuttaCore had significantly higher PGFA and lower PSFA than lateral compaction and C Point. Highest POV was seen for lateral compaction group followed by C Point and GuttaCore.

Conclusion:

Out of the three techniques examined, best results in terms of quality of root canal filling were observed for GuttaCore. C Point system was found to be associated with internal defects such as tears and delamination which may adversely affect the long term performance of this system.

Bacterial Percolation and Sealer Tubular Penetration in a Polymer-based Obturation System Compared with Warm Vertical Condensation Technique: An in Vitro Study

Introduction

This study compared bacterial percolation and sealer penetration of a novel obturation technique with the ones of warm vertical condensation technique.

Methods and Materials

A bacterial percolation test was carried out with 80 single rooted human teeth divided into 5 groups; A (n=20): warm vertical condensation and AH-Plus, B (n=20): CPoint with AH-Plus, C (n= 20): CPoint with EndoSequence BC, +ve Control (n=10): teeth with no canal obturation, -ve Control (n=10): teeth with no access cavity. The samples were inoculated with a multispecies bacterial incoulum. Bacterial percolation was evaluated by turbidity. Confocal laser scanning microscopy (CLSM) was used to observe the presence of gaps and voids. Further 48 extracted human mandibular single-canal premolars were used to determine the sealer penetration. Slices of the samples were observed by CLSM to evaluate tubules penetration of the sealer. Kaplan Meyer survival, ANOVA one way and Tuckey HSD test and a Wilcoxon signed-rank test were utilised.

Results

A Kaplan-Meier test showed no significant difference overall (P>0.05) between groups A, B and C. At 43 days, the group B showed a significantly inferior ability to prevent bacterial passage (P<0.05). The group C showed a deeper sealer penetration than group A and B with statistically significant differences (P<0.05) for the total penetration (ANOVA one way and Tukey HSD). A Wilcoxon signed-rank test showed statistically significant differences for the penetration in the middle-and apical third of the 3 groups.

Conclusion

Based on this in vitro study, the single polymer-cone obturation technique with a resin based- and bioceramic based-sealer behaved similarly to the warm vertical obturation technique in preventing bacterial passage. The bioceramic sealer showed the deepest penetration but did not fully prevent bacterial leakage.

Hermetic Seal in Obturation: An Achievable Goal with Recently Introduced Cpoint

Aim and objectives

To evaluate and compare the dentinal microcrack formation after obturation using CPoint and gutta percha as root canal filling materials.

Materials and methods

Forty orthodontically extracted single-rooted premolars were selected. The teeth were decoronated and were then divided into four groups (n = 10). In group I, samples were left unprepared and unfilled (negative control), in group II, samples were prepared and left unobturated (positive control), in group III, samples were prepared and obturation was done with Cpoint (F3) and endosequence bioceramic sealer, and in group IV, samples were prepared and obturation was done with Protaper gutta percha (F3) and endosequence bioceramic sealer. Then, the samples were kept for 1 week at 37°C and 100% humidity. All roots were then sectioned at 2 mm from the apex. Additional cross sections at a 4 mm level were made in groups III and IV. Then, the sections were observed under a scanning electron microscope and the presence of dentinal microcracks was checked.

Results

There was statistically nonsignificant difference for a mean number of microcracks in the samples after obturation with CPoint and gutta percha.

Conclusion

CPoint can be used as an alternative to gutta percha as it provides better seal because of its lateral hygroscopic expansion without causing significant damage to the dentinal microstructure.

Clinical significance

In spite of gutta percha being the gold standard in obturating material, still the desired hermetic seal could not be achieved. To achieve this attainable goal, a new material CPoint had been introduced, which has the ability to undergo hygroscopic expansion within the root canal.

How to cite this article

Somani R, Jaidka S, Singh DJ, et al. Hermetic Seal in Obturation: An Achievable Goal with Recently Introduced Cpoint. Int J Clin Pediatr Dent 2019;12(5):410-413.

Comparison of push-out bond strength of three different obturating systems to intraradicular dentin: An In vitro study

Background:

To increase the push-out bond strength of endodontic materials, newer obturation materials and obturation techniques are being introduced.

Aim:

The present study aimed to evaluate the push-out bond strength of three different obturating materials using a universal testing machine (UTM).

Materials and Methods:

A total of thirty freshly extracted maxillary anterior teeth were collected and randomly divided into three groups of ten each. Biomechanical preparation was done in all the teeth, and they were then divided into three experimental groups according to the obturation material and technique used, as follows: Group I: gutta-percha (GP) with AH Plus root canal sealer (lateral condensation); Group II: thermoplasticized GP technique – noncarrier based (CALAMUS^®) with AH Plus sealer (backfill); and Group III: C-points (self-sealing root canal obturating system) with bioceramic sealer (single cone). Each specimen was subjected to push-out test using the UTM, where the punch moved in an apical to coronal direction at a crosshead speed of 0.5 mm/min, which resulted in the displacement of the filling material. The depth of dye penetration was examined under a stereomicroscope at ×30 magnification.

Results:

All the analyses were performed using SPSS software version 16. P < 0.05 was considered statistically significant. Comparisons of mean values were done using ANOVA with post hoc Games–Howell test and ANOVA with post hoc Tukey's test. Group III demonstrated the highest mean push-out bond strength and Group I exhibited the least bond strength. A statistically significant difference was found between Group III and Group I with regard to the push-out bond strength assessment.

Conclusion:

Push-out bond strength differs among different obturation materials and obturation techniques.

Evaluation of the diagnostic yield of dental radiography and cone-beam computed tomography for the identification of anatomic landmarks in small to medium-sized brachycephalic dogs

OBJECTIVE To evaluate the diagnostic yield of dental radiography (Rad method) and 3 cone-beam CT (CBCT) methods for the identification of predefined anatomic landmarks in brachycephalic dogs. ANIMALS 19 client-owned brachycephalic dogs admitted for evaluation and treatment of dental disease. PROCEDURES 26 predefined anatomic landmarks were evaluated separately by use of the RAD method and 3 CBCT software modules (serial CBCT slices and custom cross sections, tridimensional rendering, and reconstructed panoramic views). A semiquantitative scoring system was used, and mean scores were calculated for each anatomic landmark and imaging method. The Friedman test was used to evaluate values for significant differences in diagnostic yield. For values that were significant, the Wilcoxon signed rank test was used with the Bonferroni-Holm multiple comparison adjustment to determine significant differences among each of the 6 possible pairs of diagnostic methods. RESULTS Differences of diagnostic yield among the Rad and 3 CBCT methods were significant for 19 of 26 anatomic landmarks. For these landmarks, Rad scores were significantly higher than scores for reconstructed panoramic views for 4 of 19 anatomic landmarks, but Rad scores were significantly lower than scores for reconstructed panoramic views for 8 anatomic landmarks, tridimensional rendering for 18 anatomic landmarks, and serial CBCT slices and custom cross sections for all 19 anatomic landmarks. CONCLUSIONS AND CLINICAL RELEVANCE CBCT methods were better suited than dental radiography for the identification of anatomic landmarks in brachycephalic dogs. Results of this study can serve as a basis for CBCT evaluation of dental disorders in brachycephalic dogs.

An In vitro Comparison and Evaluation of Sealing Ability of Newly Introduced C-point System, Cold Lateral Condensation, and Thermoplasticized Gutta-Percha Obturating Technique: A Dye Extraction Study

Aim

The aim of this study is to compare and to evaluate sealing ability of newly introduced C-point system, cold lateral condensation, and thermoplasticized gutta-percha obturating technique using a dye extraction method.

Materials and Methodology

Sixty extracted maxillary central incisors were decoronated below the cementoenamel junction. Working length was established, and biomechanical preparation was done using K3 rotary files with standard irrigation protocol. Teeth were divided into three groups according to the obturation protocol; Group I-Cold lateral condensation, Group II-Thermoplasticized gutta-percha, and Group III-C-Point obturating system. After obturation all samples were subjected to microleakage assessment using dye extraction method. Obtained scores will be statistical analyzed using ANOVA test and post hoc Tukey's test.

Results

One-way analysis of variance revealed that there is significant difference among the three groups with P value (0.000 < 0.05). Tukey's HSD post hoc tests for multiple comparisons test shows that the Group II and III perform significantly better than Group I. Group III performs better than Group II with no significant difference.

Conclusion

All the obturating technique showed some degree of microleakage. Root canals filled with C-point system showed least microleakage followed by thermoplasticized obturating technique with no significant difference among them. C-point obturation system could be an alternative to the cold lateral condensation technique.

Fracture resistance of roots obturated with novel hydrophilic obturation systems

Aim:

Comparative assessment of fracture resistance of roots obturated with three hydrophilic systems — novel CPoint system, Resilon/Epiphany system, and EndoSequence BC sealer; and one hydrophobic gold standard gutta-percha/AHPlus system.

Materials and Methods:

Ninety freshly extracted, human, single-rooted mandibular premolars were selected. The specimens were decoronated and standardized to a working length of 13 mm. The teeth were randomly divided into six groups (n = 15). In Group A, teeth were left unprepared and unfilled (negative control). Rest of the groups were prepared by using ProTaper system up to a master apical file F3; followed by which Group B was left unobturated (positive control); Group C, novel CPoint System; group D, Resilon/Epiphany system, Group E EndoSequence BC sealer, and Group F gutta-percha and AH Plus. Specimens were stored for 2 weeks at 100% humidity. Each group was then subjected to fracture testing by using a universal testing machine. The force required to fracture each specimen was recorded and the data was analyzed statistically using analysis of variance (ANOVA) test and Tukey's post-hoc test.

Results:

The hydrophilic obturation systems have shown to exhibit significantly higher fracture resistance as shown by the values in Groups C, D, and E (P < 0.05) when compared with Group F. Within hydrophilic groups there was significant difference between Group D and Groups C and E (P < 0.05), while Groups C and E had no significant difference (P > 0.05).

Conclusion:

In contrast to hydrophobic systems, hydrophilic systems showed higher fracture resistance in a single-rooted premolar.

Effect of advanced irrigation protocols on self-expanding Smart-Seal obturation system: A scanning electron microscopic push-out bond strength study

Introduction:

The aim of this study was to evaluate the effect of different final irrigation activation techniques affect the bond strength of self-expanding Smart-Seal obturation at the different thirds of root canal space.

Materials and Methods:

One hundred single-rooted human teeth were prepared using the Pro-Taper system to size F3, and a final irrigation regimen using 3% sodium hypochlorite and 17% EDTA was performed. The specimens were randomly divided into five groups (n = 20) according to the final irrigation activation technique used as follows: No activation (control), manual dynamic activation (MDA), CanalBrush activation, ultrasonic activation (UA) and EndoActivator. Five specimens from each group were subjected to scanning electron microscopic observation for assessment of the smear layer removal after the final irrigation procedures. All remaining roots were then obturated with Smart-Seal obturation system. A push-out test was used to measure the bond strength between the root canal dentin and Smart-Seal paste. The data obtained from the push-out test were analyzed using two-way analysis of variance and Tukey post-hoc tests.

Conclusions:

It was observed that UA improved the bond strength of Smart-Seal obturation in the coronal and middle third and MDA/EndoActivator in the apical third of the root canal space.

Sealing ability of a novel hydrophilic vs. conventional hydrophobic obturation systems: A bacterial leakage study

Aim:

Comparative assessment of apical sealing ability of a novel Smart-Seal System, Resilon, and conventional Gutta-Percha system using a bacterial leakage model.

Materials and Methods:

Seventy freshly extracted human single rooted teeth with fully formed apices were randomly divided into three groups (20 each) and two control groups (5 positive and 5 negative). Teeth were de-coronated, and roots were standardized to a working length of 16 mm. Root canal preparation was done with rotary pro-taper file system in all groups. Group A was obturated using Smart-Seal system (Hydrophilic), Group B using Resilon/Epiphany system (Hydrophilic), and Group C using Gutta-Percha (GP)/AH plus system (Hydrophobic) in a single cone technique. Using Enterococcus faecalis, a split chamber bacterial leakage model was developed to evaluate the sealing ability of three obturation systems. Samples will be monitored every 24 hours for 60 days.

Results:

All three groups have shown leakage. Novel Smart-Seal System and Resilon have shown similar results and relatively lesser samples leaked in comparison to GP obturations at the end of the observation period. There was no significant difference amongst Resilon and Smart-Seal System (P > 0.05) but there was a significant difference amongst them when compared to GP obturations (P < 0.05).

Conclusion:

Hydrophilic obturations of the root canal shows a better resistance to bacterial leakage as compared to hydrophobic obturations.