Evaluation of Microleakage of Different Intraorifice Barrier Materials in Endodontically Treated Teeth

Research Article

J Dent App. 2016; 3(3): 333-336.

Evaluation of Microleakage of Different Intraorifice Barrier Materials in Endodontically Treated Teeth

Özyürek T1*, Özsezer Demiryürek E1, Demiroğlu M2 and Sari ME3

¹Ondokuz Mayis University, Faculty of Dentistry, Department of Endodontics, Samsun, Turkey

²Staff Endodontist, Oral and Dental Health Hospital, Samsun, Turkey

³Ondokuz Mayis University, Faculty of Dentistry, Department of Pedodontics, Samsun, Turkey

*Corresponding author: Taha Özyürek, Faculty of Dentistry, Department of Endodontics, Ondokuz Mayis University, ID: orcid.org/0000-0003-3299-3361, Samsun, Turkey

Received: September 29, 2016; Accepted: November 02, 2016; Published: November 04, 2016

Abstract

Aim: The aim of this study was to compare the sealing ability of 4 different intraorifice barrier materials (MTA Angelus, Filtek Ultimate light-cured flowable composite resin, Filtek Z250 light-cured composite resin, SDR light-cured flowable bulk-fill composite resin)using the dye penetration method.

Materials and Methods: One hundred forty single-rooted teeth were obturated using warm vertical compaction technique. The teeth were randomly divided into four groups of 30 teeth each and positive and negative control group of 10. The access openings were filled with one of the tested intraorifice barrier materials in four groups. The sealing ability of the test materials was evaluated by dye penetration method.

Results: MTA Angelus group showed the lowest mean microleakage value and the flowable composite resin group had the highest microleakage value among the experimental groups (p = 0.001).

Conclusion: Within the limits of present study, MTA Angelus and SDR showed a better leakage resistance than the flowable composite resin and composite resin.

Keywords: Smart Dentin Replacement (SDR); Mineral Trioxide Aggregate (MTA); Dye Penetration; Leakage; Endodontics

Introduction

Microorganisms and their products are one of the main causes of periapical inflammation. Thus, root canal treatment aims at removing microorganisms from the root canals and preventing being re-infected [1,2]. Coronal leakage has an important place among the causes of failure following the completion of root canal treatment [3]. Ray and Trope [4] reported that the quality of coronal restoration was more important than the quality of root canal filling in protecting the periapical heath.

Studies have shown that gutta-percha and root canal sealer could not resist leakage for a long time when they contact with the oral flora all by themselves without any protective intraorifice barrier material [5]. Swanson and Madison [6] stated that contamination occurred in such a short time as 3 days when there is no coronal sealing.

Among the alternative methods suggested are placing an intraorifice barrier material on canal orifice by removing 3 or 4 mm part of the gutta-percha or canal sealer in order to prevent oral fluids and microorganisms from entering the root canals [6], or sealing the pulp chamber floor with a restorative material [7]. The studies have shown that sealing the pulp chamber floor with adhesive systems using intraorifice barrier materials after the root canal treatment constitutes a second defense line against bacterial leakage [7,8]. Different materials such as amalgam, Cavit, glass ionomer cement, composite resin, Mineral Trioxide Aggregate (MTA), and Intermediate Restorative Material (IRM) for this purpose [9,10].

Although there are many studies comparing the efficiencies of intraorifice barrier materials, there is no global consensus on how to use which material [9,10].

While our literature review resulted in finding no studies investigating the resistance of the light-cured bulk-fill flowable composite material (Surefil SDR; Dentsply Caulk, Milford, DE, USA) against leakage as an intraorifice barrier material, we found that there were very few studies on the coronal sealing of MTA. Therefore the purpose of this in vitro study was to compare the sealing ability of 4 different intraorifice barrier materials (MTA Angelus, Filtek Ultimate light-cured flowable composite resin, Filtek Z250 light-cured composite resin, Smart Dentin Replacement light-cured flowable bulk-fill composite resin) in extracted human teeth using the dye penetration method. The null hypothesis of our study was that there would be no difference between the dye leakage values of the tested restorative materials.

Materials and Methods

After ethic committee approval, 140 extracted human maxillary central incisors were used in this in vitro study. After the access cavity preparation, the pulp tissue was removed. The working length was determined by measuring the length of a #10 K-file (Dentsply, Maillefer, Switzerland) just visible at the apical foramen. The canals were instrumented up to 40.06 apical diameters with ProTaper NEXT (Dentsply, Maillefer, Switzerland) nickel titanium files using X1, X2, X3 and X4 files respectively. After each file 2ml 5.25% NaOCl was used for irrigation. To eliminate the smear layer in the final irrigation 2ml 17% EDTA for 3 minutes and 2ml 5.25% NaOCl were used respectively.

After the instrumentation all canals were dried with paper points (DiaDent Group International Inc., Cheungju, Korea). AH Plus (Dentsply De-Trey, Konstanz, Germany) was mixed according to the manufacturer’s instructions, and ProTaper X4 gutta-percha cones (Dentsply, Maillefer, Switzerland) were coated with sealer and placed into the root canal to the working length. Gutta-percha was then down-packed with a medium size plugger (Calamus Dual 3D Obturation System; Dentsply, Maillefer). Gutta-percha at the apical level was condensed using hand pluggers (Buchanan; SybronEndo, Orange, CA, USA). A backfill procedure was performed using the extruder hand-piece of the Calamus Dual 3D Obturation System. After completion of the filling procedures the teeth were sectioned just apical to the cement-enamel junction with a low-speed diamond saw.

The roots were randomly divided to four experimental groups with 30 samples each; 20 roots were served as control (10 teeth as positive control and 10 teeth as negative control). Coronal cavity was prepared by removing gutta-percha with System B (SybronEndo, Orange, CA, USA) to the experimental depth of 3mm. The depth was verified with a periodontal probe. The coronal 3 mm was rinsed with alcohol and distilled water respectively and dried with an air stream.

The first group (n: 30) received a 3mm barrier of MTA Angelus (Angelus, Londrina, PR, Brazil). The second group (n: 30) received light-cured flowable composite resin (Filtek Ultimate; 3M-ESPE, St. Paul, MN, USA). The third (n: 30) and fourth group (n: 30) were sealed with Smart Dentin Replacement light-cured flowable bulk-fill (SDR); and light-cured composite resin (Filtek Z250; 3M-ESPE, St. Paul, MN, USA) respectively. MTA Angelus was mixed and handled according to manufacturer’s instruction. Before usage of the other materials entire cavity surface treated with 37% phosphoric acid (3M ESPE) for 15s, rinse with water for 10s, and gentle dried with cotton pellets. A thin layer of bonding agent (Adper Single Bond 2; 3M-ESPE, St. Paul, MN, USA) and gentle air stream was applied and light cured (Elipar S10; 3M-ESPE, St. Paul, MN, USA) for 20s.

After placement of the test materials into the cavities, the samples were stored in 100% humidity at 37°C for one week. The samples were thermocycle for 100 cycles in distilled water at 5°C/55°C, with a dwell time of 4 hours in each bath. After thermocycling, the surfaces of specimens were dried and coated using nail varnish expect 1mm around the coronal filling cavity side. The samples in the experimental groups and positive control group were coated with two layers of nail varnish except for 1mm around the tooth-restoration interface. The positive control group consisted of 10 teeth obturated in the same manner as the experimental teeth without a coronal barrier.

The negative control group consisted of 10 matching obturated teeth without coronal barrier, but with crowns and roots covered completely with nail varnish and sticky wax. Then the samples were immersed in 1% Pelikan ink (Pelikan, Hannover, Germany) for 10 days. After 10 days all samples were immersed in 1% methylene blue dye and centrifuged at 30g for 5min. The samples were then washed under tap water for 1 hour and air-dried. Mid-sagittal cutting was performed using a diamond disc without water-cooling to prevent dye removal (Figure 1).

Citation: Özyürek T, Özsezer Demiryürek E, Demiroğlu M and Sari ME. Evaluation of Microleakage of Different Intraorifice Barrier Materials in Endodontically Treated Teeth. J Dent App. 2016; 3(3): 333-336. ISSN:2381-9049