ISSN 0970-9290
Indian Journal of Dental Research Indian Journal of Dental Research • Volume 20 • Issue 2 • April - June 2009 • Pages 135-254
Volume 20
Jul - Sep 2009
Issue 03
Contents } Dental caries and treatment needs of children (6-10 years) in rural Udaipur,
Rajasthan } In vivo autofluorescence characteristics of pre- and post-treated oral submucous
fibrosis: A pilot study } Cleaning and shaping curved root canals: Mtwo® vs ProTaper® instruments, a lab
comparison } Comparative study of clinicofunctional staging of oral submucous fibrosis with
qualitative analysis of collagen fibers under polarizing microscopy } Flexural modulus, flexural strength, and stiffness of fiber-reinforced posts } Fracture resistance of endodontically treated teeth restored by different FRC posts:
An in vitro study } Evaluation of salivary cortisol and psychological factors in patients with oral lichen
planus } Effect of microwave postpolymerization treatment on residual monomer content
and the flexural strength of autopolymerizing reline resin } GST null genotype and antioxidants: Risk indicators for oral pre-cancer and cancer
Online full text at www.ijdr.in Published by Medknow Publications
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ORIGINAL RESEARCH In vitro analysis of the cement film thickness of two endodontic sealers in the apical region Lucas da Fonseca Roberti Garcia, Simonides Consani, Fernanda de Carvalho Panzeri Pires-de-Souza1, Gabriela Lemos de Almeida
Piracicaba School of Dentistry, State University of Campinas (FOP-UNICAMP), Piracicaba, 1 Ribeirão Preto School of Dentistry, University of São Paulo (FORP-USP), Ribeirão Preto, SP, Brazil
ABSTRACT
Received : 16-03-08 Review completed : 04-06-08 Accepted : 04-07-08 PubMed ID : *** DOI: 10.4103/0970-9290.57383
Objectives: The objective of the present study was to evaluate in vitro film thickness of two endodontic sealers containing epoxy-resin and zinc-oxide-eugenol, respectively in the apical region of the root canal system. Materials and Methods: A total of 20 palatine roots of the first maxillary molars were submitted to instrumentation up to a #40 file by the step-back technique and irrigated with 2 ml of NaOCl after each change of file. The roots were divided at random into two groups of 10 elements; one group was sealed with the Sealer 26® cement and the other one with the EndoFill® cement using the classical technique. The roots were abraded in the apical region until exposure of the filling and cut crosswise at 3 mm to obtain samples. The samples were analyzed by optic microscopy with 40X magnification. The images obtained were recorded using the Adobe Premiere 5.1® software and submitted to morphometric analysis using an integration grid that permitted the quantification of the area filled with the sealer or gutta-percha, and eventual empty spaces. Results: Statistical analysis of the data (Kruskal-Wallis test, P < 0.05) revealed no significant differences between the epoxy-resin-based cement Sealer 26® (47.85%) and the zinc-oxide-eugenol-based cement EndoFill® (54.16%). Conclusion: We conclude that the two sealers tested showed a similar behavior regarding the cement film thickness in the apical region. Key words: Dental materials, endodontics, physicochemical properties, root canal sealers
After adjusted cleanness, disinfection and modeling of the root canal system, the effective apical seal, is an important factor for the success of the endodontic treatment.[1,2] Clinicaly, the quality of obturation of root canal is only evaluated by a radiographic examination; experimentally, some methods are used to survey the capacity of seal of a cement obturator. Among them, it can be cited as the mensuration of the passive penetration of a courant agent.[3] Another methodological proposal for the evaluation of the radicular obturation is the one which aims the quantitative analysis of gutta-percha in the interior of the root canals, either the mensuration of density[4,5] or the morphometric analysis.[6-10] Such proposals become of great value, and that some researchers had associated a lesser degree of inÞltration to a bigger presence of gutta-percha in the interior of the radicular canals.[3] Others had related that a lesser thickness of the cement Þlm obturator promotes a better seal.[11,12] De Deus et al.,[7] had carried a quantitative analysis of the Address for correspondence: Dr. Lucas Garcia E-mail:
[email protected] e9
cement Þlm thickness after the accomplishment of three distinct techniques of obturation. In Group I, it was carried though the lateral condensation; in Group II through hydraulic compression; and in Group III by the condensation wave technique. There were no statistical differences among Groups I and II, and both had disclosed a greater cement Þlm thickness than the wave condensation technique used in group III. De Deus et al.,[8] evaluated the depth of penetration of the cement obturator in the dentinal tubules tubes promoted by three different techniques: Lateral condensation, warm vertical condensation, and ThermaÞll® system. The results demonstrated that the thermoplastiÞcation promoted a greater penetration of the cement in the interior of the dentinal tubules compared to other techniques. The aim of this study was to evaluate in vitro Þlm thickness of the cement in the apical region of two endodontic sealers, respectively, comprising of epoxy-resin and zinc-oxideeugenol.
MATERIALS AND METHODS A total of 20 palatine roots of Þrst maxillary human molars, Indian J Dent Res, 20(3), 2009
Cement Þlm thickness of two endodontic sealers
in accordance with the ethical standards of the responsible committee on human experimentation of this institution, were used in this study. The teeth were immersed in 0.1% thymol at 9oC, and then washed under running water for 24 hours to remove traces of the thymol solution. The teeth were cross-sectioned along their axes, leaving a root remnant of 14 mm. Pulp tissue was removed by abundant irrigation with 0.5% sodium hypochlorite. Odontometry was performed by introducing # 10 K-Þles (Dentsply ®, Maillefer, Ballaigues, Switzerland),inside the root canal until their tip could be seen in the apical foramen, followed by a 1 mm withdrawal, and the measurement of its actual length. Root canals were instrumented using the crown-down technique. The root canals were irrigated with 0.5% sodium hypochlorite at each instrument change. Following the biomechanical preparation of the root canals, the teeth were randomly divided into two experimental groups of 10 teeth each (n = 10). Group I: Preparation by step-back technique till the Þle # 40, obturation of the root canal with the EndoÞll® cement (Dentsply ®, Herpo, Petróplis, RJ), comprising zinc oxide and eugenol, by classical technique; Group II: Preparation by step-back technique till the Þle #40, obturation of the root canal with the Sealer 26® cement (Dentsply-Brasil®, Petrópolis, RJ), consisting of epoxy resin, by classical technique. After being sealed, the teeth were immersed in distilled water and incubated at 37 oC for a period equivalent to three times the time required to harden the cement according to the manufacturer. Then, the teeth were removed and dried. After obturation, the apical region of all teeth were abraded till the exposure of the Þlling material using an Endo-Z bur. Samples were cut cross-sectionally at a thickness of 3 mm.
Figure 1: Specimen of Group I. Area occupied by gutta-percha (a) and cement (b) (40× magniÞcation)
Indian J Dent Res, 20(3), 2009
Garcia
The apical region with the root canal Þlling material and surrounding dentin was photographed using an optical microscope (Nikon, Tokyo, Japan) at a magniÞcation of 40× [Figure 1]. Images were captured by Adobe Premiere 5.1®. Images were captured and analyzed by Adobe Premiere 5.1® software (Adobe System Incorporated®, San Jose, CA, US) using an integration grid [Figure 2]. For each specimen, the number of points that coincided on gutta-percha (a), cement (b) and eventual empty spaces were recorded and the percentage of the area occupied by cement, gutta-percha and empty spaces were calculated by the software using a three-point scale.
RESULTS The data for the teeth sealed with EndoÞll® (Group I) and Sealer 26® (Group II) are shown in Table 1. The original data were submitted to the Kruskal-Wallis test (P < 0.05), indicating that there was no signiÞcant statistical difference between the studied sealers.
DISCUSSION The hermetic sealing of root canals is of central importance in successful endodontic therapy. This step comprises sealing the entire root canal system with biologically tolerated materials with good physicochemical properties, resistant to microleakage, and capable of creating an appropriate environment for tissue regeneration.[13] So far, however, no material has shown all these desired properties. Thus, to a greater or lesser extent, apical microleakage has continued to occur in endodontic seals.[13-16] Apical microleakage in the root canal is a complex phenomenon due to the interplay of numerous factors such as the anatomy of the root canal, properties of the irrigating
Figure 2: Specimen of Group I. Area occupied by gutta-percha (a) and cement (b), with integration grid inserted (40× magniÞcation)
e10
In vitro analysis of the cement line
Garcia
Table 1: Mean values in percents (%) and standard deviation (SD) for the number of points occupied by cement, guttapercha and eventual empty spaces Sealer 26 Cement
(%) ± SD
37.5 49.36 65.28 44.23 45.71 60.71 36.50 43.47 52.63 43.18 47.85 ± 6.8
Gutapercha 65.2 50.63 31.78 55.76 54.26 39.28 63.49 56.52 47.36 56.81 52.10 ± 7.1
2.
Endofill Empty Cement Guttaspace percha 24.52 68.86 45.94 43.24 80.00 16.36 58.86 41.71 71.79 28.20 56.60 35.84 40.38 55.76 77.77 22.22 64.86 35.13 45.45 54.54 54.16 ± 47.21 ± 8.2 6.4
Empty space 6.6 10.81 1.88 7.54 3.84 3.06 ± 0.1
3. 4.
5.
6. 7.
SD - Standard deviation
solution, physicochemical characteristics of sealants, and different sealing techniques.[11] Since, no ideal Þlling material is currently available, special attention should be paid to the biomechanical preparation of the tooth, for which different irrigating solutions are used and the properties of the endodontic sealers, which are used as support. It is the interdependence of one treatment step on another that has to be attended to in order for the Þnal results to be optimal.[17] Some researchers had associated a lesser degree of inÞltration to a greater presence of gutta-percha in the interior of the root canals.[18] Others had related that a lesser thickness of the cement Þlm obturator promotes a better seal.[11,12]
8.
9.
10. 11.
12. 13. 14. 15.
De Deus et al.,[19] reported that greater sealer thickness inßuenced negatively the sealing ability of the root canal Þlling. The two types of root canal sealers used in this study, EndoÞll® and Sealer®, had similar behavior, promoting complete sealing of the apical region, with minimum presence of cement.
CONCLUSION The two tested sealers (epoxy-resin and zinc-oxide-eugenol) showed a similar result regarding the cement Þlm thickness in the apical region.
16.
17.
18.
19.
Marchesan MA, Arruda MP, Silva-Sousa YT, Saquy PC, Pécora JD, Sousa-Neto MD. Morphometrical analysis of cleaning capacity using nickel-titanium rotatory instrumentation associates with irrigating solutions in mesio-distal flattened root canals. J Appl Oral Sci 2003;11:55-9. Goldman M, Simmonds S, Rush R. The usefulness of dye-penetration studies reexamined. Oral Surg Oral Med Oral Pathol 1989;67:327-32. Deitch AK, Liewehr FR, West LA, Patton WR. A comparison of fill density obtained by supplementing cold lateral condensation with ultrasonic condensation. J Endod 2002;28:665-7. Nelson EA, Liewehr FR, West LA. Increased density of gutta-percha using a controlled heat instrument with lateral condensation. J Endod 2000;26:748-50. Cathro PR, Love RM. Comparison of MicroSeal and System B/Obtura II obturation techniques. Int Endod J 2003;36:876-82. De Deus GA, Martins F, Lima AC, Gurgel-Filho ED, Maniglia CF, Coutinho- Filho T. Analysis of the film thickness of a root canal sealer following three obturation techniques. Braz Oral Res 2003;17:119-25. De Deus GA, Gurgel-Filho ED, Maniglia-Ferreira C, Coutinho-Filho T. The influence of filling technique on depth of tubule penetration by root canal sealer: A study using light microscopy and digital image processing. Aust Endod J 2004;30:23-8. Gençoğlu N. Comparison of 6 different gutta-percha techniques (part II): Thermafil, JS Quick-Fill, Soft Core, Microseal, System B, and lateral condensation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:91-5. Wu MK, Wesselink PR. A primary observation on the preparation and obturation of oval canals. Int Endod J 2001;34:137-41. Georgopoulou MK, Wu MK, Nikolaou A, Wesselink PR. Effect of thickness on the sealing ability of some root canal sealers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80:338-44. Wu MK, De Gee AJ, Wesselink PR. Leakage of four root canal sealers at different thickness. Int Endod J 1994;27:304-8. Dalat DM, Onal B. Apical leakage of a new glass ionomer root canal sealer. J Endod 1998;24:161-3. Antonopoulos KG, Attin T, Hellqig E. Evaluation of the apical seal of root canal fillings with different methods. J Endod 1998;24:655-8. Hasselgren G, Tronstad L. The use of transparent teeth in the teaching of preclinical endodontics. J Endod 1975;1:278-80. Sousa-Neto MD, Passarinho-Neto JG, Carvalho-Junior JR, Cruz-Filho AM, Pécora JD, Saquy PC. Evaluation of the effect of EDTA, EGTA and CDTA on dentin adhesiviness end microleakage with different root canal sealers. Braz Dent J 2002;13:123-8. De Deus GA, Murad CF, Reis CM, Gurgel-Filho E, Coutinho Filho T. Analysis of the sealing ability of different obturation techniques in oval-shaped canals: A study using a bacterial leakage model. Braz Oral Res 2006;20:64-9. Baumgardner KR, Krell KV. Ultrasonic condensation of gutta-percha: An in vitro dye penetration and scanning electron microscopic study. J Endod 1990;16:253-9. De Deus GA, Coutinho-Filho T, Reis C, Murad C, Paciornik S. Polymicrobial leakage of four root canal sealers at two different thicknesses. J Endod 2006;32:998-1001.
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Barbizan JV, Fariniuk LF, Marchesan MA, Pécora JD, Sousa-Neto MD. Effectivenes of manual and rotatory instrumentation techniques for cleaning flattened root canals. J Endod 2002;28:365-6.
How to cite this article: Garcia LFR, Consani S, Pires-de-Souza FCP, de Almeida GL. In vitro analysis of the cement film thickness of two endodontic sealers in the apical region. Indian J Dent Res 2009;20:e9-11. Source of Support: Nil, Conflict of Interest: None declared.
Indian J Dent Res, 20(3), 2009
