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Table of Contents   
ORIGINAL RESEARCH  
Year : 2011  |  Volume : 22  |  Issue : 6  |  Page : 881
A SEM evaluation of dentinal adaptation of root canal obturation with GuttaFlow and conventional obturating material


1 Department of Pedodontics, Faculty of Dental Sciences, IMS, B.H.U, Varanasi, India
2 Department of Prosthodontics, U.P Dental College, B.B.D, Varanasi, India
3 Department of Pedodontics, C.S.M.M.U [Upgraded K.G.M.C], Varanasi, India
4 Department of Orthodontics, Faculty of Dental Sciences, IMS, B.H.U, Varanasi, India
5 Scientist, Birbal Sahni Institute of Paliobotany, Lucknow, Uttar Pradesh, India

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Date of Submission18-May-2010
Date of Decision12-May-2011
Date of Acceptance03-Aug-2011
Date of Web Publication5-Apr-2012
 

   Abstract 

Objective: The aim of this in-vitro study was to compare dentinal adaptation of conventional obturating material and GuttaFlow in young permanent teeth of child patients.
Materials and Methods: Ten young permanent anterior teeth with closed foramen were selected for the study. Root canal preparations were carried out using a step back technique. The canal was alternately irrigated with 5.25% sodium hypochlorite solution and 17% EDTA and normal saline. After root canal preparation specimens were randomly divided into two groups (n=5). GROUP "A": Obturated with zinc-oxide eugenol sealer and gutta-percha cone using cold lateral obturation technique. GROUP "B": Obturated with GuttaFlow as per the manufacturer's instruction. The teeth were split into two halves. Five randomly chosen longitudinal split teeth samples each from Group "A" and Group "B" was observed under scanning electron microscope to access the interface between obturating material and dentin at the level of 2 mm from the apex.
Results: On statistical analysis the dentinal adaptation (μm) of Group A was observed with a mean of 0.52 and standard deviation 0.15, while the value of mean and standard deviation were noted 0.12 and 0.02 for Group B.
The "t" value on comparison of Group A and Group B is 5.79 with "P " value of <0.001, which is highly significant.
Conclusion: From result of the study it can be concluded Group B samples showed significantly superior seal when compared with Group A. Complete seal was not observed in any of Group A samples.

Keywords: Dentinal adaptation, GuttaFlow, scanning electron microscope, UTHSCSA image tool program software

How to cite this article:
Upadhyay V, Upadhyay M, Panday R K, Chturvedi T P, Bajpai U. A SEM evaluation of dentinal adaptation of root canal obturation with GuttaFlow and conventional obturating material. Indian J Dent Res 2011;22:881

How to cite this URL:
Upadhyay V, Upadhyay M, Panday R K, Chturvedi T P, Bajpai U. A SEM evaluation of dentinal adaptation of root canal obturation with GuttaFlow and conventional obturating material. Indian J Dent Res [serial online] 2011 [cited 2018 Jul 21];22:881. Available from: http://www.ijdr.in/text.asp?2011/22/6/881/94696
The achievement of a "hermetic seal" is often cited as a major goal in root canal treatment. According to accepted definitions, the word hermetic means sealed against the escape or entry of air- or made airtight by fusion or sealing. However, root canal seals are commonly evaluated for fluid leakage - a parameter used to characterized obturation materials and technique. The leakage occurs both apically and coronally. Somehow the term hermetic has crept into endodontic nomenclature in a manner probably quite similar to an invention of an airtight seal. A God of a wisdom, Learning, and magic in ancient Egypt, Thorth, better known as Hermes Trismegistus (Hermes thrice greatest), is credited with this invention. Endodontically the term hermetic is inappropriate; instead, terms such as fluid tight, fluid-impervious, or bacteria-tight seals are more contemporary. [1]

Many endodontic obturation techniques, material, and sealers are used for endodontic treatment. The ideal endodontic materials should be biocompatible with peripheral tissues, easy to use, opaque to X-rays expand slightly on setting, easily removes and provide an excellent long lasting seal. [2]

Various endodontic materials have been advocated for obturation of the radicular space. Most techniques employ a core material and sealer. Regardless of the core material a sealer essential to every technique provides fluid tight seal.

Recently, a polydimethyl siloxane-based root canal sealer has been introduced. The initial version was called Roeko Seal (Coltene/Whaledent, Altstatten, Switzerland). The GuttaFlow is enhanced formula of original Roeko Seal which was first released as a product in 1999. GuttaFlow is a modern interpretation of gutta-percha and consists of a mixture between gutta-percha powder (less than 30 μm) and sealer with silicone base. The outcome from, this is cold flowable gutta-percha. The basic idea behind the development of GuttaFlow was to make sealer to gutta-percha ratio as close as possible to gutta-percha and at same time reduced the number of gutta-percha points. Gutta-Flow is a self-curing cold flowable obturating system. Its working time up to 15 min and curing takes place after 25-30 min. This injectable system provides a reliable and time saving obturation in straight and curved narrow canals. Its capsule designed for single use so no contamination can occurs. It gives better seal, easier, and faster to use and no condensation required. GuttaFlow easily removed for retreatment and post-preparation. It cures within wet and dry environment of root canal, insoluble, dimensionally stable, good adhesion to dentin and gutta-percha, radiopaque and biocompatible. The solubility of GuttaFlow is virtually zero. [3] GuttaFlow expands slightly in canal resulting in an excellent seal of root canal. [4] Its nano-silver particles have a preservative effect in a root canal. The chemical form and concentration of silver do not lead to any corrosion discoloration of GuttaFlow.


   Materials and Methods Top


Ten single rooted young permanent anterior teeth with single canal and closed foramen were selected from freshly extracted teeth. The selected teeth were stored in artificial saliva (WET MOUTH). The crowns were sectioned at cement enamel junction on labial surface using high speed airotor hand piece.

Canal patency was achieved with an ISO #10 flexO-file Densply) and the working length was established 0.5 mm short of apex. Instrumentation was performed with a step-back technique. The canal was alternately irrigated with 5.25% sodium hypochlorite solution (Dent pro) and ethylene diamine tetra acetate (EDTA, Glyde 15% EDTA and 10% carbamide peroxide). Final irrigation done with 5.25% sodium hypochlorite solution. The apical preparation was done up to ISO #40. During this process principle of frequent recapitulation and irrigation was followed. The canal was thoroughly dried with multiple paper points and then the randomly divided into two groups (n=5). GROUP "A": The prepared root canal in this group was obturated with zinc-oxide eugenol sealer and gutta-percha cone using cold lateral obturation technique. The consistency of zinc oxide eugenol sealer was kept constant in all samples. GROUP "B": The prepared root canal in this group was obturated with GuttaFlow as per the manufacturer's instruction.

After obturation the teeth of Group "A" was stored for 48 h at room temperature to allow for the complete setting of the sealer. After this all specimens of both groups superficial longitudinal grooves were made along the mesial and distal wall of the root using the diamond disc with slow speed hand piece. The teeth were split into two halves using chisel and mallet. Five randomly chosen longitudinal split teeth samples each from Group "A" (zinc oxide eugenol/gutta-percha) and Group "B" (GuttaFlow) was observed under scanning electron microscope (SEM). These samples were mounted on an aluminum stub, coated with gold atoms and examined using LEO 430 Cambridge Scanning Electron Microscope to access the interface between obturating material and dentin at the level of 2 mm from the apex with ×850 magnification. On each selective electron microscope photographs, three different point chosen (in middle and both corner) and using UTHSCSA image tool program software, the interface between obturating material and tooth was measured executively and mean value was submitted for statistical analysis.

UTHSCSA image tool program software

It is the free image processing and analysis program for Microsoft Windows 95 or windows NT. It has been written in Borland's C++ version 5.02. It has been developed at university of Texas Health Science Centre. San Antonio Texas, by C. Donald Wilcox, S. Brent Dove, W. Doss Mc David and David B. Geev. Image analysis function of this program included dimensional (area, distance, angle, and perimeter) and gray-scale measurement (point, line, and, area histogram statistics). Information related to the program can be accessed by world wide web at http://ddsdx.uthscsa.edu/.


   Results Top


Dentinal adaptation was recorded by scanning electron microscope (SEM) using UTHSCSA Image Tool Program at apical 2 mm on different sites. The range of dentinal adaptation (μm) was found be 0.35 to 0.70 for gutta-percha/zinc oxide eugenol and 0.10 to 0.15 for GuttaFlow [Table 1].
Table 1: Dentinal adaptation (μm)

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On statistical analysis of the dentinal adaptation (μm) of (Group A) and (Group B), the values of (Group A) were observed with a mean of 0.52 and standard deviation 0.15 while the values of mean and standard deviation were noted 0.12 and 0.02 for (Group B) [Table 2].
Table 2: Summary statistics of dentinal adaption (μm) of zinc oxide eugenol/gutta-percha and GuttaFlow

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The "t " value on comparison of gutta-percha/zinc oxide eugenol (Group A) and GuttaFlow (Group B) is 5.79 with P value of <0.001, [Table 2] which is highly significant.

The mean dentinal adaptation values were compared by applying Fisher's t-test. On the basis of the result obtained between these two groups each consist of five samples. Hence, the degree of freedom obtained was 8 [n 1 + n 2 - 2 = 8], which is quite reasonable as the t test is valid for small sample size.

In Group A there is a big deviation from. 0.35 to 0.70 because three different point were chosen (in middle and both corner) on each selected electron microscope photographs and gaps were often found between sealers and dentine walls with an unclear and curved contact line in the sealer-dentine interface.

But in Group B there is extremely good adhesion to dentinal wall a smooth contact line on the sealer-dentine interface without gaps.


   Discussion Top


Three-dimensional sealing of the root canal is the ultimate aim of the endodontic therapy which enables the preservation of the health of the periapical tissues, hence ensuring the success of the root canal treatment. [5] Dow and Ingle [6] demonstrated in an in vitro experiment the possibilities of apical percolation using a radioactive isotope. On the basis of this study it is hypothesized that the penetration of radioactive iodine into a poorly filled root canal in vitro is analogous to fluid percolation into the canal of in situ pulpless teeth with incomplete canal obliteration.

Single rooted teeth with single patent root canal were selected for the study to minimize anatomical variation and to achieve standardization. The sample were then stored in artificial saliva (wet mouth) at room temperature, which creates oral environment around teeth and prevents them from being dehydrated and becoming brittle during the experimental study.

The root canals of teeth were prepared till International standard organization (ISO) size 40 for effective irrigation and irrigations done with sodium hypochlorite (NaOCl) and ethylene diamine tetra-acetic acid (EDTA). Ram [7] did a study which confirmed that for root canals to be effectively irrigated, the canals should be enlarged to at least ISO size 40. Bystrom [8] studied the antibacterial action of NaOCl and ethylene diamine tetra-acetic acid (EDTA) in endodontic therapy, and found that an alternate irrigation with NaOCl and EDTA effectively removed the smear layer, tissue predentin, and increases the antimicrobial activity.

Roggendrof [9] evaluated the micro leakage of Roeko Seal Automix and GuttaFlow using different filling methods and found GuttaFlow exclusively as root canal filling material showing microleakege similar to RoekoSeal.

GuttaFlow is newer version of Roeko Seal and its property resembles to Roeko Seal.

Taranu [10] evaluate apical seal of root filling with GuttaFlow, Epiphany, and Rely X Unicem, after a storage time of ninety days and reported that GuttaFlow exhibit lowest leakage value.

Brackett [11] used the fluid filtration technique and compared microleakege of GuttaFlow with AH Plus/gutta-percha using the warm vertical compaction technique and found GuttaFlow create apical seal in equivalent to AH Plus/gutta-percha using the warm vertical compaction technique.

Gutta-percha/zinc oxide eugenol sealer does not produce a complete seal and there was evidence of a space at the tooth restoration interface in most samples [Figure 1].
Figure 1: Two randomly chosen SEM photographs of Group A

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The results of dentinal adaption in the present study are accordance with studies Leski and Pawlicka, [12] who compared the penetration of Roeko Seal, AH Plus sealer, and GuttaFlow into dentinal tubules and concluded that AH Plus sealer had less penetration into dentinal tubules than Roeko Seal and GuttaFlow.

The study which support the present study was conducted by Elayouti and Acheleithner, [13] this experimental study evaluated the homogeneity and adaption of a GuttaFlow to root canal walls and found that GuttaFlow completely filled the prepared root canal but small voids were frequently present within the core of the filling material [Figure 2].
Figure 2: Two randomly chosen photographs of Group B

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Scanning electronic microscopic methodology evaluates the sealing ability and adhesiveness of the sealer to dentine walls. According to SEM findings in this research, the samples of Group A obturated with ZnO-oxide eugenol/gutta-percha using a cold lateral obturation technique. Gaps were often found between sealers and dentine walls with an unclear and curved contact line in the sealer-dentine interface. In GuttaFlow i.e. Group B showed extremely good adhesion to the dentine walls with the tight sealer-dentin interface, no spaces or ruptures between the sealer and canal walls. GuttaFlow showed a smooth contact line on the sealer-dentine interface without gaps, and may be with massive penetration of the sealers inside the tubules. The findings obtained during SEM observation in this research suggest that the physical integrity of the sealer matrix is also important. As a resin-based sealer GuttaFlow has a homogeneous structure with particles of gutta-percha and appears to fill the dentinal tubules well with extremely good adhesion to gutta-percha cones. Zinc oxide eugenol sealer composed of mainly zinc oxide and appears porous after mixing with eugenol. This could be the reason for a lower adhesion to gutta-percha and root dentinal wall when compared to GuttaFlow.

The GuttaFlow does not create a chemical bond with in the internal tooth structure, but its apical seal is greater than Zno-eugenol/gutta-percha using cold lateral obturation. This study shows that GuttaFlow has potential to replace Zno-eugenol/gutta-percha filling in young permanent teeth.

 
   References Top

1.Cohen S, Hargreaves KM. Pathways of the pulp. 10 th ed. St. Louis, Mo.: Elsevier Mosby, 2011. P.352  Back to cited text no. 1
    
2.Gorssman LI. Improved root canal cement. J Am Dent Assoc 1958;56;381.  Back to cited text no. 2
    
3.Schafer E, Zandbiglari T. Solubility of root-canal sealers in water and artificial saliva. Int Endod J 2003;36:660-9.  Back to cited text no. 3
    
4.Zmener O, Spielberg C, Lamberghini F, Rucci M. Sealing properties of a new epoxy resin-based root-canal sealer. Int Endod J 1997;30:332-4.  Back to cited text no. 4
    
5.Walton RE. Histologic evaluation of different methods of enlarging the pulp canal space. J Endod 1976;2:304-11.  Back to cited text no. 5
    
6.Dow PR, Ingle JI. Isotope determination of root canal failure. Oral Surg 1955;8:1-100.  Back to cited text no. 6
    
7.Ram Z. Effectiveness of root canal irrigation. Oral Surg Oral Med Oral Pathol 1977;44;306-14.  Back to cited text no. 7
    
8.Bystrom A, Sundqvist G. The antibacterial action of sodium hypochlorite and EDTA in 60 cases of endodontic therapy. Int Endod J 1985;18:35-40.  Back to cited text no. 8
    
9.Roggendrof M, Ebert J. Microleakage evaluation of polyvinylsiloxane-based endodontic filling materials using various filling methods. San Antonio, USA: The 32 nd Annual Meeting of the AADR; 2003. p. 12-5.  Back to cited text no. 9
    
10.Taranu R, Wegerer U, Roggendrof MJ, Ebert J, Petschelt A, Frankenberger R. Leakage analysis of three modern root filling materials after 90 days of storage. Int Endod J 2005;38:928.  Back to cited text no. 10
    
11.Brackett MG, Martin R, Sword J, Oxford C, Rueggeberg FA, Tay FR, et al. Comparison of seal after obturation technique using a polydimethylsiloxane-based Root Sealer. J Endod 2006;32:1188-90.  Back to cited text no. 11
    
12.Laski M, Pawlicka H. A comparison of the penetration of three sealers into dentinal tubules: A SEM study. J Endod 2005;38:932.  Back to cited text no. 12
    
13.Elayouti A, Achleithner C, Lost C, Weiger R. Homogeneity and adaptation of a new gutta-percha paste to root canals wall. J Endod 2005;31:687-90.  Back to cited text no. 13
    

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Correspondence Address:
Vinod Upadhyay
Department of Pedodontics, Faculty of Dental Sciences, IMS, B.H.U, Varanasi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.94696

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