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Table of Contents   
ORIGINAL RESEARCH  
Year : 2013  |  Volume : 24  |  Issue : 4  |  Page : 474-477
Comparing the sealing properties of mineral trioxide aggregate and an experimental ceramic based root end filling material in different environments


1 Department of Endodontics, School of Dentistry, Torabinejad Dental Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 General Dentist, Isfahan, Iran
3 Department of Endodontics, Dental School, Iranian Center for Endodontic Research, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Endodontics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
5 Dental Research Center, Dental School, Shahid Beheshti University of Medical Sciences, Terhran, Iran

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Date of Submission14-Jun-2011
Date of Decision28-Feb-2012
Date of Acceptance15-Oct-2012
Date of Web Publication19-Sep-2013
 

   Abstract 

Background: An apical seal is an important factor in achieving success in surgical endodontics.
Aim: The purpose of this study was to compare the sealing properties of mineral trioxide aggregate (MTA) with a new ceramic based root end filling material (Cold Ceramic) in different environments.
Materials and Methods: One hundred teeth were selected. The root canals were instrumented and obturated. Except for the apical 2 mm, the root surfaces were sealed. After root resection, 3 mm depth root-end cavities were prepared. For each material, roots were divided into 3 equal subgroups and the root-end filling was done in different environments (dry, saliva contaminated, blood contaminated). Five roots served as positive and 5 roots as negative controls. Samples were immersed in 2% methylene blue dye. Roots were sectioned longitudinally and examined under stereomicroscope to record the extension of dye penetration.
Results: All experimental groups demonstrated dye penetration. The lowest linear leakage was seen in Cold Ceramic blood contaminated group while the highest leakage was observed in MTA blood contaminated group. The linear dye penetration of both MTA and Cold Ceramic (CC) groups did not show any significant differences among different environments. Also, the difference between MTA and CC was not significant in dry and saliva contaminated subgroups. Only the difference between dye penetration of MTA and CC in blood contaminated subgroups showed significant difference ( P = 0.008).
Conclusion: The sealing property of this ceramic based root end filling material (Cold Ceramic) is better than MTA in blood contaminated condition and at least similar to MTA in other conditions.

Keywords: Ceramic based root-end filling material, cold ceramic, dye penetration, mineral trioxide aggregate, sealing property

How to cite this article:
Hasheminia SM, Nejad SL, Dianat O, Modaresi J, Mahjour F. Comparing the sealing properties of mineral trioxide aggregate and an experimental ceramic based root end filling material in different environments. Indian J Dent Res 2013;24:474-7

How to cite this URL:
Hasheminia SM, Nejad SL, Dianat O, Modaresi J, Mahjour F. Comparing the sealing properties of mineral trioxide aggregate and an experimental ceramic based root end filling material in different environments. Indian J Dent Res [serial online] 2013 [cited 2019 Jul 18];24:474-7. Available from: http://www.ijdr.in/text.asp?2013/24/4/474/118399
Root-end resection followed by root-end filling is a well-established approach in the treatment of persistent periapical infections and teeth in which conservative therapy has failed. [1] The main objective of root-end fillings is to provide an apical seal that prevents the penetration of microorganisms and their by-products from the root canal system into the periradicular tissues. Therefore, the apical seal is the most important factor in achieving success in surgical endodontics. [2]

The ideal root-end filling material should be biocompatible, moisture indifferent, antibacterial, nontoxic, noncorrosive, non-absorbable, easy to manipulate, dimensionally stable, radiopaque, cost-effective, and adaptable/adhere to the dentinal walls, and finally, be well tolerated by periapical tissues and promote regeneration of the periodontal apparatus. [1],[3]

Many different methods have been employed to assess endodontic microleakage. Often, these include the use of bacteria, dye/ink, electrochemical methods, radio isotope and fluid filtration. [4],[5] The linear measurement of tracer or dye penetration is the easiest method and most popularly employed. [5],[6]

Various root-end filling materials have been introduced. [3],[7] Among them, MTA has shown promising results as a root-end filling material, [8] and because of its other desirable features such as biocompatibility and non-toxicity, [9],[10],[11] it can be used as a gold standard for comparing other materials. However, no material has yet presented the characteristic of an ideal material.

An experimental ceramic based root end filling material, Cold Ceramic (CC), has recently been introduced and showed appropriate properties. [12],[13] Its main component is calcium hydroxide. The material is biocompatible. [12] It sets in the present of moisture by adding its special mixing liquid. The primary setting time is about 10 minutes and it completely sets after 24 hours. Cold Ceramic can be sterilized by dry heat. Cold ceramic has shown appropriate properties. [6] An in-vitro study has shown that it provides better seal when compared to amalgam. [13] Another study compared the tissue reaction of MTA and Cold Ceramic and showed that they are both well tolerated. [12]

Clinically, it is inevitable that any moisture including saliva and blood will contaminate the root end cavity preparations and filling materials as they are placed.

Presence of moisture, saliva or blood might affect the sealing ability of the root end filling materials. Previous studies reported that the sealing ability of MTA cannot be influenced by blood or saliva contamination. [14],[15] But the sealing properties of Cold Ceramic in blood or saliva contaminated environments have not been evaluated. Thus, the purpose of this in-vitro study was to compare the apical sealing properties of Cold Ceramic and MTA in dry, blood and saliva contaminated environments using the dye leakage method.


   Materials and Methods Top


This study was approved by Ethics Committee of Isfahan University of Medical Sciences. One hundred freshly extracted single-rooted human anterior teeth were used in this study. The selection criteria were the presence of a single root canal, no evidence of cracks, fractures, root caries, or restoration. All teeth had mature apices and straight canals without calcification. After extraction, teeth were soaked in 5.25% Sodium hypochlorite (NaOCl) for 30 minutes to remove root surface debris and then stored in 0.5% chloramine-T.

Crowns were removed at the cementoenamel junction (CEJ). Working length (WL) was determined by placing a #15 file (Mani Inc., Tochigi-ken, Japan) into the canal until it reached the apical foramen. The apical enlargement of each root was carried out to a #40 file in 0.5 mm short of WL and the rest of the canal was flared using Step-back technique to #70 file at 0.5 mm increments. The canals were copiously irrigated with 5.25% sodium hypochlorite and normal saline. Root canals were obturated with lateral condensation technique using gutta-percha (Diadent, Seoul, Korea) and AH26 sealer (Dentsply, DeTrey, Konstanz, Germany). After filling of access cavities with Coltosol (Coltene, Altstatten, Switzerland), teeth were placed in a 37°C and 100% humidity incubator for five days. Then root-end resections were made by removing 2 to 3 mm of the apex at a 90 degree angle to the long axis of the root with a diamond disc (D and Z, Darmstadt, Germany). A 3 mm depth root-end cavity was prepared ultrasonically, powered by a Piezon Suprason P5 unit (SBL, Satelect, France). Then, all teeth surfaces were coated by two layers of nail varnish and one layer of sticky wax except for the area corresponding to the resected root end surface. The prepared roots were randomly divided into following groups. Five root ends were filled with gutta-percha without sealer and used as positive controls. Another five root ends were filled with sticky wax and used as negative controls. The remaining 90 roots were divided into two equal groups of 45 roots each. Forty-five roots in MTA group were divided into 3 subgroups of 15 roots each (1a, 1b, 1c). ProRoot MTA (Tooth colored formula, Dentsply, Tulsa, USA) was mixed according to manufacturer's instruction and the cavities were filled in dry (1a), blood (1b), and saliva (1c) contaminated environments. Similarly, forty-five roots in the Cold Ceramic (CC) group were divided into 3 subgroups of 15 roots each. The new experimental material was also mixed and the root-end cavities were filled in dry (2a), blood (2b) and saliva (2c) contaminated environments. Regarding the procedure of contamination, root end cavity preparations were filled with blood before placement of root end filling materials in 1b and 2b subgroups and saliva in 1c and 2c subgroups. Blood was obtained by using a 27-gauge needle from one of investigators, immediately before the root-end filling. In order to gather saliva, one of the investigators was asked to force out 3 ml of saliva into a container.

Samples were incubated for 24 hours at 37°C and 100% humidity. Then the roots were immersed in 2% methylene blue dye in a reduced pressure environment for 48 hours. After that, the roots were rinsed in running tap water for 10 minutes. The roots were grooved on the buccal and lingual surfaces down to the gutta-percha and were split into two sections and the retrograde filling materials were removed. Linear dye penetration was measured to its furthest extent within the root end cavity using a stereomicroscope (MBC-IO, St. Petersburg, Russia) at ×16 magnification and the aid of computer software (Motic Images Plus 2.0 ML, Motic Instrument Inc., Richmond, Canada) with precision of 0.001 millimeter. The results were analyzed using T-test, one-way ANOVA and Kruskall-Wallis tests. Statistically significant differences among the groups were set at P < 0.05.


   Results Top


The positive control samples showed total dye penetration, while the negative controls showed no evidence of dye penetration. All experimental subgroups demonstrated dye penetration. The least leakage among all subgroup was observed in Cold Ceramic blood contaminated subgroup and the greatest leakage was seen in MTA blood contaminated subgroup [Figure 1]. The mean ± SD linear dye penetration of both MTA and CC groups didn't show any significant differences in dry and saliva environments. But the difference between MTA and CC groups was statistically significant in blood contaminated environment [Table 1].
Figure 1: Mean linear penetration of mineral trioxide aggregate and cold ceramic in dry saliva and blood contamination

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Table 1: Measurement of liner dye penetration of MTA and cold ceramic in three different environments

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   Discussion Top


Successful periradicular surgery is achieved via a hermetic apical seal, using a well-adapted root-end filling material. Since achieving a dry apical field is not always attainable during endodontic surgery, this study designed to compare the sealing properties of test materials in blood and saliva contaminated environment which is usually a simulation of virtual clinical conditions.

Several methodologies such as dye, radioisotope, bacterial penetration, electrical impedance or resistance, hiatus measurement with scanning electron microscopy or filtration have been employed to assess apical microleakage. There is a lack of evidence to suggest that the use of any particular method is superior to the others. [16],[17],[18],[19],[20] Each technique has significant limitations that can result in errors. [21] The most frequently used technique is linear measurement of dye penetration. Although this technique presents the disadvantage of semi-quantitative analyses, often involving only one plane of view, [22] it is the easiest method to select new materials. [23] Entrapped air may influence the dye penetration results, so Spangberg et al.[24] recommended negative pressure dye penetration methods to solve this problem. Although some researchers believe that dye particles are much smaller than the microorganisms or their by-products and this makes the rate of microleakage more than what is measured in clinical situation, [25] others believe that if a filling material doesn't let smaller molecules pass it can prevent leakage of bigger particles such as bacteria and their by-products. [5],[8] In this study, linear measurement of negative pressure dye penetration was carried out as a criterion for judgment.

Various methylene blue dye penetration studies reported excellent sealing ability for MTA and demonstrated its superiority in comparison to other commonly used root-end fillings. [6],[14],[26],[27] Therefore, in this study MTA was used as an index to compare the sealing ability of Cold Ceramic. The results of the present study proved equal sealing ability for Cold Ceramic and MTA, without any significant differences in different conditions.

Torabinejad et al.[14] assessed root-end dye microleakage in dry and blood contaminated environments and reported that MTA sealing ability was significantly better than Amalgam, IRM and Super EBA. Their study also showed that MTA mean dye leakage in blood contaminated environment was less than in a dry environment. In our study, linear dye penetration wasn't affected by the environment either. However, the leakage in a blood contaminated environment was more than the dry environment.

Farhad et al.[15] demonstrated that the difference in linear dye penetration in root-ends filled with MTA in dry, blood and saliva contaminated environments was not statistically significant, which is in agreement with this study.

Modaresi [13] reported that MTA and Cold Ceramic are both biocompatible. An in-vitro study has shown that Cold Ceramic has proper sealing ability and reduced initial setting time that shows its potential as an alternative root end filling material. [28] Also, it is has been demonstrated that Cold Ceramic provide a better seal when compared to amalgam. [12]


   Conclusion Top


Based on the results obtained from this study, Cold Ceramic cement exhibited superior apical sealing ability compared to MTA in blood contaminated areas and similar sealing properties in dry and saliva contaminated environments. Therefore, besides its equal biocompatibility and faster initial setting time, it could be suggested as an alternative root end filling material. However, more investigations are needed to be carried out to determine the clinical usage of this material.


   Acknowledgment Top


The authors would like to express their gratitude to the Professor Torabinejad Research Center for technical assistance.

 
   References Top

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23.Roux D, Doméjean-Orliaguet S, Saade M. Leakage associated with intermediate restorative material and glass-ionomer cement retrograde filling: A human and sheep teeth comparison with 2 different aging procedures. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:81-7.  Back to cited text no. 23
    
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Correspondence Address:
Omid Dianat
Department of Endodontics, Dental School, Iranian Center for Endodontic Research, Shahid Beheshti University of Medical Sciences, Tehran
Iran
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Source of Support: The authors would like to express their gratitude to Professor Torabinejad Research Center for assistance, Conflict of Interest: None


DOI: 10.4103/0970-9290.118399

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