|Year : 2020 | Volume
| Issue : 1 | Page : 37-41
|In Vitro comparison of the microbial leakage of obturation systems: Epiphany with resilon, guttaflow, and ah plus with gutta percha
KJ Prithviraj1, Sreegowri1, RK Manjunatha2, Priya Horatti3, Nageshwar Rao3, S Gokul4
1 Department of Conservative Dentistry and Endodontics, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka, India
2 Department of Conservative Dentistry and Endodontics, Govt. Dental College and Research Institute, Bellary, Karnataka, India
3 Department of Conservative Dentistry and Endodontics, S.D.M College of Dental Sciences and Hospital, Dharwad, Karnataka, India
4 Department of Oral Pathology and Microbiology, YMT Dental College and Hospital, Kharghar, Navi Mumbai, India
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|Date of Submission||08-Feb-2018|
|Date of Decision||23-Oct-2018|
|Date of Acceptance||27-May-2019|
|Date of Web Publication||02-Apr-2020|
| Abstract|| |
Aim: To compare the microbial leakage of three root canal filling materials: AH Plus with Gutta-percha, Epiphany with Resilon, and Guttaflow using Enterococcus faecalis as the bacterial marker. Materials and Methods: In total, 30 caries free, human maxillary incisors with straight roots were used. The teeth were de-coronated with a diamond disc and the length was standardized for all specimens. Access opening was done through the coronal portion and the working length was determined. All the teeth were prepared to a standardized size apically and coronally. The teeth were then randomly divided into three experimental groups each. After obturation of the root canals, the outer surfaces of the teeth were coated with two layers of nail enamel except the apical 2 mm. The teeth were then subjected for bacterial leakage test using E. faecalis as a bacterial marker in dual chamber bacterial leakage model for a period of 30 days. Statistical Analysis Used: Chi-square test. Results: Results showed that Resilon/Epiphany (Group-2) demonstrated less leakage and Gutta-percha/AH Plus (Group-1) showed maximum leakage with the statistically significant difference between the two (P < 0.05). Guttaflow (Group-3) also showed less leakage than Gutta-percha/AH Plus (Group-1) with the statistically significant difference between the two (P < 0.05). There was no statistically significant difference between Resilon/Epiphany (Group-2) and Guttaflow (Group-3). Conclusion: Resilon/Epiphany and Guttaflow groups demonstrated less microbial leakage than Gutta-percha/AH Plus group.
Keywords: Dual-chamber microbial leakage model, Guttaflow, microbial leakage, Resilon/Epiphany
|How to cite this article:|
Prithviraj K J, Sreegowri, Manjunatha R K, Horatti P, Rao N, Gokul S. In Vitro comparison of the microbial leakage of obturation systems: Epiphany with resilon, guttaflow, and ah plus with gutta percha. Indian J Dent Res 2020;31:37-41
|How to cite this URL:|
Prithviraj K J, Sreegowri, Manjunatha R K, Horatti P, Rao N, Gokul S. In Vitro comparison of the microbial leakage of obturation systems: Epiphany with resilon, guttaflow, and ah plus with gutta percha. Indian J Dent Res [serial online] 2020 [cited 2021 May 11];31:37-41. Available from: https://www.ijdr.in/text.asp?2020/31/1/37/281824
| Introduction|| |
Healing of periradicular pathosis mainly depend upon proper disinfection, hermetic obturation, and the placement of adequate coronal sealing of the root canal. Leakage of microorganisms and their by-products are considered to be the major cause of pulpal and periradicular pathosis.,, Success of root canal treatment depends on meticulous cleaning and shaping of the root canal system; its three-dimensional obturation and well-adapted leakage-free restoration.,
Obturation materials should hinder the release of bacteria trapped within the root canal system,,, and maintain the disinfected status achieved by the biomechanical preparation, providing a complete obturation of the prepared root canal space. However, obturation materials and methods have failed to show a long-lasting perfect seal with the cavity wall. Hence, newer obturating materials and methods are developed, such as Resilon/Epiphany and Guttaflow.
Canal obturation modality involves gutta-percha popularized by Bowen in 1867 as the material of choice. Many alternatives are being proposed, to the “gold standard” root canal filling material to minimize the microbial leakage. Among them is Guttaflow,, a new flowable root canal filling paste, which is a nonheated flowable obturation system that combines both the sealer and the gutta-percha in one product. Resilon, a thermoplastic synthetic polymer-based material that comes under the category of resin obturating system, is another group of root canal filling materials and the sealer Epiphany is a dual cure resin composite sealer.
Therefore, the purpose of thisin vitro study was to compare the microbial leakage of three root canal filling materials: AH Plus with Gutta-percha, Epiphany with Resilon and Guttaflow using Enterococcus faecalis as the bacterial marker.
| Materials and Methods|| |
The materials and methods used for this study are described under the following subheadings.
Selection of specimens
In total, 30 caries free, human maxillary incisors with straight roots were used in this study. The teeth were immersed in 5% sodium hypochlorite (NaOCl) for ~15 min, to remove organic material from the root surfaces. The teeth were then stored in sterile distilled water until further use.
Preparation of the specimens
The teeth chosen were de-coronated with a diamond disc and the length was standardized at 15 mm. The coronal surfaces of the root were smoothened with high-speed hand piece and a multipurpose bur. All the teeth were prepared till ISO #45 K-files apically and #1-3 GatesGlidden (Mani, India) drills coronally. Copious irrigation was done during the instrumentation with 2.5% sodium hypochlorite and 17% EDTA, followed by 2.5% NaOCl as the final rinse to remove the smear layer.
After cleaning and shaping of the root canals, all the teeth were sterilized in an autoclave. Obturation of the autoclaved teeth was carried out under a laminar flow (Kartos, India) to prevent any bacterial contamination. The teeth were then randomly divided into three experimental groups, each containing 10 teeth.
Group 1: Teeth were obturated using gutta-percha with AH Plus sealer.
Group 2: Teeth were obturated using Resilon cones and Epiphany sealer.
Group 3: Teeth were obturated using the Guttaflow system as per the manufacturer's instructions.
Leakage apparatus preparation
Following obturation of the root canals, the outer surfaces of the teeth were coated with two layers of nail enamel except the apical 2 mm. No. 20 Foley's catheter was cut to ~8 mm sections. Orthodontic ligature wire was passed through the tube and attached to the rubber stopper of the glass vials followed by sterilization in an autoclave.
The tube was then attached to the teeth under a laminar flow and was passed over the crown portion of the tooth covering about coronal 4 mm. An excess 3 mm of the tubing was left above the coronal portion of the tooth which formed the upper chamber of the apparatus. The junction of the tube and tooth was sealed adequately with cyanoacrylate. The rubber stopper with the attached tooth and tubing were placed in the sterile glass vial creating two separate reservoirs. The glass vial was then filled with 2-mL sterile BHI broth, which formed the lower chamber of the apparatus.
The sterilized set up along with the obturated teeth was incubated at 37°C for 48 h to allow the sealer to set and to ensure sterilization. Turbidity if seen in the lower chamber of any of these samples was considered as contamination. Such samples were thereby discarded.
Bacterial leakage test
Enterococcus faecalis was used as an indicator of microbial leakage. The strains used were obtained as clinical isolates from infected root canal cases as in previous studies. The isolates were incubated in BHI broth for 4 h. This was filled in the upper chamber of the apparatus, whereasthe lower chamber contained sterile BHI broth.
The upper chamber of the apparatus with the attached teeth was suspended in such a way that the apical 2 mm of the tooth was immersed in the broth. The entire assembly was then incubated at 37°C and observed every day for turbidity in the lower chamber, for a period of 30 days. The strain E. faecalis was replenished every week to ensure the viability of the bacterial marker. Utmost care was taken to avoid spillage and accidental contamination of the lower chamber.
Any turbidity in the sterile BHI broth (lower chamber) was considered as indication of bacterial leak from the upper to lower chamber through the obturation. Turbidity in the lower chamber, if any, was tested for presence of E. faecalis by standard microbiological techniques [Figure 1].
The investigators examining leakage during the 30 days were blinded to all the groups.
Statistical analysis was performed using the Chi-square test. P < 0.05 was considered to be statistically significant.
| Results|| |
[Table 1] demonstrates the microbial leakage exhibited by the three groups when observed for a period of 30 days. [Table 2] depicts the comparison of three groups and the difference was statistically significant (P < 0.05) between the three groups. Groups 1 and 2, and Groups 1 and 3 showed statistically significant differences in terms of microbial leakage. There was no statistical significance between Group II and III.
| Discussion|| |
The goal of the root canal treatment is to eradicate microorganisms from the pulp canal system and to avoid reinfection. Therefore, a well-adapted and a three dimensionally fluid tight obturation is an important aspect for the outcome of a successful endodontic treatment.,,
A complete seal, which is one of the requirements for obturation, has not been achieved when the gutta-percha was used as an obturating material.,, To overcome this issue, newer obturation systems have been introduced in the market. Two such systems included in this study are Resilon/Epiphany and Guttaflow.
Advances in dentin bonding have led to the recent development of composite resin root filling material, such as Resilon. Resilon is high-performance industrial polyurethane that has been adapted for dental use. It can be placed using warm vertical compaction, thermoplastic injection, and also lateral compaction. Unlike previous resin filling materials that could not be effectively removed from the canal, Resilon can be softened and dissolved like gutta-percha.
Epiphany sealer is a dual cure dental resin composite sealer, wherein curing is initiated by 40 seconds of light exposure to cure the coronal 2 mm of canal, whereas the entire filling will self-cure in approximately 15–30 min.
Guttaflow is a nonheated flowable obturation material that is supplied in the form of two components, a paste-paste system contained in a single capsule. Before use, the two components of the capsule are mixed by triturating it in a triturator for about 30 seconds and then inserted in the canal with the help of applicator tips. This is a single component obturation system and no separate sealer is required for use with it. However, the use of a single master cone is recommended. This obturation system has a working time of 10 min and sets completely in about 15 min.
The microbial leakage of the three root canal filling systems, Guttaflow, Resilon, and Gutta-percha with AH plus sealer, were then evaluated by bacterial leakage method. The tracers that most often used to evaluate micro leakage are dyes, radioisotopes, bacteria, or bacterial by-products. Currently, fluid filtration and dye extraction methods are also used to test the micro leakage through the root canal filling material. Although dyes may be a good tool for comparing relative leakage, the disadvantage is that they do not simulate the type of microbial leakage that may occur clinically and the air entrapped in voids along the root canal filling may hinder the fluid movement.
Use of bacteria to assess leakage of root canal system (mainly coronal) is considered to be of greater clinical and biological relevance than the other methods. In this study, microbial leakage through the obturating material was evaluated using Gram-positive facultative bacteria E. faecalis. The prominence of E. faecalis in root-filled teeth is considered as a main etiological factor for the apical periodontitis in the endodontically treated teeth. This organism is common isolate from infected root canals. Its prevalence ranges from 24% to 77%. This finding can be explained by various virulence factors possessed by it, including its ability to invade deep into the dentinal tubules and resist nutritional deprivement. Thus, these bacteria seem relevant to clinical practice. For the purpose of the study, clinical isolate of E. faecalis was used.,,
Commonly used culture media for facultative bacteria include brain heart infusion broth (BHI), trypticase soy broth, or phenol red broth. In this study, BHI broth was used, the turbidity of which was considered an indication of bacterial leakage.
When evaluated on the basis of the number of days at which the leakage occurred, as observed for a period of 30 days, the results showed, gutta-percha group was the first to exhibit leakage at approximately the seventh day of obturation. First sample of Resilon and Epiphany group showed leakage at the 16th day of Obturation, whereas in the Guttaflow group, the first sample leaked at 11th day. About 80% samples in Resilon and Guttaflow group remained leakage free till the end of the 30-day observation period.
When evaluated on the basis of the number of leaked samples which were observed for a period of 30 days, the results showed that 80% samples leaked in the Gutta-percha and AH Plus group. On the other hand, the Resilon groups with Epiphany sealer and the silicone based Guttaflow group showed leakage in 20% of cases, i.e. less than half of that in gutta-percha and AH Plus group.
All these results were logical with the studies conducted in the past. Shipper et al. in anin vitro study, assessed bacterial leakage using Streptococcus mutans and E. faecalis through gutta-percha and a thermoplastic synthetic polymer-based root filling (Resilon) during a 30-day period with the use of two filling techniques. Aptekar et al. conducted anin vitro study in which they compared micro leakage of Resilon/Epiphany and gutta-percha using a dye. Stratton et al.
conducted anin vitro study to compare the sealing ability of gutta-percha and AH Plus sealer versus Resilon and Epiphany resin root canal sealer using three different final irrigants with the fluid filtration model. In all these studies, results showed that Resilon with Epiphany sealer demonstrated significantly lesser leakage than gutta-percha and AH Plus sealer. Tunga et al. compared the leakage allowed by different obturation materials (gutta-percha and AH 26 or AH plus sealers, or Epiphany sealer and Resilon core material) using a fluid-transport method. Results showed that the teeth filled with gutta-percha and AH 26 exhibited the most leakage and Epiphany sealer and Resilon core material exhibited least leakage.
The mechanism of sealing ability of Resilon may be attributed to the mono block, which is created by the Resilon filling closely adapting to the Epiphany sealer and, in turn, the Epiphany sealer adapting to the dentin walls. This is facilitated by the removal of smear layer and application of the Epiphany primer, which is a self-etch primer. It contains sulfonic acid terminated functional monomer, HEMA, water, and polymerization initiator as components. The preparation of the dentin through these chemical agents may prevent shrinkage of the resin filling away from the dentinal wall and aid in sealing the roots filled with Resilon.
Studies conducted previously have individually tested the microbial leakage of Resilon/Epiphany and Guttaflow. The excellent sealing ability of the Guttaflow root canal filling material could be attributed to its good flow properties. This allows for optimum distribution of the paste throughout the canal. The material is thyrotrophic, i.e. the viscosity diminishes under pressure, and so it flows and adapts well to the canal walls.
Previous studies indicate good sealing ability for both the Resilon/Epiphany and Guttaflow obturation systems. Thus, this study was attempted to further compare these two systems with respect to each other, using Gutta-percha/AH Plus group as the standard.
| Conclusion|| |
Resilon/Epiphany and Guttaflow groups demonstrated good sealing ability when evaluated by microbial leakage test, of which Resilon/Epiphany resisted bacterial leakage for a longer period of time. Gutta-percha and AH Plus group showed poor sealing ability.
However, further studies are required to evaluate the properties of these materials.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Department of Conservative Dentistry and Endodontics, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2]
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