|Year : 2021 | Volume
| Issue : 5 | Page : 109-111
Assessment of fracture resistances of endodontically treated teeth filled with different root canal filling systems
Padma Chandra1, Vishal Singh2, Shelly Singh3, Govind Nandkumar Agrawal4, Amit Heda4, Nikita Sureshkumar Patel5
1 Department of Dentistry, Jawaharlal Nehru Medical College and Hospital, Bhagalpur, Uttar Pradesh, India
2 Department of Dentistry, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
3 MDS, Clove Dental, Chandigarh Tricity Zone, India
4 Department of Conservative Dentistry and Endodontics, Dr R R Kambe Dental College and Hospital, Kanheri Sarap, Akola, Maharashtra, India
5 BDS, MHA, Private Practitioner, Gujarat, India
|Date of Submission||23-Sep-2020|
|Date of Decision||23-Sep-2020|
|Date of Acceptance||24-Sep-2020|
|Date of Web Publication||05-Jun-2021|
Department of Dentistry, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The motive of endodontic therapy is cleaning, shaping, and subsequently obturation. This study assessed different root canal filling systems in terms of fracture resistances of endodontically treated teeth. Methodology: This study was conducted on eighty single-rooted permanent mandibular incisor teeth which were divided into five groups: Group I was negative control; Group II was positive control; Group III comprised of gutta-percha/AH Plus; Group IV comprised of Thermafil/AH Plus; and Group V Resilon/Epiphany SE. Universal testing machine measured fracture resistance. Results: The mean fracture resistance in Group I was 458.6 ± 112.4 N, in Group II was 214.8 ± 104.6 N, in Group III was 428.6 ± 108.2 N, in Group IV was 388.2 ± 126.2 N, and in Group V was 334.8 ± 102.7 N. The difference found to be statistically significant (P < 0.05). Intergroup comparison showed a statistically significant difference (P < 0.05) between Groups I-II, I-V, II-III, and II-IV. Conclusion: The authors found that lateral condensation performed with AH Plus sealer and gutta-percha and the Thermafil technique were the highest among all other methods.
Keywords: Gutta-percha, root canal material, thermafil
|How to cite this article:|
Chandra P, Singh V, Singh S, Agrawal GN, Heda A, Patel NS. Assessment of fracture resistances of endodontically treated teeth filled with different root canal filling systems. J Pharm Bioall Sci 2021;13, Suppl S1:109-11
|How to cite this URL:|
Chandra P, Singh V, Singh S, Agrawal GN, Heda A, Patel NS. Assessment of fracture resistances of endodontically treated teeth filled with different root canal filling systems. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Jun 19];13, Suppl S1:109-11. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/109/317542
| Introduction|| |
Root canal treatment has proved beneficial in the management of teeth with pulpal and periapical pathologies. The motive of endodontic therapy is cleaning, shaping, and obturation. Other function is to inhibit re-infection, to maintain the integrity of periodontium and accomplishing healing.
It is has observed that root canal-treated teeth are more vulnerable to get fractured as compared to vital tooth because after root canal treatment they become weaker. Biomechanical preparation causes loss of moisture and dentin, extended use of chemical agent during disinfection, and application of excessive pressure. Thus, enhanced root canal strength, better root fracture resistance, and mechanical bonding between dentin and obturating materials are the aims of obturation technique. Root canal sealers help in the binding of gutta-percha to canal walls and fill extra the voids, irregularities, and accessory canals and thus assist in attaining complete sealing of the root canal system.
Root fractures may result from over-instrumentation, extended use of calcium hydroxide (Ca (OH)2, type of irrigation agents used, and excessive with pressure application during the condensation of filling materials. Other causes of tooth fractures are loss of dentin from cuspal region, reduction of pulp chamber roof, and shoulders in dentine elasticity.
Gutta-percha is frequently and widely used endodontic obturating material that has been used since years. Thermafil system is a newly invented thermoplasticized endodontic filling system which is capable of adapting to the root canal irregularities. Resilon is a secondary monoblock system containing self-etch dual cure hydrophilic resin and which attaches to dentine without needing primer. This study evaluated the fracture resistance of endodontically treated teeth restored with different root canal filling systems.
| Methodology|| |
This study was started after obtaining ethical clearance from the Institutional Ethical Committee. We recruited eighty single-rooted permanent mandibular incisor teeth with mature apices and without any fractures or cracks. At cemento-enamel junction, all teeth were sectioned. Smallest diameter to the greatest diameters specimens was maintained.
Biomechanical preparation was done as per the standardized protocol. The instrumented specimens were randomly classified into different groups. In Group I, no shaping and filling was done (negative control: 10 specimens). Group II was positive control in which specimens were instrumented with 0.04 tapered 30 K3 files and no filling was done, Group III comprised of gutta-percha/AH Plus, Group IV comprised of Thermafil/AH Plus. Group V Resilon/Epiphany SE. Passive lateral condensation technique was used for root canal obturation.
We inserted the specimens at apical 4 mm level in cold curing acrylic. A universal testing machine was used for recoding the fracture resistance, and the value at which fracture occurred was recorded. Values were recorded in Newtons. The results were entered in MS excel sheet for the statistical analysis using one-way ANOVA and Tukey's test. Level of significance was recorded at 0.05.
| Results|| |
[Table 1] shows the distribution of specimens in five groups based on the material used.
[Table 2] and Graph I show that mean fracture resistance in Group I was 458.6 ± 112.4 N, in Group II was 214.8 ± 104.6 N, in Group III was 428.6 ± 108.2 N, in Group IV was 388.2 ± 126.2 N, and in Group V was 334.8 ± 102.7 N. The difference found to be significant (P < 0.05).
[Table 2] shows that on applying Tukey's HSD, we obtained significant difference (P < 0.05) between Groups I-II, I-V, II-III, and II-IV.
| Discussion|| |
Gutta-percha is considered to be the best material as root canal sealers because to its biological compatibility, nontoxic nature, and easy removal from the root canal. However, apart from its advantages, there are few limitations such as it is not completely bond to dentin leading to incomplete obliteration and hence does not provide strength to the root canal. Cold lateral compaction of gutta-percha is the technique of choice which became evident in year 2004. In this technique, flowable gutta-percha was introduced which led to less stress on the radicular portion of tooth. The elasticity module for dentin is 14.000 MPa. Thus, it is known that elasticity of dentin is sufficient enough for providing bonding for the root restoration. Kinney et al. conducted a study in which they studied the effect of Young's modulus of peritubular and intertubular dentin and hardness and revealed that age, disease, and restorative methods may affect the stresses and strains generated in the dentin. Hence, it is imperative that a thorough knowledge of the dentine is essential in terms of its mechanical properties as well as knowing the distribution of masticatory strains in a tooth. It was found in the result that Young's modulus values for peritubular dentin is approximately 29.8 Mpa and for intertubular dentin, there is range from 17.7 to 21.1 Gpa. In this study, we determined fracture resistances of teeth which were endodontically treated and restored with different filling systems.
We recruited 80 mandibular incisor teeth for the study which were divided into five groups. Group I was negative control, Group II was positive control, Group III comprised of gutta-percha/AH Plus, and Group IV comprised of Thermafil/AH Plus. Group V Resilon/Epiphany SE. We found that mean fracture resistance in Group I was 458.6 ± 112.4 N, in Group II was 214.8 ± 104.6 N, in Group III was 428.6 ± 108.2 N, in Group IV was 388.2 ± 126.2 N, and in Group V was 334.8 ± 102.7 N.
Sandikci and Kaptan included 120 single-rooted mandibular incisors which were randomly classified into seven groups: Group 1, 3, 3, 4, 5, 6, and 7, and they were negative control, positive control, gutta-percha/AH Plus, Thermafil/AH Plus, Resilon/(Epiphany SE), gutta-percha/Epiphany SE, and EndoREZ sealer/EndoREZ cone, respectively. Fracture resistance in each group was noted and measured in MPa. It was found that all groups exhibited lower fracture resistance as compared to the negative control group. There were almost similar characteristics in all groups. The result showed significantly lower fracture resistance of positive control as compared to negative control, gutta-percha/AH Plus, Thermafil/AH Plus (P < 0.01), and gutta-percha/Epiphany SE (P < 0.05) groups. There were no significant differences between the fracture resistances of the Resilon/Epiphany SE and EndoREZ sealer/EndoREZ cone and positive control groups (P > 0.05).
We found that intergroup comparison revealed significant difference (P < 0.05) between Groups I II, I V, II III, and II IV [Table 3]. Punjabi et al. conducted a study on 120 single-rooted teeth which were divided into four groups of 25 each and two control groups of 10 each. Group I was negative control, Group II was positive control, Group III specimens underwent obturation with cold lateral compaction technique, Group IV specimens underwent obturation with cold free-flow compaction technique, Group V underwent obturation with warm vertical compaction technique, and Group VI underwent obturation with injection-molded thermoplasticized technique. Highest fracture resistance was observed in Group I and lowest fracture resistance was seen with Group II. Cold free-flow compaction technique with Gutta Flow 2 (Group IV) showed higher fracture resistance as compared to the Group III, Group V, and Group VI.
It is mentioned in the studies that elasticity modulus and flexural strength of dentin are greatly affected by the application of sodium hypochlorite (NaOCl) due to its ability to remove type I collagen, chondroitine sulphate, and glycosaminoglycans. It is evident that root canal sealers penetrate in dentinal tubules with smear layer resulting into better bonding between the dentine and the sealer. It is hence better to use distilled water as the final rinse to neutralize the effects of irrigation solutions.
The limitation of the study is small sample size, and only three materials were compared.
| Conclusion|| |
The authors found that lateral condensation performed with AH Plus sealer and gutta-percha and the Thermafil technique were the highest among all other methods.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod 1989;15:512-6.
Versluis A, Messer HH, Pintado MR. Changes in compaction stress distributions in roots resulting from canal preparation. Int Endod J 2006;39:931-9.
Lertchirakarn V, Palamara JE, Messer HH. Patterns of vertical root fracture: Factors affecting stress distribution in the root canal. J Endod 2003;29:523-8.
Oyarzún A, Cordero AM, Whittle M. Immunohistochemical evaluation of the effects of sodium hypochlorite on dentin collagen and glycosaminoglycans. J Endod 2002;28:152-6.
Weiger R, Heuchert T, Hahn R, Löst C. Adhesion of a glass ionomer cement to human radicular dentine. Endod Dent Traumatol 1995;11:214-9.
Karapinar Kazandag M, Sunay H, Tanalp J, Bayirli G. Fracture resistance of roots using different canal filling systems. Int Endod J 2009;42:705-10.
Sagsen B, Er O, Kahraman Y, Akdogan G. Resistance to fracture of roots filled with three different techniques. Int Endod J 2007;40:31-5.
Saw LH, Messer HH. Root strains associated with different obturation techniques. J Endod 1995;21:314-20.
Kinney JH, Balooch M, Marshall SJ, Marshall GW Jr, Weihs TP. Hardness and Young's modulus of human peritubular and intertubular dentine. Arch Oral Biol 1996;41:9-13.
Sandikci T, Kaptan RF. Comparative evaluation of the fracture resistances of endodontically treated teeth filled using five different root canal filling systems. Niger J Clin Pract 2014;17:667-72.
] [Full text]
Punjabi M, Dewan RG, Kochhar R. Comparative evaluation of fracture resistance of root canals obturated with four different obturating systems. J Conserv Dent 2017;20:445-50.
] [Full text]
Hammad M, Qualtrough A, Silikas N. Effect of new obturating materials on vertical root fracture resistance of endodontically treated teeth. J Endod 2007;33:732-6.
[Table 1], [Table 2], [Table 3]