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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 375-378  

In vitro assessment of apical microleakage of teeth sealed with three different root canal sealers: A comparative study


1 Department of Conservative Dentistry and Endodontics, Seema Dental College and Hospital, Rishikesh, Uttarakhand, India
2 Department of Conservative Dentistry and Endodontic, Himachal Dental College, Mandi, Himachal Pradesh, India
3 Department of Conservative Dentistry and Endodontics, Himachal Dental College and Research Center, Mandi, Himachal Pradesh, India
4 Department of Pediatric and Preventive Dentistry., Dr. D. Y. Patil Vidyapeeth, Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune, Maharashtra, India
5 Department of Prosthodontics and Crown & Bridge, Shaheed Kartar Singh Sarabha Dental College and Hospital, Ludhiana, Punjab, India
6 Department of Conservative Dentistry and Endodontics, Jan Nayak Chaudhary Devi Lal Dental College, Sirsa, Haryana, India

Date of Submission28-Sep-2020
Date of Decision30-Sep-2020
Date of Acceptance01-Oct-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Prabhat Mandhotra
Department of Conservative Dentistry and Endodontic, Himachal Dental College, Sundernagar, Mandi, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_610_20

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   Abstract 


Background: For the success of an endodontic treatment, a hermetic seal is of utmost importance. The event of entry of cariogenic bacteria through the interface between the tooth and the restoration of a proliferation of these microbes and subsequent adverse effects on the pulpal tissue or recurrent caries can be expected. Hence, the present study was undertaken for evaluating the apical microleakage of teeth sealed with four different root canal sealers. Materials and Methods: Collection of a total of ninety freshly extracted mandibular first premolars was done for the present study. Establishment of working length was done by measuring the root canal length and subtracting 1 mm from it. All the specimens were divided into three study groups as follows: Group A: Endofill sealer group, Group B: EndoREZ sealer group, and Group C: AH Plus group. The resin points were supplied with the sealer (according to their respective study groups), and obturation was done. Application of four layers of nail polish was done on the entire tooth surface leaving the apical 2 mm portion. This was followed by immersion of the specimens in the India ink followed by storage for 1 week at room temperature. Afterward, thorough washing of the specimens was done in running water. Removal of the nail polish was done. All the specimens were observed under microscope for assessing the extent of dye penetration. Results: The mean apical dye penetration among specimens of Group A, Group B, and Group C was found to be 0.86 mm, 0.39 mm, and 0.03 mm, respectively. While comparing statistically, significant results were obtained. The mean apical dye penetration was highest for Group A and was lowest for Group C. Conclusion: Minimal microleakage is exhibited by a resin-based sealer. Hence, they provide a better apical seal in patients undergoing root canal therapy.

Keywords: Apical, root canal, sealers


How to cite this article:
Rai K, Mandhotra P, Sharma N, Patil L, Sharma A, Singh S. In vitro assessment of apical microleakage of teeth sealed with three different root canal sealers: A comparative study. J Pharm Bioall Sci 2021;13, Suppl S1:375-8

How to cite this URL:
Rai K, Mandhotra P, Sharma N, Patil L, Sharma A, Singh S. In vitro assessment of apical microleakage of teeth sealed with three different root canal sealers: A comparative study. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Sep 28];13, Suppl S1:375-8. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/375/317582




   Introduction Top


Root canal-treated teeth often do not have enough support to receive a final restoration. Therefore, an intracanal post may be a prerequisite for achieving adequate retention of the core. For the success of an endodontic treatment, a hermetic seal is of utmost importance. A hermetic apical seal is necessary to ensure a successful endodontic treatment, and it is all the more necessary not to disrupt it during the preparation of the post space.[1],[2],[3] A lot of researches have been carried out showing variable results on the apical leakage due to post space preparation depending on the time duration following the obturation procedure. The preparation of the post space can be done immediately following the obturation procedure, or it can be carried out after a gap of 1 week.[4],[5]

The bacteria may creep into the interface between the tooth and the restoration due to the marginal gaps that exist around the restoration. This phenomenon can be described as bacterial microleakage, and it can only be observed at microscopic level. It has been illustrated by various studies that the event of entry of cariogenic bacteria through the interface between the tooth and the restoration of a proliferation of these microbes and subsequent adverse effects on the pulpal tissue or recurrent caries can be expected. However, there still seems to be doubts regarding the size of the marginal gaps and the chances of development of recurrent caries.[6],[7] Hence, the present study was undertaken for evaluating apical microleakage of teeth sealed with four different root canal sealers.


   Materials and Methods Top


The present study was planned with the aim of evaluating the apical microleakage of teeth sealed with four different root canal sealers. Collection of a total of ninety freshly extracted mandibular first premolars was done for the present study. Deformed and grossly decayed tooth specimens were excluded. Immediately after extraction, all the specimens were stored in a thymol solution for 1 day. After that, the specimens were cleaned and were stored in normal saline for 3 days. Thereafter, visual inspection of all the specimens was done. Establishment of the canal length was done using ten number K-file in the pulp canal space. Establishment of working length was done by measuring the root canal length and subtracting 1 mm from it. This was followed by enlargement of the root canal space before the commencement of instrumentation. With the help of K3 instruments, enlargement of the apical portion was done. Intermittent irrigation was done using a 1% sodium hypochlorite solution. This was followed by drying of the root canal space with paper points. Afterward, all the specimens were divided into three study groups with thirty specimens in each group, as shown in [Table 1]. Group A included specimens in which root canal was obturated using Endofill (zinc oxide and eugenol sealer). Group B included specimens in which root canal was obturated using EndoREZ (urethane dimethacrylate [UDMA] resin-based root canal sealer). Group C included specimens in which root canal was obturated using AH Plus (epoxy resin-based sealer). The resin points were supplied with the sealer (according to their respective study groups), and obturation was done. This was followed by storing of the specimens at 37° centigrade for 3 days for permitting complete setting of the sealers. Application of four layers of nail polish was done on the entire tooth surface leaving the apical 2 mm portion. This was followed by immersion of the specimens in the India ink followed by storage for 1 week at room temperature. Afterward, thorough washing of the specimens was done in running water. Removal of the nail polish was done with the help of scalpel blade. This was followed by demineralization of the specimens using acetic acid followed by washing in running water and then dehydrating. After clearing of the teeth, all the specimens were observed under microscope for assessing the extent of dye penetration. All the results were recorded and analyzed by SPSS software version 16.0 (IBM, Armonk, New York). Student's t-test was used for evaluation of level of significance.
Table 1: Distribution of specimens into specific study groups

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   Results Top


In the present study, thirty tooth specimens were divided into three study groups, with thirty specimens in each group. Group A included specimens in which root canal was obturated using Endofill (zinc oxide and eugenol sealer). Group B included specimens in which root canal was obturated using EndoREZ (UDMA resin-based root canal sealer). Group C included specimens in which root canal was obturated using AH Plus (epoxy resin-based sealer). The mean apical dye penetration among specimens of Group A, Group B, and Group C was found to be 0.86 mm, 0.39 mm, and 0.03 mm, respectively. While comparing statistically, significant results were obtained. The mean apical dye penetration was highest for Group A and was lowest for Group C as shown in [Table 2] and [Graph 1].
Table 2: Comparison of mean apical dye penetration (millimeters) among different study groups

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   Discussion Top


The purpose of sealers in root canal treatment may vary from filling the irregularities of the internal architecture of root canal, to act as a lubricating medium and to establish attachment of gutta-percha to the walls of the root canal. Every endodontic sealer should fulfill certain criteria before their usage during root canal treatment. Some of them include biocompatible nature, dimensional stability, insolubility in oral fluids, presence of radiopacity, convenience of application, antibacterial characteristics, adaptability to the walls of root canal, and finally, the ability to produce a hermetic seal.[7],[8],[9] A much as 58% of cases of endodontic failures can be attributed to incomplete obturation of the root canal. Either incomplete instrumentation or improper obturation technique may be responsible for incomplete obturation. By filling the gaps between the canal wall and the gutta-percha and also by acting as a lubricant, the sealer helps in final seating the gutta-percha cones. Apart from the above features, a sealer should be capable of filling the accessory and lateral canals, bury any microbes within the dentinal tubule, and should also permit the repair of the infected periapical tissue.[4],[5],[6],[7] Hence, the present study was undertaken for evaluating the apical microleakage of teeth sealed with four different root canal sealers.

In the present study, 30 tooth specimens were divided into three study groups, with thirty specimens in each group. Group A included specimens in which root canal was obturated using Endofill (zinc oxide and eugenol sealer). Group B included specimens in which root canal was obturated using EndoREZ (UDMA resin-based root canal sealer). Group C included specimens in which root canal was obturated using AH Plus (epoxy resin-based sealer). The mean apical dye penetration among specimens of Group A, Group B, and Group C was found to be 0.86 mm, 0.39 mm, and 0.03 mm, respectively. Our results were in concordance with the results obtained by previous authors who also reported similar findings. Dultra F et al. carried out a comparison between the apical sealing capacities of four endodontic sealers. A total of forty extracted maxillary canines of permanent dentition of humans were used in this study. Instrumentation of these teeth was carried out 1 mm short of the anatomical apex. These were then designated to one of the four study groups randomly (n = 10), depending on the root canal sealer used for the purpose of obturation: Endofill, AH Plus, EndoREZ, and Epiphany. A measuroscope was used to measure the extent of apical dye penetration in all aspects within the canal. There was no statistical difference between AH Plus, Epiphany, and EndoREZ. The maximum dye penetration mean was observed with Endofill, and this difference was statistically significant (P < 0.01). It was inferred that zinc oxide- and eugenol-based sealers exhibited a greater apical microleakage when compared with resin-based sealers.[10]

In the present study, while comparing statistically, significant results were obtained. The mean apical dye penetration was highest for Group A and was lowest for Group C. Ballullaya SV et al. evaluated the extent of microleakage among different root canal sealers. In this in vitro study, a total of sixty extracted permanent dentition single-rooted human teeth were used. A comparative analysis for microleakage was carried out between zinc oxide- and eugenol-based sealer, Sealapex, AH Plus, MTA Plus, EndoREZ, and EndoSequence BC. The maximum microleakage was observed with zinc oxide- and eugenol-based sealer. Least dye leakage was exhibited by EndoSequence BC. The hydrophilic nature of bioceramic sealers resulted in greater sealing ability when compared to resin- and eugenol-based sealers.[11],[12] Goodacre CJ et al. carried out a study on delayed post space preparation using AH plus sealer and observed a significantly greater dye penetration in comparison with immediate post space preparation. Ørstavik et al., on the basis of results of their study, came to a conclusion that epoxy-based materials exhibited expansion after setting to a certain extent. An expansion of up to 0.4% was observed with AH Plus after 4 weeks. It showed continued expansion to as much as 1.2% during the following 4-week period. The presence of microleakage was attributed to the dimensional changes of these materials upon the final setting.[13] Xu et al. in their study observed no difference between the microleakage of Sealapex and AH Plus. Similarly, Sagsen et al. also observed no difference between microleakage of AH Plus and Sealapex. Different studies with methodological differences have observed varying results regarding the microleakage of AH Plus and Sealapex.[14]


   Conclusion Top


Under the light of the above-obtained results, the authors concluded that minimal microleakage is exhibited by a resin-based sealer. Hence, they provide a better apical seal in patients undergoing root canal therapy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
DeCleen MJ. The relationship between the root canal filling and post space preparation. Int Endod J 1993;26:53-8.  Back to cited text no. 1
    
2.
Cheung W. A review of the management of endodontically treated teeth. Post, core and the final restoration. J Am Dent Assoc 2005;136:611-9.  Back to cited text no. 2
    
3.
Solano F, Hartwell G, Appelstein C. Comparison of apical leakage between immediate versus delayed post space preparation using AH Plus sealer. J Endod 2005;31:752-4.  Back to cited text no. 3
    
4.
Huang TH, Yang JJ, Li H, Kao CT. The biocompatibility evaluation of epoxy resin-based root canal sealers in vitro. Biomaterials 2002;23:77-83.  Back to cited text no. 4
    
5.
Borges ÁH, Orçati Dorileo MC, Dalla Villa R, Borba AM, Semenoff TA, Guedes OA, et al. Physicochemical properties and surfaces morphologies evaluation of MTA FillApex and AH plus. ScientificWorldJournal 2014;2014:589732.  Back to cited text no. 5
    
6.
Dalat DM, Spångberg LS. Effect of post preparation on the apical seal of teeth obturated with plastic thermafil obturators. Oral Surg Oral Med Oral Pathol 1993;76:760-5.  Back to cited text no. 6
    
7.
Bouillaguet S, Shaw L, Barthelemy J, Krejci I, Wataha JC. Long-term sealing ability of Pulp Canal Sealer, AH-Plus, GuttaFlow and Epiphany. Int Endod J 2008;41:219-26.  Back to cited text no. 7
    
8.
Caicedo R, von Fraunhofer JA. The properties of endodontic sealer cements. J Endod 1988;14:527-34.  Back to cited text no. 8
    
9.
Dultra F, Barroso JM, Carrasco LD, Capelli A, Guerisoli DM, Pécora JD. Evaluation of apical microleakage of teeth sealed with four different root canal sealers. J Appl Oral Sci 2006;14:341-5.  Back to cited text no. 9
    
10.
Ballullaya SV, Vinay V, Thumu J, Devalla S, Bollu IP, Balla S. Stereomicroscopic dye leakage measurement of six different root canal sealers. J Clin Diagn Res 2017;11:ZC65-8.  Back to cited text no. 10
    
11.
Goodacre CJ, Spolnik KJ. The prosthodontic management of endodontically treated teeth: A literature review. Part II. Maintaining the apical seal. J Prosthodont 1995;4:51-3.  Back to cited text no. 11
    
12.
Ørstavik D, Nordahl I, Tibballs JE. Dimensional change following setting of root canal sealer materials. Dent Mater 2001;17:512-9.  Back to cited text no. 12
    
13.
Xu Q, Fan MW, Fan B, Cheung GS, Hu HL. A new quantitative method using glucose for analysis of endodontic leakage. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:107-11.  Back to cited text no. 13
    
14.
Sagsen B, Er O, Kahraman Y, Orucoglu H. Evaluation of microleakage of roots filled with different techniques with a computerized fluid filtration technique. J Endod 2006;32:1168-70.  Back to cited text no. 14
    



 
 
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