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ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 629-632  

The effects of various final irrigants on the bond strength of root dentin exposed to chloroform: An In vitro study


1 Department of Conservative Dentistry and Endodontics, Mar Baselios Dental College, Ernakulam, Kerala, India
2 Department of Conservative Dentistry and Endodontics, MES Dental College, Perinthalmanna, Kerala, India
3 Senior Resident, Endodontics, Employees State Insurance Corporation Hospital, Ezhukone, Kollam District, Kerala, India
4 Department of Oral and Maxillofacial Surgery, Annoor Dental College, Muvattupuzha, Kerala, India

Date of Submission22-Sep-2020
Date of Decision30-Oct-2020
Date of Acceptance24-Nov-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Feby Kuriakose
Department of Conservative Dentistry and Endodontics, Mar Baselios Dental College, Ernakulam, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_555_20

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   Abstract 


Aim: The aim of the study was to assess the reaction of different final irrigants to the bond strength of root dentin exposed to chloroform. Materials and Methods: Fifty extracted maxillary central incisors were selected. Working length was determined, and canal was instrumented with ProTaper rotary system (Dentsply Maillefer) till F4 file. The specimens were then divided into five groups (n = 10). Group 1: not disclosed to any root canal solvent, Group 2: disclosed to chloroform for 5 min, Group 3: chloroform for 5 min followed by absolute alcohol, Group 4: chloroform for 5 min followed by chlorhexidine (CHX), And Group 5 – chloroform for 5 min followed by saline. The canals were obturated with F4 gutta-percha cones with AH Plus sealer. The samples will be sectioned horizontally into 1 ± 0.1 mm thick slices. The push-out bond strength was performed in a universal testing machine. Results were statistically analyzed by one-way analysis of variance. Results: There existed a significant difference between the mean push-out bond strength of different groups. Irrigation with chloroform negatively affected the bonding between root canal sealer and root dentine. Absolute alcohol significantly improved the bond strength values. Conclusion: Exposure with chloroform during the retreatment will decrease the bonding between sealer (AH Plus) and root dentine. The use of absolute alcohol as a final irrigant improved the bonding between sealer and dentin. CHX and saline showed no improvement in bond strength.

Keywords: Absolute alcohol, AH plus, chlorhexidine, chloroform, push-out bond strength, retreatment, saline, sodium hypochlorite


How to cite this article:
Kuriakose F, Joy B, Mathew J, Karathodiyil R, Hariprasad R, Philip T. The effects of various final irrigants on the bond strength of root dentin exposed to chloroform: An In vitro study. J Pharm Bioall Sci 2021;13, Suppl S1:629-32

How to cite this URL:
Kuriakose F, Joy B, Mathew J, Karathodiyil R, Hariprasad R, Philip T. The effects of various final irrigants on the bond strength of root dentin exposed to chloroform: An In vitro study. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Oct 27];13, Suppl S1:629-32. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/629/317527




   Introduction Top


A successful root canal treatment primarily depends on the complete cleaning and shaping followed by proper obturation of the root canal systems. There are always chances of posttreatment complications if these parameters are not achieved.[1] When a root canal treatment fails, retreatment is the choice to eliminate the infection.

Nonsurgical treatment demands complete removal of previously filled gutta-percha along with the sealer from the root canal system. Usually, mechanical removal is assisted by various chemical solvents.[2] The use of chemical solvents is aimed at the effective removal of the gutta-percha from the canal space. There are a wide variety of solvents that is available for retreatment procedures, out of which the most commonly used is chloroform because of its effectiveness in removal of the gutta-percha.[3]

Chloroform when used in retreatment will change the mineral composition of the dentinal walls and thus will adversely affect the bond strength of root canal sealer to root dentin.[4] Treatment with chloroform will leave a thin layer of softened gutta-percha that cannot be removed completely.[5] Hence, there is always a need for a final irrigant after the exposure of root canal walls to remove this residual gutta-percha and root canal solvents which was left behind. Effects of various final irrigants on the root dentin treated with chloroform have not been evaluated in any endodontic literature so far. Hence, our study was aimed to assess effects of different final irrigants on the push-out bond strength of root canal sealer to root dentin exposed to chloroform.


   Materials and Methods Top


A total of fifty extracted human maxillary central incisors were selected and stored in the distilled water until required. Criteria for tooth selection included a completely formed apex and absence of previous root filling, resorption, or calcifications. Access cavities were made with round burs (Diatech; Coltene Whaledent, Altstatten, Switzerland) using an airotor with sufficient water cooling. A No: 10 K-file (Dentsply Maillefer) was introduced into the canal till it was seen at the apical foramen. The working length was calculated by reducing 1 mm from this measurement. The samples were prepared with the Pro-Taper rotary system (Dentsply Maillefer) up to size F4 (master apical file). During biomechanical preparation, the root canal was irrigated with 5 mL of 2.5% sodium hypochlorite (NaOCl) solution between each instrument change.

The total of 50 teeth was assigned to five experimental groups.

  • Group 1 – not disclosed to any root canal solvent
  • Group 2 – disclosed to chloroform for 5 min
  • Group 3 – disclosed to chloroform for 5 min followed by irrigation with absolute alcohol for 5 min
  • Group 4 – chloroform for 5 min followed by irrigation with chlorhexidine (CHX) for 5 min
  • Group 5 – chloroform for 5 min followed by irrigation with saline for 5 min.


0.2 ml of each solvent was placed in the root canal space and left in place till the completion of the exposure time (5 min) and was then eliminated with paper points followed by irrigation with the abovementioned final irrigants.

The sealer used will be AH Plus (Dentsply DeTrey GmbH, Konstanz, Germany), and the canals were obturated with F4 gutta-percha cones (Dentsply Maillefer). 1 mm of filling material was then removed from the coronal area and spaces were filled with a temporary filling material. Radiographs were taken to conform complete filling. All the specimens were stored in 37° in 100% humidity for 2 weeks.

Push-out bond testing

The sections were horizontally sectioned into 1 ± 0.1 mm thickness serial slices from the middle third using a precision saw with adequate cooling. The thickness was confirmed using a digital caliper. Specimens were examined microscopically to confirm circular canal shape. The push-out test was carried out in a universal testing machine [Figure 1] (Tinus Oslen, USA).
Figure 1: (a) 50 extracted central incisor teeth, (b) 50 specimens of cross-sectioned teeth, (c) cross-sectioned slice of thickness 1 mm, (d) universal testing machine in action

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Statistical analysis

Data were compiled on excel. Statistical analysis was done using SPSS software (V.17.0) (SPSS Inc., Chicago, IL, USA). The results were tabulated and analyzed statistically by one-way analysis of variance (ANOVA).


   Results Top


The highest value was recorded by the control group 1 with a mean push-out bond strength value of about 6.58 MPa [Table 1]. When the tooth samples were treated with chloroform, all the groups showed a significant decrease in bond strength values. Absolute alcohol-treated group showed a significant increase in bond strength values with a mean value of about 4.43 MPa. The push-out bond strength values of CHX (Group 4) and saline (Group 5) treated samples were 3.73 and 3.78, respectively.
Table 1: Push-out bond strength of root canal sealer to root dentin in mega Pascal (MPa)

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We compared a one-way ANOVA to compare the push-out bond strength of different root canal sealer after exposing it with chloroform followed by irrigation with different final irrigants. There existed a significant difference between the mean push-out bond strength of different groups with a f = 71.113 and significance level of 0.000 [Table 2].
Table 2: Push-out bond strength of Root canal sealer (MPa)

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   Discussion Top


Adhesion is one of the most important physical properties that is required by the root canal sealers.[6] It helps to obtain a tight seal, which is essential for attaining success in root canal treatment. AH Plus is a resin-based sealer available as a 2 paste system. Due to its excellent properties, such as low solubility, small expansion, adhesion to dentin, and very good sealing ability,[7] AH plus is considered as a benchmark “Gold Standard.” Hence, AH Plus was taken as the choice of sealer in our study.

In root canal retreatment procedure, we have to remove the gutta-percha that was previously obturated in the canal spaces and it requires a solvent. A root canal solvent is meant to dissolve as much as gutta-percha a possible.[8] Chloroform is an organic solvent and is effective in dissolving gutta-percha.[9] In fact, the gutta-percha was originally designed to get dissolved in chloroform and the mixture of chloroform and gutta-percha is called as chloropercha.[10] In clinical practice, chloroform still remains the most effective and widely used solvent for the dissolution of the gutta-percha.[11]

In a previous study, Shokouhinejad et al.[12] estimated the push-out bond strength Resilion/Epiphany self-etch system to radicular dentin after retreatment. They first obturated the canal and then removed the obturation with a combination of solvents and retreatment files. After the removal, the root canal space was again obturated with Resilion/Epiphany self-etch, but doing so will involve a lot of variables. Ring et al.[13] did a study, in which he compared the efficacy of different retreatment solvents and rotary files to remove the obturation material from the root canal space, and he concluded that it is unable to completely remove the obturation materials from the root canal space. In our study to reduce the variables involved, an initial root canal filling was not done.

In the present study, all the single-rooted maxillary central incisor specimens were obturated with the F4 gutta-percha. F4 size gutta-percha was selected because it matched the size and taper of the master apical rotary file that could fill the root canal space almost completely when used as a single cone.[14] Nagas et al.[15] compared the bond strength of master gutta-percha points with different tapers (0.02, 0.04, and 0.06) in canals instrumented with a 0.06 tapered master apical file and found that the highest bond strength was provided by 0.06 tapered single cone.

According to a previous study by Neelakantan et al.,[16] the bond strength values are greater in coronal followed by middle and apical third. In our study, to make the study more standardized and for the ease of sectioning, only middle third section of the root matching the plunger size of 0.8 mm was taken into account in testing the push-out values.

Kaufman et al.[17] showed that the calcium and phosphorus levels of human dentin were changed after treatment with the chloroform. The results of our study were similar to the one conducted by Topcuoglu et al.,[18] in which he concluded that bond strength was crucially affected by solvent type and time. The use of chloroform for 5 min in the root canal space reduced the bond strength of all sealers.


   Conclusion Top


  • The highest push-out bond strength value was recorded by Group 1, which was not exposed to any root canal solvents with a mean push-out bond strength of 6.58 MPa
  • Exposure to chloroform significantly decreased bonding of epoxy resin-based (AH Plus) root canal sealer with root dentin with mean push-out bond strength values of 3.80 MPa (Group 2)
  • On irrigation with absolute alcohol, there was a gain in push-out bond strength after exposure to chloroform and Group 3 samples recorded a mean value of 4.48 MPa
  • Irrigation with CHX and saline (Group 3 and Group 4) samples recorded values of 3.73 and 3.78 MPa, respectively, indicating that it showed no improvement in bonding between root canal sealer and root dentin with these groups.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Siqueira JF Jr. Aetiology of root canal treatment failure: Why well-treated teeth can fail. Int Endod J 2001;34:1-10.  Back to cited text no. 1
    
2.
Gilbert BO Jr., Rice RT. Re-treatment in endodontics. Oral Surg Oral Med Oral Pathol 1987;64:333-8.  Back to cited text no. 2
    
3.
McDonald MN, Vire DE. Chloroform in the endodontic operatory. J Endod 1992;18:301-3.  Back to cited text no. 3
    
4.
Erdemir A, Eldeniz AU, Belli S. Effect of gutta-percha solvents on mineral contents of human root dentin using ICP-AES technique. J Endod 2004;30:54-6.  Back to cited text no. 4
    
5.
Ring J, Murray PE, Namerow KN, Moldauer BI, Garcia-Godoy F. Removing root canal obturation materials: a comparison of rotary file systems and re-treatment agents. J Am Dent Assoc. 2009;140:680-8.  Back to cited text no. 5
    
6.
Grossman LI. Physical properties of root canal cements. J Endod 1976;2:166-75.  Back to cited text no. 6
    
7.
McMichen FR, Pearson G, Rahbaran S, Gulabivala K. A comparative study of selected physical properties of five root-canal sealers. Int Endod J 2003;36:629-35.  Back to cited text no. 7
    
8.
Kaplowitz GJ. Evaluation of the ability of essential oils to dissolve gutta-percha. J Endod 1991;17:448-9.  Back to cited text no. 8
    
9.
Magalhães BS, Johann JE, Lund RG, Martos J, Del Pino FA. Dissolving efficacy of some organic solvents on gutta-percha. Braz Oral Res 2007;21:303-7.  Back to cited text no. 9
    
10.
Schafer E, Zandbiglari T. A comparison of the effectiveness of chloroform and eucalyptus oil in dissolving root canal sealers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:611-6.  Back to cited text no. 10
    
11.
Mushtaq M, Farooq R, Ibrahim M, Khan FY. Dissolving efficacy of different organic solvents on gutta-percha and resilon root canal obturating materials at different immersion time intervals. J Conserv Dent 2012;15:141-5.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Shokouhinejad N, Sabeti MA, Hasheminasab M, Shafiei F, Shamshiri AR. Push-out bond strength of Resilon/Epiphany self-etch to intraradicular dentin after retreatment: A preliminary study. J Endod 2010;36:493-6.  Back to cited text no. 12
    
13.
Ring J, Murray PE, Namerow KN, Moldauer BI, Garcia-Godoy F. Removing root canal obturation materials: A comparison of rotary file systems and re-treatment agents. J Am Dent Assoc 2009;140:680-8.  Back to cited text no. 13
    
14.
Gordon MP, Love RM, Chandler NP. An evaluation of 0.06 tapered gutta-percha cones for filling of 0.06 taper prepared curved root canals. Int Endod J 2005;38:87-96.  Back to cited text no. 14
    
15.
Nagas E, Altundasar E, Serper A. The effect of master point taper on bond strength and apical sealing ability of different root canal sealers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e61-4.  Back to cited text no. 15
    
16.
Neelakantan P, Subbarao C, Subbarao CV, De-Deus G, Zehnder M. The impact of root dentine conditioning on sealing ability and push-out bondstrength of an epoxy resin root canal sealer. Int Endod J 2011;44:491-8.  Back to cited text no. 16
    
17.
Kaufman D, Mor C, Stabholz A, Rotstein I. Effect of gutta-percha solvents on calcium and phosphorus levels of cut human dentin. J Endod 1997;23:614-5.  Back to cited text no. 17
    
18.
Topcuoglu HS, Demirbuga S, Tuncay O, Arslan H. The bond strength of endodontic sealers to root dentin exposed to different gutta-percha solvents. Int Endod J 2014;47:1100-6.  Back to cited text no. 18
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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