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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 857-860  

Comparison of sealing ability of bioceramic sealer, AH plus, and guttaflow in conservatively prepared curved root canals obturated with single-cone technique: An In vitro study


1 Department of Pedodontics and Preventive Dentistry, Indira Gandhi Government Dental College and Hospital, Jammu, India
2 Conservative Dentistry and Endodontics, Indira Gandhi Government Dental College and Hospital, Jammu, Jammu and Kashmir, India
3 Department of Public Health Dentistry, Clinical Practitioner, Mumbai, Maharashtra, India
4 Metropolitan Dental Center, Troy, MI, USA
5 Department of Pedodontics and Preventive Dentistry, RVS Dental College and Hospital, Coimbatore, Tamil Nadu, India

Date of Submission03-Feb-2021
Date of Decision10-Feb-2021
Date of Acceptance15-Feb-2021
Date of Web Publication30-Apr-2021

Correspondence Address:
Dr. Ajay Kumar
Department of Conservative Dentistry and Endodontics, Indira Gandhi Government Dental College and Hospital, Jammu, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.jpbs_52_21

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   Abstract 


Background: Inadequate obturation techniques of the root canal system have been found to be the most frequent reason of failure post root canal treatment. An ideal endodontic sealer should fulfill all ideal requisites. The present study aimed to compare apical sealing ability between bioceramic (BC) sealer, GuttaFlow, and AH Plus. Methodology: One hundred and twenty-five curved roots of maxillary and mandibular third molar teeth with fully formed apex were collected for this study. The root canals were cleaned and shaped using a standard single-cone preparation to file at the established working length and divided into five groups of 25 each. Dye leakage was carried out. Group A: with GP, using EndoSequence BC sealer with conventional with 4% gutta-percha (Brasseler USA, Savannah, Georgia, USA); Group B: with ceramic coated with 4% gutta-percha (Brasseler USA, Savannah, Georgia, USA); Group C: with GP, using AH Plus sealer (Dentsply, De-Trey Konstanz, Germany) with 4% gutta-percha; Group D: with GuttaFlow bioseal (Roeko-Coltène/Whaledent, Langenau, Germany) with 4% Gutta-percha; and Group E is a negative control group. Statistical analysis was done using the Statistical Package for the Social Sciences software and Student's unpaired t-test. Results: The group AH Plus showed more leakage values than the GuttaFlow group and of two groups of BC sealer and negative control. Student's unpaired t-test disclosed no significant difference (P < 0.05) between the groups. Conclusion: None of the sealers used in the study could completely seal the apical foramen to have a fluid-tight seal.

Keywords: AH Plus, apical leakage, bioceramic sealer, GuttaFlow, sealer


How to cite this article:
Kaul S, Kumar A, Badiyani BK, Sukhtankar L, Madhumitha M, Kumar A. Comparison of sealing ability of bioceramic sealer, AH plus, and guttaflow in conservatively prepared curved root canals obturated with single-cone technique: An In vitro study. J Pharm Bioall Sci 2021;13, Suppl S1:857-60

How to cite this URL:
Kaul S, Kumar A, Badiyani BK, Sukhtankar L, Madhumitha M, Kumar A. Comparison of sealing ability of bioceramic sealer, AH plus, and guttaflow in conservatively prepared curved root canals obturated with single-cone technique: An In vitro study. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Jul 29];13, Suppl S1:857-60. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/857/315277




   Introduction Top


The scientific and biological pillar of endodontics is well rooted and highlights the dominant role of microorganisms in the initiation, development, and persistence of periapical disease and apical periodontitis.[1],[2],[3],[4],[5] Therefore, the main principle for successful root canal treatment (RCT) is the prevention of oral flora and toxins from entering through the root canal system into the periapical tissues. This is obtained by obturating the root canal system completely, including the coronal and apical seal.[6],[7],[8] Inadequate obturation techniques of the root canal system have been found to be the most frequent reason of failure post RCT. An ideal endodontic sealer should fulfill all ideal requisites. The tight seal at the apex can be enhanced, sealer bonds chemically to the dentinal wall of root canal, and mild expansion of the sealer improves its adaptation to the canal walls. The three-dimensional obturation is the primary objective of root canal therapy; the purpose of obturation, in turn, is to seal all “portals of exit.”[9],[10],[11],[12],[13],[14],[15] Obturation impedes any sort of communication between periapex, periodontal space, and root canal, thus entombing the microorganisms and preventing reinfection by spread of microbial toxins. Conventionally, sealers can be a cause of root canal failure due to microleakage at sealer–dentin or sealer–core material interface. Bonding of the sealer to the root canal dentin wall and formation of a monoblock can eliminate this drawback. It should be antibacterial and resistant to dissolution. The present study was undertaken to compare and evaluate the apical sealing ability of bioceramic (BC) sealer, AH Plus, and GuttaFlow in conservatively prepared narrow canals obturated with single-cone technique in an in vitro study.


   Methodology Top


The study was conducted on 125 extracted human curved roots of maxillary and mandibular third molar teeth. Seventy-five extracted human single-rooted permanent teeth with fully developed root apices, straight roots, free of cracks, caries, resorptive defects, and fractures were selected for the study. After removal of the external debris, teeth were placed in 2.5% sodium hypochlorite (NaOCl) solution for 2 h and stored in normal saline. Teeth were decoronated 12 mm from the apex; canals were accessed. Instrumentation was done with 4% and up to 11 mm working length using neo-endo endodontic Ni-Ti rotary files and keeping Schilder's technique in mind. Canals were irrigated with 10 mL of a freshly prepared solution of 5.25% NaOCl and 17% ethylenediaminetetraacetic acid solution alternatively between files, and the final irrigation was done with normal saline. The canals were then dried with sterile paper points. Single-cone method of obturation was performed with size 30 as the master cone.

Obturation of canals

The specimens were randomly divided into five groups of 25 samples each.

  1. Group A: With GP, using EndoSequence BC sealer with conventional with 4% gutta-percha (Brasseler USA, Savannah, Georgia, USA)
  2. Group B: With ceramic coated with 4% gutta-percha (Brasseler USA, Savannah, Georgia, USA)
  3. Group C: Using AH Plus sealer (Dentsply, De-Trey Konstanz, Germany) with 4% gutta-percha
  4. Group D: With GuttaFlow bioseal (Roeko-Coltène/Whaledent, Langenau, Germany) with 4% gutta-percha
  5. Group E is a negative control group.


Following obturation of each group, gutta-percha was removed from the coronal 2 mm of the obturated root canals with a warm instrument after the sealer had hardened and the coronal end of all canals was sealed with glass-ionomer cement. The teeth were stored in an incubator in 100% humidity at 37°C for 48 h to ensure the complete setting of the sealers. Root surfaces of all the samples except negative control were coated with two coats of nail varnish except apical 2 mm. Numerous studies have evaluated the apical sealing ability of root canal fillings using methods such as dye leakage,[8] electrochemical techniques,[9],[10] bacterial penetration measurement,[11] radioisotope techniques,[12] and fluid filtration[13] techniques. Although there are many studies of the apical sealing abilities of different root obturation techniques, studies that compare leakage evaluation methods are less common and their results conflict with each other. All the root surfaces of all the teeth were thoroughly dried and coated with two coats of nail varnish, except at the apical 2 mm of the root, with each coat being allowed to dry before the subsequent one was applied.

These samples were suspended in dye, i.e., 1% methylene blue in a glass container for 72 h at 37°C in the incubator. One percent methylene blue has been shown to have a better result than other dyes used in dentistry.[8] The samples were suspended in the dye in a vertical direction with the help of a sticky wax so that the dye can penetrate by capillary action. After removal from the dye, the teeth were washed under running tap water to remove excess dye and nail varnish was removed using Bard-Parker blade.

A demineralization and clearing process was carried out. The teeth were demineralized by placing in 5% nitric acid solution; the acid was changed daily for 5 days. The teeth were dehydrated in 70%, 80%, 90%, and absolute alcohol for 1 h in each concentration. By immersing the teeth in methyl salicylate solution, clearing process was completed.

The samples were then examined under stereomicroscope (magnification: ×4–40) for the evaluation of dye penetration. A single examiner measured the extent of microleakage. The dye penetration scores were recorded and tabulated, and statistical analysis was carried out. The dye used has multiple advantages such as dissolution during the demineralization and clearing processes, and hence, the teeth were demineralized and cleared.


   Results Top


The efficacy was evaluated based on the dye penetration test. This in vitro study was conducted to evaluate the apical sealing ability between two types of BC sealer, AH Plus, and GuttaFlow. The original values of apical microleakage for all three sealers were recorded [Table 1]. The group AH Plus showed more leakage values than the GuttaFlow group and two types of BC sealer. The results showed that both the BC sealer groups had had a mean leakage of 0.89 mm whereas the GuttaFlow group had a mean leakage of 1.42 mm whereas AH Plus had a mean of 1.73 mm. The standard deviation of BC sealer, GuttaFlow, and AH Plus was 0.3002, 0.2998, and 0.2721, respectively.{Table 1}

Statistical analysis was done using the Statistical Package for the Social Sciences software, and Student's unpaired t-test disclosed no significant difference (P > 0.05) between the groups [Table 2].{Table 2}


   Discussion Top


The goal of root canal filling is always to prevent the ingress of microorganisms and their by-products along the root canal. Among all the tested groups used in this study, TotalFill BC sealer with BC gutta-percha was the best group which showed the least leakage. Better performance of TotalFill BC can be explained on the basis of its small particle size, hydrophilicity, and low contact angle which enable the cement to spread easily over the dentin walls of the root canal and get inside and fill the lateral microcanals. BC root canal sealers also exhibit chemical bonding to root canal dentin walls as well as its corresponding BC particle impregnated gutta-percha. It also exhibits a significant expansion of 0.20%. These features result in gap–free chemical bond between the sealer and dentinal walls, thus making it an effective sealer.[11],[12],[13] A silicone-based sealer (GuttaFlow) has been introduced as one of various root filling materials. GuttaFlow is 2 in 1 cold, fluid obturation system that mixes sealer and gutta-percha together. It consists of a polymer matrix, which is filled with very finely ground gutta-percha. Polydimethylsiloxane has been utilized in the dental field for many years, especially in prosthodontics, as an impression material with only limited dimensional change in setting expansion. The finely ground gutta-percha powder and the silicone-based matrix are dispensed homogeneously after mixing. Laboratory investigations indicate setting expansion of 0.2% biocompatibility.[8],[9],[16],[17],[18],[19],[20] GuttaFlow contains nanosilver. Nanosilver is metallic silver that is uniformly dispersed on the surface of the filling. The corrosion or color changes in GuttaFlow are not caused by the chemical type and concentration of the nanosilver. There is adequate nanosilver in the material to avert further spread of bacteria, and nanosilver is highly biocompatible.[10] AH Plus (Dentsply Maillefer, Ballaigues, Switzerland) is an epoxy-based endodontic sealer that is used with gutta-percha. It consists of a paste-to-paste system, supplied in two tubes in a double-barrel syringe. AH Plus contains silicone oils along with other ingredients. AH Plus has a film thickness of approximately 25 mm, which is clearly below the value of <50 mm required by the ISO standard for root canal sealing materials.[11] In this dye leakage study, methylene blue dye was used because it shows a high sensitivity and its particles are of a similar dimension to microorganisms and their metabolites.[12],[13] In the present study, dye penetration was observed in all specimens. Statistical analysis revealed that the lowest dye penetration was in Group 1 (BC sealer) followed by Group 2 (GuttaFlow) followed by (in ascending order of dye penetration) Group 3 (AH Plus). Leakage of AH Plus may be rippled from inadequate bonding between the sealer and the gutta-percha point, allowing fluid to pass at the interface. This possibility is in agreement with the results of Bouillaguet S et al.[18] One in vitro study compared the microleakage of three sealers, namely EndoSequence BC sealer, AH Plus, and Epiphany, suggesting that newly introduced BC and Epiphany sealers sealed better compared to AH Plus sealer.[19] In one comparative study of apical sealing ability of a new resin-based obturation system (Resilion) with AH 26, it was found that there was no significant difference between both the materials.[20]


   Conclusion Top


Dye penetration was observed in all the specimens. This shows that none of the sealers used in the study could completely seal the apical foramen to have a fluid-tight seal. Although BC sealer, GuttaFlow, and AH Plus showed no statistically significant difference in microleakage, the better result was shown by BC sealer. BC sealer seems to be a promising filling material because of the good sealing ability, ease of handling, and application of the material. The results of dye penetration studies only indicate the comparative sealing ability of root canal fillings in vitro, and they do not indicate their ability to prevent the ingress of bacteria into filled root canals in vivo. Further, in vivo studies need to be done to correlate with the present study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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