Filling Effectiveness and Dentinal Penetration of Endodontic Sealers: A Stereo and Confocal Laser Scanning Microscopy Study.

Rogério Vieira Silva,Ivaldo Gomes De Morais,Marco Antônio Húngaro Duarte,Martinho Campolina Rebello Horta,Eduardo Nunes,Frank Ferreira Silveira,Bruno Cavalini Cavenago

doi:10.1590/0103-6440201300138

Abstract

The aim of this study was to evaluate the filling effectiveness and dentinal penetration of the sealers AH Plus, Pulp Canal Sealer EWT, Sealapex and MTA Fillapex applied according to the vertical condensation technique using thermoplastic gutta-percha. Forty single-rooted teeth were selected. After chemical-mechanical preparation and root-canal filling, sections of the root (2, 4 and 6 mm from the apex) were obtained and analyzed by stereo microscopy and confocal laser scanning microscopy. Data were tabulated and statistically analyzed. With regard to the assessment of void spaces in the filling material at 2 mm from the apex, the sealers showed similar results, but at 4 and 6 mm from the apex, MTA Fillapex had inferior performance compared to AH Plus (at 4 mm), Pulp Canal Sealer EWT (at 4 and 6 mm) and Sealapex (at 6 mm) (p<0.05). With regard to the penetration into dentinal tubules at 2 mm from the apex, the sealers also showed similar results, but at 4 and 6 mm Pulp Canal Sealer EWT had an inferior performance compared to MTA Fillapex and AH Plus, respectively (p<0.05). All four sealers were found to be similar regarding adaptation of the filling material to the root canal walls, except the MTA Fillapex, which showed failures at 4 and 6 mm from the root apex. With regard to the ability to penetrate into the dentinal tubules, the sealers were found to be equivalent, except for the Pulp Canal Sealer EWT as it had poorer results at 4 and 6 mm compared to MTA Fillapex and AH Plus, respectively.

Highlights

The most frequent cause of apical periodontitis is the bacterial infiltration resulting from caries and/or crownroot fractures, which can reach the system of root canals and dentinal tubules
Complete sealing of the root canal system (RCS) is a challenge to be achieved during the endodontic therapy, since the quality of the root canal filling is directly related to the chemical-mechanical preparation, whose objective is to act on anatomical irregularities, curves, isthmuses, and ramifications
Significant difference was observed between MTA Fillapex and Pulp Canal Sealer EWT as well as between MTA Fillapex and AH Plus at 4 mm from the root apex (Kruskal-Wallis and Dunn’s multiple comparison tests, p

Summary

Introduction

The most frequent cause of apical periodontitis is the bacterial infiltration resulting from caries and/or crownroot fractures, which can reach the system of root canals and dentinal tubules Microorganisms with their by-products account for the start and/or maintenance of the periapical inflammatory process [1]. Complete sealing of the root canal system (RCS) is a challenge to be achieved during the endodontic therapy, since the quality of the root canal filling is directly related to the chemical-mechanical preparation, whose objective is to act on anatomical irregularities, curves, isthmuses, and ramifications Filling these complex anatomies is as difficult as cleaning them because the aim is the three-dimensional sealing of the entire endodontic cavity [3]. Penetration of endodontic sealers presents advantages because they are biologically beneficial, due to their antibacterial effects on the infected dentinal tubules [6]

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Conclusion