AH-Plus Sealer Research Articles

“Comparative evaluation of dentinal penetration of three different endodontic sealers with and without smear layer removal” - Scanning electron microscopic study

Aim and Objectives: The aim of this study was to test the dentinal tubule penetration of mineral trioxide aggregate (MTA) Fillapex (Angelus, Londria, PR, Brazil), GuttaFlow® 2 sealer (Coltene/Whaledent) with standard sealer AH Plus (Dentsply Detrey, Konstanz, Germany) in instrumented root canals obturated by using cold lateral compaction techniques in either the presence or absence of the smear layer. Materials and Methods: Sixty extracted human mandibular premolars with a single root canal were used for this study. All teeth were prepared using F2 Pro Taper nickel–titanium rotary system. Teeth were randomly divided into three groups of 20 teeth each. GuttaFlow 2, MTA Fillapex and AH Plus were used as sealers in Group I, Group II, and Group III, respectively. Groups were divided into two subgroups in which either the smear layer was removed or retained. Removal of smear layer was achieved by continuous irrigation with 5.25% sodium hypochlorite and 2 ml of 17% ethylenediaminetetraacetic acid. The canals were dried and obturated using respective sealers by cold lateral compaction techniques. After storage at 37°C and 100% humidity for 14 days, the roots were then split into two halves using chisel and mallet. On each section, sealer penetration in the dentinal tubules at cervical, middle, and apical levels was examined by using scanning electron microscope. Results: Sealer penetration into the dentinal tubules was noticed in all groups. AH plus showed deeper penetration, followed by MTA Fillapex and GuttaFlow® 2. The penetration depth of the sealers at the cervical and middle third of root was significantly more than those at apical third. Conclusions: Within the parameters of the present study it was concluded, with the removal of smear layer AH plus sealer showed deeper penetration into the dentinal tubules at cervical and middle third of root compared with apical third.

Salvaging the Mutilated Internally Resorbed and Perforated Maxillary Incisor-One Year Six Months Follow-Up.

A 28-year-old male patient reported with the chief complaint of hollowing and discoloration of upper front teeth. The teeth were traumatized 10-12 years back [Table/Fig-1a]. Patient had undergone root canal treatment of 21 seven years back. Root canal of 12 was accessed elsewhere two days before the patient reported to the Department of Conservative Dentistry and Endodontics at Hitkarini Dental College and Hospital, Jabalpur, India. [Table/Fig-1a,b]: (a) Pre-operative picture showing hollowed and discoloured 11 and discoloured 21 and pre-operative IOPA radiograph revealed Internal resorption in 11, iatrogenic lateral perforation in 12, incomplete obturation in 21. On intraoral examination, there was a draining sinus, in relation to carious 11. Periodontal examination revealed a clinical probing depth of 5 mm in relation to 11, measured with Naber’s probe. Intraoral periapical radiograph revealed internal resorption in 11, iatrogenic lateral perforation with 12, incomplete obturation of 21[Table/Fig-1a]. Endodontic treatment of 11, 12 and re-treatment of 21 followed by flap debridement along with placement of MTA and PRF at the perforation site was planned. First phase included Tooth 11: After complete removal of infected dentin and irrigation with sodium hypochlorite. Working length was radiographically determined. Intracanal calcium hydroxide paste was placed and access cavity was sealed with Cavit temporary filling material. On recall examination next week, the sinus opening disappeared. The calcium hydroxide was flushed out and canal was irrigated with normal saline. After drying the canal with paper points, sectional obturation was performed using 60 (2%) master cone by vertical compaction with appropriate sized hand plugger, using AH-Plus sealer. After sectional obturation a fiber post was cemented with a core buildup material [Table/Fig-1b]. Tooth 12: Pulp was extirpated after modification of access cavity. The canal was cleaned and shaped. Tooth was obturated with gutta percha using lateral compaction method [Table/Fig-1b]. Tooth 21: Complete removal of gutta purcha was done using rotary re-treatment files and H file. After cleaning and shaping, ortho grade obturation was done with 70 (2%) master cone with lateral compaction [Table/Fig-1b]. Patient was recalled for 2nd phase of treatment. Full thickness mucoperiosteal flap was reflected extending from middle of the canine region of 1st quadrant to distal of lateral incisor of 2nd quadrant. The perforation site was exposed [Table/Fig-2a, 2b]. [Table/Fig-2a,f]: (a),(b) Mucoperiosteal flap raised and perforation site exposed. All the granulation tissue was curetted. The surgical field was cleaned, dried and MTA was placed at the site of perforation [Table/Fig-2c]. Intravenous blood was collected and PRF was prepared in a centrifugation machine [Table/Fig-2d]. After which PRF was placed on the surgical field [Table/Fig-2e]. The mucoperiosteal flap was repositioned and simple interrupted sutures were given using absorbable vicryl suture. Post-operative care was explained to the patient, with instructions to report back after a week for checkup [Table/Fig-2f]. After one month, fixed crowns were placed. Follow-up recall demonstrated satisfactory healing [Table/Fig-3b-3e,3g,3h]. Periodontal examination revealed reduction in clinical probing depth of 5 mm to 3 mm in relation to 11, measured with Naber’s probe. [Table/Fig-3a,f]: Preoperative IOPA radiograph and picture, recall IOPA radiograph and picture b) one month, c) six months, d), g)one year demonstrating 3mm probing depth, e), h)one year six months.

To evaluate the influence of smear layer with different instruments and obturation methods on microleakage of root canal filled teeth: In vitro study.

Aims and Objectives:The success of root canal treatment depends on proper debridement, instrumentation, proper accessibility, and proper restoration. The presence of a smear layer is considered to be a significant factor. This in vitro study was conducted to assess the effect of the presence/absence of a smear layer on the microleakage of root canal filled teeth using different instruments and obturation methods.Materials and Methods:One hundred extracted mandibular premolars with closed apices and single roots were chosen and then divided into six groups, A to F, consisting of 15 teeth each. The control group included 10 teeth; 5 positive and 5 negative. The teeth were decoronated at the cementoenamel junction. Groups A, B, C, and D were instrumented with engine-driven rotary Protaper NiTi files. Groups E and F were instrumented with conventional stainless steel hand files. Groups A, C, and E were flushed with 3 ml of 17% EDTA to remove the smear layer prior to obturation. All teeth were flushed with 5.25% sodium hypochlorite solution and obturated with AH-Plus sealer with lateral condensation technique for Groups C, D, E, F and with thermoplasticized gutta-percha technique for Groups A and B. Using an electrochemical technique, leakages in the obturated canals were assessed for 45 days. The results were tabulated using Student's t-test (paired and unpaired t-test) with the Statistical Package for the Social Sciences Software Version 21 (IBM Company, New York, USA).Results:Group A showed the lowest mean value at intervals of 10, 20, 30, and 45 days. There was no current flow in the negative controls during the test period. There was leakage in the positive controls within a few minutes of immersion.Conclusion:The results showed that rotary instrumentation contributed toward an exceptional preparation of root canals compared to hand instrumentation. Elimination of the smear layer enhanced the resistance to microleakage; thermoplasticized gutta-percha obturation technique produced a better seal compared to the lateral condensation technique.

The sealing ability of novel Kryptonite adhesive bone cement as a retrograde filling material.

Background. This study evaluated the ability of Kryptonite bone cement in sealing retrograde cavities.Methods. The root canals of one hundred extracted human maxillary incisor teeth were instrumented up to master apical file #40 using Mtwo rotary system and obturated with gutta-percha and AHPlus sealer by cold lateral compaction method. The specimens were assigned to one control group and four experimental groups based on the retrograde filling materials (n=20). The specimens were immersed in 0.5% Rhodamine B solution for 48h. Then the specimens were divided longitudinally into two parts and the depth of dye penetration was assessed under ×10 magnification. Data were analyzed using one-way ANOVA and Bonferroni tests.Results. There were statistically significant difference between the experimental groups and the control group (P<0.05). There were no statistically significant differences between the experimental groups in dye penetration scores (P>0.05).Conclusion. Kryptonite cement provided optimal apical seal in a manner similar to MTA, amalgam and IRM when used as a retrograde filling cement.

The effect of temperature on rheological properties of endodontic sealers.

Aim:The purpose of this study was to investigate temperature-dependent rheological properties of three endodontic sealers MTA Fillapex (Angelus, Brazil), AH Plus (Dentsply, Germany), and EndoREZ (Ultradent, USA).Materials and Methods:Five samples of each group of endodontic sealers (n = 30) were freshly mixed and placed on the plate of a rheometer (MCR 301, AntonPaar, Physica) and examined at 25°C and 37°C temperature, respectively. Rheological properties of the sealers were calculated according to the loss modulus (G″), storage modulus (G′), loss factor (Tan δ), and complex viscosity (η*) using dynamic oscillatory shear tests.Results:Statistical analysis (Wilcoxon signed-rank test) demonstrated that MTA Fillapex exhibited higher loss modulus (G″ > G′) and a crossover region. AH Plus and EndoREZ had a higher storage modulus (G′ > G″) at both temperatures. Loss factor (Tan δ) of MTA Fillapex was the highest compared to AH Plus, followed by EndoREZ. With a temperature change from 25°C to 37°C, MTA Fillapex exhibited a decrease while AH Plus exhibited an increase and, EndoREZ exhibited the least change, in complex viscosity (η*).Conclusions:EndoREZ exhibited better rheological properties compared to the other two test sealers.

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

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.

STUDIUL INFILTRAŢIEI APICALE A OBTURAŢIILOR DE CANAL CU GUTAPERCĂ VERSUS RESILON

The purpose of the study is to assess the apical sealing ability of the endodontic space using two types of canal filling techniques: vertical compaction of warm gutta-percha and AhPlus sealer compared with Resilon and RealSeal SE. Two sets of extracted human teeth were prepared with rotary instruments, each 20 teeth being obturated by the two techniques: the classical and the adhesive root canal filling. The apical leakage of the root canal filling made with Resilon and RealSeal SE was higher than the one with gutta-percha and AhPlus. The difference was statistically significant.

Comparison of bacterial leakage resistance of various root canal filling materials and methods: Confocal laser-scanning microscope study.

This study evaluated the bacterial leakage resistance and root canal lining efficacy of various root canal filling materials and methods by using confocal laser-scanning microscope (CLSM). Sixty extracted human premolars with mature apex and single root canal were randomly divided into 2 control groups and 4 experimental groups. Group CW was filled with continuous wave technique using gutta-percha and AH Plus sealer. Group GC was coated with AH-Plus sealer and then obturated with soften GuttaCore. Group GF was obturated using GuttaFlow and gutta-percha. Group EM was filled with EndoSeal MTA and gutta-percha using ultrasonic vibration. The AH-Plus, GuttaFlow, and EndoSeal were labeled with Hoechst 33342 to facilitate fluorescence. The obturated root tip was incubated with Carboxyfluorescein diacetate succinimidyl ester (CFSE)-stained E. faecalis for 14 days. CLSM was performed to evaluate the sealer distribution and bacterial leakage for the apical 1-, 2-, 3-mm specimens. Statistically significant differences were determined by 1-way ANOVA with Tukey's post-hoc test and Pearson's correlation analysis. Group EM showed the better sealer distribution score than the other groups (p < 0.05). Group CW and group GC exhibited the less bacterial leakage than the group GF, while group EM showed the similar bacterial leakage score with the groups CW and GC. There was no significant correlation between the sealer distribution and bacterial leakage (p > 0.05). Under the conditions of this study, different root canal filling materials and methods showed different efficacy for canal distribution and bacterial leakage resistance.

Influence of Irrigation Sequence on the Adhesion of Root Canal Sealers to Dentin: A Fourier Transform Infrared Spectroscopy and Push-out Bond Strength Analysis

IntroductionThere is a lack of evidence on the chemical interaction between sealers and dentin. The influence of irrigation on the chemical interaction between root canal sealers and dentin was analyzed by using Fourier transform infrared spectroscopy (FTIRS) and measurement of dislocation resistance. MethodsSingle-rooted teeth (n = 120) were instrumented with 3% NaOCl as the irrigant and divided into 4 groups (n = 30) on the basis of irrigation protocol: group 1, 3% NaOCl, 17% EDTA, water; group 2, 17% EDTA, 3% NaOCl, water; group 3, 3% NaOCl, QMix, water; group 4, 3% NaOCl, water. Each group was divided into 3 subgroups (n = 10) on the basis of the root canal sealer: A, epoxy resin (AH Plus); B, silicone (RoekoSeal); C, calcium hydroxide (Sealapex). The dislocation resistance was assessed by using push-out bond strength test. The data were statistically analyzed by three-way analysis of variance and Holm-Sidak tests (P = .05). Dentin powder treated as per the conditioning protocols mentioned was mixed with the sealers and analyzed by FTIRS. ResultsA significant interaction was observed between irrigation protocol, type of sealer, and root segment (P < .001) for AH Plus but not for RoekoSeal and Sealapex (P > .05). AH Plus showed the highest bond strength (P < .05). FTIRS showed chemical bonding between AH Plus and dentinal collagen. In groups 2 and 4, no chemical bonding was observed. ConclusionsBond strength of sealers is differentially affected by the irrigation protocol. The epoxy resin sealer AH Plus chemically bonds to dentinal collagen. This interaction is influenced by the irrigation protocols.

AN INVITRO COMPARATIVE EVALUATION OF FRACTURE RESISTANCE OF ENDODONTICALLY TREATED TEETH OBTURATED WITH RESILON AND GUTTA-PERCHA

Abstract Aim: To compare and evaluate in-vitro the fracture resistance of endodontically treated teeth obturated with resilon &amp; epiphany sealer and guttapercha using different sealers. Epoxy resin based sealer AH-plus and zinc oxide eugenol based sealer-TubliSeal (EWT). Methodology: sixty four human single rooted maxillary anterior teeth, cleaned stored in 0.9% saline. All the teeth were decoronated to root length 14mm and bucco-lingual diameter of 5-7mm, After access openings teeth were instrumented using K3.06 up to final apical size 30/.06 and randomly allocated into 4 experimental groups (n=16 per group). Group 1(Control group): teeth were instrumented but not obturated, Group 2: Resilon cones and epiphany SE-sealer. Group 3: guttapercha cones and epoxy based sealer AH plus. Group 4: guttapercha and Tubli seal EWT. Coronal seal was done using IRM cement. Each of the specimens were tested for fracture resistance by instron universal testing machine. Results: Higher fracture resistance values were observed for group 2 (Resilon &amp; Epiphany SE sealer) followed by group 3(Guttapercha &amp; AH Plus sealer) and group 4(Guttapercha &amp; TubliSeal EWT) when compared to group1 (control-instrumented but not obturated). Conclusion: filling the root canals with contemporary polymer based root canal obturating system- Resilon increased the in vitro fracture resistance of endodontically treated teeth.

Coronal bacterial leakage in root canals filled with single cone technique and different endodontic sealers

Objective: To evaluate coronal bacterial leakage comparing five endodontic sealers (AH Plus, Apexit Plus, Copaifera sp oil, EndoREZ and Polifil), and comparing root canals filled with EndoREZ sealer/EndoREZ® Points and EndoREZ sealer/conventional gutta-percha points.Material and Methods: 84 human teeth were prepared and filled with gutta-percha points using the single cone technique. Roots were randomly divided into 6 groups: Apexit Plus, AH Plus, Copaifera sp oil, Polifil, EndoREZ, and EndoREZ/EndoREZ Points. After setting time, the roots were incorporated in a leakage model, which upper chamber contained a suspension of Streptococcus mutans, and lower chamber a broth. Leakage was assessed for turbidity in lower chamber for 60 days. Statistic analysis was performed using the nonparametric Kaplan-Meier method (p&lt;0.05).Results: All experimental groups presented leakage during the study’s period. The medium time of leakage was: Apexit Plus and AH Plus 6,3 days, Polifil 5,1 days, Copaifera 1,2 days, and both EndoREZ groups infiltrated in the first day.Conclusions: There was no statistically significant difference between the sealers Apexit Plus, AH Plus and Polifil, but they prevented leakage better than Copaifera sp oil and both EndoREZ groups. However, none of the tested sealers was capable of resisting coronal bacterial leakage for more than 22 days.

Mandibular molar with six canals: Report of cases

A mandibular molar with more than four canals is an interesting example of anatomic variations. This case report describes a mandibular first molar with six canals, three canals located in the mesial root and three canals in distal root. The canals were instrumented with rotary system and irrigated with NaOCl (5.25%) and normal saline as the final irrigant. The canals were filled with gutta-percha (Denstply, Maillefer, Switzerland) and AH-plus sealer (Dentsply DeTrey GmbH Konstanz, Germany). This case shows a rare anatomic configuration and points out the importance of search for additional canals.

The effect of smear layer on the push-out bond strength of root canal calcium silicate cements

IntroductionThe aim of this study was to evaluate the effect of smear layer removal on the push-out bond strength between radicular dentin and three calcium silicate cements (CSC) in comparison with gutta percha and sealer. MethodsEighty human anterior extracted teeth were decoronated, cleaned and shaped to size 50/0.05 apically and randomly divided into 2 major groups: (A) smear layer preserved, and (B) smear layer removed using irrigation with 17% EDTA. Roots within each major group were further divided into 4 subgroups according to the obturation material used: (1) ProRoot MTA, (2) Biodentine, (3) Harvard MTA, (4) Gutta percha and AH-plus sealer. Obturated roots were stored in synthetic tissue fluid for 7 days to allow maximum setting of the root filling materials. Three 2-mm-thick slices were obtained from each root at different section levels (coronal, middle, apical). The canal diameters and slice thickness were measured, and the adhesion surface area for each slice was calculated. Push-out bond strength test was carried out using a universal testing machine. The bond failure mode was assessed under an optical microscope at 40×. ResultsThe mean push-out bond strength in groups 1A, 2A and 3A were 7.54 (±1.11), 7.64 (±1.08) and 8.79 (±1.55)MPa respectively, while those for groups 1B, 2B and 3B were 6.58 (±1.13), 6.47 (±1.08), 7.71 (±1.81)MPa, respectively. In the gutta percha and sealer groups the push-out bond strength means were: 1.98 (±0.48) and 2.09 (±0.51)MPa in the preserved and removed smear layer groups respectively. The push-out strength values were significantly reduced when the smear layer was removed in the CSC groups (P<0.05) while no significant difference was detected in the gutta percha and sealer groups. ConclusionsBased on the conditions of this ex vivo study, it can be concluded that smear layer removal is detrimental to the bond strength between calcium silicate cements and dentin.

In vitro antimicrobial efficiency of different root canal sealers against Enterecoccus faecalis

Abstract Objective: The antibacterial effectiveness of four different sealers AH Plus, EndoRez, mineral trioxide aggregate (MTA) Fillapex, iRoot SP against Enterococcus faecalis was evaluated by time kill assay method in vitro. Materials and Methods: Four sealers are used in this study: An epoxy resin-based sealer, AH Plus (Dentsply, Maillefer, Switzerland), a polymethacrylate resin-based sealer, EndoRez (Ultradent, South Jordan, UT) and two calcium silicate-based sealers, MTA Fillapex (Angelus Solucxoes Odontologicas, Londrina, Brazil), iRoot SP (Innovative BioCreamix Inc., Vancouver, Canada). Each sealer was mixed according to manufacturer′s instructions. Five mg of each sealer was added to sterile tubes separately and evaluated at 20 min, 24 h, 7 days, and 30 days. Two tubes were used as positive and negative. Results: At the 20th min AH Plus and iRoot SP were bactericidal, MTA Fillapex, and EndoRez were ineffective at the 20th min. At the 1st day MTA Fillapex was ineffective and rest of the sealers was bacteriostatic. At the 7th day, only MTA Fillapex showed bactericidal effect, AH Plus, iRoot SP and EndoRez were bacteriostatic. At the 30th day, MTA Fillapex was still bactericidal, AH Plus, iRoot SP, and EndoRez were still bacteriostatic. Conclusion: All root canal sealers tested were effective against E. faecalis. Fresh iRoot SP and fresh AH Plus had bactericidal action against E. faecalis. EndoRez has bacteriostatic behavior against E. faecalis. MTA Fillapex was the only sealer that could be bacteriocidal at 7th and 30th day.

Influence of dental materials on dental MRI

To investigate the potential influence of standard dental materials on dental MRI (dMRI) by estimating the magnetic susceptibility with the help of the MRI-based geometric distortion method and to classify the materials from the standpoint of dMRI. A series of standard dental materials was studied on a 1.5 T MRI system using spin echo and gradient echo pulse sequences and their magnetic susceptibility was estimated using the geometric method. Measurements on samples of dental materials were supported by in vivo examples obtained in dedicated dMRI procedures. The tested materials showed a range of distortion degrees. The following materials were classified as fully compatible materials that can be present even in the tooth of interest: the resin-based sealer AH Plus(®) (Dentsply, Maillefer, Germany), glass ionomer cement, gutta-percha, zirconium dioxide and composites from one of the tested manufacturers. Interestingly, composites provided by the other manufacturer caused relatively strong distortions and were therefore classified as compatible I, along with amalgam, gold alloy, gold-ceramic crowns, titanium alloy and NiTi orthodontic wires. Materials, the magnetic susceptibility of which differed from that of water by more than 200 ppm, were classified as non-compatible materials that should not be present in the patient's mouth for any dMRI applications. They included stainless steel orthodontic appliances and CoCr. A classification of the materials that complies with the standard grouping of materials according to their magnetic susceptibility was proposed and adopted for the purposes of dMRI. The proposed classification can serve as a guideline in future dMRI research.

Predictive models of pain following root canal treatment: a prospective clinical study

To determine the probability of the incidence, intensity, duration and triggering of post-endodontic pain, considering factors related to the patient (age, gender, medical evaluation) and to the affected tooth (group, location, number of canals, pulp vitality, preoperative pain, periapical radiolucencies, previous emergency access, presence of occlusal contacts with antagonist). A total of 500 one-visit root canal treatments (RCTs) were performed on patients referred to an endodontist. Shaping of root canals was performed manually with Gates-Glidden drills and K-Flexofiles, and apical patency was maintained with a size 10 file. A 5% NaOCl solution was used for irrigation, and canals were filled with lateral compaction and AH-Plus sealer. Independent factors were recorded during the treatment, and characteristics of post-endodontic pain (incidence, intensity, type and duration) were later surveyed through questionnaires. Of the 500 questionnaires, 374 were properly returned and split in two groups for two different statistical purposes: 316 cases were used to adjust the logistic regression models to predict each characteristic of post-endodontic pain using predictive factors, and the remaining 58 cases were used to test the validity of each model. The predictive models showed that the incidence of post-endodontic pain was significantly lower when the treated tooth was not a molar (P=0.003), demonstrated periapical radiolucencies (P=0.003), had no history of previous pain (P=0.006) or emergency endodontic treatment (P=0.045) and had no occlusal contact (P<0.0001). The probability of experiencing moderate or severe pain was higher with increasing age (P=0.09) and in mandibular teeth (P=0.045). The probability of pain lasting more than 2days was increased with age (P=0.1) and decreased in males (P=0.007) and when a radiolucent lesion was present on radiographs (P=0.1). Predictive formulae for the incidence, the intensity and the duration of post-endodontic pain were generated and validated taking account of the interrelation of multiple concomitant clinical factors. A predictive model for triggering post-endodontic pain could not be established.

An innovative technique to assess the quality of root canal fillings using spiral - Computed tomography

The study is aimed to evaluate in-vitro the quality of root fillings completed by two gutta percha techniques – lateral condensation and single cone technique. Two sets of maxillary and mandibular teeth were selected (upto second molar). Root canals were prepared with Protaper instruments and then randomly divided into two groups. In group 1 canals were filled with lateral condensation technique and in group 2, canals were filled with single cone technique. AH-Plus sealer was used in all groups. After obturation the quality was assessed by subjecting the samples through spiral CT using an innovative technique having pixel frames. Percentage of root canal filled and unfilled space was calculated and compared using obturation index. Both techniques produced comparable results in terms of percentage of root canal filling. Void distribution was found to be different in both groups. External voids were found to be more common in single cone technique and internal voids were found mostly with lateral condensation technique. The Obturation Index (as proposed by the authors) may find its applications in daily clinical practise for judging the efficacy of obturation techniques, so that a technique with an aim to create voidless obturation space may be devised.

Endodontic treatment of a maxillary second molar with two separate palatal roots: a case report.

The incidence of a two palatal rooted maxillary second molar has rarely been seen in literature [1]. Libfeld and Rotstein, in a radiographic survey done on 1200 teeth, reported a 0.4% incidence of four rooted maxillary second molars. Christie reported 14 cases of maxillary second molars with two palatal roots in a period of 40 years. Slowey reported a maxillary molar with two palatal roots [2]. A precise radiographic examination alerts the clinician to the presence of a varied root canal anatomy. A surgical operating microscope has been found to be particularly useful, as it gives the clinician the opportunity to distinguish microstructures that are not distinctly seen with the naked eye [3]. A 32-year-old, female with a non contributory medical history was referred to the Department of Endodontics, Hitkarini Dental College, Jabalpur, with spontaneous pain in maxillary right posterior teeth, which aggravated on chewing and thermal stimuli since the past 3 days. Clinical examination revealed a fixed partial denture (FDP) involving second premolar and second molar as abutments [Table/Fig-1]. Cold vitality testing done on maxillary second molar caused severe lingering pain. The FPD was removed under local anaesthesia and the teeth were temporized. Second molar still revealed severe tenderness to percussion and a premature response to electric stimulation on the next day. A diagnosis of symptomatic irreversible pulpitis with apical periodontitis was made. An access cavity was prepared under local anaesthesia after rubber dam isolation. A clinical examination done with a DG 16 explorer revealed four orifices (mesoibuccal, distobuccal, mesiopalatal and distopalatal).The access cavity was modified to a square shape, to clearly expose the distopalatal orifice. The working length was determined using an apex locator (Root ZX; Morita). Multiple radiographs taken [Table/Fig-2 and ​and3],3], confirmed the presence of four separate roots. The case was classified under Type 3 Christie et al’s. classification. A biomechanical preparation was made by using crown down technique. The middle and apical third of the teeth were instrumented using flexofiles (Dentsply Maillefer) while irrigating with normal saline and 3% NaOCl. The canals were dried and obturated using lateral condensation technique with guttapercha and AHplus (Dentsply) sealer [Table/Fig-4]. A recall after one week showed that the patient was asymptomatic. [Table/Fig-1]: Pre Operative Radiograph [Table/Fig-2]: Diagnostic radiograph 1 [Table/Fig-3]: Diagnostic Radiograph 2 [Table/Fig-4]: Post obturation radiograph The prevalence of maxillary second molar with two palatal roots is very rare. However, clinicians ought to be aware of the possibilities, as nontreatment of one canal could lead to endodontic failure.

Effect of time of extraction on the biocompatibility of endodontic sealers with primary human fibroblasts

The aim of this work was to evaluate the effects of different times of extraction on the cytotoxicity of six representatives of different root canal sealer groups-Real Seal SE, AH Plus, GuttaFlow, Sealapex, Roth 801, and ThermaSeal Plus-with human gingival fibroblasts. The materials were prepared according to manufacturers' specifications, and were incubated in culture medium (DMEM) at 37ºC for 1, 7, 14, 21, and 28 days, with daily washing, to simulate periodontal ligament clearance. Human fibroblasts were exposed to the final extracts at 24 hours, and cell viability was determined by MTT assay, with exposure to unconditioned DMEM as a negative control. Statistical analysis comparing cytotoxicities at each exposure time was performed by ANOVA with Scheffé adjustment for multiple comparisons at a 95% confidence level. Results indicated that GuttaFlow was significantly less cytotoxic than all other sealers (p < 0.05) at 1 day of extraction. After 7 days of extraction, cell viability for GuttaFlow was significantly increased as compared with that of all groups except sealer AH Plus. At day 14, cytotoxicity of Sealapex was significantly higher than that of all other sealers (p < 0.05). At days 21 and 28, there were no significant differences in cytotoxicity among sealer groups. All materials presented some level of cytotoxicity to fibroblasts, while GuttaFlow was the least cytotoxic sealer tested. However, the cytotoxicity of all materials seemed to decrease similarly in a time-dependent manner.

Cytotoxicity of endodontic sealers after one year of agingin vitro

The in vitro cytotoxic response to endodontic sealers was assessed for one year. AH-Plus (AHP), Epiphany (EPH), EndoRez (ER), Guttaflow (GF), InnoEndo (IN), and Pulp Canal Sealer (PCS) were exposed to mouse osteoblasts and human monocytes after curing, 52 weeks of aging, and after resurfacing post-aging; cellular response was estimated by succinate dehydrogenase (SDH) activity. The effect of materials on TNFα secretion from activated (LPS) and inactivated monocytes also was measured. Cell responses were compared with ANOVA and Tukey post hoc analysis (α = 0.05). Initially, all materials except GF suppressed osteoblastic SDH activity compared with Teflon (Tf) controls. SDH activity in cells exposed to some aged sealers improved significantly; but IN and ER remained cytotoxic. When aged materials were resurfaced then tested, AHP, ER, GF, and IN did not change. EPH and PCS were more toxic. Monocytes responded similarly to the osteoblasts. No endodontic sealer activated monocytic TNFα secretion (p > 0.05 vs. -LPS Tf-controls). LPS-activated monocytes exposed to unresurfaced AHP and IN significantly suppressed TNFα secretion. When activated monocytes were exposed to the resurfaced sealers, differential suppression of TNFα secretion was observed for three of the four sealers tested (EPH, IN, and PCS). The results suggest that long-term aging may be a useful adjunct to in vitro assessment of these materials.