Coronal Plug Research Articles

Discoloration after revascularization using calcium phosphosilicate-based bioceramic versus mineral trioxide aggregate in necrotic immature permanent anterior teeth: A Randomized clinical trial.

The aim of the current study is to evaluate the effect of calcium phophosilicate-based bioceramic "Totalfill bioceramic putty" and white mineral trioxide aggregate (WMTA) as the coronal plug on discoloration after revascularization of necrotic immature permanent anterior teeth. This study was conducted on (48) necrotic young permanent central incisors in children ranging from 8 to 14 years old, that were randomly allocated to either Totalfill bioceramic (Group I = 24) or WMTA (Group II = 24) as the coronal plug. Two visits revascularization protocol was adopted in this study using 1.5% sodium hypochlorite, followed by 17% ethylenediaminetetraacetic acid, and ending with a saline flush as irrigation solution. The double antibiotic paste was used as intracanal medication. The blood clot was used as scaffold followed by the application of collagen membrane followed by coronal plud malterial. Finally, the access was sealed using resin composite restoration and composite restoration. Clinical assessment was conducted at 1, 3, 6, 9, and 12 months, while radiographic assessment was conducted at 6 and 12 months. Data were statistically analyzed using the Chi-squared test for intergroup comparisons and Cochran's Q test for intragroup comparison. Clinically, Group I exhibited a success rate of 100%, whereas Group II exhibited a success rate of 85.7%. Radiographically, both materials showed a 90.5% success rate. There was no statistically significant difference between both materials for all assessed clinical and radiographic parameters at different follow-up periods. Both Totalfill bioceramic putty and WMTA can be used successfully as coronal plug in esthetic areas.

Revascularization of Non-Vital, Immature, Permanent Teeth with Two Bioceramic Cements: A Randomized Controlled Trial

The aim of this study was to clinically and radiographically assess the effects of two bioceramic cements as coronal plug materials for the revascularization of non-vital, immature, permanent teeth with apical periodontitis. Twenty non-vital, immature, permanent, anterior teeth with apical periodontitis were included in this study. Samples were randomly divided into two groups based on the coronal plug materials used; group I (GI): Well Root PT (Vericom, Gangwon-do, Korea) and group II (GII): MTA Biorep (Itena Clinical, Paris, France) (n = 10). Follow-up was conducted clinically and radiographically for up to 12 months to evaluate the changes in root dimensions and resolution of the periapical disease and investigate the degree of success. Data were statistically analyzed using ANOVA tests and Mann–Whitney U tests at a 0.05 significance level. At 12 months, none of the patients in either test group had clinical signs/symptoms. There was a slight increase in root length (4.4% in GI and 3.4% in GII) and a slight increase in dentin wall thickness (10.2% in GI and 9.9% in GII) with no statistically significant (p > 0.05) differences. Whilst there was a significant decrease in lesion dimension in all patients after 12 moths of treatment (93% in GI and 91% in GII), there were no statistically significant differences between the two study groups (p > 0.05). Regarding the degree of success, all cases (100%) achieved the primary goal (the elimination of symptoms and the evidence of bony healing), while 60% in GI and 40% in GII achieved the secondary goal (increased root wall thickness and/or increased root length). No statistically significant difference was found between groups (p > 0.05). Both bioceramic cements showed satisfactory clinical and radiographic findings. Premixed calcium aluminosilicate and tricalcium silicate cements could be used as coronal plug materials in revascularization procedures. Bioceramic cements can be considered promising coronal plug materials for the revascularization of immature, permanent teeth with necrotic pulps and apical periodontitis due to their physicochemical and biological properties.

Assessment of biomechanical behavior of immature non-vital incisors with various treatment modalities by means of three-dimensional quasi–static finite element analysis

The objectives of this study were to evaluate the stress distribution and risk of fracture of a non-vital immature maxillary central incisor subjected to various clinical procedures using finite element analysis (FEA). A three-dimensional model of an immature central incisor was developed, from which six main models were designed: untreated immature tooth (C), standard apical plug (AP), resin composite (RC), glass-fibre post (GFP), regeneration procedure (RET), and regeneration with induced root maturation (RRM). Mineral trioxide aggregate (MTA) or Biodentine® were used as an apical or coronal plug. All models simulated masticatory forces in a quasi–static approach with an oblique force of 240 Newton at a 120° to the longitudinal tooth axis. The maximum principal stress, maximum shear stress, risk of fracture, and the strengthening percentage were evaluated. The mean maximum principal stress values were highest in model C [90.3 MPa (SD = 4.4)] and lowest in the GFP models treated with either MTA and Biodentine®; 64.1 (SD = 1.7) and 64.0 (SD = 1.6) MPa, respectively. Regarding the shear stress values, the dentine tooth structure in model C [14.4 MPa (SD = 0.8)] and GFP models [15.4 MPa (SD = 1.1)] reported significantly higher maximum shear stress values compared to other tested models (p < 0.001), while no significant differences were reported between the other models (p > 0.05). No significant differences between MTA and Biodentine® regarding maximum principal stress and maximum shear stress values for each tested model (p > 0.05). A maximum strain value of 4.07E−03 and maximum displacement magnitude of 0.128 mm was recorded in model C. In terms of strengthening percentage, the GFP models were associated with the highest increase (22%). The use of a GFP improved the biomechanical performance and resulted in a lower risk of fracture of a non-vital immature maxillary central incisor in a FEA model.

Clinical and radiographic evaluation of NeoMTA versus conventional white mineral trioxide aggregate in revascularization of non-vital immature permanent anterior teeth (A randomized controlled trial)

ObjectiveTo evaluate and compare clinically and radiographically the effect of using two different coronal plug materials (NeoMTA versus Conventional White mineral trioxide aggregate) in revascularization of non-vital immature permanent anterior teeth, with special reference to the assessment and evaluation of discoloration potential over a period of one year.MethodsRevascularization procedure was performed in (30) immature permanent non-vital anterior teeth which were randomly allocated to two equal groups (n = 15). NeoMTA was used as coronal plug material in the Experimental Group (N), while conventional White mineral trioxide aggregate (WMTA) was used as a coronal plug material in the Control Group (W). All treated teeth were evaluated clinically at 1 week, 1, 3, and 12 months and radiographically at 12 months.ResultsThe overall clinical and radiographic success rate of Groups (N) and (W) at the end of the 12-month follow-up period was 100%. The discoloration was detected in a single tooth (9.1%) in Group (N) and three teeth (27.3%) in Group (W) but the difference between groups was not statistically significant.ConclusionsBoth NeoMTA and conventional WMTA were successful coronal plug materials in the revascularization of non-vital immature permanent teeth achieving a high level of clinical and radiographic success. NeoMTA is a promising coronal plug material that can be used for revascularization procedures in the esthetic zone as it showed less discoloration potential compared with conventional WMTA, however, there was no statistically significant difference between both materials.

Effects of various thicknesses and levels of mineral trioxide aggregate coronal plugs on nanoleakage and fracture resistance in revascularization: An invitro study.

The aim of this study was to evaluate the effects of mineral trioxide aggregate (MTA) applied at varying levels and thickness in the cervical region of the root on the leakage and fracture resistance of the simulated immature teeth. 3 study groups (n = 16) (Group 1: 2 mm MTA, Group 2: 4 mm MTA, Group 3: 2 mm MTA+2 mm RMGIC below cementoenamel junction) and 2 control groups (Group 4: Complete canal obturation, Group 5: No coronal plug) were used for the study. Nanoleakage was measured using a micro-computed tomography system. For the fracture resistance test, a universal testing machine was used. The amount of silver nitrate penetration decreased while MTA thicknesses increased (P < 0.001). However, the placement of MTA as a thicker layer did not make any additional contribution on the fracture resistance (P > 0.05). The 4-mm coronal MTA plug can be suggested in RETs for its superior sealing and reinforcement abilities.

Influence of different obturation techniques in coronal bacterial infiltration: study in dogs

The objective of this study was to evaluate, in vivo, coronal bacterial infiltration after endodontic treatment with different obturation technique. Forty-five dogs’ root canals, originated from incisors and premolars, were used. The animals were intubated after general anesthesia. After local antisepsis and placement of rubber dam isolation, teeth were opened and instrumented up to a Kerr handfile #40, followed by three obturation protocols with Endofill®: Lateral condensation, Lateral condensation with a coronal plug of set Endofill® and Tagger hybrid technique. Access openings were not sealed and root fillings remained exposed to oral environment for 90 days. After this period, animals were euthanized and specimens were histologically processed and stained with Brown and Brenn. Dentinal tubules were evaluated with presence or absence of bacteria descriptive analysis. Bacterial infiltration was identified on root canal walls in six out of 14 root canals filled with the lateral condensation technique (42,8%), two out of 15 canals filled with Lateral condensation with a plug of set Endofill® (13,3%) and in two out 13 root canals filled with the Tagger hybrid technique (15,3%). Although the use of a coronal plug or a thermomechanical compaction technique showed less bacterial infiltration than conventional lateral condensation, none of the obturation techniques prevented bacterial infiltration to periapical area, evidencing the importance of a proper coronal seal or final restoration.

Comparison of MTA, CEM Cement, and Biodentine as Coronal Plug during Internal Bleaching: An In Vitro Study.

Background Internal bleaching is a choice of treatment in discolored endodontically treated teeth. Cervical root resorption is one of the important complications of this treatment. A suggested procedure to prevent this type of resorption is using a coronal barrier under the bleaching materials. The aim of the study was to compare the microleakage of mineral trioxide aggregate (MTA), calcium-enriched mixture (CEM) cement, and Biodentine. Materials and Methods In this in vitro study, a total of 60 single canal incisors were included. They were randomly divided into three experimental groups (n = 16), one positive control group (n = 6), and one negative control group (n = 6). Coronal portion of the canals in the experimental groups was sealed with 3 mm of MTA, CEM cement, or Biodentine as a coronal barrier. After 3 days, specimens were bleached. A fresh Enterococcus faecalis suspension was added to the samples. The culture tubes were observed for 45 days, and the daily turbidity was recorded. Statistical analysis was accomplished by the Kaplan–Meier test and SPSS 22. Results All positive samples showed turbidity, whereas none of the negative samples allowed bacterial leakage. Results showed no significant difference between MTA, CEM cement, and Biodentine groups. (P value = 0.304, 0.695, and 0.217). The bacterial microleakage for the two groups also did not show significant differences. Conclusions CEM cement and Biodentine showed promising results as coronal plug, and clinical studies are needed to test these materials with MTA for avoiding microleakage in internal bleaching treatment.

Three-dimensional qualitative and quantitative analyses of the effect of periradicular lesions on the outcome of regenerative endodontic procedures: A prospective clinical study

Qualitative and quantitative evaluation of the outcomes of regenerative endodontic procedure (REP) on human immature necrotic teeth with apical periodontitis using cone-beam computed tomography (CBCT) MATERIALS AND METHODS: Immature permanent teeth (n = 50) with necrotic pulp and periradicular pathosis were treated with a cell-homing concept-based REP. Following the procedure, a limited field-of-view CBCT scan was obtained. At each recall session (6, 12, 18 months), clinical tests were performed, and a digital periapical radiograph was taken. When significant radiographic changes were evident in the follow-up, a final CBCT scan was taken for qualitative and quantitative assessment. These initial and follow-up CBCT scans were assessed for quantification of changes in root length, pulp space diameter and periradicular lesion size. The data were statistically analysed using t test, one-way ANOVA, post hoc test and paired t test (P = 0.05). Of the teeth, 94.6% were clinically successful based on the lack or regression of signs and symptoms after 48 months follow-up. REP resulted in a statistically significant increase in root length, decrease in pulp space diameter and periradicular radiolucency (P < 0.05). CBCT images illustrated various patterns of root maturation including an increased thickening of the canal walls and continued root maturation (37.1%), continued root development with the apical foramen remaining open (57.1%), severe calcification (obliteration) of the canal space (2.9%) and hard tissue barrier formation in the canal space between the coronal plug and the root apex (2.9%). This study highlighted that the expected outcome of radiographic root development was less predictable when immature permanent teeth with periradicular pathosis were treated with REP. The size and extent (expansion/destruction of the cortical plate) of periradicular lesions and abscesses influence the outcome of REP. These factors must be taken into consideration during treatment planning.

Clinical and radiographic evaluation of Biodentine and Mineral Trioxide Aggregate in revascularization of non-vital immature permanent anterior teeth (randomized clinical study).

To asses clinically and radiographically the effect of using two types of coronal plug materials in revascularization of non-vital immature teeth. A total of 26 necrotic immature permanent anterior teeth were enrolled for pulp revascularization using a double antibiotic mix for root canal disinfection. They were randomly divided into the following based on coronal plug materials used: Biodentine (Group I) and white Mineral Trioxide Aggregate (Group II; n=13). Clinical and radiographic assessments were performed after 3, 6, 9, and 12months. When comparing the overall clinical successes and percentage of increase in root length between the two groups, there was no statistically significant difference (P>0.05). There was a significant difference in the distribution of discoloration between the two groups. One case was reported in Group I, and seven cases were reported in Group II (P=0.01). Both Biodentine and Mineral Trioxide Aggregate were successful clinically regarding the resolution of signs and symptoms associated with the necrotic teeth.

Effect of Coronal Barrier Thickness on Fracture Strength of Immature Teeth

Objectives: Secondary trauma is one of the main causes of root fracture in regenerative endodontic cases. The aim of this study was to compare the influence of placing Biodentine as a barrier material at different thicknesses on the fracture strength of simulated immature teeth. Materials and Methods: The root canals of 65 human maxillary central incisors were instrumented using Peeso reamers to simulate immature teeth. Ten teeth were assigned to the negative control group and received no access cavity preparation. The access cavities of the remaining 55 teeth were prepared. Among them, the root canals of 10 teeth were filled with calcium hydroxide to serve as the positive control. Forty-five teeth were randomly distributed into 3 groups (n=15); Group 1: 2-3 mm thick coronal plug, Group 2: 5-6 mm thick coronal plug, Group 3: complete obturation. After the storage period, fracture testing was performed using a universal testing machine. One-way analysis of variance and Tukey tests were used to analyze the data. Results: No significant difference was found among the positive control, group 1 and group 2 (P &amp;gt; 0.05). The negative control and group 3 presented the highest fracture strength values (P &amp;lt; 0.05), while there was no significant difference between them (P &amp;gt; 0.05). All fractures occurred through the cervical region of the root horizontally or obliquely. Conclusions: No significant reinforcement effect was obtained when Biodentine was used as a coronal plug. The complete root canal obturation of simulated immature teeth using Biodentine provided the best reinforcement effect. The coronal plug thickness had no influence on the fracture strength of immature teeth.

Effect of Orifice Plugs on Periapical Inflammation in Dogs

Gutta-percha (G) and sealer do not resist coronal leakage. In this study, the effect of orifice plugs using dentin-bonding/composite resin(C) or IRM on coronal leakage was evaluated in vivo. Sixty-one premolar roots in three beagle dogs were instrumented and filled with G and AH 26(S), or G alone. The coronal 2 mm was replaced with C or IRM, or left untreated. The access cavities were kept open for 8 months, the dogs were killed and the periapical regions of the roots were histologically examined. Periapical inflammation was observed in 89% of the group without plugs, but in those with plugs, the occurrence was decreased to 39% (C + G + S), 38% (IRM + G + S) and 58% (C + G), respectively. Furthermore, severe inflammation was observed in 50% of the former group but only 0 to 17% of the latter. The substantial reduction in apical periodontitis by the use of coronal plug underscores the clinical importance of providing an additional barrier to coronal leakage in comparison to that provided by gutta-percha and sealer alone.