Coronal Seal Research Articles

The options for a tooth that requires root canal treatment

Abstract: There have been many advances in the replacement of teeth, especially using dental implants. There are a number of other options for when a tooth is lost; however, there is also value in maintaining a tooth with the provision of root canal treatment and a good coronal seal. This article summarizes the advantages and disadvantages of each option with supporting evidence from the literature. CPD/Clinical Relevance: This review article provides an updated practical perspective to decision-making when it comes to teeth requiring root canal treatment.

Middle Mesial and Middle Distal Canals in Mandibular First Molar.

Root canal anatomy is a complex entity. The main objective of root canal treatment is to get rid of the infection and have a good apical and coronal seal with an appropriate filling. Inability to achieve thorough cleaning and shaping followed by three-dimensional obturation of the root canal system usually causes root canal treatment failure. For this reason, clinicians should be aware of these anatomical variations to achieve successful treatment. The aim of this article is to report on the successful treatment and follow-up of mandibular first molar with additional middle mesial (MM) and middle distal (MD) canals. A 29-year-old white male patient reported with a complaint of pain in relation with tooth #19. On clinical examination, diagnosis of symptomatic irreversible pulpitis with symptomatic apical periodontitis and condensing osteitis was made and nonsurgical root canal treatment was planned. Initially, two mesial and two distal canals were located, and the patient was planned for the obturation in the second visit. The complaint of mild persistent symptoms gave a possibility of additional canals. Under the dental operating microscope and selective troughing on the floor of the pulp chamber with ultrasonic tips, additional canals were located as MM and MD canals. Leaving some area of the root canal system untreated is found to be one of the main reasons for root canal treatment failure. Dentists should take advantage of new tools, such as dental operating microscope and ultrasonic tips to be able to locate and treat the hidden and unusual anatomy. Mandibular first molar with six canals is very rare to encounter. Clinician should have a thorough knowledge of these unusual anatomy to avoid treatment failure due to incomplete disinfection of the root canal system.

Tissue Engineering of Necrotic Dental Pulp of Immature Teeth with Apical Periodontitis in Dogs: Radiographic and Histological Evaluation.

To evaluate tissue engineering technology to regenerate pulp-dentin like tissues in pulp canals of immature necrotic permanent teeth with apical periodontitis in dogs. The study was performed on 36 teeth in 12 dogs. The experiment was carried out using split mouth design. In each dog 3 teeth were selected for implementing the study procedure. Apical periodontitis was induced in Group A and B teeth. Group (A): immature upper left 2nd permanent incisors that were transplanted with a construct of autologous dental pulp stem cells with growth factors seeded in a chitosn hydrogel scaffold. Group (B): immature upper right 2nd permanent incisor that received only growth factors with scaffold. A third tooth in each dog was selected randomly for isolation of dental pulp stem cells (DPSCs). Both groups were closed with a double coronal seal of white MTA (Mineral trioxide aggregate) and glass ionomer cement. Both groups were monitored radiographically for 4 months and histologically after sacrificing the animals. There was no statistically significant difference in radiographic findings between group (A) and group (B) for healing of radiolucencies, while there was statistically significant difference between group (A) and group (B) regarding radicular thickening, root lengthening and apical closure. Histologically, group (A) teeth showed regeneration of pulp- dentin like tissue while group (B) teeth did not show any tissue regeneration. Dental pulp stem cells and growth factors incorporated in chitosan hydrogel are able to regenerate pulp- dentine like tissue and help in complete root maturation of non-vital immature permanent teeth with apical periodontitis in dogs.

The Effect of Thickness on Sealing Ability of Calcium Enriched Cement as a Coronal Seal Barrier

Abstract Introduction: Thickness of a coronal seal barrier is an important factor for preventing microleakage. The aim of this in vitro study was to compare the sealing ability of two different thicknesses of calcium Enriched Mixture (CEM) cement as a coronal seal barrier. Methods: A total of 40 canals of extracted maxillary central incisors were instrumented and obturated using lateral compaction technique. The teeth were randomly divided into two experimental (N=15) and two control groups (N=5). For experimental groups, the obturation material was removed up to the experimental depths (2 and 3 mm) and were sealed with CEM. Sealing ability was evaluated by dye penetration method using pelikan ink and a stereomicroscope at x10 magnification and 0.01 mm accuracy. Data was analyzed using T-test and P<0.05. Results: The mean linear dye microleakage for the two thicknesses of CEM cement groups (2mm and 3mm) were 0.930 and 0.67 mm respectively. There was no statistically significant difference between the two groups (p<0.088). Conclusion: under the condition of this in vitro study, coronal microleakage in 2mm thickness of CEM cement had no statistically significant difference with 3 mm thickness of the material.

2016 ASE undergraduate essay competition candidate information.

The aim of this review is to discuss the role of medicaments and materials used in teeth undergoing root canal treatment and how they affect the overall prognosis of root canal treated teeth. Irrigants, medicaments and materials play a vital role in RCT. They reduce the overall microbial load within the root canal system, help reduce inter-appointment pain, and induce apexification during RCT of permanent teeth with immature apices. In addition, they also help create a hermetic coronal and periradicular seal to entomb any residual microorganisms within the canals and prevent future ingress of contaminants into the root canal system and subsequent reinfection. Whilst the role of various materials in RCT has been thoroughly investigated, the available literature and longitudinal clinical studies evaluating the affect of such materials on the prognosis of RCT is scarce, and requires further investigation.

Comparative evaluation of sealing ability of light cure glass ionomer cement and light cure composite as coronal sealing material: An in vitro study

Aim: To compare and evaluate the sealing ability of light cure composite and light cure GIC as coronal sealing materials. Materials and Methods: 30 extracted human teeth were divided into three experimental groups of 10 teeth each. The teeth in group I are obturated without coronal seal, teeth in group II are obturated with light cure GIC (3M ESPE VITREMER) as coronal seal and teeth in group III are obturated with light cure composite(3M ESPE filtek z250) as coronal seal, after removing 2mm of coronal gutta percha. These teeth (crown portion) are then suspended in methylene blue, sealed and kept for 72 hours, to observe the amount of dye penetration. After 72 hours teeth were removed, washed under running water, dried and sectioned longitudinally, separating buccal and lingual halves. The linear extent of dye penetration was measured from cavosurface margin of the access cavity to the most apical extent of dye penetration point. The length from the cavosurface margin to the apex of the tooth was also measured and percentage linear micro leakage was estimated. Statistical Analysis: Data was statistically analyzed using one-way ANOVA followed by Post-Hoc Multiple comparison (Bonferroni). Results: In the present study specimens in group I showed the maximum percentage of linear microleakage of 31.51 percent. The specimens in group II showed the minimal amount of linear micro leakage of 6.49 percent. Conclusion: It can be concluded coronal seal reduces the micro leakage, and light cure GIC has better coronal sealing ability.

Coronal Sealing Capacity of Temporary Restorative Materials in Pediatric Dentistry: A Comparative Study.

AimsThe aim of this in vitro study is to compare the coronal microleakage of three common temporary restorative materials, namely Coltosol, Compoglass, and Zonalin, used in pediatric dentistry after endodontic treatment at different time intervals (1 week, 1, and 2 months) using dye penetration.Materials and methodsAccess cavities were prepared in 72 intact extracted premolar teeth. The samples were divided into three groups (n = 24) and filled with Coltosol, Compoglass, or Zonalin. After thermal cycling for 500 cycles (5-55°C), the teeth were immersed in 1% methylene blue dye at 37°C for 1 week (n = 8), 1 month (n = 8), and 2 months (n = 8). The samples were sectioned buccolingually, and the linear depth of dye penetration was measured using a stereomicroscope at 16 × magnification. The data were analyzed using Kruskal-Wallis test.ResultsThere were no significant differences in the micro-leakage values of Coltosol and Zonalin or Zonalin and Com-poglass groups at 1 week (p > 0.05) or 1 month (p > 0.05) intervals, but a significant difference was noted between Coltosol and Compoglass groups (p < 0.01); Coltosol provided a more favorable coronal seal. No significant difference was found among the experimental groups at the 2-month interval (p > 0.05).ConclusionAt 1 week or 1 month of use, Coltosol showed better coronal seal. At 2 months, there was no significant difference apparent between the groups. A longer time lapse was associated with an increased likelihood of microleakage.How to cite this articleMilani S, Seraj B, Heidari A, Mirdamadi A, Shahrabi M. Coronal Sealing Capacity of Temporary Restorative Materials in Pediatric Dentistry: A Comparative Study. Int J Clin Pediatr Dent 2017;10(2):115-118.

Sealing Ability of Esthetic Post and Core Systems.

To review the literature on the sealing ability of esthetic post systems with different cementation techniques. An important factor for successful root canal treatment is the development of a coronal seal to the treated root canal system. Review result: The current literature describes promising results using fiber posts with a dual-cure, self-etch resin cement system. However, none of the published results describe a post system or cementation technique that achieved a homogeneous and tight coronal seal. Fiber post systems appear to be favorable alternatives to metallic or ceramic post systems. Furthermore, dual-cure, self-etch resin cement systems represent superior alternatives to other cement systems. The clinician should be aware of the differences between various post systems and different cement systems to select and apply the most appropriate post and cement in each clinical situation.

Comparative Evaluation of Sealing Ability, Water Absorption, and Solubility of Three Temporary Restorative Materials: An in vitro Study.

BackgroundThe quality of the coronal seal of root canal filling material is important for periapical health. Absorption of water or saliva by the temporary restorative materials leads to dimensional changes, loss of retention, staining and breaking in margin contours. Hence this study was carried out to evaluate and compare the sealing properties, water absorption and solubility of IRM (intermediate restorative material), Cavit G and GC Caviton.Study designExperimental, in vitro intergroup randomized control trial.Material and methods36 non carious premolars were randomly selected assigned to three groups, 12 teeth in each. Standard endodontic access cavities of approximately 4x4mm wide were prepared followed by the root canal obturation with Gutta-percha and restoration with experimental materials. For microleakage testing dye penetration method was used with 2% methylene blue dye. Followed by evaluation and scoring under stereomicroscope at 40x magnification.Disc shaped 12 specimens for each group were prepared for each material, stored in desiccator at 37° C, weighed daily to verify mass stabilization (dry mass,m1). Thereafter, the specimens were stored in distilled water at 37°C for 7days to obtain the mass after saturation with water (m2). The specimens were placed in the desiccators again, at 37° C, and reweighed until a constant dry mass is obtained (m3). Water absorption (WS) and solubility (SL) was determined by using the formulas, WS = m3 - m2/V and SL= ml - m3/ V.ResultsGC Caviton showed least microleakage and least water absorption followed by IRM and Cavit G, the differences were statistically highly significant ( p < 0.001) and there was no statistical difference found in all the groups with respect to solubility.ConclusionsGC Caviton is best and suitable temporary restorative material in endodontic interappointments followed by IRM and Cavit GHow to cite this articlePrabhakar AR, Rani NS, Naik SV. Comparative Evaluation of Sealing Ability, Water Absorption, and Solubility of Three Temporary Restorative Materials: An in vitro Study. Int J Clin Pediatr Dent 2017;10(2):136-141.

Bacterial microleakage of temporary filling materials used for endodontic access cavity sealing

Background/purposeProviding a tight coronal seal is key for the success of endodontic treatment, therefore the study aimed to assess bacterial microleakage of materials used for short- and long-term temporization. Materials and methodsOne hundred and twenty-eight human upper-third molars were divided into six experimental groups (n = 20) and two control groups: negative (n = 4) and positive (n = 4). The standardized access cavities were prepared and filled with: (1) Cavit; (2) Fuji II LC; (3) Fuji IX; (4) Voco Clip; (5) AdheSE and Tetric EvoCeram; (6) Excite and Tetric EvoCeram. The crown of each tooth was sectioned to obtain 5.5-mm-high disks, which were assembled in a standard setup for bacterial microleakage studies using Streptococcus mutans. The monitoring lasted 90 days. Kaplan–Meier survival analysis was performed. ResultsThe lowest amount of leaking samples was found in AdheSE and Tetric EvoCeram (31.3%), Cavit (33.3%), and Excite and Tetric EvoCeram groups (35.3%), followed by Fuji II LC (66.7%), Voco Clip (83.3%). and Fuji IX (88.2%) groups. According to the day of microleakage, materials could be classified in three groups with statistically significant differences (P < 0.05). In the first group were Cavit (70 days), AdheSE and Tetric EvoCeram (68 days), and Excite and Tetric EvoCeram (65 days), in the second group were Voco Clip (44 days) and Fuji II LC (43 days), and in the third group was Fuji IX (21 days). ConclusionNone of the tested materials were able to completely prevent bacterial microleakage. Adhesively bonded composites and Cavit offer better sealing compared with glass ionomer cements, resin modified glass ionomer cements, and composites without the use of an adhesive system.

Dental Pulp Revascularization of Necrotic Permanent Teeth with Immature Apices

The treatment of immature necrotic teeth with apical periodontitis presents challenges in endodontic and pediatric dentistry. Revascularization is a recent treatment for such cases as an alternative to conventional apexification. The purpose is to examine the effect of a pulpal revascularization procedure on immature necrotic teeth with apical periodontitis. Twenty patients were enrolled for pulp revascularization procedure by root canal disinfection using a triple antibiotic mixture for 1-2 weeks, followed by creating a blood clot, sealing the root canal orifice using white mineral trioxide aggregate and a coronal seal of composite resin. Patients were recalled periodically for up to 24 months. During follow-up, all patients were asymptomatic. Three cases of chronic apical periodontitis showed clinical disappearance of the sinus tract 2 weeks after treatment. Radiography revealed progressive periapical radiolucency resolution within the first 12 months. Within 12-24 months, the treated teeth showed progressive increases in dentinal wall thickness, root length and continued root development. Clinical and radiographic evidence showed successful revascularization treatments of immature necrotic permanent teeth with apical periodontitis. More studies are necessary to understand the underlying mechanisms and to perform histopathology of the pulp space contents after revascularization procedures.

Clinical procedures for revitalization: current knowledge and considerations.

Revitalization or regenerative treatment approaches in teeth with incomplete root formation and pulp necrosis have become part of the therapeutic endodontic spectrum and should be considered as an alternative to conventional apexification. Ideally, regenerative endodontic procedures allow not only for a resolution of pain, inflammation and periapical lesions, but also for the formation of an immunocompetent tissue inside the root canal which can reconstitute the original biological structure and function of dental pulp and thus lead to an increase in root length, and thickness and strength of previously thin, fracture-prone dentine walls. Common features of regenerative procedures performed in immature teeth with pulp necrosis include (i) minimal or no instrumentation of the dentinal walls, (ii) disinfection with irrigants, (iii) application of an intracanal medicament, (iv) provocation of bleeding into the canal and creation of a blood clot, (v) capping with calcium silicate, and (vi) coronal seal. Although case reports and case series provide promising results, the protocol for regenerative endodontic treatment is not fully established; questions remain regarding the terminology, patient selection and informed consent as well as procedural details, especially on the choice of irrigants, intracanal medicaments and materials for cavity sealing. Animal studies document repair rather than regeneration, which opens the discussion on prognosis and outcome, especially the biological versus the patient-based outcome. This review will provide an overview of the current state of regenerative endodontic therapies, discuss open questions and provide recommendations based on the recent literature.

Evaluation of the Factors and Treatment Options of Separated Endodontic Files Among Dentists and Undergraduate Students in Riyadh Area.

Separation of endodontic files during root canal treatment is a common multifactorial problem facing most of dental practitioners both dentists and students that has high impact on treatment and prognosis outcome. To compare the incidence, factors and treatment options of separated endodontic files among dentists and undergraduate students in Riyadh area. A survery of 35-questionnaire was formulated and e-mailed to all 149 dentists of different dental specialties who are working in different clinical centers in Riyadh area and are attending the 26(th) Saudi Dental Society International Dental Conference in addition to 130 undergraduate students in different dental colleges in Riyadh. Overall, 118 participants of dentists completed the survey, with response rate of 79% and the same number of students with response rate of 90.7%. Total of 57.6% dentists' faced separated files problem during root canal preparation, while only 7.6% of students faced this problem. 53% of separated endodontic files (SEF) were hand files, 65% stainless steel files, 81% were small size files most common sizes (#15-20) (p <0.0001). Causes of SEF were root Canal anatomy, in 45%. 66% of SEF occurred in curved canals, 98% were in molars in mesiobuccal and mesiolingual canals, (p <0.0001). 44% of SEF were successfully bypassed, 53% were successfully removed from coronal third of root canal, 42% of SEF successfully removed using ultrasonics under visualization of operating microscope. 73% of retained SEF cases showed good prognosis, (p <0.0001). SEF is a multifactorial clinical problem that must be either removed, by passed to allow complete cleaning, shaping, disinfection, obturation and effective coronal seal.

Effect of bleaching agents having a neutral pH on the surface of mineral trioxide aggregate using electron microscopy and energy dispersive X-ray microanalysis.

Aim:To investigate the effect of bleaching agents having a neutral pH on the surface of mineral trioxide aggregate (MTA) used as a coronal seal material for nonvital bleaching, beneath the bleaching agent, with the help of energy dispersive X-ray microanalysis and scanning electron microscopy (SEM).Materials and Methods:Six samples of plastic tubes filled with white MTA (Angelus white) were kept in 100% humidity for 21 days. Each sample was divided into 2 and made into 12 samples. These were then divided into three groups. Group A was exposed to Opalescence Boost 40% hydrogen peroxide (HP) (Ultradent). Group B to Opalescence 10% carbamide peroxide (Ultradent) and Group C (control group) not exposed to any bleaching agent. After recommended period of exposure to bleaching agents according to manufacturers’ instructions, the samples were observed under SEM with an energy dispersive X-ray microanalysis system (JSM-6380 LA).Results:There were no relevant changes in color and no statistically significant surface structure changes of the MTA in both the experimental groups.Conclusion:The present findings suggest that even high concentration HP containing bleaching agents with neutral pH can be used on the surface of MTA without causing structural changes. The superior sealing ability of MTA and the high alkalinity would prevent cervical resorption postbleaching.

Importance of coronal seal: Preventing coronal leakage in endodontics

The primary goal of endodontic treatment is to keep the pulpal space free of microorganisms and to prevent recurrent infection. Oral bacteria and their by-products can penetrate this space if there is inadequate coronal or apical seal. Apical leakage leading to reinfection of an obturated canal has been the major cause of failed endodontic treatment. However, recently, attention has been drawn to the significance of coronal seal in endodontic success. Microbial contamination through the occlusal surface, leading to coronal leakage constitutes a large percentage of failed root canal treatments. This paper highlights the clinical and biological implications of coronal leakage and the means to prevent the same.

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Evaluation of Composite Adaptation to Pulpal Chamber Floor Using Optical Coherence Tomography

IntroductionA coronal seal is fundamental for a positive outcome to endodontic therapy. In this in vitro study, we evaluated the adaptation of composite resins in postendodontic restorations using optical coherence tomographic (OCT) imaging. Our null hypothesis was that there would be no difference in marginal adaptation to the pulp chamber floor between resin composites of different viscosities. MethodsThirty intact upper molars extracted for periodontal reasons were selected, endodontically treated, and filled with gutta-percha. The excess gutta-percha was entirely removed from the pulp chamber floor, and teeth were randomly divided into 3 groups (n = 10) according to the material used for the restoration: group 1: 0.5-mm horizontal layer of flowable composite followed by nanohybrid composite, group 2: bulk layering of bulk fill flowable composite; and group 3: oblique layering of nanohybrid composite. The degree of adaptation to the cavity floor was assessed using OCT imaging, and images were analyzed with the software program ImageJ (National Institutes of Health, Bethesda, MD) to assess the marginal gap between the composite and the pulp chamber floor. Collected data were statistically analyzed using analysis of variance testing, and statistical significance was set at P < .05. ResultsFlowable composites showed significantly better adaptation than traditional packable nanohybrid composites (P < .05). All significant differences were found between groups 1 and 2. ConclusionsWithin the limitations of this OCT imaging–based in vitro study, it was concluded that the flowable composite (flow + nanofilled; flow bulk fill composite) adapted better to the pulp chamber floor than the packable nanohybrid composite resin. Further studies are necessary to confirm these results.

Microbial Leakage of Enterococcus Faecalis of Temporary Restorative Materials in Endodontic Treatment

&lt;p&gt;&lt;span&gt;The aim of this study was to determine whether there is any significant difference in average days of Enterococcus faecalis microleakage through the coronal seal of four temporary restorative materials used in endodontics , Cavit® (3M), Duotemp® (Coltène), Clip® (VOCO) y Cimpat L.C® (Septodont). Ninety caries free extracted human premolars were randomly divided into 4 groups after the coronal access preparation; Group 1. Cavit® , Group 2 Duotemp® , Group 3. Clip , Group 4 Cimpat and controls were not restored with any material. Each group were mounted in 24 sterile well plates. Each well contained 2 ml of broth with bromocresol purple indicator 1% glucose. All Samples, except negative controls, were inoculated with E. faecalis in saline 0.85% 10 ^ 6 U / ml. The groups were observed daily for 30 days to detect changes in the indicator color from purple to yellow. ®. Jonckheere-Terpstra test was used with a 95% of confidence. The average days Filtration of materials was 12.50 for Clip®, 12.83 for Cavit®, 13.44 for DuoTemp® and 14.44 for Cimpat LC®. The temporary restorative materials studied shows microbial leakage after 15 days. &lt;/span&gt;&lt;/p&gt;

COMPARISON OF BACTERIAL CORONAL LEAKAGE BETWEEN DIFFERENT OBTURATION MATERIALS (AN IN VITRO STUDY)

Introduction: Bacteria and their by-products are the main cause of pulpal and periapical diseases. That is why all routes between root canal system and peridontium should be sealed to prevent bacterial leakage. Objectives: Was to compare the coronal bacterial leakage between different obturation materials. Materials and methods: Sixty single-canaled lower premolars were used in this study. Teeth were decoronated to standardize root length to 12 mm. Instrumentation was done using Protaper universal rotary system to file size F4, then teeth were divided into six groups, four experimental and two control (n=10). Group I: obturation was done using CPoint and Endosequence bioceramic sealer using single-cone technique; Group II: obturation was done using Protaper gutta percha and Endosequence bioceramic sealer; Group III: obturation was done using Protaper gutta percha and Adseal resin sealer; Group IV: obturation was done using Protaper gutta percha and MTA Fillapex sealer; Group V: used as positive control; Group VI: used as negative control. Groups II, III, IV, VI were obturated using lateral condensation technique. A split-chamber microbial leakage model was used to detect bacterial leakage. Turbidity in the lower chamber was observed daily for 60 days. Data were analyzed using Kruskal–Wallis and Monte-Carlo test.Results: all experimental groups showed leakage throughout the study period, Group I showed the best results with a mean of (37.30 ± 23.61) days while Group II and III showed nearly equal results with a mean of (32.10 ± 22.57) and (33.10 ± 19.90) days, respectively. Group IV showed a mean of (16.90 ± 8.21) days and was found to be statistically significant than the other groups (P= 0.048).Conclusions: None of the tested materials were able to provide a complete hermetic seal. CPoint with endosequence bioceramic sealer provided the best coronal seal while MTA Fillapex was the worst. CPoint obturation system can be an alternative to lateral condensation technique. Keywords: Endodontics, Bacterial leakage, CPoint, Endosequence bioceramic sealer, Adseal, MTA Fillapex.

Effects of different instrumentation techniques on calcium hydroxide removal from simulated immature teeth.

The aim of this study was to evaluate the effectiveness of endodontic instrument systems in the removal of calcium hydroxide [Ca(OH)(2)] from simulated immature teeth. The root canals of 106 human single-rooted teeth were shaped with ProTaper rotary files up to an F5 file size. Simulation of roots with immature apices was carried out using size 4 green 1.5-mm diameter Unicore drills. A non-setting Ca(OH)(2) was injected into each root canal and inserted into the working length using lentulo spiral, after which cotton pellets were placed over canal orifices. The apical and coronal side of the roots were then sealed with glass ionomer cement and light cured. Specimens were stored in distilled water for 3 months at 37 °C. After 3 months, the temporary coronal seal was removed and the samples were randomly divided into five experimental groups according to the method used for Ca(OH)(2) removal (ProTaper, Reciproc, OneShape, WaveOne, and Manual) (n = 20), one positive control group (n = 3) and one negative control group (n = 3). The amount of remaining Ca(OH)(2) in the canal walls was measured under a stereomicroscope at 30× magnification. The data were analyzed using Kruskal-Wallis test and Mann-Whitney U test at a significance level of 0.05. Positive and negative control groups were found to be statistically different from all other groups (p < 0.05). There were no significant differences among the ProTaper, Reciproc, OneShape, WaveOne, and Manual groups (p > 0.05). As a conclusion, none of the techniques completely removed Ca(OH)(2) from simulated immature teeth.