Root-end Filling Material Research Articles

Marginal Adaptation and Porosity of a Novel MTA Brand Applied as Root-End Filling Material: A Micro-CT Study

Marginal adaptation and internal porosity characteristics of root-end filling materials are important factors determining their clinical performance. The aim of this study was to quantitatively evaluate the marginal adaptation to radicular dentin (interfacial void volume) and internal porosity volume of a novel mineral trioxide aggregate brand using micro-CT analysis. Ten extracted upper central incisors were selected, instrumented, and obturated. Roots were resected at the apical 3 mm, and root-end cavities were prepared ultrasonically and filled with Harvard MTA. SkyScan 1272 micro-CT equipment was used to scan the specimens at a resolution of 6 μm, and three-dimensional images were reconstructed. All volumetric porosity parameters of the tested material were calculated in absolute (mm3) and relative values (%), as follows: open porosity volume (OPV), closed porosity volume (CPV), and total porosity volume (TPV). The mean OPV and OPV% found for Harvard MTA were 0.0268 mm3 and 0.91%, respectively. The mean CPV and CPV% were 0.0283 mm3 and 0.94%, respectively. The TPV and TPV% were 0.0569 mm3 and 1.85%. There was no significant difference between the OPV% and CPV% (p < 0.05). In conclusion, when applied as a retrofilling material, Harvard MTA exhibited excellent marginal adaptation to the dentin with minimal interfacial voids and internal microporosity. Therefore, this new calcium silicate brand may be considered an efficient alternative to conventional products.

Comparative Evaluation of Sealing Ability of Different Type of MTA as Root-End Filling Materials Using Dye Penetration Technique - An In Vitro Study

ABSTRACT Introduction: The main goal of the root-end filling material is to create a hermetic seal to protect against microbes and their by-products. Excellent biocompatibility and sealing ability are characteristics of MTA developed by Torabinejad et al. This study aimed to compare the sealing ability of different type MTA as root-end filling material using dye penetration technique. Material and Method: One-twenty (N = 120) extracted human maxillary anterior teeth were decontaminated, cleaned, and decoronated. Endodontic treatment and root-end resection were done. Then root-end cavity was prepared and filled with tested materials (N = 30). A calibrated stereomicroscope was used to evaluate linear measurement. All data were tabulated and statistically analyzed with a level of significance set at P < .05. Result: This order of increasing microleaks was observed: MTA Angelus < MTA Plus < PRO-Root MTA < Control group. There was a statistically significant difference in mean microleakage in MTA Angelus and MTA Plus groups (P = 0.040). MTA Angelus shows the least microleakage among all the bioceramic material groups. Conclusion: Although the sealing ability of MTA Angelus is superior to MTA Plus, PRO-Root MTA. MTA Plus, PRO-Root MTA could be considered an acceptable alternative to MTA Angelus in peri-radicular surgeries.

Interfacial adaptation of NeoMTA Plus, BioRoot RCS and MTA in root-end cavities: A micro-CT study.

This study aimed to use the micro-computed tomography to evaluate the interfacial adaptation and the presence of gaps of NeoMTA Plus, BioRoot RCS, and MTA in the root-end cavities. Thirty standardized bovine roots measuring 15 mm in length were selected. Chemical-mechanical preparation was performed up to instrument #80 and obturation with the cold lateral compaction technique with cement based on zinc oxide and eugenol. The roots were kept at 37°C for 7 days. Afterward, apicectomy of the apical 3 mm and a root-end filling cavity was performed at 3 mm depth. Micro-computed tomography (micro-CT) was performed to measure the volume of the retroactivity. The roots were divided by stratified randomization into three groups according to the retro-end filling material: NeoMTA Plus, BioRoot RCS, and MTA. A new micro-CT was performed to assess the presence of voids in the root-end filling material and between it and the canal wall. One-way ANOVA and Tukey tests were performed using the BioEstat 4.0 program. There was no difference in the initial volume values of the root-end cavities (p > .05). After the insertion of root-end filling materials, the most significant volumes of voids were observed in the NeoMTA Plus group (p < .05), with no difference for the BioRoot RCS and MTA Angelus groups (p > .05). Micro-computed tomography showed that MTA and BioRoot RCS have better interfacial adaptation and presented fewer number of gaps than NeoMTA Plus when used as root-end filling materials. Micro-computed tomography evaluation of different root-end fillings materials.

Antibacterial Activity and Sustained Effectiveness of Calcium Silicate-Based Cement as a Root-End Filling Material against Enterococcus faecalis.

Several calcium silicate cement (CSC) types with improved handling properties have been developed lately for root-end filling applications. While sealing ability is important, a high biocompatibility and antimicrobial effects are critical. This study aimed to conduct a comparative evaluation of the antimicrobial efficacy and sustained antibacterial effectiveness against Enterococcus faecalis (E. faecalis) of commercially available CSCs mixed with distilled water (DW) and chlorhexidine (CHX). Various products, viz., ProRoot mixed with DW (PRW) or with CHX (PRC), Endocem mixed with DW (EW) or with CHX (EC), and Endocem premixed (EP) syringe type, were used. While antibacterial activity against E. faecalis was evaluated using a direct contact method, the specimens were stored in a shaking incubator for 30 d for antibacterial sustainability. The cytotoxicity was evaluated using a cell counting kit-8 assay in human periodontal ligament stem cells. The antibacterial activities of EP, EW, and EC were greater than those of PRC and PRW (p < 0.05). The antibacterial sustainability of EP was the highest without cytotoxicity for up to 30 days (p < 0.05). In conclusion, the pre-mixed injectable type EP was most effective in terms of antibacterial activity and sustained antibacterial effectiveness without cytotoxicity.

Effect of Blood and Synthetic Tissue Fluid on Marginal Adaptation and Surface Microstructure of Different Root-end Filling Materials: A Scanning Electron Microscope Study

Aim: This study aimed to evaluate the effect of blood and synthetic tissue fluid on marginal adaptation and surface microstructure of Mineral trioxide aggregate (MTA) and Endosequence root repair material (ERRM Putty).&#x0D; Materials and Methods: Sixty human single-rooted teeth were endodontically treated, and root-end cavities were prepared to 3 mm depth. The teeth were divided randomly into three groups (n = 20) based on the contamination, and each group was again divided into two subgroups (n=10) based on the root-end filling material used.&#x0D; Group I (Blood Exposed): The root-end cavities were filled with fresh blood then gently aspirated. The retro cavities were then filled with MTA and ERRM putty and placed in molds containing heparinized blood.&#x0D; Group II (STF-Exposed): STF was mixed accordingly and the retro cavities were then filled with STF and then gently aspirated. The cavities were now filled with MTA and ERRM putty and placed in molds containing STF.&#x0D; Group III (Control): The root end cavities were not contaminated with any fluid and were filled with MTA and ERRM putty in this group. All samples were viewed Under SEM at 2000x magnification and statistically analyzed with Tukey post hoc test.&#x0D; Results: Mean gap width in microns (SEM) was blood with MTA(22.12), followed by blood with ERRM putty (18.89), Control with ERRM putty (14.53), STF with MTA (6.86), Control with MTA (6.85) and STF with ERRM putty (3.78). A significant difference was observed among the three groups (Blood, STF and Control) with gap width in microns (SEM) at 5% level of significance. &#x0D; Conclusions: The samples contaminated with blood showed more gap width, and ERRM putty exhibited better marginal adaptation.

Periapical Surgery with BiodentineTM as a Root-End Filling Material

MTA® is considered as the biomaterial of choice because of its excellent characteristics. Biodentine™ has been introduced into periapical surgery and has proven its efficacity in sealing root-end cavities. Despite of the desirable properties of BiodentineTM, there are limited published cases that described the use of BiodentineTM in periapical surgery.

Sealing Ability and Adaptability of Nano Mineral Trioxide Aggregate as a Root-End Filling Material

Aim: Comparison between Nano MTA &amp; MTA as a root-end filling materials regarding adaptability and sealing ability.&#x0D; Materials and Methods: Forty extracted human maxillary incisors with straight roots were used. After root canals preparation and obturation, the apical 3 mm of each root was resected perpendicular to the long axis of the tooth. Root end cavities were prepared to a depth of 3mm parallel to the long axis of the tooth. The teeth were randomly divided into two main equal groups of 20 samples each according to the root-end filling material used either MTA or Nano MTA. Ten samples from each group were sectioned longitudinally into two equal halves to measure the sealing ability and another ten samples from each group were sectioned transversally to obtain 1 mm thick section to measure the adaptability of both materials. All samples were photographed under the SEM at three different magnifications (×1000). The gap thickness between the root end filling material and the retro cavity dentine walls were measured at seven selected points at the material-dentine interface in micrometers (µm).&#x0D; Results: Nano MTA and MTA showed no statistically significant difference in the gap thickness between dentin-material interface in both longitudinal and transverse sections. Regarding the sealing ability, the mean value in MTA was (3.27±0.77), while the mean in Nano-MTA was (3.15±0.71). Regarding the adaptability, the mean value in MTA was (2.46±0.60), while the mean in Nano-MTA was (2.05±0.712). Both materials showed good sealing ability and good adaptation to the dentinal wall.&#x0D; Conclusion: Nano MTA revealed good sealing ability and adaptability comparable to MTA when used as a retrograde filling material.

EDAX and FTIR Characterization and Setting Time of an Experimental Nanoparticle Incorporated Root-end Filling Material

The evolution of calcium silicate based cements in the field of dentistry has been rewarding. It offers a plethora of advantages with respect to physicochemical and biological properties. How-ever, the extended setting time and limited antibacterial activity in these cements is quite a concern. This study aimed to develop a fast-setting nanoparticle incorporated root-end filling material for use after periapical surgeries. With the incorporation of the silver nanoparticles, and using calcium chloride as the liquid component, the desirable study outcome was achieved. The set-ting time was significantly reduced when compared to the commercially available root-end filling material

Comparative Study of Sealing Ability of Different Filling Materials for Root End: An In Vitro Evaluation

Abstract Introduction Failure in surgical endodontic techniques can occur most commonly due to improper seal in the apical region. The root-end filling material used should not allow the contamination of the periapical tissue. The aim of the present study was to compare the ability of white mineral trioxide aggregate (MTA), white Portland cement (PC) and intermediate restorative material (IRM) for sealing root-end by dye leakage test. Materials and Methods 120 teeth with single root were prepared through instruments. Following obturation, the apex was cut, and a cavity was made. Then, the teeth were divided into four groups (Group I: MTA, Group II: white PC, Group III: IRM, Group IV: control). Cavities made at apex in the first three groups were then filled with the respective materials. Exposure to the dye, India Ink, was then done for a time period of 72 hours. The depth of penetration of dye inside the whole root was then evaluated with a magnification of 16X under stereomicroscope in vitro. Result MTA showed statistically significant difference in sealing ability (p &lt; 0.05) as compared with other materials. Conclusion MTA cement showed better sealing ability. It is an ideal retrograde filling material, because it is a biocompatible material and has a good marginal adaptation as compared with PC which, in turn, showed better sealing ability than IRM.

Retrospective Analysis of Root-end Microsurgery Outcomes in a Postgraduate Program in Endodontics Using Calcium Silicate–based Cements as Root-end Filling Materials

IntroductionThe purpose of this retrospective study was to determine the clinical and radiographic outcomes of root-end microsurgery in a postgraduate program in endodontics using modern techniques and calcium silicate–based root-end filling materials (ProRoot MTA; Dentsply International, Johnson City, TN, and EndoSequence Root Repair Material [ERRM]; Brasseler USA, Savannah, GA) and to identify any potential prognostic factors that may have affected healing outcomes. MethodsClinical records and periapical radiographs were collected from patients who had undergone endodontic microsurgery between 2007 and 2018 in a postgraduate endodontic clinic with a minimum follow-up interval of 6 months. Either ProRoot MTA or ERRM was used as the root-end filling material. Outcomes were categorized into healed, healing, and nonhealing based on clinical and radiographic findings. Healed and healing cases were pooled and considered as successes, whereas nonhealing cases were considered as failures. ResultsA total of 129 patients with 142 teeth were included in the final analysis. Seventy-six cases were root-end filled with ProRoot MTA and 66 root-end filled with ERRM. The ProRoot MTA group had a success rate of 92.1%, and the ERRM group had a success rate of 92.4% with no significant difference between the groups (P > .05). Vertical root fracture was found to be the predominant cause of failure. No patient- or treatment-related factor was identified to have any significant impact on healing. ConclusionsHigh overall success can be achieved in a postgraduate endodontic program when either ProRoot MTA or ERRM is used as the root-end filling material.

Outcome of Endodontic Microsurgery Using Mineral Trioxide Aggregate or Root Repair Material as Root-end Filling Material: A Randomized Controlled Trial with Cone-beam Computed Tomographic Evaluation

IntroductionThe purpose of this randomized clinical trial was to evaluate healing after endodontic microsurgery (EMS) using mineral trioxide aggregate (MTA) versus EndoSequence root repair material (RRM; Brasseler, Savannah, GA) as root-end filling materials. MethodsTwo hundred forty-three teeth with persistent or recurrent apical periodontitis were randomly assigned to either the MTA or RRM group. EMS was performed, and follow-up visits with clinical and radiographic investigation were scheduled at 6, 12, and 24 months with follow-up cone-beam computed tomographic (CBCT) imaging after 12 months. ResultsOne hundred twenty teeth with an average follow-up of 15 months were evaluated. The overall success rate was 93.3% for periapical (PA) evaluation and 85% for CBCT evaluation. The RRM group exhibited 92% and 84% success rates as assessed on PA and CBCT imaging, respectively. The MTA group exhibited 94.7% and 86% success rates as assessed on PA and CBCT imaging, respectively. No significant difference was observed between the 2 groups. Microsurgical classification, root canal filling quality, root-end filling material depth, and root fracture were found to be significant outcome predictors. ConclusionsEMS is a predictable procedure with successful outcome both 2-dimensional and 3-dimensional radiographic evaluation when RRM or MTA was used as the root-end filling material.

Evaluation of Marginal Adaptation of MTA, Biodentine, and MTA Plus as Root-End Filling Materials—An SEM Study

Abstract Objective This study aimed to evaluate adaptation of mineral trioxide aggregate (MTA), Biodentine, and MTA Plus when used as root-end restorative materials using scanning electron microscope. Materials and Methods Forty-five extracted teeth with one root canal were cleaned and sectioned at cementoenamel junction, maintaining a standardized length of 15 mm. Chemomechanical preparation and obturation was done in all the samples, and access was restored with glass ionomer cement (GIC). Root-end cavities were prepared in all the samples after 3-mm apical root end was resected. Forty-five samples were divided into three groups with 15 samples each. Root apices were filled with ProRoot MTA in group I, Biodentine in group II, and MTA Plus in group III. The sample teeth were sectioned for examination of gaps at the margins using scanning electron microscope. The data collected were put to statistical analysis by one-way ANOVA (analysis of variance) and post hoc tests. Results The minimum margin gap score of 2.44 μm was observed in group II (Biodentine), whereas maximum gap score of 5.63 μm was observed in group I (ProRoot MTA); 4.92 μm mean margin gap score was observed in group III (MTA Plus). Conclusion Biodentine showed least margin gap at the interface, so it can be considered as the best root-end filling material, whereas, MTA Plus can be considered as a substitute to ProRoot MTA as a root-end filling material.

Effects of Blood Contamination on Sealing Ability and Microhardness of Mineral Trioxide Aggregate Used as a Root-end Filling Material

Effects of Blood Contamination on Sealing Ability and Microhardness of Mineral Trioxide Aggregate Used as a Root-end Filling Material

Tissue Reaction to Subcutaneous Implantation of SuperEBA (Reinforced Zinc Oxide Cement) Used as Root-End Filling Material: A Histological Study in Rats

The retrograde filling is a critical step to a successful outcome of the endodontic surgery. Despite the progress in the technology of novel root-end filling materials, zinc oxide-eugenol cement superEBA is still preserving its clinical value on long-term basis. The study aimed to reconsider the tissue response to the initial irritating effect of this material. Silicon tubes filled with superEBA were subcutaneously implanted for 120 days in white Wistar rats which were afterwards sacrificed. The connective tissue surrounding the superEBA implants revealed fibroblast proliferation and a definite reparatory process without inflammatory reaction. A non-specific tissue healing in progress around the implants, without calcifications, necrosis, and apoptosis was also described after 4 months. SuperEBA proved on animal model that its cytotoxicity is reducing gradually in time until no adverse reaction is observed. The reduced content in eugenol compared to other surgical zinc oxide cements and the benefic effect of o-ethoxybenzoic acid are the support to reconsider SuperEBA as a biocompatible retrograde filling material.

Evaluation and Reduction of Artifacts Generated by 4 Different Root-end Filling Materials by Using Multiple Cone-beam Computed Tomography Imaging Settings

IntroductionAfter endodontic surgery, radiographic assessment is the method of choice to monitor bone defect healing. Cone-beam computed tomography scans are useful to check and identify the reasons of failure of surgical intervention or confirm healing; however, the artifact generated by some root-end filling material might compromise this task. The objective of the study was to compare the amount of artifacts generated by 4 root-end filling materials and to test multiple exposure settings used with these materials, when the effective dose generated by each protocol was taken into consideration. MethodsTwenty central incisors were endodontically treated with retrograde obturation by using amalgam, Biodentine, MTA, and Super-EBA (5 of each). They were placed in a skull with soft tissue simulation and scanned by using the Planmeca Promax Max with different kilovolt peaks (kVp): 66, 76, 84, and 96 with and without the use of metal artifact reduction (MAR) algorithm and with low, normal, and high resolution and high definition. The Dose Area Product was registered, and the effective dose was calculated. ResultsAmalgam generated the highest amount of artifacts, whereas MAR and low resolution created fewer artifacts than other settings. The artifacts were also reduced with 96 kVp. The effective dose calculated with low resolution was remarkably lower than other resolutions. ConclusionsWhen used as root-end filling material, Biodentine, MTA, and Super-EBA generated fewer artifacts than amalgam. The use of 96 kVp with MAR and low resolution also reduced artifacts on the image and at the same time generated the lowest effective dose.

Clinical Outcome of Endodontic Microsurgery That Uses EndoSequence BC Root Repair Material as the Root-end Filling Material

IntroductionThe purpose of this retrospective study was to determine the clinical and radiographic outcome of root-end surgery when EndoSequence BC Root Repair (ES-BCRR) was used as the root-end filling material and to identify any possible prognostic factors that may have affected the healing outcome. MethodsClinical records and periapical radiographs were collected from patients who had undergone endodontic microsurgery between 2009 and 2013 in a private endodontic office and had a minimum 1-year follow-up. All surgical procedures were performed by a single endodontist. ES-BCRR was used as the root-end filling material in all cases. Outcome was categorized into healed, healing, and non-healing on the basis of clinical and radiographic findings. The healed and healing cases were pooled and considered as success, and non-healing cases were considered failure. For statistical analysis of the prognostic factors, the dependent variable was the dichotomous outcome (ie, success versus failure). ResultsNinety-four patients with 113 teeth met the inclusion criteria and were included in the study. The overall success rate was 92.0%. None of the prognostic factors, including age, sex, tooth position, size of periapical radiolucency, presence of a sinus tract, preoperative symptoms, and retreatment previous to surgery, appeared to have any significant effects on the outcome (P > .05). ConclusionsThis current study suggests that ES-BCRR is a suitable root-end filling material to be used in endodontic surgery.

Healing after Root-end Microsurgery by Using Mineral Trioxide Aggregate and a New Calcium Silicate–based Bioceramic Material as Root-end Filling Materials in Dogs

IntroductionThe purpose of this study was to compare healing after root-end surgery by using grey mineral trioxide aggregate (MTA) and EndoSequence Root Repair Material (RRM) as root-end filling material in an animal model. MethodsApical periodontitis was induced in 55 mandibular premolars of 4 healthy beagle dogs. After 6 weeks, root-end surgeries were performed by using modern microsurgical techniques. Two different root-end filling materials were used, grey MTA and RRM. Six months after surgery, healing of the periapical area was assessed by periapical radiographs, cone-beam computed tomography (CBCT), micro computed tomography (CT), and histology. ResultsMinimal or no inflammatory response was observed in the majority of periapical areas regardless of the material. The degree of inflammatory infiltration and cortical plate healing were not significantly different between the 2 materials. However, a significantly greater root-end surface area was covered by cementum-like, periodontal ligament–like tissue, and bone in RRM group than in MTA group. When evaluating with periapical radiographs, complete healing rate in RRM and MTA groups was 92.6% and 75%, respectively, and the difference was not statistically significant (P = .073). However, on CBCT and micro CT images, RRM group demonstrated significantly superior healing on the resected root-end surface and in the periapical area (P = .000 to .027). ConclusionsLike MTA, RRM is a biocompatible material with good sealing ability. However, in this animal model RRM achieved a better tissue healing response adjacent to the resected root-end surface histologically. The superior healing tendency associated with RRM could be detected by CBCT and micro CT but not periapical radiography.

The Effect of Thickness on the Sealing Ability of CEM Cement as a Root-end Filling Material.

Background and aims. Different materials have been used for root-end filling during surgical endodontic treatment. The aim of this in vitro study was to evaluate the dye penetration in different thicknesses of calcium enriched mixture (CEM) cement as root-end filling material. Materials and methods. Following root canal filling in 70 extracted human single-rooted premolar teeth, the apical 3 mm of their root-ends was resected; the root-end cavities with depths of 1, 2 and 3 mm were prepared by ultrasonic retrotips and filled with CEM cement. After setting of cement, the roots were immersed in 2% Rhodamine B and the dye leakage was measured under stereomicroscope (×16) using Image J software. The data were analyzed by one-way ANOVA and Bonferroni post hoc tests at 5% significance level. Results. The means and standard deviations of dye penetration in the 1, 2, and 3 mm groups were 3395.5±1893.4, 3410.4±1440.5, and 2581.6±1852.9 μm, respectively. The one-way ANOVA analysis indicated significant differences (P < 0.001); however, the Bonferroni post hoc test revealed that only the positive control group differed significantly from the experimental groups (P < 0.001). Conclusion. The findings demonstrated CEM cement to have an adequate root-end sealing ability in 3-mm thickness.

Ex Vivo Evaluation of Light-curing MTA-like Resin as Root-end Filling Material

<i>Ex Vivo</i> Evaluation of Light-curing MTA-like Resin as Root-end Filling Material

Evaluation of Microsurgery with SuperEBA as Root-end Filling Material for Treating Post-treatment Endodontic Disease: A 2-year Retrospective Study

IntroductionThis retrospective study assessed the effects of microsurgical treatment of post-treatment endodontic disease using SuperEBA (Bosworth, Skokie, IL) as the root-end filling material and evaluated the potential prognostic factors in relation to outcome. MethodsData were collected from patients diagnosed with post-treatment endodontic disease who then underwent endodontic microsurgery between April 2007 and October 2010. The effect was evaluated 2 years after the operation. Surgical procedures were performed by a single endodontic specialist. After surgery, operation records were recorded including preoperative, intraoperative, and postoperative factors from the clinical and radiographic measures. For statistical analysis of the predisposing factors, the dependent variable was the dichotomous outcome (ie, success vs failure). ResultsEighty-two patients with 101 treated teeth met the inclusion criteria. The recall rate was 87.2%. Of these microsurgically treated cases, the overall healing rate was 93.1%. At the 0.05 significance level, age, sex, tooth position, size of periapical radiolucency, biopsy result of periapical lesion, and presence of a sinus tract appeared to have no significant effects on the outcome (P > .05). ConclusionsMicrosurgical endodontic treatment using SuperEBA as the root-end filling material is a favorable option for post-treatment endodontic disease.