Sealing ability of mineral trioxide aggregate, calcium phosphate cement, and glass ionomer cement in the repair of furcation perforations

An in-vitro assessment of the irrigants and irrigation protocols effect on the ProRoot MTA marginal leakage in the furcal perforations

To assess the effects of 5.25% sodium hypochlorite (NaOCl), 17% ethylenediaminetetraacetic acid (EDTA), and 2% chlorhexidine (CHX), individually and in combination, as part of an irrigation protocol on furcal perforations treated with ProRoot MTA, using the dye extraction (DE) method for evaluation. Sixty intact mandibular molars were used. Perforations were created with a 1.2 mm diameter at the FA of the molars and sealed the perforations with MTA. Then the samples were divided randomly after to six groups according to the irrigant used: Group 1 (n = 10), 5.25% NaOCl; Group 2 (n = 10), 17% EDTA; Group 3 (n = 10), 2% CHX, Group 4 (n = 10), saline serum (control group); Group 5 (n = 10), (5.25% NaOCl,17% EDTA, 5.25% NaOCl) protocol replaced with saline serum between each irrigant; and Group 6 (n = 10), (5.25% NaOCl, 17% EDTA, 2% CHX). Specimens were immersed for 24 h in 2% methylene blue. Subsequently, a DE test was performed. Data analysis employed the One-Way ANOVA and LSD tests. The significance level was set at 0.05. DE values between groups revealed significant differences in this study (p < 0.01). Control group DE values were less than NaOCl (p < 0.05), EDTA (p < 0.01), CHX (p < 0.01), protocol (NaOCl - EDTA - NaOCl) (p < 0.01), and protocol (NaOCl - EDTA - CHX) (p < 0.01) groups, proposing the order: Control group < NaOCl < EDTA < CHX≤(NaOCl - EDTA - NaOCl) protocol≤(NaOCl - EDTA - CHX) protocol. Deterioration of the MTA sealing ability was noted when contacted with 5.25% NaOCl, 17% EDTA, 2% CHX, and both protocols.

How Irrigants Affect Mineral Trioxide Aggregate (MTA) Sealing in Furcal Perforations: An In Vitro Study

Objective This study aimed to evaluate the effect of 5.25% sodium hypochlorite (NaOCl) and 2% chlorhexidine (CHX) on ProRoot mineral trioxide aggregate (MTA) used for treating furcal perforations, compared to no solution application, using the dye penetration (DP) method. Materials and methods The study included 36 intact mandibular molars in the furcal area (FA) with well-spaced roots. Using dental operating microscopes, perforations were created at the FA of the molars with a 1.2 mm diameter. Subsequently, ProRoot MTA (Dentsply, Germany) was applied to seal the perforations. After 24 hours, the samples were randomly assigned to three groups: Group A (n = 12), irrigated with 5.25% NaOCl; Group B (n = 12), irrigated with 2% CHX; and Group C (n = 12), without irrigation (control group). Specimens' pulp chambers were immersed in 2% methylene blue for 24 hours. Buccal-lingual sections were performed, and the depth of marginal dye leakage was assessed using a stereomicroscope at 20x magnification. Data analysis employed the one-way analysis of variance (ANOVA) test and Bonferroni post-hoc test (α = 0.05). Results The study revealed significant differences in DP values between groups (p-value < 0.01). DP values in the control group (no irrigation) were lower than both NaOCl (p < 0.05) and CHX (p < 0.01) groups. Furthermore, DP values in the CHX group were higher than those in the NaOCl group (p < 0.01), suggesting the order: no irrigation < NaOCl < CHX (p < 0.05). Conclusions The sealing ability of MTA was compromised when irrigated with 2% CHX and 5.25% NaOCl. CHX significantly impacted the marginal leakage and sealing ability of MTA. Care should be taken when resuming endodontic treatment after the application of MTA in cases of furcal perforations as the use of CHX and NaOCl may affect the marginal leakage of MTA.

Stereomicroscopic Evaluation of Sealing Ability of Three Different Furcal Perforation Repair Materials: An In vitro Study

Background

The choice of sealing material is a crucial factor that influences the outcome of endodontic treatment.

Aim

The purpose of this study was to compare the sealing ability of mineral trioxide aggregate (MTA) Angelus, Endocem MTA, and NeoPutty MTA when used as furcal perforation repair materials.

Materials and Methods

A total of 45 mandibular molars were used. Root canal treatment was carried out following which standardized furcal perforations were made. The specimens were randomly divided into three groups of 15 teeth each. Group A-Furcal perforation repair by means of MTA Angelus, Group B-Furcal perforation repair using Endocem MTA, and Group C-Furcal perforation repair by NeoPutty MTA. Following the repair procedure, the pulp chambers and access openings were filled with temporary restorative material and immersed in 1% basic fuchsin dye for 24 h. The teeth were sectioned longitudinally and the linear dye penetration was measured using a stereo-microscope.

Results

The one-way analysis of variance (ANOVA) revealed a statistically significant difference among the groups (F = 16.15, P < 0.001). On calculating the depth of leakage to the total length of the perforation, it was observed that the mean leakage was 32.83% in Group I, 52.92% in Group II and the lowest, 16.35% in Group III. The ANOVA test reveals a statistically significant difference among the groups (F = 15.92, P < 0.001). Comparing the depth of dye penetration of dye, 33.3% of the Group I samples showed ≥50%, 49%-25%, and <25% dye penetration. Although 56.7% of Group II samples showed ≥50% dye penetration, whereas 63.3% of Group III showed <25% dye penetration.

Conclusion

The present study indicated that NeoPutty MTA had the least dye penetration followed by MTA Angelus and Endocem MTA.

Endodontic Perforation Closure by Five Mineral Oxides Silicate-Based Cement with/without Collagen Sponge Matrix

Endodontic perforations are common accidents that occasionally happen as a result of misuse or difficult anatomy of some teeth; it may lead to teeth loss unless a good management is provided. Bioceramic (silicate-based) cements like mineral trioxide aggregate have a big role in management of such accidents. This case report aimed to evaluate the ability of five mineral oxides cement "5MO" in sealing two root canal perforations (furcation and postdrill perforations) and inducing clinical and radiographic healing in the periodontal tissues with/without the use of collagen sponge matrix. A 58-year-old healthy female was referred to our dental office complaining of severe pain in the upper left premolars' region. Periapical radiographic examination revealed unsatisfactory root canal treatment of the teeth #24 and #25 with a furcation perforation and a postdrill perforation, respectively. Cone-beam computed tomography "CBCT" scans confirmed the findings of the periapical radiography and revealed the presence of radiolucent lesions surrounding the apex of both teeth #24 and #25. The treatment plan was a nonsurgical root canal retreatment by endodontic access through the full-ceramic crowns. After three years of follow-up, CBCT scans revealed a complete healing and bone formation on both premolars. This case report indicates the use of 5MO cement for endodontic perforations management.

[Current situation and strategy on perforation repair]

Perforations are common complications of root canal therapy. In clinic, perforations that were improperly and untimely repaired can seriously affect the prognosis of teeth after root canal treatment. At present, the status of perforation repair in our country is worrisome. This paper focused on the progress of perforation repair in the country by discussing the current situation of repair methods and materials. This review aims to improve knowledge and aid clinical doctors in the sophistication of perforation repair in order to improve the retention rate of root-canal-treated teeth.

Biodentine for Furcation Perforation Repair: An Animal Study with Histological, Radiographic and Micro-Computed Tomographic Assessment

Introduction:

Biodentine has been scarcely studied as a furcation perforation (FP) repair material, mostly by in vitro methodologies. This animal study aimed to compare the histological responses, radiographic, and micro-computed tomographic (micro-CT) outcomes after FP repair with Biodentine or ProRoot MTA (MTA) in dogs’ teeth.

Methods and Materials:

Fifty teeth from five dogs were divided into 4 groups: MTA (n=20, FP repaired with ProRoot MTA), BDT (n=20, FP repaired with Biodentine), PC (n=5, positive control, FP without repair) and NC (n=5, negative control, without perforation). The animals were euthanized after 4 months. Histological assessment included inflammatory cell infiltration, hard tissue resorption, hard tissue repair, and cement repair in the furcation area. Immediate postoperative and 4 months follow-up radiographs were compared for radiolucency in the furcation region. The volume of extruded material was quantified using micro-CT images.

Results:

The tested materials showed equivalent radiographic response, together with similar hard tissue resorption and repair but, BDT group showed significantly less inflammation, lower volume of extruded material and higher cement repair than MTA group.

Conclusion:

The outcomes of this study, taken together with other favorable results in literature, are highly suggestive that Biodentine is a promising biomaterial to be used for FP repair.

Animal models used in furcation perforation studies: A systematic review and comprehensive synthesis of model characteristics

In order to systematise furcation perforation (FP) experimental animal models described in the literature and to determine whether there is evidence that a model is superior to others, MEDLINE/PubMed, SciELO and Cochrane Library were searched to find studies which used animal models of FP. Data were gathered concerning model characteristics, chosen groups, sample numbers, type of outcomes, journal and main area studied. Twenty-five articles were included in this systematic review, four conducted in rodent models, three in non-human primates and 18 in dogs. Medians were six animals and 34 teeth per study; 10 teeth per test group and, when performed, six teeth per control group. Twenty-four studies investigated the use of materials for FP repair; eight also tested adjuvant materials/substances. Although there is no model which can be described as ideal and superior than others for FP studies, dogs appear to possess the most suitable model characteristics.

Bacterial Leakage of Mineral Trioxide Aggregate, Calcium-Enriched Mixture and Biodentine as Furcation Perforation Repair Materials in Primary Molars

Introduction:

Adequate seal of iatrogenically perforated area within the root canal system can improve the long term treatment prognosis. This in vitro study evaluated the sealing ability of mineral trioxide aggregate (MTA), calcium-enriched mixture (CEM) cement and Biodentine in repair of furcation perforation in primary molars.

Methods and Materials:

A total of 61 freshly extracted primary mandibular second molars were randomly divided into three groups (n=17) and 10 teeth were put in negative (without perforation, n=5) and positive (perforated without repair, n=5) control groups. Turbidity was used as the criteria of bacterial leakage, when detected in the model of dual-chamber leakage. Data were analyzed using the Chi-Square and Kaplan-Meier survival analysis in SPSS software. The level of significance was set at 0.05.

Results:

All positive samples showed turbidity, whereas none of the negative samples allowed bacterial leakage. There was no significant difference between the number of turbidity samples in repaired teeth with all test materials (P=0.13). No significant difference was also detected in the mean survival time (P>0.05).

Conclusion:

CEM cement and Biodentine showed promising results as perforation repair materials and can be recommended as suitable alternatives of MTA for repair of furcation perforation of primary molars.

Development of calcium phosphate/sulfate biphasic cement for vital pulp therapy

OBJECTIVES

Bioactive calcium phosphate cement (CPC) has been used widely to repair bone defects because of its excellent biocompatibility and bioactivity. However, the poor handling properties, low initial mechanical strength, and long setting time of CPC limit its application in vital pulp therapy (VPT). The aim of this study was to synthesize biphasic calcium phosphate/sulfate cements and evaluate the feasibility of applying these cements in VPT.

METHODS

The physical, chemical, and mechanical properties of CPC were improved by mixing the cement with various amounts of α-calcium sulfate hemihydrate (CSH). The hydration products and crystalline phases of the materials were characterized using scanning electron microscopy and X-ray diffraction analysis. In addition, the physical properties, such as the setting time, compressive strength, viscosity, and pH were determined. Water-soluble tetrazolium salt-1 and lactase dehydrogenase were used to evaluate cell viability and cytotoxicity.

RESULTS

The developed CPC (CPC/CSH cement), which contains 50wt% CSH cement, exhibited no obvious temperature increase or pH change during setting when it was used as a paste. The initial setting time of the CPC/CSH biphasic cement was substantially shorter than that of CPC, and the initial mechanical strength was 23.7±5.6MPa. The CPC/CSH cement exhibited higher viscosity than CPC and, thus, featured acceptable handling properties. X-ray diffraction analysis revealed that the relative peak intensity for hydroxyapatite increased, and the intensity for calcium sulfate dehydrate decreased as the amount of CPC was increased. The cell viability and cytotoxicity test results indicated that the CPC/CSH cement did not harm dental pulp cells.

SIGNIFICANCE

The developed CPC/CSH biphasic cement exhibits substantial potential for application in VPT.