Evaluation and comparison of sealing ability of three different obturation techniques - Lateral condensation, Obtura II, and GuttaFlow: An in vitro study

Comparison of Sealing Ability of Bioceramic Sealer, AH Plus, and GuttaFlow in Conservatively Prepared Curved Root Canals Obturated with Single-Cone Technique: An In vitro Study

Background:

Inadequate obturation techniques of the root canal system have been found to be the most frequent reason of failure post root canal treatment. An ideal endodontic sealer should fulfill all ideal requisites. The present study aimed to compare apical sealing ability between bioceramic (BC) sealer, GuttaFlow, and AH Plus.

Methodology:

One hundred and twenty-five curved roots of maxillary and mandibular third molar teeth with fully formed apex were collected for this study. The root canals were cleaned and shaped using a standard single-cone preparation to file at the established working length and divided into five groups of 25 each. Dye leakage was carried out. Group A: with GP, using EndoSequence BC sealer with conventional with 4% gutta-percha (Brasseler USA, Savannah, Georgia, USA); Group B: with ceramic coated with 4% gutta-percha (Brasseler USA, Savannah, Georgia, USA); Group C: with GP, using AH Plus sealer (Dentsply, De-Trey Konstanz, Germany) with 4% gutta-percha; Group D: with GuttaFlow bioseal (Roeko-Coltène/Whaledent, Langenau, Germany) with 4% Gutta-percha; and Group E is a negative control group. Statistical analysis was done using the Statistical Package for the Social Sciences software and Student's unpaired t-test.

Results:

The group AH Plus showed more leakage values than the GuttaFlow group and of two groups of BC sealer and negative control. Student's unpaired t-test disclosed no significant difference (P < 0.05) between the groups.

Conclusion:

None of the sealers used in the study could completely seal the apical foramen to have a fluid-tight seal.

Thermafil: A New Clinical Approach Due to New Dimensional Evaluations

Background

There are a lot of techniques to obturate the root canals, but lateral condensation of gutta-percha is the most used one. An important aspect of thermafil is the error margin tolerated by the manufacturer in the production of plastic carriers. In literature, there is no evidence about discrepancy percentage between different carriers. It is demonstrated that the error margin of gutta-percha is 0.5% and is 0.2% for metal files (ISO standards).

Objective

The aim of this study was to evaluate the real dimensions of thermafil plastic carriers observed by the stereo microscope measuring the dimensional discrepancy between them.

Methods

For this study, 80 new thermafil (Dentsply Maillefer) have been selected. 40 thermafil 0.25 and 40 thermafil 0.30. Through 60X stereo microscope, the dimensions of the plastic carrier tips have been measured. The dimensions of the plastic carrier were also measured after a heating cycle. ZL GAL 11TUSM (Zetaline stereo evolution) microscope was used to observe the samples. Measurements were made through a dedicated software (Image Focus). All samples were analysed at 60X.

Results

A non-parametric paired test (Wilcoxon test) was used to compare baseline and after heating values; p-values ≤ 0.05 were assumed to be statistically significant.

Conclusion

The samples we measured showed a mean value of the diameters in Thermafil 25 that was 0.27 mm, for Thermafil 30 the mean value was 0.33 mm.We have measured a dimensional variable of 8% in the 25 group while in group 30 the maximum possible variation found was 4%, that's why we propose a new protocol of obturation with thermafil. We can also conclude that a single heating process does not affect clinically the plastic carrier dimensions.

A comparison of apical sealing ability between GuttaFlow and AH plus: An in vitro study

Aims:

The present study aimed to compare apical sealing ability between GuttaFlow and AH Plus.

Materials and Method:

Eighty extracted human maxillary anterior teeth with fully formed apex and straight root were collected for this study. The root canals were cleaned and shaped using a standard step back preparation to size 60# master apical file at the established working length and divided into four groups: Group 1, GuttaFlow sealer with gutta-percha; Group 2, AH Plus sealer with gutta-percha; Group 3, positive control group (Teeth were instrumented and left without obturation); Group 4, negative control group (Teeth were totally coated with nail varnish) Dye leakage was carried out. Statistical analysis was done using the Statistical Package for the Social Sciences software and Student's unpaired t-test.

Results:

The GuttaFlow group had a mean leakage of 1.38 mm whereas AH Plus had a mean of 1.425 mm. The standard deviation of GuttaFlow and AH Plus were 0.3861 and 0.3226, respectively. Student's unpaired t-test disclosed no significant difference (P < 0.05) between the groups.

Conclusion:

None of the sealers used in the study could completely seal the apical foramen to have a fluid-tight seal. GuttaFlow and AH Plus showed no statistically significant difference in microleakage; the better result was shown by GuttaFlow.

Evaluation of the Quality of Obturation with Obtura at Different Sizes of Apical Preparation Through Microleakage Testing

INTRODUCTION

Obturation of the root canal system is required to prevent recontamination of the root canal after cleaning and shaping procedures and to seal the root canal completely, both the apical and coronal avenues of potential leakage and to maintain the disinfected status.

AIM

The aim of this study was to determine the microleakage by dye leakage method at 1mm, 3mm and 5mm short of the apex with different sizes of apical preparation, obturated by Obtura.

MATERIALS AND METHODS

Sixty freshly extracted human single rooted teeth were randomly distributed into six equal groups. Group I (control group) was obturated by lateral compaction technique. Group II to VI were experimental groups (apical preparations done upto ISO sizes 20, 30, 40, 50 and 60 respectively), obturated by Obtura technique. After storing the samples at 100% humidity for seven days and one day in 2% methylene blue, the roots of the teeth were sectioned at 3mm short of the apex. They were observed under stereomicroscope at 20X magnification and the images were analysed for microleakage using the scoring criteria. The data obtained were analysed by One-way ANOVA followed by Tukey pair-wise multiple comparison test and p ≤ 0.05 was considered as the level of significance.

RESULTS

The lowest mean microleakage score was seen in Group VI (0) and the highest mean leakage score was seen in Group II (1.5). There was statistically significant difference between Group II and Group V (p = 0.044), Group II and Group VI (p = 0.013). There was no significant difference between all the other groups (p> 0.05).

CONCLUSION

Comparison of microleakage between different groups from ISO sizes 20-60 recommends a minimum apical preparation of ISO size 30.

Comparison of Obturation Quality in Modified Continuous Wave Compaction, Continuous Wave Compaction, Lateral Compaction and Warm Vertical Compaction Techniques

OBJECTIVES

The aim of this study was to introduce modified continuous wave compaction (MCWC) technique and compare its obturation quality with that of lateral compaction (LC), warm vertical compaction (WVC) and continuous wave compaction techniques (CWC). The obturation time was also compared among the four techniques.

MATERIALS AND METHODS

Sixty-four single-rooted teeth with 0-5° root canal curve and 64 artificially created root canals with 15° curves in acrylic blocks were evaluated. The teeth and acrylic specimens were each divided into four subgroups of 16 for testing the obturation quality of four techniques namely LC, WVC, CWC and MCWC. Canals were prepared using the Mtwo rotary system and filled with respect to their group allocation. Obturation time was recorded. On digital radiographs, the ratio of area of voids to the total area of filled canals was calculated using the Image J software. Adaptation of the filling materials to the canal walls was assessed at three cross-sections under a stereomicroscope (X30). Data were statistically analyzed using ANOVA, Tukey's post hoc HSD test, the Kruskal Wallis test and t-test.

RESULTS

No significant difference existed in adaptation of filling materials to canal walls among the four subgroups in teeth samples (P ≥ 0.139); but, in artificially created canals in acrylic blocks, the frequency of areas not adapted to the canal walls was significantly higher in LC technique compared to MCWC (P ≤ 0.02). The void areas were significantly more in the LC technique than in other techniques in teeth (P < 0.001). The longest obturation time belonged to WVC technique followed by LC, CW and MCWC techniques (P<0.05). The difference between the artificially created canals in blocks and teeth regarding the obturation time was not significant (P = 0.41).

CONCLUSION

Within the limitations of this in vitro study, MCWC technique resulted in better adaptation of gutta-percha to canal walls than LC at all cross-sections with fewer voids and faster obturation time compared to other techniques.

Retrieval of extensive gutta-percha extruded into the maxillary sinus: use of 3-dimensional cone-beam computed tomography

INTRODUCTION

Close proximity of the maxillary sinus to the roots of maxillary teeth can predispose to the inadvertent deposition of endodontic products into the maxillary sinus. One such material is thermoplasticized injectable gutta-percha, which has gained popularity of late. As a consequence of overfilling, some patients warrant surgical retrieval.

METHODS

A case report of extreme overextension of gutta-percha within the maxillary sinus after endodontic retreatment on tooth #14 was provided. The distobuccal and palatal canals had been obturated with gutta-percha master cones and backfilled with thermoplasticized injectable warm gutta-percha. The mesiobuccal canal had only been filled with thermoplasticized injectable warm gutta-percha, the origin of the extrusion. Imagery with 3-dimensional cone-beam computed tomography was performed for localization of the gutta-percha.

RESULTS

The patient underwent a Caldwell-Luc approach for removal of the extruded material. The gutta-percha was successfully removed intact, and the patient had an unremarkable postoperative course. However, the patient continues to have mild tenderness in the sinus region.

CONCLUSIONS

The featured case exemplified the consequence of overinstrumentation and ensuing inadequate apical stop. In these situations, the obturation of a maxillary tooth with thermoplasticized injectable gutta-percha, without master cones, can potentially result in overfilling and deposition into the antrum. Use of 3-dimensional cone-beam computed tomography could enhance endodontic diagnosis, serve as an aid for visualization of foreign materials within the sinus and contiguous soft tissue structures, and improve clinical outcome.

An In-Vitro Evaluation and Comparison of Apical Sealing Ability of Three Different Obturation Technique - Lateral Condensation, Obtura II, and Thermafil

INTRODUCTION

Success of non-surgical root canal treatment is predicted by meticulous cleaning and shaping of the root canal system, three-dimensional obturation and a well-fitting "leakage-free" coronal restoration. The techniques of obturation that are available have their own relative position in the historical development of filling techniques. Over the years, pitfalls with one technique have often led to the development of newer methods of obturation, along with the recognition that no one method of obturation may satisfy all clinical cases.

MATERIALS AND METHODS

A total of 120 extracted human permanent anterior maxillary and mandibular single rooted teeth were selected for the present study and divided into 3 groups based on the method of obturation technique. Following the preparation the patency at the apical foramen was confirmed by passing a file #15. After obturation of all three groups, teeth were immersed in 1% of aqueous methylene blue dye for a period of two weeks and then samples were subjected to spectrophotometric analysis.

RESULTS

The present study was conducted to evaluate in vitro the spectrophotometric analysis to quantitatively analyze relative amount of dye penetration using lateral condensation (Group I), Obtura II (Group II ), Thermafil obturating technique (Group III) with ZOE sealer used in all groups. Teeth obturated with lateral condensation (Group I) shows mean value of 0.0243 and standard deviation of 0.0056. The Group II thermoplasticized injectable moulded Guttapercha (Obtura II) showed 0.0239 mean and standard deviation value of 0.0045 and Group III Thermafil obturation technique shows 0.0189 as mean value and 0.0035 standard deviation values.

CONCLUSION

Following conclusion was drawn from the present study. Group III i.e., Thermafil obturating technique shows minimum mean apical dye penetration compared to Group II (ObturaII) and Group I (lateral condensation).Lateral condensation shows maximum mean apical dye penetration in all three groups.There is no significant difference between the apical dye penetration of lateral condensation and Obtura II.

KEYWORDS

Obturation, lateral condensation, Obtura II, Thermafil, Spectrophotometer, dye penetration. How to cite this article: Samson E, Kulkarni S, Sushil K C, Likhitkar M. An In-Vitro Evaluation and Comparison of Apical Sealing Ability of Three Different Obturation Technique - Lateral Condensation, Obtura II, and Thermafil. J Int Oral Health 2013; 5(2):35-43.

A clinical trial of cold lateral compaction with Obtura II technique in root canal obturation

INTRODUCTION

The purpose of obturation of the prepared root canal space is to prevent coronal leakage and bacterial contamination and to seal the apex from the periapical tissue fluids. Cold lateral technique has been considered to be a gold standard, however considering its limitations various thermoplasticized gutta-percha techniques have been recommended. This study compares radiographic quality of obturation in molar teeth, obturated with cold lateral condensation and thermoplasticized injectable gutta-percha technique (Obtura II system).

MATERIALS AND METHODS

Sixty patients were equally divided into two groups, Group A obturated with Cold lateral condensation technique and group B with Obtura II. Periapical radiographs were obtained immediately after the obturation using paralleling device method. The radiographs were examined by an observer, who was blinded to the group allocation. Data was compared using χ(2) (Chi square) test and Independent sample t test was used to compare the mean ages.

RESULTS

Both groups were comparable in all respects such as tooth type, preoperative diagnosis and preoperative pain (P>0.05); however, more pre-operative radiolucency cases were allocated to Obtura II (P<0.05). There was no difference between the two groups, both in terms of postoperative voids as well as apical termination of the obturation (P>0.05).

CONCLUSION

Within the limitations of the study, it was found that statistically there was no significant difference between cold lateral and obtura II technique, in terms of post obturation voids and apical termination, as observed in radiographs.

Percentage of gutta-percha in mesial canals of mandibular molars obturated by lateral compaction or single cone techniques

The aim of this study was to compare the percentage of gutta-percha (PGP) in mesial root canals of mandibular molars obturated with LC (Lateral Compaction) or SC (Single Cone) ProTaper Universal System techniques at different levels of the root. Mesial root canals of 20 human permanent molars with similar anatomical characteristics were instrumented using the ProTaper Universal rotary system technique until the F2 instrument, with 20 canals filled by SC ProTaper Universal technique and 20 canals by the LC technique. The mesial roots were sectioned transversely to 3, 5, and 7 mm from the root apex. Digital images of specimens were obtained at MIC-D digital microscope in increases of 30 to 35X. The gutta-percha area was measured using ImageTool software. Data were analyzed using two-way ANOVA and Bonferroni test (α = 0.05). The SC technique provided greater PGP than the LC technique in the apical third (3 mm) (P < 0.001). In the other thirds (5 and 7 mm) there was no statistical difference between the two techniques regarding the PGP (P > 0.05). There was no statistically significant difference between thirds of the root canal for both techniques (P > 0.05). It was concluded that SC technique provided greater PGP than the LC technique in the apical third of mesial root canals of mandibular molars. There was no difference between the two techniques regarding the PGP in the cervical and middle thirds.

Apical Sealing Ability of MTA in Different Liquid to Powder Ratios and Packing Methods

INTRODUCTION

In apical surgery, after apicoectomy and retro-preparation of canal, a retrofil material is applied to seal the apical region of the root canal. Mineral trioxide aggregate (MTA) is the gold standard material for this purpose. Changing water/powder ratios of MTA affects its properties. The purpose of this in vitro study was to determine the effect of liquid/powder ratio of retrofil MTA on apical dye leakage, and also compare two packing techniques for MTA.

MATERIALS AND METHODS

In this in vitro study, 126 intact single-root extracted teeth were instrumented using step-back technique, and obturated with lateral condensation method. The apical 3 mm of roots was resected, and retrograde preparation was performed by an ultrasonic device. Specimens were randomly assigned to 6 groups of 20 each and 6 teeth served as positive and negative controls. All teeth were retrofilled with White ProRoot MTA. Three groups were retrofilled with 0.28, 0.33, and 0.40 water/powder ratios of MTA and packed with plugger; the other three groups were retrofilled with 0.28, 0.33, and 0.40 water/powder ratios and packed with wet-cotton. Linear dye leakage was used to check apical sealing ability, and data were statistically analyzed using Kruskal-Wallis test.

RESULTS

In 0.40 liquid/powder ratio the best applicator for packing MTA was plugger. In 0.28 liquid/powder ratio, moist cotton pellet was the best applicator; in 0.33 liquid/powder ratio, there was no significant difference between the two techniques.

CONCLUSION

Under the condition of this in vitro study, packing with moist cotton pellet in lower liquid/powder ratios of MTA, as well as packing with a plugger in higher liquid/powder ration decreased apical dye leakage.