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| Year : 2014 | Volume
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| Issue : 1 | Page : 69-72 |
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| In vitro evaluation of two methods of ultrasonic irrigation on marginal adaptation of MTA plugs in open apex teeth: A SEM analysis |
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Navid Khalighinejad1, Behnaz Barekatine2, Seyed Mohsen Hasheminia3, Hamed Gheibolahi1
1 Torabinejad Research Center, Isfahan University of Medical Science, Isfahan, Iran
2 Departments of Endodontics, Torabinejad Dental Research Center, Isfahan, Iran
3 Dental Materials Research Center, School of Dentistry, Isfahan University of Medical Science, Isfahan, Iran
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| Date of Submission | 23-Apr-2013 |
| Date of Decision | 06-Jun-2013 |
| Date of Acceptance | 18-Jan-2014 |
| Date of Web Publication | 21-Apr-2014 |
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 Abstract | | |
Context: Different factors can affect the marginal adaptation of MTA.
Aims: The present study was designed to investigate the effect of two ultrasonic irrigation methods on the marginal adaptation of MTA plug in open apex teeth by scanning electron microscope.
Settings and Design: Thirty single mature teeth were included in this in vitro experimental prospective study.
Materials and Methods: A total of 5 mm thickness of MTA plug was inserted at the end of the canals and after 24 h an ultrasonic file was used to irrigate the canals and remove the MTA remnants. Teeth were randomly divided into three groups: In the first and second groups, the canals were irrigated for 1 min by 2.5% sodium hypochlorite as #25 ultrasonic file was in direct contact and 1 mm away from MTA plug, respectively. The third group was not irrigated and left as control. A total of 1 mm transverse sections were prepared through the coronal and the apical parts of MTA plug and specimens were prepared for SEM analysis. The extent of gap was measured linearly under SEM device.
Statistical Analysis Used: Statistical analysis of the results was performed using the kruskal-Wallis test by SPSS software ver.18(a = 0.05).
Results: There was no significant difference between groups regarding the marginal gap size in apical (P: 0.17) and coronal sections (P: 0.33). However, the mean marginal gap size was higher in apical section compared to coronal section.
Conclusions: It can be concluded that ultrasonic irrigation dose not adversely affect the marginal adaptation of MTA plugs. Keywords: Canal irrigation, mineral trioxide aggregate, open apex, scanning electron microscope, ultrasonic
How to cite this article:
Khalighinejad N, Barekatine B, Hasheminia SM, Gheibolahi H. In vitro evaluation of two methods of ultrasonic irrigation on marginal adaptation of MTA plugs in open apex teeth: A SEM analysis. Indian J Dent Res 2014;25:69-72 |
How to cite this URL:
Khalighinejad N, Barekatine B, Hasheminia SM, Gheibolahi H. In vitro evaluation of two methods of ultrasonic irrigation on marginal adaptation of MTA plugs in open apex teeth: A SEM analysis. Indian J Dent Res [serial online] 2014 [cited 2023 Mar 21];25:69-72. Available from: https://www.ijdr.in/text.asp?2014/25/1/69/131132 |
Root canal treatment of immature teeth has been a challenge for clinicians. Divergent apices and thin dentinal walls hinder the effective debridement and controlled obturation of root canals. [1] There is a consensus among clinicians that apexification can induce a calcific barrier at the end of the root in teeth with necrotic pulp and open apex. [2] Traditionally, calcium hydroxide (CH) was used to fulfil this aim; however, despite promising results gained by CH, multi session treatments, high costs, tooth susceptibility to fracture, and peri-radicular necrosis after CH treatment are the main limitations of CH. [3] To negate these impediments, Torabinejad et al., [4] suggested the use of mineral trioxide aggregate (MTA) as an apical barrier in open apex teeth. MTA is bacteriostatic [5] biocompatible [6] and can provide an appropriate apical barrier against root obturating materials. [4] Different studies have shown the superiority of the MTA over other root end filling materials in its sealing capacity [7] and the MTA was shown to induce apical hard tissue formation in open apex teeth. [8],[9]
The complexity of the root canal systems makes the disinfection of inaccessible regions of the canal very difficult. As a result different chemo-mechanical protocols have been proposed to improve the canal cleanliness. Different disinfectant solutions such as sodium hypochlorite and EDTA are used to chemically disinfect the root canals; however, the effectiveness of irrigation relies on both mechanical flushing and chemical ability of the irrigants. [10],[11] The flushing action of an irrigant is effective in removing the organic debris and microorganisms from the root canal. [12] It has been shown that the flushing action of an irrigants is relatively weak from the end of a syringe [10] and the solution can just progress 1 mm beyond the syringe tip. [13] The only way to effectively irrigate the inaccessible parts of root canals is to move the irrigation solution [14] and ultrasonic (US) can accomplish this aim by continually moving the irrigant. [14],[15] Passive ultrasonic irrigation (PUI) is an irrigation protocol using a non-cutting ultrasonically activated file which is not in direct contact with canal walls. In different studies the superiority of PUI was shown over conventional syringe irrigation in removing dentin debris [16],[17] and bacterial reduction. [18],[19]
During orthograde placement of the MTA plug, MTA remnants may pollute the dentinal tubules and this may prevent the efficient penetration of sealer into tubules during obturation. As a result, complete irrigation of root canals after MTA placement seems crucial.
Over the year SEM images have played an important role in evaluating marginal adaptation of filling materials. Torabinejad et al., in 1995 showed the marginal adaptation superiority of MTA over other root end filling materials using scanning electron microscope (SEM); however Shipper et al., [20] announced that sample preparations and other shortcomings of earlier SEM may have affected the outcome of their study. Since ultrasonic irrigation has shown promising results and the effect of PUI has not been surveyed on the marginal adaptation of MTA plug in other studies, the present study was designed to investigate the effect of two methods of ultrasonic irrigation on the marginal adaptation of MTA plug in open apex teeth by SEM.
| Materials and Methods | |  |
Specimen selection
Thirty single rooted human, maxillary central and lateral teeth with mature apex were selected for the present prospective experimental study. Teeth with root fracture, caries and peri-radicular resorption were excluded. Soft tissues were removed using a curette and brush and teeth were kept in 2% thymol prior the study for 8 weeks. To obtain a standard root length of 15 mm, the tooth crowns were removed below the cement-enamel junction using a diamond disk (DandZ, Darmstadt, Germany) and non-stop devices (Krupp dental, Hilzingen, Germany).
Canal preparation
The patency of each canal was confirmed by inserting a #15 k-file (Mani, Touchi, Japan) and the working length was established by inserting a #15 K file until it was visible at the apical foramen (observed under magnifying loups) and by subtracting 1 mm from this point. Next, the canal preparation was performed using Gates Glidden drills #5 up to #1 (Mani, Tochigi, Japan) according to the crown down technique until the #1 bur reached the apical foramen. Then the canals were prepared using #50 K-file so that #90 file passed 1 mm beyond the apical foramen. Therefore, #110 divergent open apex was created at the foramen. A total of 2.5% sodium hypochlorite (LenzaFarmaceutica, Divisa˜oOdontologica, Belo Horizonte, Brazil) was used to irrigate the root canals during the canal preparation. Then the smear layer was removed using 5 ml of 17% EDTA (ApadanaTak, Tehran, Iran) for 1 min followed by 2 ml 5.25% NaoCL [21] and then canals were dried using #80 absorbent paper points (Tanariman Industrial Ltda., Manaus, Brazil).
MTA plug
MTA powder (Dentsply, Tulsa Dental, Tulsa, USA) was mixed at a 3:1 ratio and carried into the canal by a MTA carrier (Kerr, West collins, CA, USA) according to the manufacturer's instruction. Then the inserted MTA was packed with plugger (Maillefer) until a 5 mm thickness of MTA plug was achieved at the end of the canals. The teeth were attached to pre-moistened foam to stimulate the peri-apical tissue characteristics and to provide a slight resistance against MTA extrusion. The correct placement of the MTA plugs was verified with periapical radiograph. A # 80 K-file wrapped in humid cotton was used to remove the excess of MTA from canal walls. All specimens were incubated in an incubator for 24 ho at 37°C.
After preparation, the teeth were randomly divided into two experimental groups (n = 13) and one control group (n = 4). In the first and second groups, the canals were irrigated for 1 min with 2.5% sodium hypochlorite using an ultrasonic device (Satelec, Merignac, France) attached to a #25 ultrasonic file in order to eliminate the MTA remnant from dentinal tubules (Satelec, Merignac, France). In the first group, the ultrasonic file was in direct contact with MTA plug and in the second group the #25 ultrasonic file was not in direct contact with MTA plug. In the third group, the canals were not irrigated and left as control.
All specimens were mounted in a self-cure acrylic resin and then two, 1 mm transverse sections were provided through the coronal and the apical part of MTA plug. Specimens were dehydrated in graded series of ethanol solutions, critical point dried, gold-sputtered, and prepared for SEM imaging. The marginal adaptation of MTA plug was analyzed using image tool 3.0 software and the extent of gap was measured linearly in micrometers at 600× magnification under SEM device (JSM-6510LV, JEOL, Tokyo, Japan). Statistical analysis of the results was performed using the kruskal-Wallis test by SPSS software ver.18(a = 0.05).
| Results | | |
The mean and standard deviation of marginal gap size between MTA plug and dentinal wall in two apical and coronal sections have been shown in [Table 1] in different groups. | Table 1: The mean and standard deviation of marginal gap size in two apical and coronal sections in different groups
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In the first group (ultrasonic file was in direct contact with MTA plug) in both apical and coronal samples there were two teeth, which showed no sign of marginal gap. However, in the second and third groups all samples showed marginal discrepancies. Maximum amount of marginal gap size was seen in the apical section of the first group. Also SEM images of marginal gap between MTA and dentinal wall have been demonstrated in [Figure 1]. | Figure 1: Micrographs of an open apex teeth fi lled with MTA (H and E, x600)
Click here to view |
kruskall-Walis test was performed to compare the means of different groups in two apical and coronal sections. It was shown that there was no significant difference between different groups regarding the marginal gap size between MTA plug and dentinal wall in both apical (P = 0.33) and coronal sections (P = 0.17). However, the mean marginal gap size was higher in apical section compared to coronal section in all groups.
| Discussion | | |
MTA is used in the treatment of immature teeth that their root formation has been halted by necrosis of the pulp. MTA has been proved to be an ideal alternative to calcium hydroxide and recent studies have confirmed its success. [2],[22],[23]
MTA insertion has been shown to contaminate the dentinal tubules which prevent sealer infiltration; therefore efficient irrigation after MTA insertion seems rational. In the present study for the first time the effect of two methods of ultrasonic irrigation were investigated on the MTA marginal adaptation in two different coronal and apical sections.
SEM images have been used in different studies to evaluate the marginal adaptation of apical barriers in immature teeth. [24] Pashley [25] stated that micro-leakage is a serious clinical problem which can threaten the outcome of endodontic treatments. Different methods have been used to assess the micro-leakage of root end filling materials like scanning electron microscope, [26] fluid infiltration, [27] and dyes. [26] Since apical barriers play an important role in preventing micro-leakage and determining the success rate of endodontic treatments, in the present study the marginal adaptation of MTA plug was assessed using SEM. [24]
Artificially open apexes specimens were prepared using Gates Glidden #1 in the present survey. The drill was used to pass the apex as described by Deus et al., [28] Then smear layer was removed and all canals were filled orthogradally after canal preparation. These procedures were conducted based on studies which declared that the type of apical barrier delivery [29] and smear layer removal [27] can affect the marginal adaptation of MTA plug. Therefore, all specimens were standardized to merely investigate the effect of irrigation on marginal adaptation.
There are no conclusive results regarding the appropriate thickness of MTA as an apical barrier. [24],[28] In this study, 5 mm apical barrier was used as described by Al-Kahtani et al., [30] who declared that 5 mm thickness of MTA can efficiently prevent the apical infiltration.
In the current study the marginal adaptation of MTA plug was assessed in three different groups: In the first groups, the specimens were irrigated for 1 min by 2.5% sodium hypochlorite while #25 ultrasonic file was in direct contact with MTA plug. In the second group, the canals were irrigated for 1 min by 2.5% sodium hypochlorite as #25 ultrasonic file was 1 mm away from the MTA plug and the third group left intact and no irrigation was done. Although the marginal gap reached its maximum and minimum size in the first group in apical sections and in the control group in coronal sections, respectively, there was no significant difference in the size of MTA marginal gap between groups in both apical and coronal sections. At the first glance the results of the present study seem contrary to other studies which compared the ultrasonically placed MTA versus hand placed. It has been proposed that the ultrasonic vibration applied to an endodontic condenser can improve the flow, setting and compaction of MTA plugs. However, in the present study ultrasonic vibration was applied after the MTA setting time, so it is not rational to imagine that vibration can affect the flow and setting of MTA plugs. So it can be postulated that the vibration of ultrasonic file can create an unacceptable marginal gap between the MTA and dentinal wall. This can explain the fact that the control group and the group with direct contact to ultrasonic file showed minimum and maximum marginal gap sizes, respectively.
In this study the coronal sections showed less marginal gap size compared to apical sections regardless of irrigation technique. This statement can be explained by the fact that MTA plugs were manually packed by hand and MTA plugs were packed more accurately in the coronal half compared to apical half. Also, it can be said that there is a difference in the condensing force of the MTA in two different apical and coronal halves. Since MTA can be packed with greater force in coronal half the difference between marginal gap sizes in two different sections seems rational.
In view of the benefits of using MTA to create an appropriate apical barrier more ex vivo and in vivo studies should be conducted.
| Conclusion | | |
Based on the result of the present study, it can be concluded that the passive ultrasonic irrigation dose not adversely affect the marginal adaptation of MTA plugs. Also it can be hypothesized that the direct contact of the ultrasonic file with MTA plug does not threaten the MTA plug adaptation. Hence, possible contacts of ultrasonic tip to MTA plug during irrigation cannot threaten the marginal adaptation of MTA plugs.
| References | | |
| 1. | Seltzer S. Endodontology biologic consideration in endodontic procedures. 2 nd ed. Philadelphia: Lee and Febiger; 1988. p. 369-74. 
|
| 2. | Simon S, Rilliard F, Berdal A, Machtou P. The use of mineral trioxide aggregate in one-visit apexification treatment: A prospective study. Int Endod J 2007;40:186-97.
|
| 3. | Frank AL. Therapy for the divergent pulpless tooth by continued apical formation. J Am Dent Assoc 1966;72:87-93.
[PUBMED] |
| 4. | Shabahang S, Torabinejad M. Treatment of teeth with open apices using mineral trioxide aggregate. Pract Periodontics Aesthet Dent 2000;12:315-20.
|
| 5. | Holland R, de Souza V, Nery MJ, Otoboni Filho JA, Bernabe PF, Dezan Junior E. Reaction of rat connective tissue to implanted dentin tubes filled with mineral trioxide aggregate or calcium hydroxide. J Endod 1999;25:161-6.
|
| 6. | Torabinejad M, Hong CU, Pitt Ford TR, Kettering JD. Antibacterial effects of some root end filling materials. J Endod 1995;21:403-6.
|
| 7. | Xavier CB, Weismann R, de Oliveira MG, Demarco FF, Pozza DH. Root-end filling materials: Apical microleakage and marginal adaptation. J Endod 2005;31:539-42.
|
| 8. | Shabahang S, Torabinejad M, Boyne PP, Abedi H, McMillan P. A comparative study of root-end induction using osteogenic protein-1, calcium hydroxide, and mineral trioxide aggregate in dogs. J Endod 1999;25:1-5.
|
| 9. | Pace R, Giuliani V, Pini Prato L, Baccetti T, Pagavino G. Apical plug technique using mineral trioxide aggregate: Results from a case series. Int Endod J 2007;40:478-84.
|
| 10. | Bodrumlu E. Biocompatibility of retrograde root filling materials: A review. Aust Endod J 2008;34:30-5.
[PUBMED] |
| 11. | Kettering JD, Torabinejad M. Investigation of mutagenicity of mineral trioxide aggregate and other commonly used root-end filling materials. J Endod 1995;21:537-42.
|
| 12. | Asrari M, Lobner D. In vitro neurotoxic evaluation of root-end-filling materials. J Endod 2003;29:743-6.
|
| 13. | Tunca YM, Aydin C, Ozen T, Seyrek M, Ulusoy HB, Yildiz O. The effect of mineral trioxide aggregate on the contractility of the rat thoracic aorta. J Endod 2007;33:823-6.
|
| 14. | Zhu Q, Haglund R, Safavi KE, Spangberg LS. Adhesion of human osteoblasts on root-end filling materials. J Endod 2000;26:404-6.
|
| 15. | Bates CF, Carnes DL, del Rio CE. Longitudinal sealing ability of mineral trioxide aggregate as a root-end filling material. J Endod 1996;22:575-8.
|
| 16. | Cameron JA. The synergistic relationship between ultrasound and sodium hypochlorite: A scanning electron microscope evaluation. J Endod 1987;13:541-5.
[PUBMED] |
| 17. | Sabins RA, Johnson JD, Hellstein JW. A comparison of the cleaning efficacy of short-term sonic and ultrasonic passive irrigation after hand instrumentation in molar root canals. J Endod 2003;29:674-8.
|
| 18. | Alves FR, Almeida BM, Neves MA, Moreno JO, Rocas IN, Siqueira JF Jr. Disinfecting oval-shaped root canals: Effectiveness of different supplementary approaches. J Endod 2011;37:496-501.
|
| 19. | Weber CD, McClanahan SB, Miller GA, Diener-West M, Johnson JD. The effect of passive ultrasonic activation of 2% chlorhexidine or 5.25% sodium hypochlorite irrigant on residual antimicrobial activity in root canals. J Endod 2003;29:562-4.
|
| 20. | Shipper G, Grossman ES, Botha AJ, Cleaton-Jones PE. Marginal adaptation of mineral trioxide aggregate (MTA) compared with amalgam as a root-end filling material: A low-vacuum (LV) versus high-vacuum (HV) SEM study. Int Endod J 2004;37:325-36.
|
| 21. | Yildirim T, Er K, Tasdemir T, Tahan E, Buruk K, Serper A. Effect of smear layer and root-end cavity thickness on apical sealing ability of MTA as a root-end filling material: A bacterial leakage study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e67-72.
|
| 22. | Witherspoon DE, Small JC, Regan JD, Nunn M. Retrospective analysis of open apex teeth obturated with mineral trioxide aggregate. J Endod 2008;34:1171-6.
|
| 23. | Holden DT, Schwartz SA, Kirkpatrick TC, Schindler WG. Clinical outcomes of artificial root-end barriers with mineral trioxide aggregate in teeth with immature apices. J Endod 2008;34:812-7.
|
| 24. | Bidar M, Disfani R, Gharagozloo S, Khoynezhad S, Rouhani A. Medication with calcium hydroxide improved marginal adaptation of mineral trioxide aggregate apical barrier. J Endod 2010;36:1679-82.
|
| 25. | Pashley DH. Clinical considerations of microleakage. J Endod 1990;16:70-7.
[PUBMED] |
| 26. | Torabinejad M, Higa RK, McKendry DJ, Pitt Ford TR. Dye leakage of four root end filling materials: Effects of blood contamination. J Endod 1994;20:159-63.
|
| 27. | Yildirim T, Orucoglu H, Cobankara FK. Long-term evaluation of the influence of smear layer on the apical sealing ability of MTA. J Endod 2008;34:1537-40.
|
| 28. | De-Deus G, Audi C, Murad C, Fidel S, Fidel R. Similar expression of through-and-through fluid movement along orthograde apical plugs of MTA Bio and white Portland cement. Int Endod J 2008;41:1047-53.
|
| 29. | Kanter V, Weldon E, Nair U, Varella C, Kanter K, Anusavice K, et al. A quantitative and qualitative analysis of ultrasonic versus sonic endodontic systems on canal cleanliness and obturation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:809-13.
|
| 30. | Al-Kahtani A, Shostad S, Schifferle R, Bhambhani S. In-vitro evaluation of microleakage of an orthograde apical plug of mineral trioxide aggregate in permanent teeth with simulated immature apices. J Endod 2005;31:117-9.
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Correspondence Address:
Seyed Mohsen Hasheminia
Dental Materials Research Center, School of Dentistry, Isfahan University of Medical Science, Isfahan
Iran
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9290.131132
[Figure 1]
[Table 1] |
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