Comparison of the Sealing Ability Amongst Orthograde Apical Plugs of Mineral Trioxide Aggregate Plus, Mineral Trioxide Aggregate Repair HP, and Biodentine After Root Resection: a Bacterial Leakage Study

Overview

Journal Odontology

Specialty Dentistry

Date 2023 Aug 26

PMID 37632561

Authors

Chhaya Harinkhere

Pallav Mahesh Patni

Pradeep Jain

Swadhin Raghuwanshi

Sanket Hans Pandey

Sakshi Bilaiya

Affiliations

Soon will be listed here.

Abstract

This study aimed to analyse the effect of root-end resection on the sealing ability of orthograde apical plugs of three root-end filling materials (MTA Repair HP, Biodentine, MTA Plus) using the bacterial leakage method and compare it with the retrograde root-end filling technique. Eighty-four extracted mandibular premolar teeth with single root and single straight canals were selected and randomly divided into two main experimental groups (n = 36) depending on the apical plug placement technique and a control: Group I: orthograde technique, followed by root-end resection; Group II: retrograde root-end filling technique; one control Group III (n = 12): obturation with gutta-percha, followed by root-end resection. Experimental groups were further subdivided into three subgroups A, B, and C (n = 12) depending on the three different root-end filling materials used. An apical plug of 3 mm thickness was obtained in both the experimental groups. The apical sealing ability was evaluated with the dual-chamber bacterial leakage method. Statistical analysis was performed using the Kaplan-Meier survival analysis test. By the end of 30 days, the occurrence of turbidity indicating bacterial leakage was 75% in MTA Repair HP, 83.3% in Biodentine, and 91.7% in MTA Plus samples. This trend of turbidity was similar in both orthograde and retrograde technique. The control group showed turbidity in all the samples (100%). More MTA Repair HP samples (25%) survived the 30 days observation period with no bacterial leakage compared to Biodentine (16.7%) and MTA Plus (8.3%). The sealing ability of already set root-end filling materials placed through the orthograde technique did not deteriorate after root-end resection. Also among three root-end filling materials, MTA Repair HP presented the lowest bacterial microleakage followed by Biodentine and MTA Plus, respectively.

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References

Moradi S, Disfani R, Ghazvini K, Lomee M . Sealing Ability of Orthograde MTA and CEM Cement in Apically Resected Roots Using Bacterial Leakage Method. Iran Endod J. 2013; 8(3):109-13. PMC: 3734512. View

Montellano A, Schwartz S, Beeson T . Contamination of tooth-colored mineral trioxide aggregate used as a root-end filling material: a bacterial leakage study. J Endod. 2006; 32(5):452-5. DOI: 10.1016/j.joen.2005.07.001. View

Medeiros P, Bernardineli N, Cavenago B, Torres S, Duarte M, Bramante C . Sealing ability of MTA, CPM, and MBPc as root-end filling materials: a bacterial leakage study. J Appl Oral Sci. 2016; 24(2):148-52. PMC: 4836922. DOI: 10.1590/1678-775720130103. View

Gondim E, Zaia A, Gomes B, Ferraz C, Teixeira F, Souza-Filho F . Investigation of the marginal adaptation of root-end filling materials in root-end cavities prepared with ultrasonic tips. Int Endod J. 2003; 36(7):491-9. DOI: 10.1046/j.1365-2591.2003.00679.x. View

Moradi S, Disfani R, Lomee M, Naghavi N . Effect of root resection on sealing ability of orthograde apical plugs of mineral trioxide aggregate and calcium enriched mixture. J Dent (Tehran). 2015; 11(4):447-54. PMC: 4283747. View

Habibi M, Ghoddusi J, Habibi A, Mohtasham N . Healing process following application of set or fresh mineral trioxide aggregate as a root-end filling material. Eur J Dent. 2011; 5(1):19-23. PMC: 3019748. View

Torabinejad M, Ung B, Kettering J . In vitro bacterial penetration of coronally unsealed endodontically treated teeth. J Endod. 1990; 16(12):566-9. DOI: 10.1016/S0099-2399(07)80198-1. View

Gorni F, Gagliani M . The outcome of endodontic retreatment: a 2-yr follow-up. J Endod. 2004; 30(1):1-4. DOI: 10.1097/00004770-200401000-00001. View

Timpawat S, Amornchat C, Trisuwan W . Bacterial coronal leakage after obturation with three root canal sealers. J Endod. 2001; 27(1):36-9. DOI: 10.1097/00004770-200101000-00011. View

10.

Barthel C, Moshonov J, Shuping G, Orstavik D . Bacterial leakage versus dye leakage in obturated root canals. Int Endod J. 1999; 32(5):370-5. DOI: 10.1046/j.1365-2591.1999.00235.x. View

11.

Sim T, Knowles J, Ng Y, Shelton J, Gulabivala K . Effect of sodium hypochlorite on mechanical properties of dentine and tooth surface strain. Int Endod J. 2001; 34(2):120-32. DOI: 10.1046/j.1365-2591.2001.00357.x. View

12.

Hachmeister D, Schindler W, Walker 3rd W, Thomas D . The sealing ability and retention characteristics of mineral trioxide aggregate in a model of apexification. J Endod. 2002; 28(5):386-90. DOI: 10.1097/00004770-200205000-00010. View

13.

Hong S, Bae K, Baek S, Kum K, Lee W . Microleakage of accelerated mineral trioxide aggregate and Portland cement in an in vitro apexification model. J Endod. 2007; 34(1):56-8. DOI: 10.1016/j.joen.2007.09.008. View

14.

Kim S, Kratchman S . Modern endodontic surgery concepts and practice: a review. J Endod. 2006; 32(7):601-23. DOI: 10.1016/j.joen.2005.12.010. View

15.

Post L, Lima F, Xavier C, Demarco F, Gerhardt-Oliveira M . Sealing ability of MTA and amalgam in different root-end preparations and resection bevel angles: an in vitro evaluation using marginal dye leakage. Braz Dent J. 2010; 21(5):416-9. DOI: 10.1590/s0103-64402010000500007. View

16.

Lamb E, Loushine R, Weller R, Kimbrough W, Pashley D . Effect of root resection on the apical sealing ability of mineral trioxide aggregate. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 95(6):732-5. DOI: 10.1067/moe.2003.98. View

17.

Wuchenich G, Meadows D, Torabinejad M . A comparison between two root end preparation techniques in human cadavers. J Endod. 1994; 20(6):279-82. DOI: 10.1016/s0099-2399(06)80816-2. View

18.

Engel T, Steiman H . Preliminary investigation of ultrasonic root end preparation. J Endod. 1995; 21(9):443-5. DOI: 10.1016/S0099-2399(06)81524-4. View

19.

Navarre S, Steiman H . Root-end fracture during retropreparation: a comparison between zirconium nitride-coated and stainless steel microsurgical ultrasonic instruments. J Endod. 2002; 28(4):330-2. DOI: 10.1097/00004770-200204000-00018. View

20.

Al-Hezaimi K, Naghshbandi J, Oglesby S, Simon J, Rotstein I . Human saliva penetration of root canals obturated with two types of mineral trioxide aggregate cements. J Endod. 2005; 31(6):453-6. DOI: 10.1097/01.don.0000145429.04231.e2. View