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Longitudinal sealing ability of mineral trioxide aggregate as a root-end filling material.

This study evaluated the ability of mineral trioxide aggregate (MTA) to seal the root end effectively. Seventy-six single-rooted, extracted human teeth were cleaned and shaped using a step-back technique. After root-end resection and ultrasonic preparation, 72 root sections were randomly allocated to three groups and filled with dental amalgam and cavity liner, Super-EBA, or MTA. Microleakage was assessed at 24 h, 72 h, 2 wk, 4 wk, 8 wk, and 12 wk, using a fluid filtration measurement system. MTA demonstrated excellent sealing ability throughout 12 wk of fluid immersion, comparable with that observed for Super-EBA. Microleakage in the MTA group, as well as the Super-EBA group, was significantly less (p < 0.05) than in the amalgam group at 24 h, 72 h, and 2 wk. At the subsequent periods, there were no significant differences among the three materials. In this study, MTA was determined to be superior to amalgam, and comparable with Super-EBA in preventing microleakage when used as a root-end filling.

Aluminum Compounds↗

Sealing ability of five different retrograde filling materials.

The sealing ability of Amalgam, Harvard-Cement, Diaket, gold-leaf, and Ketac-Endo as retrofilling materials was investigated. Paper cones were fixed with Harvard-Cement in the instrumented roots of 100 extracted human incisors. Apicectomy was performed and a 2-mm-deep retrograde cavity was prepared. Teeth were assigned to five groups (n = 20); each group received a different filling material. Surfaces of the roots were isolated with nail polish. Teeth, were stored in 1% methylene blue dye for 72 h. Roots were sectioned, and the depth of dye penetration was evaluated through a stereomicroscope. Retrofills with Ketac-Endo showed significantly less leakage compared with amalgam. There was no significant difference between the amalgam and Diaket groups. The sealing ability of Harvard-Cement and gold foil was lower than amalgam. It was concluded that retrograde fillings with Ketac-Endo or Diaket can be considered as alternatives for amalgam.

Bismuth↗

Retrograde root filling with dentin-bonded modified resin composite.

A retrograde root-end cover with a special resin composite (Retroplast) combined with the dentin bonding agent Gluma (Bayer AG) has been used since 1984 by the authors. Its content of silver, added to promote radiopacity, has been found to lower the working time and storage stability of the composite and might cause discolorations. Since 1990, silver has therefore been replaced with ytterbium trifluoride, which eliminates these side effects. The purpose of this study was to compare the clinical results obtained with these two resin composites and to evaluate the healing results after several years in function. Apical fillings (351) with the modified Retroplast showed the following radiographic healing pattern 1 yr after surgery: 80% complete healing, 2% scar tissue, 12% uncertain healing, and 6% failure. No significant difference in this healing pattern was found, compared with that obtained with the silver-containing Retroplast. Cases with ytterbium trifluoride classified as scar tissue and uncertain healing at 1 yr when examined at 2 to 4 yr postoperatively showed 89% complete healing. 0% scar tissue, 1% uncertain healing, and 9% failure. This result is significantly different from that obtained 1 yr after surgery. Based on calculations, it was predicted that with time 90% will become complete healing, whereas 10% will become failure.

Bisphenol A-Glycidyl Methacrylate↗

Long-term, postsurgical results on teeth with periapical radiolucencies.

Reported high failure rates of endodontic surgical procedures seemed to be inconsistent with the clinical impression of a high success rate. A retrospective study of endodontic surgical cases treated longer than 10 yr ago was done to look at long-term results. Forty-one teeth in 39 patients were able to be evaluated. These teeth had either an apicoectomy, an apicoectomy with a root-end amalgam, or in two cases, a root amputation. Of the 23 teeth that had an apicoectomy, 19 (82.6%) completely healed. Of the 16 teeth that had an apicoectomy followed by a root-end amalgam, 10 (62.5%) completely healed. Surgical endodontic procedures performed before the use of magnification, newer root-end filling materials, and ultrasonics, still had a high rate of success.

Adult↗

Endoscope--an endodontic application.

The endoscope utilized by otolaryngologists for the past 10 yr has a place in the armamentarium of the endodontist as well. It provides improved visualization of root apicies, especially those not in the line of direct vision. It can illuminate and identify roots in the sinus if such treatment becomes necessary. By allowing a magnified view of the root-end preparation before and after placement of the filling material, any fractures or extraneous material can be identified. This instrument is quite small and readily transportable from one operatory to another. The cost is a fraction of the price of the surgical microscope.

Adult↗

Long-term evaluation of retrograde root filling with dentin-bonded resin composite.

The purpose of this study was to investigate the long-term stability of apical retrograde root fillings using a dentin-bonded resin composite. Radiographs were used to establish the degree of healing around the apically filled roots. Patients examined were those who had previously showed complete healing 1 yr after surgery. Thirty-three of the first 34 consecutively placed resin composite apical fillings performed since the introduction of this method in 1984 were examined. Six of these fillings were examined 8 yr after surgery, and 27 of these fillings were examined 9 yr after surgery. Only one patient showed recurrence of periapical inflammation 8 yr after operation, probably caused by a root fracture. It was concluded that the bond established between dentin and the resin composite was stable during the observation period, and that the filling material had not been harmful to the surrounding tissues. If complete bone healing has been observed, it could be expected to remain stable, unless new factors, such as root fracture, occurred.

Adolescent↗

Blood mercury levels with amalgam retroseals: a longitudinal study.

A clinical study was performed to determine if placement of an amalgam retroseal resulted in elevated blood mercury levels. Ten subjects had blood drawn 7 days before and immediately before placement of an amalgam retroseal. Postoperative blood draws occurred at 7 and 30 days. Blood samples were analyzed for mercury content by Cold-Vapor Atomic Absorption Spectrophotometry. No statistically significant increase in blood mercury levels was detected at 7 and 30 days after placement of an amalgam retroseal as compared with preoperative levels (p = 0.97). Findings support the hypothesis that placement of an amalgam retroseal does not result in significant elevations of blood mercury levels.

Adult↗

Histologic assessment of mineral trioxide aggregate as a root-end filling in monkeys.

Mineral Trioxide Aggregate (MTA) has been shown in a number of experiments to be a potential root-end filling material. The purpose of this study was to examine the periradicular tissue response of monkeys to MTA and amalgam as root-end fillings. The pulps were removed from all the maxillary incisors of three monkeys. The root canals were prepared and filled with laterally condensed guttapercha and sealer, and the access cavities were restored with amalgam. Buccal mucoperiosteal flaps were raised, and root-end resections were performed before root-end cavity preparation with burs. The root-end cavities in half of the teeth were filled with MTA, while amalgam was placed in the other cavities. After 5 months the periradicular tissue response was evaluated histologically. The results showed no periradicular inflammation adjacent to five of six root ends filled with MTA; also five of six root ends filled with MTA had a complete layer of cementum over the filling. In contrast, all root ends filled with amalgam showed periradicular inflammation, and cementum had not formed over the root-end filling material, although it was present over the cut root end. Based on these results and previous investigations, MTA is recommended as a root-end filling material in man.

Aluminum Compounds↗

Titanium-inlay--a new root-end filling material.

To obtain better results following periradicular surgery, we have developed a Titanium-Inlay with SuperEBA cement as a sealer as a new root-end filling material. This was combined with an ultrasonic root-end preparation technique. The preliminary results suggest that the surgical method we adopted is simple and the results are predictable. The material and technique are presented in this article.

Biocompatible Materials↗

A new single-step technique for apical retrofilling that significantly reduces microleakage.

One of the properties of an ideal retrofilling material is little or no microleakage. A new dentin bonding agent based on polyacrylic acid (PAA) is ideally suited to the moist apical environment because of its hydrophilic nature. PAA as a dentin bonding agent for apical retrofillings was tested in an in vivo leakage study using single canal roots of extracted human teeth. Bonding was attained by pretreatment of the dentin in apical retrofilling preparations with a solution of PAA, followed by placement of a nonaqueous restorative material. Using PAA as dentin bonding agent reduced apical leakage at statistically significant levels with Super EBA as a restorative material. In vivo testing is required to validate these findings.

Acrylic Resins↗

Effect of root canal contents on healing of teeth with dentin-bonded resin composite retrograde seal.

Healing results were compared among 551 infected roots apically sealed with a dentin-bonded resin composite (Gluma-Retroplast). These roots contained either 1) root filling to apex after resection, 2) insufficient root filling, or 3) empty root canals with necrotic pulp remnants. At 2- to 4-yr follow-up, complete bone healing was found to be 92%, 85%, and 81% in groups 1, 2, and 3, respectively. The results from groups 1 and 3 were significantly different, and the results from group 2 did not differ significantly from that of groups 1 or 3. Reasons for "Failures" were found to be mainly loose filling or uncovered canal. After 21 roots classified as "Failures" were reoperated, 76% of these showed "Complete Healing" after 1 yr.

Adult↗

Evaluation for cracks associated with ultrasonic root-end preparation of gutta-percha filled canals.

Many clinicians use ultrasonics for root-end preparations. The purpose of this study was to evaluate resected root-end surfaces of bilaterally matched human teeth for cracks before and after ultrasonic root-end preparation. Twenty matched pairs of extracted single rooted teeth were divided into two experimental groups. In group 1, root-end resection was performed on uninstrumented teeth. In group 2, root-end resection was performed after the canals were instrumented and filled with gutta-percha. All teeth in both groups received root-end preparations using ultrasonic instrumentation at low power. Two examiners evaluated the root-ends after root-end resection and again after root-end preparation using zoom magnification of 20x to 63x. The number, types, and location of cracks were mapped. There were no significant differences when gutta-percha filled roots were compared to uninstrumented roots with regard to the number or type of cracks after root-end resection or root-end preparation. In addition, there were no significant differences in the number or type of cracks following root resection and ultrasonic root-end preparation when compared to teeth with root resection alone.

Analysis of Variance↗

Effects of dentin bonding agents on macrophage mitochondrial activity.

Dentin bonding agents (DBA) have been considered for use as root-end fillings. Previous studies have documented the release of DBA components in vivo and in vitro, but the biological implications are not clear. The macrophage is important in wound healing, and likely to be important in any inflammatory response. Therefore, this study determined the concentrations of the components of DBAs that suppress the mitochondrial activity of human macrophages in vitro. THP-1 macrophages were cultured in the presence of four DBA components (2-hydroxyethyl methacrylate (HEMA), 4-methacryloxyethyl trimellitate anhydride (4-META), bisphenol-glycidylmethacrylate (Bis-GMA), and urethane dimethacrylate (UDMA)) at various concentrations and for varying durations. Residual effects were also measured after the resins were removed. Controls received only the vehicle solution, ethanol or water. THP-1 mitochondrial activity was estimated using the MTT assay, and the 50% toxicity concentrations (TC50) were determined graphically. Resin components suppressed the mitochondrial activity of macrophages at different concentrations (TC50 values for HEMA (10,000 mumol/L), 4-META (3,800 mumol/L), Bis-GMA (130 mumol/L), and UDMA (110 mumol/L) at 24 h, and the effect was time-dependent. Residual effects were observed for all resins.

Acrylic Resins↗

Long-term seal provided by some root-end filling materials.

A tight and long-lasting seal of root-end fillings is of prime clinical importance. A hundred standard bovine root sections, each 3 mm high and with a central pulp lumen of 2.6 mm in diameter, were filled with five commonly used or potential root-end filling materials. At 24 h, or at 3, 6, or 12 months after filling, leakage along these filling materials was determined under a low headspace pressure of 10 kPa (0.1 atm) using a fluid transport model. During the first 3 months, the percentage of gross leakage (> 20 microliters day-1) increased noticeably for Tytin amalgam (from 20 to 100%) and Super-EBA (from 0 to 55%), whereas it decreased noticeably for mineral trioxide aggregate (MTA; from 55% to 0%). Thereafter, the increased leakage of amalgam and Super-EBA decreased with time, whereas the improved seal of MTA was maintained until the end of the experiment. At 3-, 6-, and 12-month time intervals, both glass ionomer cements (Fuji II and Hi Dense) and MTA showed less leakage than the conventional amalgam and Super-Eba, of which amalgam leaked more.

Aluminum Compounds↗

Cytotoxicity of endodontic materials.

An in vitro cell culture model of human gingival fibroblasts and L-929 cells was used to measure the cytotoxicity of currently used root canal sealers Endomet, CRCS, and AH26 and root-end filling materials Amalgam, Gallium GF2, Ketac Silver, mineral trioxide aggregate (MTA), and Super-EBA. Cytotoxic effects were assessed using the MTT assay for mitochondrial enzyme activity and the CV assay for cell numbers. Using inserts culture and L-929 fibroblasts. All-Bond-2 was also evaluated. The statistical analysis of results showed that CRCS was the least cytotoxic sealer followed by Endomet and AH26. Among root-end filling materials, MTA was not cytotoxic; Gallium GF2 displayed little cytotoxicity; and Ketac Silver, Super-EBA, and Amalgam showed higher levels of cytotoxicity. All Bond-2 also displayed a high degree of cytotoxicity. CRCS was the best root canal sealer and MTA the best root-end filling material. The outcome was favorable also for Gallium GF2 as a retrofilling material.

Alloys↗

Surgical endodontics of upper molars: relation to the maxillary sinus and operation in acute state of infection.

Findings in 200 cases of root resection of first maxillary molars showed perforation to the sinus in half of the cases. In 42% of the cases, the first maxillary molar had root resection performed in a subacute or acute state of infection. Only two cases developed postoperative sinusitis. Antibiotic treatment was indicated preoperatively in 3% and postoperatively in 5%. Postoperative symptoms, such as pain and swelling, were usually moderate, possibly because of a nontraumatizing operation technique, a careful removal of infected tissue, and a good drainage by loose suturing.

Acute Disease↗

Effects of resorbable membrane placement and human osteogenic protein-1 on hard tissue healing after periradicular surgery in cats.

Periradicular surgeries were performed on the maxillary cuspid teeth of twelve cats. Before reapproximation of the surgical flaps, eight of the osteotomies were covered with a resorbable membrane and eight were filled with human osteogenic protein-1 (hOP-1) on a collagen carrier. The remaining eight sites received no further treatment and served as controls. The animals were euthanized after 12 wk, and the specimens were examined histomorphometrically for the presence or absence of osseous regeneration, inflammation, and cementum formation on the root ends. The results showed that the sites treated with the membrane exhibited significantly more inflammation adjacent to the resected root ends (p < 0.05), and that the use of the membrane had no statistically significant effect on osseous healing or new cementum formation. The use of hOP-1 was associated with a significant decrease in the thickness of new cementum formed on the resected root ends (p < 0.05), but had no statistically significant effect on osseous healing or degree of inflammation. Based on these results, it seems that neither the use of hOP-1 nor resorbable membranes have a positive effect on periradicular tissue healing in endodontic surgery.

Absorbable Implants↗

Ultrasonic root-end preparation: influence of cutting angle on the apical seal.

Apical resection is fundamental in obtaining a correct apical seal. The purpose of this study was to evaluate how the apical root resection angle and the cavity made by ultrasonic retrotips may influence the apical seal. A total of 48 extracted teeth were endodontically treated and sealed by guttapercha vertical compaction: 24 were resected with a 45 degrees angle and 24 with a 90 degrees one. An ultrasound source (P.M. 400 EMS) and a CT5 Scaler were used to make the retrograde cavity that was filled afterwards with EBA-zinc oxide-eugenol alumina-added cement. Apical leakage was determined using fuchsin and assessed after the roots were sectioned longitudinally. Linear dye penetration in dentin and at the interface between dentin and cement was measured with a stereomicroscope (x 12 magnification), and the results were statistically analyzed. Results showed that there was less infiltration both in dentin and in the space between the filling and the dentinal wall in the group with the 90 degrees angle, but this difference was statistically significant (p < 0.0001) only for the dentin. None of the samples showed leakage greater than the depth of the preparation. An apical cavity of 3 mm or more along the vertical axis can produce a safe and effective seal.

Bicuspid↗