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ORIGINAL ARTICLE
Year : 2020  |  Volume : 10  |  Issue : 2  |  Page : 95-99

A comparative evaluation of sealing ability of three perforation repair materials using a field emission gun-scanning electron microscope


Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be) University Dental College and Hospital, Sangli, Maharashtra, India

Date of Submission03-Apr-2019
Date of Decision15-Jun-2019
Date of Acceptance13-Jul-2019
Date of Web Publication23-Apr-2020

Correspondence Address:
Dr. Saquib Mulla
Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be) University, Dental College and Hospital, Sangli-Miraj Road, Wanlesswadi, Sangli, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sej.sej_55_19

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  Abstract 

Introduction: The study aimed to assess the sealing ability of Biodentine™, ProRoot mineral trioxide aggregate (MTA), and Super-EBA as furcation perforation repair materials using field emission gun-scanning electron microscope (FEG-SEM).
Materials and Methods: Thirty-six extracted human permanent mandibular molar teeth were collected and cleaned. Standard access cavity preparation was made, and intentional perforation was created in each of the access cavity-prepared teeth using #12 round bur. The teeth were randomly divided into three groups each containing 12 teeth. The perforations were sealed as follows: Group A with Biodentine™, Group B with ProRoot MTA, and Group C with Super-EBA. The repair materials for all the three groups were evaluated for marginal adaptation using FEG-SEM. Data were statistically analyzed using one-way ANOVA and Tukey's honest significance test.
Results: Quantitative FEG-SEM observations illustrated that the mean gap at the dentin–furcation repair material interface was as follows: Biodentine (3.01 ± 0.37 μm), ProRoot MTA (4.98 ± 0.68 μm), and Super-EBA (8.03 ± 0.68 μm). The difference between Biodentine™ and ProRoot MTA was not statistically significant (P > 0.05). Individually, Biodentine and ProRoot MTA showed statistically significant differences when compared to Super-EBA (P < 0.05).
Conclusion: The sealing ability of ProRoot MTA and Biodentine™ as a repair material of furcation perforation was better than Super-EBA.

Keywords: Biodentine, field emission gun-scanning electron microscope, furcation perforation, ProRoot mineral trioxide aggregate, Super-EBA


How to cite this article:
Mulla S, Kamat S, Hugar S, Nanjannawar G, Kulkarni N. A comparative evaluation of sealing ability of three perforation repair materials using a field emission gun-scanning electron microscope. Saudi Endod J 2020;10:95-9

How to cite this URL:
Mulla S, Kamat S, Hugar S, Nanjannawar G, Kulkarni N. A comparative evaluation of sealing ability of three perforation repair materials using a field emission gun-scanning electron microscope. Saudi Endod J [serial online] 2020 [cited 2020 Aug 8];10:95-9. Available from: http://www.saudiendodj.com/text.asp?2020/10/2/95/283141


  Introduction Top


Various procedures of endodontic treatment can lead to iatrogenic mishaps leading to failures. One such procedural error is furcation perforation which not only accounts for the highest rate of failure among endodontic complications but also is the second highest cause of overall endodontic failure.[1],[2] Root canal perforation is a mechanical or pathological communication between pulp space and periodontium. Internal or external resorption, caries, and operator's performance during access and post space preparation are a few common enlisted causes. In addition, it can also occur due to root damage during mini screw or implant placement.[3] Iatrogenic perforations of the furcation may occur as a result of misdirection of a bur during access preparation, overinstrumentation, and post space preparation.[4]

The creation and detection of perforation not only can be distressing but may also radically alter the treatment plan and ultimate prognosis of the tooth. The prognosis of a tooth with a perforation depends on the location of the perforation, the time it is open to contamination, the possibility of sealing the perforation, and the accessibility of the main canal.[4] Prompt diagnosis, immediate repair, and choice of material form the hallmark of successful perforation repair.[5],[6]

Furcal perforations are the most difficult to manage because of their proximity to the epithelial attachment and possible communication with the gingival sulcus.[2]

There are a variety of materials available to seal the furcation perforation. The ideal repair material should provide an adequate seal, be biocompatible, and possess the ability to induce osteogenesis and cementogenesis.[7] In view of this, the aim of the present study was to evaluate the sealing ability of Biodentine, mineral trioxide aggregate (MTA), and Super-EBA in the repair of furcation perforations using field emission gun-scanning electron microscopy (FEG-SEM).


  Materials And Methods Top


The study was conducted in the Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth (Deemed to be) University Dental College and Hospital, Sangli, India. The study was approved by the Institutional Ethical Committee, bearing approval number: BVDUMC and H/Sangli IEC/Dissertation 2014-15/99.

Thirty-six extracted human permanent mandibular molar teeth were collected. After their visual inspection to ensure that the teeth did not show any exclusion criteria (resorption, caries, cracks, fusion, and curvatures), the teeth were cleaned with pumice and water and then stored in 10% formalin.

Standard access cavity was prepared in each tooth using #5 round bur (S. S. White, USA). Intentional perforation was made in each of the access cavity-prepared teeth using #12 round bur in a high-speed handpiece with air–water coolant. The chamber and perforation were flushed with water and dried. The diameter of the perforation was equal to the diameter of the bur. Post perforation, the teeth were randomly divided into three groups with 12 samples in each experimental group.

  • Group A: The perforation site of this group was sealed with Biodentine™ (Septodont, France). The material was mixed according to the manufacturer's instructions until ideal consistency was achieved. It was then placed in the perforations with a spatula, slightly condensed with amalgam pluggers, and allowed to set for 12 min. After the setting of Biodentine occurred, access cavity was sealed with cotton pellet and IRM (Dentsply DeTrey, Konstanz, Germany)
  • Group B: The perforation site was sealed with ProRoot MTA (ProRoot, Tulsa, Brazil). The material was mixed according to the manufacturer's instructions, then placed in the perforation site, and compacted with Buchanan pluggers (Hu-Friedy, Chicago, IL, USA). A cotton pellet moistened with saline was placed in the pulp chamber over the MTA surface for 72 h. After this period of time, the cotton pellet was removed, and the access cavity was sealed with IRM
  • Group C: The perforation site was sealed using Super-EBA (Bosworth Co., USA). Super-EBA cement was mixed according to manufacturer's recommendations. It was placed in the perforation site with a spoon excavator and compacted with Buchanan pluggers. After setting, the cavity was sealed with cotton pellet and IRM.


All teeth were decoronated 3 mm above the cementoenamel junction and roots were amputated 3 mm below the furcation, and all specimens were stored in a wet sponge for 7 days at room temperature to create an environment similar to that of oral cavity.

The IRM filling and sponge were removed; then, specimens were dehydrated with graded ethanol series and critical point dried. They were further vacuum treated to remove any residue moisture present in the samples. After this, the specimens were mounted on the stubs, sputter coated with 25 nm layer of platinum, and examined with FEG-SEM (SEM-JEOL JSM 7610F; JEOL USA Inc., Peabody, MA, USA) at a magnification of 500 × for evaluating the sealing ability. Photomicrographs of the gap between the repair materials and cavity wall were taken and evaluated using ATLAS software (ATLAS.ti, Berlin, Germany). The measurement of the gap (in μm) between the pulpal floor and the repair material was done using a measuring tool available in the ATLAS software (ATLAS.ti, Berlin, Germany). The largest gap present between the material and cavity wall was measured, and the mean gap was calculated for each sample. The data were subjected to statistical analysis using one-way ANOVA and Tukey's honest significance tests for intergroup analysis (level of significance < 0.05).


  Results Top


Quantitative FEG-SEM observations made in the current study illustrated that the mean gap at the dentin–furcation repair material interface was as follows: 4.76 ± 0.47 μm for Biodentine™ [Figure 1], 3.30 ± 0.77 μm for ProRoot MTA [Figure 2], and 6.35 ± 2.96 μm for Super-EBA [Figure 3].
Figure 1: Field emission gun-scanning electron microscope image of gap at the dentin–furcation repair material interface of Biodentine

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Figure 2: Field emission gun-scanning electron microscope image of gap at the dentin–furcation repair material interface of mineral trioxide aggregate

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Figure 3: Field emission gun-scanning electron microscope image of gap at the dentin–furcation repair material interface of Super-EBA

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The difference between Biodentine™ and ProRoot MTA was not statistically significant (P > 0.05). Individually, Biodentine and ProRoot MTA showed statistically significant differences when compared to Super-EBA (P < 0.05).


  Discussion Top


Perforation during endodontic procedures is cited as the second greatest cause of treatment failures.[8] It accounts for 9.6% of the total endodontic failures and hence necessitates immediate treatment for a favorable prognosis. Earlier materials such as gutta-percha, amalgam, indium foil, tricalcium phosphate, Cavit, calcium hydroxide, zinc oxide eugenol, hydroxyapatite, plaster of Paris, freeze-dried bone graft, glass-ionomer cement, and resin composites require moisture-free environment, evoke inflammatory response at the perforation site, and do not adapt well to the dentinal walls resulting in the microleakage.[9] None of these materials promoted the regeneration of the attachment apparatus at the perforation site.[9] The success of the furcation repair is always dependent on the effective seal between the pulp chamber and the periodontal ligament.[10] This can be achieved by a suitable material that stops the microleakage and communication between the tooth and the periodontal ligament. To obtain success, the perforation repair material should ideally result in the formation of new bone, periodontal ligament, and cementum.

The search for alternative materials has been aimed to overcome the drawbacks of previously used materials, and two such materials are MTA and Biodentine™. Both MTA and Biodentine™ are capable of causing complete regeneration of the adjacent dentoalveolar tissue in permanent teeth and are hence used in furcal perforation repairs.[11]

In the present study, mandibular molars were selected because they are often tilted lingually and so the placement of access cavities as it relates the pulp chamber of the idealized occlusal anatomy may not always be relevant, which may lead to furcal perforations.

The sealing adaptability was evaluated by measuring the gap (in μm) between the pulpal floor and the material used for the furcal repair. The quality and durability of the interface is a key factor for the survival of a restorative material in clinical conditions. In addition, the marginal adaption and the intimate contact with the surrounding material (dentin and dental material) are determinative features.[7] Hence, the sealing adaptability was evaluated by measuring the gap (in μm) similar to Samuel et al.[12]

The present study used FEG-SEM to assess the interfacial seal between dentin and the repaired materials. The FEG-SEM carries many advantages compared to that of a traditional SEM. FEG-SEM uses field emission source producing a cleaner image, less electrostatic distortions, and spatial resolution <2 nm.[13]

Although the mean values of the gaps at the perforation site for Group A (Biodentine™) were slightly more than Group B (ProRoot MTA), it was, however, statistically insignificant (P > 0.05). Our inference is in approval with the stereomicroscopic study which concluded that both the materials (ProRoot MTA and Biodentine™) had good results as furcation repair materials.[14] The property of slight expansion upon complete setting after 72 h may be responsible for lesser gaps.[15],[16] It can also be concluded from this that the marginal adaptation is time dependent.

Group B (ProRoot MTA) provided a much superior seal in comparison to Group C (Super-EBA), and hence, the mean gaps of both the groups were statistically significant (P < 0.05). The result of the current study is similar to a dye extraction study which concluded that MTA provided a superior seal compared to Super-EBA.[17] Sensitivity to moisture as well as inability to properly condense Super-EBA cement due to its paste-like consistency could have led to void formation.[17] In addition, Super-EBA lacks the property to induce cementogenesis and thus inferior to MTA and Biodentine™.[17]

The result also showed a considerable difference in the sealing ability of Group A (Biodentine™) and Group C (Super-EBA), and the mean of gaps was statistically significant (P < 0.05). This inference was similar to a study which concluded a better sealing ability of Biodentine compared to Super-EBA.[18] The inability of Super-EBA to bind to the dentinal wall because of its consistency accounts for the statistically significant difference between the groups.

Unlike Super-EBA, Biodentine™ can induce the synthesis of a dentin-like matrix by human odontoblast-like cells in the form of mineralization nodules that have the molecular characteristics of dentin. This is of prime importance during the process of sealing, as silica can induce the mineralization function of cells by affecting cell proliferation and gene expression.[19]

The images also showed the occurrence of a cohesive failure with Super-EBA cement with alteration of the tooth-biomaterial interfaces (seen as discontinuity/crack in the dentin), as compared to Biodentine™.

Although the setting of both materials is affected by moisture, Super-EBA is more affected by any change in the pH and osmolarity during the setting. Biodentine™ remains unaffected by any such change.[17]

The possible reason for the decrease in diameter of gaps in Group A and Group B as compared to Group C can be attributed to the similar basic composition of Biodentine™ and ProRoot MTA. Furthermore, the biomineralization ability (Ca and Si uptake) by these materials causes chemical and structural modification of dentin, which result in close sealing ability.[20] Another reason for the similar sealing abilities is the apatite-forming ability of both the materials.


  Conclusion Top


ProRoot MTA showed the best sealing abilities of the perforation among all the three tested materials. However, the mean value of gaps of perforation repair between ProRoot MTA and Biodentine was not significant, and hence, Biodentine™ can also be considered as a material of choice for furcation perforation repair. The poorest sealing ability was seen with the Super-EBA group.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Savitha A, Rekha AS, Ataide I, Hegde J. Retreatment and surgical repair of the apical third perforation and osseous defect using mineral trioxide aggregate. Saudi Endod J 2013;3:34-8.  Back to cited text no. 8
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Arens DE, Torabinejad M. Repair of furcal perforations with mineral trioxide aggregate: Two case reports. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:84-8.  Back to cited text no. 10
    
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Samuel A, Asokan S, Geetha Priya PR, Thomas S. Evaluation of sealing ability of Biodentine™ and mineral trioxide aggregate in primary molars using scanning electron microscope: A randomized controlledin vitro trial. Contemp Clin Dent 2016;7:322-5.  Back to cited text no. 12
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Sulaiman JM, Yahya MM, Al-Ashou WM. Anin vitro scanning electron microscope comparative study of dentine-biodentine interface. J Bagh Coll Dent 2014;26:42-8.  Back to cited text no. 15
    
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Balachandran J, Gurucharan. Comparison of sealing ability of bioactive bone cement, mineral trioxide aggregate and super EBA as furcation repair materials: A dye extraction study. J Conserv Dent 2013;16:247-51.  Back to cited text no. 17
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Laurent P, Camps J, About I. Biodentine™ induces TGF-β1 release from human pulp cells and early dental pulp mineralization. Int Endod J 2012;45:439-48.  Back to cited text no. 19
    
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