Evaluation of Marginal Adaptation of Three Biomaterials as Apical Barrier in Experimental Apexification Model

Year 2024, Volume: 13 Issue: 3, 409 - 415, 24.09.2024

Nagehan Aktaş , Didem Sakaryalı Uyar , Didem Atabek

https://doi.org/10.54617/adoklinikbilimler.1451031

Abstract

Aim: The purpose of this study was to compare the marginal adaptation of Mineral Trioxide Aggregate (MTA), Biodentine, and EndoSequence as apical plug materials after orthograde placement in an experimental apexification model using confocal laser scanning microscopy (CLSM).
Material and Methods: The study was conducted with sixty single-rooted mature mandibular premolar teeth. These teeth were prepared as 12 mm root lengths, and apical regions of teeth were enlarged by using peeso reamers to give the open apex form likely with the immature teeth as an experimental apexification model. ProRoot MTA, Biodentine, and EndoSequence used as apical plug materials were placed into the apical region of samples with a thickness of 4 mm. After filling the remaining root canal with gutta-percha, each sample was divided into three transverse sections by using a hard tissue microtome to evaluate marginal adaptation between dentine walls and apical plug material using a confocal laser scanning microscopy. Then, gap areas of all microscope images were measured with Image J program.
Results: MTA showed the highest marginal adaptation, followed by EndoSequence and Biodentine. Biodentine was significantly inferior to the other materials in marginal adaptation (p<0.01). There were no significant differences between EndoSequence and ProRoot MTA groups (p>0.01).
Conclusion: MTA and EndoSequence exhibited superior marginal adaptation as apical plugs compared to Biodentine. Biodentine had the poorest adaptation among the three materials.

Keywords

Apexification, Apical plug, Calcium silicate-based cements, Confocal laser scanning microscopy, Immature permanent teeth

Deneysel Apeksifikasyon Modelinde Apikal Bariyer Olarak Üç Farklı Biyomateryalin Marjinal Adaptasyonunun Değerlendirilmesi

Abstract

Amaç: Bu çalışmanın amacı, deneysel apeksifikasyon modelinde ortograt yerleştirme sonrasında Mineral Trioksit Agregat (MTA), Biodentin ve EndoSequence’in apikal bariyer materyalleri olarak marjinal uyumunun, konfokal lazer tarama mikroskop kullanarak karşılaştırmaktı.
Gereç ve Yöntem: Çalışmada, 60 adet matür tek köklü mandibular premolar diş kullanıldı. Dişler 12 mm kök uzunlukları olacak şekilde hazırlandı ve dişlerin apikal bölgesi immatür dişlerdeki açık apeks formunu vermek için peeso reamer kullanılarak genişletildi. Apikal bariyer materyali olarak kullanılan ProRoot MTA, Biodentin ve EndoSequence, örneklerin apikal bölgesine 4 mm kalınlığında yerleştirildi. Kalan kök kanalı gutta-perka ile doldurulduktan sonra, her örnek, marjinal adaptasyonu değerlendirmek için sert doku mikrotomu kullanılarak üç enine kesite bölündü. Lazer taramalı konfokal mikroskobu kullanılarak dentin duvarları ve apikal bariyer materyali arasındaki marjinal adaptasyon değerlendirildi. Daha sonra tüm mikroskop görüntülerinin boşluk alanları Image J programı ile ölçüldü.
Bulgular: MTA en yüksek marjinal uyumu gösterirken, onu EndoSequence ve Biodentine izlemiştir. Biodentinin marjinal adaptaasyonu diğer materyallere kıyasla anlamlı derecede daha düşük olduğu bulunmuştur. (p<0.01). EndoSequence ve ProRoot MTA grupları arasında anlamlı bir fark bulunmamıştır (p>0.01).
Sonuç: MTA ve EndoSequence, Biodentin kıyasla apikal bariyer olarak üstün marjinal adaptasyon sergilemiştir. Üç materyal arasında en zayıf marjinal adaptasyonu Biodentin göstermiştir.

Keywords

Apeksifikasyon, Apikal bariyer, Kalsiyum silikat bazlı simanlar, Lazer taramalı konfokal mikroskop, İmmatür daimi dişler

References

• Rafter M. Apexification: a review. Dent Traumatol 2005;21:1-8.
• Tran D, He J, Glickman GN, Woodmansey KF. Comparative analysis of calcium silicate-based root filling materials using an open apex model. J Endod 2016;42:654-8.
• Yassen GH. The orthograde application of mineral trioxide aggregate apical plug may be an effective treatment approach in teeth with open apices. J Evid Based Dent Pract 2013;13:104-6.
• Abbas A, Kethineni B, Puppala R, Birapu UC, Raghavendra KJ, Reddy P. Efficacy of Mineral Trioxide Aggregate and Biodentine as apical barriers in immature permanent teeth: a microbiological study. Int J Clin Pediatr Dent 2020;13:656-62.
• Dawood AE, Parashos P, Wong RHK, Reynolds EC, Manton DJ. Calcium silicate-based cements: composition, properties, and clinical applications. J Investig Clin Dent 2017;8:1-15.
• Mente J, Leo M, Panagidis D, et al. Treatment outcome of mineral trioxide aggregate in open apex teeth. J Endod 2013;39:20-6.
• 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.
• 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.
• 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.
• Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review--Part III: Clinical applications, drawbacks, and mechanism of action. J Endod 2010;36:400-13.
• Taha NA, Safadi RA, Alwedaie MS. Biocompatibility evaluation of EndoSequence root repair paste in the connective tissue of rats. J Endod 2016;42:1523-8.
• Caronna V, Himel V, Yu Q, Zhang JF, Sabey K. Comparison of the surface hardness among 3 materials used in an experimental apexification model under moist and dry environments. J Endod 2014;40:986-9.
• Toia CC, Teixeira FB, Cucco C, Valera MC, Cavalcanti BN. Filling ability of three bioceramic root-end filling materials: A micro-computed tomography analysis. Aust Endod J 2020;46:424-31.
• Chen I, Karabucak B, Wang C, et al. Healing after root-end microsurgery by using mineral trioxide aggregate and a new calcium silicate-based bioceramic material as root-end filling materials in dogs. J Endod 2015;41:389-99.
• Rencher B, Chang AM, Fong H, Johnson JD, Paranjpe A. Comparison of the sealing ability of various bioceramic materials for endodontic surgery. Restor Dent Endod 2021;46:e35.
• Camilleri J, Grech L, Galea K, et al. Porosity and root dentine to material interface assessment of calcium silicate-based root-end filling materials. Clin Oral Investig 2014;18(5):1437-46.
• Džanković A, Hadžiabdić N, Korać S, Tahmiščija I, Konjhodžić A, Hasić-Branković L. Sealing Ability of Mineral Trioxide Aggregate, Biodentine and Glass Ionomer as Root-End Materials: A Question of Choice. Acta Med Acad 2020;49:232-39.
• Kollmuss M, Preis CE, Kist S, Hickel R, Huth KC. Differences in physical characteristics and sealing ability of three tricalcium silicate-based cements used as root-end-filling materials. Am J Dent 2017;30:185-9.
• Ravichandra P V, Vemisetty H, K D, et al. Comparative Evaluation of Marginal Adaptation of Biodentine(TM) and Other Commonly Used Root End Filling Materials-An Invitro Study. J Clin Diagn Res 2014;8:243-5.
• Juez M, Ballester ML, Berástegui E. In vitro comparison of apical microleakage by spectrophotometry in simulated apexification using White Mineral Trioxide Aggregate, TotalFill Bioceramic Root Repair material, and BioDentine. J Conserv Dent 2019;22:237-40.
• Refaei P, Jahromi MZ, Moughari AAK. Comparison of the microleakage of mineral trioxide aggregate, calcium-enriched mixture cement, and Biodentine orthograde apical plug. Dent Res J (Isfahan) 2020;17:66-72.
• 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.
• Shetty S, Hiremath G, Yeli M. A comparative evaluation of sealing ability of four root end filling materials using fluid filtration method: An in vitro study [published correction appears in J Conserv Dent 2017;20:307-10.
• Lertmalapong P, Jantarat J, Srisatjaluk RL, Komoltri C. Bacterial leakage and marginal adaptation of various bioceramics as apical plug in open apex model. J Investig Clin Dent 2019;10:e12371.
• Atmeh AR, Chong EZ, Richard G, Festy F, Watson TF. Dentin-cement interfacial interaction: calcium silicates and polyalkenoates. J Dent Res 2012;91:454-9.
• Camilleri J. Investigation of Biodentine as dentine replacement material. J Dent 2013;41:600-10.
• Camilleri J, Pitt Ford TR. Evaluation of the effect of tracer pH on the sealing ability of glass ionomer cement and mineral trioxide aggregate. J Mater Sci Mater Med 2008;19:2941-8.
• Torabinejad M, Watson TF, Pitt Ford TR. Sealing ability of a mineral trioxide aggregate when used as a root end filling material. J Endod 1993;19:591-5.
• Nabavizadeh M, Moazzami F, Bahmani M, Mirhadi H. The Effect of Intracanal Medicaments on Microleakage of Mineral Trioxide Aggregate Apical Plugs. Iran Endod J 2017;12:329-33.
• Ulusoy Öİ, Olcay K, Ulusoy M. Effect of various calcium hydroxide removal protocols on the dislodgement resistance of biodentine in an experimental apexification model. J Dent Sci 2021;16(3):964-70