Evaluation of the Apical Seal of Mineral Trioxide Aggregate
in the Absence and Presence of Smear Layer
Presented by
Dheepshi
MDS Ist year
Enass Shamsy et al.Dental Health Care Department, Inaya Medical College, Riyadh,
Kingdom of Saudi Arabia, Department of Prosthetic Dental Sciences, AlFarabi College
for Dentistry and Nursing, Riyadh, Kingdom of Saudi Arabia.
The Journal of Contemporary Dental Practice, March 2019;20(3):298-303
•INTRODUCTION
•AIM
•MATERIALS AND METHODS
•RESULTS
•DISCUSSION
•CONCLUSION
•CRITICAL ANALYSIS
•CRITICAL REFLECTION
•CROSS REFERENCES
Clean and shape the root canal and to seal with filling
that does not allow leakage
Ideal
obturation
Requires resistant and steady hermetic seal
Wu MK, De Gee AJ, Wesselink PR. Leakage of AH26 and Ketac-Endo used with injected warm guttapercha. J Endod 1997 May;23(5):331-334.
Bogen G, Kuttler S. Mineral Trioxide Aggregate Obturation: A review and case series.J Endod 2009
Jun;35(6):777-90.
GP still
dominant
Ease of use, handling
properties, and
biocompatability
Inherent weaknessnot ideal
GMTA
Differs in the
conc of Al₂O₃,
MgO, FeO
MTA
WMTA
Bogen G, Kuttler S. Mineral Trioxide Aggregate Obturation: A review and case series.J Endod
2009 Jun;35(6):777-90.
Asgary S, Parirokh M, Egbbal MJ, et al. Chemical differences between white and gray mineral
trioxide aggregate. J Endod 2005 Feb;31(2):101-103.
MTA
Properties
Uses
• Biocompatability
• Antibacterial
• Marginal adaptation
• Sealing properties
• Root end filling
• Pulp capping
• Pulpotomy
• Apical barrier
formation
• Root perforation
• Root canal filling
Torabinejad M, Hong CU, McDonald F, et al. Physical and chemical properties of a new rootend filling material. J Endod 1995Jul;21(7):349-353.
Parirokh M1, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review–
Part I: chemical, physical, and antibacterial properties. J Endod 2010Jan;36(1):16-27.
Instrumentation
Smear
layer
Smear layer and smear plug
causes
prevention
Leakage between
root canal walls and
the obturating
material
Prevent penetration
of irrigants and
medicaments into
dentinal tubules
Interfere with
adatation of
obturation
Bacteriological
diffusion
Sen BH1, Wesselink PR, Türkün M. The smear layer: a phenomenon in root canal therapy. Int Endod J 1995
May;28(3):141-148.
Yamada RS, Armas A, Goldman M, et al. A scanning electron microscopic comparison of a high volume final
flush with several irrigating solutions: Part 3. J Endod 1983 Apr; 9(4):137-142.
To evaluate the apical sealability of MTA when
used as an orthograde root filling material in the
presence or absence of smear layer .
40 single rooted
mand premolars
selected
Inclusion criteriaone canal, no
cracks, free of
resorption, caries
and restoration.
Extracted – perio or
orthodontic
consideration
40 teeth randomly
divided into 2
groups
Group 1: distilled
water irrigationsmear layer intact
Group 2: NaOCl
5.25% and EDTA
17% - to remove
smear layer
Scaling and polishing done
Crowns sectioned at CEJ with high speed
diamond bur- for access
Length checked with 10 k file
Working length established 1mm short &
Instrumented – with 40 k file -step back tech
1ml of distilled water
After each instrumentation
using Max I Probeirrigation probes size 30
gauge(Dentsply Rinn, york)
Final- 5ml of distilled water
Irrigated- 1ml
of 5.25%
NaOCl after
Max I Probe
instrumentati
on -30 gauge
Then 3ml of
17% EDTA for
1min
Then 3ml of
5.25% NaOCl
– to
neutralize
EDTA
finally
flushed5ml of
distilled
water
Dried- sterile
paper
points(Diade
nt, South
Korea)
Obturated using WMTA(ProRootMTA; Tulsa dental)
Powder+ liquid – manufacturer’s
instruction
Applied to canal- amalgam carrier
Condensed vertically- hand
pluggers
Moist cotton- on top- to complete
setting
Length, density,
absence of voidsradiographically
confirmed
Access sealedIRM(Dentsply DeTrey
GmbH, Germany)
Teeth incubated at
100% humidity 37˚ C
for 7 days- obturation
to set
Teeth- coated 2
layers of nail
varnish- except
apical foramen
To test nail
varnishsealability and
dye
penetrability- 6
teeth add
3- GP
obturated &
ZOE sealerpositive control
3- no
obturationnegative
control
Negative
control- 2
layers of
varnish
including apical
foramen
Specimens + control- test tube of 0.2%
rhodamine B solution(SIGMAA- ALDRICH,USA)
Rinsed in running water & dried at room temp24 hrs
Sectioned longitudinally- buccolingual directiondiamond disk(22mm diameter and 0.3mm
thickness)- slow speed & water coolant
Examined- steromicroscope- 20X- linear dye
penetration& tooth material interface
Escobar et al criteria were used to evaluate the
infiltration proportions:
• 0: Infiltration loss (dye penetration 0 ≤ 1.5 mm).
• 1: Simple infiltration (dye penetration 1.5–3 mm).
• 2: Medium infiltration (dye penetration > 3 mm).
The data analyzed -Mann–Whitney U-test &significance
set at 0.05.
Group 2 – higher
frequency of medium
infiltration & lower
infiltration loss
Group 1
Proves conditions of
the tests are correct
Positive control- 3
roots – dye
penetration entire
length
Negative control- no
evidence of dye
penetration
MTA – with
smear layer
˂
MTA -without
smear layer
Apical seal??
• Endodontic failure- leakage into and out of the canal
• Dye penetration- easy to handle and does not need
complicated methods
Rhodamine B??
• Methylene blue- Mixing MTA- CaO + water- ca(OH)2 –
INCREASE pH
• Discoloration of surface occurs
17% EDTA for 1 min??
EDTA + NaOCl
• Peritubular and intertubular dentinal erosion if exceeds
1min
• Best results
Bodrumlu E, Tunga U. Apical leakage of Resilon obturation material. J Contemp Dent Pract 2006 Sep
1;7(4):45-52.
Coneglian PZ, Orosco FA, Bramante CM, et al. In vitro sealing ability of white and gray mineral trioxide
aggregate (MTA) and white Portland cement used as apical plugs. J Appl Oral Sci 2007Jun;15(3):181-185.
Final flush??
• EDTA +NaOCl – crystals on canal walls
Smear layer intactbetter
• Acts as coupling agent- improves bonding between MTA and tubular dentin
• Hydrophilic material and sets in the presence of moisture -positive effect to
improve the adaption between MTA and the walls of the root canal
Li and Zhang study
• removal did not cause significant less apical microleakage
Uyanik Studyleakage
• NaOCl +MTAD/EDTA before WMTA placement ˃˃ NaOCl or no irrigation
Paul ML, Mazumdar D, Niyogi A, et al. Comparative evaluation of the efficacy of different irrigants including
MTAD under SEM. J Conserv Dent 2013 Jul-Aug; 16(4): 336-341.
Uyanik MO, Nagas E, Sahin C, et al. Effects of different irri- gation regimens on the sealing properties of
repaired furcal perforations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009 Mar;107(3):e91-e95.
Dotto SR, Travassos RMC, de Oliveira EPM, et al. Evaluation of ethylenediaminetetraacetic acid (EDTA)
solution and gel for smear layer removal. Aust Endod J 2007 Aug; 33(2):62-65.
MTA
Viable optionresorption,
open apices
capacity to
reinforce
immature teeth
Increase
fracture
resistance
Jacobovitz M1, de Lima RK. Treatment of inflammatory internal root resorption with mineral trioxide
aggregate: a case report. Int Endod J 2008 Oct;41(10):905-912.
Bortoluzzi EA, Souza EM, Reis JM, et al. Fracture strength of bovine incisors after intra-radicular treatment
with MTA in an experimental immature tooth model. Int Endod J 2007 Sep;40(9):684-691.
Milani AS, Rahimi S, Borna Z, et al. Fracture resistance of immature teeth filled with mineral trioxide
aggregate or calcium-enriched mixture cement: An ex vivo study. Dent Res J 2012 May-Jun;9(3): 299-304.
Apical seal by MTA
when smear layer is
intact
MTA – promising root
canal filling material +
good sealing ability in
the presence of smear
layer
Abstract : 318
Key words: microleakage, mineral trioxide aggregate,
obturation smear layer.
MeSH words: 4
IMRAD format followed
Aim : null hypothesis not provided
Materials and methods: laboratory conditions are not
exactly similar to that of clinical conditions, and results
for in vivo studies may differ
Discussion : justification of the article was given
Referencing style: vancouver
•Using white MTA material for obturation of root
canals is a useful procedure.
•Can be done without complexity in irrigation
during root canal treatment and cause no
discoloration to the teeth.
AUTHOR
YEAR
JOURNAL
TITLE
RESULT
Singh R
2016
Journal of dental
research, dental c
linics, dental
prospects
The effect of irrigating
solutions on
the apical sealing
ability of MTA Fillapex
and Adseal root canal
sealers
NaOCl + EDTAbest seal
(obturated with
GP) + Adseal
Emmanuel S
2013
Journal of
International oral
health
An In-Vitro Evaluation
and Comparison
of Apical Sealing
Ability of Three
Different Obturation
Technique - Lateral
Condensation, Obtura
II, and Thermafil.
Thermafil
˂obtura II˂ Lat
condensation
AUTHOR
YEAR
JOURNAL
TITLE
RESULT
Ahuja L
2016
Journal of Clinical a A Comparative
nd Diagnostic Res Evaluation of Sealing
earch
Ability of New MTA
Based Sealers with
Conventional Resin
Based Sealer: An Invitro Study
Adseal ˂ProRoot MTA˂
MTA fillapex
Mohamed
EA
2019
Journal of
Contemporary
Dental Practice
AH Plus/gutta-percha no apical leakage with 3%
hydrogen peroxide. 2%
chlorohexidine improved
sealing- MTA
Fillapex/gutta-percha.
sealing ability -Realseal
SE/Resilon decreased
when 3% hydrogen
peroxide or 2%
chlorhexidine was used.
Effect of Different
Irrigation Solutions on
the Apical Sealing
Ability of Different
Single-cone
Obturation Systems:
An In Vitro Study
•
•
•
•
•
•
•
Wu MK, De Gee AJ, Wesselink PR. Leakage of AH26 and Ketac-Endo used
with injected warm gutta-percha. J Endod 1997 May;23(5):331-334.
Gartner AH, Dorn SO. Advances in endodontic surgery. Dent Clin North Am
1992 Apr;36(2):357-378.
Bogen G, Kuttler S. Mineral Trioxide Aggregate Obturation: A review and
case series Endod 2009 Jun;35(6):777-90.
Lee SJ, Monsef M, Torabinejad M. Sealing ability of a mineral trioxide
aggregate for repair of lateral root perforations. J Endod
1993Nov;19(11):541-544.
Tanomaru-Filho M, Figueiredo FA, Tanomaru JMG. Effect of different dye
solutions on the evaluation of the sealing ability of mineral trioxide
aggregate. Braz Oral Res 2005;Apr/June 19(2):119-122.
Calt S, Serper A. Time-dependent effects of EDTA on dentin structures. J
Endod 2002 Jan;28(1):17-19.
Baumgartner JC, Mader CL. A scanning electron microscopic evaluation of
four root canal irrigation regimens. J Endod 1987 Apr;13(4):147-57.
•
•
•
•
•
•
Smith JB, Loushine RJ, Weller RN, et al. Metrologic evaluation of the
surface of white MTA after the use of two endodontic irrigants. J Endod
2007 Apr;33(4):463-67.
Jacobovitz M1, de Lima RK. Treatment of inflammatory internal root
resorption with mineral trioxide aggregate: a case report. Int Endod J 2008
Oct;41(10):905-912.
Bortoluzzi EA, Souza EM, Reis JM, et al. Fracture strength of bovine
incisors after intra-radicular treatment with MTA in an experimental
immature tooth model. Int Endod J 2007 Sep;40(9):684-691.
Milani AS, Rahimi S, Borna Z, et al. Fracture resistance of immature teeth
filled with mineral trioxide aggregate or calcium-enriched mixture
cement: An ex vivo study. Dent Res J 2012 May-Jun;9(3): 299-304
Jeon IS, Spänberg LSW, Yoon TC, et al. Smear layer production by 3 rotary
reamers with different cutting blade design in straight root canals: a
scanning electron microscopic study. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 2003 Nov;96(5):601-607.
Hülsmann M, Schade M, Schäfers F. A comparative study of root canal
preparation with Hero 642 and Quantec SC rotary NiTi instruments. Int
Endod J 2001 Oct;34(7):538-546.