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.