|Year : 2015 | Volume
| Issue : 2 | Page : 44-49
Analysis of marginal seal of ProRoot MTA, MTA Angelus biodentine, and glass ionomer cement as root-end filling materials: An in vitro study
Sakshi Malhotra, Mithra N Hegde
Department of Conservative Dentistry and Endodontics, A.B. Shetty Memorial Institute of Dental Sciences, Nitte University, Deralakatte, Mangalore, Karnataka, India
|Date of Web Publication||22-Dec-2015|
Department of Conservative Dentistry and Endodontics, Third Floor, A. B. Shetty Memorial Institute of Dental Sciences, Nitte University, Deralakatte, Mangalore - 575 018, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Search for a root-end filling material fulfilling all the ideal characteristics is an ongoing process. The present study aimed to evaluate the marginal seal of the following materials when used as root-end filling materials, MTA Angelus, White ProRoot MTA, Biodentine and Glass ionomer cement (GIC).
Materials and Methods: Sixty single-rooted maxillary central incisors were included in the study. The crowns were resected followed by cleaning and shaping with hand files and protaper rotary files followed by obturation of the roots. The root ends were resected at 3 mm level. Then, root-end cavity preparation of 3 mm depth was done using ultrasonic tips. The samples were randomly divided into four groups of 15 each and cavities restored with, such as (1) Group 1: MTA Angelus, (2) Group 2: ProRoot MTA, (3) Group 3: Biodentine, and (4) Group 4: GIC. The root samples were coated with two coats of nail varnish and immersed in methylene blue dye 2% for 48 h. Longitudinal root resection was done. The depth of dye penetration was evaluated under the stereomicroscope to examine the extent of microleakage. The amount of dye penetration was measured in millimeters. The results were then statistically analyzed using one-way analysis of variance and post-hoc Tukey's test.
Conclusion: Microleakage was present in all the samples. Least amount of apical dye microleakage was seen in biodentine with mean value of 0.16 mm followed by ProRoot MTA 0.68 mm, MTA Angelus 0.74 mm, and GIC 1.53 mm. The best sealing ability was seen in biodentine, and this difference was statistically significant.
Keywords: Biodentine, dye leakage, glass ionomer cement, microleakage, mineral trioxide aggregate - angelus, ProRoot mineral trioxide aggregate, root-end
|How to cite this article:|
Malhotra S, Hegde MN. Analysis of marginal seal of ProRoot MTA, MTA Angelus biodentine, and glass ionomer cement as root-end filling materials: An in vitro study. J Oral Res Rev 2015;7:44-9
|How to cite this URL:|
Malhotra S, Hegde MN. Analysis of marginal seal of ProRoot MTA, MTA Angelus biodentine, and glass ionomer cement as root-end filling materials: An in vitro study. J Oral Res Rev [serial online] 2015 [cited 2020 Mar 31];7:44-9. Available from: http://www.jorr.org/text.asp?2015/7/2/44/172493
| Introduction|| |
One of the most important factors for a successful endodontic treatment is the removal and elimination of microorganisms and the development of fluid tight seal. , Newer techniques and concepts along with the use of more efficient instrumentation and materials may not always result in resolution of periapical pathosis (Sousa et al. 2004). In cases where endodontic therapy is not successful, surgical treatment may be indicated. 
Various materials have been used as root-end filling materials. The ideal requisites for an ideal root-end filling material include that it should be manipulated easily, dimensionally stable, radiopaque, insoluble, impermeable to tissue fluids, adhesive to dentin, nonabsorbable, biocompatible, and promote healing. , Several root-end filling materials have been used such as Gutta-percha, silver amalgam, cavit, intermediate restorative material, super ethoxy benzoic acid, glass ionomers, mineral trioxide aggregate (MTA), and a newer material biodentine. 
Variations in the anatomy of the root-end may result in treatment failure. Therefore, it is necessary to eliminate the apical 3 mm of the apex.  90° angulation is most acceptable for root resection.  The depth of penetration should be 3 mm. 
The aim of this in vitro study is to evaluate and compare the marginal seal of the following materials when used as root-end filling in the root-end preparations:
- White ProRoot MTA.
- MTA Angelus.
- Glass ionomer cement (GIC).
| Materials and Methods|| |
The present study was conducted in the Department of Conservative Dentistry and Endodontics and Department of Oral Pathology and Microbiology, A. B. Shetty Memorial Institute of Dental Sciences, Mangalore.
The study was conducted on 60 extracted human maxillary central incisors collected from the Department of Oral and Maxillofacial surgery, A. B. Shetty Memorial Institute of Dental Sciences, Deralakatte, Mangalore.
- Maxillary central incisors having a single root canal.
- Teeth should have a fully formed apex.
- Teeth having developmental anomalies.
- Teeth having root caries.
- Teeth having root fractures.
- Teeth having an open apex.
Disinfection protocol as given by Occupational Safety and Health Administration and Centers for Disease Control for disinfection of the extracted teeth was followed.
They were randomly divided into four groups containing 15 samples each. They will be:
- Group 1: ProRoot MTA.
- Group 2: MTA angelus.
- Group 3: Biodentine.
- Group 4: GIC.
All samples were carefully examined with a dental operating microscope (OPMI Pico Dental Microscope, Carl Zeiss, Oberkochen, Germany) to rule out any teeth with root caries or restorations, open apices, fractures, cracks, or craze lines.
Radiographs from facial and proximal orientation were taken to confirm the presence of a single canal without previous root canal treatment, resorptions, or calcifications. Soft tissue remnants present over the tooth were removed using curettes.
Sixty maxillary teeth were collected, and specimens were sectioned at cemento-enamel junction [Figure 1] with a diamond disc in a micromotor contra-angle handpiece. Endo-Z bur (Dentsply, Malleifer, Tulsa Dental, Tulsa, USA) was used to refine the endodontic access cavities, and pulpal tissue was removed using a barbed broach (Dentsply).
ISO 15 K file (MANI Inc., Utsunomiya, Tochigi, Japan) is used to confirm the root canal patency. Working length was determined by passing an ISO 15 K file (MANI Inc., Utsunomiya, Tochigi, Japan) into the root canal until the tip of the file was visible at the apical foramen, and then 1 mm was subtracted from that length.
The teeth were instrumented to a size 25 hand file (MANI Inc., Utsunomiya, Tochigi, Japan). Following this, Protaper Universal rotary files (Dentsply) were used for instrumentation up to number 40. About 2.5% sodium hypochlorite was used as an irrigant in between successive files. Recapitulation was done during biomechanical preparation. The smear layer was removed by irrigation with 10 ml of 17% ethylenediaminetetraacetic acid solution and 10 ml sodium hypochlorite, each for 3 min. Saline was used as a final rinse.
Paper points were used to dry the canal. Gutta-percha and AH plus sealer were used to obturate the canals. Size 40/0.06 Gutta-percha cones (Dentsply) were used as master cone, and obturated composite resin was placed over the coronal access.
3 mm of root resection was done at an angulation of 90° to the long axis of the tooth using a cross cut fissure bur. Ultrasonic tips (Zirconium nitride coated [KiS] retrotips: KiS-1D; USA) were used to prepare cavities in the root-end to a depth of 3 mm under continuous irrigation with water with magnification under the microscope.
Lamb et al.  in an in vitro leakage study had demonstrated significantly increased amount leakage between MTA plug that were 2 mm thick compared to 3 mm in a fluid filtration model. The cavities will be irrigated with saline and dried.
The teeth were randomly divided into four groups of 15 specimens each:
- Group I: MTA (MTA angelus - Angelus, Londrina, PR, Brazil).
- Group II: MTA (ProRoot MTA, Maillfer, Dentsply, Switzerland).
- Group III: Biodentine (Septodont, Saint-Maur-des-Fosses, France).
- Group IV: GIC (Fuji II, GC gold label 2, GC International, Japan).
Materials were mixed according to instructions by the manufacturer, and they were placed in the cavities in the root-end.
Moist cotton pellets were placed over the repair materials, and they were kept in cotton moistened with saline in an attempt to stimulate clinical condition. They were kept in 100% humidity for 24 h to allow materials to set.
The outer surfaces of all teeth were covered with two coats of nail varnish except at the apical end and then allowed to dry.
2% methylene blue dye was used to immerse the teeth for 48 h. Teeth were washed, and they were split longitudinally using diamond disc with water coolant.
The depth of dye penetration was examined under the stereomicroscope to evaluate the roots for the extent of microleakage [Figure 2], [Figure 3], [Figure 4] and [Figure 5]. The greatest depth of dye penetration along one of the cavity walls was taken and measured using Motic Images Plus Software in millimeters.
The acquired data were analyzed statistically with one-way analysis of variance (ANOVA) and post-hoc Tukey's test.
| Results|| |
The assessment of the effectiveness of seal was based on dye penetration method. This was based on the microleakage measured in mm using Motic Image Plus Software. The difference in microleakage was statistically analyzed using one-way ANOVA, post-hoc Tukey's test was applied for comparison between the groups because ANOVA test was significant.
[Table 1] depicts the mean, standard deviation, and ANOVA results of the various groups:
|Table 1: The mean, standard deviation, and analysis of|
variance results of the various groups
Click here to view
- According to the results, there was microleakage seen in all samples as seen in Graph 1[Additional file 1].
- Least microleakage was seen with biodentine having average value of 0.16 mm.
- This was followed by ProRoot MTA having 0.68 mm microleakage and then MTA Angelus was 0.74 mm.
- The maximum microleakage was seen in GIC having value of 1.53 mm.
The ANOVA test depicted overall significant difference between the groups, so a post-hoc Tukey test for comparison between the means of the groups was performed.
[Table 2] depicts results of the pair wise comparison between the groups:
- Biodentine exhibited minimum dye penetration which showed that the microleakage exhibited in the group is the least. This is statistically significant when compared to ProRoot MTA, MTA Angelus, and GIC.
- The maximum dye penetration was with GIC. This showed that the microleakage is maximum in this group, and the difference is statistically significant when intergroup comparison is done with ProRoot MTA, MTA Angelus, and biodentine.
- The dye penetration in the MTA Angelus and ProRoot MTA is similar, and the difference is not significant compared with each other. However, the difference with GIC and biodentine was statistically significant.
| Discussion|| |
Periradicular surgery is aimed at achieving access to the affected area, evaluation of root anatomy, and restoration of root apex with a biocompatible material which promotes healing. Clinical success, apical seal, handling properties, and biocompatibility help in determining the choice of root-end filling material. 
GIC has been used as dentin substitute; it forms a chemical bond with the tooth which aids in obtaining a good seal. However, the marginal seal is compromised and it exhibits maximum microleakage. This is due to the technique sensitivity and the dissolution of glass ionomer due to exposure to tissue fluids. 
The intergroup comparison between MTA angelus and ProRoot MTA showed no statistical difference. Following its introduction, MTA has been commonly used as a root-end filling material. ,,, MTA has received increased interest due to its good biocompatibility and favorable tissue response. The limitations of MTA include its longer setting time and its handling properties that prevent it from being the ideal root-end filling material. 
Biodentine is similar to MTA in composition. It has a predosed capsule formulation for use in mixing device which aids in improving physical properties of the material making it easier to use. The setting is faster than MTA, and this may have a reduced risk of bacterial contamination.  Biodentine is a fast setting calcium-silicate based cement. It can be used for dentin replacement as it is bioactive, biocompatible, and has excellent sealing properties.
Ultrasonic tips were used for the root-end cavity preparation. Ultrasonic root-end preparation technique gives excellent results for periradicular surgery and is simple to use.  Use of ultrasonic tips in apical surgery improved the result of the treatment. 
The apical seal that is obtained by the root-end filling materials can be assessed by the means of various methods such as degree of dye penetration, radioisotope penetration, bacterial leakage analysis, fluid filtration, and others. It is one of the most commonly used and oldest method to assess the marginal sealing ability of these materials.  These studies have the advantage of being easy to perform and they are cost effective. In the present study, methylene blue has been used as the dye. It is a commonly used dye and has proved to be an important in several endodontic studies assessing microleakage. 
Longitudinal sectioning method was used to assess the dye penetration into the filling material.  Schδfer and Olthoff  have shown that greater linear dye penetration provides enough data regarding apical leakage even though it does not provide data about area. Lucena-Martνn et al.  and Ahlberg et al.  have shown that transverse root sectioning results in loss of dye and portion of dentinal tissue due to the technique used. In each section, this allows to determine only if there is presence or absence of penetration. 
Motic Image Plus Software was used for measurement of depth of dye penetration along the walls. The measurement was made in millimeters. This software has advantages of regional zoom, scale tools, advanced adjustments, white balance, and color adjustment. Image analysis can make measurements with the added benefit of use of filters.
AH plus sealer was used as the sealer for obturation. Film thickness of 26 mm is seen in AH plus which is in accordance with the ISO standard of <50 mm for root canal sealing materials.  The flow of the resin cement is 36 mm and it meets the ISO standards of <25 mm. AH plus sealer is an epoxy resin-based sealer and thus has a greater adhesion to root dentin when compared to other resin sealers. Due to its creep capacity and long setting time, AH plus has better penetration into the micro-irregularities and this increases the mechanical interlocking of root dentin and the sealer.  Owing to its properties such as low solubility, adhesion to dentin, good sealing ability, and small expansion, it can be considered a benchmark "Gold Standard." ,
The results of this study showed that all materials exhibited microleakage, but there was significantly less microleakage in biodentine. The microleakage values of GIC and MTA were similar to studies that have been previously conducted. ,,,, MTA has been proven to show less microleakage compared to other materials (Aqrabawi, 2000: Chong et al., 2003: Chong et al., 1995: Nakata et al., 1998: Perez et al., 2003: Shipper et al., 2004: Sousa et al., 2004). However, the least microleakage was exhibited by biodentine. This may be attributed to:
- The smaller size of biodentine particles may aid in enhanced adaptation at the cavity surface and filling interface.
- The decreased pore volume and porosity of biodentine as compared to MTA may contribute to better sealing. 
- Its better handling properties may attribute to its improved adaptation to cavity walls. It may also be due to its modified composition of the powder such as addition of accelerators and softeners and fixed dosage capsule which aids in improving its physical properties such as sealing properties.
- The faster setting time of biodentine may prevent prolonged leakage when used reducing the bacterial contamination. This may be of significance when it is used in clinical situations.
- Tags such as structures are formed by the interaction of dentine and biodentine, and there is presence of mineral infiltration zone which is an interfacial layer. The hydration products of calcium silicate cements provide a highly alkaline environment which causes degradation of collagen present in interfacial dentine. 
- Sealing ability of biodentine may be attributed to the tag formation of biodentine, as seen in the study conducted by Han and Okiji where tag formation was higher in biodentine than MTA. Therefore, the sealing ability may be enhanced. 
This is in accordance with the study conducted by Khandelwal et al., which concluded that biodentine can be used as a replacement for MTA.  The study by Radeva et al. concluded that biodentine can be more effective as apical sealing material compared to MTA.  The study by Ravichandra et al. concluded that biodentine exhibited better marginal seal than MTA and GIC. 
| Conclusion|| |
The present study concluded that all materials showed microleakage when assessed under the microscope for the dye penetration. However, the least microleakage was seen in case of biodentine, which was statistically significant. Maximum microleakage was seen in GIC group. However, further research is required for properties of biodentine to assess its use as an ideal root-end filling material apart from its sealing ability.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2]