RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. /NAME OF THE CANDIDATE AND ADDRESS / Dr. RENJITH RAJ.C.V
ROOM NO. 203
R. V. D. C. BOYS HOSTEL,
J. P. NAGAR 1ST PHASE,
BANGALORE-560078
2. / NAME OF THE INSTITUTION / D. A. P. M. R. V. DENTAL COLLEGE AND HOSPITAL, 24th MAIN
J. P. NAGAR 1ST PHASE,
BANGALORE-560078
3. / COURSE OF THE STUDY AND SUBJECT / MASTER OF DENTAL SURGERY
CONSERVATIVE DENTISTRY AND ENDODONTICS
4. / DATE OF ADMISSION TO COURSE / 30.05.2012
5. / TITLE OF THE TOPIC:
COMPARATIVE EVALUATION OF APICAL SEAL AND MARGINAL ADAPTATION OF FOUR ROOT-END FILLING MATERIALS-AN INVITRO STUDY.
6) / BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY
Most endodontic failures occur when treatment procedures have not reached a satisfactory standard for the control and elimination of infection. Even when the highest standards and the most careful clinical procedures are followed, failures still occur because of the anatomic complexity of the root canal system with regions that cannot be instrumented with existing instruments, materials and techniques.1
When non surgical attempts become unsuccessful, surgical endodontic therapy is performed to save the tooth which involves exposure of the involved root apex, resection of its apical end, root end cavity preparation and insertion of appropriate root-end filling material.2
Many materials have been evaluated for retrograde filling including gutta-percha, amalgam, Cavit, IRM, super-EBA, Diaket and glass ionomers. Most of these have been proved to be either cytotoxic or unsuitable as retroseals.3 Newer root-end filling materials like proRoot Mineral trioxide aggregate(MTA), Biodentin ; a tricalcium silicate cement, bioceramic based Diaroot bioaggregate and polymethylmethacrylate (PMMA) bone cement are currently under focus.4,5
Although various microleakage testing methods using dyes, radioactive isotopes, bacterial leakage and fluid filtration have been used as sealability tests, none of them is universally accepted owing to limitations presented by them. The recently developed glucose leakage model(GLM) employed in this study, is considered to overcome many of the limitations displayed by other models as glucose molecule, a known nutrient source for bacteria is considered more clinically relevant and its enzymatic reading is more sensitive than the bubble movement in the fluid filtration model.4 Scanning electron microscopy (SEM) has been used to analyze the interface between dentin and root-end filling materials and to evaluate marginal adaptation because it provides higher image magnifications.6
As the ability to provide a tight seal and adherence to root dentin is of paramount importance in determining efficacy of root-end filling materials, this study aims to compare the apical sealing ability of four root-end filling materials; white ProRoot MTA, tricalcium silicate cement; Biodentin, Polymethylmethacrylate (PMMA) Bone cement and Diaroot bioaggregate,(DBA) using a Glucose leakage model (GLM) and also evaluate their marginal adaptation by scanning electron microscopy.
6.2 REVIEW OF LITERATURE
1. An in vitro study was done to compare sealing ability of Diadent bioaggregate(DBA) versus amalgam, intermediate restorative material and white MTA, using methylene blue dye penetration technique. Results revealed significant difference in sealing ability among four tested materials. Microleakage was seen through all materials, but significantly less in DBA when compared to white MTA, IRM and amalgam.2
2. An in vitro study was done to evaluate the marginal adaptation of polymethylmethacrylate(PMMA)bone cement, MTA and amalgam as root end filling materials by scanning electron microscopy. Results revealed that both bone cement and MTA exhibited a better adaptation to the dentinal walls than amalgam. It was concluded that the good adaptation of MTA to the cavity margins might be intrinsically linked to the hydrophilic nature of the material and the poor adaptation of amalgam due to its contraction on setting.4
3. An in vitro study was done to compare the root end seal provided by Ceramicrete, Bioaggregate, white proRoot MTA using glucose leakage model. Glucose leakage was measured at the end of one hour. Results showed a significant difference between the three materials. Ceramicrete showed significantly lower glucose penetration than bioaggregate. There was no difference in leakage between bioceramic materials and white MTA.5
4. An in vitro study was done to evaluate the marginal adaptation of five root end filling materials; silver amalgam, White MTA-angelus, white Portland cement, Vitremer and GC Fuji ortho LC as well as compare the results obtained in the evaluation of teeth and their replicas using scanning electron microscopy. Results showed that materials containing calcium oxide (MTA and Portland cement) showed similar results. Resin modified glass ionomer cements presented similar variations in marginal adaptation when compared to GC Fuji ortho LC, but Vitremer showed significantly greater marginal adaptation.6
5. An in vitro study was done to quantitatively assess endodontic leakage with commonly used root canal sealers, Pulp Canal Sealer EWT, Sealapex and AH Plus based on filtration rate of glucose along the root canal filling. The amount of leakage was quantified with spectrophotometry. Leakage was measured at periodic intervals. Results indicated that Pulp Canal Sealer EWT showed the greatest amount of leakage, whereas the difference between sealapex and AH Plus groups was not significant at any of the intervals.7
6. An in vitro study was done to evaluate sealing ability of Ca3SiO5/CaCl2 composite cement by employing a fluid transport model using glucose. Results showed that the sealing ability of Ca3SiO5/CaCl2 composite cement and cortisomol paste were higher than that of zinc oxide eugenol(ZOE) cement, and that no significant difference was observed between Ca3SiO5/CaCl2 composite cement and cortisomol paste. It was concluded that the good sealing ability of cortisomol paste could be due to its low solubility and polymerization shrinkage.8
6.3 OBJECTIVE OF THE STUDY
The purpose of this in vitro study is to evaluate and compare the (1) Apical seal and (2) Marginal adaptation of four root-end filling materials:-
(A) White proRoot MTA
(B) Biodentin
(C) Polymethylmethacrylate(PMMA) Bone cement
(D) Diaroot bioaggregate
MATERIALS AND METHODS:
7.1 SOURCE OF DATA
Eighty single rooted teeth with single canal, extracted due to periodontal and orthodontic reasons will be used for the study.
Glucose leakage analysis and scanning electron microscopy used in this study will be performed at R.V College of Engineering, Bangalore.
MATERIALS:-
1. Diaroot bioaggregate (Diadent, Canada)
2. White mta (proroot mta,Dentsply)
3. Biodentin (Septodont,Europe)
4. Pmma bone cement (Palacos,Germany)
5. High speed air turbine handpiece (Nsk,japan)
6. Stainless steel k files (Mani,Japan)
7. 3% sodium hypochlorite
8. Paper points
9. Guttapercha cones (Dentsply Mallifer, China)
10. Carborundum disc
11. Straight fissure diamond bur (sf 41, Mani, Japan)
12. 0.9% sodium chloride(storage medium)
13. Glucose leakage model
14. DNS(Dinitrosalicylic acid) reagent for estimation of glucose
15.Scanning electron microscope
7.2 METHOD OF COLLECTION OF DATA
Eighty single rooted teeth with single canal, extracted due to periodontal and orthodontic reasons, collected from the Department of Oral and Maxillofacial surgery, D.A. Pandu Memorial. R .V. Dental College, Bangalore will be used for the study.
Inclusion criteria:-
1. Teeth with single root canal.
2. Teeth without visible root caries.
3. Teeth with fully formed apex.
4. Teeth with normal anatomical roots.
5. Teeth without crown and root fractures.
Exclusion criteria:-
1. Teeth with severe anatomical variations.
2. Teeth with open apex.
3. Teeth with extreme curvature of root.
4. Teeth with crown and root fractures.
METHODOLOGY:
SAMPLE PREPARATION
Eighty sound human single rooted teeth with single canal, extracted for periodontal and orthodontic reasons will be collected for the study. The teeth will then be hand scaled and kept in saline solution (0.9%sodium chloride in water) at 370 C for no longer than one month before being used in the experiment. Standard access cavities will be prepared and the canal orifices located and apical patency will be confirmed with a size 15 K-file. The working length will be established 1 mm from the apex. Root canals will be prepared using step back technique until reaching a master apical file size 45. The canals will be irrigated with 2 ml of 3% sodium hypochlorite between successive files. After the preparation, the canals will be dried with paper points. The samples will be then decoronated with a carborundum disc in a slow speed micromotor to standardize root length to 15 mm.
Root end resection and preparation
The apical 3 mm of roots will be resected at 90 degrees to the long axis by using a cross cut fissure bur. A master gutta- percha cone will be inserted without cementation into the canal and through the apical foramen until tug-back will be achieved. The apically extruded gutta-percha will be sectioned. Standardized 3 mm deep and 0.8 mm wide retrograde cavities will be prepared in all the roots using a straight fissure diamond point in a high speed air turbine handpiece.
CLASSIFICATION OF GROUPS:
The collected eighty decoronated tooth samples in which root end cavities are prepared will then be divided into two sets of four groups, one set for testing apical sealing ability and the other for testing marginal adaptation with 10 teeth in each group. The prefitted gutta-percha cone will serve as a barrier for condensation of root-end filling materials.
Group A: This group will receive White proRoot MTA as root-end filling. The cement will be
manipulated by mixing the powder with saline in the ratio 3:1 and the cavities will be restored with the mixed cement.
Group B: This group will receive Biodentin as root end filling. The cement will be mixed according to manufacturer’s instructions and the cavities will be restored with the mixed cement.
Group C: This group will recieve Polymethylmethacrylate(PMMA) Bone cement as the root-end filling. The cement will be mixed according to manufacturer’s instructions and the cavities will be restored with the mixed cement.
Group D: This group will receive Diaroot bioaggregate as the root-end filling. The material will be mixed according to manufacturer’s instructions and the cavities will be restored with the mixed cement.
Sample size for each group is ten (n=10).
Root-end filling procedures:-
The materials will be mixed according to manufacturers’ instructions. All materials will be placed into the root-end cavities using a cement carrier and will be compacted. Immediately after filling, all samples will be stored in 100% humidity for 72 hours to allow the final set of the cements. After the initial set (24 h) of the cements, the gutta- percha will be removed from each root canal.
Evaluation of apical seal
Teeth will be placed into a device designed to measure glucose leakage. Teeth will be individually inserted into an Eppendorf tube (1.5 ml) with the apical 7mm protruding through the end. The upper portion of the eppendorf tube will be connected to a plunger-less syringe containing 0 .75 ml of 1 mol/L glucose solution. The lower portion of the eppendorf will be inserted into another eppendorf tube containing 0.75 ml of deionized water in such a way that 3 mm of the root apex will be immersed in the water. Low viscosity cyanoacrylate adhesive will be used to seal all the interfaces and connections.
The upper part of the syringe containing glucose solution will be connected to a pressure source to create appropriate headspace pressure for 60 min. After that, a 10 µL aliquot of solution will be drawn from the inferior Eppendorf using a micropipette and then analyzed using DNS (Dinitrosalicylic acid) reagent to obtain optical density (OD) value for each sample. OD values will be converted in glucose concentrations (g/L) .
Evaluation of marginal adaptation
A carborundum disc will be used to cut the root samples longitudinally into two halves. The sections will be prepared for analysis with scanning electron microscope. The distances between the root-end filling materials and cavity walls will be measured in micrometres directly.
STATISTICAL ANALYSIS
The values obtained for glucose leakage and marginal adaptation will be subjected to statistical analysis by ONE WAY ANOVA TEST.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON THE PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.
NOT APPLICABLE AS THIS IS AN IN VITRO STUDY.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?
YES.
8) / LIST OF REFERENCES:
1. Stephen Cohen, Kenneth M. Hargreaves. Pathways of the Pulp. 9th ed. New Delhi; Mosby Inc;2006. P276-277,918.
2. El Sayed MA, Saeed MH. In vitro comparative study of sealing ability of Diadent Bioaggregate and other root-end filling materials. J Conserv Dent 2012;15:249-252.
3. Ingle, Bakland, Baumgartner. Ingle’s endodontics. 6th ed. Hamilton:BC Decker Inc;2008. p.1261-1262.
4. Amany E. Badr. Marginal adaptation and Cytotoxicity of Bone Cement compared with amalgam and Mineral Trioxide Aggregate as root-end filling materials. J Endod 2010;36:1056-106
5. Leal F, De-Deus G, Brandao C, Luna AS, Fidel SR, Souza EM. Comparison of root-end seal provided by bioceramic repair cements and white MTA. Int Endod J 2011;44, 662-668.
6. Costa AT, Konrath F, Dedavid B, Weber JBB, Oliveira MG. Marginal adaptation of Root-end Filling Materials: An In vitro Study with Teeth and Replicas. J Contemp Dent Pract 2009 March: (10)2:075082.
7. Qiong Xu, Ming-wen Fan, Bing Fan, Gary S.P. Cheung, Han-lin Hu. A new quantitative method using glucose for analysis of endodontic leakage. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:107-11.
8. Xiaohong WANG, Jiang CHANG, Sheng HU. A study on the sealing ability and antibacterial activity of Ca3SiO5/CaCl2 composite cement for dental applications. Dent Mater J. 2012;31(4):617-622.
9) / SIGNATURE OF THE CANDIDATE:
10) / REMARKS OF THE GUIDE:
11) / 11.1 NAME AND
DESIGNATION OF
THE GUIDE / Dr. SHASHIKALA K.
PROFESSOR AND HEAD
DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS
11.2 SIGNATURE OF THE
GUIDE
11.3 HEAD OF THE DEPARTMENT / Dr. SHASHIKALA K.
PROFESSOR AND HEAD
DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS
11.4 SIGNATURE OF THE
HOD
12) / 12.1 REMARKS OF THE
CHAIRMAN AND
PRINCIPAL
12.2 SIGNATURE
I have gone through the protocol from the point of view of statistical planning and analysis on the topic “COMPARATIVE EVALUATION OF APICAL SEAL AND MARGINAL ADAPTATION OF FOUR ROOT-END FILLING MATERIALS – AN IN VITRO STUDY” by Dr. RENJITHRAJ.C.V for dissertation. The sample size for the particular study seems adequate for applying statistical tests. I am of the opinion that it fulfils the statistical criteria for analysis.
Mr. Thejaswi
Statistical analyst