Evaluation of Sealing Ability of MTA Flow, Biodentine and Pro-Root MTA to Seal the Furcal Perforation with and without Internal Matrix- An In vitro Study

ABSTRACT

Introduction:

Endodontic mistakes, also known as procedural accidents, are those bad events that occur during treatment, some of which are attributable to a lack of attention to detail and others of which are completely unforeseeable. The second most frequent reason for root canal failure is perforation.

Aims and Objective:

The current in vitro study’s objective was to assess the furcal perforation’s potential to be sealed with and without internal matrix by MTA flow, Biodentine, and pro-root MTA.

Materials and Methods:

60 samples were allocated into six groups at random (10 each). In intact permanent mandibular first and second teeth, furcal perforation sites were made and sealed with various materials. Following perforation sealing, the specimens’ capacity for sealing was evaluated using the dye penetration method.

Result:

The current study’s findings indicated that Group 2 has the least amount of microleakage and Group 5 has the most.

Conclusion:

Biodentine has excellent sealing capabilities and can be utilised to heal furcation perforations with or without internal matrix.

INTRODUCTION

Procedural accidents, also known as endodontic mishaps, are unlucky events that occur during treatment. Some are caused by a lack of attention to detail, while others are completely unanticipated. Failure to grasp the rationale behind the endodontic treatment and its thorough knowledge can increase the occurrence of various complications.[1] The second most frequent reason for root canal failure is perforation.[1-3]

The location, size, periodontal health, amount of time the perforation is exposed to contamination, ability to seal the perforation, sterility of the canal, biocompatibility of the material, accessibility to the main canal, etc., all affect the prognosis for a tooth with a perforation.[3-5] Internal matrix idea for the treatment of the perforation was introduced in order to prevent the extrusion of the material used for repair material into the surrounding structures, such as periodontal ligament and bone, during root perforation closure either collagen, hydroxyappetite or calcium sulphate make up the interior matrix. The current in vitro study’s objective was to assess the furcal perforation’s potential to be sealed by MTA flow, Biodentine and pro-root MTA employing the dye-penetration method, a leakage assessment technique.

MATERIALS AND METHODS

The samples were cleaned off from debris and residual tissues with the help of an ultrasonic scaler (Woodpecker Ultrasonic Scaler UDS P) and stored in the solution of 2% Glutaraldehyde (Korsolex Rapid, Hartman) for 5 days for disinfection. Inclusion criteria includes freshly extracted intact human permanent mandibular molar teeth, teeth without any caries, calcification, any previous treatment, teeth extracted for periodontal reasons and teeth with non-fused roots and well-developed roots. Teeth with cracks and resorption and fractured teeth were excluded.

A standard endodontic access opening was prepared using carbide round bur followed by Endo-Z (Dentsply, Maillefer, Ballaigeus, Switzerland) bur in specimen. After that, teeth were decoronated with a diamond disc while continuously cooling under water 4 millimetres above the cement-enamel junction. Similar to that, roots were amputed at mid-root level. Temporary filling material (Orafil-G) was placed to seal over the orifice and the apical end of each canal. Perforations were made in the furcation area with No. 4 Round carbide bur which is 2 mm in diameter.

Specimens were separated into six groups each consist of 10 specimen (n = 10) [Table 1].

Table 1.

Study groups

Group No.	Material	With or without internal matrix
1	Biodentine	Without
2	Biodentine	With
3	Pro-root MTA	Without
4	Pro-root MTA	With
5	MTA Flow	Without
6	MTA Flow	With

Internal matrix of 3 mm was placed at the furcal perforation site in the respective groups. Each repair material was prepared and placed into the perforation defect to the level of the pulpal chamber floor, then mixed as per guidelines. For the purpose of simulating a clinical setting while the root was being repaired, a cotton pellet was used to inertly hydrate it. The access cavity was filled with composite resin after 24 hours. For two days, every tooth was placed in a thermocycling machine.

With the exception of the area around the perforation area, the surfaces of the molars, including the access filling, were entirely covered by two successive coats of clear varnish, allowing the dye to only pass through the perforation location. The specimen was soaked in a 2% methylene blue dye solution for 48 hours, followed by a 30-minute rinse under running water. The level of the pulpal floor to the outer edges of the perforated cavity was used to determine the real value of dye leakage in each area. Using a stereomicroscope, the maximal dye penetration along the buccal and lingual walls of the mesial or distal portion was noted (×10).

RESULTS

Microleakage in group 1 specimen (Biodentine without internal matrix) ranges from 1.26 mm to 1.33 mm. Microleakage in group 2 specimen (Biodentine with internal matrix). ranges from 1.48 mm to 1.53 mm. Specimen of group 3 (pro-root MTA without internal matrix) showed more microleakage than group 4 (pro-root MTA with internal matrix). Specimen of group 5 (MTA flow without internal matrix) showed more microleakage than group 6 (MTA flow with internal matrix). The mean microleakage scores for the experimental groups 1, 2, 3, 4, 5 and 6 are 1.50, 1.29, 1.70, 1.50, 1.90 and 1.70 mm, respectively. Where Group 2 has minimum microleakage and group 5 has maximum microleakage [Figure 1].

Figure 1.

Mean microleakage in all 6 groups

DISCUSSION

Most common endodontic mishaps such as perforation during access cavity preparation, file fractures, zipping, canal transportation, ledging, sodium hypochlorite accidents, occur in insertion of posts; during routine endodontic treatment, removing of due to anatomical variances, the tooth’s inaccessibility, and the operator’s inexperience. The root canal system and the periodontium start to communicate in an unfavourable way because of perforations.[6-9]

In multirooted teeth, pulpal floor perforations end up causing the periodontium to become inflamed, which can cause irreparable attachment loss.[1,10] Evidence of prolonged bleeding into the pulp space is the first sign of an iatrogenic perforation.[11] Guttapercha, super-EBA, composite, conventional GIC, decalcified freeze-dried bone, mineral trioxide aggregate, resin modified GIC, etc., are some of the materials used to repair furcation perforation.[12]

MTA flow, Biodentine and pro-root MTA were chosen in this study to seal the furcal perforation because they are more biocompatible, capable of sealing and properly adapt to the dentinal walls than other materials. The powder known as mineral trioxide aggregate is made up of tiny hydrophilic particles that can set when exposed to moisture.[13-15] When applied in touch with cells and tissues, MTA might prove to be a biocompatible substance.[16] MTA that flows is MTA that hasn’t had any resin, calcium hydroxide, or other chemicals added to it.[17] Biodentine is an excellent good material for the repair of perforation.[18] Resorbable and non-resorbable internal matrix are the two varieties that are available.[19] Collagen is a protein fibre with a triple helix shape made of interconnected fibres that gives it a great degree of strength. The final product serves as a physiological barrier by reflecting the functioning periosteum.[20]

According to the study’s findings, group 2 (Biodentine with internal matrix) had the least amount of microleakage, which was followed by group 1 (Biodentine without internal matrix). Groups 1, 3, 4 and 6 also exhibited major differences. In the current investigation, we discovered that Biodentine has great sealing capacity and recommended to use for perforation repair. These results are in accordance with: A study conducted by Krupalini KS, Udayakumar, Jayalakshmi K.B. (2003).[21]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.