ABSTRACT
Aim:
To compare the sealing ability of three different materials when used as postendodontic restoration barriers to coronal microleakage in root-filled teeth.
Materials and Methods:
In the present study, 60 single-rooted mandibular premolars with single canals were selected. After endodontic treatment was done with protaper files, they were divided into three groups of 20 teeth each, which were restored with Zirconomer (Group I), Hi-Dense (Group II), and Surefil composite (Group III), respectively. After storing in artificial saliva for 10 days, all teeth were then immersed in Rhodamine 6G fluorescent dye. Teeth were then sectioned buccolingually in a longitudinal direction. The coronal microleakage was measured in both halves under a fluorescence microscope and images were taken with a digital camera. Data obtained from the study in the form of scoring as per specific criteria was subjected to statistical analysis.
Result:
Results of the study showed that the minimum amount of coronal microleakage was seen in Group II restored with Hi-Dense followed by Group III restored with Surefil Composite and the maximum amount of coronal microleakage was seen in Group I restored with Zirconomer.
Conclusion:
On the basis of the results of the present study, it may be concluded that Hi-Dense showed better coronal sealing ability in access cavities. Surefil composite exhibited coronal microleakage less than Zirconomer but more than Hi-Dense.
KEYWORDS: AH-Plus, Hi-Dense, Surefil Composite, Zirconomer
INTRODUCTION
The efficacy of endodontic therapy depends on the thorough chemomechanical preparation needed to remove bacteria and necrotic debris from the root canal, followed by root canal closure to prevent the introduction of germs and tissue fluids. The movement of apical tissue fluids coronally at any interface between a root canal surface and its obturating materials also falls under the definition of microleakage.[1] The infiltration of oral fluids along any interface between a tooth surface, restoration, cement, or root canal filling material is known as microleakage.[2] Coronal microleakage as a cause of endodontic treatment failure has received a lot of attention, and the quality of the final restoration is given substantial importance.[3] An effective replacement method for minimizing coronal leakage in teeth that have undergone endodontic treatment is to place an intraorifice barrier. As soon as the coronal section of gutta-percha and sealer is removed, more material is placed into the canal orifice to stop microleakage.[4] Therefore, in the current investigation, the ability of ZIRCONOMER (SHOFU), HI-DENSE (SHOFU), and SUREFIL COMPOSITE (DENTSPLY) to act as barriers to coronal microleakage in teeth that have had endodontic treatment was evaluated.
MATERIALS AND METHODS
Sixty premolars with single roots of the mandibular region with fully formed apex were collected from the Department of OMFS, Darshan Dental College, Udaipur. After cleaning, they were stored in a sterile saline solution. Inclusion criteria: teeth extracted for orthodontics and periodontal reasons, noncarious teeth, intact teeth, whereas carious teeth, teeth with visible cracks or fractures, restored teeth, teeth with any developmental anomalies, and primary teeth had been excluded.
Initial endodontic treatment
Protaper files were used during the endodontic procedure. Glyde was used to expand canals for working length facilitation up to F2. Each time an instrument was changed during instrumentation, 2.5 mL of 3% NaOCl irrigation solution was applied to all canals. Following a final flush with 5 mL of 17% EDTA for 30 s, the area was rinsed with 5 mL of saline. After the canals had been dried using paper points, the obturation technique was carried out using an F2 gutta-percha cone and accessory cones with lateral condensation utilizing AH Plus sealer. After the sealer had a week to set, 4 mm of gutta-percha was extracted from the canal orifice (cemento-dentinal junction) using hot endodontic hand pluggers. Three groups of 20 prepared teeth each were given a random distribution of all 60 prepared teeth.
Coronal restoration placement
Group I: Zirconomer (Zirconia Reinforced Glass Ionomer Cement): (n = 20),
Zirconomer was mixed and placed into the prepared coronal cavity using the plastic filling instrument and condensed using hand pluggers.
Group II: Hi-Dense (Silver Reinforced Glass Ionomer Cement): (n = 20),
Hi-Dense was mixed and placed into the prepared coronal cavity using plastic filling instruments and condensed using hand pluggers.
Group III SureFil Composite: (n = 20): A microbrush was used to apply One Coat Bond (a self-etching adhesive), which was then gently air-dried for 5 s before being light-cured for 20 s. Surefil composite was placed in two increments of 2 mm each using Teflon-coated instruments and then light cured.
Preparation of samples for dye leakage
After being submerged in artificial saliva for 10 days, all of the specimens in the groups were rinsed under running water, dried, and covered with two layers of nail varnish, with the exception of the 2 mm area around the coronal restoration.
Dye penetration
After that, all teeth were submerged in newly made Rhodamine 6G Fluorescent dye in accordance with the manufacturer’s instructions. Samples were immersed in dye for 24 h before being withdrawn and properly cleaned off under running water for 15 min. The coronal surface was then carefully washed of varnish.
Microscopic evaluation of dye penetration
The teeth were grooved in a buccolingual direction with a diamond disc and sectioned longitudinally. Both halves were subjected to assessment under fluorescence microscope and images were taken with a Canon EOS 700D DLSR camera and then transferred to a computer. These photos were examined for dye penetration and scored using a scoring criterion for leaking.
Criteria for scoring
0 for no leakage found,
1 = Just entering the pulp chamber,
2 = Moderate, entering the pulp chamber midway,
3 = Profound, with leakage reaching the pulp chamber’s floor,
4 = Gross, entering the root canal and/or furcation.
Results and statistical analysis
Dye penetration scores were tabulated in Table 1. Scoring of leakage was maximum in Group I (Zirconomer) as compared with Group II (Hi-Dense) and Group III (Surefil Composite). Group II (Hi-Dense) showed the least microleakage. The Pearson Chi-square one-way analysis of variance (ANOVA) nonparametric statistical analysis indicated varying degrees of statistically significant difference in dye leakage between all three restorative materials. Using post hoc least significant difference (LSD) test when Group I (Zirconomer) and Group II (Hi-Dense) were compared, there were statistically highly significant differences found (P = 0.000). When Group I (Zirconomer) and Group III (Surefil Composite) were compared there were statistically highly significant differences found (P = 0.007).When Group II (Hi-Dense) and Group III (Surefil Composite) were compared there were statistically significant differences found (P = 0.011) When all experimental groups were compared, it was observed that there was microleakage in all the groups. This difference was statistically significant.
Table 1.
Distribution of dye penetration scores in samples of all the three groups
| Group | Samples | Microleakage scoring | ||||
|---|---|---|---|---|---|---|
|
| ||||||
| 0 | 1 | 2 | 3 | 4 | ||
| Group I (Zirconomer) | 20 | 0 | 2 | 3 | 7 | 8 |
| Group II (Hi-Dense) | 20 | 4 | 9 | 6 | 1 | 0 |
| Group III (Surefil) | 20 | 3 | 4 | 4 | 6 | 3 |
DISCUSSION
Root canal shaping aims to preserve the original anatomy of the root canals and produce constantly tapering canals.[5] One of the most crucial aspects of effective endodontic therapy is canal preparation.[6] Endodontic procedures are becoming less upsetting as new materials and technology progress. Cone beam computed tomography (CBCT) scans, advanced microscopes, inventive access cavities, and new access designs are a few examples.[7] According to the study’s findings, Group II, Hi-dense had the least degree of microleakage when compared with Surefil and Zirconomer. The manufacturer claims that glassionomer, which is based on pure polyacrylic acid and makes up around 80% of Hi-Dense, has the best adhesion of any polyacid and exceptional resistance to acid erosion. The discovery of minimal microleakage at the enamel and dentine margins lends credence to the idea that the consistency of the restorative material may affect microleakage. Hi-Dense with all other chemically activated glass ionomer cement, during the early stages of the setting reaction, when calcium salts are produced, is susceptible to moisture contamination and dehydration. It could be compressed like amalgam into the hollow preparations because it was so viscous.[5] Thus, a resin layer is required to maintain this crucial water balance. To lessen the effect on the microleakage scores, the resin coating was then polished off.[8] Hi-Dense showed more leakage while Zirconomer showed less leakage than Surefil Composite. There are many potential reasons for contaminant microleakage at the dentin healing margin.[9] The microleakage of posterior teeth treated with amalgam, composite, and Zirconomer was evaluated in 2015 by Mayank et al. They found that Zirconomer had the highest microleakage in comparison with composite and amalgam.[10]
In 2017, Kathal S et al. evaluated the microleakage of Zirconomer, Amalgomer CR, and Conventional Glass Ionomer (type II) and found that Zirconomer had the highest microleakage in contrast to Amalgomer CR and Conventional Glass Ionomer type II.[11] According to the limitations of the current in vitro experiment, Hi-Dense outperformed Surefil and Zirconomer when used as a coronal barrier to microleakage in teeth that had undergone endodontic treatment. Compared with Hi-Dense, Zirconomer has less microleakage, whereas Surefil does. Zirconomer showed the greatest amount of microleakage in endodontically treated tooth samples.
CONCLUSION
Zirconomer, Hi-Dense, and Surefil Composite were tested in vitro for their potential to act as a barrier against coronal microleakage in root-filled teeth. Comparing Hi-Dense with Surefil Composite and Zirconomer, Hi-Dense demonstrated the least degree of coronal microleakage. In comparison with Hi-Dense, Surefil Composite showed more leakage, but less than Zirconomer. The most coronal microleakage was seen in Zirconomer out of the three groups.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
We would like to acknowledge Deanship of Scientific Research, Prince Sattam Bin Abdul Aziz University, Alkharj KSA, for supporting this research and gratitude to all who helped by sparing their time.
REFERENCES
- 1.Divya KT, Satish G, Srinivasa TS, Reddy V, Umashankar K, Rao BM. Comparative evaluation of sealing ability of four different restorative materials used as coronal sealants: An in vitro study. J Int Oral Health. 2014;6:12–7. [PMC free article] [PubMed] [Google Scholar]
- 2.Sabir M, Abdul Shameem K, Rekha PT, Francis PG, Jayapalan CS, Abdul Hafiz KA. Microleakage in endodontics. J Int Oral Health. 2014;6:99–104. [PMC free article] [PubMed] [Google Scholar]
- 3.Kurtzman G. Improving endodontic success through coronal leakage prevention. Medicine. 2006 [Google Scholar]
- 4.Yavari H, Samiei M, Eskandarinezhad M, Shahi S, Aghazadeh M, Pasvey Y. An in vitro comparison of coronal microleakage of three orifice barriers filling materials. Iran Endod J. 2012;7:156–60. [PMC free article] [PubMed] [Google Scholar]
- 5.Langaliya A, Kothari A, Buch A, Dave R, Shah J, Shah N. Comparative Evaluation of Root Canal Transportation and Centering Ability in Curved Mesiobuccal Canals of Mandibular First Molars after Instrumentation with Different File Systems-An In vitro Study. J Pharm Bioallied Sci. 2023;15(Suppl 2):S1211–4. doi: 10.4103/jpbs.jpbs_157_23. doi: 10.4103/jpbs.jpbs_157_23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Langaliya A, Chaudhari E, Patel A, Shah J. Computer-aided design-CAM-guided endodontic microsurgical localization and retrieval of two separated instruments from the periapical area of a mandibular second molar. Endod. 2021;33:112–7. doi: 10.4103/endo.endo_60_20. [Google Scholar]
- 7.Marvaniya J, Agarwal K, Mehta DN, Parmar N, Shyamal R, Patel J. Minimal invasive endodontics: A comprehensive narrative review. Cureus. 2022;14:e25984. doi: 10.7759/cureus.25984. doi: 10.7759/cureus.25984. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Yap AU. Effects of storage, thermal and load cycling on a new reinforced glass-ionomer cement. J Oral Rehabil. 1998;25:40–4. doi: 10.1046/j.1365-2842.1998.00192.x. [DOI] [PubMed] [Google Scholar]
- 9.Hegde MN, Vyapaka P, Shetty S. A comparative evaluation of microleakage of three different newer direct composite resins using a self etching primer in class V cavities: An in vitro study. J Conserv Dent. 2009;12:160–3. doi: 10.4103/0972-0707.58340. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Patel MU, Punia SK, Bhat S, Singh G, Bhargava R, Goyal P, et al. An in vitro Evaluation of Microleakage of Posterior Teeth Restored with Amalgam, Composite and Zirconomer-A Stereomicroscopic Study. J Clin Diagn Res. 2015;9:ZC65–7. doi: 10.7860/JCDR/2015/13024.6225. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Kathal S, Bhayya DP, Gupta S, Rao A, Pal A, Saxena ST. Comparative Evaluation of Microleakage of Zirconomer, Amalgomer CR and Conventional Glass Ionomer (Type II) as Restorative Cements in Primary Teeth. An In-Vitro Study. Int J Oral Care Res. 2017;5:1–7. [Google Scholar]
