Abstract
Context
Pulpectomy is recommended for primary teeth when both the coronal and radicular pulp tissues are irreversibly damaged. Biomechanical preparation of root canals is essential for the success of endodontic treatment. Achieving the optimal length during obturation while minimizing voids and ensuring a hermetic seal is crucial for the success of pulpectomy procedures.
Aims
The aim of this in vitro study is to compare the root canal obturation quality among Lentulo Spiral, Pastinject, and Dispo Van syringe in primary teeth using cone-beam computed tomography (CBCT) scanning.
Settings and design
The selected extracted primary teeth were from the age-group of 4–7 years. Teeth indicated for pulpectomy with at least two-thirds of the total root length present were included. The study was conducted over a duration of 6 months.
Methods and materials
The study examined 60 primary tooth root canals, divided into three groups. Endoflas was used for obturation with Lentulo Spiral, Pastinject, and Dispo Van syringe. Postoperative CBCT was used to assess the presence of voids.
Statistical analysis used
The values were analyzed for the success rate of obturation using an independent t-test with MedCalc for Windows.
Results
In this study, three different filling techniques were evaluated and compared based on the presence of voids in the canals. Pastinject exhibited superior performance with the fewest voids, followed by the Lentulo Spiral and Dispo Van syringe.
Conclusion
The findings indicated that the most effective technique for obturating primary teeth was the Pastinject method.
How to cite this article
Adhya S, Chakraborty S, Dey B, et al. Comparative Evaluation of Obturation Quality Using Three Different Obturation Techniques in Primary Teeth: A Cone-beam Computed Tomography Analysis: An In Vitro Study. Int J Clin Pediatr Dent 2024;17(11):1248–1251.
Keywords: Cone-beam computed tomography, Endoflas FS, Eugenol, Obturation, Pedo rotary files, Pulpectomy, Zinc oxide
Introduction
In pediatric dentistry, safeguarding the integrity of primary teeth until natural exfoliation is of paramount importance. Pulpectomy is pivotal, utilizing diverse materials and techniques to fill primary teeth canals, thus preserving their function and structure effectively.1
The American Academy of Pediatric Dentistry (AAPD) guidelines recommend pulpectomy for primary teeth with irreversible pulpitis or periapical infection. If coronal pulp amputation is performed and the radicular pulp shows clinical signs of hyperemia or evidence of necrosis, with or without caries involvement, pulpectomy is indicated.2
Root canal obturation aims to achieve a complete, impermeable seal from the coronal opening to the apical terminus of the root canal.3 An optimal filling technique achieves complete canal filling while minimizing voids and preventing overfill, thereby promoting optimal treatment outcomes and long-term success.4 Root canal obturation involves filling and sealing a cleaned and shaped root canal with a root canal sealer and core filling material.5
Pulpectomy success relies on factors such as obturation ease, material control, and cost-effectiveness. Various techniques, like amalgam pluggers, tuberculin syringes, disposable injection techniques, NaviTip, hand-held and rotary Lentulo Spiral instruments, Jiffy tubes, endodontic pressure syringes, and paste injector methods, are utilized.
Lentulo Spiral obturation technique was introduced by Kopel in 1970. According to Torres et al.6 in 2004 and Sigurdsson et al. in 1992, it was demonstrated that Lentulo Spiral obturation yields more homogeneous results compared to the calcium hydroxide syringe. It is also more effective for filling the straight root canals of primary teeth than other techniques.6
Pastinject, akin to a Lentulo Spiral, features a flattened blade and helical shape for carrying obturating paste into root canals, ensuring flexibility and translational movement for quality obturation.7
Dispo Van syringe is the simplest, cost-effective technique for canal obturation of primary teeth.
Cone-beam computed tomography (CBCT) produces highly magnified and minimally distorted images. CBCT offers clear advantages over standard CT for pediatric patients, notably shorter scan times, which reduce children's anxiety. This improvement in efficiency enhances the overall experience for young patients undergoing dental imaging procedures.8
To date, no obturation techniques can be claimed as the gold standard for the obturation procedure in primary teeth. Therefore, the aim was to make a comparative evaluation between traditional techniques like Lentulo Spiral and disposable syringe with Pastinject as obturation methods in primary teeth using CBCT. Numerous studies have been undertaken to identify the ideal root canal filling material and the best obturation technique; unfortunately, they have not provided any conclusive results.
Subjects and Methods
This in vitro study was conducted in the Department of Pedodontics and Preventive Dentistry at Haldia Institute of Dental Sciences and Research, West Bengal, India.
A total of 60 root canals of extracted primary anterior teeth were selected for the study. The selected extracted primary teeth were in the age range of 4–7 years, irrespective of gender, and indicated for pulpectomy with at least two-thirds of the total root length present. Teeth with internal resorption were not selected as samples for the study.
Teeth were extracted and immersed in a 0.5% sodium hypochlorite solution (SAFE ENDO, India) for one week, followed by storage in a 0.9% sodium chloride solution. The selected teeth were then divided randomly into three different groups, each having an equal number (n = 20) of canals. The coronal part of the teeth was flattened to achieve a fixed reference point. Standard endodontic access to the pulp chamber was prepared for all tooth samples using diamond round burs (Horico). The initial patency filing was conducted with a 10K file (MANI Inc., Japan). Working length was set 1 mm short of the measured length. Biomechanical preparation commenced using a 25 No K file (MANI Inc., Japan).
KEDO SG Blue Rotary File (KEDO File, Japan) anterior U1 file was used for canal preparation with the crown-down technique by Coltene Canal Pro Cl 2i endo motor (torque 2.2 Ncm and 300 rpm), along with copious irrigation utilizing a 1:4 ratio of 5.25% sodium hypochlorite (SAFE ENDO, India) and 17% EDTA (Orikam Healthcare, India). A uniform blend of zinc oxide and iodoform paste (Endoflas) was administered following the manufacturer's guidelines for root canal filling, employing one of the randomly assigned assessed techniques.
Group A (20 canals): A Lentulo Spiral was selected (one size smaller than the last file size). A rubber stopper was placed around the spiral part 1 mm short of the working length to inhibit apical displacement during the filling of root canals. The Lentulo Spiral was dipped into the Endoflas mixture and rotated into the 20 prepared canals. The Lentulo Spiral was then gently withdrawn from the canals while rotating, ensuring the canals were filled to the orifice with paste.
Group B (20 canals): A Pastinject instrument was selected (one size smaller than the last file size) and mounted on a slow-speed handpiece. A rubber stop was placed on the spiral part 1 mm short of the working length to prevent apical displacement of the instrument during the filling procedure. The Pastinject was coated with the Endoflas mixture and rotated into the 20 prepared canals. The Pastinject was then slowly withdrawn from the canal while still rotating, and an additional amount of paste was gradually introduced into the canals until they were filled to the orifice.
Group C (20 canals): A hypodermic 2-mL, 27-gauge Dispo Van syringe with a 1.5-inch needle was employed for obturation. The needle was inserted into the canal to a depth of 1 mm short of the apical foramen, and the root canal filling material was smoothly injected until it was visible at the canal orifice. The needle was then gradually withdrawn from the canal with continuous deposition of the material until it reached the pulp chamber.
Postoperative Evaluation
After the procedure, scanning was done using the MyRay Hyperion X9 Pro (Italy) CBCT scanner, and the number of voids in the root canals was observed in different slices (sagittal, coronal, and transverse) using iRYS software.
Statistical Analysis
The values obtained from group A, group B, and group C were statistically analyzed using an independent t-test with MedCalc for Windows, version 11.3.0.0 (MedCalc Software, Ostend, Belgium). The level of significance was set to p < 0.05 (Fig. 1).
Fig. 1:
Values obtained from Pastinject, Lentulo Spiral, and Dispo Van syringe were statistically analyzed using an independent t-test with MedCalc for Windows, version 11.3.0.0
Results
The study assessed three filling techniques based on the presence of voids in canals. Pastinject showed superior performance, exhibiting the fewest voids, followed by the Lentulo Spiral (Fig. 2). However, the Dispo Van syringe was deemed the least effective in this regard. These findings suggest that Pastinject may offer a more reliable method for root canal filling, potentially enhancing treatment outcomes (Table 1). Further research could explore ways to optimize the efficiency of these techniques, ensuring the most effective approach for reducing voids and promoting successful root canal treatment in clinical practice.
Fig. 2:
Postoperative CBCT images of canals obturated by Pastinject, Lentulo Spiral, and Dispo Van syringe
Table 1:
Values obtained from Pastinject, Lentulo Spiral, and Dispo Van syringe
| N | Mean | 95% confidence interval | Standard deviation | Standard error mean | |
|---|---|---|---|---|---|
| Pastinject | 20 | 2.110 | 2.240 | 1.00 | 0.0400 |
| Lentulo Spiral | 20 | 3.200 | 2.641–3.759 | 1.3540 | 0.2708 |
| Dispo Van | 20 | 4.00 | 3.454–4.546 | 1.4029 | 0.3646 |
Discussion
In this study, three different filling techniques were evaluated and compared. The study shows a statistically significant (p = 0.0398) difference among Lentulo Spiral, Pastinject, and Dispo Van regarding the presence of voids in obturated canals, with Pastinject being the better technique, exhibiting fewer voids.
Lentulo Spiral is one of the most highly effective, frequently used, and accepted techniques for obturating primary root canals.
In the study by Oztan et al.,9 Lentulo Spiral and Pastinject were compared as carriers for intracanal calcium hydroxide placement. They found that canals filled with Lentulo Spiral exhibited significantly more voids than those filled with Pastinject.10 Grover et al. found that Pastinject resulted in the most optimally filled canals, while the pressure syringe method led to overfilled canals.11 Canals filled with Pastinject mostly displayed optimal filling due to its design with flattened blades, enhancing material placement and reducing occurrences of underfilled and overfilled canals, as well as voids.
In my present study, the number of voids was found to be maximum with the disposable syringe, predominantly in the middle third area. This is in agreement with a study by Bhandari et al., who also observed that the maximum number of voids was seen in the disposable syringe due to air bubble entrapment in the paste during mixing of powder with liquid.12 Nagarathna et al. (2018) stated that the modified disposable syringe technique offers a less invasive and more efficient approach to root canal obturation in pediatric dentistry, minimizing patient discomfort and procedural time compared to the handheld Lentulo Spiral technique.13
In the present study, the obturating material used was Endoflas, from Sanlor, Colombia, which blends ZOE, Ca(OH)2, and iodoform to mitigate drawbacks and optimize resorption in primary teeth without causing a hollow tube effect.9
According to Jha et al. in 2011, Endoflas, being hydrophilic, suits mildly humid canals and securely adheres to root canal surfaces for effective sealing. Its broad antibacterial action disinfects dentinal tubules and inaccessible accessory canals, enhancing cleansing where mechanical means fall short.14 According to Rewal et al. in 2014, Endoflas matches physiological root resorption, limiting material resorption to excess extruded extraradicularly, without intraradicular signs. It boasts superior clinical and radiographic success over zinc oxide eugenol.10
Despite reported drawbacks, zinc oxide eugenol remains widely utilized in pediatric dentistry since its discovery by Bonastre and adoption by Chisholm, showcasing its enduring significance in the field despite criticisms.15
Conclusion
This study has shown Pastinject to be better than Lentulo Spiral and the disposable syringe in terms of fewer voids and better packing of obturating material in the root canal.
Though Pastinject has shown better efficacy, Lentulo Spiral can also be used in obturating root canals of primary teeth, as it has shown good quality obturation throughout the length of the root canals.
Limitations
More sample number is needed for better understanding of the comparison.
A volumetric study would have revealed more accurate results.
Orcid
Sudipta Adhya https://orcid.org/0009-0002-2569-7193
Footnotes
Source of support: Nil
Conflict of interest: None
References
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