JICDRO is a UGC approved journal (Journal no. 63927)

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ARTICLE
Year : 2009  |  Volume : 1  |  Issue : 2  |  Page : 57-64

Comparison of apical leakage between immediate versus delayed post space preparation using two resin sealers


1 Lecturer, Department of Conservative Dentistry & Endodontics, P.D.M. Dental College & Research Centre, Bahadurgadh, Haryana, India
2 Professor & H.O.D, Department of Conservative Dentistry, Endodontics & Esthetic Dentistry, Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune, India
3 Professor, Department of Conservative Dentistry, Endodontics & Esthetic Dentistry, Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune, India

Date of Web Publication4-Mar-2011

Correspondence Address:
Priyanka Kaushal Kalra
Lecturer, Department of Conservative Dentistry & Endodontics, P.D.M. Dental College & Research Centre, Bahadurgadh, Haryana
India
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Source of Support: None, Conflict of Interest: None


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   Abstract 

Post & Core Procedures have became an integral part of a dentist's arsenal. This study was carried out in order to assess the microleakage when immediate and delayed post space preparations were done using resin sealers. Immediate post space preparations showed lesser apical leakage as opposed to delayed post space preparation.


How to cite this article:
Kalra PK, Mulay S, Aggarwal S. Comparison of apical leakage between immediate versus delayed post space preparation using two resin sealers. J Int Clin Dent Res Organ 2009;1:57-64

How to cite this URL:
Kalra PK, Mulay S, Aggarwal S. Comparison of apical leakage between immediate versus delayed post space preparation using two resin sealers. J Int Clin Dent Res Organ [serial online] 2009 [cited 2019 May 20];1:57-64. Available from: http://www.jicdro.org/text.asp?2009/1/2/57/77280


   Introduction Top


To examine & comparatively evaluate the effectiveness of the apical seal obtained when immediate Vs delayed post space preparation was done using [2] resin based sealers : AH Plus & RC Seal.

Majority of the endodontic failures are due to incomplete sealing of the root canal [1],[2] . Therefore, for the endodontic treatment to be successful, the materials used in canal obturation should have good sealing qualities, and the techniques used in manipulating these materials during and after the obturation should have minimal effect on their ability to produce a good seal.

During the preparation of post space, it is important not to disrupt the integrity of the apical seal. There has been much debate as to how, when and how much of the gutta-percha should be removed when making a post space.

This study was undertaken to examine and comparatively evaluate the effectiveness of the apical seal obtained when immediate versus delayed post space preparation was done using two resin based sealers: AH Plus and RC Seal; when a continuous wave of condensation was used as a method of obturation. Also the comparative apical sealing ability of the two sealers was assessed after post space preparation.


   Materials and Method Top


Seventy extracted single rooted, single, straight canalled human anterior teeth were selected for the study.

The extracted teeth were cleaned using ultrasonic scaler tips. The teeth were decoronated to a length of 16 mm and a flat occlusal plane was prepared for each tooth to serve as a fixed coronal reference point for all the measurements.

Standard access to the root canal system was prepared. After establishment of working length, using 15 K file, biomechanical preparation was done till apical size 50 K file using a step back technique with frequent recapitulation of files to establish a progressively tapering root canal preparation. The coronal two thirds of each canal was flared using Gates Glidden drills no. 1, 2 and 3. Chemical cleaning of the canal was achieved with 15% EDTA gel & 5 ml of 5% sodium hypochlorite solution.

The final rinse was done with 10 ml of 17% EDTA solution for 1 min followed by 10 ml of 5 % sodium hypochlorite solution and 0.9 % Normal saline.

The teeth were dried with paper points and randomly divided into six groups. Group I- IV contained 15 teeth each. Group V & VI served as positive & negative controls respectively and contained 5 teeth each.

Group I: Obturation using AH Plus sealer followed by immediate post space preparation [AHP Imm]

Group II: Obturation using AH Plus Sealer followed by delayed post space preparation [AHP Del]

Group III: Obturation using RC Seal sealer followed by immediate post space preparation. [RCS Imm]

Group IV: Obturation using RC Seal sealer followed by delayed post space preparation. [RCS Del]

Group V: Positive control.

Group VI: Negative control.

The instrumented specimens were taken and standardized gutta-percha master cones of size 50 were selected for each specimen. The sealers were manipulated according to the manufacturer's instructions and were introduced into the prepared canal using a lentulospiral no. 40. The obturations were carried out using the E & Q Plus system as recommended by the manufacturer. After compaction of the gutta-percha at the apical end, all canals were backfilled with thermoplasticized gutta-percha using the E & Q gun provided in the kit.

Radiographs were taken to evaluate the status of the root canal filling. If the obturation appeared to be inadequate, the root canal filling was removed and refilled.

In groups I and III, post space was prepared immediately at the time of obturation using Peezo reamers in a slow speed handpiece at a constant rpm, to a depth that left 5 mm of remaining gutta-percha apically in the root canal. [3] The post space was prepared till Peezo size 3. Multiple studies have demonstrated that there is no difference in leakage between removing gutta-percha with hot instruments and removing it with rotary instruments. [3],[4],[5],[6]

In Group V Positive control was formed by teeth that were only obturated with gutta-percha to fit tug-back with no sealer. Group VI consisted of negative control. Here the teeth were instrumented, with no obturation material placed and the teeth were completely sealed with sticky wax and finger nail polish.

All the teeth were placed in capped vials containing 2x2 inch gauze pads saturated with normal saline at 37o C in an incubator for 1 week after obturation, to simulate the clinical situation.

The post space in group II and IV (after 1 week) was then prepared in the same manner as in Groups I and III.

After the post space preparation, the coronal opening was sealed with sticky wax and two coats of finger nail polish was applied to cover the entire length of the root canal surface except the last 2 mm.

Placement of the specimens in the dye:

All the specimens including the positive and negative controls were vertically suspended in 2% aqueous solution of Methylene Blue dye buffered to pH 7 for 24 hrs. Thereafter, the specimens were taken out and washed under running tap water for 20 minutes. The specimens were sectioned using diamond coated disc longitudinally.

Measurement of dye penetration:

The specimens were taken and mounted on a stand and the coronal extent of the dye penetration was measured using a Stereomicroscope. The measurements were made at a magnification of 6.5X. The data was analyzed using the Students unpaired t-test. The "t" value; and "p" value at 95% level of significance was determined to interpret the results of the study.


   Results Top


Immediate post space preparation done using AH Plus sealer showed the least amount of dye penetration of at the end of 24hrs. This is significantly less than that of delayed post space preparation using AH Plus sealer. (p=0.000). It is also the least amount of dye penetration observed amongst all the groups.

Delayed post space preparation done using AH Plus sealer showed dye penetration which was significantly more than immediate post space preparation. (P=0.000).

Immediate post space preparation done using RC Seal sealer showed a mean dye penetration that was significantly less than that of delayed post space preparation using RC Seal sealer (p=0.000).

Though RC Seal showed higher mean leakage than AH Plus in both immediate (p=0.136) and delayed (p=1.000) groups, the leakage between the two were not significantly different

The negative control group showed no leakage at all.

The positive control showed maximum dye penetration.




   Discussion Top


The process of dowel space preparation subsequent to obturation may influence the ultimate prognosis of the case. Leakage after obturation, if occurs, can take place either at gutta-percha sealer interface or at the sealer dentinal wall interface. Therefore, physical properties of the sealer and the possible effect of a post space preparation on the sealer become important. [7]

The negative control group showed no leakage at all, indicating the two coats of nail varnish were efficient enough in preventing dye penetration. The positive control showed maximum dye penetration, thereby confirming the efficacy of Methylene blue dye penetration in leakage studies. [8]

Immediate post space preparation done using AH Plus sealer showed the least amount of dye penetration of at the end of 24hrs. This could be explained by the fact that AH Plus is a epoxy resin sealer and has an 8 hour setting time. Hence, when the post space is prepared at the time of obturation itself, the sealer has not yet formed a lasting bond to the gutta-percha or the canal wall. When the heated instrument or a rotary instrument is inserted into the canal to remove the gutta-percha, the sealer is still within its working time. This allows the sealer to set without introducing microfractures where the sealer is in contact with the gutta-percha and the root canal wall. When the sealer is set during the delayed post space preparation, it is possible that the rotational forces and vibrations of the mechanical drills cause movement of the gutta-percha, thus breaking the bond at the sealer interface. [9]

The second possible reason could be the dimensional changes of the material upon setting. All epoxy based materials show some expansion after setting. AH Plus expanded up to 0.4% after 4 weeks and depicted a slight but continuous expansion up to 1.2% during the next 4 week period in a study by Orstavik D et al, 2001. [10]

The uninterrupted setting of the sealer may occur followed by its slight expansion that is achieved when the post space is prepared immediately after obturation. This may also contribute towards the observations of low amounts of dye penetration in the groups with immediate post space preparation.

Delayed post space preparation done using AH Plus sealer showed dye penetration which was significantly more than immediate post space preparation. (P=0.000).

The reason for the increased dye penetration in this group could be due to the fact that when the sealer is set during the delayed post space preparation, it is possible that the rotational forces of the mechanical drills cause movement of the gutta-percha, thus breaking the adhesive bond at the sealer interface.

Similarly, immediate post space preparation done using RC Seal sealer showed a mean dye penetration that was significantly less than that of delayed post space preparation using RC Seal sealer (p=0.000).

Delayed post space preparation using RC Seal sealer showed a dye penetration that was higher than the corresponding immediate group and the difference was statistically significant (p=0.000).

The above mentioned reasons for AH Plus could also justify the similar observations found in the second resin based sealer i.e. RC Seal in groups of immediate and delayed post space preparation respectively.

The insignificant leakage between AH Plus & RC Seal groups could be due to the fact that both AH Plus and RC Seal belong to the same genre of epoxy resin based root canal sealers. The non significant but higher microleakage observed with RC seal could be due to its poor initial adaptation, solubility and disintegration, improper blending of filler particles, filler particle size or film thickness. [11],[12]

The results of this study that compare the leakage between the immediate versus delayed groups are in agreement with the results of Karapanou V et al, 1996, Fernando Solano et al, 2005, Kwan and Harrington, 1981, Portell et al, 1982. [7],[9],[13],[14]

Some authors have suggested no significant difference between immediate and delayed post space preparation [15],[16] . Therefore in addition, before accepting a new material for routine clinical use, further clinical experiments should also be performed to evaluate other aspects of the materials' physical properties and biological properties such as biocompatibility, adhesion, solubility, disintegration, radiopacity and dimensional stability.


   Conclusion Top


With the help of the above results, we can safely conclude that the time of post space preparation has a strong influence on the outcome and is probably a good indicator of success or failure of post endodontic treatment.[Table 1],[Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5],[Figure 6].
Table 1: Mean and SD values of apical leakage in all groups

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Figure 1: Apical leakage seen in immediate post space preparation using AH Plus sealer

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Figure 2: Apical leakage seen in immediate post space preparation using AH Plus sealer

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Figure 3: Apical leakage seen in immediate post space preparation using AH Plus sealer

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Figure 4: Apical leakage seen in immediate post space preparation using AH Plus sealer

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Figure 5: Positive control

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Figure 6: Negative control

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   References Top

1.Ingle JI, Leif K, Beveridge EE, Glick DH, Hoskinson AE. Modern Endodontic Therapy in Ingle JI & Bakland LK: "Endodontics' 5th Ed, p  Back to cited text no. 1
    
2.Dow PR, Ingle JI. Isotope determination of root canal failure. Oral Surg 1955; 8: 1100-4.  Back to cited text no. 2
    
3.Mattison GD, Delivanis PD, Thacker RW, Hassel KJ. Effect of post preparation on apical seal. J Prosthet Dent 1984; 51:785-9  Back to cited text no. 3
    
4.Dickey DJ, Harris GZ, Lemon RR, Luebke RG. .Effect of post space preparation on apical seal using solvent techniques and peezo reamers. J Endod, 1982, 8:351-4  Back to cited text no. 4
    
5.Camp, LR & Todd MJ. The effect of dowel preparation on the apical seal of three common obturating techniques. Journal of prosthetic Dentistry, 1983; 50, 664-666.  Back to cited text no. 5
    
6.Hiltner RS, Kullid JC, Weller RN. Effect of mechanical versus thermal removal of gutta percha on the quality of apical seal following post space preparation. J Endod 1992, 18:451-5  Back to cited text no. 6
    
7.Karapanou V, Vera J, Cabrera P, White RR, Goldman. Effect of immediate versus delayed post space preparation on apical dye leakage using two different sealers. J Endod, 1996, 22 (11): 583-585.  Back to cited text no. 7
    
8.Matloff IR, Jenson JR, Singer L & Tabibi A. A comparison of methods used in root canal sealability studies. Oral Surgy, Oral Med and Oral Patho , 1982; 53: 203-208.  Back to cited text no. 8
    
9.Solano F, Hartwell G, Appelstein C. Comparison of apical leakage between immediate versus delayed post space preparation using AH Plus sealer. J Endod 2005, 31:752-4.  Back to cited text no. 9
    
10.Orstavik D, Nordahl I, Tibbalis JE. Dimensional change following setting of root canal sealer materials. Dent Mater 2001; 17:512-9.  Back to cited text no. 10
    
11.McMichen FR, Pearson G, Rahbaran S, Gulabivala K. A comparative study of selected physical properties of five root canal sealers. Int Endod J, 2003; 36: 629-635.  Back to cited text no. 11
    
12.Mahajan VA, Kamra AI. An in-vitro evaluation of apical sealing of three epoxy resin based commercial preparations. J Endodontology, June 2007, 19 (1):7-11.  Back to cited text no. 12
    
13.Kwan EH, Harrington GW. The effect of immediate post space preparation on apical seal. J Endod 1981, 7: 325-9  Back to cited text no. 13
    
14.Portell FR, Bernier WE, Lorton I Peters DD. The effect of immediate versus delayed dowel space preparation on the integrity of apical seal. J Endod, 1982, 8: 154-60.  Back to cited text no. 14
    
15.Zmener O. Effect of dowel preparation on the apical seal of endodontically treated teeth. Journal of Endodontics, 1980; 6: 687- 690  Back to cited text no. 15
    
16.Bourgeois RS, Lemon RR Dowel space preparation and apical leakage. J Endod 1981; 7: 66-9  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1]



 

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