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

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ORIGINAL RESEARCH
Year : 2019  |  Volume : 11  |  Issue : 1  |  Page : 9-13

Comparative evaluation of the effect of various endodontic irrigants on the push-out bond strength of endosequence, Biodentine™, and MTA Plus™ root repair materials: An in vitro study


Department of Conservative Dentistry and Endodontics, Dr. D.Y Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India

Date of Web Publication24-Jun-2019

Correspondence Address:
Dr. Nitika Tiwari
Flat No. D-303, Poorva Residency, Shiv Sai Lane, Pimple Saudagar, Pune - 411 027, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jicdro.jicdro_3_19

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   Abstract 


Aim: This study aimed to evaluate and compare the effects of 2% chlorhexidine and 3% sodium hypochlorite (NaOCl) irrigating solutions on the push-out bond strength of EndoSequence, Biodentine™, and MTA Plus™ root repair materials. Materials and Methods: Teeth were decoronated, and the midroot was sectioned horizontally into slices with the thickness of 2.0 mm with the help of diamond discs. The canal space was enlarged to diameter of 1.4 mm with the help of Gates-Glidden Drill. The samples were divided into three groups (n = 12). EndoSequence, Biodentine™, and MTA Plus™ root repair materials were condensed in the canal space and allowed to set for 10 min. The three groups were further subdivided into two subgroups each. Each material was immersed in NaOCl and chlorhexidine gluconate (CHX), respectively, for 30 min, rinsed with distilled water, and allowed to set for 48 h at 37°C with 100% humidity in an incubator. The push-out bond strength value was then measured using a universal testing machine. Data obtained were statistically analyzed. Results: EndoSequence root repair material (ERRM) proved to have the highest push-out bond strength followed by Biodentine™ and MTA Plus™ root repair materials. In subgroups, CHX in contact with ERRM showed the highest push-out bond strength followed by NaOCl, whereas Biodentine™ when in contact with NaOCl showed more push-out bond strength than when in contact with CHX. MTA Plus™ in contact with CHX showed the least push-out bond strength. Conclusion: The push-out bond strength of ERRM significantly increased after exposure to NaOCl and has the highest push-out bond strength followed by Biodentine™, and MTA Plus™ has the least push-out bond strength.

Keywords: Biodentine™, chlorhexidine, EndoSequence, MTA Plus™ root repair materials, push-out bond strength, sodium hypochlorite


How to cite this article:
Tiwari N, Borkar AC, Tandale A, Nighot N, Ghare S, Maral S. Comparative evaluation of the effect of various endodontic irrigants on the push-out bond strength of endosequence, Biodentine™, and MTA Plus™ root repair materials: An in vitro study. J Int Clin Dent Res Organ 2019;11:9-13

How to cite this URL:
Tiwari N, Borkar AC, Tandale A, Nighot N, Ghare S, Maral S. Comparative evaluation of the effect of various endodontic irrigants on the push-out bond strength of endosequence, Biodentine™, and MTA Plus™ root repair materials: An in vitro study. J Int Clin Dent Res Organ [serial online] 2019 [cited 2019 Aug 20];11:9-13. Available from: http://www.jicdro.org/text.asp?2019/11/1/9/260950




   Introduction Top


An endodontic therapy is considered successful when there is proper chemomechanical preparation of root canal system as well as three-dimensional obturation that completely seals the spaces previously filled by canal contents.[1] Procedural accidents that occur during endodontic treatment like perforation unfavorably affect the prognosis of the treatment. Root perforation is an artificial communication between root canal and periodontal tissues of the oral cavity.[2]

Root canal perforations in endodontics can occur during:

  • Access cavity preparation
  • Location of the canal and its identification
  • Instrumentation of the root canal
  • Preparation of postspace.[3]


Management of affluent repair of perforation creates a summons for a clinician.[4],[5] It is important to provide an adequate seal immediately to avoid further recontamination of the area.[6] Clinically, an endodontic repair material is used to repair the perforation site immediately to reduce bacterial load and irritation of periodontal tissues, which happens due to frequent utilization of root canal irrigants.[7]

Perforation repair materials chemically and mechanically bond to dentin and seal it. However, none of the materials were able to attain all the demands of a root canal perforation repair materials. Few materials have been introduced which fulfills almost all the demands of a perfect repair material, which are mineral trioxide aggregate (MTA), MTA Plus™, bioceramic, and Biodentine™.[8] However, MTA has some drawbacks, including difficulty in handling,[6] potential tooth discoloration, and high cost. Another major disadvantage of MTA is the long setting time of 140 min, and it is recommended to place a moist cotton pellet over MTA to allow for setting and to complete the treatment in another visit.[9],[10],[11]

MTA Plus™ has fragments which are finer in size and also have a larger area. Because of minute size of fragments, it has reduced setting time when compared to MTA. The minute particle size makes its manipulation and placement easier. MTA Plus™ kit is there to improve its washout resistance which has an optional gel as the mixing vehicle.[12]

Biodentine™ (Septodont, Saint Maur Des Fosses, France) is a high-purity calcium silicate-based dental material composed of tricalcium silicate, calcium carbonate, zirconium oxide, and a water-based liquid-containing calcium chloride as the setting accelerator and water-reducing agent.[13] It is recommended for use as a dentin substitute under resin composite restorations and an endodontic repair material because of its good sealing ability, high compressive strengths, short setting time, biocompatibility, bioactivity, and biomineralization properties. Biodentine™ promotes dentinogenesis by enrolling pulpal cells and its separation, also organizes transforming factors.[14] It shows active intercommunication with dentin and pulpal tissues bond.[15]

EndoSequence root repair material (ERRM) is a bioceramic material which is made out of calcium silicates, zirconium oxide, tantalum oxide, monobasic calcium phosphate, and fillers. The bioceramic material enters dentinal tubules and collaborates with the humidity available in the dentin because it is produced with nanosphere particles;[16] this makes a mechanical security during hardening of cement. Previous studies have proved that ERRM is biocompatible,[16],[17] seals root-end cavities,[18] bioactive,[19] antibacterial,[20] and has high compressive strength.[21] It sets in 20 min, and its hardening starts within the sight of humidity.[17]

The achievement of endodontic therapy relies upon the removal of microorganisms from the root canal channel and prohibition of reinfection. To achieve this, effective irrigation is of utmost importance.[18] After perforation repair, the clinician should proceed with nonsurgical endodontic therapy that causes unavoidable contact of the irrigant with the repair material. Hence, after perforation repair, there is unavoidable contact with the irrigants. Push-out test is a test to measure the interfacial shear strength developed between different surfaces. It provides information about the adhesive property of the material tested and helps to understand the resistance of the tested material to dislodgment. In endodontics, the push-out bond strength is done for root-end filling, perforation repair, obturation, and root canal sealer materials, to study their resistance to dislodgment.[19]

The aim of the present in vitro study was to assess the push-out bond strength of MTA Plus™, ERRM, and Biodentine™ root canal perforation repair materials after exposure to 3% sodium hypochlorite (NaOCl) and 2% chlorhexidine gluconate (CHX) irrigating solutions.[8]


   Materials and Methods Top


Eighteen extracted single-rooted permanent teeth were collected. The teeth were cleaned using ultrasonics and were stored in 2% thymol. The presence of a single canal was confirmed radiographically. Teeth were decoronated, and the midroot dentin was sectioned horizontally into slices with thickness of 2.0 mm with the help of diamond discs. The canal space was then enlarged to the diameter of 1.4 mm with the help of Gates-Glidden Drill [Figure 1].
Figure 1: enlarging root canal space with Gates-Glidden Drill

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The samples were divided into three groups: Group A – ERRM (n = 12), Group B – Biodentine™ root repair material (n = 12), and Group C – MTA Plus™ root repair material (n = 12).

The test materials were mixed according to the manufacturer's instructions and were incrementally placed into the canal spaces of the dentin slices and condensed. Excess material was trimmed from the surface of the samples with a scalpel [Figure 2]. Subsequently, the samples were wrapped in wet gauze, placed in an incubator, and allowed to set for 10 min at 37°C with 100% humidity. Immediately after incubation, the samples were divided into three subgroups for each test material. They were immersed in NaOCl and CHX, respectively for 30 min.
Figure 2: filled root canal spaces with root repair materials

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After 30 min of immersion, all samples were removed from the test solutions, rinsed with distilled water, and allowed to set for 48 h at 37°C with 100% humidity in an incubator.

Push-out test

The push-out test was carried out using a universal testing machine [Figure 3] (Instron Testing Machine; Model 5965, ITW, MA, USA). The samples were placed on a metal slap containing a central hole to allow for the free motion of the plunger with a 1.2 mm diameter, at a constant vertical downward pressure at a speed of 1 mm/min. The plunger tip was positioned to contact the test material only. The test was carried out until total bond failure. The highest force applied to materials at the time of dislodgment was recorded in megapascal.
Figure 3: checking push-out bond strength using a universal testing machine

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   Results Top


ERRM when immersed in NaOCl displayed greater push-out values compared to control groups.[1] Push-out bond strength was more when ERRM was in contact with 2% CHX compared to when in contact with NaOCl. Biodentine™ showed more push-out bond strength than MTA Plus™ but less than ERRM. It showed more strength when in contact with NaOCl rather than when in contact with CHX. MTA Plus™ demonstrated more push-out bond strength with NaOCl when compared to CHX[9] [Graph 1]. By applying Tukey–Kramer [Table 2] multiple comparison test, there is a significant difference between the mean values of push-out bond strength (MPa) in all study groups and control groups together (P = 0.0001).
Table 2: One-way ANOVA test: For all study groups together

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   Discussion Top


It has been reported that 47% of perforations occurred during endodontic treatment.[20] It is important to seal the defect of the perforated area immediately to avoid bacterial contamination and periodontal tissue irritation due to frequent usage of root canal irrigants.[7] Ideally, a perforation should be repaired with a biocompatible, nonabsorbable, radiopaque material, which imparts a compacted seal at the location.[8]

Calcium silicate-containing materials introduced in the market are MTA BioAggregate, MTA Angelus (Angelus), Biodentine™, MTA Plus™, and ERRM.[12] These materials have various advantages over the previous materials used which are bioactive, biocompatible, and antibacterial effect and good-sealing ability. Furthermore, they have reduced the setting time and improved mechanical properties.[21] Hence, this study was undertaken to evaluate and compare the effect of 2% CHX and 3% NaOCl irrigating solutions on the push-out bond strength of ERRM, Biodentine™, and MTA Plus™ root repair materials.

The results obtained at the end of this study [Table 3] showed that ERRM had the highest push-out bond strength when compared to MTA Plus™ and Biodentine™ when irrigated with 3% NaOCl and 2% CHX, and the lowest push-out bond strength was seen with MTA Plus™ [Table 1]. Shokouhinejad et al. in 2013[22] conducted a study using phosphate-buffered saline as an irrigant, which proved that higher bond strength values were obtained for ERRM as compared to MTA and Biodentine™. It can be attributed to greater adherence to dentinal walls and to the delivery system of these materials, which is premixed putty for ERRM and separate powder and liquid for both MTA and Biodentine™. Furthermore, the thickening and filler agents added to ERRM to make its putty form might be associated with higher bond strength. The presence of zirconium oxide in the ERRM might also result in higher bond strength of ERRM.[23] ERRM when immersed in NaOCl displayed greater push-out values compared to control groups[1] [Table 1]. Alsubait SA 2017 proved in her study that ERRM and ProRoot MTA immersed in NaOCl showed greater push-out values comparatively to control groups. It has been showed that NaOCl improved the physical property of ERRM.[1]
Table 3: One-way ANOVA test: For all study groups and control groups together

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Table 1: Comparison of mean and standard deviation values of push-out bond strength (MPa) in various groups under study

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Push-out bond strength of Biodentine™ was more than MTA Plus™ but less than ERRM. It showed more strength when in contact with NaOCl rather than when in contact with CHX [Table 1]. Aggarwal et al. proved in a study that Biodentine™ had an essentially higher push-out bond strength than MTA after 24-h setting time.[12] In another study conducted by Guneser et al., it was concluded that compressive strength of Biodentine™ increased when in contact with NaOCl.[24] Biodentine™ is more impervious to dislodgment forces than MTA Plus™ in the current investigation. It could be because of biomineralization capacity of Biodentine™, undoubtedly through the arrangement of tags which might be the reason of the dislodgment opposition.[3],[24]

MTA Plus™ demonstrated more push-out bond strength with NaOCl when compared to CHX[9] [Table 1]. This outcome was similar to Hong et al.,[25] who demonstrated that 2% CHX resulted in decreased push-out strength of MTA Plus™.[25],[26],[27]

CHX reduced the push-out bond strength of both Biodentine and MTA. This result was consistent with the results of Hong et al., who showed that 2% CHX reduced the push-out strength of accelerated MTA. Exposure to 2% CHX, even though it is not an acid, may result in a reduced surface hardness, a decreased sealing ability, a slower setting time, and a lower resistance to dislodgment forces. It has been proved that 2% CHX decreased the surface hardness of set white MTA significantly and suggested that CHX irrigation within 24 h of placement of white MTA should be avoided.[3]

Nikhade et al. in 2016 conducted a study in which root sections were filled with ERRM, MTA, and Biodentine. Root sections were randomly divided into two subgroups and immersed in PBS for 1 week and 3 weeks and concluded that MTA, Biodentine, and ERRM had higher bond strength values at 3 weeks compared with those observed at 1 week with phosphate-buffered saline. This could be attributed to the bioactivity of calcium silicate-based materials.[15],[28],[29]


   Conclusion Top


Within the limitation of this in viro study, it was concluded that among all the groups, the push-out bond strength of ERRM significantly increased after exposure to NaOCl and has the highest push-out bond strength followed by Biodentine™ and MTA Plus™.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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