Biodentine versus Mineral Trioxide Aggregate versus Intermediate Restorative Material for Retrograde Root End Filling: An Invitro Study.

Original Article Biodentine versus Mineral Trioxide Aggregate versus Intermediate Restorative Material for Retrograde Root End Filling: An Invitro Study Saravanapriyan Soundappan1, Jothi Latha Sundaramurthy2, Sandhya Raghu2, Velmurugan Natanasabapathy3 1 Post Graduate Student, Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India 2 Senior Lecturer, Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India 3 Professor and Head of the Department, Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India  Corresponding author: J. Latha Sundaramurthy , Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India Received: 5 July 2013 Accepted: 27 November 2013 Abstract Objective: The aim of this study was to evaluate the marginal adaptation of Biodentine in comparison with Mineral Trioxide Aggregate (MTA) and Intermediate Restorative Material (IRM), as a root end filling material, using Scanning Electron Microscopy (SEM). Materials and Methods: Thirty permanent maxillary central incisors were chemomechanically prepared and obturated. Three millimetres of the root end were resected and 3mm retro cavity preparation was done using ultrasonic retrotips. The samples were randomly divided into three groups (n=10) and were restored with root end filling materials: Group I– MTA, Group II – Biodentine, Group III –IRM. The root ends were sectioned transversely at 1mm and 2mm levels and evaluated for marginal adaptation using SEM. The gap between dentin and retro filling material was measured at four quadrants. The mean gap at 1mm level and 2mm level from the resected root tip and combined mean were calculated. The data were statistically analyzed, using one-way ANOVA and Tukey’s HSD post hoc test for intergroup analysis and paired t-test for intragroup analysis. Results: The overall results showed no statistically significant difference between MTA and IRM but both were superior when compared to Biodentine. At 1mm level there was no statistically significant difference among any of the tested materials. At 2mm level MTA was superior to both IRM and Biodentine. Conclusion: In overall comparison, MTA and IRM were significantly superior when compared to Biodentine in terms of marginal adaptation, when used as retrograde filling material. Keywords: Marginal adaptation; Biodentine; MTA; IRM; Root end filling material; Scanning electron microscopy Journal of Dentistry, Tehran University of Medical Sciences, Tehran, Iran (2014; Vol. 11, No. 2) INTRODUCTION The success of periapical surgery is dictated by elimination of infected tissues and adequate www.jdt.tums.ac.ir March 2014; Vol. 11, No. 2 apical seal [1]. Ideal apical seal prevents ingress of residual irritants into the periapical region and percolation of periapical tissue 143 1 Journal of Dentistry, Tehran University of Medical Sciences fluid in to the canal system [2]. Various root end filling materials have been tested for their sealing ability and newer materials are still under research. The root end filling material should possess ideal properties such as biocompatibility, dimensional stability, radiopacity, ability to set in a wet environment, antibacterial properties, easy handling, adequate compressive strength and hardness, osteoinductive and osteoconductive properties and adherence to the canal walls to provide a good apical seal [3,4]. Among the various root end filling materials tested, Mineral Trioxide Aggregate (MTA) has shown good sealing ability and biocompatibility in previous in-vitro and in-vivo studies [5]. In recent years, various materials like Biodentine [6], CER (Cemento Endodontico Rapido/ Fast endodontic cement) [7], ERRM (Endosequence Root Repair Material) [8] and Endocem (MTA- derived pozzolan cement) [9] have been introduced with the aim of overcoming some of the disadvantages of the MTA, such as the difficulties in handling and long setting time [10, 11, 12]. Biodentine is a relatively new material introduced as a dentine substitute. Biodentine powder is mainly composed of highly pure tricalcium silicate, which regulates the setting reaction. Other components are calcium carbonate (filler) and zirconium dioxide (radiopacifier). The liquid contains calcium chloride (setting accelerator), water reducing agent (superplasticizer) and water. The super-plasticizer reduces the viscosity of the cement and improves handling [6]. The manufacturer claims that this material can be used for pulp capping, pulpotomy, apexification, root perforation, internal and external resorption and also as a root end filling material in periapical surgery. In the previous studies, Biodentine showed biocompatibility and the ability to induce odontoblast differentiation and mineralization in cultured pulp cells [13]. The main benefits of Biodentine over other calcium silicate based materials are the reduced setting time, better handling and mechanical proper2144 Soundappan et. al ties [11]. The importance of marginal adaptation is that it may have an indirect correlation with the sealing ability of retro-filling materials. There is no previous study assessing the marginal adaptation of Biodentine when used as a root end filling material [14]. Hence, the aim of this study was to evaluate the marginal adaptation of Biodentine in comparison with MTA and IRM, as a root end filling material, using Scanning Electron Microscopy (SEM). MATERIALS AND METHODS Thirty freshly extracted maxillary central incisors with mature apices were selected for the study. All the teeth were cleaned, autoclaved and stored in 0.2% thymol solution until they were used. Access cavity preparation was done using a #2 round diamond point (NSK, Japan) and coronal preflaring was done using Gates-Glidden drills (MANI,Inc, Japan). Size #10 K-file (Mani, Inc, Japan) was introduced into the root canal until it was visible at the apex and then 1mm was subtracted from that point to establish the working length. Biomechanical preparation was done using step-back technique with apical enlargement up to #60 size K-file (Mani Inc., Japan). Copious irrigation with 3% sodium hypochlorite (Vensons, India) was done all through the procedure. Final irrigation was done with 17% EDTA (Prime Dental Products, India) followed by 3% sodium hypochlorite for 1 minute each and rinsing with saline. The canals were dried using absorbent points and obturation was done with 2% gutta percha points (Dentsply Maillefer, China) and zinc oxide eugenol sealer (Bombay Burmah trading corp., Mumbai, India), using the lateral condensation technique. After 24 hrs. of obturation, the root ends were resected 3mm from the apex using a No.1557 fissure bur; retrograde cavity was prepared to a depth of 3mm coaxially using surg (...truncated)