Journal of Conservative Dentistry
Home About us Editorial Board Instructions Submission Subscribe Advertise Contact e-Alerts Login 
Users Online: 587
Print this page  Email this page Bookmark this page Small font sizeDefault font sizeIncrease font size
 


 
Table of Contents   
ORIGINAL RESEARCH ARTICLE  
Year : 2018  |  Volume : 21  |  Issue : 2  |  Page : 221-225
Influence of ultrasonics on the penetration depth of AH plus, acroseal, and EndoREZ root canal sealers: An in vitro study


Department of Conservative Dentistry and Endodontics, Chhattisgarh Dental College and Research Institute, Rajnandgaon, Chhattisgarh, India

Click here for correspondence address and email

Date of Submission28-Dec-2016
Date of Decision20-Nov-2017
Date of Acceptance09-Jan-2018
Date of Web Publication22-Mar-2018
 

   Abstract 

Aim: The aim of this study is to evaluate the effect of ultrasonic activation on the penetration depth of AH Plus, Acroseal, and EndoREZ sealers into dentinal tubules using Confocal laser microscopy.
Methods: A total of 60 single-rooted teeth were prepared and divided into three groups on the basis of the type of sealer used (G1: AH Plus, G2: Acroseal and G3:EndoREZ). Each group was further subdivided into two equal subgroups on the basis of ultrasonic activation of sealers and nonactivation. Teeth were obturated and coronally sealed with GIC. Horizontal sections at 2 mm, 4 mm, and 6 mm from the apex were obtained, and the depth of sealer penetration into the dentinal tubules was measured using confocal laser scanning microscopy. Statistical analysis was performed using Students unpaired t-test, ANOVA, and Tukey's multiple comparison test.
Results: Within the three groups, ultrasonically activated subgroups showed significantly (P < 0.05) higher depth of sealer penetration. Among the groups, Group 1 showed significantly (P < 0.05) higher depth of sealer penetration than Group 2 and Group 3 while the difference between Group 2 and Group 3 was not significant (P > 0.05).
Conclusion: The use of ultrasonic activation with AH Plus sealer showed better results.

Keywords: Confocal microscopy; tubular penetration; ultrasonic activation

How to cite this article:
Prasad P K, Sankhala A, Tiwari A, Parakh S, Madan GR, Singh A. Influence of ultrasonics on the penetration depth of AH plus, acroseal, and EndoREZ root canal sealers: An in vitro study. J Conserv Dent 2018;21:221-5

How to cite this URL:
Prasad P K, Sankhala A, Tiwari A, Parakh S, Madan GR, Singh A. Influence of ultrasonics on the penetration depth of AH plus, acroseal, and EndoREZ root canal sealers: An in vitro study. J Conserv Dent [serial online] 2018 [cited 2019 Aug 25];21:221-5. Available from: http://www.jcd.org.in/text.asp?2018/21/2/221/228274

   Introduction Top


During the past two decades, the field of endodontics as a specialty has shown noticeable improvements in the development of newer materials that have significantly altered the treatment modalities and enhanced the success. The presence of gaps and porosities at the sealer/dentin interface is one of the common causes of failure of endodontic treatment. The complete sealing of the root canal system can result in the better prognosis of the treatment.[1],[2] As the gutta-percha lacks adhesion to the dentinal walls, the sealer should fill the canal irregularities and the tubules of the root canal system.

Resin-based sealers are said to be associated with reduced solubility, better apical seal, and microretention to the root dentin.[3],[4],[5] One of these sealers is AH Plus (Dentsply Maillefer, Switzerland), which has been thoroughly studied for its physicochemical properties, tissue response, and interfacial adaptation.[6],[7],[8] Acroseal (Septodont, France) is an epoxy resin based sealer that contains 28% calcium hydroxide in its composition. Various studies have shown its sealing ability, activity against Enterococcus faecalis, and adaptation to the root canal walls.[8],[9],[10] Endorez (Ultradent, USA) is a methacrylate-based endodontic sealer that is hydrophilic in nature. Endorez is said to exhibit excellent adaptation to root canal walls, well tolerated by periapical tissues with minimal cytotoxicity.

Ultrasound was first introduced to endodontics by Richman in 1957. Currently, it has been advocated in a range of endodontic procedures.[11] A greater agitation of irrigating solutions promoted by ultrasound increases their energy, thereby intensifying their penetration into the dentinal tubules and consequently improving the cleaning ability. The activation of root canal sealers may improve their penetration inside the dentinal tubules, improving sealability [12] and antimicrobial effects.[13] The effect of ultrasonic activation of different sealers has not been explored sufficiently. Hence, this study was undertaken to evaluate the effect of ultrasonic activation on the penetration depth of AH-plus, Acroseal, and EndoREZ sealers into dentinal tubules using Confocal laser microscopy.


   Methods Top


Sixty freshly extracted human single-rooted teeth without any previous endodontic treatment, fractures, resorptive defects, calcifications or open apices were selected for the study. They were cleaned of any residual tissue tags, rinsed under running water, and stored in 10% formaline solution. The crowns were removed at the cementoenamel junction using a diamond disc (DFS, Germany), and the root canal length was established at 15 mm. After the removal of pulp tissue, the working length was established by measuring the penetration of a size 10 K-file (MANI, PRIME DENTAL) until it reached the apical foramen and then subtracting 1 mm. Root canal shaping was performed using ProTaper rotary instruments (Dentsply Maillefer) up to F4.

During instrumentation, each canal was irrigated with 3% sodium hypochlorite solution (HYPO 3, Xenon Biomed, India) using a syringe with 27G needle placed 1 mm short of the working length. At the end of shaping, the root canal was filled with 3% NaOCl and was ultrasonically activated by placing the tip 1 mm short of working length.[14] A final flush of 2 mL 18% EDTA (Ultradent, USA) was done for 60 s to eliminate the smear layer. The canals were washed with saline solution (Claris Otsuka Limited) and dried with paper points (Dentsply Maillefer).

The specimens were randomly divided into three groups of 20 each according to the sealer used (n = 20):

  • Group 1: AH-PLUS
  • Group 2: ACROSEAL
  • Group 3: ENDOREZ.


The sealers were manipulated according to the manufacturer's instructions. To allow visualization under a confocal laser microscope, each sealer was mixed with fluorescent rhodamine B dye (Loba chemie, India) in a concentration of 0.1% by weight.[15] The sealers were placed in each root canal using a size 40 paste carrier (MANI, PRIME DENTAL), maintaining the instrument 4 mm from the apex.

Each group of specimens was further divided into two subgroups (n = 10) according to the ultrasonic activation of the sealers:

  • Subgroup 1: Ultrasonic activated (A)
  • Subgroup 2: Nonultrasonic activated (NA).


As the ultrasonic oscillates in a single plane, the activation in Subgroup 1 of each group was done in two planes simultaneously, i.e., for 20 s in the buccolingual direction and another 20 s in the mesiodistal direction of the root canal, 2 mm short of the working length as a standardization procedure (EMS, Switzerland, power level 1). After activation, all the canals were obturated with F4 and size #20 (0.02) gutta-percha. Access cavity was sealed with Glass ionomer cement (GC Corporation). The specimens were placed in 100% humidity at 37°C for 1 week to allow the sealer to set.

After 1 week, the specimens were sectioned horizontally at 2, 4, and 6 mm levels from the apical foramen and polished with sandpaper. The segments of the root canal in which the sealer penetrated into the dentinal tubules were analyzed under Confocal laser scanning microscope (Zeiss LSM 510, Germany). For a correct visualization of all images, the sections were analyzed under 10X lens. The respective absorption and emission wavelengths for the rhodamine B were set to 561 and 575 nm, respectively. The images were recorded at 100X magnification using the fluorescent mode. Images were analyzed using LSM Image Browser Software (Carl Ziess Microimaging GmbH) [Figure 1].
Figure 1: Confocal laser scanning microscopic images showing sealer penetration with and without ultrasonic activation at the level of 2 mm, 4 mm, and 6 mm from the apex

Click here to view


Statistics

The depth of sealer penetration into the dentinal tubules was measured and recorded. Data were collected and statistically analyzed using Students unpaired t-test, ANOVA, and Tukey's multiple comparison test.


   Results Top


The depth of sealer penetration of different groups and subgroups comparison is summarized in tables [Table 1] and [Table 2].
Table 1: Multiple comparison: Tukey's test for comparison among ultrasonically activated groups

Click here to view
Table 2: Multiple comparison: Tukey's test for comparison among ultrasonically nonactivated groups

Click here to view


Mean depth of sealer penetration of Group 1, 2, and 3 sealers was higher at 4 mm and 6 mm levels in ultrasonically activated subgroups and was statistically significant (P < 0.05). No significant difference was seen at 2 mm level.

Irrespective of the ultrasonic activation Group 1 showed better penetration than Group 2 and Group 3 at 4 mm and 6 mm levels (P < 0.05).


   Discussion Top


Technical and scientific advances in modern endodontic practice have resulted in wide acceptance of root canal therapy with an improved success rate. Numerous studies have demonstrated the importance of root canal sealer to fill irregularities and voids between nonadherent gutta-percha and canal walls during obturation. Most leakage studies have shown that the use of sealer results in significantly less leakage than when it is not used.[16],[17],[18]

The ultrasonic system properties of vibration, cavitation, and acoustic streaming are seemingly responsible for the improved canal system cleaning. Few authors showed that the ultrasonic activation of calcium hydroxide pastes advocated a higher pH level and calcium release promoting a greater tubular penetration. In accordance with the results mentioned previously, the present study showed that the ultrasonic activation improved dentinal sealer penetration which can promote confinement of microorganisms present in the dentinal tubules. In addition, sealer plugs inside the dentinal tubules provide a mechanical interlocking, hence improving the retention of the filling material along the root canal walls.[19]

In the present study, ultrasonically activated subgroups of each group showed better tubular penetration at 4 mm and 6 mm levels which were statistically significant (P < 0.05). These findings are similar to the studies done by Chandrasekhar et al.[20] and Nikhil and Singh.[21] It may be due to increased kinetic energy, thereby generating higher velocity and flow within the sealer due to ultrasonic activation, hence facilitating tubular penetration. Moreover, the ultrasonic energy apparently impels the relatively viscous sealer to the appropriate depth along the length of the file and horizontally into numerous canal aberrations.[22] The difference between the two subgroups with respect to the sealer penetration at 2 mm level was nonsignificant (P > 0.05). This is in close approximation to the studies done by Guimarães et al.[23] and Silva et al.[24] It may be attributed to poor smear layer removal at the apical region due to the reduced density of dentinal tubules. It can also be associated with increased dentinal sclerosis and a tendency of increasing peritubular dentin toward the apical region.[25]

Among the ultrasonically activated subgroups of all the three groups, Group 1 showed better tubular penetration than Group 2 and Group 3 at 4 mm and 6 mm level. The differences between ultrasonically activated subgroups were statistically significant between Group 1 and 2 as well as Group 1 and 3 (P < 0.05). The present study coincides with the studies of Chandrasekhar et al.,[20] H Arslan et al.,[26] Guimarães et al.,[23] and Nikhil and Singh [21] It may be attributed to the structure and better coherence of the matrix of AH plus sealer into the dentinal tubules.[27] No significant difference was seen in the tubular penetration among ultrasonically activated Group 2 and Group 3 at 4 mm and 6 mm levels (P = 0.757, P = 0.992). Comparatively, less penetration of Group 2 and Group 3 may be due to the poor adaptation and penetration ability of the sealers. Moreover, increased shrinkage occurs in EndoREZ sealer due to methacrylate structure.[28] At 2 mm level, no significant difference was observed among the three ultrasonically activated subgroups pertaining to sealer penetration. The poor penetration at 2 mm might be due to the direct physical contact of the activated file in the apically constricted area and thereby hampering the necessary nodes for acoustic streaming and cavitation.[29]

Among the nonactivated subgroups of all the three groups, a statistically significant difference was seen between the Groups 1 and 2 as well as Groups 1 and 3 at 4 mm and 6 mm levels (P < 0.05). This observation is similar to studies conducted by Balguerie et al.,[30] Vijay et al., and Chandra et al.[31] It may be associated with the reduced surface tension of AH plus sealer. Moreover, there was no statistically significant difference in the penetration depth of nonactivated Groups 2 and 3 at 2 mm, 4 mm, and 6 mm levels. These findings resemble studies of Sevimay and Kalayci [28] and Hoen et al.[22] This may be associated with the fact of poor removal of the smear layer and the ineffective delivery of irrigant to the apical region of the canal.

The tubular penetration depth may vary with the different physical and chemical properties of the sealers used. Formation of sealer plug inside the tubules may provide the mechanical interlocking leading to improved retention of the material.[32] Moreover, sealer penetration into the dentinal tubules increases the interface between sealer and dentin, thereby improving the sealing ability.[33] The present study focuses on the method of sealer activation as well as one of the desirable properties of an ideal root canal filling material, i.e., the bond between the filling material and dentine. The use of ultrasonic activation at different levels facilitated better dentinal sealer penetration with all the three sealers at the level of 4 mm and 6 mm from the apex. Ultrasonic activation proved to positively influence the sealer penetration hence promoting the longevity minimizing the chances of microleakage. Further studies should be conducted to analyze the entire canal rather than a portion with bigger sample size as penetration depth of sealer may be important in future endodontic treatment outcomes.


   Conclusion Top


Under the conditions of this in vitro study, following conclusions were drawn:

  1. Ultrasonic activation of sealers showed extensive tubular penetration at 4 mm and 6 mm level from the apex
  2. The difference in penetration of the sealers into the dentinal tubules was statistically significant between Groups 1 and 2 and Groups 1 and 3 (P < 0.05)
  3. The difference between Group 2 and Group 3 was nonsignificant (P > 0.05)
  4. No significant difference was seen among the groups at the level of 2 mm from the apex irrespective of with and without ultrasonic activation (P > 0.05).


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Buckley M, Spångberg LS. The prevalence and technical quality of endodontic treatment in an American subpopulation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;79:92-100.  Back to cited text no. 1
    
2.
Bouillaguet S, Shaw L, Barthelemy J, Krejci I, Wataha JC. Long-term sealing ability of Pulp Canal Sealer, AH-Plus, GuttaFlow and Epiphany. Int Endod J 2008;41:219-26.  Back to cited text no. 2
[PUBMED]    
3.
Carvalho-Júnior JR, Guimarães LF, Correr-Sobrinho L, Pécora JD, Sousa-Neto MD. Evaluation of solubility, disintegration, and dimensional alterations of a glass ionomer root canal sealer. Braz Dent J 2003;14:114-8.  Back to cited text no. 3
    
4.
Sousa-Neto MD, Passarinho-Neto JG, Carvalho-Júnior JR, Cruz-Filho AM, Pécora JD, Saquy PC, et al. Evaluation of the effect of EDTA, EGTA and CDTA on dentin adhesiveness and microleakage with different root canal sealers. Braz Dent J 2002;13:123-8.  Back to cited text no. 4
    
5.
Tagger M, Tagger E, Tjan AH, Bakland LK. Measurement of adhesion of endodontic sealers to dentin. J Endod 2002;28:351-4.  Back to cited text no. 5
[PUBMED]    
6.
Leonardo MR, Flores DS, de Paula E Silva FW, de Toledo Leonardo R, da Silva LA. A comparison study of periapical repair in dogs' teeth using RoekoSeal and AH plus root canal sealers: A histopathological evaluation. J Endod 2008;34:822-5.  Back to cited text no. 6
[PUBMED]    
7.
Duarte MA, Ordinola-Zapata R, Bernardes RA, Bramante CM, Bernardineli N, Garcia RB, et al. Influence of calcium hydroxide association on the physical properties of AH plus. J Endod 2010;36:1048-51.  Back to cited text no. 7
[PUBMED]    
8.
Marciano MA, Guimarães BM, Ordinola-Zapata R, Bramante CM, Cavenago BC, Garcia RB, et al. Physical properties and interfacial adaptation of three epoxy resin-based sealers. J Endod 2011;37:1417-21.  Back to cited text no. 8
    
9.
Vasconcelos BC, Bernardes RA, Duarte MA, Bramante CM, Moraes IG. Apical sealing of root canal fillings performed with five different endodontic sealers: Analysis by fluid filtration. J Appl Oral Sci 2011;19:324-8.  Back to cited text no. 9
[PUBMED]    
10.
Pinheiro CR, Guinesi AS, Pizzolitto AC, Bonetti-Filho I.In vitro antimicrobial activity of Acroseal, Polifil and Epiphany against Enterococcus faecalis. Braz Dent J 2009;20:107-11.  Back to cited text no. 10
    
11.
Plotino G, Pameijer CH, Grande NM, Somma F. Ultrasonics in endodontics: A review of the literature. J Endod 2007;33:81-95.  Back to cited text no. 11
    
12.
Wu MK, de Gee AJ, Wesselink PR. Effect of tubule orientation in the cavity wall on the seal of dental filling materials: An in vitro study. Int Endod J 1998;31:326-32.  Back to cited text no. 12
    
13.
Heling I, Chandler NP. The antimicrobial effect within dentinal tubules of four root canal sealers. J Endod 1996;22:257-9.  Back to cited text no. 13
    
14.
van der Sluis LW, Shemesh H, Wu MK, Wesselink PR. An evaluation of the influence of passive ultrasonic irrigation on the seal of root canal fillings. Int Endod J 2007;40:356-61.  Back to cited text no. 14
    
15.
D'Alpino PH, Pereira JC, Svizero NR, Rueggeberg FA, Pashley DH. Use of fluorescent compounds in assessing bonded resin-based restorations: A literature review. J Dent 2006;34:623-34.  Back to cited text no. 15
    
16.
Marshall FJ, Massler M. The sealing of pulpless teeth evaluated with radioisotopes. J Dent Med 1961;16:172-84.  Back to cited text no. 16
    
17.
Kapsimalis P, Evans R. Sealing properties of endodontic filling materials using radioactive polar and non-polar isotopes. Oral Surg 1966;22:386-93.  Back to cited text no. 17
    
18.
Hovland EJ, Dumsha TC. Leakage evaluation in vitro of the root canal sealer cement Sealapex. Int Endod J 1985;18:179-82.  Back to cited text no. 18
    
19.
Nikhil V, Bansal P, Sawani S. Effect of technique of sealer agitation on percentage and depth of MTA Fillapex sealer penetration: A comparative in-vitro study. J Conserv Dent 2015;18:119-23.  Back to cited text no. 19
[PUBMED]  [Full text]  
20.
Chandrasekhar V, Rudrapati L, Badami V, Anita Rao S, Tummala M, Majethi C. To compare the pursuance of ultrasonic activation at distinct planes of endodontic therapy on filling superiority of different root canal sealers. Br J Med Med Res 2016;14:1-9.  Back to cited text no. 20
    
21.
Nikhil V, Singh R. Confocal laser scanning microscopic investigation of ultrasonic, sonic, and rotary sealer placement techniques. J Conserv Dent 2013;16:294-9.  Back to cited text no. 21
[PUBMED]  [Full text]  
22.
Hoen MM, LaBounty GL, Keller DL. Ultrasonic endodontic sealer placement. J Endod 1988;14:169-74.  Back to cited text no. 22
    
23.
Guimarães BM, Amoroso-Silva PA, Alcalde MP, Marciano MA, de Andrade FB, Duarte MA, et al. Influence of ultrasonic activation of 4 root canal sealers on the filling quality. J Endod 2014;40:964-8.  Back to cited text no. 23
    
24.
Silva RV, Silveira FF, Horta MC, Duarte MA, Cavenago BC, Morais IG, et al. Filling effectiveness and dentinal penetration of endodontic sealers: A Stereo and confocal laser scanning microscopy study. Braz Dent J 2015;26:541-6.  Back to cited text no. 24
    
25.
Ballal NV, Kandian S, Mala K, Bhat KS, Acharya S. Comparison of the efficacy of maleic acid and ethylenediaminetetraacetic acid in smear layer removal from instrumented human root canal: A scanning electron microscopic study. J Endod 2009;35:1573-6.  Back to cited text no. 25
    
26.
Arslan H, Abbas A, Karatas E. Influence of ultrasonic and sonic activation of epoxy-amine resin-based sealer on penetration of sealer into lateral canals. Clin Oral Investig 2016;20:2161-4.  Back to cited text no. 26
    
27.
Kokkas AB, Boutsioukis ACh, Vassiliadis LP, Stavrianos CK. The influence of the smear layer on dentinal tubule penetration depth by three different root canal sealers: An in vitro study. J Endod 2004;30:100-2.  Back to cited text no. 27
    
28.
Sevimay S, Kalayci A. Evaluation of apical sealing ability and adaptation to dentine of two resin-based sealers. J Oral Rehabil 2005;32:105-10.  Back to cited text no. 28
    
29.
Ahmad M, Pitt Ford TJ, Crum LA. Ultrasonic debridement of root canals: Acoustic streaming and its possible role. J Endod 1987;13:490-9.  Back to cited text no. 29
    
30.
Balguerie E, van der Sluis L, Vallaeys K, Gurgel-Georgelin M, Diemer F. Sealer penetration and adaptation in the dentinal tubules: A scanning electron microscopic study. J Endod 2011;37:1576-9.  Back to cited text no. 30
    
31.
Chandra SS, Shankar P, Indira R. Depth of penetration of four resin sealers into radicular dentinal tubules: A confocal microscopic study. J Endod 2012;38:1412-6.  Back to cited text no. 31
    
32.
White RR, Goldman M, Lin PS. The influence of the smeared layer upon dentinal tubule penetration by plastic filling materials. J Endod 1984;10:558-62.  Back to cited text no. 32
    
33.
Sen BH, Pişkin B, Baran N. The effect of tubular penetration of root canal sealers on dye microleakage. Int Endod J 1996;29:23-8.  Back to cited text no. 33
    

Top
Correspondence Address:
Dr. Abhishek Sankhala
S/O Shri N K Sankhala, 86/G North Sadar Ward, Dhamtari - 493 773, Chhattisgarh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCD.JCD_406_16

Rights and Permissions


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
 
  Search
 
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


    Abstract
   Introduction
   Methods
   Results
   Discussion
   Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed878    
    Printed21    
    Emailed0    
    PDF Downloaded153    
    Comments [Add]    

Recommend this journal