| Abstract|| |
Aim: The purpose of this study was to evaluate the effect of 17% ethylenediaminetetraacetic acid (EDTA) and 0.2% chitosan on pushout bond strength of biodentine and ProRoot mineral trioxide aggregate (MTA).
Materials and Methods: Midroot dentin of single-rooted human canine teeth were sectioned into 2-mm-thick slices horizontally (n = 60). The canal space of each dentin slice was enlarged with a 1.3-mm-diameter diamond bur. The samples were divided into two groups (n = 30) based on the type of perforation repair material placed, i.e., Biodentine and ProRoot MTA. The samples were wrapped in wet gauge for 10 min, and based on the type of chelating agent used for removal of smear layer, each group is further divided into three subgroups (n = 10), to be immersed into saline (control), 17% EDTA and 0.2% chitosan for 30 min, and a wet cotton pellet was placed over each test material. After 48 h of incubation, the dislodgement resistance of the samples was measured using a universal testing machine.
Statistical Analysis: Data were analyzed using one-way analysis of variance and post hoc Tukey tests. The level of statistical significance was set at 0.05.
Results: Biodentine showed significantly higher pushout bond strength than ProRoot MTA. Biodentine and ProRoot MTA lost strength when exposed to 0.2% chitosan.
Conclusion: Biodentine showed considerable performance as a perforation repair material than ProRoot MTA even after being exposed to various endodontic chelating agents.
Keywords: Biodentine; chelating agents; mineral trioxide aggregate; pushout bond strength
|How to cite this article:|
Prasanthi P, Garlapati R, Nagesh B, Sujana V, Kiran Naik K M, Yamini B. Effect of 17% ethylenediaminetetraacetic acid and 0.2% chitosan on pushout bond strength of biodentine and ProRoot mineral trioxide aggregate: An in vitro study. J Conserv Dent 2019;22:387-90
|How to cite this URL:|
Prasanthi P, Garlapati R, Nagesh B, Sujana V, Kiran Naik K M, Yamini B. Effect of 17% ethylenediaminetetraacetic acid and 0.2% chitosan on pushout bond strength of biodentine and ProRoot mineral trioxide aggregate: An in vitro study. J Conserv Dent [serial online] 2019 [cited 2020 Apr 6];22:387-90. Available from: http://www.jcd.org.in/text.asp?2019/22/4/387/270503
| Introduction|| |
Perforation is a procedural complication that can occur during endodontic therapy or post space preparation of teeth. Delayed perforation repair therapy can cause periodontal or endodontic lesions and lateral periodontal abscesses occurring secondary to delayed diagnosis, which usually prognosticates a high failure risk. Hence, immediate repair of perforation is important to avoid contamination and thereby preventing endodontic failure.
An ideal endodontic root repair material should be biocompatible, radiopaque, antibacterial, dimensionally stable, easy to manipulate, and unaffected by blood contamination. It should also remain in place under dislodging forces, such as mechanical loads of occlusion or the condensation of restorative materials over it. Therefore, the pushout bond strength is an important factor for perforation repair materials.
Although many perforation repair materials such as amalgam, cavity, composite resin, glass ionomer cement, calcium hydroxide, super EBA, intermediate restorative material, and mineral trioxide aggregate (MTA) have been used, most of these materials show significant shortcomings in one or more of the following areas: solubility, leakage, biocompatibility, handling properties, and moisture incompatibility. Despite the numerous favorable properties of MTA that support its clinical use when compared with other traditional materials, there are several critical drawbacks of MTA such as the prolonged setting time, difficult handling characteristics, high cost, and potential of discoloration. A variety of new calcium silicate-based materials have been developed recently aiming to improve MTA shortcomings.
Biodentine is introduced as an alternative to MTA. Biodentine (septodont) 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.
After repairing the furcal perforation, endodontic treatment should be performed with various irrigants to disinfect the root canal system, including chelating agents for smear layer removal. During biomechanical preparation, the smear layer is formed over the cut dentinal surfaces. Various agents, such as sodium hypochlorite, ethylenediaminetetraacetic acid (17% EDTA), mixture of tetracycline acid detergent, and organic acids (e.g., citric acid), have been introduced for smear layer removal. The alternating use of 17% EDTA and sodium hypochlorite has been recommended for the efficient removal of the smear layer. However, the use of these solutions may cause periapical inflammatory reactions and reduce periapical healing. 17% EDTA, which is the most commonly used calcium chelator, has inhibited the setting of MTA. To minimize their harmful effects on periapical tissues, the use of biocompatible solutions is essential.
Chitosan is a natural polysaccharide that is biocompatible, nontoxic, and having chelating property. Chitosan is natural polysaccharide obtained by the deacetylation of chitin, but it has limited solubility. Chitosan and chitin do not cause any biological hazard, and both are inexpensive. Chitosan exhibits many biological actions such as antimicrobial, wound healing, mucoadhesive, sustained drug releasing property. Chitosan is used as as a chelating agent and as an irrigating solution during endodontic treatment.
Hence, in this study, smear layer removing agents 17% EDTA and 0.2% chitosan were used. Root canal treatment procedure may cause unavoidable contact of chelating solutions with the repair materials. Thus, the purpose of this in vitro study was to evaluate the effect of chelating agents, i.e., 17% EDTA, 0.2% chitosan on the pushout bond strength of biodentine in comparison with ProRoot MTA.
| Materials and Methods|| |
Freshly extracted single-rooted human canine teeth were selected. The crowns of all teeth were removed, and the midroot dentin was sectioned horizontally into slices with a thickness of 2 mm (n = 60) using hard tissue microtome. In each slice, the space of canal was enlarged with a 1.3-mm-diameter diamond bur. The specimens (n = 60) were randomly divided into two groups (n = 30) and the following test materials were used: Group 1: Biodentine and Group 2: ProRoot MTA. The test materials were incrementally placed into canal spaces of the dentin slices and condensed. Excess material was trimmed from the surface of the samples with a scalpel. Subsequently, the samples were wrapped in wet gauze placed in incubator and allowed to set for 10 min at 37°C with 100% humidity. Setting time of biodentine is 10 min, so it was allowed to set for 10 min. As the initial setting time of ProRoot MTA is 10 min, it was allowed to set for 10 min only. Immediately after incubation, the samples were divided into three subgroups (n = 10) to be immersed into saline solution (control), 17% EDTA, 0.2% chitosan. After 30 min of immersion, all samples were removed from the test solutions, rinsed with distilled water, and were placed in incubator at 37°C with 100% humidity for 48 h.
After 48 h, the pushout bond strength values were measured using a universal testing machine (Instron Universal Machine) [Figure 1]. The samples were placed on a base of a metal slab of universal testing machine to allow the free motion of the plunger. The compressive load was applied by exerting a download pressure on the surface of test material in each sample, with the Instron probe moving at a constant speed of 1 mm/min. The plunger size of 1 mm had a clearance of approximately 0.2 mm from the margin of the dentinal wall to ensure contact only with the test materials. The maximum force applied to materials at the time of dislodgement was recorded in newtons. The pushout bond strength in megapascal (MPa) was calculated by dividing this force (N) by the surface area of the test material where N/2p × r × h, p is the constant 3.14, r is the root canal radius, and h is the thickness of the dentin slice in millimeters. Data were analyzed using one-way analysis of variance and post hoc Tukey tests. The level of statistical significant was set at P < 0.05.
| Results|| |
[Table 1] shows the mean values and standard deviations of the pushout bond strength (MPa) of all groups. The lowest pushout bond strength was observed in the ProRoot MTA group (P < 0.05). Biodentine displayed a significantly higher resistance to displacement than the ProRoot MTA group. In biodentine, saline (control) group showed the highest pushout bond strength whereas chitosan group showed the least pushout bond strength next to EDTA group. In ProRoot MTA, saline (control) group showed the highest pushout bond strength, whereas chitosan showed the least pushout bond strength next to EDTA group [Figure 2].
|Table 1: Mean pushout bond strength values and standard deviations of all test groups|
Click here to view
|Figure 2: Comparison of six groups (biodentine – control, biodentine – chitosan, biodentine – ethylenediaminetetraacetic acid, mineral trioxide aggregate – control, mineral trioxide aggregate – chitosan and mineral trioxide aggregate – ethylenediaminetetraacetic acid)|
Click here to view
| Discussion|| |
After repair of the perforation, the success of the endodontic therapy depends on a well-placed coronal restoration as well as the resistance of the repair material to displacement forces happening while undergoing condensation of permanent restorative materials. Thus, the bond strength of the perforation repair materials is an important factor in clinical practice. To assess the bond strength, the pushout bond test has been shown to be efficient, practical, and reliable.,
The presence of smear layer may inhibit or significantly delay the penetration of irrigating solutions, sealers, and medicaments into the dentinal tubules. There is a controversy regarding the presence and removal of smear layer. It is now generally advocated that the smear layer should be removed prior to the root canal obturation to facilitate better adaptation of the filling material to the root canal wall and to improve adhesion.
Alternate use of EDTA and NaOCl as retro smear layer removing agents may cause periapical inflammatory reactions at surgical site. Calt et al. observed that usage of EDTA for prolonged periods caused excessive tubular and intertubular dentin erosion. Hence, the use of biocompatible retro smear layer removing agents is essential. Chitosan is a natural polysaccharide that is biocompatible, nontoxic, and having chelating property.
This study evaluated the pushout bond strength between biodentine and ProRoot MTA after exposure to endodontic chelating agents, i.e., 17% EDTA and 0.2% chitosan. In the present study, among ProRoot MTA groups, saline-treated ProRoot MTA samples resisted dislodgment forces >17% EDTA-treated ProRoot MTA samples and 0.2% chitosan-treated ProRoot MTA samples. This was in accordance with the results of the study done by Loxely et al. who reported that the compressive strength of MTA increased when immersed in saline solution because of the remaining unreacted mineral oxides. These may be solidified after additional supplied hydration and may result in the increased strength of material.
ProRoot MTA samples treated with 17% EDTA showed lower resistance to dislodgement forces. Lee et al. showed the adverse effects of 17% EDTA on calcium silicate-based cement (CSC) hydration. Yan et al. showed that 17% EDTA decreased the bond strength between dentine and CSC. Nagesh et al. reported that sealing ability of MTA with chitosan was less.
Biodentine has a similar composition to MTA, differing mostly by being aluminum-free and having tantalum oxide as a radiopacifier in place of the bismuth oxide. This is claimed to be associated with improved biological property. The presence of calcium chloride, and the concordant reduced setting time and contact time, probably provided the high-bond strength in biodentine group.
Biodentine was more resistant to dislodgement forces than MTA in the present study. The biomineralization ability of biodentine, most likely through the formation of tags, may be the reason of the dislodgement resistance. The higher bond strength values of biodentine may, in part, result from its smaller particle size, which has the potential to enhance penetration of the cement into the medicament-free dentinal tubules, leading to improved bond strength. This effect might be further reinforced through the formation of dentinal bridges as a result of crystal growth within the dentinal tubules, leading to increased micromechanical retention (Han and Okiji 2011, Atmeh et al. 2012). Biodentine may have a more prominent biomineralization ability than MTA, as biodentine specimens showed wider Caand Sirich dentine areas and larger incorporation depths than MTA. This could be because of the amount of Ca and Si dissolution that could be larger in biodentine than in MTA. Chemical analysis of the interfacial dentine layer confirmed increased Ca levels and Ca/P ratios in the biodentine and MTA specimens. This finding is related to Ca incorporation. As such, the quality of the interfacial dentine layer appeared to be improved. The higher content of calcium-releasing products in biodentine than in MTA may promote to higher biomineralization and higher bond strength.
Biodentine also displayed a lower resistance to dislodgement after exposure to 17% EDTA and chitosan solutions. Lee et al. showed the adverse effects of 17% EDTA on CSC hydration, microhardness, and cell adhesion. In addition, Yan et al. showed that EDTA decreased the bond strength between dentine and CSC. Uyanik et al. examined the effect of different irrigation regimens on the sealing ability of CSC and showed that using EDTA significantly increases leakage of CSC. In another study, CSC showed significantly higher leakage when smear layer was removed before placing the material. This might be because of the reaction between CSC and residual EDTA inside the root canal. Pushout bond strength is reduced when exposed to chitosan due to more chelation property which interferes with the setting reaction of CSCs.
| Conclusion|| |
Within the limitations of this in vitro study, it can be concluded that:
- The force needed for dislodgement of biodentine from root dentin was significantly higher than ProRoot MTA
- Endodontic chelating agents influence the resistance to dislodgement of biodentine and ProRoot MTA.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Guneser MB, Akbulut MB, Eldeniz AU. Effect of various endodontic irrigants on the push-out bond strength of biodentine and conventional root perforation repair materials. J Endod 2013;39:380-4.
Gluskin AH, Peters CI, Wong RD Ming, Ruddle CJ. Retreatment of non-healing endodontic therapy and management of mishaps. In: Ingle JI, Bakland LK, Baumgartner C, editors. Text book of Endodontics. 6th
ed. Hamilton, Ontario, USA: BC Decker; 2008. pp. 1088-61.
Sharma A, Bal CS, Bhullar K, Malhotra S. Bonding ability of perforation repair materials with the tooth structure. Indian J Compr Dent Care 2015;5:518-22.
Saghiri MA, Shokouhinejad N, Lotfi M, Aminsobhani M, Saghiri AM. Push-out bond strength of mineral trioxide aggregate in the presence of alkaline pH. J Endod 2010;36:1856-9.
Üstün Y, Topçuoǧlu HS, Akpek F, Aslan T. The effect of blood contamination on dislocation resistance of different endodontic reparative materials. J Oral Sci 2015;57:185-90.
Yahya MM. The effect of root canal irrigants on the push out bond strength of biodentine. Tikrit J Dent Sci 2015;1:69-75.
Nagesh B, Jeevani E, Sujana V, Damaraju B, Sreeha K, Ramesh P, et al.
Scanning electron microscopy (SEM) evaluation of sealing ability of MTA and EndoSequence as root-end filling materials with chitosan and carboxymethyl chitosan (CMC) as retrograde smear layer removing agents. J Conserv Dent 2016;19:143-6.
] [Full text]
Nandini S, Natanasabapathy V, Shivanna S. Effect of various chemicals as solvents on the dissolution of set white mineral trioxide aggregate: An in vitro
study. J Endod 2010;36:135-8.
Calt S, Serper A. Time-dependent effects of EDTA on dentin structures. J Endod. 2002;28:17-9.
Loxley EC, Liewehr FR, Buxton TB, McPherson JC. The effect of various intracanal oxidizing agents on the push-out strength of various perforation repair materials. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:490-4.
Lee YL, Lin FH, Wang WH, Ritchie HH, Lan WH, Lin CP. Effects of EDTA on the hydration mechanism of mineral trioxide aggregate. J Dent Res 2007;86:534-8.
Yan P, Peng B, Fan B, Fan M, Bian Z. The effects of sodium hypochlorite (5.25%), chlorhexidine (2%), and glyde file prep on the bond strength of MTA-dentin. J Endod 2006;32:58-60.
Uzunoglu E, Aktemur Turker S, Uyanik MO, Nagas E. Effects of mixing techniques and dentin moisture conditions on push-out bond strength of ProRoot MTA and Biodentine. J Adhes Sci Technol 2016;30:1891-8.
Han L, Okiji T. Uptake of calcium and silicon released from calcium silicate-based endodontic materials into root canal dentine. Int Endod J 2011;44:1081-7.
Nagas E, Cehreli ZC, Uyanik MO, Vallittu PK, Lassila LV. Effect of several intracanal medicaments on the push-out bond strength of ProRoot MTA and biodentine. Int Endod J 2016;49:184-8.
Akcay H, Arslan H, Akcay M, Mese M, Sahin NN. Evaluation of the bond strength of root-end placed mineral trioxide aggregate and biodentine in the absence/presence of blood contamination. Eur J Dent 2016;10:370-5.
] [Full text]
Uyanik MO, Nagas E, Sahin C, Dagli F, Cehreli ZC. Effects of different irrigation regimens on the sealing properties of repaired furcal perforations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:e91-5.
Dr. Pandi Prasanthi
Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Takkellapadu, Guntur 522 509, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2]