| Abstract|| |
Background: Perforation repair materials should have excellent sealing ability and dislodgement resistance. While several materials have been employed for perforation repair, newer calcium-silicate materials, such as Biodentine and TheraCal LC, have shown promising outcomes.
Aims: This study aimed to evaluate the effect of different irrigants on the dislodgement resistance of Biodentine and TheraCal LC when used for perforation repair in simulated conditions.
Methods and Material: 3% sodium hypochlorite, 2% chlorhexidine gluconate, and 17% EDTA were evaluated for their effect on the dislodgement resistance of Biodentine and TheraCal LC. 48 permanent mandibular molars were selected for the study. The samples were divided into two groups: Group I – Biodentine and Group II – TheraCal LC, with 24 samples each.
Statistical Analysis: The mean dislodgement resistance and standard deviation of Group I (Biodentine) and Group II (TheraCal LC) were compared and Failure pattern analysis was done.
Results: Biodentine showed a significant decrease in push-out bond strength after contact with 3% NaOCl, 2% CHX, and 17% EDTA whereas, TheraCal LC showed no significant decrease in push-out bond strength after exposure to 3% NaOCl, 2% CHX, and 17% EDTA.
Conclusions: Overall, TheraCal LC can be considered good perforation repair material with excellent physical and biological properties.
Keywords: Biodentine; irrigation; perforation repair; push-out bond strength; TheraCal LC
|How to cite this article:|
Sethi S, Bhushan J, Joshi RK, Singla R, Sidhu K. Effect of different irrigants on the push-out bond strength of biodentine and TheraCal LC when used for perforation repair in simulated condition. J Conserv Dent 2023;26:321-5
|How to cite this URL:|
Sethi S, Bhushan J, Joshi RK, Singla R, Sidhu K. Effect of different irrigants on the push-out bond strength of biodentine and TheraCal LC when used for perforation repair in simulated condition. J Conserv Dent [serial online] 2023 [cited 2023 Sep 21];26:321-5. Available from: https://www.jcd.org.in/text.asp?2023/26/3/321/372281
| Introduction|| |
Perforation is defined as a “mechanical or pathological communication between the root canal system and the external tooth surface, which is caused by caries, resorption, or iatrogenic factors.” A good perforation repair material should have an excellent sealing ability and dislodgement resistance to withstand the functional forces and forces of condensation acting on it. The prognosis of a root perforation is determined by the site and size of the perforation, the duration between diagnosis and management, and the type of sealing material used.
Several materials such as amalgam, composite, cavit, calcium hydroxide, glass ionomer cement, decalcified freeze-dried bone, intermediate restorative material, super ethoxy–benzoic acid, and mineral trioxide aggregate (MTA) have been employed for perforation repair. However, these materials have numerous limitations such as the risk of discoloration, higher solubility, poor sealing abilities, biocompatibility, poor handling qualities, moisture incompatibility, high cost as well as prolonged setting time.
Newer calcium-silicate materials, notably Biodentine (Septodont, Saint-Maur-des-Fossés, France) have recently been introduced to compensate for various shortcomings of MTA. Its various application includes retrograde fillings, pulp-capping procedures, apexification, resorptions, and dentine replacement. Studies have shown promising outcomes of Biodentine as a perforation repair material.
TheraCal LC (Bisco Inc., Schaumburg, IL, USA) is a novel light-cured calcium silicate-containing material. According to numerous studies, TheraCal LC owns the bioactive property. It can stimulate hydroxyapatite formation which aids in its superior chemical bonding than MTA and Biodentine., TheraCal LC is mainly used as a liner, base, and pulp-capping agent. Considering the physical and biological properties of TheraCal LC, which are comparable to other root perforation repair materials, it seems to have the potential for perforation repair.
The unavoidable interaction of various irrigants with perforation repair materials can affect their push-out bond strength. Hence, this study aimed to evaluate the effect of 3% sodium hypochlorite (NaOCl), 2% chlorhexidine gluconate (CHX), and 17% ethylenediaminetetraacetic acid (EDTA) on the dislodgement resistance of Biodentine and TheraCal LC.
| Materials and Methods|| |
The study obtained ethical clearance from the institutional research committee with reference number PUIEC210312-I-022. Forty-eight permanent mandibular molars except third molars were selected. Teeth with carious and cracked pulpal floor, resorption, and root canal treatment were excluded from the study.
Preparation of sample
All the obtained samples were decoronated at the cementoenamel junction using a diamond disk. An intentional perforation was created in the furcation area using a round bur (BR-46 Mani, Japan). The size of the perforation was sequentially enlarged from #2 to #5 GG drill (Mani, Japan) to obtain a standardized diameter of 1.3 mm and depth of 1.5 mm in all the samples. Thereafter, the root sections were mounted in acrylic molds with a 3 mm space beneath the perforation. All the samples were divided into two groups (24 samples each): Group I – Biodentine and Group II – TheraCal LC.
A piece of hemostatic sponge was placed beneath the furcation area using a hand plugger (Hu-Friedy, Chicago, US). This would serve as a matrix for perforation repair material. To simulate clinical conditions, the blood collected from a biochemistry laboratory was injected into the pulp chamber space. Samples were irrigated with distilled water using a 27 gauge needle to clean the perforation site. Excess water was then removed with paper points and perforation repair was carried out. Group I and Group II were repaired using Biodentine (Septodont, Saint Maur des Fosses, France) and TheraCal LC (Bisco Inc., Schaumburg, IL, USA), respectively. Biodentine powder was mixed with five drops of liquid and triturated in an amalgamator at 4000 rpm for 30 s, carried to the perforation area using an MTA carrier, and condensed properly with a hand plugger (Hu-Friedy, Chicago, US). TheraCal LC was placed in the perforation area in not more than 1 mm increments and light-cured for 20 s. Subsequently, all the samples were covered in moist cotton and incubated at 37°C with 100% humidity for 10 min. Depending on the type of irrigant, each experiment group was subsequently divided into four subgroups (n = 6).
Biomechanical preparation of root canals
After the perforation repair, biomechanical preparation was done. The working length was taken radiographically using the #10 k file (Mani, Japan) and canals were prepared using Hylex CM (Coltene/Whaledent, Altstatten, Switzerland) with a rotational speed and torque of 500 rpm and 2.5 N/cm, respectively. First, the orifice and coronal third were prepared with a 25/0.08 file. Subsequently, sizes 15/0.04, 20/0.04, 25/0.04, 20/0.06, and 30/0.04 were used. In between the instrumentation canals were irrigated as follows:
Groups Ia and IIa – 5 ml of 3% NaOCl was used for 1 min after each instrument change followed by a final rinse with distilled water.
Groups Ib and IIb – 5 ml of 2% CHX was used for 1 min after each instrument change followed by a final rinse with distilled water.
Groups Ic and IIc – 5 ml of 3% NaOCl for 1 min followed by 5 ml of 17% EDTA for 1 min was used after each instrument change followed by a final rinse with distilled water.
Groups Id and IId – distilled water was used
Subsequently, all the samples were incubated at 37°C with 100% humidity for 48 h.
Push-out bond strength test
To evaluate the dislodgement resistance of tested materials push-out bond strength test was performed with a universal testing machine. The samples were mounted on a metal slab and compression force was applied to the test materials with a 1 mm diameter plunger. The crosshead speed of the plunger was kept at 1 mm/min. The peak force at the time of dislodgement was measured in newtons. This measured force was divided by the surface area of test material (N/2prh) to calculate the push-out bond strength in megapascals where P is the constant 3.14, r is the radius of perforation, and h is the height of perforation.
Nature of bond failures
Subsequently, all the tested samples were placed under a stereomicroscope (Carl Zeiss, Oberkochen, Germany) at ×16 to determine the failure pattern. The failure patterns were classified into the following three types: cohesive, adhesive, and mixed failures [Figure 1].
|Figure 1: Stereomicroscopic images of the types of bond failures. (a) Cohesive failure, (b) adhesive failure, and (c) mixed failure|
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| Results|| |
Push-out bond strength
The mean dislodgement resistance and standard deviation of Group I (Biodentine) and Group II (TheraCal LC) are listed in [Table 1]. Group I had a significantly lower mean push-out bond strength value than Group II [P < 0.05, [Table 2]]. Biodentine showed a significant decrease in push-out bond strength after contact with 3% NaOCl, 2% CHX, and 17% EDTA as compared to control (P < 0.05). On the contrary, TheraCal LC showed no significant decrease in push-out bond strength after exposure to 3% NaOCl, 2% CHX, and 17% EDTA (P > 0.05).
|Table 1: Mean push-out bond strength and standard deviation of all the tested samples of Group I (Biodentine) and Group II (TheraCal light-cured)|
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Failure pattern analysis
Biodentine showed maximum cohesive failures (62.5%) followed by mixed (20.8%) and adhesive failures (16.7%). TheraCal LC showed maximum cohesive failures (75%) followed by mixed (16.7%) and adhesive failures (8.3%) [Graph 1].
| Discussion|| |
Contact of perforation repair material with various irrigants and blood can inadvertently affect their physical properties and consequently affect the treatment outcome. A perforation repair material ought to have adequately high dislodgement resistance to withstand the functional forces and forces of condensation. Push-out bond strength test is widely employed to study the dislodgement resistance of perforation repair materials in endodontics. This test is preferred over other bond strength tests as it is more accurate and reliable, and creates shear stress similar to clinical conditions. Hence, this study intends to measure the impact of 3% NaOCl, 2% CHX, and 17% EDTA on the dislodgement resistance of Biodentine and Theracal LC when used for perforation repair in simulated clinical conditions.
The dislodgement resistance of TheraCal LC was significantly greater than Biodentine (P < 0.05). These results are in accordance with previous studies.,, This can be attributed to the presence of a hydrophilic monomer (polyethylene glycol dimethacrylate) which absorbs water during the setting reaction and leads to its expansion during the setting. This expansion of TheraCal LC could enhance its penetration into dentinal tubules and hence contribute to its enhanced bond strength to dentine.
Irrigation with 3% NaOCl significantly reduced the dislodgement resistance of Biodentine as compared to TheraCal LC (P < 0.05). These findings are consistent with previous studies., Grech et al. found that the final setting time of Biodentine is 45 min. PalatyŃska-Ulatowska et al. stated that NaOCl irrigation should be performed after 24 h to allow complete setting and maturation. Since in this study, irrigation was performed after 10 min this could conceivably affect the push-out bond strength of Biodentine.
Irrigation with 2% CHX significantly decreased the dislodgement resistance of Biodentine as compared to TheraCal LC (P < 0.05). This is in accordance with previous studies by Tiwari et al. Contact of 2% chlorhexidine within 24 h of placement decreases the surface hardness of white MTA. Aggarwal et al. stated that 2% chlorhexidine significantly affects the physical properties of MTA.
Irrigation with 17% EDTA significantly decreased the dislodgement of Biodentine as compared to TheraCal LC (P < 0.05). These results are in agreement with a study by Prasanthi et al. and Do Prado et al., EDTA chelates with calcium ions released during the hydration of MTA and consequently affects the physical properties of MTA. Govindaraju et al. found a decrease in the compressive strength of Biodentine after exposure to EDTA. Uyanik et al. found that EDTA significantly increases the leakage of calcium silicate-based materials. Both Biodentine and TheraCal LC release calcium ions during their setting phase but Biodentine releases more calcium than TheraCal LC. Hence, EDTA could have a more negative effect on the dislodgement resistance of Biodentine than Theracal LC.
In this study, 3% NaOCl, 2% CHX, and 17% EDTA did not significantly affect the dislodgement resistance of TheraCal LC. This is because after light-curing the monomers present in TheraCal LC create an external polymeric resin network that stabilizes the outer surface of the cement and prevents its subsequent interaction with irrigants.
Biodentine showed maximum cohesive failures (62.5%) followed by mixed (20.8%) and adhesive failures (16.7%). These results are in accordance with previous studies that also found predominately cohesive types of bond failures in Biodentine.,, Possible explanation could be the biomineralization ability and calcium uptake into the dentine leading to the tag-like structure which favors the cohesive failure under the dislodging forces. TheraCal LC showed maximum cohesive failures (75%) followed by mixed (16.7%) and adhesive failures (8.3%). This is in accordance with a previous study by Fares et al. In addition to calcium uptake by the dentine, TheraCal LC also exhibits higher fluidity and hygroscopic expansion which in turn leads to its better penetration in the dentinal tubules. This imparts an additional frictional resistance to TheraCal LC under dislodging forces. The combination of all these factors contributes to the superior adhesion of TheraCal LC to dentine and results in predominantly cohesive failures.
| Conclusion|| |
TheraCal LC showed better performance compared to Biodentine even after exposure to various irrigants. Hence, TheraCal LC appears to be an appropriate material for perforation repair. However, more in vitro studies are required to comprehend the effect of irrigants on the chemical composition and surface topography of Biodentine and TheraCal LC.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Dr. Jagat Bhushan
Department of Conservative Dentistry and Endodontics, Dr. Harvansh Singh Judge Institute of Dental Sciences and Hospital, Panjab University, Chandigarh
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2]