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 Table of Contents  
ORIGINAL RESEARCH
Year : 2020  |  Volume : 11  |  Issue : 4  |  Page : 97-102

Evaluation of the Marginal Adaptation of ProRoot MTA, Biodentine, and RetroMTA as Root-end Filling Materials


1 Dental Caries Prevention Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
2 Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran and School of Dentistry, Qom University of Medical Sciences, Qom, Iran
3 Faculty of Dentistry, Semmelweis University, Budapest, Hungary

Date of Submission29-Apr-2020
Date of Decision21-May-2020
Date of Acceptance28-Jun-2020
Date of Web Publication18-Nov-2020

Correspondence Address:
Farnaz Seyed Mostafaei
Student Research Committee, Qazvin University of Medical Sciences, Bahonar Blvd., Qazvin
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/denthyp.denthyp_50_20

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  Abstract 


Introduction: Evaluation of the marginal adaptation of root-end filling materials to root canal walls provides invaluable information on their sealing ability. Different materials, such as Mineral Trioxide Aggregate (MTA), have been used for root-end fillings. Recently, elements such as RetroMTA or Biodentine have been introduced to overcome the drawbacks of MTA. This research was carried out to evaluate the marginal adaptation of root-end filling materials, RetroMTA, Biodentine, and ProRoot MTA, using an experimental method. Materials and Methods: In this experimental research, 45 single-rooted teeth were prepared and obturated; then, 3 mm of the apical third of the roots were resected, and root-end cavities were prepared using a standard ultrasonic method. The teeth were randomly divided into three groups and filled with RetroMTA, Biodentine, and ProRoot MTA. After a week, epoxy resin replicas of the root-ended surfaces were provided after a longitudinal section. The size of gaps between the filling material and the canal walls were measured with SEM at longitudinal and transverse sections at eight points and compared between the three filling materials using one-way ANOVA. Results: The mean gaps between the filling material and canal wall in Biodentine, Retro-MTA, and MTA ProRoot groups in longitudinal sections were rated at 4.49 µm, 8.55 µm, and 14.34 µm, respectively (P = 0.007). However, no significant differences were identified between the three filling materials in transverse sections. Conclusion: The best marginal adaption in longitudinal sections were identified in Biodentine, RetroMTA, and MTA ProRoot, respectively. However, in transverse sections, there were no significant differences between the three materials.

Keywords: Marginal adaptation, mineral trioxide aggregate, ProRoot MTA, tricalcium silicate


How to cite this article:
Bolbolian M, Mostafaei FS, Faegh S. Evaluation of the Marginal Adaptation of ProRoot MTA, Biodentine, and RetroMTA as Root-end Filling Materials. Dent Hypotheses 2020;11:97-102

How to cite this URL:
Bolbolian M, Mostafaei FS, Faegh S. Evaluation of the Marginal Adaptation of ProRoot MTA, Biodentine, and RetroMTA as Root-end Filling Materials. Dent Hypotheses [serial online] 2020 [cited 2020 Dec 4];11:97-102. Available from: http://www.dentalhypotheses.com/text.asp?2020/11/4/97/300866




  Introduction Top


Most pulpoperiapical diseases result from the direct or indirect invasion of bacteria.[1],[2] In cases where the non-surgical root canal treatment outcome is unfavorable, surgical treatment may be prescribed.[3] The rationale of periradicular surgery is the elimination of the etiologic factor, sealing the apical area to prevent further infection of the area and to confine the remaining stimuli into the root canal system.[4],[5] Thus, endodontic surgeries consist of resecting the root end, preparation of root-end cavities, and filling them.[3] Several materials are used for sealing the retro end cavity preparation such as: amalgam, Intermediate Restorative Material (IRM), super EBA (Ethoxy Benzoic Acid), Mineral Trioxide Aggregate (MTA), Calcium Enriched Mixture (CEM), composite resin, gutta-percha, glass-ionomer cement, and Biodentine.[6] MTA contains tricalcium silicate, tricalcium aluminate, tetracalcium aluminoferrite, calcium sulfate, and bismuth oxide. Due to high biocompatibility and appropriate sealing ability, MTA is used as a material of choice for vital pulp therapy, pulp capping and pulpotomy,[7] apexification, and apical filling.[8],[9] MTA has high sealing ability and capability to stimulate osteoblasts.[10],[11] Therefore, it is used as a gold standard for retro and filling materials.[12] Drawbacks such as long setting time, high cost, the potential of color change, and inappropriate handling properties, have led to the search for newer materials.[13],[14]

Biodentine is a new material based on calcium silicate technology, which sets in 12 minutes after mixing. If a softener and an accelerator are added to its structure, working with this material becomes easier and its maximum physical properties are achieved for retrofilling procedures.[15] Recently, BioMTA Co. (South Korea) has marketed a material with very fine (2 μm) hydrophilic particles. The zirconia calcium complex is used as a radio opacifier in the structure of this material, and it contains calcium carbonate, aluminum oxide, silicon dioxide, and zirconium oxide. It is available in two forms, OrthoMTA and RetroMTA, with a high potential for biological mineralization. Its working time is 12.5 minutes, and its handling properties are favorable.[16]

Various methods have been used to measure microleakage and determine the quality of root canal treatments, including dye penetration, clearing, spectrophotometry, electrochemical,[17] radioisotope penetration, bacterial penetration, saliva penetration,[18] determination of marginal adaptation with electron microscopy (SEM), and fluid filtration.[18]

This in vitro study aimed to evaluate the marginal adaptation of ProRoot MTA, Biodentine, and RetroMTA as root-end filling materials, using the SEM technique.


  Materials and Methods Top


The in vitro study was approved by the Ethics Committee of Qazvin University of Medical Sciences (IR.QUMS.REC.1397.036).

Forty-five newly extracted one-rooted and single-canal human teeth were selected. After the removal of soft and hard tissues, radiographs were provided before evaluating the buccolingual and mesiodistal angles to confirm the single canal of roots and the absence of internal and external resorption, calcification, and cracks. The specimens were kept in 1% thymol solution[19] for one week and after being washed with water, they were kept in distilled water until they were used in experiments.

The tooth crowns were removed from the cementoenamel junction (CEJ), using a cylindrical bur (Tizkavan, Tehran, Iran) and high-speed handpieces. A standard length of 15 mm from the apex was obtained for all the specimens. The working length was 1 mm shorter than the apex, and the K-files (Mani, Inc., Japan) were visible at the apical foramina. The teeth were prepared using the standard method by ProTaper Rotary files system (Dentsply, Maillefer, Ballaigues, Switzerland) to the F3 file. The root canals were obturated with gutta-percha (Meta Bio-med Co., LTD, Seoul, Korea) and the AH26 sealer (Dentsply, De Trey, Konstanz, Germany) using lateral compaction technique. The apical 3-mm length of each root was resected at a right angle to the long axis of the tooth with a diamond fissure bur in a high-speed handpiece under water spray. Standard root-end cavities were prepared using an ultrasonic microsurgery tip (Varios 970, NSK, Japan) at a power of 6 according to the manufacturer’s instructions (NSK, Tokyo F 31D Japan) by removing gutta-percha in 3-mm depth. The head of E4D was used to create 0.5-mm-diameter cavities. Then the samples were evaluated under an optical microscope for any cracks. Samples with cracks were excluded from the study.

Grouping and measurements

The teeth were randomly assigned to three groups, and each group consists of 15 teeth. The retrograde cavities in group 1 were filled with Biodentine (Septodont®, France), in group 2 with RetroMTA (MetaBiomed, Seoul, Korea), and in group 3 with Proroot MTA (Dentsply Tulsa, Tulsa, OK, USA). The materials were prepared following the manufacturers’ recommendations. An MTA carrier was used to place the materials in the root-end cavities, followed by packing with pluggers. After this process, the samples underwent a radiography procedure for any possible voids. The samples were incubated at 37°C at 100% humidity for one week.

In the next stage, impressions were taken from the root-end sections of roots with extra-light and heavy consistencies of polyvinyl siloxane material (Panasil, Kettenbach GmbH & Co. KG, Germany). Epoxy resin with low viscosity (Epoxiran, Tehran, Iran) was mixed and molded according to the manufacturer’s instructions to prepare resin replicas. The molds were kept for 24 hours for complete setting. The roots were grounded longitudinally with a diamond bur until the gutta-percha and root-end filling materials were completely exposed to calculate the longitudinal interface between the root-end filling materials and the root-end cavity walls. Subsequently, resin replicas were obtained from the longitudinal section. Then the samples were sent to the laboratory where the epoxy resin replicas were mounted on metallic stubs, gold-sputtered and evaluated under a SEM (Vega II XMU, Tescan, Czech Republic) under ×30 to ×2000 magnification. The presence of gaps at dentin–material interface was evaluated and measured under an SEM by a blinded technician [Figure 1][Figure 2][Figure 3][Figure 4][Figure 5]. The sizes of transverse gaps in eight areas and longitudinal gaps in eight areas were measured and recorded. In each area, if there was a gap, the maximum gap size was used for calculations.
Figure 1: Longitudinal and transverse sections of the root end.

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Figure 2: Microleakage between the materials and the canal walls (shown with arrows) in a longitudinal section.

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Figure 3: RetroMTA sample.

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Figure 4: ProRoot MTA sample.

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Figure 5: Biodentine sample.

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Statistical analysis

The data were analyzed using SPSS 25 (SPSS Inc., Chicago, IL, USA). Comparison of marginal adaption in different areas of transverse and longitudinal sections with root-end filling materials was carried out using one-way ANOVA. p<0.05 was considered significant.


  Results Top


The mean (SD) gaps between the root-end filling material and root canal wall in the longitudinal section of the Biodentine, RetroMTA, and ProRoot MTA groups were 4.49 (6.09), 8.55 (5.25), and 14.34 (10.93) µm, respectively [Table 1]. The differences were statistically significant between the three groups (p = 0.007). The minimum mean gap between the filling material and root canal wall was recorded in the Biodentine group, with the highest in the ProRoot MTA group. RetroMTA group gaps were between these two groups. The mean (SD) gaps between the root-end filling materials and root canal walls in the transverse section in thev Biodentine, RetroMTA, and ProRoot MTA groups were 22.41 (36.86), 19.02 (16.56), and 7.79 (11.90) µm, respectively (p = 0.238) [Table 2]. The lowest mean gap was recorded in the ProRoot MTA group. RetroMTA material was placed between these two groups.
Table 1 Mean gaps in longitudinal sections (μm)*

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Table 2 Mean gaps in transverse sections (μm)*

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  Discussion Top


In the present study, the adaption of root-end filling materials containing ProRoot MTA, RetroMTA, and Biodentine was evaluated using the epoxy resin replica technique and SEM observations. SEM observations of the original samples of root canal are associated with some disadvantages. In addition to its two-dimensional nature, the preparation of tooth roots before the SEM observations under a high-vacuum condition might lead to the separation of the material from the root-end cavity wall and dehydration of the root-end filling material and tooth structure, finally resulting in crack formation and artifacts.[20],[21] To overcome these problems, the resin replica technique has been suggested to determine the marginal adaptation of dental materials.[21],[22] It has been reported that making replicas using epoxy resin − similar to the method used for the present research − can simulate adaption at 1–2-μm level, which is an extremely appropriate scale.[23] In the present research, the adaptation of root-end filling materials was simulated on resin replicas with longitudinal and transverse sections of the roots in different areas. Ghorbanzadeh et al.[24] used the same method for determining the standard marginal adaption of root-end filling materials. In the present research, standard retrograde cavities were prepared using the ultrasonic micro-surgery technique. The ultrasonic technique provides better control and greater ability for creating centrality in the created canal and reduces the risk of perforation.[25] According to the present research results, in longitudinal sections, the difference between the filling materials was significant from the marginal adaption standard point of view. Biodentine exhibited the best marginal adaptation in the longitudinal section, followed by RetroMTA and ProRoot MTA. However, in transverse sections, no significant differences were observed between the root-end filling materials from the standard marginal adaption point of view. One of the reasons for better marginal adaptation of MTA at the depth of the retrograde cavity is easier handling and the size of the smallest particles that adapt well with the cavity walls[26]; besides, MTA has favorable firmness that makes packing easier at the depth of the cavity.

Malhotra and Hegde[27] in 2015, used the methylene blue penetration technique. The lowest microleakage was reported in Biodentine, followed by ProRoot MTA, MTA Angelus, and glass-ionomer. In the present research, the standard of the depth of dye penetration was measured using a stereomicroscope. In addition, Gundam et al.[28] evaluated the marginal adaption of MTA, glass-ionomer cement, and IRM as retrofilled root-end materials, using direct SEM observation, with 1-mm root-ending cross-sections. The gaps at the interface of the tooth and the filling material were measured, and the smallest gap sizes were observed in MTA, consistent with the present research. However, in the present research, no significant difference was observed in transverse sections.[28] The type of MTA used in the study above was not specified. Ravichandra et al.[15] evaluated the marginal adaptation of Biodentine, Proroot MTA, and glass-ionomer in three transverse sections, using confocal microscopy and dye penetration, and showed that Biodentine marginal adaption was better in comparison with the other groups, which is different from the results of the present research in transverse sections. The difference in the technique used to determine the standard marginal adaption (dye penetration vs. SEM) and different transverse sections under consideration are relevant in the two studies.

It has been reported that the cutting angles of tooth roots can impact the results of the marginal root-end filling material.[21] Root-end filling materials might have appropriate marginal adaptation in one of the directions of the root canal walls. However, at the same time, the adaptation to root canal walls in the other direction, or in general, is not favorable. In the present research, the standard of marginal adaptation of root-end filling material of Biodentine with canal walls in the longitudinal sections was more favorable than the other materials. According to the present results, the size of gaps in the longitudinal and transverse sections was different in root-end filling materials, and their sizes were overestimated in in some transverse sections and longitudinal sections. For example, large gaps were observed with Biodentine in transverse sections, while in longitudinal sections, the gaps were much smaller.

It is difficult to compare the results of different studies due to the use of different protocols to evaluate marginal adaptation, that is, direct observation or the use of resin replicas, the angles of the root sections, the instruments and tools used to determine gap sizes in different studies, incubating or not incubating the specimens at 100% humidity, and the use of different storage environments, such as water or wet gas.[29],[30] Exposure of root-end filling materials in different condition before the estimation of marginal adaptation might affect the results. In the present study, the specimens were stored at 37°C and 100% humidity for a week for complete setting. It has been shown that when the incubation time increases before evaluation of microleakage, the marginal adaptation of root-end filling materials increases.[30],[31] The MTA root-end filling material has exhibited more favorable marginal adaptation compared to amalgam, Vitremer, and IRM.[21],[30] Given the similarities between the structures of RetroMTA and MTA, the above-mentioned mechanisms for MTA are applicable to RetroMTA, too. It should be noted that the materials used in the present study for the retrograde procedure were not exposed to a Phosphate-Buffered Solution environment, which is one of the limitations of the present study.


  Conclusion Top


Despite several different studies on the standard of root-end filling materials, it is not still clear what degree of gap formation can be problematic in clinical conditions. Also, complex clinical conditions, like host defense, can affect the results and their interpretation. Therefore, further clinical and experimental studies are necessary. In this study, Biodentine exhibited the best marginal adaptation in longitudinal sections, but in transverse sections, there were no significant differences between the materials.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
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