Filling Ability of Various Root Canal Sealers into Simulated Lateral Canals: An In Vitro Study

Nur Ayad Alalaf; Emad Farhan Alkhalidi

doi:10.4103/denthyp.denthyp_64_21

ORIGINAL RESEARCH

Year : 2022 | Volume : 13 | Issue : 2 | Page : 40-44

Filling Ability of Various Root Canal Sealers into Simulated Lateral Canals: An In Vitro Study

Nur Ayad Alalaf¹, Emad Farhan Alkhalidi²
¹ Ministry of Health-Nineveh Health Directorate, University of Mosul, Mosul, Iraq
² Ministry of Health-Nineveh Health Directorate; Department of Conservative Dentistry College of Dentistry, University of Mosul, Mosul, Iraq

Date of Submission	20-Jan-2021
Date of Decision	23-Apr-2021
Date of Acceptance	28-Dec-2021
Date of Web Publication	12-Jul-2022

Correspondence Address:
Nur Ayad Alalaf
Ministry Of Health-Nineveh Health Directorate
Iraq

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/denthyp.denthyp_64_21

Abstract

Background: This study aimed to assess and compare the depth of penetration of TotalFill BC, AH Plus Jet, and GuttaFlow Bioseal sealers into simulated lateral canals. Materials and Methods: A total of 30 extracted mandibular premolars were selected. Simulated lateral canals were made. The specimens were randomized into three experimental groups of 10 each. The specimens were cleared for visualization under a stereomicroscope at 10× magnification. The depth of penetration was assessed by a four-grade scoring system. Data were submitted to Fisher exact test at 5% significance. Results: There was statistically no significant difference among the experimental groups regarding the depth of penetration (P > .05). Conclusion: All root canal sealers experimented with herein showed a comparable depth of penetration in the simulated lateral canals regarding their filling ability.

Keywords: Clearing technique, filling ability, root canal sealer, simulated lateral canals

How to cite this article:
Alalaf NA, Alkhalidi EF. Filling Ability of Various Root Canal Sealers into Simulated Lateral Canals: An In Vitro Study. Dent Hypotheses 2022;13:40-4

How to cite this URL:
Alalaf NA, Alkhalidi EF. Filling Ability of Various Root Canal Sealers into Simulated Lateral Canals: An In Vitro Study. Dent Hypotheses [serial online] 2022 [cited 2023 Jun 5];13:40-4. Available from: http://www.dentalhypotheses.com/text.asp?2022/13/2/40/350792

Introduction

Root canal morphology presents with different anatomical complexities,^[1] limiting the ability of a clinician to achieve these goals owing the direct effect on chemomechanical preparation and filling of the root canal system; however, root canal morphology is a necessary prerequisite for the success of root canal treatment.^[2] The penetration of root canal sealer into dentinal tubules within anatomical complexities and main root canals increases the contact angle between root canal sealer and dentinal tubules, thus improving the sealing ability as a result of mechanical locking.^[3] The penetration of sealer is also important for entombing residual microorganisms within the tubules inaccessible by chemomechanical preparation.^[4] Hence, the concept of sealer penetrating dentinal tubules has created a requirement to improve the sealing ability of root canal fillings.^[5] Several techniques have been used to study the root canal system configuration, such as clearing technique with and without dye injection, sectioning technique, stereomicroscopy, and scanning electron microscopy evaluation.^[6] The clearing technique is an in vitro examination of root canal systems that provides a continuous tridimensional view of the internal anatomy of root canals without loss of the tooth substance, the influence of biomechanical procedures on the root canal morphology, and the physical appearance of root canal filling techniques.^[7] Hence, this study aimed to assess and compare the depth of penetration of TotalFill BC (FKG Dentaire SA, Switzerland), AH Plus Jet (Dentsply/Detrey, Konstanz, Germany), and GuttaFlow Bioseal (RoekoColtène/Whaledent, Germany) sealers in apical, middle, and coronal thirds of simulated lateral canals. The null hypothesis was assumed that there must be no difference in the depth of penetration among the experimental root canal sealers into simulated lateral canal thirds.

Materials and Methods

This in vitro study was conducted in the Department of Conservative Dentistry, University of Mosul/Collage of Dentistry, Mosul, Iraq, and it was approved by the Scientific Committee of University of Mosul/Collage of Dentistry (NO: D.R 242, Date: 21/1/2020). It was a single-blinded study and evaluated by a single examiner.

Selection of teeth

Thirty single rooted human mandibular premolars teeth were used as study specimens and immersed in a 0.1% thymol solution at room temperature till the time of the experiment.^[8] A preoperative periapical radiograph (Carestream, USA) was taken in buccolingual and mesiodistal directions for an individual tooth to confirm the presence of a single straight root canal and exclude teeth with previous root canal treatment, calcification, and internal resorption.^[9] The teeth were decoronated at/below the cementoenamel junction with a diamond fissure bur underneath continuous water cooling^[10] for standardizing root length of 15 mm.^[11]

Generation of simulated lateral canals

Simulated lateral canals were prepared at 3 mm (apical third), 6 mm (middle third), and 10 mm (coronal third) from the apex with a 0.3 mm active end cylinder-shaped bur^[12] attached and fixed on the milling machine (bio art 1000MAX, Brazil). The connection between the root surface and the main root canal by the simulated lateral canal was evaluated with a size 08 K-ﬁle (Dentsply Maillefer, Switzerland). If the ﬁle did not enter into the main root canal, the root was excluded from the experiment.^[13]

Preparation of specimens

The specimens were accessed, a size 10 K-file was inserted into the root canal till it was visible at the apical foramen, the length of the K-file was measured, and the working length was established by subtracting 1 mm from this length.^[14] The specimens were instrumented by the crown down technique with Protaper Next rotary system nickel-titanium files (Dentsply Maillefer, Switzerland) in sequence order (X1-X2).^[15] The irrigation procedure was performed; 2 mL of 5% sodium hypochlorite (NaOCl) (CHLORAXID, ul. Kwiatkowskiego) and 17% ethylenediaminetetraacetic acid (EDTA) gel (Dentsply Maillefer, Switzerland) were used as a lubricant during the instrumentation procedure.^[15] After the end of the instrumentation, all specimens were washed with 5 mL of 5% NaOCl solution for 1 min, followed by 5 mL of distilled water, 5 mL of 17% EDTA (Dentsply Maillefer, Switzerland) for 1 min, and finally with 5 mL of distilled water.^[16]

Specimens grouping and root canal filling

The specimens were randomly distributed into three experimental groups (n = 10) according to the type of root canal sealers (TotalFill BC, AH Plus Jet, and GuttaFlow Bioseal sealers). The experimental sealers were handled according to the manufacturer’s instructions, and the specimens were filled by the single cone technique.

Clearing technique

This technique was performed in the following phases: The first step was the decalcification procedure through submerging the specimens into 5% nitric acid for 4 days and on the fourth day the specimens were examined by trying to thrust a thin needle through the coronal third.^[17] If the needle went easily through, the specimens were ready for the next phase. Then the specimens were washed under running water for 4 hours.^[17] The next phase was the dehydration procedure through submerging the specimens in 80%, 90%, and 100% ethyl alcohol solution, and finally the transparency step through submerging the specimens in 100% methyl salicylate for 2 hours till the specimens were made transparently.^[17]

Stereomicroscopic assessment

The specimens were observed under a stereomicroscope (OPTIKA, Italy) at 10× magnification; the depth of sealer penetration into the simulated lateral canals was assessed on digital images of specimens that were captured by the attached camera (OptikamB5, Italy) on a stereomicroscope. The depth of sealer penetration into the simulated lateral canal thirds was scored as: Score 0: no sealer penetration; Score 1: if sealer was present in less than half of the simulated lateral canal; Score 2: if the sealer covered more than half of the simulated lateral canal; Score 3: simulated lateral canal was filled with a sealer,^[11] as shown in [Figure 1].

Figure 1 Assessment of depth of sealer penetration into simulated lateral canals

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Statistical analysis

Data were analyzed by the Statistical Package for Social Sciences (SPSS, version 25) (IBM, Chicago IL, USA). Fisher exact test was used to compare the experimental root canal sealers at 5% significance.

Results

All experimental root canal sealers revealed the ability to penetrate in simulated lateral canals; the measured depth of penetration among experimental root canal sealers was compared within each root third. Fisher exact test indicated that no significant differences among experimental root canal sealers regarding their filling ability into simulated lateral canal thirds [Table 1] (P > 0.05).

Table 1 Analysis the depth of penetration scoring distribution in root third of simulated lateral canals percentage (%), number of specimens (N), and P value

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Discussion

In this study, simulated lateral canals are prepared at the apical third, middle third, and coronal third of the root at 3, 6, and 10 mm from the root apex with a 0.3 mm active end cylinder-shaped bur.^[12] The prepared simulated lateral canals possessed a larger diameter (about 300 µm) as shown in [Figure 2] than that of the natural lateral canals, which were less than 100 µm in diameter.^[18] However, considering the aim and importance of in vitro studies by a standardized model to assess and compare the depth of penetration among experimental root canal sealers at simulated lateral canals, simulated lateral canals were prepared with natural teeth following the protocol suggested by Tanomaru-Filho et al.^[12] The ability of root canal filling materials to fill or penetrate natural lateral canals in extracted human teeth was assessed,^[19] but due to the difficulty in obtaining natural teeth with a natural lateral canal for comparison and studies^[20] and the significance of in vitro studies by standardized specimens to assess the filling ability of lateral canals of various root canal filling techniques and materials.^[12] Thus, simulated lateral canals had been made.^[20] Assessment of the filling ability of root canal filling materials into simulated lateral canals was made by either natural teeth^[12] or artificial resin block teeth.^[21] Despite the simplicity in developing narrow ramifications in resin blocks, the surface texture and condition could affect the flow properties of root canal sealer.^[22] The depth of sealer penetration into simulated lateral canals of natural teeth was assessed by analysis of cleared specimens following a clearing technique in which the specimens were rendered transparent and cleared allowing a three-dimensional view of the root canal filling.^[23] A stereomicroscope has been used to assess the filling ability of cleared specimens.^[24] In this study, no significant differences were detected in the depth of penetration of experimental root canal sealers regarding their filling ability into simulated lateral canals. Thus, this study data accepted the null hypothesis that there must be no difference among the root canal sealers regarding their filling ability indicating that TotalFill BC, AH Plus Jet, and GuttaFlow Bioseal sealers had the relatively good filling ability.^[25] This result could be attributed to the physicochemical properties of the root canal sealer.^[10] The finding of this study was in conformance with Candeiro et al.^[9] who concluded that Endosequence BC sealer presented a similar filling ability of simulated lateral canals as AH Plus sealer. In contrast, Akcay et al.^[14] iRoot SP sealer showed a significantly higher penetration ability than AH Plus and GuttaFlow Bioseal sealers by single cone technique and irrespective of the final irrigation procedure. Wang et al.^[24] concluded that iRoot SP had comparable filling quality and better dentinal tubules penetration than AH Plus regardless of the filling technique. Fernandez et al.^[13] concluded that AH Plus sealer was better than calcium silicate-based sealer regardless of the filling technique concerning its filling ability of the simulated lateral canals.

Figure 2 Scanning electron microscopy micrographs of simulated lateral canal

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Conclusions

All root canal sealers experimented herein were able to penetrate the simulated lateral canal but in various depths. TotalFill BC, AH Plus Jet, and GuttaFlow Bioseal sealers showed a comparable depth of penetration in the simulated lateral canals regarding their filling ability. The depth of penetration into simulated lateral canals was not significantly affected by the root canal sealer type.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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