A novel simplified approach for endodontic retrograde surgery in short single-rooted teeth.

BACKGROUND: High technical thresholds, long operative times, and the need for expensive and specialized equipment impede the widespread adoption of endodontic microsurgery in many developing countries. This study aimed to compare the effects of a simplified, cost-effective, and time-efficient surgical approach involving orthograde obturation using biological ceramic material greater than 6 mm combined with apicoectomy for single-rooted teeth with short lengths with those of the conventional and current standard methods. MATERIALS AND METHODS: Forty-five premolars equally categorized into three groups: conventional surgery group, standard surgery group, and modified surgery group. A µCT scan was used to calculate the volume of voids. A micro-leakage test and scanning electron microscope (SEM) were performed to assess the sealing effect. Additionally, four cases of chronic periapical periodontitis in the anterior region were selected, and the patients received either the modified approach or the standard surgery for endodontic microsurgery. RESULTS: The volumes of voids in the apical 0-3 mm of the modified group and the standard group were comparable. The micro-leakage test and SEM examination demonstrated closely bonded fillings in the dentinal walls in both the modified surgery group and standard surgery group. The outcomes of the preliminary application of this modified procedure on patients were successful at the time of the follow-up cutoff. CONCLUSIONS: The modified surgery group exhibited similar root canal filling and apical sealing abilities with the standard procedure for single-rooted teeth with short lengths (< 20 mm). The preliminary application of this modified surgical procedure achieved favorable results.

Sealing Ability of Nano-fast Cement vs. Mineral Trioxide Aggregate as Retrograde Apical Plugs: An In-vitro Microleakage Study.

Introduction: Apical surgery aims to eradicate the apical part of the root and the lesion to enhance the healing. The sealing ability of retrograde filling material is an essential factor affecting the success rate of the surgery. Mineral trioxide aggregate (MTA) is the gold standard of retrograde filling materials, with approved sealing capability and biocompatibility. Newly introduced root repair material with an approved antibacterial effect similar to MTA is Nano-fast cement (NFC) which should be investigated for its sealing ability. This study aimed to evaluate the sealing ability of NFC vs. MTA. Materials and Methods: Root apices of 48 single-rooted teeth were resected at 90 degrees and were prepared at 3 mm depth. The teeth were randomly divided into 2 experimental groups (n=21), negative control group (n=3), and positive control group (n= 3). MTA and NFC plugs were condensed as retrograde filling material. The samples were evaluated by a modified fluid filtration device for 1 hour. The measurement was conducted at 24 h, 1, and 3 months. Data were analyzed by Friedman Test and Kruskal-Wallis test. Results: According to the results, NFC at 3-months interval showed the least microleakage, and MTA had the highest at the baseline. However, the results between the two groups were not statistically significant in all intervals. NFC reached the ideal sealing ability within 1 month, which was reached for MTA after 3 months. Conclusions: The results of this in vitro study showed that the microleakage value of NFC is comparable to MTA. In light of current findings, NFC shows characteristics of a suitable calcium silicate-based cement. Further clinical researches are needed to introduce the NFC as retrograde apical plug or for other endodontic applications.

Scanning electron microscopic evaluation of the effect of different root-end resection methods in the crack formation in root canals filled with mineral trioxide aggregate or calcium-enriched mixture cement.

Background: There is some concern that root resection may alter the surface features and crack formation of the previously set orthograde material. The aim of this in vitro study was to evaluate the crack formation in orthograde mineral trioxide aggregate (MTA) and calcium-enriched mixture (CEM) plugs after root resection. Materials and Methods: This in vitro study was conducted on 170 extracted human maxillary anterior teeth. The teeth were randomly divided three experimental (n = 50) and control (n = 20) groups. In Group 1, after root canal treatment, half of the roots were cut with a bur, and the other half with an ultrasonic cutter. In Groups 2 and 3, after the 4-mm CEM and MTA plugs were placed and set, the root ends of half of the samples were cut with a bur and the other half by an ultrasonic cutter. The prevalence of cracks in the dentin and orthograde apical plugs of MTA and CEM was then assessed by scanning electron microscopy. Data were analyzed using the McNemar's, Chi-square, and Fisher's exact tests at P ≤ 0.05 level of significance. Results: In general, the prevalence of crack in dentin in Groups 2 and 3 was significantly higher than in the plug (P < 0.05). There was no significant difference in the prevalence of dentin crack in the studied groups (P > 0.05). The prevalence of crack in dentin was lower when the bur was used to cut off the end of the root, although the difference was not significant. The prevalence of crack in the plug was similar in CEM and MTA. Conclusion: Based on the results of this study, the prevalence of crack in dentin is always significantly higher than its prevalence in the plug, and the prevalence of crack in the plug was similar in CEM and MTA; then, when there is an orthograde access to the root canal and surgery is likely in future, MTA and CEM can be placed in an orthograde technique and it just resects the root during surgery.

Marginal gaps and voids of three root-end filling materials: A microcomputed tomographic study.

A root-end filling material is required to fill the root-end cavity without gaps or voids, to prevent root canal reinfection and to provide periapical healing. Thus, this study evaluated the volume of marginal gaps and voids of three root-end filling materials using microcomputed tomography (micro-CT). Thirty maxillary incisors were prepared and filled with gutta-percha and endodontic sealer. The specimens were scanned using micro-CT and distributed into three groups (n = 10): White MTA, MTA Repair HP, and Bio-C Repair. The root tips were resected at 90° to the longitudinal axis and the cavity (3 mm depth) was prepared with an ultrasonic tip. The materials were handled, and the cavities were filled. The specimens were rescanned and the percentual volume of gaps and voids were analyzed. The data were analyzed using Kruskal-Wallis and Dunn tests (p < .05). No statistical difference was found in the percentage of gaps among the tested materials (p > .05). White MTA presented less voids than Bio-C and MTA Repair HP (p < .05). The materials presented a similar percentual volume of gaps and White MTA presented less voids than other tested materials.

Physical properties of MTA, BioAggregate and Biodentine in simulated conditions: A micro-CT analysis.

The aim of this study was to evaluate the physical properties of calcium-silicate based cements as retrograde filling in different pH and blood conditions using micro-CT. Eighty-four teeth were obturated and after root-end resection, 3 mm-deep root-end cavity was ultrasonically prepared. The samples were divided into four test groups (n=21). Cements were freshly prepared and analyzed with micro-CT before and after exposed. The test groups were exposed for four days to environments containing acid, alkali, or blood. An acidic pH significantly reduced the volume of all materials after four days and differed from the other environments. Biodentine has the highest percentage of loss in volume and density after treatment in an acidic environment. Porosity formation in the acidic medium was observed in Biodentine amongst all materials. The three-dimensional structures of all materials changed after exposed to an acidic pH, while fewer changes were observed in the structures of materials treated with blood and alkali.

In vitro evaluation of apical microleakage in retrofillings with different resection angles.

Paraendodontic surgery is a procedure that aims to solve problems that could not be solved by, or when it is not possible to perform conventional endodontic treatment. The aim of this experimental study was to compare the apical microleakage of teeth sectioned at 45° or 90° to the long axis of the tooth and rootend filled with mineral trioxide aggregate (MTA) using stereomicroscopy. In this study, 26 maxillary central incisors were used. Cleaning and shaping were performed with use of the Oregon technique and the samples were randomly divided into two groups. In Group A (n=10) apical section was performed at an angle of 90°, making a retrocavity with an ultrasonic tip and retrofilling with MTA. In group B (n=10) the same procedures were performed, but the apical section was at a 45° angle. Then the samples were immersed in a dye (India ink), placed in an oven at 37° for 48 h before applying the clearing technique. Afterwards the teeth were assessed by stereomicroscope at 20x magnification to analyze dye leakage. Data were submitted to the Student'st test with significance level p<0.05. There was statistically significant difference between groups. Group B showed higher apical microleakage values compared with group A (P=0.004), but both groups showed dye leakage. The results showed that the 90° apical section promoted lower dye microleakage values at the dentinretrofilling material interface than the 45°section and could be considered the most effective technique for apical preparation in paraendodontic surgery.

A cirurgia paraendodôntica é um procedimento que visa resolver problemas que não poderiam ser resolvidos, ou quando não é possível realizar o tratamento endodôntico convencional. O objetivo deste estudo experimental foi comparar a microinfiltração apical de dentes seccionados a 45° ou 90° em relação ao longo eixo do dente e extremidade radicular preenchida com agregado de trióxido mineral (MTA) utilizando estereomicroscopia. Neste estudo, 26 incisivos centrais superiores foram utilizados. Limpeza e modelagem foram realizadas com o uso da técnica de Oregon e as amostras foram divididas aleatoriamente em dois grupos. No Grupo A (n = 10) foi realizada seção apical em ângulo de 90°, reali zando retrocavidade com ponta ultrassônica e retrobturação com MTA. No grupo B (n = 10), os mesmos procedimentos foram realizados, mas a seção apical estava em um ângulo de 45°. Em seguida, as amostras foram imersas em um corante (nanquim), colocadas em estufa a 37°C por 48 h, antes da aplicação da técnica de clareamento. Posteriormente, os dentes foram avaliados por estereomicroscópio, com aumento de 20x, para análise do vazamento de corante. Os dados foram submetidos ao teste t de Student, com nível de significância p <0,05. Houve diferença estatisticamente significante entre os grupos. O grupo B apresentou maiores valores de microinfil tração apical em comparação ao grupo A (P = 0,004), mas ambos os grupos apresentaram vazamento de corante. Os resultados mostraram que a seção apical de 90° promoveu menores valores de microinfiltração de corante na interface do material retrobturador dentinário do que a seção 45° e pode ser considerada a técnica mais efetiva para preparo apical em cirurgia paraendodôntica.

The Simultaneous Effect of Apical Resection Angle and Depth of Retrograde Cavity on Apical Microleakage via Fluid Filtration Method.

Introduction: The goal of apical surgery is to eliminate the root apex, apical lesions and promote tissue repair. In apical surgery, the root is resected at an angle of 45, 60 or 90 degree. In many cases, it is not possible to resect the root at 90-degree bevel and prepare a root-end cavity with 4-mm depth. The aim of this study was to evaluate the simultaneous effect of apical resection angle and depth of the retrograde filling with mineral trioxide aggregate (MTA) on apical microleakage. Methods and Materials: Root ends were resected at 45 degree, 60 degree and 90 degree bevels in 110 extracted human single root permanent teeth. For each apical surgery, root-end cavities were filled with MTA to depths of 2 mm, 3 mm and 4 mm. Root end-filled teeth were mounted in fluid filtration device. The evaluation was conducted after 24-h, 1 week, 1 month, 2 months and 3 months. Each group included 10 samples. Also 20 roots were used as positive and negative control samples, in the negatives the entire root surface was coated with 2 layers of nail varnish and positives were unfilled root-end preparation. Statistical analysis consisted of the Kruskal-Wallis test and Pairwise comparison. Results: There were no significant differences in apical microleakage after 24 h and 1 week in the experimental groups. In the 3rd month, samples with 90° bevel and 4-mm-thick MTA showed significant statistical differences with all samples with 45° and 60° bevels and depths of 2- and 3-mm-thick MTA (P<0.05). Conclusions: This in vitro study showed that when the resection angle is 90°, retrograde depth does not affect microleakage, but resection angles other than 90°, require 4 mm-retrograde depth to be sealed.

Apical surgery failures: Extraction or re-surgery? Report of five cases.

Apical surgery (AS) is considered as the last attempt to save teeth which cannot be treated with conventional endodontic approach. The main goal of apical surgery is to create a barrier between the root-canal system and the peri-radicular tissues by means of a tight root-end filling after resection. However, failures in this treatment is usually result with tooth loss. In such cases surgical re-treatment would take into consideration as viable alternative. In this case series, successful ARs that performed in ten teeth of five patients who applied for extraction after an unsuccessful apical surgery, were presented. It is pointed that if appropriate surgical and endodontic intervention is performed and adequate apical obturation is provided with retrograde filling, teeth can be treat without extraction.

Effect of ultrasonic agitation on push-out bond strength and adaptation of root-end filling materials.

OBJECTIVES: This study evaluated the effect of ultrasonic agitation of mineral trioxide aggregate (MTA), calcium silicate-based cement (CSC), and Sealer 26 (S26) on adaptation at the cement/dentin interface and push-out bond strength. MATERIALS AND METHODS: Sixty maxillary canines were divided into 6 groups (n = 10): MTA, S26, and CSC, with or without ultrasonic activation (US). After obturation, the apical portions of the teeth were sectioned, and retrograde cavities were prepared and filled with cement by hand condensation. In the US groups, the cement was activated for 60 seconds: 30 seconds in the mesio-distal direction and 30 seconds in the buccal-lingual direction, using a mini Irrisonic insert coupled with the ultrasound transducer. After the materials set, 1.5-mm thick sections were obtained from the apexes. The presence of gaps and the bond between cement and dentin were analyzed using low-vacuum scanning electron microscopy. Push-out bond strength was measured using a universal testing machine. RESULTS: Ultrasonic agitation increased the interfacial adaptation of the cements. The S26 US group showed a higher adaptation value than MTA (p < 0.05). US improved the push-out bond strength for all the cements (p < 0.05). CONCLUSIONS: The US of retrograde filling cements enhanced the bond to the dentin wall of the root-end filling materials tested.

Cirurgia paraendodôntica com retro-obturação utilizando MTA Repair HP®: análise tomográfica longitudinal prospectiva de dois casos clínicos / Periradicular surgery with retrofilling by MTA Repair HP® having concomitant cone beam computed tomography follow-up analysis: case series repor

Objetivo: Avaliar tomograficamente, em dois casos clínicos, o efeito da nova formulação do MTA, o MTA Repair HP, na contribuição para a remissão de lesões periapicais em cirurgias paraendodônticas, bem como a sua manipulação e as suas propriedades físicas. Relatos de caso: Paciente R.C.R., 57, reportou-se à Faculdade de Odontologia da Universidade Federal de Juiz de Fora para avaliação de lesão periapical no elemento 11. Ao exame radiográfico, observou-se tratamento endodôntico e uma área radiolúcida, unilocular, circunscrita envolvendo o ápice dentário. Solicitou-se um exame de TCFC (I-Cat®, Imaging Sciences International, Hatfield, Pensilvânia, EUA), no qual foi confirmada a presença da lesão com rompimento da cortical óssea vestibular. Foram realizadas apicectomia, curetagem, retropreparo pela Técnica Clássica, e retroobturação com o novo material. Realizaram-se tomografias nos momentos pós-operatórios de três e cinco meses. Paciente R.J.G.M., 46, relatava dor, aumento de volume intraoral e drenagem de secreção purulenta na arcada superior esquerda. Aos exames clínico e radiográfico, observou-se presença de fístula e lesão refratária ao tratamento endodôntico no dente 25. Realizou-se TCFC, na qual pode-se observar a presença de uma área hipodensa circunscrita, envolvendo o ápice do 25, com rompimento da cortical óssea vestibular. Foi proposto o mesmo tratamento descrito no caso anterior. Para o acompanhamento foram realizadas novas tomografias nos mesmos tempos pós-operatórios do caso anterior. Discussão: O MTA Repair HP surgiu da necessidade de um material mais biocompatível com as estruturas dentárias no procedimento de obturação retrógrada. Este produto auxilia na regressão de lesões periapicais e na formação dos componentes do periodonto e apresenta como vantagens, o maior tempo de presa, não provocar o escurecimento coronário e maior facilidade na manipulação. Conclusão: Conclui-se que houve formação de tecido calcificado no decorrer dos tempos de três e cinco meses. Em relação à manipulação do material, não foi observada melhora pela adição de agente plastificante. Contudo, observou-se um tempo de presa menor do que o esperado, dificultando a inserção do material

Aim: To evaluate, tomographically, in two clinical cases, the effect of the new MTA formulation of the Angelus, the MTA Repair HP, in the contribution to remission of periapical lesions in paraendodontic surgery, as well its physical properties and manipulation. Case report: Patient R.C.R, 57, attended at the Faculty of Dentistry of the Federal University of Juiz de Fora for evaluation of periapical lesion in the element 11. It was observed, at the clinical and radiographic exams, endodontic treatment and a circumscribed, unilocular and radiolucid area at the apex of the tooth. It was requested a CBCT exam (I-Cat®, Imaging Sciences International, Hatfield, Pennsylvania, USA), which confirmed the presence of the lesion and rupture of the buccal cortical plate. Thus, it was performed curettage, apicectomy, retropreparation and retrofilling with the described cement. It was solicited two additional CBCT exams at the period of three and five months post-operative. Patient R.J.G.M, 46, with mean complain of pain, increased intraoral volume and purulent discharged in the upper left arch. The clinical and radiographic exams revealed fistu-la and refractory lesion, despite the endodontic treatment of the tooth 25. A CBCT exam was done and it was observed a circumscribed hypodense area, around the apex of the 25, with rupture of the buccal cortical plate. It was suggested the same surgical treatment described in the case above. It was performed two more CBCT exam, at three and five months after the procedure. Discussion: The MTA Repair HP was developed from the necessity of a more biocompatible material with the dental structures in the retrograde filling process. This product helps in the remission of periapicals lesions and in the new formation of the periodontum components; also it has the advantages of longer set-ting time, not causing the darkening of the coronary portion and easier manipulation. Conclusion:Regarding the remission of the lesions, it was noticed the generation of calcified tissue across the periods of three and five months. Regarding the manipulation and application, it was not observed any improvement related to the addition of the plasticizer. However, it was noticed a shorter setting time, making it difficult to insert the material.

Effect of root resection on sealing ability of orthograde apical plugs of mineral trioxide aggregate and calcium enriched mixture.

OBJECTIVE: There is some concern that root resection may alter the seal of the previously set orthograde material. The aim of this study was to evaluate the apical sealing ability of orthograde mineral trioxide aggregate (MTA) and calcium enriched mixture (CEM) plugs after resection of the roots. MATERIALS AND METHODS: The fluid filtration method was carried out on a total of 51 roots in three experimental (n=15) and two control (n=3) groups. The root canals were prepared 3 mm shorter than the working length. In groups A and B, 4 mm of MTA and CEM were placed in an orthograde technique, respectively, and after setting, 3 mm of the root end was resected. In group C, the apical 3 mm of each root was resected, root end preparation was carried out to a depth of 3 mm and filled with MTA. Apical microleakage values of each group were measured. Data was analyzed using Kruskal-Wallis test. RESULTS: Means and standard deviations of apical microleakage in groups A (MTA orthograde), B (CEM orthograde) and C (MTA retrograde) were 2.31×10(-4) (0.32×10(-4)), 3.33×10(-4) (0.29×10(-4)) and 4.42×10(-4) (0.40×10(-4)) µl.min(-1).cmH2o(-1), respectively. The mean values were greater in group C; however, statistical analysis revealed no significant differences between these groups (P>0.05). CONCLUSION: Based on the results of this study, when there is an orthograde access to the root canal and surgery is likely to be necessary in the future, MTA and CEM can be placed in an orthograde technique and it just resects the root during surgery.

Evaluación de la citotoxicidad de Biodentine, IRM y MTA en cultivos de fibroblastos del ligamento periodontal humano / An evaluation of the cytotoxicity of Biodentine, IRM and MTA in cultures of human periodontal ligament fibroblasts

Introducción: Los materiales para la obturación retrógrada son diversos. Actualmente, IRM y MTA son las alternativas clínicas más utilizadas, no obstante, es relativamente reciente la introducción de materiales a base de silicatos tricálcicos tal como Biodentine. Objetivo: Determinar la citotoxicidad de fibroblastos del ligamento periodontal humano expuestos a medios de cultivo condicionados con Biodentine, IRM y MTA. Material y métodos: 1 × 103 fibroblastos del ligamento periodontal humano fueron expuestos a medios DMEM/F12 condicionados con MTA, IRM y Biodentine en tres protocolos diferentes. Se realizó un ensayo de MTT para determinar la viabilidad celular a las cero, 24, 48, 72 horas, siete y 14 días. Se realizó una prueba ANOVA (p < 0.05). Resultados: En los tres protocolos con los diferentes medios de cultivo condicionados, la viabilidad de las células fue predominantemente proliferativa; sin embargo, las células expuestas a Biodentine mostraron una tendencia mayor que la MTA o la IRM. Conclusión: Las células expuestas a la Biodentine mostraron un comportamiento proliferativo a los 14 días de análisis. Se debe realizar más investigación a nivel in vivo y clínico para obtener más información sobre la conducta de estos materiales empleados para la obturación retrógrada (AU)

Introduction: The materials for retrograde filling are diverse. Currently, IRM and MTA are the most commonly used clinical alternatives, however, the introduction of materials based on tricalcium silicates such as Biodentine is relatively recent. Objective: To determine the cytotoxicity of human periodontal ligament fibroblasts exposed to culture media conditioned with Biodentine, IRM and MTA. Material and methods: 1 × 103 fibroblasts of the human periodontal ligament were exposed to DMEM/F12 media conditioned with MTA, IRM and Biodentine in 3 different protocols. An MTT assay was performed to determine cell viability at 0, 24, 48, 72 hours, seven and 14 days. An ANOVA test was performed (p < 0.05). Results: In the three protocols with the different conditioned culture media, the viability of the cells was predominantly proliferative, however, the cells exposed to Biodentine showed a higher tendency than the MTA or the IRM. Conclusion: The cells exposed to the Biodentine showed a proliferative behavior at 14 days of analysis. More research should be done at in vivo and clinical level to obtain more information about the behavior of these materials used for retrograde filling (AU)

Evaluation of the dislodgement resistance of bioceramic reparative cements placed in a retrograde cavity using a different technique

Aim: Calcium silicate-based fillings have been widely used in surgical endodontic treatment because of hard-tissue conductive and inductive properties. The aim of present study is to investigate the bond strength of different calcium silicate-based fillings in retrograde cavities. Methods: Forty-four maxillary single rooted teeth were endodontically treated. The apical portions of the teeth were removed and root-end cavities were prepared using an ultrasonic tip. The roots were randomly divided into four experimental groups (n = 11) according to the material used; (1) MTA-FILLAPEX, (2) MTA Repair HP, (3) MTA-FILLAPEX+ MTA Repair HP, and (4) MTA Plus. Two horizontal cross sections (1±0.1 mm thick) from each specimen were resected from the apices. These sections were placed in a universal testing machine to evaluate the push-out bond strength force required for dislodgement of the root end filling was recorded. The failure type was also evaluated by using a stereomicroscope. The differences in bond strength were analyzed using the two-way analysis of variance (ANOVA). Results: MTA-FILLAPEX and MTA Plus displayed the lowest and highest dislocation resistance, respectively (P < 0.05). In the apical level, bond strength was significantly higher than the coronal level in all groups except for MTA-FILLAPEX. Mixed failure was prevalent in all groups, except for MTA-FILLAPEX, which showed purely cohesive failures. Conclusions: Investigated calcium silicate-based filling materials showed different bond strength to the root-end cavity. The bond strength was significantly decreased when the prior application of MTA-FILLAPEX before delivery of MTA Repair HP

Comparación de la eficacia de los materiales usados como obturadores retrógrados en cirugías dentales apicales / Comparison of the effectiveness of materials used as retrograde obturators in apical dental surgeries

Introducción: las lesiones perirradiculares aparecen solo cuando los conductos radiculares están expuestos a la microbiota oral. Estos conductos radiculares albergan a varias especies bacterianas y sus toxinas que llegan a los tejidos perirradiculares y se inicia la formación de lesiones Objetivo: evaluar la eficacia de los materiales usados como obturadores retrógrados en cirugías apicales según capacidad de microfiltración y adaptación marginal en dientes permanentes. Metodología: se realizó una revisión bibliográfica de bases de datos electrónicas de los últimos 10 años. Se excluyeron artículos no originales, que solo medía la eficacia de un material o que comparaba dos marcas o tipos de un mismo material. Resultados: la mayor cantidad de artículos fueron del año 2014. El MTA fue el material más estudiado. La amalgama se estudia hasta el año 2015 y en el mismo año desaparecen las investigaciones del Biodentine. La mayoría de los artículos evaluó la microfiltración para medir la eficacia. El material que fue considerado eficaz en mayor porcentaje fue el MTA con 27% en estudios de microfiltración y 15% de adaptación. El Biodentine es el siguiente con un 15% de estudios de microfiltración y 6% de adaptación marginal. Se puede concluir que el MTA todavía es el material más eficaz cuando se lo utiliza en obturaciones retrógradas, seguido del Biodentine. Conclusiones: en base a los resultados de los investigadores, se podría considerar al material recientemente fabricado, Biodentine, con igual eficacia que al MTA.

Introduction: periradicular lesions appear only when the root canals are exposed to the oral microbiota. These root canals house several bacterial species and their toxins that reach the periradicular tissues and the formation of lesions begins Objective: to evaluate the effectiveness of the materials used as retrograde obturators in apical surgeries according to microfiltration capacity and marginal adaptation in permanent teeth. Methodology: a bibliographic review of electronic databases of the last 10 years was carried out. Non-original articles were excluded, which only measured the effectiveness of a material or that compared two brands or types of the same material. Results: the largest number of articles were from 2014. The MTA was the most studied material. The amalgam is studied until 2015 and in the same year the Biodentine research disappears. Most articles evaluated microfiltration to measure effectiveness. The material that was considered effective in the highest percentage was the MTA with 27% in microfiltration studies and 15% adaptation. Biodentine is next with 15% of microfiltration studies and 6% of marginal adaptation. It can be concluded that MTA is still the most effective material when used in retrograde seals, followed by Biodentine. Conclusions: based on the results of the researchers, the newly manufactured material, Biodentine, could be considered as effectively as the MTA.

In vitro evaluation of apical microleakage in retrofillings with different resection angles / Avaliaçâo in vitro da microinfiltraçâo apical de retrobturaçoes com diferentes ángulos de ressecçâo

ABSTRACT Paraendodontic surgery is a procedure that aims to solve problems that could not be solved by, or when it is not possible to perform conventional endodontic treatment. The aim of this experimental study was to compare the apical microleakage of teeth sectioned at 45° or 90° to the long axis of the tooth and root-end filled with mineral trioxide aggregate (MTA) using stereomicroscopy. In this study, 26 maxillary central incisors were used. Cleaning and shaping were performed with use of the Oregon technique and the samples were randomly divided into two groups. In Group A (n=10) apical section was performed at an angle of 90°, making a retrocavity with an ultrasonic tip and retrofilling with MTA. In group B (n=10) the same procedures were performed, but the apical section was at a 45° angle. Then the samples were immersed in a dye (India ink), placed in an oven at 37° for 48 h before applying the clearing technique. Afterwards the teeth were assessed by stereomicroscope at 20x magnification to analyze dye leakage. Data were submitted to the Student's-t test with significance level p<0.05. There was statistically significant difference between groups. Group B showed higher apical microleakage values compared with group A (P=0.004), but both groups showed dye leakage. The results showed that the 90° apical section promoted lower dye microleakage values at the dentin-retrofilling material interface than the 45°-section and could be considered the most effective technique for apical preparation in paraendodontic surgery.

RESUMO A cirurgia paraendodontica é um procedimento que visa resolver problemas que nao poderiam ser resolvidos, ou quando nao é possível realizar o tratamento endodontico convencional. O objetivo deste estudo experimental foi comparar a microinfiltragao apical de dentes seccionados a 45° ou 90° em relagao ao longo eixo do dente e extremidade radicularpreenchida com agregado de trióxido mineral (MTA) utilizando estereomicroscopia. Neste estudo, 26 incisivos centrais superiores foram utilizados. Limpeza e modelagem foram realizadas com o uso da técnica de Oregon e as amostras foram divididas aleatoriamente em dois grupos. No Grupo A (n = 10) foi realizada segao apical em ángulo de 90°, realizando retrocavidade com ponta ultrassonica e retrobturagao com MTA. No grupo B (n = 10), os mesmos procedimentos foram realizados, mas a segao apical estava em um ángulo de 45°. Em seguida, as amostras foram imersas em um corante (nanquim), colocadas em estufa a 37°Cpor 48 h, antes da aplicagao da técnica de clareamento. Posteriormente, os dentes foram avaliados por estereomicroscópio, com aumento de 20x, para análise do vazamento de corante. Os dados foram submetidos ao teste t de Student, com nivel de significáncia p <0,05. Houve diferenga estatisticamente significante entre os grupos. O grupo B apresentou maiores valores de microinfil-tragao apical em comparagao ao grupo A (P = 0,004), mas ambos os grupos apresentaram vazamento de corante. Os resultados mostraram que a segao apical de 90° promoveu menores valores de microinfiltragao de corante na interface do material retrobturador dentinário do que a segao 45° e pode ser considerada a técnica mais efetiva para preparo apical em cirurgia paraendodontica.

In vitro comparative study of apical microfiltration in retrograde fillings between dental cements: MTA Repair Hp and Biodentine / Estudio comparativo"in vitro" de lamicro filtración apical en obturaciones retrógradasentre cementos dentales: MTA Repair Hp y Biodentine

Abstract Objective: To compare "in vitro" the degree of bacterial microfiltration in the apical third of the root canal, when performing the retrograde filling technique using two endodontic cements: MTA Repair Hp (Angellus) and Biodentine (Septodont). Materials and methods: Twenty-two uniradicular teeth were used (upper central and lateral incisors), whose ducts were instrumented up to the working length with the Limas K File hand instruments (Dentsply / Maillefer, Ballaigues, Switzerland). The teeth were randomly divided into 4 groups A, B, C and D, group A and B of 10 teeth each. The root canals of group A were obturated using retrograde technique with MTA Repair Hp, and those of Group B with Biodentine, Group C root canals positive control, Group D root canals negative control. The samples were screened and photographed, and the images were analyzed in the three thirds root using the program Motic Images 5.0. Results: Group A (MTA Repair Hp) showed a greater penetration of Chinese ink in the last 3 millimeters of the apical third, as well as in the middle third in relation to Group B (Biodentine), and although this difference was not statistically significant one observed a tendency to smaller microfiltrations with Biodentine. Conclusion: The technique of retrograde obturation with Biodentine presents a greater tendency to provide a more hermetic peripheral seal of the apical third, as compared to the retrograde obturation technique with MTA Repair Hp.

Resumen Objetivo: Comparar "in vitro" el grado de microfiltración bacteriana en el tercio apical del conducto radicular, al realizar la técnica de obturación retrógrada mediante el uso de dos cementos endodónticos: el MTA Repair Hp (Angellus) y el Biodentine (Septodont). Materiales y Métodos: Se utilizaron 22 dientes uniradiculares extraídos (incisivos centrales y laterales superiores) cuyos conductos fueron instrumentados hasta la longitud de trabajo con los instrumentos manuales Limas K File (Dentsply/Maillefer, Ballaigues, Suiza). Los dientes se dividieron al azar en 4 grupos A, B, C y D, el grupo A y B de 10 piezas dentales cada uno. Los conductos radiculares del grupo A fueron obturados mediante técnica retrógrada con MTA Repair Hp, y los del Grupo B con Biodentine, Grupo C conducto control positivo, Grupo D conducto control negativo. Las muestras fueron transparentadas y fotografiadas, y las imágenes se analizaron en los tres tercios radiculares mediante el programa Motic Images 5.0. Resultados: El grupo A (MTA Repair Hp) mostró una penetración mayor de la tinta china en los 3 últimos milímetros del tercio apical, así como en tercio medio respecto al Grupo B (Biodnetine), y aunque esta diferenciano fue estadísticamente significativa si se observa una tendencia a menores microfiltraciones con el Biodentine. Conclusión: La técnica de obturación retrógrada con Biodentine presenta una mayor tendencia a brindar un sellado periférico más hermético del tercio apical, en comparación con la técnica de obturación retrógrada con MTA Repair Hp.

Sealing Ability of Orthograde MTA and CEM Cement in Apically Resected Roots Using Bacterial Leakage Method.

INTRODUCTION: The aim of this in vitro study was to determine the sealing ability of orthograde ProRoot mineral trioxide aggregate (MTA) and calcium enriched mixture (CEM) cement as root-end filling materials. MATERIALS AND METHODS: Fifty four extracted single-rooted human teeth were used. The samples were randomly divided into 3 experimental groups. In group A and B, 4 mm of WMTA and CEM cement were placed in an orthograde manner and 3 mm of apices were resected after 24 hours. In group C the apical 3 mm of each root was resected and the root-end prepared with ultrasonic tips to a depth of 3 mm and subsequently, then filled with MTA. The apical sealing ability was performed with bacterial leakage method. Statistical analysis was carried out with Chi-square test. RESULTS: There were no significant differences in the extent of bacterial leakage between the three experimental groups (P>0.05). CONCLUSION: Based on the limitations of this in vitro study, we concluded that MTA and CEM cement can be placed in an orthograde manner when there is a potential need for root-end surgery.

Evaluating the Effect of Resection on the Sealing Ability of MTA and CEM Cement.

INTRODUCTION: In cases of limited access to the surgical site, an alternative approach is to obturate the canal prior to surgery. Endodontic surgery is subsequently performed by root-end resection without retro-cavity preparation. This in vitro study was designed to compare the sealing ability of resected roots filled with either mineral trioxide aggregate (MTA) or calcium enriched mixture (CEM) cement. MATERIALS AND METHODS: Seventy maxillary anterior teeth were selected. Following canal preparation, the teeth were randomly divided into four experimental (n=15) and two control (n=5) groups. In Group 1, CEM cement was placed into the apical 6-mm of the canal. The remainder of the canal was filled with gutta-percha/AH26 and 3-mm root-ends were resected. In Group 2: the teeth were treated as described above except that MTA was used instead of CEM cement. Group 3: The canals were obturated with gutta-percha/AH26. After root-end resection, retro cavities were prepared and filled with CEM cement. Group 4: The teeth were treated as described for group 3 except that MTA was used instead of CEM cement. The root apices of teeth were then placed in India ink, and maximum dye penetration was measured with a stereomicroscope. Nested ANOVA and Independent samples t-test were used to evaluate the statistical significance. RESULTS: The mean dye leakage values for groups 1 to 4 were 402.6, 526.4, 141.0, and 177.4, respectively. The retrofilled groups had less microleakage compared to the resected materials; in the CEM cement groups this was statistically significant (P<0.05), i.e. root-end resection had no significant influence on the sealing ability of MTA, but significantly increased the microleakage of CEM cement (P=0.017). Overall, CEM cement showed less microleakage compared to MTA, however the difference was not significant. CONCLUSION: Within the limitations of this dye leakage study, we can conclude that if limited access prohibits retrofill placement, MTA or CEM cement can be used to fill the canal prior to root-end resection; as they have similar sealing ability. However, further laboratory and clinical studies are required to evaluate this alternative method.

Solubility and bacterial sealing ability of MTA and root-end filling materials

ABSTRACT Objective To evaluate solubility and sealing ability of Mineral Trioxide Aggregate (MTA) and root-end filling materials. Material and Methods The materials evaluated were: MTA, Calcium Silicate Cement with zirconium oxide (CSC/ZrO2), and zinc oxide/eugenol (ZOE). Solubility test was performed according to ANSI/ADA. The difference between initial and final mass of the materials was analyzed after immersion in distilled water for 7 and 30 days. Retrograde cavities in human teeth with single straight root canal were performed by using ultrasonic tip CVD 9.5107-8. The cavities were filled with the evaluated materials to evaluate sealing ability using the bacterial leakage test with Enterococcus faecalis. Bacterial leakage was evaluated every 24 hours for six weeks observing the turbidity of Brain Heart infusion (BHI) medium in contact with root apex. Data were submitted to ANOVA followed by Tukey tests (solubility), and Kruskal-Wallis and Dunn tests (sealing ability) at a 5% significance level. Results For the 7-day period, ZOE presented highest solubility when compared with the other groups (p<0.05). For the 30-day period, no difference was observed among the materials. Lower bacterial leakage was observed for MTA and CSC/ZrO2, and both presented better results than ZOE (p<0.05). Conclusion MTA and CSC/ZrO2 presented better bacterial sealing capacity, which may be related to lower initial solubility observed for these materials in relation to ZOE.

Materiais usados em retro-obturações: comparação entre cimento de ionômero de vidro fotopolimerizável e cimento de portland / Materials used in retrograde obturations: comparison between light-cured glass ionomer and Portland cement

O objetivo deste estudo foi comparar, por meio de um teste in vitro, se ocorre infiltração ou não pelo corante azul de metileno a 0,2% em retro-obturações seladas com cimento ionômero de vidro fotopolimerizável e cimento Portland. Quarenta dentes unirradiculares receberam tratamento endodôntico convencional. As coroas foram removidas com um corte na junção cemento-esmalte, perpendicular ao longo eixo do dente e um corte horizontal de 2 a 3 mm do ápice. As raízes foram revestidas externamente, com duas camadas de esmalte de unha. Foi realizada uma cavidade apical para retro-obturação dos condutos. A amostra foi dividida em 2 grupos: Grupo 1 - isolamento apical com cimento de ionômero de vidro fotopolimerizável e Grupo 2 - isolamento com cimento Portland. Logo após a realização da obturação retrógrada, as amostras foram submetidas à imersão parcial em corante azul de metileno a 0,2% de pH neutro, durante 24 horas. As amostras foram lavadas em água corrente por 12 horas e 10 dias de secagem. Depois, as raízes foram seccionadas longitudinalmente no sentido mésio-distal e observadas por 2 examinadores independentes, com o auxílio de uma lupa com aumento de duas vezes. Foi utilizado o teste estatístico qui-quadrado para verificar as hipóteses. No total de 20 dentes retro-obturados com ionômero, apenas 1 deles foi infiltrado. Entretanto, com relação ao cimento Portland, em 18 dentes, houve infiltração com azul de metileno 0,2%. Nesse teste in vitro, os resultados apontam que o selamento apical com ionômero de vidro é superior ao selamento com cimento Portland.

The objective of this study was to compare through an in vitro test, if infiltration occurs or not by 0.2% methylene blue dye in retrograde obturations sealed with glass ionomer light-curing cement and Portland cement. Forty single-rooted teeth recieved conventional endodontic treatment. The crowns were removed with a cut at the cementoenamel junction perpendicular to the long axis of the tooth and a horizontal cut 2 to 3 mm from the apex. The roots were externally coated with two layers of nail polish. An apical cavity was performed for retrofilling of the conduits. The sample was divided into 2 groups: Group 1 with apical insulated glass ionomer light-curing cement and Group 2 with insulation with Portland cement. After the completion of the retrograde filling, the samples were subjected to partial immersion of 0.2% methylene blue dye in neutral pH for 24 hours. The samples were washed in running water for 12 hours and then 10 days of drying. After the roots were split lengthwise mesiodistally and observed by two independent examiners with the aid of a magnifying glass with an increase of twice. The chi-square statistical test was used to verify the hypotheses. Of the total of 20 teeth with retrograde obturations using ionomer, only one tooth was infiltrated, since with respect to Portland cement in 18 teeth there was infiltration with 0.2% methylene blue. In this in vitro test, the results suggest that the apical seal with glass ionomer is better than the sealing with Portland cement.