|Year : 2020 | Volume
| Issue : 3 | Page : 39-42
An evaluation of the efficiency of a novel polyamide polymer bioceramic obturating system in cases with periapical lesions: An in vivo study
Rahul Paresh Ved, Vibha Hegde
Department of Conservative Dentistry and Endodontics, Dr G. D. Pol Foundation’s Y.M.T Dental College and Hospital, Mumbai, Maharashtra, India
|Date of Submission||23-Jun-2020|
|Date of Acceptance||24-Jul-2020|
|Date of Web Publication||28-Sep-2020|
Dr. Rahul Paresh Ved
Department of Conservative Dentistry and Endodontics, Dr. G.D. Pol Foundation’s Y.M.T. Dental College and Hospital, Institutional Area Sector 4 Kharghar, Navi Mumbai, Maharashtra.
Source of Support: None, Conflict of Interest: None
Introduction: The ultimate goal of obturation is to prevent the reinfection of root canals. The bioceramic hydrophilic obturation materials could prove to be advantageous in clinical situations where periapical lesions are present and could help in the effective resolution of the periapical lesions due to their better mechanical and biological properties. Aims and Objectives: The aim of this study was to evaluate the efficiency of a novel polyamide polymer bioceramic obturating system in cases with a periapical lesion as compared with traditional obturating techniques. Materials and Methods: A total of 20 cases that fulfilled the criteria of the study were randomly divided into groups and obturation was done using either gutta percha and AH Plus sealer or the newer bioceramic and the healing of the lesions was monitored at 3,6 and 12 months. Descriptive statistics was expressed as mean ± standard deviation (SD) for each group. The change in mean area of the periapical lesion for 12 months in each group was analyzed using the repeated-measures ANOVA test. Intergroup comparison was done using the Student’s t test. In the above tests, a value of P ≤ 0.05 was taken to be statistically significant. All analyses were performed using SPSS software, version 17.0. Results: Both the groups showed satisfactory results, but the rate of healing of bioceramic group was significantly better. Conclusion: Both the groups tested for their efficiency in healing of periapical lesion were successful in resolution of the periapical lesion over a time period of 12 months. Smart seal group showed better healing of the lesion as compared to gutta percha and AH plus group at both 6 months and 12 months following root canal treatment.
Keywords: Bioceramic obturation, periapical lesion, smart seal system
|How to cite this article:|
Ved RP, Hegde V. An evaluation of the efficiency of a novel polyamide polymer bioceramic obturating system in cases with periapical lesions: An in vivo study. Int J Oral Care Res 2020;8:39-42
|How to cite this URL:|
Ved RP, Hegde V. An evaluation of the efficiency of a novel polyamide polymer bioceramic obturating system in cases with periapical lesions: An in vivo study. Int J Oral Care Res [serial online] 2020 [cited 2021 Jun 17];8:39-42. Available from: https://www.ijocr.org/text.asp?2020/8/3/39/296222
| Introduction|| |
The ultimate goal of obturation is to prevent the re-infection of root canals. Successful obturation requires the use of materials and techniques capable of densely filling the entire root canal space and providing a fluid-tight seal from the apical segment of the canal to the canal orifice to prevent reinfection.
Gutta percha has been used as a core obturating material with various sealers but resin-based sealers have shown better adaptability, adhesive property, and less dissolution.
The most recent advancement in endodontic obturating materials uses a hydrophilic polymer in the root canal, The Smart-Seal system (Prosmart – DRFP Ltd., Stamford, UK). The system consists of obturation points (Pro-points) containing a polyamide core with an outer bonded hydrophilic polymer coating and an accompanying sealer which is further provided with polymer powder to be incorporated during the manipulation of the sealer.
The bioceramic hydrophilic obturation materials could prove to be advantageous in clinical situations where periapical lesions are present and could help in effective resolution of the periapical lesions due to their better mechanical and biological properties. Therefore, this study was conducted to evaluate the efficiency of a novel polyamide polymer bioceramic obturation system as compared to traditional gutta percha and AH plus combination.
| Materials and Methods|| |
After obtaining informed consent from the patients, 20 patients between the age of 20 and 40 with no significant medical history and periapical lesions in upper central or lateral incisor were selected. Teeth with root resorption were excluded. Preoperative clinical examination for signs and symptoms of pain, tenderness to percussion, and radiographic examination was conducted.
Isolation of tooth with rubber dam was done. Access cavity preparation was initiated with small round bur no. 2. Coronal enlargement was done with help of rotary Sx. Canal patency was established with #15 k file. Working length was measured with Root ZX mini apex locator and confirmed with radiographs. Apical gauging was done to determine size of apical foramen. During instrumentation files were coated with 5% EDTA gel and recapitulation was done with #15 k file. Canals were enlarged to apical size 0.30 with rotary protaper (F3) files.
During instrumentation, canals were irrigated with 3% NaOCl (2mL) after each file. During cleaning and shaping canals were lubricated with 17% aqueous EDTA.
Calcium hydroxide in a vehicle of saline was placed in the canal for 1 week. The patient was recalled and evaluated for the presence of tenderness or draining sinus or any other symptom. If the teeth were symptomatic then calcium hydroxide was placed for another 1 week. Final irrigation was done with 10mL of NaOCl (3%) followed by 5mL of 17% EDTA to remove calcium hydroxide and smear layer for two minutes then with a final rinse of 2mL saline. Canals were dried with absorbent paper points. Patients were randomly divided into two groups depending on the obturation protocol.
GROUP A (Control group)
Obturation with gutta percha and AH plus sealer by cold lateral condensation
GROUP B (Smart seal group)
C-point was selected according to the size of last master apical file. Sealer was dispensed into the canals using the syringe provided by the manufacture.
Coronal restoration of all teeth with type II GIC and nanohybrid composite was performed
Patients were recalled at 3 months, 6 months, and 12 months periodic follow-up of periapical lesion. Patients were evaluated for absence of clinical signs and symptoms.
Radiographic evaluation was done to check for resolution of the lesion. All the radiographs were taken by the same operator at the same angulation and at a voltage of 70 kVp and 10 mAm. Measurement of the size of the lesion preoperatively and on subsequent follow-up was done by the same operator using Image J software.
Descriptive statistics was expressed as mean ± standard deviation (SD) for each group. The change in mean area of the periapical lesion for 12 months in each group was analyzed using repeated-measures ANOVA test. Intergroup comparison was done using Student’s t test. In the above tests, a value of P ≤ 0.05 was taken to be statistically significant. All analyses were performed using SPSS software, version 17.0.
| Results|| |
This in vivo study was carried out on 20 patients with periapical lesion which were divided into two groups based on the type of obturating material used.
Group 1: Gutta percha and AH plus
Group 2: Smart seal system (Propoint and Smart paste bio)
The following observations and analyses were made:
| Discussion|| |
This study was a clinical study to evaluate the healing of periapical lesion when obturated with two different obturating materials. In our study, successful healing of periapical lesions was observed on clinical and radiographic follow-up due to adherence of proper clinical protocol and proper infection control. These findings are similar to those reported by Çaliskan. There have also been case reports, which have shown the failure of endodontic therapy and attributed this failure to poor quality of obturation. In a study by Chanda, importance was given on thorough biomechanical preparation of the canal, use of various irrigants, removal of smear layer, use of intracanal medicament, and a three-dimensional seal of the root canal. In this study, hydrophilic smart seal system and hydrophobic gutta percha were used with a resin-based sealer (AH Plus) and showed satisfactory clinical and radiographic healing. However, a significant difference in the time period for healing was observed. Perhaps the properties of the sealers that could have influenced the results are penetration depth, dimensional stability, and push-out bond strength.
Singh et al. in their study concluded that AH Plus had better penetration depth than zinc oxide eugenol sealer and demonstrated that the property of penetration depth leads to increased push-out bond strength as well as stable interfacial bond and therefore less leakage which contributes to the three-dimensional seal and to clinical success. Similarly, Schafer and Zandbiglari evaluated the solubility of AH Plus sealer and concluded that AH Plus sealer showed least solubility as compared to other sealers and they maintained that stability of sealer dentine interface is important for healing of periapical lesions. Similarly, manual dynamic agitation used in this study could have lead to aiding sealer penetration and better adaptation of obturating materials and bonding to dentine. Studies have shown hydrophilic smart seal system to have better linear penetration depth as compared to gutta-percha obturation even when warm techniques were used with gutta percha for obturation. El-Sayed et al. evaluated glucose leakage associated with gutta percha and AH Plus as compared to the hydrophilic smart seal group and concluded that leakage associated with smart seal group was significantly lesser than with gutta perch and AH plus group and the results were attributed to its high flowability into dentinal tubules and anatomical irregularities. In addition, formation of apatite crystals is a common characteristic of calcium silicate containing biomaterials which develops a chemical bond with the dentinal walls. Similar findings were found by Hegde and Arora, who also evaluated the bacterial leakage associated with smart seal system as compared to gutta percha and AH plus and attributed the results to the property of expansion of the hydrophilic sealer and the obturating cone (Propoint) which is claimed to be 14% at 20 min after insertion and a maximum of 17% of its original dimension. The bioceramic sealer is composed of zirconium oxide, tricalcium silicate, dicalcium silicate, and calcium hydroxide and has the ability to stimulate hydroxyapetite formation on setting. Fayyad Mukhtar evaluated the cytotoxicity of bioceramic materials like on human fibroblasts and concluded that bio ceramic-based materials showed an acceptable biocompatibility. This biocompatibility might be attributed to the presence of calcium phosphate, which is one of the main components of these materials. It has also been proposed that bioceramic have biomineralization ability and that this property could play an important role in healing of periapical lesions. Guven et al. evaluated the induction capacity and biomineralization ability of mineral trioxide aggregate and a bioceramic root canal sealer (iroot sp) and concluded that both bioceramic sealer and MTA were successful in stimulating mRNA expression for progenitor cells for bone formation and attributed this result to the ability of the material to release calcium ions and form hydroxyapatite gel on coming in contact with body fluids. Thus it can be seen that bio ceramic-based smart seal system may not only have better mechanical properties but also better biological properties as compared to resin-based obturating materials. Radiographic analysis was used in our study to evaluate the resolution of periapical healing along with absence of clinical signs and symptoms. Diago et al. evaluated the various criteria for successful healing of periapical tissues and concluded that Von Arx and Kurt’s clinical and radiographic criteria were the most reliable in evaluation of healing of periapical lesion. Similar criteria were followed in our study and subsequent evaluation of the area of periapical lesion was conducted at 3 months, 6 months and 12 months. As can be seen from [Table 1], reduction in size of the periapical lesion was successfully evaluated by use of image J software.
|Table 1: Comparison between the 2 groups as far as healing of periapical lesion is concerned at 3, 6 and 12 months as measured in image J software|
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Limitations of the study are that this study being a clinical study it was difficult to point out specifically the property responsible for the better results of bioceramic group. Histological analysis of the healing tissue in the periapical area is required to determine the quality of the healed periapical tissue which is not possible under the present conditions Conclusion: Both the groups tested for their efficiency in healing of periapical lesion were successful in resolution of the periapical lesion over a time period of twelve months.
Smart seal group showed better healing of the lesion as compared to gutta percha and AH Plus group at both 6 months and 12 months following root canal treatment. The use of bioceramics in endodontics could potentially open new horizons in treatment of periapical lesion with nonsurgical endodontics
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Delivanis PD, Mattison GD, Mendel RW The survivability of F43 strain of streptococcus sanguis in root canals filled with gutta-percha and procosol cement. J Endod 1983;9:407-10.
Goodman A, Schilder H, Aldrich W The thermomechanical properties of gutta-percha. II. The history and molecular chemistry of gutta-percha. Oral Surg Oral Med Oral Pathol 1974;37:954-61.
Highgate DJ, Frankland JD Deformable polymeric compositions. United States Patent Number 4,565,722; Jan 21, 1986.
Calişkan MK Prognosis of large cyst-like periapical lesions following nonsurgical root canal treatment: A clinical review. Int Endod J 2004;37:408-16.
Puri S, Pandya M Second chance to save your tooth”- A Case report. IJCD 2011;2:70-5.
Chanda A Discuss the factors that affect the outcome of endodontic treatment. Aust Endo J 2009;35:98-107.
Singh CV, Rao A, Rao SA, Chandrashekar V An in vitro
comparison of penetration depth of two root canal sealers: An SEM study. J Conserv Dent 2012;15:261-4.
Schäfer E, Zandbiglari T Solubility of root-canal sealers in water and artificial saliva. Int Endod J 2003;36:660-9.
El-Sayed MA, Taleb AA, Balbahaith MM An in vitro
comparative analysis of glucose leakage for three contemporary single-cone obturation systems. J Res Dent 2014;2:1-5.
Hegde V, Arora S Sealing ability of a novel hydrophilic vs. Conventional hydrophobic obturation systems: A bacterial leakage study. J Conserv Dent 2015;18:62-5.
] [Full text]
Fayyad Mukhtar D Cytocompatibility of new bioceramic-based materials on human fibroblast cells (MRC-5). Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112:e137-42.
Güven EP, Taşlı PN, Yalvac ME, Sofiev N, Kayahan MB, Sahin F In vitro
comparison of induction capacity and biomineralization ability of mineral trioxide aggregate and a bioceramic root canal sealer. Int Endod J 2013;46:1173-82.
Diago MP, Sanchez BO, Mira BG, Bowen EM, Arx TV, Escoda CG Evaluation of healing criteria for success after periapical surgery. Med Oral Patol Oral Cir Bucal2008;13:e143-7.