Compar of Sealing Ability

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Journal of Restorative Dentistry / Vol - 2 / Issue - 1 / Jan-Apr 2014 27

Comparison of the sealing ability of

different glass ionomer cements asroot-end filling materialsFuat Ahmetoglu, K. Meltem olak Topu1, Hasan Oruolu2

Departments of Endodontics, Faculty of Dentistry, Institute of Health Sciences, Inonu University, Malatya, 1Atatrk University, Erzurum, 2Abant Izzet Baysal University,

Bolu, Turkey

Address for correspondence: Dr. Fuat Ahmetoglu, Department of Endodontics, Faculty of Dentistry, Institute of Health Sciences, Inonu University, 44280, Malatya,Turkey. E-mail: [email protected]

INTRODUCTION

Most of the endodontic failures occur as a result of theleakage of irritants from pathologically involved rootcanals. When nonsurgical aempts prove unsuccessfulor are contraindicated, endodontic surgery is needed to

save the root.[1,2]Surgical procedures usually consist onexposure of the involved apex, periradicular cureage,root resection, preparation of root-end and placementof a lling.[1,3]The aim of the rootend lling (RF) is toprovide a hermetic sealing in an apical region. Success of

the surgery has been aected signicantly by propertiesof used materials and sealing ability.[4] An ideal RFmaterial should adhere and adapt to the dentin wallsof the root end preparation, should prevent leakageof microorganisms and their byproducts into theperiradicular tissues and should be biocompatible. Onthe other hand, it should also be insoluble in tissue uids,dimensionally stable and unsusceptible to the presence ofmoisture.[1]However, no material has been found, whichhas all or most of the ideal properties of a RF material.

Objectives:The purpose of this study was to compare the sealing ability of different glass ionomer

cements (GIC) as rootend filling (RF) materials.Materials and Methods:One-hundred and

eleven extracted human canines were cleaned and prepared using a rotary nickel titanium les with

crowndown technique. All the teeth were lled with guttapercha and then the apical third of each root

was resected perpendicularly to the long axis direction. After, rootend cavity was prepared using a

round bur. The specimens were randomly divided into 7 groups of 15 samples, lled with one of the

test materials (Ionol, Ketac Molar Quick Aplicap, Argion Molar AC, Photac Fil Quick Aplicap, Fuji II

LC Capsule, Dyract Extra, Glasiosite Caps) and were stored at 37C and 100% humidity for 7 days.

1week later, apical parts of roots of 10 0.05 mm were attached to the computerized uid ltration

device. The data obtained were analyzed using an ANOVA and posthocTukeys tests (P 0.05).

Results:Statistical analysis indicated that RF with Argion molar AC (reinforced GIC) had the least

microleakage of all and whereas Ketac Molar Quick Aplicap (conventional GIC) showed highest apical

leakage than the other groups. Conclusion:This present study has shown that none of GICs, which

used as a RF material unable to prevent apical leakage exactly and Argion Molar AC is used as a RFmaterial among current GICs better than others.

Keywords:Computerized uid ltration meter, glass ionomer cements, microleakage,rootend lling

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DOI:10.4103/23214619.129014

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ABSTRACT

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Ahmetoglu,etal.: Sealing ability of glass ionomer cements as rootend lling materials

28 Journal of Restorative Dentistry / Vol - 2 / Issue - 1 / Jan-Apr 2014

study. These teeth were extracted for various reasonsand none had received endodontic therapy beforeextraction. To standardize these samples, all the selectedteeth were 2325 mm in length. All teeth were stored in0.5% of chloramine T immediately after extraction. Allthe softtissues and calculus were removed mechanicallyfrom the teeth. Crowns of teeth were sectioned at the

cementoenamel junction using a low speed diamondsaw. The working length was established 1 mm shortof the point at which the le exited the apical foramen.The root canals were prepared by using a rotary nickeltitanium les (Hero 642; MigroMega, Besancon, France)and a crowndown technique. The instrumented canalswere dried with paper points and lled with laterallycompacted guapercha (Aceonedent Korea Ind. Co.,Bucheonsi, South Korea). The cervical access wassealed with a temporary lling (Cavit; ESPE, Seefeld,Germany).

Apical root resections were then performed by

removing 3 mm of the apex, at a 90degree angleto the long axis of the root. Afterward root endpreparations (3 mm deep) were created using round

bur #2. After that, 105 teeth were randomly divided intoseven experimental groups of 15 teeth each accordingto the RF material to be used: Group 1, Ionol; Group 2,Ketac Molar Quick Aplicap; Group 3, Argion Molar AC;Group 4, Photac Fil Quick Aplicap; Group 5, Fuji Ii LCCapsule; Group 6, Dyract Extra; Group 7, GlasiositeCaps [Table 1].

RF materials were prepared according to themanufacturers instructions and placed into the

rootend cavities. An additional of 6 teeth was usedfor control (3 for positive and 3 for negative controls).Positive controls were left unlled. But negative controlswere lled any material and were totally coated with twolayers of nail vanish, including the RF surface. All theother root surfaces in experimental groups and positivecontrols were coated with a two layer of nail varnish,avoiding the apical surface of the RF.

Many RF materials have been used from past to present.While some of these materials are still in use, the use ofsome has been abandoned. As a result of the review ofliterature, it has been found limited studies that havecomprehensive investigation about still in used glassionomer cements (GICs) as a RF material for apicalsealing and also there has not been such a study with

the computerized uid ltration technique, yet. For thisreason, this study is important and aims to shed light onthe clinician in rootend sealing which planned with GICs.

In development process, GICs were produced rstlyas conventional GIC (CGIC) and then the addition ofmetals to the ller component in order to reinforced GIC(RGIC) has been proposed. As a result of this addition,it has been more radiopaque material to obtainedfacilitates posttreatment controls.[5,6] The negativityof CGIC is sensitivity of moisture especially in thehardening time. This limitation has been addressedthrough the introduction of hybrid GICs (HGIC) as the

resinmodied GIC (RMGIC) and polyacidmodiedcomposite resins (PMCR). These materials, through bothsets of polymerization and polyacid/base reactions, can benished immediately and have a beer appearance thanCGIC.[7]There are some advantages of frequently usedGIC for many years. As regards to biocompatibility, thesematerials exhibit a very low cytotoxicity and they do notinduce inammatory tissue responses; they also presentgood sealing properties because of their ability to forma chemical bond with dentine.[5]Bonding chemically todentin reduces the sealing signicantly. These cementsgenerate no heat while seing, they will not cause thermaldamage to tissues and will not aect heatlabile drugs

incorporated in the matrix phase of the cement.[6]AsRF GICs have a beer performance in sealing the apicalportion, even when the root canal was left unlled.[8]

A method of measuring microleakage by uid ltrationmethod[9]reported to have some advantages compared toother methods. Samples are not destroyed and it is possibleto obtain measurements of microleakage at intervals overextended time periods. In addition, computerized, fullyelectronic, reliable and digital air pressure checkingsystem is required to remove these deciencies.[10]

The purpose of this study was to evaluate apical leakageof dierent GICs (Ionol, Ketac Molar Quick Aplicap,Argion Molar AC, Photac Fil Quick Aplicap, Fuji II LCCapsule, Dyract Extra, Glasiosite Caps) comparatively asRF materials using a computerized uid ltration meterwith a laser system and a digital air pressure regulator.

MATERIALS AND METHODS

One hundred eleven freshly extracted human noncariousmaxillary and mandibular canines were used in this

Table 1: Glass ionomer cements, tips and manufacturers

used in this study

Product Tip Manufacturer

Ionol Conventional GIC Voco, GermanyKetac MolarQuick Aplicap

Conventional GIC Espe, Seefeld,Germany

Argion Molar AC Reinforced GIC Voco, Germany

Photac Fil QuickAplicap

Resinmodied GIC Espe, Germany

Fuji II LC Capsule Resinmodied GIC GC Corporation, Japan

Dyract extra Poliacidmodiedcomposite resin

Dentsply, Germany

Glasiosite caps Poliacidmodiedcomposite resin

Voco, Germany

GIC = Glass ionomer cement



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For leakage study, apical roots of 10.00 0.05 mm weresectioned using low speed diamond saw. Root sectionswere inserted into the plastic tube from the apicalside and connected to 18gauge stainless steel tube.The cyanoacrylate adhesive (Zapit, Dental Venture ofAmerica Inc., Anaheim Hills, CA, USA) was appliedcircumferentially between the root and plastic tube.

A new computerized fluid filtration meter with alaser system[10] used in this study have had a 25lmicropipee (Microcaps, Fisher Scientic, Philadelphia,PA, USA) mounted in horizontally. O

2from a pressure

tank of 120 kPa (1.2 atm) was applied at the apical side.The pressure was constant throughout the experiment

by means of a digital air pressure regulator addedto pressure tank. A 25l micropipette (microcaps)connected to the pressure reservoir by polyethylenetubing (microcaps). All pipees, syringes and the plastictubes at the apical side of the sample were lled withdistilled water. Water was sucked back with the microsyringe for approximately 2 mm. In this way, an air

bubble created in the micropipee and the air bubblewas adjusted to a suitable position in the syringe. Thenew computerized fluid filtration meter was basedon basically light refraction at starting and endingposition of air bubble movement inside micropipee.Through one side of the micropipee inside the device,an infrared light was passed. Two light sensitivephotodiode was arranged on the opposite side of themicropipee to detect any movement of an air bubbleinside micropipette. All operations were controlledwith PCcompatible software (Fluid Filtration03,Konya, Turkey). A 5min pressurization preload ofthe system was completed before taking readings.Measurements of uid movement were automaticallymade at 2 min during 8 min for each sample by usingPCcompatible software (uid ltration03). The softwareconverts minute linear movement of the bubble intonano liter movement at a rate of one measurement. Thisinformation is fed into PCcompatible software. Leakagequantity was expressed as l/cm H

2O/min and means

determined.

The oneway ANOVA and posthoc Tukeys honestlysignificant difference tests were used to determinewhether differences were significant at the 95% of

condence level (P< 0.05).

RESULTS

In this study, all the rootend materials showed dierentlevels apical leakage. Mean microleakage measurementsand standard errors are shown in Table 2 for all materials.While Argion Molar AC showed the lowest leakage,Ketac molar quick aplicap showed the maximum leakage.The positive controls demonstrated extreme amountsof apical leakage. The negative controls registered no

Table 2: Mean microleakage value and SD for experimental

groups

Groups Cements No. ofteeth

Meanmicroleakage

SD

1 Ionol 15 0.0128cd 0.0051

2 Ketac Molar Quick Aplicap 15 0.0162a 0.0064

3 Argion Molar AC 15 0.0114d 0.0035

4 Photac Fil Quick Aplicap 15 0.0122d 0.0051

5 Fuji II LC Capsule 15 0.0142bc 0.0057

6 Dyract extra 15 0.0123cd 0.0046

7 Glasiosite caps 15 0.0152ab 0.0054

*Means with different superscript symbols indicate signicant differences (P 0.05). On the otherhand, no statistically signicant dierence was found

between Glasiosite Caps and Ketac Molar Quick Aplicap

that showed the highest leakage (P> 0.05).

DISCUSSION

The choice of materials to be used in periapical surgeryand amount of rootend cuing angles is an importantissue in terms of apical leakage. For this reason, themicroleakage, which occurring after the apical resection

by using various cements and the techniques triedto reduced or even eliminate completely. Althoughdierent cements have also been used, any material ormethod to prevent microleakage completely has not been

found yet. Therefore, several studies have still remainedto prevent the apical microleakage.

Conventional seing and formulations of HGICs havebeen used as RF materials.[6] GICs were investigatedcomparatively with dierent materials as RF materialin many studies.[3,1115]In all this and similar studies, atype of GICs was compared with other dierent types RFmaterials. By considering the results of such assessmentsto say that more eective for leakage of which type ofGIC may be misleading. Therefore in this study, onlydierent types of GICs were compared with each otherand tried to determine the ideal GIC, which has the value

of leakage at least when it used as a RF material.

The evaluation method is as much crucial as theevaluated material. Many methods have been usedto assess the leakage of RF materials. Dye, bacterialand radioisotope analysis of the penetration and theelectrochemical method are among the most frequentlyused methods.[1619] However, most of these methodsaect the tested examples, unable to give the quantitativeresults and cause conict in the interpretation. In additionto this, a variety of assessment methods and dierences



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30 Journal of Restorative Dentistry / Vol - 2 / Issue - 1 / Jan-Apr 2014

In another present study have founded no statisticallysignicant dierence among Argion Molar AC, PhotacFil Quick Aplicap (RMGIC) and Dyract Extra (PMCR).Chong etal.[32]compared the leakage rate HGIC, CGICand Amalgam and they determined that the leakage rateof HGIC and CGIC is equal and more successful. Thisresult is parallel to our study.

Sealing value of Dyract extra (a PMCR) was found to besimilar to RMGIC. Toledano etal.[33]compared RMGICand PMCRs in terms of sealing and ultimately they did notnd a statistically signicant dierence between the twogroups. Similarly, Bracke etal.[7]reported that the sameresult. In our study, we demonstrated that no dierencetoo in terms of sealing between the groups; Dyract Extra (aPMCR), Photac Fil Quick Aplicap (a RMGIC) and FujiII LC (a RMGIC). However, Glasiosite Caps (anotherPMCR) showed more leakage than Dyract Extra. Showingdierent values of these materials which the same kindmaterials may be depend upon their chemical content.

Ketac Molar Quick Aplicap (a CGIC) showed themaximum leakage between the groups. Rossi etal.[34]identied that Ketac Molar shows more leakage. Inanother study[35]was indicated that the material showsmore leakage than RMGIC, it is similar to our results.

Through the details of their composition vary, RMGICsare generally able to form strong bonds to both enameland dentin.[36]This is a positive impact on sealing. Rosaleset al.[5]detected that HGIC creates less leakage thanCGIC. In this study, Photac Fil Quick Aplicap (a HGIC)

and Dyract Extra (a HGIC) provide more successfulsealing than Ketac Molar Quick Aplicap, but they showno statistically significant difference with Ionofil. Itis thought that the result is due to dierent chemicalcontent of Ionol than Ketac Molar Quick Aplicap.

In the present study, while Argion Molar AC, PhotacFil Quick Aplicap, Dyract Extra and Ionol showed thelowest leakage respectively, Ketac Molar Quick Aplicap,Glasiosite Caps and Fuji II LC showed the maximumleakage regardless of the groups. It was found out thatthe dierence resulted from structures of the materials,which were independent of the groups. It is reported

that the dierence may have resulted from the structuralchanges such as sensitivity characteristics of the materialsto moisture on the surface of dentin, material viscosities,dust particle sizes and the dierences in the dustliquidratio.[37]

CONCLUSIONS

It was concluded that none of GIC, which is used as RFmaterial unable to prevent the apical leakage exactly.

in the parameters of evaluation also make it dicult toestablish the relationship between the studies. Pommeletal.[20]showed that apical leakage has been tested withthree dierent methods on the same tooth in their studyand the used method have a strong impact on the results.

Wu et al.[21] suggested the use of liquid filtration

system to increase the reliability of endodontic leakagestudies. When liquid ltration method compared toother methods, it has some advantages such as toobtain quantitative volumetric data, to measure in lesstime, prevent damage to the samples and to conductrepeatable measurements on the same sample at giventime intervals.[22,23]Furthermore, the molecule size thatmakes up the problem of standardization dependingupon the materials such as dye, bacteria or radioactiveisotope, the dentin anity or the problems associatedwith pH are not the problem in this method.[21,2426] Inaddition, Oruolu et al. [10] have modified the fluidltration system and developed it that evaluates with a

completely electronic system, detects movement of uidwith a laser and the results are evaluated with a computerprogram. In present study, due to the all features of thetechnique, computerized uid ltration technique wasconsidered to be used because it is known to have moreadvantages than other methods.

In this study, Argion Molar AC, which is a RGICshowed the lowest leakage as a numeric value. RGICwas obtained by hightemperature sintering of silver intothe glass ionomer to improve the properties of CGIC.[27]More spherical particles in comparison with CGIC have

been obtained as a result of this reaction It is also the

seing time of RGIC is shorter that makes moisturecontamination less likely in a surgical environment.[8]Bhler[28]found that longterm performance of RGIC issuccessful. Vasudev[29]emphasis to the same conclusionthat they reported less leakage for RGIC and suggestedto use it as a RF material. The results which obtained bymetalreinforced GIC conrm the datas in our study.However, King et al. [30] expressed that Ketac silverwhich is a RGIC shows more leakage in proportion toAmalgam and Super EBA. We believe that the reason forthese dierent results may originate from the structuraldierences of Argion Molar AC and Ketac Silver and used

measurement method. Ionol, which is a CGIC showedthat the second the lowest leakage, it links to dentin, butduring the hardening time; disruption of its integrity ofthe result of moisture contamination creates the biggestdisadvantage. The leakage is more than RGIC may beconnected with the disadvantages. In addition, the metalalloys that have been added to Argion Molar AC may

be caused a decrease of the leakage by increasing thelling rate of GIC. However, the dierence in this studyis not signicant statistically. In fact, Roth[31] indicatedthat CGIC could be used as an alternative RF material.



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Furthermore, it was found that while Argion Molar AC,which is a RGIC showed the lowest leakage, Ketac MolarQuick Aplicap, which is a CGIC showed the maximumleakage in this study.

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How to cite this article: Ahmetoglu F, Topu K, Oruoglu H.Comparison of the sealing ability of different glass ionomer cements as

rootend lling materials. J Res Dent 2014;2:2731.

Source of Support:Nil, Conict of Interest:Nil.


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Compar of Sealing Ability