|Year : 2022 | Volume
| Issue : 3 | Page : 175-179
Comparative evaluation of the fracture resistance of roots after the application of three different root canal sealers: AH Plus, MTA Fillapex, and BioRoot RCS: An in vitro study
Aparna V Muraleedhar1, Sarvapelli Venkata Satish1, Roshan Uthappa2, Ashwini M Patil3, Basavana Gowda1
1 Department of Conservative Dentistry and Endodontics, Navodaya Dental College, Raichur, Karnataka, India
2 Department of Restorative Dental Sciences, College of Dentistry, Majamaah University, Al Zulfi, Saudi Arabia
3 Department of Conservative Dentistry, Navodaya Dental College, Raichur, Karnataka, India
|Date of Submission||26-Mar-2022|
|Date of Acceptance||14-Nov-2022|
|Date of Web Publication||31-Dec-2022|
Dr. Sarvapelli Venkata Satish
Department of Conservative Dentistry and Endodontics, Navodaya Dental College, Raichur, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: Root canal fillings using Gutta-percha and root canal sealers are considered the gold standard in endodontics. Bondable root canal sealers help in strengthening the root by penetrating into the dentin.
Aim: The aim was to compare and evaluate the fracture resistance of root dentin following the application of AH Plus sealer, MTA Fillapex sealer, and BioRoot RCS sealer.
Materials and Methods: Decoronation was performed on 70 extracted single-rooted premolars at the cementoenamel junction. The samples were divided into three experimental and two control groups. Fourteen samples served as the negative control (Group 4), which were left unprepared. The remaining 56 samples were prepared with ProTaper rotary files up to F3. The roots were obturated using cold lateral compaction using Gutta-percha and AH Plus sealer (Group 1), MTA Fillapex (Group 2), and BioRoot RCS (Group 3). Group 5 served as the positive control group. A universal testing machine was used to compress the samples until fracture occurred. One-way analysis of variance with post hoc Tukey's test was used to analyze the data.
Results and Discussion: The highest resistance to fracture was shown by Group 4 (negative control), followed by Group 1 (AH Plus), Group 3 (BioRoot RCS), Group 2 (MTA Fillapex), and the least by Group 5 (positive control). There was a statistically significant difference between all the groups (P = 0.00) except between AH Plus and BioRoot RCS (P > 0.05).
Conclusion: Samples in all the groups fractured when vertical force was applied. The maximum resistance to fracture was shown by the roots which were neither instrumented nor obturated. AH plus sealer showed the highest resistance to fracture among the three experimental groups, followed by BioRoot RCS and MTA Fillapex.
Keywords: AH plus, BioRoot RCS, fracture resistance, MTA Fillapex, root canal sealers
|How to cite this article:|
Muraleedhar AV, Satish SV, Uthappa R, Patil AM, Gowda B. Comparative evaluation of the fracture resistance of roots after the application of three different root canal sealers: AH Plus, MTA Fillapex, and BioRoot RCS: An in vitro study. Saudi J Oral Sci 2022;9:175-9
|How to cite this URL:|
Muraleedhar AV, Satish SV, Uthappa R, Patil AM, Gowda B. Comparative evaluation of the fracture resistance of roots after the application of three different root canal sealers: AH Plus, MTA Fillapex, and BioRoot RCS: An in vitro study. Saudi J Oral Sci [serial online] 2022 [cited 2023 Feb 6];9:175-9. Available from: https://www.saudijos.org/text.asp?2022/9/3/175/366529
| Introduction|| |
Root canal fillings using Gutta-percha and root canal sealers are considered the gold standard in endodontics. It is postulated that endodontically treated teeth are more susceptible to vertical root fracture due to loss of tooth structure because of various reasons such as access cavity preparation, excessive pressure during root canal cleaning and shaping, effect of irrigation, condensation pressure during obturation, and removal of intracanal post.,
Root canal sealers that strongly adhere to the dentin help strengthen the root against fracture. Bondable root canal sealers help in strengthening the root by penetrating into the dentin. This property is known as the monoblock effect.
AH Plus is a resin-based root canal sealer with excellent sealing properties. They can penetrate into the dentin and forms a monoblock between the root dentin and root filling., MTA Fillapex is a mineral trioxide aggregate-based sealer. It has an elastic modulus similar to that of dentin. In several studies, MTA Fillapex has shown the ability to promote the formation of hard tissue at the root apex and perforation site. BioRoot RCS is a tricalcium silicate-based sealer and exhibits the property of biomineralization. When this sealer is exposed to a physiologic solution, a layer of calcium phosphate (apatite) is formed, which helps to form a chemical bond with root dentin.
The goal of this in vitro study was to evaluate the resistance to fracture of roots after the application of three different root canal sealers – AH Plus, MTA Fillapex, and BioRoot RCS.
| Materials and Methods|| |
Preparation of the samples
Seventy recently extracted single-rooted premolars without caries, curvatures, or cracks were collected. Soft tissue residues and calculus were removed using a piezo scaler. Two hours of immersion in 5% sodium hypochlorite solution was used to disinfect the samples. Under a light microscope at ×20 magnification, the teeth were thoroughly examined to exclude any teeth with restorations, immature apices, root caries, cracks, or fractures. After decoronation with a fissure diamond bur, the specimens were irrigated with copious amount of water to yield 13 mm roots.
As a negative control group, 14 samples were selected at random that were neither instrumented nor obturated. The working length of remaining 56 samples was determined by subtracting 1 mm from the length of an inserted #15 K-File with its tip visible at the apex. Root canals were prepared using ProTaper Gold rotary files (Dentsply Maillefer, Switzerland) in a single-length technique up to F3.
In between each filing, the canals were rinsed using of 2.5% NaOCl. After the completion of instrumentation, the roots were rinsed with 5.25% NaOCl followed by 1 ml of 17% Ethylenediaminetetraacetic acid (EDTA) for 60 s to remove the smear layer and finally with distilled water. To dry the canals, paper points were used. Depending on the sealers used, the samples were divided into three experimental groups and two control groups:
Group 1: AH Plus sealer
AH Plus sealer (Dentsply DeTrey, Konstanz, Germany) consists of two pastes. On a glass slab, equal amounts of both pastes were mixed together with a metal spatula to achieve a homogenous consistency. The sealer was then applied to the canal walls by a master Gutta-percha cone. The canals were then obturated using lateral compaction technique using Gutta-percha and AH Plus sealer.
Group 2: MTA Fillapex sealer
MTA Fillapex (Angelus, Londrina, Brazil) comes in a dual syringe, which ensures an equal mixing in 1:1 ratio. The material was mixed on a glass slab for about 30 s to a homogenous consistency. Gutta-percha and MTA Fillapex were used to fill the canal with lateral compaction.
Group 3: BioRoot RCS sealer
BioRoot RCS (Septodont, Saint-Maur-des-Fosses, France) is available in a powder-liquid form. One scoop of the powder was added with five drops of liquid and mixed on a mixing pad for about 60 s to obtain a smooth paste. The canals were then obturated using lateral compaction technique with Gutta-percha and BioRoot RCS sealer.
Group 4: Negative control
The samples were neither instrumented nor obturated.
Group 5: Positive control
The canals were instrumented, but left unobturated.
To allow the complete setting of the sealers in all experimental groups, the teeth were stored in 100% moisture at 37°C for 7 days.
Fracture resistance testing
The roots were vertically mounted in copper molds filled with autopolymerizing acrylic resin. Resin cylinders of 10 mm height and 20 mm diameter were fabricated such that 7 mm of root length was embedded in the acrylic and 6 mm was exposed.
The roots mounted in acrylic were then fixed on the jig of the universal testing machine (Instron Corp). A ball with a diameter of 3 mm was used to apply compression load over the canal orifice at a crosshead speed of 1 mm/min until fracture occurred. The load was recorded in Newton (N).
Ethical approval for this study(Ethical Committee no: 02_ D044_90212) was provided by the Ethical clearance committee of Navodaya Dental college, Karnataka on 27 November 2018.
| Results and Discussion|| |
The standard deviations and means of fracture resistance in each group are shown in [Table 1].
- The negative control group required the highest force to fracture the roots (813.82 N)
- Among the experimental groups, AH Plus sealer showed the highest resistance (667.50) followed by BioRoot RCS (614.20 N) and MTA Fillapex (477.17 N). The positive control showed the least resistance to fracture (361.06 N).
The data obtained were subjected to Shapiro–Wilk test to check for the normalcy [Table 2].
- The data showed a normal distribution. Hence, analysis of variance (ANOVA) with post hoc Tukey was applied.
ANOVA was used to analyze the difference between various test groups [Table 3].
|Table 3: Comparison of the mean fracture resistance scores using analysis of variance|
Click here to view
- It was seen that there was a statistically significant difference within the groups (P = 0.00). Hence, the further analysis was done using post hoc Tukey's test to analyze the difference between the groups.
A post hoc Tukey's test was used for comparing the fracture resistance among the groups [Table 4].
- There was a statistically significant difference seen between all the groups (P = 0.00) except between AH Plus and BioRoot RCS (P > 0.05).
| Discussion|| |
A successful endodontic procedure depends on a wide range of factors including proper canal instrumentation, biomechanical preparation, and three-dimensional root canal obturation. Combined with solid obturating materials, root canal sealants create a hermetic seal.
The primary function of root canal sealers is to seal the space between the root filling material and the root dentin, to act as a lubricant, and to seal the lateral and accessory canals of the tooth. Despite Gutta-percha and root canal sealers being considered the gold standard for root canal obturation, there are some controversies over whether these materials can reinforce endodontically treated roots.
In this study, each group consisted of specimens randomly chosen from a collection of single-rooted premolar. From the middle to the apex, the premolar teeth have a circular cross section, which ensures uniform force distribution and simulates the clinical condition when chewing forces are at maximum.
Rotational forces by rotary NiTi instruments can create cracks and reduce the fracture resistance of the roots. In the present study, ProTaper rotary instrumentation was done up to F3 to avoid the thinning and weakening of root dentin. Furthermore, it creates a round-shaped canal, which aids in the distribution of the stress uniformly during filling, reducing the fracture susceptibility.
Following the root canal instrumentation, 17% EDTA was used to irrigate the canal. EDTA helps dissolve the smear layer and opens up the dentinal tubules. This helps enhance the adaptation and bonding of the sealer to the root dentin.,
To exclude the access cavity as a variable, the samples were decoronated at the cementoenamel junction. The samples were then mounted in acrylic resin blocks to simulate healthy teeth supported by alveolar bone that can absorb the masticatory forces. 6 mm of roots were projected above the embedding material. This is to simulate the clinical condition, in which no <50% of bone support needs to be present for premolars to have a fair periodontal prognosis anticipated that the other factors are favorable.
As the obturation technique in this study, cold lateral compaction was used, because it is widely used in clinical settings. Punjabi M et al. in their study to compare the resistance to fracture of root canal sealers obturated with different obturating techniques, concluded that the maximum resistance to fracture was seen after filling the roots with cold lateral compaction technique than with the warm vertical compaction and injection-molded thermoplasticized technique.
In the present, the mean fracture resistance of the negative control group (813.82 N) was significantly higher than AH Plus (667.50 N) followed by BioRoot RCS (614.20 N), MTA Fillapex (477.17 N), and the positive control group (361.06 N). This could be because the samples in the negative control group were unprepared, and no instrumentation was done, which resulted in no loss of dentin, hence a greater resistance to fracture. Group 5 (positive control) showed the least resistance to fracture compared to the other groups probably due to a significant loss of root dentin, and the samples were left unobturated.
AH Plus showed the greatest resistance to fracture compared to MTA Fillapex and BioRoot RCS. This is due to its adhesive property of AH Plus as it can penetrate micro-irregularities and form a single unit or a monoblock, which improves the mechanical bond between the root dentin and sealer, thus improving the fracture resistance., AH Plus forms a covalent bond between the epoxy ring and the amino group in the collagen in the dentin. Due to the higher concentration of epoxy resin, AH Plus exhibits a superior flow compared to BioRoot RCS and MTA Fillapex.
BioRoot RCS induces calcium hydroxide deposition, thus promoting bioactivity and adhesion of the sealer to the root dentin., High fracture resistance of BioRoot RCS can be attributed to its biomineralization activity. In the current study, there was no statistically significant difference in fracture resistance between AH Plus and BioRoot RCS (P = 0 287)
The fracture resistance of MTA Fillapex was significantly lower than that of AH Plus and BioRoot RCS (P = 0 00). This could be due to low adhesion of MTA to the dentin as it forms an interfacial layer of apatite-like crystals. These results are comparable to that by Mandava J et al., in which MTA Fillapex had a lower fracture resistance than AH Plus. However, in contrast to the current study, Yendrembam et al. found that the MTA Fillapex showed a greater fracture resistance than AH Plus. This could be due to the difference in the methodologies followed in the studies.
| Conclusion|| |
The fracture resistance of roots after obturation with Gutta-percha and various sealers was evaluated in this in vitro study. Within the constraints of the study, it can be concluded that among the three sealers tested, AH Plus had the highest mean value of fracture resistance, followed by BioRoot RCS and MTA Fillapex. There was no statistically significant difference between AH Plus and BioRoot RCS (P > 0 05). When compared to MTA Fillapex, both AH Plus and BioRoot RCS showed a statistically significant difference (P = 0.00).
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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