Evaluation of bioceramics and zirconia-reinforced glass ionomer cement in repair of furcation perforations: An in vitro study

Abstract

Aim:The aim and objective of this study was to evaluate and compare the sealing ability of EndoSequence BC RRM-fast set putty, Proroot mineral trioxide aggregate (MTA), and Zirconomer in the repair of furcal perforation by measuring dye leakage under stereomicroscope.Methodology:A standard access cavity was made on forty-eight extracted mandibular and maxillary first molars followed by creating a furcal perforation in the center of the pulp chamber by using No. 4 round bur (creating a perforation of 2 mm diameter). Teeth were categorized into 4 groups containing 12 samples in each group based on material used for furcation repair. Group 1 – Endosequence BC RRM-fast set putty; Group 2 – Zirconomer; Group 3-MTA (positive control); Group 4 – negative control. All groups were covered with two layers of clear varnish except for 2 mm around the perforation region. All the teeth were immersed in 2% methylene blue dye for 48 h for dye penetration. Teeth were sectioned buccolingually using a diamond disk. The sectioned teeth were examined under stereomicroscope with ×10 magnification for dye penetration.Results:Endosequence showed less microleakage than MTA but not statistically significant. Zirconomer showed statistically significant higher microleakage.Conclusion:Endosequence and MTA showed less microleakage hence can be used as furcation repair materials. Due to higher microleakage, Zirconomer should be avoided as furcation repair material. Due to its favorable cost, ready availability, and almost similar outcome as bioceramics, MTA is considered as an alternative to Endosequence and is the gold standard in furcation repair.

Comparison of Mineral Trioxide Aggregate, Endosequence Root Repair Material, and Biodentine Used for Repairing Root Perforations: A Systematic Review

“…1,7,9,37 In regard to the types of root repair materials performed, fourteen studies were performed with MTA in a combination of other root repair materials such as ERRM and Biodentine. 2,8,10,12,13,17,20,26,[28][29][30][31][32]35 The placement of Biodentine alone as a root repair material for root perforation was made in three studies. 1,7,18 On the other hand, five studies, MTA has placed alone.…”

“…2 In this systematic review, few studies claimed that the perforations should be handled promptly with a biocompatible material which generates suitable sealing between the perforation and the adjacent tissues. 1,6,8,10,12 In addition, an in-vitro study conducted in 2016, after they assessed the sealing capacity of MTA and Biodentine declared that there are no considerable differences between the materials, advising for the use of Biodentine like an alternative to MTA in the perforations repair. 29 In another study done in 2017, they noticed that the MTA displayed better sealing in comparison to Biodentine.…”

“…18 Two studies affirmed that the closer to the oral cavity, the harshest prognosis is because of the bacterial contamination arising from the oral environment. 6,8 In a case report mentioned by Kaushik, et al 7 , Biodentine was the chosen material to a perforation repair situated at the cement-enamel junction due to mechanical properties, short prey time and excellent sealing, after 6 months of follow-up, the patient reported favorable outcomes in the healing of periodontal tissues. However, as a result of the absence of scientific evidence, further studies are required in order to highlight their characteristics over other materials.…”

“…4 The root perforation has as a causal element a pathological change like a large dental caries or root reabsorption, or it may happen through an operative surgical accident. [5][6][7][8] There are factors that make it hard to access to the root canal during the endodontic treatment, predisposing to dental perforation as examples: Errors regarding the canal identification, large caries, pulp calculations, badly positioned teeth, internal root reabsorption, excessive abrasion and debility of the dentin displayed in the danger zones. 9 The microorganisms deriving from the root canal, the periodontium or both may colonize the spot where the perforation happened, resulting in the contamination of the area and a probable inflammatory response.…”

“…10 The treatment may be carried out through the surgical method, although, since there is a possibility of pocket formation, the non-surgical technique is the most accepted, mainly in areas where the access is hard. 8,12 The treatment has as its aim to offer hermetic sealing and ought to be based immediately through surgical procedures or endodontic path. Because of the possibility of pockets formation in the surgical method, its more advantageous to endodontic therapy, particularly in regions of difficult access.…”