Intracanal dressing and root canal filling materials in tooth replantation: a literature review

The prognosis of tooth replantation is usually related to the need of endodontic treatment, which has a direct relationship with the occurrence of root resorptions. Several studies have been undertaken in an attempt to prevent, delay, or treat these complications, which are the main causes of loss of replanted teeth. This literature review examines research evidence on intracanal dressings and root canal filling materials used in cases of tooth replantation. A comprehensive search was performed in the Medline/Pubmed, Bireme and Scielo full-text electronic journal databases to retrieve English-language articles referring to these topics that had been published between 1964 and 2010. Calcium hydroxide (CH) remains the usually recommended choice as an intracanal medicament in replanted teeth; however, there is evidence to support the initial use of a corticosteroid-antibiotic combination such as Ledermix paste to control potential early resorption, prior to the introduction of CH where the beneficial effect in the treatment of progressive root resorption has been well proven. Regarding root filling materials, CH-containing sealers are a good option because of their biological properties. Accurate diagnosis and adequate treatment plan may constitute very complex tasks, particularly in tooth avulsion because several variables are involved. In addition to the technical knowledge and clinical experience directed toward the quality of treatment, patient education may favorably influence the survival of replanted teeth.

Radiopacity evaluation of new root canal filling materials by digitalization of images

The aim of this study was to evaluate the radiopacity of five root canal filling materials (AH Plus, Intrafill, Roeko Seal, Epiphany, and EndoRez). Following the International Organization of Standardization 687612001, five circular specimens (10 X 1 mm) were made from each material. After the material set, radiographs were made using occlusal film and a graduated aluminum step-wedge varying in thickness from 2 to 16 mm. The dental X-ray unit (GE1000) was set at 50 Kvp, 10 mA, 18 pulses/second, and distance of 33.5 cm. The radiographs were digitized, and the radiopacity was compared with the aluminum step-wedge, using WIXWIN-2000 software (Gendex). Data (mm Al) were analyzed using ANOVA and Tukey tests. AH Plus and Epiphany were the most radiopaque materials (9.8 and 8.8 mm Al, respectively), followed by EndoRez (7.2 mm Al). Roeko Seal and Intrafill presented the lowest radiopacity values (5.7 and 6.1 mm Al, respectively). Although the materials evaluated demonstrated different radiopacities, all had values above the minimum recommended by the international Organization of Standardization.

Radiopacity evaluation of root-end filling materials by digitization of images

The purpose of this study was to evaluate the radiopacity of 5 root-end filling materials (white MTA-Angelus, grey MTA-Angelus, IRM, Super EBA and Sealer 26). Five specimens (10 mm diameter X 1 mm thickness) were made from each material and radiographed next to an aluminum stepwedge varying in thickness from 2 to 16 mm. Radiographs were digitized and the radiopacity of the materials was compared to that of the aluminum stepwedge using VIXWIN 2000 software in millimeters of aluminum ( mm Al). Data were analyzed statistically by ANOVA and Tukey's test at 5% significance level. Radiopacity values varied from 3 mm Al to 5.9 mm Al. Sealer 26 and IRM presented the highest radiopacity values (p<0.05), while white/grey MTA and Super EBA presented the lowest radiopacity values (p<0.05). The tested root- end filling materials presented different radiopacities, white/grey MTA and Super EBA being the least radiopaque materials.

Mineral trioxide aggregate as a root canal filling material in reimplanted teeth. Microscopic analysis in monkeys

This study analyzed mineral trioxide aggregate (MTA) as a root canal filling material for the immediate reimplantation of monkey teeth. Four adult capuchin monkeys Cebus apella were used, which had their maxillary and mandibular lateral incisors on both sides extracted and reimplanted after 15 min. During the extra-alveolar period, the teeth were kept in saline solution and after reimplantation retention was performed with a stainless steel wire and composite resin for 14 days. After 7 days, the reimplanted teeth were submitted to endodontic treatment with biomechanics up to file n. 30 and irrigation with a saturated solution of calcium hydroxide [Ca(OH)(2)], and then divided into two study groups: group I - root canal filled with a Ca(OH)(2) paste, and group II - root canal filled with MTA. Radiographic follow up was performed at 30, 60 and 90 days postoperatively, and after 180 days the animals were killed and specimens were processed for histomorphological analysis. The results revealed that most specimens of both groups presented organized periodontal ligament with no inflammation. The resorptions observed were surface resorptions and were repaired by cementum. Both MTA and Ca(OH)(2) were good root canal filling materials for immediately reimplanted teeth, providing good repair and also allowing biological sealing of some lateral canals. There was no significant difference between the study groups (alpha = 29.60%).

Apical leakage after root canal filling with an experimental calcium hydroxide gutta-percha point

This study was an in vitro analysis of the apical seal of root canals filled with an experimental calcium hydroxide gutta-percha point. One hundred and ten recently extracted human permanent teeth with a single root were used. The root canals were biomechanically prepared, and some received a dressing of calcium hydroxide for 7 days. Root canals not dressed were filled by the lateral condensation technique with either regular gutta-percha or calcium hydroxide gutta-percha points. The dressed root canals were filled with the same sealers and regular gutta-percha points. The specimens were placed into a 2% methylene blue dye solution under vacuum, and the apical leakage was linearly evaluated. The experimental groups with calcium hydroxide dressing and the one with calcium hydroxide gutta-percha points exhibited significantly (p < 0.05) less leakage than the groups filled with regular gutta-percha points. The results obtained indicated that calcium hydroxide guttapercha points produced an improvement in the apical sealing quality of the root canal filling. Copyright © 1996 by The American Association of Endodontists.

Reaction of dogs' teeth to root canal filling with mineral trioxide aggregate or a glass ionomer sealer

This study was conducted to observe the reaction of apical tissues of dogs' teeth after root canal filling with gutta-percha and mineral trioxide aggregate (MTA) or a glass ionomer (Ketac-Endo) as a sealer. The root canals were instrumented and filled by the lateral condensation technique with the sealers studied. Animals were killed 6 months later, and the specimens were removed and prepared for histological analysis. Results showed no inflammatory reaction of apical tissue and total closure of the apical foramen of all the teeth sealed with MTA. The teeth sealed with Ketac-Endo showed two cases of partial closure and different degrees of chronic inflammatory reaction. In conclusion, MTA exhibited better biological properties than Ketac-Endo. Copyright © 1999 by The American Association of Endodontists.

In vitro evaluation of apical microleakage using different root-end filling materials

The objective of this study was to evaluate the apical leakage of retrograde cavities filled with Portland Cement (Concrebrás S/A-MG-Brazil), ProRoot MTA™ (Dentsply International, Johnson City, TN, USA) and Sealapex (Kerr Corporation, Orange, California, USA) with addition of zinc oxide (Odahcam Herpo Produtos Dentários Ltda, Rio de Janeiro, RJ, Brazil). Forty-two extracted single-rooted human teeth were decoronated and used for this study. The root canals were instrumented at 1.0mm short of the apical foramen using the step-back technique to an apical ISO size 60. The roots were obturated with gutta-percha points and sealer Sealapex (Kerr Corporation-USA) and then 3mm of each root apex was sectioned at a 90° angle. Ultrasonic retrograde preparation was performed with a diamond tip to 3mm depth and the roots were randomly divided into 3 groups according to the filling material: G1-Portland, G2-ProRoot MTA, G3- Sealapex zinc oxide-added cement. The root surfaces were covered with nail varnish up to 2mm from the apical foramen, immersed in simulated tissue fluid for 30 days, and then immersed in 0.2% Rhodamine B solution for 24 hours for evaluation of marginal leakage. The results showed mean leakage of 0.75, 0.35 and 0.35 for groups 1, 2 and 3, respectively; however, Kruskal-Wallis test revealed that there was no statistically significant difference among the results (p>0.05).

Periapical repair after root canal filling with different root canal sealers

The aim of this study was to evaluate periapical repair after root canal filling with different endodontic sealers. Sixty four root canals from dog ́s teeth were filled, divided into 4 groups (n=16). Root canals were instrumented with K-type files and irrigated with 1% sodium hypochlorite solution. Root canals were filled in the same session by active lateral condensation of the cones and sealers: Intrafill, AH Plus, Roeko Seal and Resilon/Epiphany System. After 90 days, the animals were euthanized and the tissues to be evaluated were processed and stained with hematoxylin and eosin. For histopathological analysis, the following parameters were evaluated: inflammatory process, mineralized tissue resorption, and apical mineralized tissue deposition. Histopathological analysis demonstrated that Intrafill had less favorable results in terms of apical and periapical repair, compared to the other sealers (p<0.05). AH Plus, Roeko Seal, and Epiphany sealers had similar and satisfactory results (p>0.05). In conclusion, AH Plus and the materials Roeko Seal and Epiphany are good options for clinical use in Endodontics.

Delayed tooth replantation: MTA as root canal filling

MTA has been investigated as a root-end filling material. Its mechanism of action has some similarities to that of Ca(OH())2. The purpose of this study was to evaluate the repair process taking place in the delayed replantation of monkey teeth using calcium hydroxide and MTA as root canal filling materials. Five monkeys had their lateral incisors extracted and bench-dried for 60 minutes. After root canal preparation, the teeth were assigned to two groups according to root canal filling material: I, calcium hydroxide; and II, MTA. The same treatment sequence was followed for both groups: coronal seal, periodontal ligament removal, immersion of the tooth in 2% acidulated-phosphate sodium fluoride, irrigation of the socket with saline and replantation. Both groups exhibited replacement resorption, areas of ankylosis and absence of inflammatory root resorption. Statistically similar results (p > 0.05) were observed for both groups regarding replacement root resorption, but the groups differed significantly (p < 0.05) regarding the occurrence of ankylosis. MTA may be a viable clinical option for filling teeth submitted to delayed replantation, and is an acceptable option for treating replanted permanent teeth in order to prevent tooth resorption, particularly when dressing changes are not possible.

Evaluation of pH and Calcium Ion Release of Root-end Filling Materials Containing Calcium Hydroxide or Mineral Trioxide Aggregate

Introduction: To evaluate calcium ion release and pH of Sealer 26 (S26) (Dentsply, Rio de Janeiro, RJ, Brazil), white mineral trioxide aggregate (MTA), Endo CPM Sealer (CPM1) (EGEO SRL Bajo licencia MTM Argentina SA, Buenos Aires, Argentina), Endo CPM Sealer in a thicker consistency (CPM 2), and zinc oxide and eugenol cement (ZOE). Methods: Material samples (n = 10) were placed in polyethylene tubes and immersed in 10 mL of distilled water. After 3, 6,12,24, and 48 hours and 7,14, and 28 days, the water pH was determined with a pH meter, and calcium release was assessed by atomic absorption spectrophotometry. An empty tube was used as the control group. Results: The control group presented a pH value of 6.9 at all studied periods and did not show the presence of calcium ion. S26 presented greater hydroxyl ion release up to 12 hours (p < 0.05). From 24 hours until 28 days, S26, MTA, CPM1, and CPM2 had similar results. in ail periods, ZOE presented the lowest hydroxyl ion release. CPM1, followed by CPM2, released the most calcium ions until 24 hours (p < 0.05). Between 48 hours and 7 days, CPM1 and CPM2 had the highest release. A greater calcium ion release was observed for CPM2, followed by CPM1 at 14 days and for S26, CPM1, and CPM2 at 28 days. ZOE released the least calcium ions in all periods. Conclusion: Sealer 26, MTA, and Endo CPM sealer at normal or thicker consistency release hydroxyl and calcium ions. Endo CPM sealer may be an alternative as root-end filling material. (J Endod 2009;35:1418-1421)

Root canal adhesive filling in dogs' teeth with or without coronal restoration: A histopathological evaluation

The purpose of this study was to evaluate in vivo the response of the periradicular tissues after endodontic treatment and root filling with Epiphany/Resilon (Penntron Clinical Technologies, LLC, Wallingford, CT) or gutta percha and new Sealapex (SybronEndo, Glendora, CA) in dogs' teeth with or without coronal restoration. Teeth without coronal restorations were used to assess the influence of continuous exposure to the oral environment on the periradicular tissues. Sixty root canals with vital pulps in three dogs were instrumented and obturated in a single session and randomly assigned to one of four groups as follows. group 1: root canal filling with Epiphany/Resilon with coronal restoration, group 2: root canal filling with Sealapex sealer and gutta percha with restoration, group 3: root canal filling with Epiphany/Resilon without restoration, and group 4: root canal filling with Sealapex sealer and gutta percha without coronal restoration. After 90 days, the animals were euthanized, and the maxillas and mandibles were removed and submitted for histologic processing. Longitudinal sections were obtained and stained with hematoxylin and eosin, Mallory's trichrome, and Brown and Brenn stains and examined under light microscopy. There were significant differences found between the four groups (p < 0.05). The results showed that roots canals filled with Epiphany/Resilon, with coronal restoration, had significantly less periradicular inflammation than roots canals filled with gutta percha and Sealapex, with coronal restoration (p = 0.021). No significant difference was observed in the intensity of inflammation between roots canals filled with Epiphany/ Resilon with no restoration and roots filled with gutta percha and Sealapex with restoration (p = 0.269). Roots canals filled with gutta percha and Sealapex sealer without coronal restoration showed the greatest degree of periradicular inflammation.

Evaluation of periapical repair following retrograde filling with different root-end filling materials in dog teeth with periapical lesions

Objective. The objective of this study was to evaluate periapical repair following retrograde filling using different root-end filling materials.Study design. After induction of periapical lesions, 48 root canals from do teeth were partially filled. Endodontic surgery was performed and 3 different materials were used for root-end filling: Sealer 26, Sealapex plus zinc oxide, or mineral trioxide aggregate (NITA). No additional procedures were performed in the control group after partial filling of the root canal. After 180 days, the animals were killed, the rnaxillas and mandibles were removed, and specimens were submitted for histologic processing.Results. Histopathologic analysis revealed similar periapical repair for the groups in which Sealer 26, Sealapex plus zinc oxide, and MTA were used (P >.05). The control group showed unsatisfactory periapical repair W <.05).Conclusion. There was no difference in periapical tissue healing alter retrograde filling with the tested materials, which indicates that these 3 root-end filling materials are equally useful.