Evaluation of Marginal Adaptation of Root-End Filling Materials Using Scanning Electron Microscopy Comparison of Mineral Trioxide Aggregate and iRoot BP Plus Root Repair Material as Root‐end Filling Materials in Endodontic Microsurgery: A Prospective Randomized Controlled Study Super-EBA and IRM as root-end fillings in periapical surgery with ultrasonic preparation: a prospective randomized clinical study of 206 consecutive teeth. An ex-vivo comparative study of root-end marginal adaptation using grey mineral trioxide aggregate, white mineral trioxide aggregate, and Portland cement under scanning electron microscopy Clinical results with two different methods of root-end preparation and filling in apical surgery: mineral trioxide aggregate and adhesive resin composite. A comparative prospective randomized clinical study of MTA and IRM as root-end filling materials in single-rooted teeth in endodontic surgery. Endodontic surgery using 2 different magnification devices: preliminary results of a randomized controlled study. Investigation of the marginal adaptation of root-end filling materials in root-end cavities prepared with ultrasonic tips. Biodentine versus Mineral Trioxide Aggregate versus Intermediate Restorative Material for Retrograde Root End Filling: An Invitro Study Comparative Scanning Electron Microscopic Study of the Marginal Adaptation of Four Root-End Filling Materials in Presence and Absence of Blood A prospective clinical study of Mineral Trioxide Aggregate and IRM when used as root-end filling materials in endodontic surgery. Fracture resistance of roots endodontically treated with a new resin filling material. A multivariate analysis of the outcome of endodontic treatment. An In Vitro Comparison of Marginal Adaptation of MTA and MTA-Like Materials in the Presence of PBS at One-Week and Two-Month Intervals Hemostatic efficacy and cardiovascular effects of agents used during endodontic surgery. Periapical surgery using ultrasonic preparation and thermoplasticized gutta-percha with AH Plus sealer or IRM as retrograde root-end fillings in 160 consecutive teeth: a prospective randomized clinical study. Sealing ability and adaptation of root-end filling materials in cavities prepared with different techniques.
Introduction The importance of perfect apical seal in endodontics , more specifically in periradicular surgery , is the motivation/reason for development of root-end filling material s with favorable physical , chemical and biological characteristics . The aim of this in vitro study was to evaluate the marginal adaptation of root-end filling material s using scanning electron microscopy . Material s and Methods Twenty five human maxillary anterior teeth were prepared using a K-File # 50 to 1 mm short of the apical foramen and filled with gutta-percha and Sealapex using the lateral compaction technique . The apical 3 mm of the roots were sectioned perpendicularly to the long axis of the teeth . A 3-mm-deep root-end cavity was prepared using ultrasonic tips powered by an Enac ultrasonic unit . The teeth were r and omly assigned to five groups according to the material s tested including IRM , amalgam , ProRoot MTA , Super-EBA and Epiphany/Resilon . Root-end cavities were filled with the material s prepared according to the manufacturers ’ instructions . The root apices were carefully prepared for sputter coating and later evaluation using Scanning Electron Microscope ( SEM ) . The images of root-end fillings were divided into four quadrants and distributed into five categories according to the level of marginal adaptation between the root-end material and the root canal walls . The Fisher exact test with Bonferroni correction was used for statistical analysis . The level of significance was set at P = 0.005 . Results SEM images showed the presence of gaps in the root-end filling material s. No significant difference was observed between the tested material s ( P > 0.005 ) . Conclusion ProRoot MTA , IRM , amalgam , Super-EBA and Epiphany/Resilon showed similar marginal adaptation as root-end filling material Introduction : This prospect i ve r and omized controlled study evaluated the clinical and radiographic outcome of endodontic microsurgery when using iRoot BP Plus Root Repair Material ( BP‐RRM ; Innovative BioCeramix Inc , Vancouver , BC , Canada ) or mineral trioxide aggregate ( MTA ) as the retro grade filling material and analyzed the relationship between some potential prognostic factors and the outcome of the surgery . Methods : By using strict inclusion and exclusion criteria , 240 teeth were successfully enrolled and r and omly and equally allocated to either the MTA or BP‐RRM treatment group . A st and ardized surgical procedure was performed by a single operator . The patients were followed up at 1 week , 3 months , 6 months , and 12 months ; follow‐up included clinical and radiographic examination . Clinical and radiographic evaluations acquired at the 12‐month follow‐up were taken as the primary outcome . For the identification of prognostic factors , the dichotomous outcome ( success vs failure ) was taken as the dependent variable . Results : A total of 158 teeth were analyzed at the 12‐month follow‐up , including 87 teeth in the MTA group and 71 teeth in the BP‐RRM group . The success rate in the MTA and BP‐RRM groups was 93.1 % ( 81/87 teeth ) and 94.4 % ( 67/71 teeth ) , respectively ( P > .05 ) . Three significant outcome predictors were identified : quality of root filling ( P < .05 ) , tooth type ( P < .05 ) , and size of the lesion ( P < .05 ) Conclusions : These results suggest that BP‐RRM is comparable with MTA in clinical outcome when used as root‐end filling material s in endodontic microsurgery OBJECTIVE This study evaluated the treatment outcome after periapical surgery with the use of 2 different retro grade root-filling material s and the influence of 3 pre- and perioperative variables on the periapical healing . STUDY DESIGN Two hundred six teeth in 164 patients were r and omly allocated to receive either IRM or Super-EBA as a retro grade root-end seal . The teeth were review ed 12 months after surgery . The influence of lesion size , lesion type , and ortho grade root filling quality on healing was analyzed . RESULTS One hundred ninety-four teeth in 153 patients were review ed . Radiologic evaluation and clinical examination revealed 91 % success rate for the IRM group and 82 % for the Super-EBA group . There was no statistical significance in the healing outcome between the 2 groups ( Fisher exact test ) . The analyzed pre- and perioperative variables had no significant influence on the treatment outcome ( Z test ) . CONCLUSIONS Both retro grade material s tested in this study can serve as a root-end seal in periapical infected teeth , according to the results of the healing outcome after 12 months ' follow-up Context : Where nonsurgical endodontic intervention is not possible , or it will not solve the problem , surgical endodontic treatment must be considered . A major cause of surgical endodontic failures is an inadequate apical seal , so the use of the suitable substance as root-end filling material that prevents egress of potential contaminants into periapical tissue is very critical . Aims : The aim of the present ex-vivo study was to compare and evaluate the three root-end filling material s of mineral trioxide aggregate ( MTA ) family ( white MTA [ WMTA ] , grey MTA [ GMTA ] and Portl and cement [ PC ] ) for their marginal adaptation at the root-end dentinal wall using scanning electron microscopy ( SEM ) . Material s and Methods : Sixty human single-rooted teeth were decoronated , instrumented , and obturated with Gutta-percha .  After the root-end resection and apical cavity preparation , the teeth were r and omly divided into three-experimental groups ( each containing 20 teeth ) and each group was filled with their respective experimental material s. After longitudinal sectioning of root , SEM examination was done to determine the overall gap between retro grade material s and cavity walls in terms of length and width of the gap ( maximum ) at the interface . Descriptive statistical analysis was performed to calculate the means with corresponding st and ard errors , median and ranges along with an analysis of variance and Tukey 's test . Results : The least overall gap was observed in GMTA followed by PC and WMTA . While after statistically analyzing the various data obtained from different groups , there was no significant difference among these three groups in terms of marginal adaptation . Conclusion : GMTA showed the best overall adaptation to root dentinal wall compared to PC and WMTA . Being biocompatible and cheaper , the PC may be an alternative but not a substitute for MTA INTRODUCTION The aim of apical surgery is to hermetically seal the root canal system after root-end resection , thereby enabling periradicular healing . The objective of this nonr and omized prospect i ve clinical study was to report results of 2 different root-end preparation and filling methods , ie , mineral trioxide aggregate ( MTA ) and an adhesive resin composite ( Retroplast ) . METHODS The study included 353 consecutive cases with endodontic lesions limited to the periapical area . Root-end cavities were prepared with sonic microtips and filled with MTA ( n = 178 ) , or alternatively , a shallow concavity was prepared in the cut root face , with subsequent placement of an adhesive resin composite ( Retroplast ) ( n = 175 ) . Patients were recalled after 1 year . Cases were defined as healed when no clinical signs or symptoms were present and radiographs demonstrated complete or incomplete ( scar tissue ) healing of previous radiolucencies . RESULTS The overall rate of healed cases was 85.5 % . MTA-treated teeth demonstrated a significantly ( P = .003 ) higher rate of healed cases ( 91.3 % ) compared with Retroplast-treated teeth ( 79.5 % ) . Within the MTA group , 89.5%-100 % of cases were classified as healed , depending on the type of treated tooth . In contrast , more variable rates ranging from 66.7%-100 % were found in the Retroplast group . In particular , m and ibular premolars and molars demonstrated considerably lower rates of healed cases when treated with Retroplast . CONCLUSIONS MTA can be recommended for root-end filling in apical surgery , irrespective of the type of treated tooth . Retroplast should be used with caution for root-end sealing in apical surgery of m and ibular premolars and molars OBJECTIVE R and omized clinical prospect i ve study to evaluate the application of MTA and IRM as retro grade sealers in surgical endodontics . STUDY DESIGN One hundred single-rooted teeth were surgically treated . After r and omization , MTA or IRM was used as a retrosealer . Radiographs were taken 1 week , 3 months , and 1 year postoperatively . Assessment was performed by 2 independent assessors 1 year after surgery . Both treatment groups were homogeneous in their composition , and clinical features and radiographic findings were classified according to Rud 's classification . RESULTS Complete healing was observed in 64 % of the MTA-treated teeth vs 50 % of the IRM-treated teeth . Incomplete healing was seen in 28 % ( MTA ) vs 36 % ( IRM ) , and unsatisfactory in 6 % ( MTA ) vs 14 % ( IRM ) . Only 1 failure was seen ( MTA ) . No statistically significant differences were found between the 2 retrofilling material s. CONCLUSION As root-end filling material s in this clinical prospect i ve r and omized design on single rooted teeth , MTA and IRM had the same clinical effectiveness PURPOSE The introduction of microsurgical instruments and magnification devices has brought advantages in root-end management and the application of root-end filling material s. The main purpose of this prospect i ve clinical study was to monitor the outcome of ultrasonic root-end preparation using magnification loupes or an endoscope . Tooth location and the presence of post restoration were also examined as potentially affecting the outcome . MATERIAL S AND METHODS Teeth treated surgically showed a periradicular lesion of strictly endodontic origin . A total of 59 patients were included in the study , according to specific selection criteria . Following the reflection of a full mucoperiosteal tissue flap , residual soft tissues were curetted , root ends were resected , and root-end cavities were prepared ultrasonically with a zirconium nitrate tip , and zinc oxide EBA-reinforced cement root-end fillings were placed . Thirty-two root-end management procedures were performed using magnification loupes and 39 using an endoscope . All cases followed for a period of 1 year were classified into 3 groups ( success , uncertain healing , and failure ) according to radiographic and clinical criteria . RESULTS Of the 71 teeth evaluated at 1-year follow-up , 67 teeth ( 92.95 % ) successfully healed , 3 teeth had uncertain healing , and 2 failed . In the group using endoscopy , 94.9 % of successful healing was achieved , while for the other group , 90.6 % was recorded . We found no statistically significant differences in treatment results related to the arch ( P = .20 ) , post restoration ( P = .21 ) , or type of magnification device ( P = .08 ) . CONCLUSIONS In the present study , adherence to a strict endodontic surgical protocol and the use of modern surgical endodontic procedures , together with visual magnifications , result ed in an overall high success rate AIM To compare the surface topography of root apices following ultrasonic root-end preparation , and again after root-end fillings su bmi tted to three different finishing techniques . METHODOLOGY Eighty-one root-end cavities prepared ultrasonically in human canines , were divided at r and om into three test groups of 27 each . The cavities were filled with Super-EBA , IRM , or ProRoot-MTA and finished by ball burnishing . Eighteen roots from each group received a final finish with either a 30-fluted tungsten carbide finishing bur , or a Zekrya carbide 28 mm bur after storage in water at 37 degrees C for 24 h. The root-end surface topographies were reproduced by means of polyvinylsiloxane impressions and epoxy resin replicas . Scanning electron micrography ( SEM ) images of each replica were taken prior to and after root-end filling . An image analysis system was used to compare the alteration of the marginal chipping areas and to calculate the gaps located in the dentine/root-end filling interface . RESULTS When a bur was used to finish the set material s , a significant ( P < 0.05 ) area of marginal chipping was eliminated . The finishing technique did not significantly ( P > 0.05 ) affect the incidence of gaps in groups root-end filled with MTA or IRM . Super-EBA and IRM retrofillings finished with a ball burnisher or a Zekrya bur displayed a significantly ( P < 0.05 ) larger calculated gap area than roots filled with MTA . CONCLUSION Under this in vitro study , the marginal adaptation of MTA was good with or without finishing procedures . Applying a finishing bur over the condensed and set IRM and Super-EBA created better marginal adaptation Objective The aim of this study was to evaluate the marginal adaptation of Biodentine in comparison with Mineral Trioxide Aggregate ( MTA ) and Intermediate Restorative Material ( IRM ) , as a root end filling material , using Scanning Electron Microscopy ( SEM ) . Material s and Methods : Thirty permanent maxillary central incisors were chemo-mechanically prepared and obturated . Three millimetres of the root end were resected and 3 mm retro cavity preparation was done using ultrasonic retrotips . The sample s were r and omly divided into three groups ( n=10 ) and were restored with root end filling material s : Group I – MTA , Group II – Biodentine , Group III – IRM . The root ends were sectioned transversely at 1 mm and 2 mm levels and evaluated for marginal adaptation using SEM . The gap between dentin and retro filling material was measured at four quadrants . The mean gap at 1 mm level and 2 mm level from the resected root tip and combined mean were calculated . The data were statistically analyzed , using one-way ANOVA and Tukey ’s HSD post hoc test for intergroup analysis and paired t-test for intragroup analysis . Results : The overall results showed no statistically significant difference between MTA and IRM but both were superior when compared to Biodentine . At 1 mm level there was no statistically significant difference among any of the tested material s. At 2 mm level MTA was superior to both IRM and Biodentine . Conclusion : In overall comparison , MTA and IRM were significantly superior when compared to Biodentine in terms of marginal adaptation , when used as retro grade filling material Objectives : The aim of this study was to evaluate marginal adaptation of mineral trioxide aggregate ( MTA ) , calcium enriched mixture ( CEM ) cement , Biodentine and BioAggregate in presence of normal saline and human blood . Material s and Methods : In this in-vitro experimental study , 80 extracted single-rooted human teeth were instrumented and filled with gutta-percha . After resecting the root-end , apical cavity preparation was done and the teeth were r and omly divided into 4 groups (N=20)(a total of 8 subgroups ) . Root-end filling material s were placed in 3 mm root-end cavities prepared ultrasonically . Half the specimens in each group were exposed to normal saline and the other half to fresh whole human blood . After 4 days , epoxy resin replicas of the apical portion of sample s were fabricated and scanning electron microscopy ( SEM ) analysis was performed to find gaps in the adaptation of the root-end filling material s at their interface with dentin . The Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis of data with P<0.05 as the limit of significance . Results : There were no significant differences in marginal adaptation of the 8 tested groups ( P>0.05 ) . Conclusion : Based on the results , blood contamination does not affect the marginal adaptation of MTA , CEM cement , Biodentine or BioAggregate AIM To assess the success rate of the root-end filling material , Mineral Trioxide Aggregate ( MTA ) . METHODOLOGY Referred adult patients were recruited using strict entry criteria and r and omly allocated to receive MTA or IRM . A st and ardized surgical technique was employed : the root end was resected perpendicularly and a root-end cavity was prepared ultrasonically and filled . A radiograph taken immediately after surgery was compared with those taken at 12 and 24 months . Customised film holders and the paralleling technique were used ; radiographs were assessed by two trained observers using agreed criteria . The results from 122 patients ( 58 in IRM group , 64 in MTA group ) after 12 months and 108 patients ( 47 in IRM group , 61 in MTA group ) for the 24-month review period were analysed using the chi2 test . RESULTS The highest number of teeth with complete healing at both times was observed when MTA was used . When the numbers of teeth with complete and incomplete ( scar ) healing , and those with uncertain and unsatisfactory healing were combined , the success rate for MTA was higher ( 84 % after 12 months , 92 % after 24 months ) compared with IRM ( 76 % after 12 months , 87 % after 24 months ) . However , statistical analysis showed no significant difference in success between material s ( P > 0.05 ) at both 12 and 24 months . CONCLUSIONS In this study , the use of MTA as a root-end filling material result ed in a high success rate that was not significantly better than that obtained using IRM BACKGROUND The authors evaluated the fracture resistance of endodontically treated teeth filled with either gutta-percha or a new resin-based obturation material .  METHODS The authors prepared and r and omly divided 80 single-canal extracted teeth into five groups : lateral and vertical condensation with gutta-percha , lateral and vertical condensation with the new resin-based obturation material , and a control group with no filling material . The specimens were stored in 100 percent humidity for two weeks , mounted in polyester resin and loaded to failure . RESULTS The authors found statistically significant differences among the experimental groups ( P < .05 ) . The groups with the new material displayed higher mean fracture loads and the gutta-percha groups lower mean fracture load values than the control unfilled group . However , the differences were not significant . The groups with the new material displayed significantly higher mean fracture loads than gutta-percha groups independent of the filling technique used . CONCLUSIONS Filling the canals with the new resin-based obturation material increased the in vitro resistance to fracture of endodontically treated single-canal extracted teeth when compared with st and ard gutta-percha techniques . CLINICAL IMPLICATION S ; If other properties of the new resin-based obturation material compare favorably with those of gutta-percha for filling the root canal , it should be considered as a replacement for gutta-percha , as the results of this study indicate that it could provide enhanced resistance to tooth fracture In the present study , multivariate analyses were performed on clinical and treatment variables that may influence the outcome of  endodontic treatment .  Data collected in a previous clinical -radiographic follow-up study were used . Of 810 treated , 675 roots in 498 teeth were followed for 6 months to 4 yr . Of these , 192 ( the CAP group ) had pre-existing , chronic apical periodontitis and 483 ( the NAP group ) had not .  Root canal treatment followed a st and ard procedure with one of three sealers chosen at r and om . Demographic , clinical and radiographic variables were recorded at the start of , and during treatment . The periapical index ( PAI ) score was used to record the outcome of treatment , and applied in two different endpoint modes ( END1 and END2 ) as the dependent variable for multivariate statistical analyses using logistic regression and the general model . The modes reflected increasing PAI scores ( END1 ) and conventional success/failure assessment ( END2 ) . Dropouts were largely similar to the cases followed up . A total of 10 preoperative and peroperative variables were found to be significantly associated with treatment outcome by the multivariate analyses of either the total material or the NAP or CAP subgroups . Several of these were not significant in univariate analyses ( e.g. the effect of sealer ) . Conventional success/failure analyses ( END2 ) identified fewer of the influential variables and had low explanatory power , whereas PAI scores on an ordinal scale ( END1 ) were most sensitive in identifying variables of influence on the treatment outcome Objective : This study compared the marginal adaptation of mineral trioxide aggregate ( MTA ) and MTA-like material s as root-end fillings after incubation in phosphate buffer saline ( PBS ) , a synthetic tissue fluid , for either 1 week or 2 months . Material s and Methods : In this experimental study , seventy-two extracted human single-rooted teeth were prepared and obturated with gutta-percha and AH26 sealer . The apical 3 mm of the roots were resected . Root-end cavities were prepared with an ultrasonic retrotip . The specimens were r and omly divided into three groups ( n=24 ) and filled with either ProRoot MTA , OrthoMTA , or RetroMTA . Half of the specimens in each group were stored in PBS for 1 week the other half for 2 months . Epoxy resin replicas from the resected root-end surfaces and longitudinally sectioned roots were fabricated . The gaps at the material /dentin interface were measured using a scanning electron microscope ( SEM ) . Transversal , longitudinal , and overall gap sizes were measured . The data were analyzed using Kruskal-Wallis and Mann-Whitney tests . The significance level was set at p < 0.05 . Results : There were no significant differences between the marginal adaptation of ProRoot MTA , RetroMTA , and OrthoMTA in both transverse and longitudinal sections after incubation for either 1 week or 2 months ( p > 0.05 ) . In addition , the test groups were not significantly different regarding the overall mean gap values ( p > 0.05 ) . Conclusion : Under the conditions of this study , there was no difference between the marginal adaptation of ProRoot MTA , OrthoMTA , and RetroMTA as root-end filling material s after exposure to PBS for either 1 week or 2 months The hemostatic efficacy , as well as the cardiovascular effects , of two hemostatic agents currently used during endodontic surgery was examined . The hemostatic agents used were epinephrine pellets ( Racellet pellets ) or 20 % ferric sulfate ( Viscostat ) .  Patients were assigned to one of two experimental groups .  Blood pressure and pulse rate were recorded pre- and postoperatively and at three additional times during the surgery ( root-end resection , root-end preparation , and filling ) . The adequacy of hemostasis was rated by the surgical operator . Results indicated that there is no significant change in cardiovascular effects when using either of these hemostatic agents . Except in one case where ferric sulfate was the agent , both agents produced surgical hemostasis that allowed for a dry field for root-end filling OBJECTIVE The aim of this study was to evaluate the healing outcome after periapical surgery with an ultrasonic cleaning technique in conjunction with the use of either of 2 different retro grade root-filling material s in teeth with apical periodontitis . STUDY DESIGN One hundred sixty teeth in 139 consecutive patients were r and omly allocated into 2 groups receiving either IRM or thermoplasticized gutta-percha ( GP ) with AH Plus sealer as a retro grade root-end seal . The patients were review ed 12 months after surgery . The results were analyzed with Fisher exact test . RESULTS One hundred forty-seven teeth in 131 patients were review ed . Radiologic evaluation and clinical examination showed an 85 % success rate for the IRM group and 90 % for GP group . There was no statistical significance between the 2 groups . CONCLUSION Both tested material s , IRM and GP , are suitable as retro grade root-end filling material s in conjunction with ultrasonic root-end preparation according to the results of the healing outcome after 12 months follow-up The aim of this study was to evaluate the sealing ability and marginal adaptation of calcium silicate-based cements ( CSCs ) in root-end cavities prepared by ultrasonic and laser tips . A total of 72 extracted human maxillary incisor teeth were r and omly divided as 60 teeth in experimental groups and 6 teeth each for positive and negative control groups . Specimens in experimental groups were obturated , their root-end resections were performed and r and omly divided into six groups ( n = 10 ) as follows : G1 : Ultrasonic retrotip + MTA , G2 : Ultrasonic retrotip + Calcium Enriched Mixture ( CEM ) , G3 : Ultrasonic retrotip + Biodentine , G4 : Er : YAG laser tip + MTA , G5 : Er : YAG laser tip + CEM , G6 : Er : YAG laser tip + Biodentine . The sealing ability was measured by fluid transport method . Six specimens from each experimental group were r and omly selected to analyze marginal adaptation and prepared for scanning electron microscopy ( SEM ) analysis . Micrographs were scored and also analyzed using Image J software . Data were analyzed with ; two-way ANOVA , Bonferroni , Kruskall-Wallis , Mann-Whitney-U , Siegel & Castellan , and Spearman correlation coefficient tests . No significant difference was found between material s regarding the sealing ability and marginal adaptation ( p > 0.05 ) . Significantly greater fluid movement and poor marginal adaptation were seen for material s placed in cavities prepared by laser tips ( p < 0.05 ) . Positive correlation was found between the results of scoring and Image J analysis of SEM images ( r = 0.596 , p < 0.001 ) . Fluid transport method and SEM analysis gave similar results suggesting the use of ultrasonic-retrotips for preparing root-end cavities which are going to be filled with one of these CSCs
Conclusions : The probability for success for EMS proved to be significantly greater than the probability for success for RES , providing best available evidence on the influence of cavity preparation with ultrasonic tips and /or SuperEBA ( Keystone Industries , Gibbstown , NJ ) , IRM ( Dentsply Sirona , York , PA ) , MTA , or silicate cements as root‐end filling material instead of a shallow cavity preparation and placement of a resin‐based material .
HIGHLIGHTSEndodontic microsurgery ( EMS ) with the use of high‐magnification ultrasonic root‐end preparation and root‐end filling with SuperEBA , IRM , MTA , or other calcium silicate cements has a high probability of success .
Resin‐based endodontic surgery with the use of high‐magnification preparation of a shallow concave root‐end cavity with bonded resin‐based root‐end filling material performed less favorably than EMS
Introduction : The aim of the present study was to investigate the influence of root‐end preparation and filling material on endodontic surgery outcome .