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A comparative evaluation of the effect of final alcohol rinse and 5.25% sodium hypochlorite as a final irrigant on sealer coverage of root canals. An in vitro study
A COMPARATIVE EVALUATION OF THE EFFECT OF FINAL ALCOHOL RINSE AND 5.25% SODIUM HYPOCHLORITE AS A FINAL IRRIGANT ON SEALER COVERAGE OF ROOT CANALS. AN IN VITRO STUDY Brave Dexter, * Tyagi (Mrs) P.S, ** Brave (Mrs) V.R
***
Tensioactive a gents ma y alter dentinal wettability allowin g increased sealer penetration into dentinal tubules. This ma y improve the apical seal and better entomb remaining bacteria. The purpose of this study wa s t o determine if a fin al rinse of alcohol or sodium hypochlorite increased sealer coverage of r oot canal. The samples wer e ra ndomly divid ed into four gr oups according tu the method of sealer placement and final irri gant used. Group 1 tile and 95 % ethanol, gr ou p 2 tile and 5.25% sodium hypochlorite, group 3lentulospiral and 95% ethanol, group 4lentulospiral and 5.25% sodium hypochlorite. T he samples were obtura ted wit h AH2 6 as scaler mixed with carbon black pOWclCI' and ell1h, I''' ' 'dm , All samples were decalcified with 5% nitric acid and dehydrated in alcohol , followed by clearing in methyl salicylate. The cleared samples were measured under dissecting microscopefor sealer penetration with the help of millim eter scale. Alt houg h a final rinse of alcohol did not increase sealer coverage, a high va riability wa s found in the middle and apical third portions ofthe root canals. Key words : 95 % ethanol, 5.25% sodium hypochlorite, nitric aci d, methyl salicylate. Pulpa l uecius is and periapical inflammation are lar gely cau sed by bacteria. Once established in the rool c an al , hacteria hav e been found to inv ade deep int o the d enti nal tubul es.' Canal instrumentation alone may not complete ly rem ove all bacteri a.' During ' canal instrumentation , a sme ar layer is produced th at pr events sealer penetration into th e tubul es.' Irrigation with 1'/ % elhy lcu c diamine tetra-ac etic acid (EDTA) followed by 5.25% sodium hyp ochlorite (N aOCl) renders the tubules patent and allows seale r pen etration durin g obturation.' V ario us methods have been suggested to increa se th e adhesion of sea lers onto dent in , One of th em is th e use of alco hol to dehydrate canal walls be tore sea ler pl acem ent. ~ Th e purpose of thi s study was to determine if a final rin se with either 95% ethy l alcohol (95 % ethanol) or 5.25 % sod iu m hypochlorite (5 .25 % NuUCl) III mstrumcnkd, W IC cU ll t t Climb wu ultl 'Aeuder,
I
'Proj esso r and H ead, Uperaltve Deni istrv and
F:"d,,!t"ltI Hf; ,'"" ~ n1'rujussu r, Dcp] , oj' Oral Pa thology " lid Miuroln ology, Kothiwal Den tal College and Research Centre, Moradabad - 244001, Utta r Pradesh, India.
affect th e sealer coverage of roo t cana l, when the sea ler is applied using either a file or a lentulospi ral, MEllIOD
40 extrac ted human single roo ted mandibular pr em ol ars with roo t canal curvature < 30 d egrees were stored in saline. Convention al access cavities were pr PcllCU aud wuikiug leugtlr was es tablished by subtracting 110m fro m the apex. Cl eaning and sh uping w as don e usin g K files w ith th e step back. biornec hanical preparation techniqu e till api cal ~ i7~ 35. Can als were flared coronallv using Gates Glidden drills number 3 and 4. Throu ghout the cl eaning and sha ping pro cedure , th e root canals were irrigated with 5.25% NaOCI and 17%EDTA solut ion. Th e teeth w ererand omly divid ed into four groups o f 10 eac h according to the method of sealer pl acement and the fmal irrigant used. Group 1 file and 95% ethanol , l:f0up 2. mo und 5.2.5% NoOn , eronp l lr.ntnl'-',~roi r" l and 9.5% ethanol • ~o UP 4 !cntuJ()spiral and .'i./.'i% NaOCI. After canal preparation, final irrigation was done with 1 ml of 5.25% NaOCI for group s 2 and 4 and with
JPFA, Vol. 25, December,2011
185
l
95% ethanol for groups I and 3 using 27 gauge needle placed deep in the canal. The canals were dried with fine paper points until no moisture was evident on the paper point. AH26 sea ler was mix ed according to manufacturers directions . A small amount of carbon black powder was added to it to produce a gray colour which would be visible after clearing the teeth. The sea ler was placed in the root canal in a quantity of 0.04ml which was measured with a tuherculin syrin ge and app lied in the apic al IOmm with a 35 sized K file for groups I and 2 and with a lentu lospiral number 3 for groups 3 and 4. The can als were obturated immediately after sealer placement using the lateral compaction technique with gutta perc ha. Excess gutta percha and sealer
were removed with a heated plugger and vertically condensed with hand pluggers. IRM (zinc oxide strengthened wit h po lymethacrylate) was sea led in the access cavities . Teeth were decalcified using 5% nitric acid for 8 to 10 days . Teeth were dehy drated in an ascending series of graded alcoho ls (75%,85%,95%, 100%, 2 hrs each) and cleared by immersing them in methyl salicy late initially for 6 hrs and were stor ed permanently in methyl salicylate. After cl earing with methy l salicylate each tooth was placed beside millimeter ruler under a c1iss ectmg micro sco pe and readings were taken in coronal, middle and apical thirds of each samp le. Statistical evaluation was done by ' t' test and analysis of variance.
OBSERVATIONS Table I : Mean ami standard deviations uf all groups, ALCOHOL n = 10 FILE
SODIUM HYPOCHLORITE (mm) n -IO FILE
(Group I)
(Group 2)
(mm)
ALCOHOL Il -IO LENTULOSPlRAL'
SODHJM HYPOCHLORITE (mm) Il - 10 LENTULOSPlRAL
(G roup 3 )
(Group 4)
(mm)
('
M
A
C
M
A
C
M
A
C
M
A
MEAN
5.64
4.66
4.30
5.54
4.90
4.00
5.38
4.57
4.26
5.39
4 .90
4.47
STANDARD OFYTATfON (T)
0.31
0.711
U 8
0.110
0.69
0.9'1
0.110
1.23
O:IS
0.44
U.5Y
U .5 ~
C - Coronal third of th e "a nal ) M - Midd le thi rd of the cana l ) A - Apica l third of
th e canal) n -
sample size of each group . Table 2: 't' values and standard error for groups 1 and 2. (Comparison of coronal and middle third, coronal and apical third) FILE and ALCOHOL (Group 1) Mean changes (+1- S E)
' t' value
Significance
' C vis M
0.98 ( +1- 0.27)
3.69
P < 0.002 Significant
C vis A
1.34 (+ 1- 0.)0)
'2.66
l' < U.U) Sigruncant
Comparison
FILE and SODIUM HYPOCHLORITE (Group2) C vis M
0.64 ( +1- 0.27)
2.42
P < 0.05 Significant
via 1\
1.54(+1 0.35)
4.39
P -:: 0.001 (Significunt
C
186 JPFA , Vul. 25, December, 2011
Table 3 : 't'values and standard error for groups 3 and 4. (Comparison of coronal and middle third, coron al and apical third)
-
LENTULOSPIRAL and ALC OH OL (Group 3) Comparison
Mean chan ges (+1- S E)
' t' value
Significance
C vis M
0.81(+1- 0.43)
1.86
P < 0.05 Not Signifi cant
vis A
0.27( +1 - 0.22)
2.85
P < 0.05 Significant
C
LENTULOSP IRAL & SODIUM HYP OCHLORIT E (Group4) C vis M C
--
vis A
0.49( +1- 0.25 ) 0.92(+1- 0.24)
2.0
P < 0.05 Not Significant
3.81
P < 0.002Signific'Ult
Table 4: ' t' values an d standard er ror for all groups (Compari son of middl e and apical third) FIlE
Compa rison
Mean chan ges (+1- SE)
't' valu e
Significance
Middle
Alcohol vis Sodium hypochlorite
0.24 ( +1- OJ4)
0.71
P > 0.05 Not Significant
Apical
Alcohol vis Sodium Ill' pudllUl ilu
OJ O (+1- 0.59)
0.51
MitUlc
Alcohol vis Sodium hypochlorite
0.40 ( +1- 0.34)
1.53
Apical
Alcohol vis Sodium hypuchl ui ite
0.30 ( +1- 0.45)
0.44
P >0.05 Not S l gl ll !l C,UII
LENTULOSPIIlAL
lUi." I "
-
:rs
P >O.05 Not Significant P > 0.05 Not SIV1ltkant
coronal, middle und apical thirds respectivel y.
I. For group I, the mean sea ler coverage values were5 .64mm for coronal, 4.66mm tor middle, 4Joinm for apical thirds respectively and standard deviations Wtl COJllllllJ.,O.7411un and 1.48nl1n forcoronal, middle ,!nd apical tlurd s respectively.
4. For group 4, the mean sealer coverage values were 5.39mm, 4.90nu11 and 4.47mm for coro nal , middle and apical thirds respectively and standard deviation s were 0 441ll1ll, O,')9mlll and 0.58 mm for cornnal, mi rlrll e :I nri ;Ip i r.'jl l tlnrds respectively.
2. For !,'TOUp 2, the mean sealer coverage values were 5.54mm, 4.90mm and-t.Oonun forcoronal,middle and apic al third s respectively and standard deviations were 0.40mm , 0.69mm, and 0.97mm for coronal, middle and apical third s respectively.
There was a signi ficant difference between the sealer coverage of coronal and apical thirds in all four !,'TOUpS and no significant differ ence betw een the middl e and apical thirds of all four groups.
3. For group 3, the mean sealer coverage values were 5J 8mm, 4.57 and 4.26nu11 for coronal, middle and apica l third s r esp ecti v el y and st anda rd deviations were 0.40mm , 1.23n1ll1 and 0.75nun for
DISCUSSION Failure following endodontic treatm ent has been attributed to many factors. One of them is incompl etely sealed root canal space leadin g to JPFA , Vol. 25, December, 2011
18 7
chronic periapical infection and oth er pathoses." Development of an imp ervious seal is therefore imperative that involves theuseofa solid coremateriaJ whi ch is obturated with a sealer. How ever none of the available se alers consistently pr event apical leakag e.'
strengths of etha nol becaus e the cl earing agent in not miscibl e in water but is miscibl e in alcohol." Methyl salicylate was used in this study as it is less toxic than xylene and causes minimal tissue distortion wh en compared with other cl earing
Th e lack of a prim ary bond may be du e to the presenc e of residual moisture in the roo t canal that may prevent the sealer from completely coating the canal walls."Alcohol , a volatil e solvent has been sug gested to dehydrate the ca nal wa lls before placement of the sealer .9
Th e best sea ler coverage was seen in the coronal third with high variability in the middle and apical thirds. Th is may be due due the sea ler being wip ed off in the coronal part while being introduced with either a file or a lenrulospiral , resulting in less sealer being availabl e to coat the middl e and api cal portions of the can als. No statistically significant difference wa s ob serv ed in the sea ler cov erage wh en alcohol w as used as the final irri gant as compared to sodium bypochlorit e.
In the light of the abov e, this in vitro study carri ed out to f: v il l ll il l t: (lI lC l l".I lI lI J1 (H ~ f1lC~ w·.alpf cove rage of the root canal using 95% ethanol or 5.25 % sodium hypochlorite as final irrigant with the sa me sealer(A H26) and obturating m ateri al and technique, with the sealer being placed in the root can al using either a file or a lcntulospiral.
W ilS
agents."
Lisa Wilc ox et al ( 1995) 12 performed a study on sealer coverage of root cana ls usin g alcohol as final ill i ~illl i. Til ey l:( II I1 : l lI d~ 1 (11 ,,( alco hol did not improve the sea ler coverage o f root canals when 113ed us the final irigunt.
Diomcchuuicnl prcpnration w'IH done lI! illg ~ h,1J back techn ique as it presents with th e best taper and apical stop design.'? .'i.25% NClOCI solution Th e results of this study arc in agreem ent with was us ed as dissolves vital tissue and necrotic the studies carri ed out by Micheal C Hall et al ( 199n) 19 and M .K.WI1 et al (2000)20. A recent study tissue remnants at high er concentrations ." 9.'1% by Gregory T. Engel et al(2 006)21 also showed that ethano l was used as it has b een reported to a final rinse with 70% isopropyl alcohol did not dehydrat e the canal walls before sealer placement." increase se aler penetration neith er affec ted apical AH-2G sealer was used as it is superior Lu zinc UAiul, Lll~ l,U ~ l,ll1u~ w ilh i t~lJu-t Iv streng th, llu w uuc iu leakag«.. Weuabiliiy uf a surface been show n to he dqienrlnnt on th e chrrn ica l m m po ,~ i li on of , shr ink age adhesion and solubility ." Scn lor placement was clone m;inp, either it Vi K fli p. or it th e srilir] ~l l rf(l r;~ , i t~ n;mlhn ~H i1n~11 vdration state. Dentin 11M ~ 1I0wn tv b(,l,vllll, I11UIl, hydruph ulri; lcntuloopiml. Gutta pcrchu w ua moo U3 11 core filling material as it is the most commonly used after dehydration by exposin g more hydrophobi c nhtllnttinll 11l ~t f"ri ~Jl4,1 5 J I1k'llg with h tITll1 compaction moieties and may therefor e mako dentin moro compatible with many endodontic sealers." technique as It has been found to be the most cffccti vc obturation technique involving (he usc CONCLl JSION of gutta pcrcha." Carbon black powder wa s added Within the limits of this study it was concluded to the AH26 sealer to impart a gray colour to mak e it miscibl e after clearing. It does not dissolve in . that irres pec tive of the final irri gant · used the coronal third had more than 50 % sealer 'present in nitric acid. all the teeth and th e middle and apical thirds 5% nitric acid was us ed as a dec alcying agent as showe d the most variability in sealer cov era ge. it is rapid in its action , caus es less damage to th e However furth er studi es are required for tissue and allows staining techniques to be applied. determining the role of tensioactive agent s that The samples were dehydrated in increasing
188 JPFA, Vol. 25, December, 2011
may help in a better coverage of root canals with sealer. REFERENCES
1. Haap asal oM , Orstavik D . In vitro infe cti on and disinfecti on of den tina l tubules . J Dent Res 1987;66:1375- 9. 2. Siqueira IF Jr , Rocas IN , Favieri A , L ima KC . Chemomechanical reduction of the bacteria l population in the root canal after instrumentation and irrigation with 1%, 2.5%, and 5.25 % sodium hyp ochl orit e. J End od 2000 ;26 :331--4. 3. O ksa n T, Aktener BO , Sen BH , Tezel H . The penetration ofroot cunal scalers into dentina l tubules . A scanning electron mic roscopic study. Int Endod J 1993;26:301-5 . 4. Vassiliadis LP, Sklavounos SA , Stavri anos CK. Depth of penetration and appearance of Gross ma n sealer in the dentinal tubules: an in vivo study. J Endod 1994;20:3 73-6 . S,
6.
Spanberg L. Intrucunnl medication. In . Ingle Jl, Tainter JF,eds. Endodontics 3'ded Philade lphia; Lea and Febiger 1985 : 566 - 76 . Loui s I. Gross man. Endodon tic Practice . l Oth Edition,
Philadelphia - r ,(~a :11111 Fpbigc-r, I ~) 8 1 : 1 ~1"/ . 7. Kap sim alis P, Evans R and Summit N .J. Sealine prop erties of endodontic filling mat erials u~ illg pol ar and non-pol ar radioa ctive isot op es. O .S. 1996;22:386 - 393 . 8. Gri eve A.R . Scaling prop erties of ce ments used in i uul fillings. B.D.J 1972 ; 132:19-u . 9.
Bankroft .Theo ry and pr actice o f hi st ologi cal techniques, 1982.
10 . Schilder H. Cleaning and shaping of root can al DCNA 1974 ; 18:269. 11. Go ldmann et al. Th e efficacy o f severa l endodo ntic irrigant solutions : - A scanning electron m icroscopic stud y. J Endod 1982 ; 8 :487.
12. Lisa R Wilcox and Alfred H Wiemann . E ffec t of fmal alcoho l rinse on sealer coverage of ob turated root cana ls. J Endod 1995;21;5:256 - 258 . 13. Doroth y Me Comb and Denni s C Smi th. Comparis on of physical properties of polycarboxylate based materi als on convention l root canal sea lers . J Endod 1976 ; 2; 8: 228 - 235 14. West LA , LaB ounty GL and Keller DL. Obturation qual ity utili zing ultrasonic cl ean in g and sea le r placement followe d by lateral con densation with gutta percha. J Endod 1989;15:507 - 5 1 1. 15. Cohen. S and Bums R.C. Path ways of th e pullJ.4th Edition, C.V. Mosby. 1984 : 183 . 16. Eldeeb M .E . , Zu cker K.J and Mo sser H. Ap ical leakage in relation to the radiographi c density of gutta perch a using di fferent obturation techniques . J Endod 1985; 11;1: 25 - 29 . 17. Rob ert son. D and Leeb.J . T he eva lua tio n of a transp arent tooth model system for the e valuation ofendodontically filled teeth. J Endod I 'JRO;R;7 ' 117 32 1. 18. Alfred H Wiemann and Lisa R W ilco x. In vitro cvatuauon 01 lour iuethods of sealer placement. J Endod 1991 ; 17;Y:444 -447 , 19. Ivliclleal C. Hall, David J , Cle me nt and Will iam A Walker. A comparison of sealer placement techniques in curved cana ls. J Ended 1996 ;22; 12 :638 - 642 . 20. M.k.Wu A . R. Ozo k and P. R. Wesserlink. Sealer di stribution in root ca nal s obtur ate d by three techniques. J Endnd ')Ji( i( );'3 '5:340 - 345. 2 1. Gregory T . Engel , Gary G. Goodell and Scott B. M cCl an aha n . Se aler pen et ra ti on a n d ap ica l micr oleakage in smear free dentin after a fmal rinse with either 70 % isopropy l alcoho l or perid ex. J Endod 2006 ;31;8:621 - 62 3. 22
Rosales 11, Marshall G\V, Mar~hu ll SJ, ct al. Acidetching and hydration influ enc e on dentin roughness and wettabi lity . J Dent Res 1999;78 :1554-9 .
JPFA, Vol. 25, December , 20 11 189
***
Tensioactive a gents ma y alter dentinal wettability allowin g increased sealer penetration into dentinal tubules. This ma y improve the apical seal and better entomb remaining bacteria. The purpose of this study wa s t o determine if a fin al rinse of alcohol or sodium hypochlorite increased sealer coverage of r oot canal. The samples wer e ra ndomly divid ed into four gr oups according tu the method of sealer placement and final irri gant used. Group 1 tile and 95 % ethanol, gr ou p 2 tile and 5.25% sodium hypochlorite, group 3lentulospiral and 95% ethanol, group 4lentulospiral and 5.25% sodium hypochlorite. T he samples were obtura ted wit h AH2 6 as scaler mixed with carbon black pOWclCI' and ell1h, I''' ' 'dm , All samples were decalcified with 5% nitric acid and dehydrated in alcohol , followed by clearing in methyl salicylate. The cleared samples were measured under dissecting microscopefor sealer penetration with the help of millim eter scale. Alt houg h a final rinse of alcohol did not increase sealer coverage, a high va riability wa s found in the middle and apical third portions ofthe root canals. Key words : 95 % ethanol, 5.25% sodium hypochlorite, nitric aci d, methyl salicylate. Pulpa l uecius is and periapical inflammation are lar gely cau sed by bacteria. Once established in the rool c an al , hacteria hav e been found to inv ade deep int o the d enti nal tubul es.' Canal instrumentation alone may not complete ly rem ove all bacteri a.' During ' canal instrumentation , a sme ar layer is produced th at pr events sealer penetration into th e tubul es.' Irrigation with 1'/ % elhy lcu c diamine tetra-ac etic acid (EDTA) followed by 5.25% sodium hyp ochlorite (N aOCl) renders the tubules patent and allows seale r pen etration durin g obturation.' V ario us methods have been suggested to increa se th e adhesion of sea lers onto dent in , One of th em is th e use of alco hol to dehydrate canal walls be tore sea ler pl acem ent. ~ Th e purpose of thi s study was to determine if a final rin se with either 95% ethy l alcohol (95 % ethanol) or 5.25 % sod iu m hypochlorite (5 .25 % NuUCl) III mstrumcnkd, W IC cU ll t t Climb wu ultl 'Aeuder,
I
'Proj esso r and H ead, Uperaltve Deni istrv and
F:"d,,!t"ltI Hf; ,'"" ~ n1'rujussu r, Dcp] , oj' Oral Pa thology " lid Miuroln ology, Kothiwal Den tal College and Research Centre, Moradabad - 244001, Utta r Pradesh, India.
affect th e sealer coverage of roo t cana l, when the sea ler is applied using either a file or a lentulospi ral, MEllIOD
40 extrac ted human single roo ted mandibular pr em ol ars with roo t canal curvature < 30 d egrees were stored in saline. Convention al access cavities were pr PcllCU aud wuikiug leugtlr was es tablished by subtracting 110m fro m the apex. Cl eaning and sh uping w as don e usin g K files w ith th e step back. biornec hanical preparation techniqu e till api cal ~ i7~ 35. Can als were flared coronallv using Gates Glidden drills number 3 and 4. Throu ghout the cl eaning and sha ping pro cedure , th e root canals were irrigated with 5.25% NaOCI and 17%EDTA solut ion. Th e teeth w ererand omly divid ed into four groups o f 10 eac h according to the method of sealer pl acement and the fmal irrigant used. Group 1 file and 95% ethanol , l:f0up 2. mo und 5.2.5% NoOn , eronp l lr.ntnl'-',~roi r" l and 9.5% ethanol • ~o UP 4 !cntuJ()spiral and .'i./.'i% NaOCI. After canal preparation, final irrigation was done with 1 ml of 5.25% NaOCI for group s 2 and 4 and with
JPFA, Vol. 25, December,2011
185
l
95% ethanol for groups I and 3 using 27 gauge needle placed deep in the canal. The canals were dried with fine paper points until no moisture was evident on the paper point. AH26 sea ler was mix ed according to manufacturers directions . A small amount of carbon black powder was added to it to produce a gray colour which would be visible after clearing the teeth. The sea ler was placed in the root canal in a quantity of 0.04ml which was measured with a tuherculin syrin ge and app lied in the apic al IOmm with a 35 sized K file for groups I and 2 and with a lentu lospiral number 3 for groups 3 and 4. The can als were obturated immediately after sealer placement using the lateral compaction technique with gutta perc ha. Excess gutta percha and sealer
were removed with a heated plugger and vertically condensed with hand pluggers. IRM (zinc oxide strengthened wit h po lymethacrylate) was sea led in the access cavities . Teeth were decalcified using 5% nitric acid for 8 to 10 days . Teeth were dehy drated in an ascending series of graded alcoho ls (75%,85%,95%, 100%, 2 hrs each) and cleared by immersing them in methyl salicy late initially for 6 hrs and were stor ed permanently in methyl salicylate. After cl earing with methy l salicylate each tooth was placed beside millimeter ruler under a c1iss ectmg micro sco pe and readings were taken in coronal, middle and apical thirds of each samp le. Statistical evaluation was done by ' t' test and analysis of variance.
OBSERVATIONS Table I : Mean ami standard deviations uf all groups, ALCOHOL n = 10 FILE
SODIUM HYPOCHLORITE (mm) n -IO FILE
(Group I)
(Group 2)
(mm)
ALCOHOL Il -IO LENTULOSPlRAL'
SODHJM HYPOCHLORITE (mm) Il - 10 LENTULOSPlRAL
(G roup 3 )
(Group 4)
(mm)
('
M
A
C
M
A
C
M
A
C
M
A
MEAN
5.64
4.66
4.30
5.54
4.90
4.00
5.38
4.57
4.26
5.39
4 .90
4.47
STANDARD OFYTATfON (T)
0.31
0.711
U 8
0.110
0.69
0.9'1
0.110
1.23
O:IS
0.44
U.5Y
U .5 ~
C - Coronal third of th e "a nal ) M - Midd le thi rd of the cana l ) A - Apica l third of
th e canal) n -
sample size of each group . Table 2: 't' values and standard error for groups 1 and 2. (Comparison of coronal and middle third, coronal and apical third) FILE and ALCOHOL (Group 1) Mean changes (+1- S E)
' t' value
Significance
' C vis M
0.98 ( +1- 0.27)
3.69
P < 0.002 Significant
C vis A
1.34 (+ 1- 0.)0)
'2.66
l' < U.U) Sigruncant
Comparison
FILE and SODIUM HYPOCHLORITE (Group2) C vis M
0.64 ( +1- 0.27)
2.42
P < 0.05 Significant
via 1\
1.54(+1 0.35)
4.39
P -:: 0.001 (Significunt
C
186 JPFA , Vul. 25, December, 2011
Table 3 : 't'values and standard error for groups 3 and 4. (Comparison of coronal and middle third, coron al and apical third)
-
LENTULOSPIRAL and ALC OH OL (Group 3) Comparison
Mean chan ges (+1- S E)
' t' value
Significance
C vis M
0.81(+1- 0.43)
1.86
P < 0.05 Not Signifi cant
vis A
0.27( +1 - 0.22)
2.85
P < 0.05 Significant
C
LENTULOSP IRAL & SODIUM HYP OCHLORIT E (Group4) C vis M C
--
vis A
0.49( +1- 0.25 ) 0.92(+1- 0.24)
2.0
P < 0.05 Not Significant
3.81
P < 0.002Signific'Ult
Table 4: ' t' values an d standard er ror for all groups (Compari son of middl e and apical third) FIlE
Compa rison
Mean chan ges (+1- SE)
't' valu e
Significance
Middle
Alcohol vis Sodium hypochlorite
0.24 ( +1- OJ4)
0.71
P > 0.05 Not Significant
Apical
Alcohol vis Sodium Ill' pudllUl ilu
OJ O (+1- 0.59)
0.51
MitUlc
Alcohol vis Sodium hypochlorite
0.40 ( +1- 0.34)
1.53
Apical
Alcohol vis Sodium hypuchl ui ite
0.30 ( +1- 0.45)
0.44
P >0.05 Not S l gl ll !l C,UII
LENTULOSPIIlAL
lUi." I "
-
:rs
P >O.05 Not Significant P > 0.05 Not SIV1ltkant
coronal, middle und apical thirds respectivel y.
I. For group I, the mean sea ler coverage values were5 .64mm for coronal, 4.66mm tor middle, 4Joinm for apical thirds respectively and standard deviations Wtl COJllllllJ.,O.7411un and 1.48nl1n forcoronal, middle ,!nd apical tlurd s respectively.
4. For group 4, the mean sealer coverage values were 5.39mm, 4.90nu11 and 4.47mm for coro nal , middle and apical thirds respectively and standard deviation s were 0 441ll1ll, O,')9mlll and 0.58 mm for cornnal, mi rlrll e :I nri ;Ip i r.'jl l tlnrds respectively.
2. For !,'TOUp 2, the mean sealer coverage values were 5.54mm, 4.90mm and-t.Oonun forcoronal,middle and apic al third s respectively and standard deviations were 0.40mm , 0.69mm, and 0.97mm for coronal, middle and apical third s respectively.
There was a signi ficant difference between the sealer coverage of coronal and apical thirds in all four !,'TOUpS and no significant differ ence betw een the middl e and apical thirds of all four groups.
3. For group 3, the mean sealer coverage values were 5J 8mm, 4.57 and 4.26nu11 for coronal, middle and apica l third s r esp ecti v el y and st anda rd deviations were 0.40mm , 1.23n1ll1 and 0.75nun for
DISCUSSION Failure following endodontic treatm ent has been attributed to many factors. One of them is incompl etely sealed root canal space leadin g to JPFA , Vol. 25, December, 2011
18 7
chronic periapical infection and oth er pathoses." Development of an imp ervious seal is therefore imperative that involves theuseofa solid coremateriaJ whi ch is obturated with a sealer. How ever none of the available se alers consistently pr event apical leakag e.'
strengths of etha nol becaus e the cl earing agent in not miscibl e in water but is miscibl e in alcohol." Methyl salicylate was used in this study as it is less toxic than xylene and causes minimal tissue distortion wh en compared with other cl earing
Th e lack of a prim ary bond may be du e to the presenc e of residual moisture in the roo t canal that may prevent the sealer from completely coating the canal walls."Alcohol , a volatil e solvent has been sug gested to dehydrate the ca nal wa lls before placement of the sealer .9
Th e best sea ler coverage was seen in the coronal third with high variability in the middle and apical thirds. Th is may be due due the sea ler being wip ed off in the coronal part while being introduced with either a file or a lenrulospiral , resulting in less sealer being availabl e to coat the middl e and api cal portions of the can als. No statistically significant difference wa s ob serv ed in the sea ler cov erage wh en alcohol w as used as the final irri gant as compared to sodium bypochlorit e.
In the light of the abov e, this in vitro study carri ed out to f: v il l ll il l t: (lI lC l l".I lI lI J1 (H ~ f1lC~ w·.alpf cove rage of the root canal using 95% ethanol or 5.25 % sodium hypochlorite as final irrigant with the sa me sealer(A H26) and obturating m ateri al and technique, with the sealer being placed in the root can al using either a file or a lcntulospiral.
W ilS
agents."
Lisa Wilc ox et al ( 1995) 12 performed a study on sealer coverage of root cana ls usin g alcohol as final ill i ~illl i. Til ey l:( II I1 : l lI d~ 1 (11 ,,( alco hol did not improve the sea ler coverage o f root canals when 113ed us the final irigunt.
Diomcchuuicnl prcpnration w'IH done lI! illg ~ h,1J back techn ique as it presents with th e best taper and apical stop design.'? .'i.25% NClOCI solution Th e results of this study arc in agreem ent with was us ed as dissolves vital tissue and necrotic the studies carri ed out by Micheal C Hall et al ( 199n) 19 and M .K.WI1 et al (2000)20. A recent study tissue remnants at high er concentrations ." 9.'1% by Gregory T. Engel et al(2 006)21 also showed that ethano l was used as it has b een reported to a final rinse with 70% isopropyl alcohol did not dehydrat e the canal walls before sealer placement." increase se aler penetration neith er affec ted apical AH-2G sealer was used as it is superior Lu zinc UAiul, Lll~ l,U ~ l,ll1u~ w ilh i t~lJu-t Iv streng th, llu w uuc iu leakag«.. Weuabiliiy uf a surface been show n to he dqienrlnnt on th e chrrn ica l m m po ,~ i li on of , shr ink age adhesion and solubility ." Scn lor placement was clone m;inp, either it Vi K fli p. or it th e srilir] ~l l rf(l r;~ , i t~ n;mlhn ~H i1n~11 vdration state. Dentin 11M ~ 1I0wn tv b(,l,vllll, I11UIl, hydruph ulri; lcntuloopiml. Gutta pcrchu w ua moo U3 11 core filling material as it is the most commonly used after dehydration by exposin g more hydrophobi c nhtllnttinll 11l ~t f"ri ~Jl4,1 5 J I1k'llg with h tITll1 compaction moieties and may therefor e mako dentin moro compatible with many endodontic sealers." technique as It has been found to be the most cffccti vc obturation technique involving (he usc CONCLl JSION of gutta pcrcha." Carbon black powder wa s added Within the limits of this study it was concluded to the AH26 sealer to impart a gray colour to mak e it miscibl e after clearing. It does not dissolve in . that irres pec tive of the final irri gant · used the coronal third had more than 50 % sealer 'present in nitric acid. all the teeth and th e middle and apical thirds 5% nitric acid was us ed as a dec alcying agent as showe d the most variability in sealer cov era ge. it is rapid in its action , caus es less damage to th e However furth er studi es are required for tissue and allows staining techniques to be applied. determining the role of tensioactive agent s that The samples were dehydrated in increasing
188 JPFA, Vol. 25, December, 2011
may help in a better coverage of root canals with sealer. REFERENCES
1. Haap asal oM , Orstavik D . In vitro infe cti on and disinfecti on of den tina l tubules . J Dent Res 1987;66:1375- 9. 2. Siqueira IF Jr , Rocas IN , Favieri A , L ima KC . Chemomechanical reduction of the bacteria l population in the root canal after instrumentation and irrigation with 1%, 2.5%, and 5.25 % sodium hyp ochl orit e. J End od 2000 ;26 :331--4. 3. O ksa n T, Aktener BO , Sen BH , Tezel H . The penetration ofroot cunal scalers into dentina l tubules . A scanning electron mic roscopic study. Int Endod J 1993;26:301-5 . 4. Vassiliadis LP, Sklavounos SA , Stavri anos CK. Depth of penetration and appearance of Gross ma n sealer in the dentinal tubules: an in vivo study. J Endod 1994;20:3 73-6 . S,
6.
Spanberg L. Intrucunnl medication. In . Ingle Jl, Tainter JF,eds. Endodontics 3'ded Philade lphia; Lea and Febiger 1985 : 566 - 76 . Loui s I. Gross man. Endodon tic Practice . l Oth Edition,
Philadelphia - r ,(~a :11111 Fpbigc-r, I ~) 8 1 : 1 ~1"/ . 7. Kap sim alis P, Evans R and Summit N .J. Sealine prop erties of endodontic filling mat erials u~ illg pol ar and non-pol ar radioa ctive isot op es. O .S. 1996;22:386 - 393 . 8. Gri eve A.R . Scaling prop erties of ce ments used in i uul fillings. B.D.J 1972 ; 132:19-u . 9.
Bankroft .Theo ry and pr actice o f hi st ologi cal techniques, 1982.
10 . Schilder H. Cleaning and shaping of root can al DCNA 1974 ; 18:269. 11. Go ldmann et al. Th e efficacy o f severa l endodo ntic irrigant solutions : - A scanning electron m icroscopic stud y. J Endod 1982 ; 8 :487.
12. Lisa R Wilcox and Alfred H Wiemann . E ffec t of fmal alcoho l rinse on sealer coverage of ob turated root cana ls. J Endod 1995;21;5:256 - 258 . 13. Doroth y Me Comb and Denni s C Smi th. Comparis on of physical properties of polycarboxylate based materi als on convention l root canal sea lers . J Endod 1976 ; 2; 8: 228 - 235 14. West LA , LaB ounty GL and Keller DL. Obturation qual ity utili zing ultrasonic cl ean in g and sea le r placement followe d by lateral con densation with gutta percha. J Endod 1989;15:507 - 5 1 1. 15. Cohen. S and Bums R.C. Path ways of th e pullJ.4th Edition, C.V. Mosby. 1984 : 183 . 16. Eldeeb M .E . , Zu cker K.J and Mo sser H. Ap ical leakage in relation to the radiographi c density of gutta perch a using di fferent obturation techniques . J Endod 1985; 11;1: 25 - 29 . 17. Rob ert son. D and Leeb.J . T he eva lua tio n of a transp arent tooth model system for the e valuation ofendodontically filled teeth. J Endod I 'JRO;R;7 ' 117 32 1. 18. Alfred H Wiemann and Lisa R W ilco x. In vitro cvatuauon 01 lour iuethods of sealer placement. J Endod 1991 ; 17;Y:444 -447 , 19. Ivliclleal C. Hall, David J , Cle me nt and Will iam A Walker. A comparison of sealer placement techniques in curved cana ls. J Ended 1996 ;22; 12 :638 - 642 . 20. M.k.Wu A . R. Ozo k and P. R. Wesserlink. Sealer di stribution in root ca nal s obtur ate d by three techniques. J Endnd ')Ji( i( );'3 '5:340 - 345. 2 1. Gregory T . Engel , Gary G. Goodell and Scott B. M cCl an aha n . Se aler pen et ra ti on a n d ap ica l micr oleakage in smear free dentin after a fmal rinse with either 70 % isopropy l alcoho l or perid ex. J Endod 2006 ;31;8:621 - 62 3. 22
Rosales 11, Marshall G\V, Mar~hu ll SJ, ct al. Acidetching and hydration influ enc e on dentin roughness and wettabi lity . J Dent Res 1999;78 :1554-9 .
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