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Comparison of tissue response between a synthetic gutta-percha and a natural gutta-percha endodontic filler
endodontics Editor: MILTON SISKIN, D.D.S. College of Dentistry The University of Tennessee 847 Monroe Avenue Memphis, Tennessee 38 163
Comparison of tissue response between a synthetic gutta-percha and a natural gutta-percha endodontic filler IZonald J. Nicholson, D.D.X., Frank Casanova, D.D.S., Joh?b Greenspan, D.D.S., and Marvin M. Stark, D.D.S., San Francisco, Cnlif. 1JNIVERSITY
OF
CALIFORNIA,
SCHOOL
OF
DFXTISTRY
The purpose of this experiment was to compare a new filling material consisting of a synthetic gutta-percha with a standard material consisting of natural guttapercha. Each sample, being an endodontic point, contained a quantity of fillers. The The histologic materials were implanted subcutaneously in male white rats. appearance was essentially identical for both materials.
T
he complete obturation of a root canal has always been a primary goal in endodontic therapy. Uutta-percha has been shown by numerous studies to be an acceptable filling materia1.l The works of Mitchell” and other93 4, B, G have shown natural gutta-percha to be mildly irritating. Primarily because of the increasing demand for gutta-percha and because of its decrcasing supply, a synthetic gutta-pcrcha has been developed. It is the purpose of this study to determine the degree of tissue acceptance of this material. METHODS
Comparison was made between a commonly used endodontic gutta-percha” and the newly formulated synthetic gutta-percha.i Both types of gutta-percha were shaped into rice grain configurations 4 to 6 mm. in length and 1.5 mm. in *Union t Pascal
802
Broach Company, Long Island, Company, Bellevue, Wash.
N. Y.
Tissue responses
to two types
of endodontic
filler
803
diameter in the thickest region. This shape was considered to cause the least mechanical irritation.l, 3, I0 Sixteen white rats, weighing 300 to 400 grams and of the same age, were used to test the tissue tolerance of the material. They were anesthetized with methoxyfluorothane or chloroform. The gutta-percha pellets were placed in a 9-amino-acridine solution for 45 minutes and were rinsed twice with sterile normal saline solution. Sterile surgical procedures were used to embed a pellet of gutta-percha into each dorsal quarter of the rat, 5 mm. from the midline. The right rear quarter was used in all animals for the control gutta-percha and the left rear quarter for the experimental material. The gutta-percha was embedded in the subcutaneous space just above the muscle layer. At 48 hours, 3 weeks, and 4 weeks, large tissue masses were removed from the sacrificed animals. Every effort was made not to disturb the gutta-percha pellet prior to fixing. The samples were placed in 10 per cent formalin solution, and slides were made following routine preparation with hematoxylin and eosin stain. RESULTS
Histopathologic evaluation of the tissue and cell type surrounding the guttapercha was made. The results are shown in Table I. Of the original sixteen rats, eleven survived the anesthetic procedure. Of the forty-four specimens embedded (eleven control, thirty-three test), twenty-five specimens were recovered (nine control, sixteen test). One of the recovered control specimens of rat C was eliminated becauseof poor slide preparation. The 4%hour samplesshowed the late stages of an acute inflammatory response (mononuclear inflammatory cells starting to predominate over the polymorphonuclear types). The severity of reaction as demonstrated by edema, cell quantity, capillary engorgement, etc. was equal in both the test and control specimens. The samplesat 3 and 4 weeks showed that a great deal of healing, as evidenced by formation of scar tissue, had taken place equally in both gutta-percha types. We thus conclude that there is no histologically detectable difference between the tissue reaction to the two types of gutta-percha. DISCUSSION
The thickness of the connective tissue capsule surrounding the gutta-percha did vary from specimen to specimen and at times within the same specimen. Capsule thickness as seen microscopically depends a great deal on the gross dissection of the specimen. Although a cut at 90 degrees to the surface was attempted, the filmy thin nature of the capsule itself prevented this from occurring in all instances. One may also question the presence of filler material in the two gut&per&a types. The type and percentage of each were not known. Since the objective of this study is to demonstrate any qualitative histologic difference in the tissue reaction to these materials, as they are presently prepared, the type and percentage of fillers used is immaterial.
Oral May,
Table
Surg. 1975
I d~ononucZear .Inimnl
Specimen
h
Control Test
48 hour 1% 3 TWCk C 3 week
D
Control Test
Control Test
E 3 week
Control Test
F 3 week
Test
G H
ss
crlls
inflammatory cel7.s
ss
I
I!k7ema
s
I Pnsculn
xx
I s$
Control Test
3 week
3 week
Polymorphonuclea~ inflnmmntory
Control
xx
s
s
Control Test
3 week
Control Test
I 4 week
Control Test
J 4 week
Control Test
I< 4 week
Control Test
x
X = Slight. XX = Moderate. XXX = Severe.
SUMMARY
Biologic acceptance is one of several criteria that must he met by an endodontic filling material.l” The purpose of this experiment was to compare a new filling material consisting of a synthetic gutta-percha with a standard material consisting of natural gutta-percha. Each sample, being an endodontic point, contained a quantity of fillers. The materials were implanted subcutaneously in male white rats. The histologic appearance was essentially identical for both materials. REFERENCES
1. Marshal, F. J.! and Massler, M.: The Sealing of Pulpless Teeth Evaluated With Radioisotopes, J. Dent. Med. 16: 173, 1961. 2. ~it;hell, 1~. F.: lrritational Qualities of Dental Materials, J. Am. Dent. Assoc. 59: 954-966, r 3 . 3. Iiawahara, H., Yamagami, A., and Nakamura, M., Jr. : Biologic Testing of Dental Materials by Means of Tissue Culture, Int. Dent. J. 18: 443, 1968. 4. Nygaard-Ostby, B.: Tissue Changes Incident to Root Canal Treatment, Det Norske Vidmskaps-Akademi i Oslo,, No. 2, 1944. 5. Nygaard-Ostby, B.: Chelation in Root Canal Therapy, Odontol. Tid. 65: 3, 1957. 6. SpHngberg, L.: Biological Effects of Root Canal Filling Materials. Effect In Vitro of Water-Soluble Components of Root Canal Filling Material on Hela Cells, Odontol. Revy. 20: 1, 1969.
Volume Number
Granulation tissue
Tissue
39 5
Organization earlv - late
responses
xxx xxx
xxx
xxx xxx
X
types
of
endodontic
filler
805
Comments Equal
degree
Poor
specimen
Test
samples
of repair-both
moderately
irritating
X xx
xx Control
xxx
two
Capsule thickness
n
X
to
samples
exfoliated exfoliated
xx X Test
samples
exfoliated
Test
samples
exfoliated
xx
xxx xxx
xx X
Thinner connective Tissue eapule in test material
xxx xxx
xx
Thinner Tissue
connective capsules in some test material
xxx xxx xxx
xx xx
Equal
degree
X
L
of repair
Variable thickness of capsule Test samples exfoliated
7. Feldman, G., and Nyborg, H.: Tissue Reactions to Root Filling Materials: Comparison Between Gutta-Percha and Silver Amalgam Implanted in Rabbit, Odontol. Revy. 13: 1, 1962. 8. GuHuso, J.: Histopathologic Study of Rat Connective Tissue Responses to Endodontic Materials, ORAL SURG. 16: 713, 1963. 9. Torneek, C. D.: Reaction of Hamster Tissue to Drugs Used in Sterilization of the Root Canal, ORAL BURG. 14: 730, 1961. 10. Grossman, L. I. : Endodontic Practice, ed. 6, Philadelphia, 1965, Lea & Febiger, pp. 339340. Reprint requests to: Dr. Ronald J. Nicholson University of California School of Dentistry San Francisco, Calif. 94103
Comparison of tissue response between a synthetic gutta-percha and a natural gutta-percha endodontic filler IZonald J. Nicholson, D.D.X., Frank Casanova, D.D.S., Joh?b Greenspan, D.D.S., and Marvin M. Stark, D.D.S., San Francisco, Cnlif. 1JNIVERSITY
OF
CALIFORNIA,
SCHOOL
OF
DFXTISTRY
The purpose of this experiment was to compare a new filling material consisting of a synthetic gutta-percha with a standard material consisting of natural guttapercha. Each sample, being an endodontic point, contained a quantity of fillers. The The histologic materials were implanted subcutaneously in male white rats. appearance was essentially identical for both materials.
T
he complete obturation of a root canal has always been a primary goal in endodontic therapy. Uutta-percha has been shown by numerous studies to be an acceptable filling materia1.l The works of Mitchell” and other93 4, B, G have shown natural gutta-percha to be mildly irritating. Primarily because of the increasing demand for gutta-percha and because of its decrcasing supply, a synthetic gutta-pcrcha has been developed. It is the purpose of this study to determine the degree of tissue acceptance of this material. METHODS
Comparison was made between a commonly used endodontic gutta-percha” and the newly formulated synthetic gutta-percha.i Both types of gutta-percha were shaped into rice grain configurations 4 to 6 mm. in length and 1.5 mm. in *Union t Pascal
802
Broach Company, Long Island, Company, Bellevue, Wash.
N. Y.
Tissue responses
to two types
of endodontic
filler
803
diameter in the thickest region. This shape was considered to cause the least mechanical irritation.l, 3, I0 Sixteen white rats, weighing 300 to 400 grams and of the same age, were used to test the tissue tolerance of the material. They were anesthetized with methoxyfluorothane or chloroform. The gutta-percha pellets were placed in a 9-amino-acridine solution for 45 minutes and were rinsed twice with sterile normal saline solution. Sterile surgical procedures were used to embed a pellet of gutta-percha into each dorsal quarter of the rat, 5 mm. from the midline. The right rear quarter was used in all animals for the control gutta-percha and the left rear quarter for the experimental material. The gutta-percha was embedded in the subcutaneous space just above the muscle layer. At 48 hours, 3 weeks, and 4 weeks, large tissue masses were removed from the sacrificed animals. Every effort was made not to disturb the gutta-percha pellet prior to fixing. The samples were placed in 10 per cent formalin solution, and slides were made following routine preparation with hematoxylin and eosin stain. RESULTS
Histopathologic evaluation of the tissue and cell type surrounding the guttapercha was made. The results are shown in Table I. Of the original sixteen rats, eleven survived the anesthetic procedure. Of the forty-four specimens embedded (eleven control, thirty-three test), twenty-five specimens were recovered (nine control, sixteen test). One of the recovered control specimens of rat C was eliminated becauseof poor slide preparation. The 4%hour samplesshowed the late stages of an acute inflammatory response (mononuclear inflammatory cells starting to predominate over the polymorphonuclear types). The severity of reaction as demonstrated by edema, cell quantity, capillary engorgement, etc. was equal in both the test and control specimens. The samplesat 3 and 4 weeks showed that a great deal of healing, as evidenced by formation of scar tissue, had taken place equally in both gutta-percha types. We thus conclude that there is no histologically detectable difference between the tissue reaction to the two types of gutta-percha. DISCUSSION
The thickness of the connective tissue capsule surrounding the gutta-percha did vary from specimen to specimen and at times within the same specimen. Capsule thickness as seen microscopically depends a great deal on the gross dissection of the specimen. Although a cut at 90 degrees to the surface was attempted, the filmy thin nature of the capsule itself prevented this from occurring in all instances. One may also question the presence of filler material in the two gut&per&a types. The type and percentage of each were not known. Since the objective of this study is to demonstrate any qualitative histologic difference in the tissue reaction to these materials, as they are presently prepared, the type and percentage of fillers used is immaterial.
Oral May,
Table
Surg. 1975
I d~ononucZear .Inimnl
Specimen
h
Control Test
48 hour 1% 3 TWCk C 3 week
D
Control Test
Control Test
E 3 week
Control Test
F 3 week
Test
G H
ss
crlls
inflammatory cel7.s
ss
I
I!k7ema
s
I Pnsculn
xx
I s$
Control Test
3 week
3 week
Polymorphonuclea~ inflnmmntory
Control
xx
s
s
Control Test
3 week
Control Test
I 4 week
Control Test
J 4 week
Control Test
I< 4 week
Control Test
x
X = Slight. XX = Moderate. XXX = Severe.
SUMMARY
Biologic acceptance is one of several criteria that must he met by an endodontic filling material.l” The purpose of this experiment was to compare a new filling material consisting of a synthetic gutta-percha with a standard material consisting of natural gutta-percha. Each sample, being an endodontic point, contained a quantity of fillers. The materials were implanted subcutaneously in male white rats. The histologic appearance was essentially identical for both materials. REFERENCES
1. Marshal, F. J.! and Massler, M.: The Sealing of Pulpless Teeth Evaluated With Radioisotopes, J. Dent. Med. 16: 173, 1961. 2. ~it;hell, 1~. F.: lrritational Qualities of Dental Materials, J. Am. Dent. Assoc. 59: 954-966, r 3 . 3. Iiawahara, H., Yamagami, A., and Nakamura, M., Jr. : Biologic Testing of Dental Materials by Means of Tissue Culture, Int. Dent. J. 18: 443, 1968. 4. Nygaard-Ostby, B.: Tissue Changes Incident to Root Canal Treatment, Det Norske Vidmskaps-Akademi i Oslo,, No. 2, 1944. 5. Nygaard-Ostby, B.: Chelation in Root Canal Therapy, Odontol. Tid. 65: 3, 1957. 6. SpHngberg, L.: Biological Effects of Root Canal Filling Materials. Effect In Vitro of Water-Soluble Components of Root Canal Filling Material on Hela Cells, Odontol. Revy. 20: 1, 1969.
Volume Number
Granulation tissue
Tissue
39 5
Organization earlv - late
responses
xxx xxx
xxx
xxx xxx
X
types
of
endodontic
filler
805
Comments Equal
degree
Poor
specimen
Test
samples
of repair-both
moderately
irritating
X xx
xx Control
xxx
two
Capsule thickness
n
X
to
samples
exfoliated exfoliated
xx X Test
samples
exfoliated
Test
samples
exfoliated
xx
xxx xxx
xx X
Thinner connective Tissue eapule in test material
xxx xxx
xx
Thinner Tissue
connective capsules in some test material
xxx xxx xxx
xx xx
Equal
degree
X
L
of repair
Variable thickness of capsule Test samples exfoliated
7. Feldman, G., and Nyborg, H.: Tissue Reactions to Root Filling Materials: Comparison Between Gutta-Percha and Silver Amalgam Implanted in Rabbit, Odontol. Revy. 13: 1, 1962. 8. GuHuso, J.: Histopathologic Study of Rat Connective Tissue Responses to Endodontic Materials, ORAL SURG. 16: 713, 1963. 9. Torneek, C. D.: Reaction of Hamster Tissue to Drugs Used in Sterilization of the Root Canal, ORAL BURG. 14: 730, 1961. 10. Grossman, L. I. : Endodontic Practice, ed. 6, Philadelphia, 1965, Lea & Febiger, pp. 339340. Reprint requests to: Dr. Ronald J. Nicholson University of California School of Dentistry San Francisco, Calif. 94103