Three Different Obturation Technique Biology Essay

ABSTRACT

Dr Samson Emannuel MDS, Dr Sushil Kumar C MDS, Dr Anand Kulkarni MDS

Introduction:

Success of non-surgical root canal treatment is predicated by meticulous cleaning and shaping of the canal system, it is three-dimensional obturation, and a well-fitting, "leakage-free" coronal restoration. The techniques of obturation that are available have their own relative position in the historical development of filling techniques. Over the years, pitfalls with one technique have often led to the development of newer methods of obturation, along with the recognition that no one method of obturation may satisfy all clinical cases.

Materials & Methods:

A total of 120 extracted human permanent anterior maxillary and mandibular single rooted teeth were selected for the present study and divided into 3 groups based on the method of obturation technique.Following the preparation the patency at the apical formen was confirmed by passing a file #15. obturation of all three groups, all teeth were immersed in 1% of aqueous methylen blue dye for a period of two weeks, then samples were subjected to spectrophotometric analysis.

Results:

The present study was conducted to evaluate in vitro the spectrophotometric analysis to quantitatively analyze relative amount of dyepenetration using lateral condensation (Group I), thermafil obturating technique (Group III) with ZOE sealer used in all groups.

Teeth obturated with lateral condensation (Group I) shows mean value of 0.0243 and standard deviation of 0.0056. The Group II thermoplasticized injectable moulded Guttapercha (Obtura II ) group III Thermafil obturation technique shows 0.0189 as mean value and 0.0035 standard values.

Conclusion:

Following conclusion was drawn from the present study.

Group III i.e., Thermafil obturating technique shows minimum mean apical dye penetration compared to Group II (ObturaII) and Group I (lateral condensation).

Larteral condensation shows maximum mean apical dye penetration in all three groups.

There is no significant diferrence between the apical dye penetration of lateral condensation and Obtura II.

Keywords:

Obturation, lateral condensation, spectrophotometer, Obtura II, dye.

INTRODUCTION

Success of non-surgical root canal treatment is predicated by meticulous cleaning and shaping of the canal system, it is three-dimensional obturation, and a well-fitting, "leakage-free" coronal restoration. The techniques of obturation that are available have their own relative position in the historical development of filling techniques. Over the years, pitfalls with one technique have often led to the development of newer methods of obturation, along with the recognition that no one method of obturation may satisfy all clinical cases.

It has been well documented over the years since Hess’s Classic study in 1925 that the anatomy of root canals is varied and complex.1 Ingle and Beveridge found 60% of endodontic failure was due top apical leakage. Multiple techniques have been advocated to achieve a perfect seal. Guttapercha is most frequently used by endodontists because of its inert nature, ability to adapted to the canal walls, low tissue irritation, its permanency (Wein 19962, Grossman 19833) and heated Guttapercha possesses the property of flow.

Lateral consideration of Guttapercha has been proven to be a very popular and clinically effective filling technique. However, Schilder reported that final filling by lateral consideration resulted in a non-homogeneous mass of many separate Guttapercha cones pressed together and joined only by friction and the cementing substance4.

Warm Guttapercha best fulfills the requirements of a root canal filling because homogeneity is provided throughout the entire length of filling. The various thermoplastic techniques Mc Spadden method,OturaII, Ultrafil,Endotec and Thermafil.

In Obtura II, the gutta-percha is heated from temperature range of 1600C to 2000C which is then injected through the needle. In thermafil technique, a metal carrier is used to transport the guttapercha to working length, then compacted using a single insertion motion.

Sealer is recommended largely for its role as lubricant and to enhance apical seal. The efficacy of a particular obturation technique is based on its ability to provide fluid tight apical seal. The purpose of this study is to evaluate the apical seal invitro by spectrophotometric analysis to quantitatively analyze relative amount of dye penetration using lateral condensation,thermoplasticized injection moulded Guttapercha (Obtura II) and thermafil with sealer using methylen blue dye penetration study

MATERIALS AND METHODS

A total of 120 extracted human permanent anterior maxillary and mandibular single rooted teeth were selected for the present study, Teeth were inspected for root defects, fractures and matured apex before being selected in the study.

The anatomical crown of each tooth was resected such that all the root length will be` standardized to 16mm on a model grinder Wehmer company).

After which the roots were coated with enamel paint, after the second coat of enamel paint gets dried the roots were stored in normal saline.

The working length was determined by placing a k-type file (MANI, INC )till it was just seen at the apical formen and then 1mm was subtracted from this length.Standard preparation of the root canals was preformed using K-type files to a size # 50 (MANI.INC) . Thus the apical preparation was completed to size fifty and then the canal was flared using a step back technique till size # 70 or by gates Glidden. 3% sodium hypochlorite solution (Now –Dental Products) was used as an irrigant between each instrumentation.

The roots were held in moistened gauze piece to prevent dehydration during instrumentation. Finally each canal was irrigated copiously with 3% sodium hypochlorite sodium using 2ml disposable plastic syringe and needle.

Following the preparation the patency at the apical formen was confirmed by passing a file #15 through it (MANI. INC)

The teeth were stored in normal saline and were classified in to3 groups of 30 teeth each.

Group -1 Laterally condensed Guttapercha with sealer.

The teeth were dried with paper point (Diadent). A spreader (MANI. INC) of the same size as apical instrument size was chosen so that it reaches 1mm short of the apex but did not penetrate through the apical foramen.

The fit of the primary point was ensured by a radiograph. A zinc oxide eugenol sealer. (Tubli – seal – kerr) was mixed to a creamy consistency as per the manufacturers instructions. A lentulo- spiral was used for the placement of sealer.

The premeasured master cone was then coated with the sealer and slowly moved to the full working length.

The spreader was used to laterally condense the accessory Guttapercha cones till a well condensed mass of Guttapercha was obtained. Vertical compaction with a large plugger was then followed . The excess Guttapercha points which were protruding from the access cavity were resected by a hot spoon excavator. Followed by slight vertical compaction of the material at the access cavity. The access opining was then sealed by Cavit G (E.S.P.E. Germany).

Group II – obtura II with sealer.

The Obtura II (Obtura – crop) delivery system was preheated to 160C. The canals were dried with paper points and then zinc oxide eugenol sealer (Tubli –seal kerr) was mixed to a creamy consistency as per the manufactures instruction and was placed by using lentulo spiral.

A 23 gauge applicator tip of the Obtura II system was inserted within 3 to 5mm of working length. The Guttapercha was inserted into the canal by pressing the trigger on the Obtura gun.

The back pressure during the injection process served as a guide for removal of the delivery needle, vertical condensation of Guttapercha mass was done using hand pluggers corresponding to the apical third of the root canals space was accomplished, excess opening was finally sealed with Cavit G.(E.S.P.E. Germany).

Group – III – Thermafil with sealer

The teeth were dried with paper point (Diadent). Then a verifier (Maillefer – densply) was used to determine the proper size and x-ray was taken to see the fit of the verifier, then a Thermafil obturator was selected according to the size of the ver ifier (Size No.50).

By using the calibrations on the carrier, adjustment of the rubber stopper on the obturator was done.

The thermaprep was heated for 15 seconds with obturator. During which the zinc oxide sealer (tubliseal Kerr) was placed by a lentulo spiral and then obturator was inserted to the working distance with firm apical pressure without twisting or rotating, while stabilizing the hande with the index finger, serve the shaft with a round bur with the canal orifice and the access opening was then sealed by Cavit G.

15 teeth in the syudy werte used as a positive control.

In which the teeth were not obturated while 15 remain as a negative control in which the enamel paint was not removed.

After obturation of all three groups, all teeth were immersed in 1% of aqueous methylen blue dye for a period of two weeks.

After 2 weeks the teeth were recovered fro the dye and then the enamel paint was scrapped with a scalpel blade No. 15.

Finally each tooth was dissolved in 50% (10 ml) of nitric acid and the liquid obtained was analyzed under spectrophotometer for the volume of methylene blue present which is directly proportional to the optical density( amount of light absorbed)

SPECTROPHOTOMETRIC ANALYSIS

This was accomplished using light spectrophotometry. The spectrophotometer CLINICON was used and light transmission was recorded.

All roots were dissolved individually in 10ml of 50% nitric acid.

After which 3ml sample of each solution was placed into a dye recovery spectrophotometer to quantify via light absorption the concentration of dye in each sample which is directly proportional to the Optical density (amount of light obsorbed).

The higher the spectrophotometric reading the greater was the amount of dye penetration.

RESULTS

Table I

SPECTROPHOTOMETERIC RESULTS OF TEETH OBTURATED

WITH LATERAL CONDENSATION, OBTURA II & THERMAFIL

Sl. No.

Lateral Condensation

Obtura II

Thermafil

1.

0.022

0.028

0.020

2.

0.038

0.026

0.013

3.

0.020

0.033

0.017

4.

0.024

0.021

0.021

5.

0.021

0.023

0.014

6.

0.023

0.036

0.021

7.

0.022

0.021

0.018

8.

0.020

0.029

0.019

9.

0.038

0.019

0.023

10.

0.019

0.020

0.017

11.

0.024

0.023

0.022

12.

0.020

0.021

0.016

13.

0.024

0.022

0.014

14.

0.028

0.019

0.021

15

0.024

0.020

0.019

16

0.021

0.019

0.017

17

0.019

0.022

0.019

18

0.023

0.023

0.021

19

0.026

0.031

0.026

20.

0.031

0.024

0.018

21.

0.018

0.019

0.014

22.

0.023

0.020

0.017

23.

0.032

0.022

0.021

24.

0.022

0.031

0.020

25.

0.023

0.026

0.022

26.

0.020

0.021

0.019

27.

0.019

0.023

0.021

28.

0.037

0.021

0.028

29.

0.026

0.027

0.016

30.

0.022

0.026

0.014

Min

0.018

0.019

0.013

Max

0.038

0.036

0.028

Mean

0.0243

0.0239

0.018

Table II

Sl.No.

Negative Control

Positive Contron

1.

0.000

1.328

2.

0.000

1.461

3.

0.000

1.211

4.

0.000

1.321

5.

0.000

1.331

6.

0.000

1.317

7.

0.000

1.297

8.

0.000

1.264

9.

0.000

1.326

10.

0.000

1.324

11.

0.000

1.269

12.

0.000

1.341

13.

0.000

1.319

14.

0.000

1.294

15.

0.000

1.314

Negative Control

0.000

Positive Contron

1.461

Table III

MEAN SPECTROPHOTOMETRIC VALUES AND STANDARD DEVIATION VALUES OF DIFFERENT EXPERIMENTAL GROUPS

Material

No.of

Teeth

Range of leakage

Min Max

Mean

Standard

Deviation

Group I

Lateral

Condensation

30

0.018

0.038

0.0243

0.0056

Group II

Obtura II

30

0.019

0.036

0.0239

0.0045

Group III

Thermafil

30

0.013

0.028

0.0189

0.0035

Table IV

COMPARISION OF MEAN MICROLEKAGE VALUES BETWEEN

THE THREE GROUPS

Comparison

Between

Groups

No.of

Samples

Range

Min Max

Mean

S.d

‘t’

values

‘p’

Values

Group I

Lateral

Condensation

& Group II

Obtura II

30

30

18

19

38

36

0.0243

0.0239

0.0056

0.0045

0.304

0.7<p<0.8

NS

Group I

Lateral

Condensation

& Group III

Thermafil

30

30

18

13

38

28

0.0243

0.0189

0.06656

0.0035

4.469

P<0.001

Group II

Obtura II and

Group III

Thermafil

30

30

19

13

36

28

0.0239

0.00189

0.0045

0.0035

4.771

P<0.001

RESULTS

The present study was conducted to evaluate in vitro the spectrophotometric analysis to quantitatively analyze relative amount of dyepenetration using lateral condensation (Group I), thermafil obturating technique (Group III) with ZOE sealer used in all groups.

The results derived from the present study are as follows:

Table 1- Illustrate the spectrophotometric values of teeth obturated with lateral condensation (group I), Obtura II (Group II) and Thermafil obturation technique (Group III).

It is observed that group I shows the highest apical dye penetration (0.038) while the Group III showing the lowest (0.013)

Table II-In Negative control no dye penetration was observed (0.00) While in positive control the teeth were not obturated showed maximum dye penetration (1.461).

Teeth obturated with lateral condensation (Group I) shows mean value of 0.0243 and standard deviation of 0.0056. The Group II thermoplasticized injectable moulded Guttapercha (Obtura II ) group III Thermafil obturation technique shows 0.0189 as mean value and 0.0035 standard values.

The table also illustrates the minimum and maximum amount of dye penetration of three groups.

Table IV denotes a comparsion of mean spectrophometric values between the three group, comparison in Group I and II.

Comparison in Gropus I and Group II

The ‘t’ value for group I and II is 0.304. The group II shows mean microleakage less than Group I. The difference is not significant (0.7<p<0.8).

Comparison in Gropus I and Group III

The ‘t’ value of group I and group III is 4. 469. Group III shows less mean leakage value than group I. The difference is highly significant in comparsion between group I & III. (p<0.001).

Comparison in Group II and Group III

The ‘t’ value for Group II and III is 4.771. The Group III shows mean leakage value less than group II. The difference is highly significant (p<0.001).

DISCUSSION

A major objective of endodontic obturation is to completely obliterate and seal the root canal system while maintaining accurate apical control of the filling material (Scott clerk, 1993)5

The Washington study of endodontic success and failure suggests apical percolation of periradicular exudates into the incompletely filled canals as the greatest cause of endodontic failures, (Ingle 1994)6

Although apical percolation may be considered as a logical hypothesis. However, the role of the end products of microleakage in the production of periradicular inflammation is open to speculation13. It would seem safe to assume that noxious products leaking from the apical foramen acts as an inflammatory irritants7.

Thus unless the canal lumen is sealed by obturation, the irritants, metabolites and microorganism that may cause periapical breakdown have the opportunity to return, which may lead to recurrence or flare up of the per-existing lesion.

Kavitha Anantula and Anil Kumar Ganta compared sealing ability of three different obturation techniques — Lateral condensation, Obtura II, and GuttaFlow and concluded that Obtura II group exhibited a homogenous obturation followed by lateral condensation and GuttaFlow and Obtura II exhibited good adaptation followed by GuttaFlow and lateral condensation8

Guttapercha is by far the most universally used solid core root canal filing material since its introduction by Bowman in 1867. Well obturated root canals utilizing the lateral condensation technique have been shown to lack accurate replication of the intricacies of the root canal system and homogeneity (Clerk Scott, 1993)4.

The study evaluated the apical seal produced by lateral condensation technique, injectable thermoplasticized Gutta percha (obtura II) and the Thermafil obturating technique.

Matloff et al (James Haddix, 1991)9, showed that methylene blue dye penetrates further than radio-isotopes, thereby giving a more accurate assessment of marginal leakage.

Dental application for dye recovery method (spectrophotometry) was first described by Douglas and Zakariasen. This method minimizes human measurement error and provides determinations of volume leakage rather than liner measurement.

This study measured leaking volumetrically via spectrophotometry and did not rely on investigator judgement.

A total of 120 single rooted maxillary anterior teeth were biomechanical prepared using a step back technique. The teeth were classified in 3 groups. Group I was obturated using lateral condensation Group II was obturated usig thermoplasticized injectable moulded Guttapercha (obtura II) technique, while Group III was obturated using Thermafil obturating technique (Table No. I )

In all groups ,ZOE Sealer was used,15 teeth not obturated acted as a positive control showing maximum dyee penetration while 15 teeth remained as negative control in which the enamel paint was not scraped showing no (0.00)dye penetration (Table No.II).

The mean apical dye penetration in lateral condensation group was 0.0243 and that seen in Obtura II was 0.0239 while the Thermafil obturating technique showed minimum mean dye penetration 0.0189 (Table No. III )

Statistically no significant difference was found in teeth obturated with lateral condensation and Obtura II (0.7<p>0.8). However statistically significant difference was found between the teeth obturated with lateral condensation and Thermafil obtuarating rechnique (p<0.001), also statistically significant difference was found between Obtura II and Thermafil (P<0.001) (Table No.IV). While Thermafil obturating technique showed minimum apical dye penetration (0.013) (Table No. III).

In case of Thermafil obturating technique during the study as well as radiographically maximum specimen showed extrusion of the sealer.(D. Scott Clark 19934, Mahmoud E. E1Deeb, 199310, Kenan C1inton200111).

The present study has shown that Thermafil obturating technique produces superior apical seal compared to lateral condensation and Obtura II. The results of these study can be correlated with the previous studies by Beatty 19893, Kenan Clinton 200111.

Lumnije K, Weiglein A, Städtler P radigraphically assessed five obturation techniques and concluded that All thermoplastic obturation techniques demonstrated acceptable root canal filling and sealed well with no statistically significant difference between them and in comparison to lateral condensation12.

Conclusion

Following conclusion was drawn from the present study.

Group III i.e., Thermafil obturating technique shows minimum mean apical dye penetration compared to Group II (ObturaII) and Group I (lateral condensation).

Larteral condensation shows maximum mean apical dye penetration in all three groups.

There is no significant diferrence between the apical dye penetration of lateral condensation and Obtura II.

Extrusion of sealer in maximum specimens were seen for Thermafil obturating technique.