Comparative evaluation of intracanal medicaments on sealing ability of MTA and Hydroxyapatite apical plug in simulated immature teeth – An in vitro study.
Main Article Content
Keywords
Mineral Trioxide Aggregate, Hydroxyapatite, Metapex, Chlorhexidine digluconate, Curcuma longa, Triple antibiotic paste.
Abstract
Background: Immature teeth must be managed by apexification as there is no definite apical stop. Use of intracanal medicaments prior to apexification affect the sealing ability of apical plug. Present study was done to compare the effect of various intracanal medicaments: Metapex, Chlorhexidine digluconate, Curcuma longa, and Triple antibiotic paste (TAP) on the sealing ability of MTA and Hydroxyapatite as an apical plug.
Methodology: 130 single-rooted teeth were divided into two experimental groups (n=60 each) [Group I: MTA; Group II: Hydroxyapatite], and two control groups (n=5 each) [Group IIIA: MTA; Group IIIB: Hydroxyapatite] based on the apical plug used. Experimental groups were subdivided, based on intracanal medicaments [Group IA and IIA – Metapex; Group IB and IIB - 2% Chlorhexidine digluconate, Group IC and IIC - Curcuma longa, Group ID and IID - TAP]. After biomechanical preparation, simulation of immature apex was done using peeso-reamer. Intracanal medicaments were placed, and study samples were incubated for 7 days. Then all medicaments were removed using H-files, followed by retrograde apical placement, obturation, and restoration. Samples were subjected to dye penetration test, followed by clearing procedure. Apical microleakage was assessed using stereomicroscope at 40X. Data collected was subjected to statistical analysis using SPSS version 20.0 (p=0.05).
Results: Apical dye penetration was minimum in control group, followed by Group IB (0.17±.46) < IIB (0.53±.57) < IIC (0.90±.96) < IID (0.93±.59) < IC (1.83±.83) < ID (1.91±.81) < IIA (2.13±.81) < IA (2.31±.73).Intragroup comparison for apical microleakage was statistically significant (p<0.001), whereas intergroup comparisons were statistically significant except for group IA v/s IIA, IB v/s IIB, IC v/s IIA, ID v/s IIA.
Conclusion: Hydroxyapatite showed better sealing ability than MTA with all intracanal medicaments. Sealing ability was minimal with Metapex, followed by Turmeric, TAP, and 2% Chlorhexidine.
References
2. Srivastava AA, Srivastava H, Prasad AB, Raisingani D, Soni D. Effect of calcium hydroxide, chlorhexidine digluconate and camphorated monochlorophenol on the sealing ability of biodentine apical plug. J Clin Diagn Res 2016;10:ZC43-6. doi: 10.7860/JCDR/2016/18296.7985. Epub 2016 Jun 1. PMID: 27504409; PMCID: PMC4963769 https://pubmed.ncbi.nlm.nih.gov/27504409/
3. Holden DT, Schwartz SA, Kirkpatrick TC, Schindler WG. Clinical outcomes of artificial root-end barriers with Mineral Trioxide Aggregate in teeth with immature Apices. J Endod 2008;34:812-7. doi: 10.1016/j.joen.2008.04.003. PMID: 18570985. https://pubmed.ncbi.nlm.nih.gov/18570985/
4. Zhabuawala MS, Nadig RR, Pai VS, Gowda Y. Comparision of fracture resistance of simulated immature teeth with an open apex using Biodentine and Composite resin: An in vitro study. J Indian Soc Pedod Prev Dent 2016;34:377-82. doi: 10.4103/0970-4388.191424. PMID: 27681403. https://pubmed.ncbi.nlm.nih.gov/27681403/
5. Bajaj M, Poornima P, Praveen S, Nagaveni NB, Roopa KB, Neena IE et al. Comparision of CPP-ACP, Tricalcium phosphate and Hydroxyapatite on remineralization of artificial Caries like lesions on primary enamel – An in vitro Study. J Clin Pediatr Dent 2016;40:404-8. doi: 10.17796/1053-4628-40.5.404. PMID: 27617382. https://pubmed.ncbi.nlm.nih.gov/27617382/
6. Gautam S, Rajkumar B, Landge SP, Dubey S, Nehete P, Boruah LC. Antimicrobial efficacy of Metapex (calcium hydroxide with iodoform formulation) at different concentrations against selected microorganisms- An in vitro study. Nepal Med Coll J 2011;13:297-300. https://pubmed.ncbi.nlm.nih.gov/23016485/
7. Chamele J, Bhat C. Efficacy of turmeric extract as an intracanal medicament in deciduous teeth against Enterococcus faecalis: An in vitro study. Int J Curr Microbiol App Sci 2014;3:17-25. https://www.ijcmas.com/vol-3-9/Jay%20Chamele%20and%20Chetan%20Bhat.pdf
8. Prabhakar AR, Taur S, Hadakar S, Sugandhan S. Comparison of antibacerial efficacy of Calcium hydroxide paste, 2% Chlorhexidine gel, Turmeric extract as an intracanal medicament and their effect on microhardness of root dentin – An in vitro study. Int J Clin Pediatr Dent 2013;6:171-7. https://pubmed.ncbi.nlm.nih.gov/25206217/
9. Pai S, Pai ARV, Manuel ST, Bhat V. Effect of Calcium hydroxide and triple antibiotic paste as intracanal medicaments on the incidence of inter-appointment flare-up in diabetic patients- An in vivo study. J Conserv Dent 2014;17:208-11. https://pubmed.ncbi.nlm.nih.gov/24944440/
10. Robertson D, Leeb IJ, McKee M, Brewer E. A clearing technique for the study of root canal systems. J Endod 1980;6:421-4. https://pubmed.ncbi.nlm.nih.gov/7005366/
11. Cwikla SJ, Bélanger M, Giguère S, Progulske-Fox A, Vertucci FJ. Dentinal tubule disinfection using three calcium hydroxide formulations. J Endod 2005;31:50-2. https://pubmed.ncbi.nlm.nih.gov/15614007/
12. Yaduka P, Sharma S. Novel intracanal medicaments and its future scope. Int J Pharm Bio Sci 2014;4:65-9. https://ijpbs.com/download.php?file=ijpbsadmin/upload/ijpbs_55bdb223b081c.pdf&iid=665
13. Abul N, Karthick K, Mathew S, Deepa NT. Herbal extracts in endodontics. J Indian Acad Dent Spec Res 2017;4:23-7. https://www.researchgate.net/publication/319364773_Herbal_extracts_in_endodontics
14. Parhizkar P, Nojehdehian H, Asgary S. Triple antibiotic paste: momentous roles and applications in endodontics: A review. Restor Dent Endod 2018;43:1-16. https://pubmed.ncbi.nlm.nih.gov/30135847/
15. Nikhil V, Jha P, Suri NK. Effect of methods of evaluation on sealing ability of mineral trioxide aggregate apical plug. J Conserv Dent 2016;19:231-4. https://pubmed.ncbi.nlm.nih.gov/27217635/
16. Nabavizadeh M, Moazzami F, Bahmani M, Mirhadi H. The effect of intracanal medicaments on microleakage of mineral trioxide aggregate apical plugs. Iran Endod J 2017;12:329-33. https://pmc.ncbi.nlm.nih.gov/articles/PMC5527209/
17. Bani M, Sungurtekin-Ekçi E, Odabaş ME. Efficacy of Biodentine as an apical plug in nonvital permanent teeth with open apices: An in vitro study. Biomed Res Int 2015;Article ID 359275:1-4. https://pubmed.ncbi.nlm.nih.gov/26436090/
18. Ahuja L, Jasuja P, Verma GK, Juneja S, Mathur A, Walia R et al. A comparative evaluation of sealing ability of new MTA based sealers with conventional resin based sealer: An in-vitro study. J Clin Diagn Res 2016;10:ZC76-9. https://pmc.ncbi.nlm.nih.gov/articles/PMC5020213/
19. Kim SK, Kim YO. Influence of calcium hydroxide intracanal medication on apical seal. Int Endod J 2002;35:623-8. https://pubmed.ncbi.nlm.nih.gov/12190902/
20. Brandell DW, Torabinejad M, Bakland LK, Lessard GM. Demineralized dentin, hydroxylapatite and dentin chips as apical plugs. Endod Dent Traumatol 1986;2:210-4. https://pubmed.ncbi.nlm.nih.gov/3024955/
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This is an open-access journal and articles are distributed under the terms of the Creative Commons Attribution Non-Commercial Share-Alike License 4.0. This licence allows users to download and share, remix, tweak and build upon the article for non-commercial purposes, so long as the original authorship is acknowledged and the new creations are licensed under identical terms.