Fracture resistance of over-flared root canals filled with MTA and resin-based material: an in vitro study

Abdo, Salma B.; Masudi, Sam'an Malik; Luddin, Norhayati; Husien, Adam; Khamis, Mohd Fadhli

Abstract

AIM: To measure the fracture resistance of over-flared roots filled with a variety of materials (gutta-percha-nano HA, resilon-epiphany, composite and mineral trioxide aggregate - MTA) using the Instron machine test and micro-computed tomography (Micro CT) Scan. In addition, scanning electron microscopy (SEM) images were used to illustrate the type of fracture patterns of the specimens. METHODS: One hundred and twenty extracted human mandibular single-rooted premolars were selected. A total of 105 out of the selected teeth were prepared to the working length and over-flared, leaving the apical 5 mm undisturbed. Fifteen samples had no treatment and were used as a positive control group (Group +ve). The 105 test teeth were further divided into 7 groups of 15 samples each. One of the 7 groups was designated as negative control (Group -ve) where teeth were over prepared and left without obturation. Remaining groups were filled with gutta-percha-nanoHA (Group1), gutta-percha-nano HA+composite (Group 2), gutta-percha-nano HA+MTA (Group 3), resilon-epiphany (Group 4), resilon-epiphany+composite (Group 5), and resilon-epiphany+MTA (Group 6). Fracture resistance of all samples was measured using the Instron testing machine. Three samples from each group had the depth of their fracture line measured by Micro CT Scan, and 2 samples from each group had their fracture pattern illustrated using SEM. RESULTS: The highest fracture resistance was observed in Group +ve, followed by Groups 3, 6, 5, 2, 4, 1, and Group -ve, with values (in N) of: 1598 (641.0), 1190.5(424.2), 1164.7 (489.4), 821.2 (220.9), 683.4(179), 658.4 (211.3), 658.4 (99.0), 158.3(49.3), respectively. Statistical analysis for root fracture resistance showed highly significant difference between all groups with p value < 001. CONCLUSIONS: Micro CT Scan and SEM analysis indicated the ability of MTA to withstand vertical force.

instron machine; scanning electron microscopy; micro CT scan; mineral trioxide aggregate

¹
Richard S, Schwart Z, James W, Robbins. Post placement and restoration of endodontically treated teeth. A literature review. J Endod. 2004; 30: 289-301.
²
Coelho RA, Oliveira AG, Souza-Gabriel AE, Silva SRC, Silva-Sousa YTC, Silva RG. Ex-vivo evaluation of the intrapulpal temperature variation and fracture strength in teeth subjected to different external bleaching protocols. Braz Dent J. 2011; 22: 32-6.
³
Huang T J, Schilder H, Nathanson D. Effects of moisture content and endodontic treatment on some mechanical properties of human dentin. J Endod. 1992; 18: 209-15.
⁴
Pereira JR, Mendonça Neto T, Porto VC, Pegoraro LF, Valle AL. Influence of the remaining coronal structure on the resistance of teeth with intraradicular retainer. Braz Dent J. 2005; 16: 197-201.
⁵
Marchi GM, Mitsui FH, Cavalcanti AN. Effect of remaining dentine structure and thermal-mechanical aging on the fracture resistance of bovine roots with different post and core systems. Int Endod J. 2008; 41: 969-76.
⁶
Pereira JR, de Ornelas F, Conti PC, do Valle AL. Effect of a crown ferrule on the resistance of endodontically treated teeth restored with prefabricated posts. J Prosthet Dent. 2006; 95: 50-4.
⁷
Pereira JR, Valle AL, Shiratori FK, Ghizoni JS, Melo MP. Influence of intraradicular post and crown ferrule on the fracture strength of endodontically treated teeth. Braz Dent J. 2009; 20: 297-302.
⁸
Tang W, Wu Y, Smales R J. Identifying and reducing risks for potential fractures in endodontically treated teeth. J Endod. 2010; 36: 609-17.
⁹
Sagsen B, Er O, Kahraman Y, Akdogan G. Resistance to fracture of roots filled with three different techniques. Int Endod J. 2007; 40: 31-5.
¹⁰
Fukui Y, Komada W, Yoshida K, Otake S, Okada,D, Miura H. Effect of reinforcement with resin composite on fracture strength of structurally compromised roots. Dent Mater J. 2009; 28: 602-9.
¹¹
Wilkinson K L, Beeson TJ, Kirkpatrick TC. Fracture resistance of simulated immature teeth filled with resilon, gutta-percha, or composite. J Endod. 2007; 33: 480-3.
¹²
Zogheib LV, Pereira JR, Valle AL, Oliveira JA, Pegoraro LF. Fracture resistance of weakened roots restored with composite resin and glass fiber post. Braz Dent J. 2008; 19: 329-33.
¹³
Hammad M, Qualtrough A, Silikas N. Effect of new obturating materials on vertical root fracture resistance of endodontically treated teeth. J Endod. 2007; 33: 732-6.
¹⁴
Islam I, Chng H K, Yap AU. Comparison of the physical and mechanical properties of MTA and portland cement. J Endod, 2006; 32: 193-7.
¹⁵
Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review-Part I: chemical, physical, and antibacterial properties. J Endod. 2008; 36: 16-27.
¹⁶
Parirokh,M., Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review-Part III: Clinical applications, drawbacks, and mechanism of action. J Endod. 2010; 36: 400-13.
¹⁷
Andreasen JO, Munksgaard EC, Bakland LK. Comparison of fracture resistance in root canals of immature sheep teeth after filling with calcium hydroxide or MTA. Dent Traumatol. 2006; 22: 154-6.
¹⁸
Hatibovic-Kofman S, Raimundo L, Zheng L, Chong L, Friedman M, Andreasen J. O. Fracture resistance and histological findings of immature teeth treated with mineral trioxide aggregate. Dental Traumatol. 2008; 24: 272-6.
¹⁹
Lawley GR, Schindler WG, Walker WA, Kolodrubetz D. Evaluation of ultrasonically placed MTA and fracture resistance with intracanal composite resin in a model of apexification. J Endod. 2004; 30: 167-72.
²⁰
Karapinar Kazandag M, Sunay H, Tanalp J, Bayirli G. Fracture resistance of roots using different canal filling systems. Int Endod J. 2009; 42: 705-10.
²¹
Weiger R, Heuchert T, Hahn R, Lost C. Adhesion of a glass ionomer cement to human radicular dentine. Dent Traumatol. 1995; 11: 214-9.
²²
Wu X, Chan ATT, Chen YM, Yip K H K, Smales RJ. Effectiveness and dentin bond strengths of two materials for reinforcing thin-walled roots. Dent Mater.2007; 23: 479-85.
²³
Moosavi H, Maleknejad F, Kimyai S. Fracture resistance of endodontically-treated teeth restored using three root-reinforcement methods. J Contem Dent Practe. 2008; 9: 30.
²⁴
Sim T P, Knowles J C, Ng YL, Shelton J, Gulabivala K. Effect of sodium hypochlorite on mechanical properties of dentine and tooth surface strain. Int Endod J. 2001; 34: 120-32.
²⁵
Kivanc B, Alacam T, Ulusoy O, Genc O, Gorgul G. Fracture resistance of thin-walled roots restored with different post systems. Int Endod J. 2009; 42: 997-1003.
²⁶
Ulusoy O Ý A, Genc O, Arslan S, Alacam T, Gorgul G. Fracture resistance of roots obturated with three different materials. Oral Surg Oral Med Oral Pathol and Endodontology. 2007; 104: 705-8.
²⁷
Schafer E, Zandbiglari T, Schafer J. Influence of resin-based adhesive root canal fillings on the resistance to fracture of endodontically treated roots: an in vitro preliminary study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103: 274-9.
²⁸
Bitter K, Kielbassa AM. Post-endodontic restorations with adhesively luted fiber-reinforced composite post systems: a review. Am J Dent. 2007; 20: 353-60.
²⁹
Goncalves LA, Vansan LP, Paulino SM, Sousa Neto MD. Fracture resistance of weakened roots restored with a transilluminating post and adhesive restorative materials. J Prosthet Dent. 2006; 96: 339-44.
³⁰
Bodrumlu E, Tunga U. Apical leakage of Resilon obturation material. J Contem Dent Pract. 2006; 7: 45-52.
³¹
Aptekar A, Ginnan K. Comparative analysis of microleakage and seal for 2 obturation materials: Resilon/Epiphany and gutta-percha. J Can Dent Assoc. 2006; 72: 245.
³²
Chogle S, Mickel AK, Chan DM, Huffaker K, Jones JJ. Intracanal assessment of mineral trioxide aggregate setting and sealing properties. Gen Dent. 2007; 55: 306-11.
³³
Holt DM, Watts JD, Beeson TJ, Kirkpatrick TC, Rutledge, R.E. The anti-microbial effect against enterococcus faecalis and the compressive strength of two types of mineral trioxide aggregate mixed with sterile water or 2% chlorhexidine liquid. J Endod. 2007; 33: 844-7.
³⁴
Baumgartner G, Zehnder M, Paque F. Enterococcus faecalis Type Strain Leakage through Root Canals Filled with Gutta-Percha/AH Plus or Resilon/Epiphany. J Endod. 2007; 33: 45-7.
³⁵
Rueggeberg F, Margeson D. The effect of oxygen inhibition on an unfilled/filled composite system. J Dent Res. 1990; 69:1652-8.
³⁶
Nunes VH, Silva RG, Alfredo E, Sousa-Neto MD, Silva-Sousa YTC. Adhesion of epiphany and ah plus sealers to human root dentin treated with different solutions. Braz Dent J. 2008; 19: 46-50.
³⁷
Filipov IA, Vladimirov SB. Residual monomer in a composite resin after light-curing with different sources, light intensities and spectra of radiation. Braz Dent J. 2006; 17: 34.
³⁸
Texeira FB, Teixeira ECN, Thompson J, Leinfelder KF, Trope M. Dentinal bonding reaches the root canal system. J Esthet and Rest Dent. 2004; 16: 348-54.
³⁹
Zmener O, Banegas G, Pameijer CH. Bone tissue response to a methacrylate-based endodontic sealer: a histological and histometric study. J Endod. 2005; 31: 457-9.

Publication Dates

Publication in this collection
04 June 2013
Date of issue
Dec 2012

History

Received
27 July 2012
Accepted
18 Oct 2012

This work is licensed under a Creative Commons Attribution 4.0 International License.

[1] ¹
Richard S, Schwart Z, James W, Robbins. Post placement and restoration of endodontically treated teeth. A literature review. J Endod. 2004; 30: 289-301.

[2] ²
Coelho RA, Oliveira AG, Souza-Gabriel AE, Silva SRC, Silva-Sousa YTC, Silva RG. Ex-vivo evaluation of the intrapulpal temperature variation and fracture strength in teeth subjected to different external bleaching protocols. Braz Dent J. 2011; 22: 32-6.

[3] ³
Huang T J, Schilder H, Nathanson D. Effects of moisture content and endodontic treatment on some mechanical properties of human dentin. J Endod. 1992; 18: 209-15.

[4] ⁴
Pereira JR, Mendonça Neto T, Porto VC, Pegoraro LF, Valle AL. Influence of the remaining coronal structure on the resistance of teeth with intraradicular retainer. Braz Dent J. 2005; 16: 197-201.

[5] ⁵
Marchi GM, Mitsui FH, Cavalcanti AN. Effect of remaining dentine structure and thermal-mechanical aging on the fracture resistance of bovine roots with different post and core systems. Int Endod J. 2008; 41: 969-76.

[6] ⁶
Pereira JR, de Ornelas F, Conti PC, do Valle AL. Effect of a crown ferrule on the resistance of endodontically treated teeth restored with prefabricated posts. J Prosthet Dent. 2006; 95: 50-4.

[7] ⁷
Pereira JR, Valle AL, Shiratori FK, Ghizoni JS, Melo MP. Influence of intraradicular post and crown ferrule on the fracture strength of endodontically treated teeth. Braz Dent J. 2009; 20: 297-302.

[8] ⁸
Tang W, Wu Y, Smales R J. Identifying and reducing risks for potential fractures in endodontically treated teeth. J Endod. 2010; 36: 609-17.

[9] ⁹
Sagsen B, Er O, Kahraman Y, Akdogan G. Resistance to fracture of roots filled with three different techniques. Int Endod J. 2007; 40: 31-5.

[10] ¹⁰
Fukui Y, Komada W, Yoshida K, Otake S, Okada,D, Miura H. Effect of reinforcement with resin composite on fracture strength of structurally compromised roots. Dent Mater J. 2009; 28: 602-9.

[11] ¹¹
Wilkinson K L, Beeson TJ, Kirkpatrick TC. Fracture resistance of simulated immature teeth filled with resilon, gutta-percha, or composite. J Endod. 2007; 33: 480-3.

[12] ¹²
Zogheib LV, Pereira JR, Valle AL, Oliveira JA, Pegoraro LF. Fracture resistance of weakened roots restored with composite resin and glass fiber post. Braz Dent J. 2008; 19: 329-33.

[13] ¹³
Hammad M, Qualtrough A, Silikas N. Effect of new obturating materials on vertical root fracture resistance of endodontically treated teeth. J Endod. 2007; 33: 732-6.

[14] ¹⁴
Islam I, Chng H K, Yap AU. Comparison of the physical and mechanical properties of MTA and portland cement. J Endod, 2006; 32: 193-7.

[15] ¹⁵
Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review-Part I: chemical, physical, and antibacterial properties. J Endod. 2008; 36: 16-27.

[16] ¹⁶
Parirokh,M., Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review-Part III: Clinical applications, drawbacks, and mechanism of action. J Endod. 2010; 36: 400-13.

[17] ¹⁷
Andreasen JO, Munksgaard EC, Bakland LK. Comparison of fracture resistance in root canals of immature sheep teeth after filling with calcium hydroxide or MTA. Dent Traumatol. 2006; 22: 154-6.

[18] ¹⁸
Hatibovic-Kofman S, Raimundo L, Zheng L, Chong L, Friedman M, Andreasen J. O. Fracture resistance and histological findings of immature teeth treated with mineral trioxide aggregate. Dental Traumatol. 2008; 24: 272-6.

[19] ¹⁹
Lawley GR, Schindler WG, Walker WA, Kolodrubetz D. Evaluation of ultrasonically placed MTA and fracture resistance with intracanal composite resin in a model of apexification. J Endod. 2004; 30: 167-72.

[20] ²⁰
Karapinar Kazandag M, Sunay H, Tanalp J, Bayirli G. Fracture resistance of roots using different canal filling systems. Int Endod J. 2009; 42: 705-10.

[21] ²¹
Weiger R, Heuchert T, Hahn R, Lost C. Adhesion of a glass ionomer cement to human radicular dentine. Dent Traumatol. 1995; 11: 214-9.

[22] ²²
Wu X, Chan ATT, Chen YM, Yip K H K, Smales RJ. Effectiveness and dentin bond strengths of two materials for reinforcing thin-walled roots. Dent Mater.2007; 23: 479-85.

[23] ²³
Moosavi H, Maleknejad F, Kimyai S. Fracture resistance of endodontically-treated teeth restored using three root-reinforcement methods. J Contem Dent Practe. 2008; 9: 30.

[24] ²⁴
Sim T P, Knowles J C, Ng YL, Shelton J, Gulabivala K. Effect of sodium hypochlorite on mechanical properties of dentine and tooth surface strain. Int Endod J. 2001; 34: 120-32.

[25] ²⁵
Kivanc B, Alacam T, Ulusoy O, Genc O, Gorgul G. Fracture resistance of thin-walled roots restored with different post systems. Int Endod J. 2009; 42: 997-1003.

[26] ²⁶
Ulusoy O Ý A, Genc O, Arslan S, Alacam T, Gorgul G. Fracture resistance of roots obturated with three different materials. Oral Surg Oral Med Oral Pathol and Endodontology. 2007; 104: 705-8.

[27] ²⁷
Schafer E, Zandbiglari T, Schafer J. Influence of resin-based adhesive root canal fillings on the resistance to fracture of endodontically treated roots: an in vitro preliminary study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007; 103: 274-9.

[28] ²⁸
Bitter K, Kielbassa AM. Post-endodontic restorations with adhesively luted fiber-reinforced composite post systems: a review. Am J Dent. 2007; 20: 353-60.

[29] ²⁹
Goncalves LA, Vansan LP, Paulino SM, Sousa Neto MD. Fracture resistance of weakened roots restored with a transilluminating post and adhesive restorative materials. J Prosthet Dent. 2006; 96: 339-44.

[30] ³⁰
Bodrumlu E, Tunga U. Apical leakage of Resilon obturation material. J Contem Dent Pract. 2006; 7: 45-52.

[31] ³¹
Aptekar A, Ginnan K. Comparative analysis of microleakage and seal for 2 obturation materials: Resilon/Epiphany and gutta-percha. J Can Dent Assoc. 2006; 72: 245.

[32] ³²
Chogle S, Mickel AK, Chan DM, Huffaker K, Jones JJ. Intracanal assessment of mineral trioxide aggregate setting and sealing properties. Gen Dent. 2007; 55: 306-11.

[33] ³³
Holt DM, Watts JD, Beeson TJ, Kirkpatrick TC, Rutledge, R.E. The anti-microbial effect against enterococcus faecalis and the compressive strength of two types of mineral trioxide aggregate mixed with sterile water or 2% chlorhexidine liquid. J Endod. 2007; 33: 844-7.

[34] ³⁴
Baumgartner G, Zehnder M, Paque F. Enterococcus faecalis Type Strain Leakage through Root Canals Filled with Gutta-Percha/AH Plus or Resilon/Epiphany. J Endod. 2007; 33: 45-7.

[35] ³⁵
Rueggeberg F, Margeson D. The effect of oxygen inhibition on an unfilled/filled composite system. J Dent Res. 1990; 69:1652-8.

[36] ³⁶
Nunes VH, Silva RG, Alfredo E, Sousa-Neto MD, Silva-Sousa YTC. Adhesion of epiphany and ah plus sealers to human root dentin treated with different solutions. Braz Dent J. 2008; 19: 46-50.

[37] ³⁷
Filipov IA, Vladimirov SB. Residual monomer in a composite resin after light-curing with different sources, light intensities and spectra of radiation. Braz Dent J. 2006; 17: 34.

[38] ³⁸
Texeira FB, Teixeira ECN, Thompson J, Leinfelder KF, Trope M. Dentinal bonding reaches the root canal system. J Esthet and Rest Dent. 2004; 16: 348-54.

[39] ³⁹
Zmener O, Banegas G, Pameijer CH. Bone tissue response to a methacrylate-based endodontic sealer: a histological and histometric study. J Endod. 2005; 31: 457-9.

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Fracture resistance of over-flared root canals filled with MTA and resin-based material: an in vitro study

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