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  • A Comparative Assessment of Fracture Resistance of Endodontically Treated and Re-treated Teeth_ an _i_in Vitro__i_ Study _[PAUTHORS], Journal of Conservative Dentistry (JCD)
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ORIGINAL ARTICLE Year : 2014 | Volume :17 | Issue :1 | Page : 6164 A comparative assessment of fracture resistance of endodontically treated and retreated teeth: An in vitro study Arathi Ganesh, Nagendrababu Venkateshbabu, Aby John, Gogulnath Deenadhayalan, Deivanayagam Kandaswamy Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India Correspondence Address: Arathi Ganesh Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai 600 116, Tamil Nadu India Abstract Aim: To compare and assess the fracture resistance of endodontically treated teeth with those that have been subjected to endodontic retreatment. Materials and Methods: 30 extracted mandibular premolars were decoronated at cementoenamel junction and randomly divided into 2 groups. In Group I endodontic treatment was performed with ProTaper rotary system till size F2 and obturated. In Group II, cleaning and shaping was done and teeth were subjected to Spiral CT to assess the remaining dentin thickness and obturated. Later retreatment was done using Protaper Universal Retreatment system and final shaping was performed till size F3. Remaining dentin thickness was again assessed using Spiral CT and then obturated. All the specimens were subjected to fracture resistance using universal testing machine. The results were statistically analyzed using Independent Samples t test for analysis of remaining dentin thickness using SCT within Group II and Paired Samples ttest was used for assessment of fracture resistance between Group I and II (P < 0.05). Results: In Group II, the intra group comparison of the remaining dentin thickness in the coronal third reveals statistical significance, with a significant difference noted in the apical third. Results of the fracture resistance reveal a statistically significant difference (P < 0.05) between Groups I and II with the mean fracture resistance of Group I being higher than Group II. Conclusion: Endodontically retreated teeth have shown significantly decreased resistance to fracture and this has a positive correlation to the increased loss of root dentin during the retreatment procedures How to cite this article: Ganesh A, Venkateshbabu N, John A, Deenadhayalan G, Kandaswamy D. A comparative assessment of fracture resistance of endodontically treated and retreated teeth: An in vitro study.J Conserv Dent 2014;17:6164 How to cite this URL: Ganesh A, Venkateshbabu N, John A, Deenadhayalan G, Kandaswamy D. A comparative assessment of fracture resistance of endodontically treated and retreated teeth: An in vitro study. J Conserv Dent [serial online] 2014 [cited 2015 Jul 19 ];17:6164 Available from: http://www.jcd.org.in.scihub.org/text.asp?2014/17/1/61/124146 Full Text Introduction In general, endodontically treated teeth are considered to have increased susceptibility to fracture than vital teeth. [1] The reasons attributed to this are the dehydration and loss of dentin caused during the endodontic therapy along with the pressure applied during obturation of the filling material as in lateral compaction technique. [2] The structural durability of the tooth following endodontic therapy is directly proportional to the remaining tooth structure present. Aggressive instrumentation of the root canal leads to loss of dentin which may structurally weaken the tooth. Bender and Freedland have suggested that, the highest incidence of vertical root fracture occurs in endodontically treated teeth. [3] Nonsurgical retreatment techniques are the preferred choice over surgical management to reduce or eliminate the bacterial load, to contain infection and alleviate symptoms. The goal of retreatment is to completely remove the filling material to enable thorough disinfection of the endodontic system prior to refilling. [4] Various techniques have been advocated to remove obturating materials from the root canal system during retreatment. [5],[6],[7] The ProTaper Universal Retreatment system consists of three retreatment files, D1, D2 and D3, which are designed to be used in the coronal, middle and apical third of the root canal respectively. The triangular cross section of these instruments is similar to the ProTaper shaping and finishing files. The use of a solvent has been recommended to aid in removal of Guttapercha by softening it. [8] Endodontically treated teeth are structurally more susceptible to root fractures. Proper coronal restorations following endodontic therapy is essential to restore function and esthetics. Previous studies have suggested that bonded composite restorations can be considered as the first choice for coronal restorations as they play a vital role in increasing the fracture resistance of endodontically treated teeth. [9] Furthermore, it has been shown that direct and indirect cusp coverage adhesive restorations can significantly increase the fracture resistance of endodontically treated teeth. [10] To the best of our knowledge no study has been carried out to assess the fracture resistance of teeth following endodontic retreatment. Thus, the purpose of this in vitro study was to assess the fracture resistance of teeth after endodontic retreatment with ProTaper Universal retreatment system and measure the remaining dentin thickness with spiral computed tomography (SCT) and to correlate the loss of remaining dentinal thickness with susceptibility to fracture. Materials and Methods Specimen selection A total of 30 extracted mandibular premolars with fully formed apices were used in this study. The teeth were decoronated at the cemento enamel junctions to obtain standard root lengths of 14 mm using a diamond disk (Brassler Dental Products, Savannah, Ga.). Initial endodontic treatment In Group I, the working length was established by placing a size 15 K file into the canal until it was observed at the apical foramen, then decreasing the file length by 1 mm. The canals лучший девиз для научного ВУЗа → поменять прокси SciHub

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  • 19/7/2015 Acomparativeassessmentoffractureresistanceofendodonticallytreatedandretreatedteeth:Aninvitrostudy:[PAUTHORS],JournalofConse

    http://www.jcd.org.in.scihub.org/printarticle.asp?issn=09720707year=2014volume=17issue=1spage=61epage=64aulast=Ganesh 1/3

    ORIGINALARTICLEYear:2014|Volume:17|Issue:1|Page:6164

    Acomparativeassessmentoffractureresistanceofendodonticallytreatedandretreatedteeth:AninvitrostudyArathiGanesh,NagendrababuVenkateshbabu,AbyJohn,GogulnathDeenadhayalan,DeivanayagamKandaswamyDepartmentofConservativeDentistryandEndodontics,FacultyofDentalSciences,SriRamachandraUniversity,Porur,Chennai,TamilNadu,India

    CorrespondenceAddress:ArathiGaneshDepartmentofConservativeDentistryandEndodontics,FacultyofDentalSciences,SriRamachandraUniversity,Porur,Chennai600116,TamilNaduIndia

    AbstractAim:Tocompareandassessthefractureresistanceofendodonticallytreatedteethwiththosethathavebeensubjectedtoendodonticretreatment.MaterialsandMethods:30extractedmandibularpremolarsweredecoronatedatcementoenameljunctionandrandomlydividedinto2groups.InGroupIendodontictreatmentwasperformedwithProTaperrotarysystemtillsizeF2andobturated.InGroupII,cleaningandshapingwasdoneandteethweresubjectedtoSpiralCTtoassesstheremainingdentinthicknessandobturated.LaterretreatmentwasdoneusingProtaperUniversalRetreatmentsystemandfinalshapingwasperformedtillsizeF3.RemainingdentinthicknesswasagainassessedusingSpiralCTandthenobturated.Allthespecimensweresubjectedtofractureresistanceusinguniversaltestingmachine.TheresultswerestatisticallyanalyzedusingIndependentSamplesttestforanalysisofremainingdentinthicknessusingSCTwithinGroupIIandPairedSamplesttestwasusedforassessmentoffractureresistancebetweenGroupIandII(P

  • 19/7/2015 Acomparativeassessmentoffractureresistanceofendodonticallytreatedandretreatedteeth:Aninvitrostudy:[PAUTHORS],JournalofConse

    http://www.jcd.org.in.scihub.org/printarticle.asp?issn=09720707year=2014volume=17issue=1spage=61epage=64aulast=Ganesh 2/3

    werepreparedusingProTaperUniversalNiTirotaryshapingandfinishinginstrumentsfollowingmanufacturer'sinstructionsinsequencefromSxtoF2toobtainafinalapicalsizeof25with8%taperusingcrowndowntechnique.Alongwiththisinstrumentation,canalswereirrigatedbetweentheuseofeachsucceedingfile,byintroducing10mLof3%sodiumhypochlorite(PrimeDentalProducts,India),witha27gaugeneedle.Aftercompleteinstrumentation,allspecimensreceivedfinalirrigationwith10mLof17%ethylenediaminetetraaceticacid(EDTA)(PrimeDentalProducts,India)followedby10mLofsodiumhypochloritetoremovethesmearlayer.Followingthis,10mLofsalinewasusedtoremoveanyremainingsodiumhypochloriteresidue.Thecanalsweredriedwithsterilepaperpoints.Followingthemanufacturer'sinstructions,theAHplussealer(DentsplyDeTreyGmbH,Konstanz,Germany)wasmixedandappliedwithintherootcanal.Asize25%,2%mastercone(DiaDentGroupInternational,Korea)wasplacedattheappropriateworkinglengthandapicaltuckbackwasconfirmed.Aspreaderwasusedtolaterallycompactthe2%guttaperchaaccessoryconescoatedwithAHplussealer.Excessguttaperchawasshearedoffandcondensedwithaplugger1mmbelowthecanalopening.TheopeningofthecanalwassealedwithColtosol(ColteneWhaledent,CuyahogaFalls,OH)andtheteethwerestoredat37Cin100%humidityfor2weeks.

    Spiralcomputedtomographyanalysis

    InGroupII,cleaningandshapingwasperformedinthesamemannerasforGroupIfollowingwhichtheteethweresubjectedtoSCT(Lightspeedpluscomputedtomographyscanner[GEElectricals,Milwaukee,USA])toassesstheteethatdifferentsectionsofthecoronal,middleandapicalthirdsrespectively.Theremainingdentinthicknesswasthenmeasuredfromthecentralcanaltotheouterperipheryinbuccal,lingual,mesialanddistaldirections.Followingthis,theteethwereobturatedasstatedinGroupI.

    Retreatmenttechnique

    InGroupII,retreatmentwasperformedafter48hfollowingobturationtoallowforadequatetimeforthesealertosetwithProTaperUniversalNiTirotaryretreatment(DentsplyMaillefer,Ballaigues,Switzerland)instruments,whichwereusedat300rpmand3N/cmtorque.EndosolvR(Septodent,Cedex,France)wasusedasthesolvent.TheretreatmentfileswereusedintherecommendedsequenceD1file(size30,0.09taper)forremovalofrootfillinginthecoronalthird,followedbyD2file(size25,0.08taper)forthemiddlethirdandfinally,theD3file(size20,0.07taper)wasusedatworkinglength.FinalshapingoftheapicalthirdwasperformedwithProTaperinstrumentsF2(size25,0.08taper)andF3(size30,0.09taper).Aftercompleteinstrumentation,allspecimensreceivedfinalirrigationwith10mLof17%EDTAfollowedby10mLofsodiumhypochloritetoremovethesmearlayer.Followingthis,10mLsofsalinewasusedtoremoveanyremainingsodiumhypochloriteresidue.Sterilepaperpointswereusedtodrythecanals.Aftercompletionofcleaningandshapingprocedures,thespecimenswereagainassessedwithSCTfortheremainingdentinthicknessasmentionedearlier.

    Lateralcompactionwasdoneusingasize30%,2%GuttaperchamasterpointcoatedwithAHplussealer.Followingthemanufacturer'sinstructions,thesealerwasmixedandappliedwithintherootcanal.ThemasterconewasplacedattheappropriateworkinglengthandapicaltuckbackconfirmedandaspreaderwasusedtolaterallycompacttheGuttaperchaaccessoryconescoatedwithAHplussealer.Excessguttaperchawasshearedoffandcondensedwithaplugger1mmbelowthecanalopening.TheopeningofthecanalwassealedwithColtosolFandtheteethwerestoredat37Cin100%humidityfor2weeks.

    Mountingofspecimensformechanicaltesting

    Alltheteethinbothgroupsweremountedonacustommadeacrylicblockssuchthat9mmoftherootsurfaceremainedexposedwhiletherestwasembeddedintheacrylicresin(DigitalProductsInternationalproducts,India).ThismodelwasbasedonthesetupproposedbyApicellaetal.[11]Thetemporarymaterialwasremovedusingaburandtherootcanalaccesswasshapedtoaccepttheloadingfixture.TheacrylicblocksweremountedwiththerootsalignedverticallyontheInstrontestingmachineoneatatime.ThemodeofapplicationoftheverticalloadingforcerequiredtofracturetherootspecimenswassimilartothetechniqueproposedbySedgleyandMessertotestthebrittlenessofendodonticallytreatedteeth.[12]Thespecimensweresubjectedtoaconstantloadatacrossheadspeedof1.0mm/minuntiltherootsfractured.Inthisstudy,"fracture"wasdefinedasthepointatwhichasharpandinstantaneousdropwasobserved.ThispointwasverifiedbyacomputerattachedtotheInstrontestingmachine(Model3382,Instron,UK).Formostspecimens,anaudiblecrackwasalsoheard.ThetestwasterminatedatthispointandtheforceappliedwasrecordedandmeasuredinNewtons.

    Statisticalanalysis

    StatisticalanalysiswasperformedusingindependentSamplesttestforanalysisofremainingdentinthicknessusingSCTwithinGroupIIandpairedSamplesttestwasusedforassessmentoffractureresistancebetweenGroupIandII(P

  • 19/7/2015 Acomparativeassessmentoffractureresistanceofendodonticallytreatedandretreatedteeth:Aninvitrostudy:[PAUTHORS],JournalofConse

    http://www.jcd.org.in.scihub.org/printarticle.asp?issn=09720707year=2014volume=17issue=1spage=61epage=64aulast=Ganesh 3/3

    resultedinthesubstantiallossofrootdentin.[17]Earlierinvestigationshavereportedthatthefillingmaterialtracedinthecanalwouldbereducedwhentheenlargementintheretreatmentwasbiggerthantheenlargementperformedbeforethecanalfilling.[8],[19]Thepresentstudyfollowstheprotocoltoincreasetheapicalsizefollowingretreatmenttoonesizelargerthantheinitialtreatmentgroup,whichmayhaveaccountedforthelossofrootdentinfromtheapicalthirds[Table1].TheSCTanalysisrevealsthelossofrootdentininthepreandpostretreatmentsamplesinGroupII.ThislossofrootdentinduringthecourseofretreatmentproceduremayhavecontributedtothereducedfractureresistanceofthesamplesinGroupII.

    Conclusion

    Withinthelimitationsofthisstudy,itcanbeconcludedthatendodonticallyretreatedteethhaveshownsignificantlydecreasedresistancetofractureandthishasapositivecorrelationtotheincreasedlossofrootdentinduringtheretreatmentproceduresashasbeenconfirmedbytheaidofSCT.

    References1 SornkulE,StannardJG.Strengthofrootsbeforeandafterendodontictreatmentandrestoration.JEndod199218:4403.2 HelferAR,MelnickS,SchilderH.Determinationofthemoisturecontentofvitalandpulplessteeth.OralSurgOralMedOralPathol197234:66170.3 BenderIB,FreedlandJB.Adultrootfracture.JAmDentAssoc1983107:4139.4 FriedmanS,StabholzA,TamseA.EndodonticretreatmentCaseselectionandtechnique.3.Retreatmenttechniques.JEndod199016:5439.5 MasieroAV,BarlettaFB.Effectivenessofdifferenttechniquesforremovingguttaperchaduringretreatment.IntEndodJ200538:27.6 WilcoxLR.Endodonticretreatment:Ultrasonicsandchloroformasthefinalstepinreinstrumentation.JEndod198915:1258.7 ViduciD,JukiS,KarloviZ,BoziZ,MiletiI,AniI.RemovalofguttaperchafromrootcanalsusinganNd:YAGlaser.IntEndodJ200336:6703.8 TademirT,YildirimT,CelikD.Comparativestudyofremovalofcurrentendodonticfillings.JEndod200834:3269.9 MongaP,SharmaV,KumarS.Comparisonoffractureresistanceofendodonticallytreatedteethusingdifferentcoronalrestorativematerials:Aninvitrostudy.JConserv

    Dent200912:1549.10 BassirMM,LabibzadehA,MollaverdiF.Theeffectofamountoflosttoothstructureandrestorativetechniqueonfractureresistanceofendodonticallytreatedpremolars.J

    ConservDent201316:4137.11 ApicellaMJ,LoushineRJ,WestLA,RunyanDA.Acomparisonofrootfractureresistanceusingtworootcanalsealers.IntEndodJ199932:37680.12 SedgleyCM,MesserHH.Areendodonticallytreatedteethmorebrittle?JEndod199218:3325.13 FussZ,LustigJ,KatzA,TamseA.Anevaluationofendodonticallytreatedverticalrootfracturedteeth:Impactofoperativeprocedures.JEndod200127:468.14 LertchirakarnV,TimyamA,MesserHH.Effectsofrootcanalsealersonverticalrootfractureresistanceofendodonticallytreatedteeth.JEndod200228:2179.15 SagsenB,ErO,KahramanY,AkdoganG.Resistancetofractureofrootsfilledwiththreedifferenttechniques.IntEndodJ200740:315.16 GopikrishnaV,BhargaviN,KandaswamyD.EndodonticmanagementofamaxillaryfirstmolarwithasinglerootandasinglecanaldiagnosedwiththeaidofspiralCT:A

    casereport.JEndod200632:68791.17 GuLS,LingJQ,WeiX,HuangXY.EfficacyofProTaperUniversalrotaryretreatmentsystemforguttapercharemovalfromrootcanals.IntEndodJ200841:28895.18 GluskinAH,PetersCI,WongRD,RuddleCJ.Retreatmentofnonhealingendodontictherapyandmanagementofmishaps.Ingle'sEndodontics.6thed.Hamilton:BC

    DeckerInc.2008.19 HassanlooA,WatsonP,FinerY,FriedmanS.Retreatmentefficacyoftheepiphanysoftresinobturationsystem.IntEndodJ200740:63343.20 TademirT,ErK,YildirimT,CelikD.EfficacyofthreerotaryNiTiinstrumentsinremovingguttaperchafromrootcanals.IntEndodJ200841:1916.

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