a comparative assessment of fracture resistance of endodontically treated and re-treated teeth_ an...

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.

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

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