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Abstract
ABSTRACT
Aim: This study aimed to use the micro-computed tomography to
evaluate the interfacial adaptation and the presence of gaps of NeoMTA
Plus, BioRoot RCS, and MTA in the root-end
cavities. Methodology: Thirty standardized bovine roots
measuring 15 mm in length were selected. Chemical-mechanical preparation
was performed up to instrument #80 and obturation with the cold lateral
compaction technique with cement based on zinc oxide and eugenol. The
roots were kept at 37º C for seven days. Afterward, apicectomy of the
apical 3mm and a root-end filling cavity was performed at 3mm depth.
Micro-computed tomography (micro-CT) was performed to measure the volume
of the retroactivity. The roots were divided by stratified randomization
into three groups according to the retro-end filling material: NeoMTA
Plus, BioRoot RCS, and MTA. A new micro-CT was performed to assess the
presence of voids in the root-end filling material and between it and
the canal wall. One-way ANOVA and Tukey tests were performed using the
BioEstat 4.0 program. Results: There was no difference in the
initial volume values of the root-end cavities (P > 0.05).
After the insertion of root-end filling materials, the most significant
volumes of voids were observed in the NeoMTA Plus group (P <
0.05), with no difference for the BioRoot RCS and MTA Angelus groups (P
> 0.05). Conclusion: Micro-computed tomography
showed that MTA and BioRoot RCS have better interfacial adaptation and
presented fewer number of gaps than NeoMTA Plus when used as root-end
filling materials.
Keywords: Endodontics; Apical surgery; Root-end filling material;
Micro-computed tomography.
INTRODUCTION
Apical surgery is indicated in cases where the conventional endodontic
treatment has failed or in cases of impossibility of access to the root
canal through the coronary (DEL FABBRO et al., 2016). The technique
consists of the surgical removal of the pathological periradicular
tissue, followed by resection of the root apex, preparation of a cavity
in the apical portion of the root canal, and filling this space with a
suitable root-end filling material to seal this region (GUTMANN;
HARRISON,1991). This material aims to prevent the infiltration of
bacteria and their products, allowing the reorganization of the
periodontal ligament space. (JOHNSON,1999; KIM; KRATCHMAN, 2006)
A root-end filling material choice that has adequate biological and
physical-chemical characteristics is essential for a successful apical
surgery (DEL FABBRO et al., 2016). The material’s resistance to
displacement and sealing capacity is included among the
physical-chemical characteristics. The first material based on calcium
silicate was developed in the 1990s to be used as a root-end filling
material, called Mineral Trioxide Aggregate. (MTA) (LEE; MONSEF;
TORABINEJAD, 1993) and marketed as ProRoot MTA (Tulsa Dental Products,
Tulsa, OK, EUA) in gray coloring. Adding a bismuth oxide radiopacifier
is the differential component of this product for Portland cement
(FUNTEAS; WALLACE; FOCHTMAN, 2003). MTA has hydraulic properties,
sealing ability, bioactivity, and biocompatibility (CAMILLERI, 2015a;
PRATI; GANDOLFI, 2014).
MTA can be found on the market in gray and white colors. It began to be
produced in Brazil in 2001 by Angelus company (MTA Angelus; Angelus
Produtos Odontológicos, Londrina, Brasil) in gray and, in 2004, in white
(SARZEDA et al.,2019). The sandy consistency makes handling the material
and its application challenging. MTA also presents a lengthy setting
time and can lead to coronal and gingival darkening (BORTOLUZZI et
al.,2007; SARZEDA et al.,2019). However, recent studies suggest that
some physical and chemical characteristics should be improved (SHETTY;
HIREMATH; YELI, 2017; Ber, Hatton, Stewart, 2007).
New calcium silicate-based materials have been developed and
commercialized to improve the characteristics of MTA. These materials
have been called ”bioceramic cement” or ”MTA-like” due to their
composition similar to MTA (CAMILLERI, 2015a; COOMARASWAMY; LUMLEY;
HOFMANN, 2007).
BioRoot RCS (Septodont, Saint- Mouer-Dis-Fosses, France) is a powder
(tricalcium silicate, zirconia oxide, povidone) and a liquid (hydrated
calcium chloride, polycarboxylate, and purified water). According to the
manufacturer, this cement was developed to combine high biocompatibility
with better physical properties such as ease of handling, resistance to
compression, and better biological. As root-end filling material, 1.5
scoops of powder must be mixed with five liquid drops. Even when
manipulated in a denser thickness, it has good biological properties and
little cytotoxicity (BONAFÉ, 2021; ALSUBAIT et al.,2018). BioRoot RCS
has zirconium oxide as a radiopacifier, which is not correlated with
changes in the color of the dental crown (SIBONI et al., 2017). BioRoot
RCS can also induce hard tissue formation due to its alkaline pH and
high release of calcium ions (SIBONI et al., 2017; SFEIR et al., 2021;
DONNERMEYER et al., 2018). A systematic review of in vitro studies
showed (Donnermeyer et al., 2018) high biocompatibility, low
cytotoxicity, and satisfactory clinical performance.
NeoMTA Plus (Avalon Biomed Inc. Bradenton, FL, USA) is an evolution of
MTA Plus (Avalon Biomed Inc. Bradenton, FL, USA). The primary difference
is that NeoMTA Plus features tantalum oxide as a radiopacifying agent,
while MTA Plus presents bismuth oxide. NeoMTA Plus is formed by mixing
powder and liquid. The powder contains tricalcium silicate, dicalcium
silicate, tantalum oxide, calcium aluminate, and calcium sulfate. A
water-based gel forms the liquid with thinner water-soluble agents and
polymers, which provides better handling of the cement (EID et al.,
2014; MCMICHAEL; PRIMUS; OPPERMAN, 2016).
Small powder particles also improve handling (Camilleri, Formosa, and
Damidot, 2013). Neo MTA Plus also stimulates hard tissue deposition
(CAMILLERI, 2015a). It is a biocompatible material with low cytotoxicity
(PINHEIRO et al., 2018; QUINTANA et al., 2018).
This study aims to evaluate, using micro-CT, the number of empty spaces
(i.g. voids and gaps) of NeoMTA Plus, BioRoot RCS, and MTA (Angelus,
Londrina, Brazil) in root-end cavities of bovine teeth.