• Restorative Dentistry and Endodontics
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• v.23 no.1
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• pp.163-174
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• 1998

The purpose of this study is to evaluate the distribution of stress in the root end resected teeth. The finite element method was used to compare stresses along the root and retrograde filling material in seven two-dimensional models of mandibular 2nd premolar. Each model was endodontic treatment and gold crown' restoration. Each model divided with amagam core restoration or gold casting post restoration. Thus each model divided with shape of root end resection, depth of retropreparation and exposure length of root in the bony cavity. The seven models were classified as in the table 1 below. A load of 500N was applied $45^{\circ}$ diagonally on the lingual slope of the buccal cusp. These mode were analyzed with two dimensional finite element methods. The results of this study were as follows : 1. The maximum tensile stress along the inner canal wall was shown on the model 7. 2. When the model 1 was compared with the model 5, the maximum tensile stress along the inner canal wall showed the model 1. 3. Less equivalent stress was shown on the model 6 and more equivalent stress was shown on the model 4. 4. More shear stress was shown on the retrograde filling material of the model 7. 5. The models with increased length of exposed root in the bony cavity demonstrated a gradual increase to the tensile stress in X direction which occurred approximately a boundary between the bone and exposed root in' the bony cavity. 6. The model which had a case of matching the apex of post and a boundary between the bone and exposed root in the bony cavity demonstrated more increase tensile stress in X direction than other models.

• Restorative Dentistry and Endodontics
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• v.34 no.4
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• pp.371-376
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• 2009

We evaluated in vitro microleakage of Mineral Trioxide Aggregate (MTA) powder with 4-methacryloxyethyl trimellitate anhydride (4-META) / methyl methacrylate (MMA) & tri-n-butylborane (TBB) resin as a retrograde filling material by using methylene blue dye method. Fifty-two single rooted, extracted teeth were instrumented and obturated with gutta percha and AH plus sealer. The apical 3mm of each root was resected and 3mm deep ultrasonic root end preparation was done. External surface of roots was coated with nail varnish. Prepared teeth were randomly divided into five groups; Negative control: completely covered with nail varnish; Positive control: coated with nail varnish except for apical foramen; Group 1 (retrofilled with Portland cement); Group 2 (retrofilled with MTA); Group 3 (retrofilled with MTA powder mixed with 4-META/MMA & TBB resin). Immediately after completion of root-end filling, all specimens were submerged in methylene blue dye for 72 hours in $37^{\circ}C$incubator. The roots were longitudinally sectioned and measured for extent of dye penetration by three different examiners under microscope (${\times}$10). The results were statistically analyzed using one way ANOVA and Turkey's HSD test. No leakage was evident in negative control and complete leakage in positive control group. Group 3 showed significantly less leakage than group 1 and 2 (p < 0.01). There was no significant difference between group 1 and 2 (p > 0.01). It was concluded that MTA powder with 4-META/MMA & TBB resin was excellent in reducing initial apical microleakage.

• Restorative Dentistry and Endodontics
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• v.27 no.1
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• pp.24-33
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• 2002

Leakage studies have been performed frequently, since a fluid-tight seal provided by various dental fill-ing materials has been considered clinically important. The leakage of the various root-end filling materials has been widely investigated mostly dye penetration method. These dye studies cannot offer any information about the quality of the seal of a test material over a long period of time The purpose of this study was to evaluate the microleakage of root end cavities in blood contamination filed amalgam, intermediate restorative material(IRM), light cured glass ionomer cement(GI) and mineral trioxide aggregate(MTA) by means of a modified fluid transport model. Fifty standard human root sections, each 5mm high and with a central pulp lumen of 3mm in diameter, were and filled with our commonly used or potential root end fill ing materials after they were contaminated with blood. At 24h. 72h, 1, 2, 4, 8, and 12 weeks after filling, leakage along these filling materials was determined under a low pressure of 10KPa(0.1atm) using a fluid transport model. The results were as follows : 1 MTA group showed a tendency of decreasing percent of gross leakage (20m1/day) in process of time, whereas the other materials showed a tendency of increasing in the process time. 2. At the all time interval, GI group leaked significantly less than amalgam group and IRM group (p＜0.05). 3. At the 4 weeks, the percentage of gross leakage in MTA group decreased to 0% thereafter, the low per-centage of gross leakage was maintained in MTA group until the end of the experiment, whereas the percentage in IRM group increased to 100% 4. At the 12 weeks, percentage of gross leakage was significantly low in MTA group(0%), comparison with GI group(40%), amalgam group(90%) and IRM group(100%), but there was no significant difference between latter two materials.

• Restorative Dentistry and Endodontics
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• v.22 no.1
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• pp.305-324
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• 1997

Numerous materials such as amalgam, IRM, SuperEBA, dessicated ZOE, and Ketac-Silver have been used as a root-end filling material or to repair furcation perforations. But so far no material has been found to satisfy all of the requirements of an ideal restorative material. Recently, mineral trioxide aggregate (MTA) has been suggested for use as a root end filling material and for the repair of furcation perforations. The purpose of this study was to compare the effect of MTA on the proliferation of MC3T3/E1 osteoblastic cell, formation of bone nodule, alkaline phosphatase activity, and finally the tissue reaction of bone with those of amalgam, IRM, SuperEBA, dessicated ZOE, and Ketac-Silver. The following conclusions were drawn within the limits of the experimental results : 1. MTA showed a excellent proliferation of osteoblastic cell and Ketac-Silver showed moderate proliferation of osteoblastic cell. The rest of test materials showed no proliferation of osteoblastic cell. 2. Many of definite bone nodules were found in the MTA group. In contrast, Ketac-Silver group showed no definite bone formation but only showed mild sign of bone formation. 3. Alkaline phosphatase activity of Ketac-Silver and MTA showed similar results. But both of them showed higher activity than that of other materials (p<0.005). 4. The tissue reaction to implanted MTA in the calbarium of mouse was milder than that observed with other materials. The tissue reaction of dessicated ZOE showed the worst results among the test materials.

• Restorative Dentistry and Endodontics
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• v.33 no.2
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• pp.107-114
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• 2008

This study was performed to assess the radiopacity of a variety of canal filling and retrograde root-end filling materials according to the specification concerning root canal obturation materials. Ten materials including Gutta-percha pellets, amalgam, Fuji II LC, $Dyract^{(R)}$ AP, Super $EBA^{(R)}$, $IRM^{(R)}$, AH $26^{(R)}$, $Sealapex^{TM}$, Tubli-$Seal^{TM}$, and dentin were evaluated in this study. In the first part, densitometric reading of an each step of aluminum step wedge on occlusal film were performed at 60 kVp (0.2, 0.3, 0.4 s), 70 kVp (0.2, 0.3, 0.33 s) to decide appropriate voltage and exposure time. In the second part, ten specimens which are 5 mm in diameter and 0.5, 1.0, 1.5, 2.0, 2.5, 3.0 mm in thickness, were fabricated from each material studied. The specimens were radiographed simultaneously with an aluminum step wedge under decided condition (60 kVp, 0.2 s). The mean radiographic density values of the materials were transformed into radiopacity expressed equivalent thickness of aluminum (mm Al). The following results were obtained. 1. Among the various conditions including 0.2 s, 0.3 s, 0.4 s at 60 kVp and 0.2 s, 0.3 s, 0.33 s at 70 kVp, the appropriate voltage and exposure time that meet the requirement of density from 0.5 to 2.0 was 0.2 s at 60 kVp. 2. All of the materials in this study had greater radiopacity than the minimun level recommended by ISO No. 4049 standards. 3. Most of the materials had greater radiopacity than 3 mm Al requirement of ANSI/ADA specification No. 57 (2000) and ISO No. 6876 (2001) standards except for Fuji II LC and Dyract. It suggests that all experimental canal filling and retrograde root-end filling materials have a sufficient radiopacity that meet the requirement concerning root canal obturation materials except for Fuji II LC and Dyract.

• Restorative Dentistry and Endodontics
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• v.46 no.3
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• pp.35.1-35.11
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• 2021

Objectives: Endosequence Bioceramic Root Repair Material (BC-RRM) is used in endodontic microsurgery. It is available as a paste and a putty. However, no studies to date have examined the sealing ability of these forms alone or in combination as root-end filling materials. Hence, this study aimed to compare the sealing properties of these 2 forms of BC-RRM. Materials and Methods: Forty-two extracted upper anterior teeth were divided into 3 experimental groups, a positive and negative control. After the root canal treatment, the root ends were resected, retroprepared and retrofilled with either putty, paste + putty or mineral trioxide aggregate (MTA). The teeth were mounted in tubes so the apical 3 mm was submerged in Brain Heart Infusion (BHI) broth. The coronal portions of the canals were inoculated with Enterococcus faecalis and BHI broth and incubated for 30 days. The broth in the tubes was analyzed for colony forming units to check for leakage of bacteria from the canal. The teeth from the groups were sectioned and analyzed using scanning electron microscopy (SEM). The Kruskal-Wallis test and analysis of variance were used to analyze the data with a significance level p < 0.05. Results: The BC-RRM and MTA groups showed similar sealing ability. The positive control showed leakage in all samples. The SEM imaging showed the presence of bacteria in all experimental groups at the material-tooth interface. Conclusions: No significant differences were noted in the experimental groups, providing sufficient evidence that any combination could be effectively used during endodontic microsurgery.

• Restorative Dentistry and Endodontics
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• v.24 no.1
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• pp.166-179
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• 1999

Apical sealing is essential for the success of surgical endodontic treatment. Root-end cavity is apt to be contaminated with moisture or blood, and is not always easy to be dried completely. The purpose of this study was to evaluate the influence of dry methods of retrocavity on the apical seal in endodontic surgery. Apical seal was investigated through the evaluation of apical leakage and adaptation of filling material over the cavity wall. To investigate the influence of various dry methods on the apical leakage, 125 palatal roots of extracted human maxillary molar teeth were used. The clinical crown of each tooth was removed at 10 mm from the root apex using a slow-speed diamond saw and water spray. Root canals of the all the specimens were prepared with step-back technique and filled with gutta-percha by lateral condensation method. After removing of the coronal 2 mm of filling material, the access cavities were closed with Cavit$^{(R)}$. Two coats of nail polish were applied to the external surface of each root. Apical three millimeters of each root was resected perpendicular to the long axis of the root with a diamond saw. Class I retrograde cavities were prepared with ultrasonic instruments. Retrocavities were washed with physiologic saline solution and dried with various methods or contaminated with human blood. Retrocavities were filled either with IRM, Super EBA or composite resin. All the specimens were immersed in 2% methylene blue solution for 7 days in an incubator at $37^{\circ}C$. The teeth were dissolved in 14 ml of 35% nitric acid solution and the dye present within the root canal system was returned to solution. The leakage of dye was quantitatively measured via spectrophotometric method. The obtained data were analysed statistically using one-way ANOVA and Duncan's Multiple Range Test. To evaluate the influence of various dry methods on the adaptation of filling material over the cavity wall, 12 palatal roots of extracted human maxillary molar teeth were used. After all the roots were prepared and filled, and retrograde cavities were made and filled as above, roots were sectioned longitudinally. Filling-dentin interface of cut surfaces were examined by scanning electron microscope. The results were as follows: 1. Cavities dried with paper point or compressed air showed less leakage than those dried with cotton pellet in Super EBA filled cavity (p<0.05). However, there was no difference between paper point- and compressed air-dried cavities. 2. When cavities were dried with compressed air, dentin-bonded composite resin-filled cavities showed less apical leakage than IRM- or Super EBA-filled ones (p<0.05). 3. Regardless of the filling material, cavities contaminated with human blood showed significantly more apical leakage than those dried with compressed air after saline irrigation (p<0.05). 4. Outer half of the cavity showed larger dentin-filling interface gap than inner half did when cavities were filled with IRM or Super EBA. 5. In all the filling material groups, cavities contaminated with blood or dried with cotton pellets only showed larger defects at the base of the cavity than ones dried with paper points or compressed air.

• Restorative Dentistry and Endodontics
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• v.47 no.4
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• pp.35.1-35.9
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• 2022

Although the success rates of microsurgery and micro-resurgery are very high, the influence of a recurrent perforation combined with radicular cyst remains unclear. A 21-year-old white female patient had a history of root perforation in a previously treated right maxillary lateral incisor. Analysis using cone-beam computed tomography (CBCT) revealed an extensive and well-defined periapical radiolucency, involving the buccal and palatal bone plate. The perforation was sealed with bioceramic material (Biodentine) in the pre-surgical phase. In the surgical phase, guided tissue regeneration (GTR) was performed by combining xenograft (lyophilized bovine bone) and autologous platelet-rich fibrin applied to the bone defect. The root-end preparation was done using an ultrasonic tip. The retrograde filling was performed using a bioceramic material (Biodentine). Histopathological analysis confirmed a radicular cyst. The patient returned to her referring practitioner to continue the restorative procedures. CBCT analysis after 1-year recall revealed another perforation in the same place as the first intervention, ultimately treated by micro-resurgery using the same protocol with GTR, and a bioceramic material (MTA Angelus). The 2-year recall showed healing and bone neoformation. In conclusion, endodontic micro-resurgery with GTR showed long-term favorable results when a radicular cyst and a recurrent perforation compromised the success.

• Restorative Dentistry and Endodontics
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• v.41 no.4
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• pp.310-315
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• 2016

Two case reports describing a new technique of creating a repositionable piezoelectric bony window osteotomy during apicoectomy in order to preserve bone and act as an autologous graft for the surgical site are described. Endodontic microsurgery of anterior teeth with an intact cortical plate and large periapical lesion generally involves removal of a significant amount of healthy bone in order to enucleate the diseased tissue and manage root ends. In the reported cases, apicoectomy was performed on the lateral incisors of two patients. A piezoelectric device was used to create and elevate a bony window at the surgical site, instead of drilling and destroying bone while making an osteotomy with conventional burs. Routine microsurgical procedures - lesion enucleation, root-end resection, and filling - were carried out through this window preparation. The bony window was repositioned to the original site and the soft tissue sutured. The cases were re-evaluated clinically and radiographically after a period of 12 - 24 months. At follow-up, radiographic healing was observed. No additional grafting material was needed despite the extent of the lesions. The indication for this procedure is when teeth present with an intact or near-intact buccal cortical plate and a large apical lesion to preserve the bone and use it as an autologous graft.