Dimensional changes of endodontic sealers-An in vitro model simulating a clinical extrusion scenario during 18 months

Ankur Razdan; Ana R Benetti; Azam Bakhshandeh; Tron A Darvann; Lars Bjørndal

doi:10.1002/cre2.704

Dimensional changes of endodontic sealers-An in vitro model simulating a clinical extrusion scenario during 18 months

Clin Exp Dent Res. 2023 Apr;9(2):299-313. doi: 10.1002/cre2.704. Epub 2023 Jan 11.

Authors

Ankur Razdan^{1

2

3}, Ana R Benetti¹, Azam Bakhshandeh², Tron A Darvann^{4

5

6

7}, Lars Bjørndal²

Affiliations

¹ Department of Odontology, Section of Dental Materials, Section of Clinical Oral Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark.
² Department of Odontology, Section of Cariology and Endodontics, Section of Clinical Oral Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark.
³ Department of Dentistry and Oral Health, Section for Oral Radiology, Aarhus University, Aarhus C, Denmark.
⁴ 3D Craniofacial Image Research Laboratory, School of Dentistry, University of Copenhagen, Copenhagen N, Denmark.
⁵ 3D Craniofacial Image Research Laboratory, Centre of Head and Orthopaedics, Copenhagen University Hospital Rigshospitalet, Copenhagen N, Denmark.
⁶ 3D Craniofacial Image Research Laboratory, Department of Applied Mathematics and Computer Science, Technical University of Denmark, Copenhagen N, Denmark.
⁷ Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen N, Denmark.

Abstract

Objectives: To examine the dimensional changes of endodontic sealers during 18 months using three-dimensional (3D) surface scanning and subtraction radiography in a novel in vitro sealer-extrusion model.

Material and methods: Fifty endodontically instrumented acrylic teeth were randomly allocated to five groups (n = 10) filled with Apexit Plus, AH Plus, BioRoot RCS, TubliSeal EWT, and gutta-percha (control). Freshly mixed sealers were intentionally extruded during obturation. All teeth were immersed in a physiologic solution for up to 18 months. Blinded 3D surface scans (resolution: ~10 μm) and digital radiographs of the teeth were obtained at baseline (immediately after obturation); and then after 1 week, and at 1, 3, and 18 months. For blinded assessment of sealer dimensional change, 3D models and radiographs were superimposed using specific software. Volumetric differences, root mean square (RMS), and area change from subtraction radiography measured at each period within each sealer group were thereafter calculated. Repeated measures analyses were done with Bonferroni adjustment for multiple comparisons; standard errors, p values, and 95% confidence intervals (CI) were reported.

Results: Analyses of the volumetric data confirmed significant, progressive material loss for Apexit Plus when compared to the other investigated sealers or the control group (p ≤ 0.02). Immersion period significantly influenced the volumetric dimensional changes of Apexit Plus already after 1 month (p < 0.01). For TubliSeal EW, the effect of the immersion period on the dimensional changes was noted after immersion for 3 months (p ≤ 0.02), while for BioRoot RCS this was evident only at 18 months (p < 0.01). Same trends were noted for the RMS data, whereas progressive dimensional changes using subtraction radiography only revealed significant changes for Apexit Plus (p = 0.01).

Conclusions: The largest dimensional changes were shown by Apexit Plus, followed by Tubliseal EWT and BioRoot RCS. AH Plus remained stable throughout 18 months.

Keywords: dental cements; in vitro techniques; root canal sealer; solubility.

MeSH terms

Calcium Hydroxide
Epoxy Resins
Gutta-Percha
Root Canal Filling Materials*

Substances

Apexit
Calcium Hydroxide
Epoxy Resins
Gutta-Percha
Root Canal Filling Materials