Bacterial leakage in ex vivo teeth after apicoectomy using two tricalsium silicate-based cements as root-end filling materials

Abstract

Abstract

Background The main cause of pulpal and periradicular pathosis are microorganisms and their by products in the root canal system. These have to be eliminated to promote healing. Because it´s impossible to achieve a bacteria-free root canal an additional goal of endodontic therapy is to seal the root canal system from the outside environment. Today the standard method for filling the root canals are a combination of a core material and a root canal sealer, usually gutta-percha and epoxy resin sealer. Sometimes periapical healing is not achieved even after conventional root canal treatment, if retreatment is not an option or failed, surgical endodontic treatment is indicated. Through retrograde approach the surgery comprises elimination of pathological tissue, root resection, preparation of root-end cavity and placement of a root-end filling material. For many years amalgam was considered to be a suitable material for root-end fillings, but today MTA (Pro Root MTA, Dentsply Tulsa, Dental, Tulsa, OK, USA) is the gold standard, and has been associated with high success rates.

Recently a new dentine replacement material Biodentine (Septodont, Saint-Maur des Fossés, France) has been introduced on the marked. Biodentine (BD) has shown to have similar biocompatibility and bioactivity as MTA, and because BD has shorter setting time than MTA, it should be considered an interesting alternative.

The only leakage tests done on BD are glucose leakage and dye leakage, which have shown promising results for BD, but no research has been published on the bacterial leakage of BD when used as a retrograde filling.

Aim The aim of this study was to compare the bacterial leakage in single canal roots when either BD or MTA was used as a root-end fillings material.

Results There were pre-test failures in BD, MTA, AHPlus and positive control groups, reducing the number of samples. The positive control leaked in 2 days and there was no leakage in either of the negative control samples. The proportion of leaking samples (in 60 days) were 6/6 and 4/5 for BD and MTA, respectively. The mean number of days (+/- SD) for the resistance of the leakage were 4.3 (+/-1.9) and 14.0 (+/- 22,0) for BD and MTA, respectively. The mean OD600 values were 1.9 and 1.2, for BD and MTA, respectively. None of these differences between the BD and MTA groups were statistically significant.

Conclusion Due to the weak power of the present study, it could not show any statistically significant difference between the tested materials, but there was a clear trend showing better sealing ability for MTA compared to BD. As long as there are no studies to indicate at least as good in vitro sealability for BD as shown previously for MTA, the clinical use of BD as a root-end filling material is not warranted.