19/7/2015 Acomparativeassessmentoffractureresistanceofendodonticallytreatedandretreatedteeth:An<i>invitro</i>study:[PAUTHORS],JournalofConse

ORIGINALARTICLE

Year:2014|Volume:17|Issue:1|Page:6164

Acomparativeassessmentoffractureresistanceofendodonticallytreatedandretreatedteeth:Aninvitrostudy
ArathiGanesh,NagendrababuVenkateshbabu,AbyJohn,GogulnathDeenadhayalan,DeivanayagamKandaswamy
DepartmentofConservativeDentistryandEndodontics,FacultyofDentalSciences,SriRamachandraUniversity,Porur,Chennai,TamilNadu,India
CorrespondenceAddress:
ArathiGanesh
DepartmentofConservativeDentistryandEndodontics,FacultyofDentalSciences,SriRamachandraUniversity,Porur,Chennai600116,TamilNadu
India

Abstract
Aim:Tocompareandassessthefractureresistanceofendodonticallytreatedteethwiththosethathavebeensubjectedtoendodonticretreatment.MaterialsandMethods:30
extractedmandibularpremolarsweredecoronatedatcementoenameljunctionandrandomlydividedinto2groups.InGroupIendodontictreatmentwasperformedwithProTaper
rotarysystemtillsizeF2andobturated.InGroupII,cleaningandshapingwasdoneandteethweresubjectedtoSpiralCTtoassesstheremainingdentinthicknessandobturated.
LaterretreatmentwasdoneusingProtaperUniversalRetreatmentsystemandfinalshapingwasperformedtillsizeF3.RemainingdentinthicknesswasagainassessedusingSpiral
CTandthenobturated.Allthespecimensweresubjectedtofractureresistanceusinguniversaltestingmachine.TheresultswerestatisticallyanalyzedusingIndependentSamplest
testforanalysisofremainingdentinthicknessusingSCTwithinGroupIIandPairedSamplesttestwasusedforassessmentoffractureresistancebetweenGroupIandII(P<0.05).
Results:InGroupII,theintragroupcomparisonoftheremainingdentinthicknessinthecoronalthirdrevealsstatisticalsignificance,withasignificantdifferencenotedintheapical
third.Resultsofthefractureresistancerevealastatisticallysignificantdifference(P<0.05)betweenGroupsIandIIwiththemeanfractureresistanceofGroupIbeinghigherthan
GroupII.Conclusion:Endodonticallyretreatedteethhaveshownsignificantlydecreasedresistancetofractureandthishasapositivecorrelationtotheincreasedlossofrootdentin
duringtheretreatmentprocedures

Howtocitethisarticle:
GaneshA,VenkateshbabuN,JohnA,DeenadhayalanG,KandaswamyD.Acomparativeassessmentoffractureresistanceofendodonticallytreatedandretreatedteeth:Aninvitro
study.JConservDent201417:6164

HowtocitethisURL:
GaneshA,VenkateshbabuN,JohnA,DeenadhayalanG,KandaswamyD.Acomparativeassessmentoffractureresistanceofendodonticallytreatedandretreatedteeth:Aninvitro
study.JConservDent[serialonline]2014[cited2015Jul19]17:6164
Availablefrom:http://www.jcd.org.in.scihub.org/text.asp?2014/17/1/61/124146

FullText
Introduction

SciHub

Ingeneral,endodonticallytreatedteethareconsideredtohaveincreasedsusceptibilitytofracturethanvitalteeth.[1]Thereasonsattributedtothisarethedehydrationandlossof
dentincausedduringtheendodontictherapyalongwiththepressureappliedduringobturationofthefillingmaterialasinlateralcompactiontechnique.[2]Thestructuraldurabilityof
thetoothfollowingendodontictherapyisdirectlyproportionaltotheremainingtoothstructurepresent.Aggressiveinstrumentationoftherootcanalleadstolossofdentinwhichmay
structurallyweakenthetooth.BenderandFreedlandhavesuggestedthat,thehighestincidenceofverticalrootfractureoccursinendodonticallytreatedteeth.[3]
Nonsurgicalretreatmenttechniquesarethepreferredchoiceoversurgicalmanagementtoreduceoreliminatethebacterialload,tocontaininfectionandalleviatesymptoms.The
goalofretreatmentistocompletelyremovethefillingmaterialtoenablethoroughdisinfectionoftheendodonticsystempriortorefilling.[4]Varioustechniqueshavebeenadvocated
toremoveobturatingmaterialsfromtherootcanalsystemduringretreatment.[5],[6],[7]TheProTaperUniversalRetreatmentsystemconsistsofthreeretreatmentfiles,D1,D2andD3,
whicharedesignedtobeusedinthecoronal,middleandapicalthirdoftherootcanalrespectively.ThetriangularcrosssectionoftheseinstrumentsissimilartotheProTapershaping
andfinishingfiles.TheuseofasolventhasbeenrecommendedtoaidinremovalofGuttaperchabysofteningit.[8]
Endodonticallytreatedteetharestructurallymoresusceptibletorootfractures.Propercoronalrestorationsfollowingendodontictherapyisessentialtorestorefunctionandesthetics.
Previousstudieshavesuggestedthatbondedcompositerestorationscanbeconsideredasthefirstchoiceforcoronalrestorationsastheyplayavitalroleinincreasingthefracture
resistanceofendodonticallytreatedteeth.[9]Furthermore,ithasbeenshownthatdirectandindirectcuspcoverageadhesiverestorationscansignificantlyincreasethefracture
resistanceofendodonticallytreatedteeth.[10]Tothebestofourknowledgenostudyhasbeencarriedouttoassessthefractureresistanceofteethfollowingendodonticretreatment.
Thus,thepurposeofthisinvitrostudywastoassessthefractureresistanceofteethafterendodonticretreatmentwithProTaperUniversalretreatmentsystemandmeasurethe
remainingdentinthicknesswithspiralcomputedtomography(SCT)andtocorrelatethelossofremainingdentinalthicknesswithsusceptibilitytofracture.

MaterialsandMethods

Specimenselection
Atotalof30extractedmandibularpremolarswithfullyformedapiceswereusedinthisstudy.Theteethweredecoronatedatthecementoenameljunctionstoobtainstandardroot
lengthsof14mmusingadiamonddisk(BrasslerDentalProducts,Savannah,Ga.).
Initialendodontictreatment
InGroupI,theworkinglengthwasestablishedbyplacingasize15Kfileintothecanaluntilitwasobservedattheapicalforamen,thendecreasingthefilelengthby1mm.Thecanals

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werepreparedusingProTaperUniversalNiTirotaryshapingandfinishinginstrumentsfollowingmanufacturer'sinstructionsinsequencefromSxtoF2toobtainafinalapicalsizeof
25with8%taperusingcrowndowntechnique.Alongwiththisinstrumentation,canalswereirrigatedbetweentheuseofeachsucceedingfile,byintroducing10mLof3%sodium
hypochlorite(PrimeDentalProducts,India),witha27gaugeneedle.Aftercompleteinstrumentation,allspecimensreceivedfinalirrigationwith10mLof17%
ethylenediaminetetraaceticacid(EDTA)(PrimeDentalProducts,India)followedby10mLofsodiumhypochloritetoremovethesmearlayer.Followingthis,10mLofsalinewasused
toremoveanyremainingsodiumhypochloriteresidue.Thecanalsweredriedwithsterilepaperpoints.Followingthemanufacturer'sinstructions,theAHplussealer(DentsplyDeTrey
GmbH,Konstanz,Germany)wasmixedandappliedwithintherootcanal.Asize25%,2%mastercone(DiaDentGroupInternational,Korea)wasplacedattheappropriateworking
lengthandapicaltuckbackwasconfirmed.Aspreaderwasusedtolaterallycompactthe2%guttaperchaaccessoryconescoatedwithAHplussealer.Excessguttaperchawas
shearedoffandcondensedwithaplugger1mmbelowthecanalopening.TheopeningofthecanalwassealedwithColtosol(ColteneWhaledent,CuyahogaFalls,OH)andtheteeth
werestoredat37Cin100%humidityfor2weeks.
Spiralcomputedtomographyanalysis
InGroupII,cleaningandshapingwasperformedinthesamemannerasforGroupIfollowingwhichtheteethweresubjectedtoSCT(Lightspeedpluscomputedtomographyscanner
[GEElectricals,Milwaukee,USA])toassesstheteethatdifferentsectionsofthecoronal,middleandapicalthirdsrespectively.Theremainingdentinthicknesswasthenmeasured
fromthecentralcanaltotheouterperipheryinbuccal,lingual,mesialanddistaldirections.Followingthis,theteethwereobturatedasstatedinGroupI.
Retreatmenttechnique
InGroupII,retreatmentwasperformedafter48hfollowingobturationtoallowforadequatetimeforthesealertosetwithProTaperUniversalNiTirotaryretreatment(Dentsply
Maillefer,Ballaigues,Switzerland)instruments,whichwereusedat300rpmand3N/cmtorque.EndosolvR(Septodent,Cedex,France)wasusedasthesolvent.Theretreatmentfiles
wereusedintherecommendedsequenceD1file(size30,0.09taper)forremovalofrootfillinginthecoronalthird,followedbyD2file(size25,0.08taper)forthemiddlethirdand
finally,theD3file(size20,0.07taper)wasusedatworkinglength.FinalshapingoftheapicalthirdwasperformedwithProTaperinstrumentsF2(size25,0.08taper)andF3(size30,
0.09taper).Aftercompleteinstrumentation,allspecimensreceivedfinalirrigationwith10mLof17%EDTAfollowedby10mLofsodiumhypochloritetoremovethesmearlayer.
Followingthis,10mLsofsalinewasusedtoremoveanyremainingsodiumhypochloriteresidue.Sterilepaperpointswereusedtodrythecanals.Aftercompletionofcleaningand
shapingprocedures,thespecimenswereagainassessedwithSCTfortheremainingdentinthicknessasmentionedearlier.
Lateralcompactionwasdoneusingasize30%,2%GuttaperchamasterpointcoatedwithAHplussealer.Followingthemanufacturer'sinstructions,thesealerwasmixedand
appliedwithintherootcanal.ThemasterconewasplacedattheappropriateworkinglengthandapicaltuckbackconfirmedandaspreaderwasusedtolaterallycompacttheGutta
perchaaccessoryconescoatedwithAHplussealer.Excessguttaperchawasshearedoffandcondensedwithaplugger1mmbelowthecanalopening.Theopeningofthecanal
wassealedwithColtosolFandtheteethwerestoredat37Cin100%humidityfor2weeks.
Mountingofspecimensformechanicaltesting
Alltheteethinbothgroupsweremountedonacustommadeacrylicblockssuchthat9mmoftherootsurfaceremainedexposedwhiletherestwasembeddedintheacrylicresin
(DigitalProductsInternationalproducts,India).ThismodelwasbasedonthesetupproposedbyApicellaetal.[11]Thetemporarymaterialwasremovedusingaburandtheroot
canalaccesswasshapedtoaccepttheloadingfixture.TheacrylicblocksweremountedwiththerootsalignedverticallyontheInstrontestingmachineoneatatime.Themodeof
applicationoftheverticalloadingforcerequiredtofracturetherootspecimenswassimilartothetechniqueproposedbySedgleyandMessertotestthebrittlenessofendodontically
treatedteeth.[12]Thespecimensweresubjectedtoaconstantloadatacrossheadspeedof1.0mm/minuntiltherootsfractured.Inthisstudy,"fracture"wasdefinedasthepointat
whichasharpandinstantaneousdropwasobserved.ThispointwasverifiedbyacomputerattachedtotheInstrontestingmachine(Model3382,Instron,UK).Formostspecimens,an
audiblecrackwasalsoheard.ThetestwasterminatedatthispointandtheforceappliedwasrecordedandmeasuredinNewtons.
Statisticalanalysis
StatisticalanalysiswasperformedusingindependentSamplesttestforanalysisofremainingdentinthicknessusingSCTwithinGroupIIandpairedSamplesttestwasusedfor
assessmentoffractureresistancebetweenGroupIandII(P<0.05).

Results

InGroupII,theintragroupcomparisonoftheremainingdentinthicknessinthecoronalthirdrevealsstatisticalsignificance,withasignificantdifferencenotedintheapicalthird[Table
1].{Table1}
Resultsofthefractureresistancerevealastatisticallysignificantdifference(P<0.05)betweenGroupsIandIIwiththemeanfractureresistanceofGroupIbeinghigherthanthatof
GroupII[Table2].{Table2}

Discussion

Theprognosisofanyendodontictherapyisdirectlycorrelatedtotheexecutionofitsdifferentphasesappropriately.Thepersistenceofbacterialcolonieswithintheintricaciesofthe
rootcanalsystemleadstorefractoryapicalperiodontitisinendodonticallytreatedteeth.[4]Thishasledtothechoiceofnonsurgicalmanagementbyretreatmentofpreviouslytreated
teethbyemployingtechniquesforremovalofobturatingmaterialfollowedbysufficientcleaningandreshapingprocedurestoprovideadequatedisinfectionbyappropriateirrigants.It
hasalreadybeenestablishedintheendodonticliteraturethattheincidenceofverticalrootfractureisgreaterinrootcanaltreatedteeth,whichoftenleadstoextraction.[13],[14]Hence
duringtheretreatmentprocedurescareshouldbeexercisedtopreventlossofdentinthatmayoccurfromexcessiveandaggressivereinstrumentationofrootthatcansubstantially
weakenthestructuralintegrityofthetoothmakingitmoresusceptibletofracture.[3],[15]SCTprovidesameansfornoninvasiveassessmentwithoutsampledestructionandalso
providesaprecise3Dreconstructionoftherootcanalsystem.[16]Inthepresentstudy,SCThasbeenusedtoassesstheremainingdentinthicknessafterinitialcleaningandshaping
andalsofollowingretreatmenttoevaluatethelossofrootdentinforthesamplesinGroupII.
ProTaperUniversalRetreatmentSystemhasbeencomprehensivelydesignedtoaidinremovalofexistingobturatingmaterialandtoassistincleaningandshapingtoprovidespace
forirrigationanddisinfectionandsubsequentfillingoftherootcanal.D1isusedforremovaloffillingmaterialthecoronalthirdsandD2andD3fromthemiddleandapicalthirds
respectively.TheconvexcrosssectionoftheD1instrumentalongwithitsactivetipfacilitatesitsinitialpenetrationintofillingmaterials.TheremovalofGuttaperchafromthecoronal
portionoftherootprovidesspacefortheintroductionofsolvents,whichaidsinfurtherinstrumentationprocedures.[17]Thissystemhasbeenattributedtoperformbetterduetotheir
progressivetaper,lengthofinstrumentspecificflutedesignandrotarymotion,whichtendtocutandpullGPintofileflutesanddirectittowardtheorifice.[18]Hence,ProTaper
UniversalRetreatmentSystemhasbeenusedinthisstudy.Variousstudiesassessingtheefficacyofinstrumentstoremovefillingmaterialsfromtherootcanalhavepostulatedthat
fillingresidueisminimizedwhentheenlargementinretreatmentwasbiggerthantheenlargementperformedbeforethecanalfilling.Inthepresentstudy,retreatmentprocedurewas
completedwiththeinstrumentusedforenlargement,increasedbyonlyonesize,beforeobturation.[8],[19],[20]
Theresultsofthepresentstudyrevealasignificantdifferencewithdecreasedfractureresistanceintheretreatmentgrouphavingameanvalueof280.6Nwhiletheinitialendodontic
treatmentgrouphadameanvalueof448.6N[Table2].Thisstatisticallysignificantdifference(P<0.05)inthefractureresistanceofthetwogroupscouldbepossiblyduetoa
substantialdifferenceintheremainingdentinthicknesspreandpostretreatmentinthecoronalandmiddlethirdoftherootcanal[Table1].ThiscouldbeattributedtotheuseofD1
andD2retreatmentfiles,whichhasbeenfoundtocutsuperficiallayerofdentinduringrootfillingremoval,whichalongwithsubsequentcleaningandshapingproceduresmayhave

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resultedinthesubstantiallossofrootdentin.[17]Earlierinvestigationshavereportedthatthefillingmaterialtracedinthecanalwouldbereducedwhentheenlargementinthe
retreatmentwasbiggerthantheenlargementperformedbeforethecanalfilling.[8],[19]Thepresentstudyfollowstheprotocoltoincreasetheapicalsizefollowingretreatmenttoone
sizelargerthantheinitialtreatmentgroup,whichmayhaveaccountedforthelossofrootdentinfromtheapicalthirds[Table1].TheSCTanalysisrevealsthelossofrootdentininthe
preandpostretreatmentsamplesinGroupII.Thislossofrootdentinduringthecourseofretreatmentproceduremayhavecontributedtothereducedfractureresistanceofthe
samplesinGroupII.

Conclusion

Withinthelimitationsofthisstudy,itcanbeconcludedthatendodonticallyretreatedteethhaveshownsignificantlydecreasedresistancetofractureandthishasapositivecorrelation
totheincreasedlossofrootdentinduringtheretreatmentproceduresashasbeenconfirmedbytheaidofSCT.

References
1
2
3
4
5
6
7
8
9

17
18

SornkulE,StannardJG.Strengthofrootsbeforeandafterendodontictreatmentandrestoration.JEndod199218:4403.
HelferAR,MelnickS,SchilderH.Determinationofthemoisturecontentofvitalandpulplessteeth.OralSurgOralMedOralPathol197234:66170.
BenderIB,FreedlandJB.Adultrootfracture.JAmDentAssoc1983107:4139.
FriedmanS,StabholzA,TamseA.EndodonticretreatmentCaseselectionandtechnique.3.Retreatmenttechniques.JEndod199016:5439.
MasieroAV,BarlettaFB.Effectivenessofdifferenttechniquesforremovingguttaperchaduringretreatment.IntEndodJ200538:27.
WilcoxLR.Endodonticretreatment:Ultrasonicsandchloroformasthefinalstepinreinstrumentation.JEndod198915:1258.
ViduciD,JukiS,KarloviZ,BoziZ,MiletiI,AniI.RemovalofguttaperchafromrootcanalsusinganNd:YAGlaser.IntEndodJ200336:6703.
TademirT,YildirimT,CelikD.Comparativestudyofremovalofcurrentendodonticfillings.JEndod200834:3269.
MongaP,SharmaV,KumarS.Comparisonoffractureresistanceofendodonticallytreatedteethusingdifferentcoronalrestorativematerials:Aninvitrostudy.JConserv
Dent200912:1549.
BassirMM,LabibzadehA,MollaverdiF.Theeffectofamountoflosttoothstructureandrestorativetechniqueonfractureresistanceofendodonticallytreatedpremolars.J
ConservDent201316:4137.
ApicellaMJ,LoushineRJ,WestLA,RunyanDA.Acomparisonofrootfractureresistanceusingtworootcanalsealers.IntEndodJ199932:37680.
SedgleyCM,MesserHH.Areendodonticallytreatedteethmorebrittle?JEndod199218:3325.
FussZ,LustigJ,KatzA,TamseA.Anevaluationofendodonticallytreatedverticalrootfracturedteeth:Impactofoperativeprocedures.JEndod200127:468.
LertchirakarnV,TimyamA,MesserHH.Effectsofrootcanalsealersonverticalrootfractureresistanceofendodonticallytreatedteeth.JEndod200228:2179.
SagsenB,ErO,KahramanY,AkdoganG.Resistancetofractureofrootsfilledwiththreedifferenttechniques.IntEndodJ200740:315.
GopikrishnaV,BhargaviN,KandaswamyD.EndodonticmanagementofamaxillaryfirstmolarwithasinglerootandasinglecanaldiagnosedwiththeaidofspiralCT:A
casereport.JEndod200632:68791.
GuLS,LingJQ,WeiX,HuangXY.EfficacyofProTaperUniversalrotaryretreatmentsystemforguttapercharemovalfromrootcanals.IntEndodJ200841:28895.
GluskinAH,PetersCI,WongRD,RuddleCJ.Retreatmentofnonhealingendodontictherapyandmanagementofmishaps.Ingle'sEndodontics.6th ed.Hamilton:BC

19
20

DeckerInc.2008.
HassanlooA,WatsonP,FinerY,FriedmanS.Retreatmentefficacyoftheepiphanysoftresinobturationsystem.IntEndodJ200740:63343.
TademirT,ErK,YildirimT,CelikD.EfficacyofthreerotaryNiTiinstrumentsinremovingguttaperchafromrootcanals.IntEndodJ200841:1916.

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