The Pushout Bond Strength of Three Calcium Silicate-based Materials in Furcal Perforation Repair and the Effect of a Novel Irrigation Solution: A Comparative In Vitro Study
Pamela Kassab, Claire El Hachem, Marc Habib, Walid Nehme, Carla Zogheib, Riccardo Tonini, Marc Krikor Kaloustian
Biodentine, Furcal perforation, Mineral trioxide aggregate, Pushout bond strength, Repair material, Sodium hypochlorite
Citation Information :
Kassab P, Hachem CE, Habib M, Nehme W, Zogheib C, Tonini R, Kaloustian MK. The Pushout Bond Strength of Three Calcium Silicate-based Materials in Furcal Perforation Repair and the Effect of a Novel Irrigation Solution: A Comparative In Vitro Study. J Contemp Dent Pract 2022; 23 (3):289-294.
Aim: To evaluate the pushout bond strength of three calcium silicate-based materials used as furcal perforation repair materials and the effect of root canal irrigants on the pushout strength of the tested repair materials.
Materials and methods: Furcal perforations measuring 1.3 mm in diameter were made in the center of the furcation area of 90 extracted human mandibular molars. The teeth were then randomly divided into three groups (n = 30) according to the repair material: Biodentine (Septodont, St-Maur-des-Fossés, France), PD-MTA White (Produits Dentaires, Vevey, Switzerland), and K-Biocer (REKITA, Lebanon). The specimens were stored at 100% humidity at 37°C for 72 hours. They were later divided into three subgroups (n = 10) based on the irrigation protocol: 2.5% sodium hypochlorite, BioAKT (Metabolic substrate, New Tech Solutions s.r.l., Brescia, Italy), and a control group. After incubation for 48 hours, the dislodgement resistance of the samples was measured using a universal testing machine.
Results: The mean bond strength was significantly different between repair materials in the irrigation control group (p-value <0.001). With PD-MTA White and K-Biocer, the mean bond strength was not significantly different between irrigation groups (p-value = 0.681). The mean bond strength of Biodentine was significantly different between irrigation groups (p-value = 0.002); it was the highest with BioAKT.
Conclusion: Biodentine showed a high performance as a perforation repair material and its resistance to dislocation increased after being exposed to BioAKT. K-Biocer had the lowest pushout bond strength. PD-MTA White showed intermediate bond strength and was not affected by the tested irrigants.
Clinical significance: The bond strength of endodontic materials to root dentin is an important factor to consider for long-term clinical success since the teeth are constantly subjected to masticatory forces.
Das A, Chandak MG, Manwar NU. Nonsurgical management of furcation perforation: a case report. Clin Dent 2013;7:33–36. ISSN: 0974-3979.
Tsesis I, Rosenberg E, Faivishevsky V, et al. Prevalence and associated periodontal status of teeth with root perforation: a retrospective study of 2,002 patients’ medical records. J Endod 2010;36(5):797–800. DOI: 10.1016/j.joen.2010.02.012.
Makhlouf M, Zogheib C, Makhlouf A, et al. Sealing ability of calcium silicate-based materials in the repair of furcal perforations: a laboratory comparative study. J Contemp Dent Pract 2020;21(10):1091–1097. DOI: 10.5005/jp-journals-10024-2953.
Aggarwal V, Singla M, Miglani S, et al. Comparative evaluation of push-out bond strength of ProRoot MTA, Biodentine, and MTA Plus in furcation perforation repair. J Conserv Dent 2013;16(5):462–465. DOI: 10.4103/0972-0707.117504.
Singla M, Verma KG, Goyal V, et al. Comparison of push-out bond strength of furcation perforation repair materials-glass ionomer cement type II, hydroxyapatite, mineral trioxide aggregate, and biodentine: an in vitro study. Contemp Clin Dent 2018;9(3):410–414. DOI: 10.4103/ccd.ccd_162_18.
Tsesis I, Fuss Z. Diagnosis and treatment of accidental root perforations. Endod Top 2006;13(1):95–107. https://doi.org/10.1111/j.1601-1546.2006.00213.x.
Main C, Mirzayan N, Shabahang S, et al. Repair of root perforations using mineral trioxide aggregate: a long-term study. J Endod 2004;30(2):80–83. DOI: 10.1097/00004770-200402000-00004.
Holland R, Filho JA, de Souza V, et al. Mineral trioxide aggregate repair of lateral root perforations. J Endod 2001;27(4):281–284. DOI: 10.1097/00004770-200104000-00011.
Ber BS, Hatton JF, Stewart GP. Chemical modification of ProRoot MTA to improve handling characteristics and decrease setting time. J Endod 2007;33(10):1231–1234. DOI: 10.1016/j.joen.2007.06.012.
Belobrov I, Parashos P. Treatment of tooth discoloration after the use of white mineral trioxide aggregate. J Endod 2011;37(7):1017–1020. DOI: 10.1016/j.joen.2011.04.003.
Islam I, Chng HK, Yap AU. Comparison of the physical and mechanical properties of MTA and Portland cement. J Endod 2006;32(3):193–197. DOI: 10.1016/j.joen.2005.10.043.
Laurent P, Camps J, De Méo M, et al. Induction of specific cell responses to a Ca(3)SiO(5)-based posterior restorative material. Dent Mater 2008;24(11):1486–1494. DOI: 10.1016/j.dental.2008.02.020.
Khalil I, Naaman A, Camilleri J. Properties of tricalcium silicate sealers. J Endod 2016;42(10):1529–1535. DOI: 10.1016/j.joen.2016.06.002.
Saghiri MA, Shokouhinejad N, Lotfi M, et al. Pushout bond strength of mineral trioxide aggregate in the presence of alkaline pH. J Endod 2010;36(11):1856–1859. DOI: 10.1016/j.joen.2010.08.022.
Guneser MB, Akbulut MB, Eldeniz AU. Effect of various endodontic irrigants on the push-out bond strength of biodentine and conventional root perforation repair materials. J Endod 2013;39(3):380–384. DOI: 10.1016/j.joen.2012.11.033.
Mohammadi Z, Giardino L, Palazzi F, et al. Effect of sodium hypochlorite on the substantivity of chlorhexidine. Int J Clin Dent 2013;6(2):173–178. ISSN: 1939-5833.
Ghasemi N, Reyhani MF, Salem Milani A, et al. Effect of calcium hydroxide on the push-out bond strength of endodontic biomaterials in simulated furcation perforations. Iran Endod J 2016;11(2):91–95. DOI: 10.7508/iej.2016.02.003.
Rahimi S, Ghasemi N, Shahi S, et al. Effect of blood contamination on the retention characteristics of two endodontic biomaterials in simulated furcation perforations. J Endod 2013;39(5):697–700. DOI: 10.1016/j.joen.2013.01.002.
Shahi S, Rahimi S, Yavari HR, et al. Effects of various mixing techniques on pushout bond strengths of white mineral trioxide aggregate. J Endod 2012; 38(4):501–504. DOI: 10.1016/j.joen.2012.01.001.
Huffman BP, Mai S, Pinna L, et al. Dislocation resistance of ProRoot Endo Sealer, a calcium silicate-based root canal sealer, from radicular dentine. Int Endod J 2009;42(1):34–46. DOI: 10.1111/j.1365-2591.2008.01490.x.
Pane ES, Palamara JE, Messer HH. Critical evaluation of the pushout test for root canal filling materials. J Endod 2013;39(5):669–673. DOI: 10.1016/j.joen.2012.12.032
Majeed A, AlShwaimi E. Push-out bond strength and surface microhardness of calcium silicate-based biomaterials: an in vitro study. Med Princ Pract 2017;26(2):139–145. DOI: 10.1159/000453455.
Dawood AE, Manton DJ, et al. Pushout bond strength of CPP-ACP-modified calcium silicate-based cements. Dent Mater J 2015;34(4):490–494. DOI: 10.4012/dmj.2015-017.
Sinkar RC, Patil SS, Jogad NP, et al. Comparison of sealing ability of ProRoot MTA, RetroMTA, and Biodentine as furcation repair materials: an ultraviolet spectrophotometric analysis. J Conserv Dent 2015;18(6):445–448. DOI: 10.4103/0972-0707.168803.
Elnaghy AM. Influence of acidic environment on properties of biodentine and white mineral trioxide aggregate: a comparative study. J Endod 2014;40(7):953–957. DOI: 10.1016/j.joen.2013.11.007.
Krupp C, Bargholz C, Brusehaber M, et al. Treatment outcome after repair of root perforations with mineral trioxide aggregate: a retrospective evaluation of 90 teeth. J Endod 2013;39(11):1364–1368. DOI: 10.1016/j.joen.2013.06.030.
Tonini R, Giovarruscio M, Gorni F, et al. In vitro evaluation of antibacterial properties and smear layer removal/sealer penetration of a novel silver-citrate root canal irrigant. Materials 2020;13(1):194. DOI: 10.3390/ma13010194.
Sidhu SK, Nicholson JW. A review of glass-ionomer cements for clinical dentistry. J Funct Biomater 2016;7(3):16. DOI: 10.3390/jfb7030016.
Liu W-N, Chang J, Zhu Y-Q, et al. Effect of tricalcium aluminate on the properties of tricalcium silicate-tricalcium aluminate mixtures: setting time, mechanical strength and biocompatibility. Int Endod J 2011;44(1):41–50. DOI: 10.1111/j.1365-2591.2010.01793.x.
Kogan P, He J, Glickman GN, et al. The effects of various additives on setting properties of MTA. J Endod 2006;32(6):569–572. DOI: 10.1016/j.joen.2005.08.006.
Loxley EC, Liewehr FR, Buxton TB, et al. The effect of various intracanal oxidizing agents on the pushout strength of various perforation repair materials. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95(4):490–494. DOI: 10.1067/moe.2003.32.
Hong S-T, Bae K-S, Baek S-H, et al. Effects of root canal irrigants on the pushout strength and hydration behavior of accelerated mineral trioxide aggregate in its early setting phase. J Endod 2010;36: 1995–1999. DOI: 10.1016/j.joen.2010.08.039.
Prasanthi P, Garlapati R, Nagesh B, et al. Effect of 17% ethylenediaminetetraacetic acid and 0.2% chitosan on pushout bond strength of biodentine and ProRoot mineral trioxide aggregate: an in vitro study. J Conserv Dent 2019;22(4):387–390. DOI: 10.4103/JCD.JCD_56_19.
Alsubait SA. Effect of sodium hypochlorite on pushout bond strength of four calcium silicate-based endodontic materials when used for repairing perforations on human dentin: an in vitro evaluation. J Contemp Dent Pract 2017;18(4):289–294. DOI: 10.5005/jp-journals-10024-2033.
Yan P, Peng B, Fan B, et al. The effects of sodium hypochlorite (5.25%), chlorhexidine (2%), and glyde file Prep on the bond strength of MTA-dentin. J Endod 2006;32(1):58–60. DOI: 10.1016/j.joen.2005.10.016.
Han L, Okiji T. Uptake of calcium and silicon released from calcium silicate-based endodontic materials into root canal dentine. Int Endod J 2011;44(12):1081–1087. DOI: 10.1111/j.1365-2591.2011.01924.x.