Citation Information :
Mattos NH, Perin CP, Roskamp L, Araújo CM, Gabardo MC, Westphalen VP, Fariniuk LF, Baratto–Filho F. Influence of Filling Material Remnants on the Diffusion of Hydroxyl Ions in Endodontically Retreated Teeth: An Ex Vivo Study. J Contemp Dent Pract 2022; 23 (8):768-774.
Aim: To assess the influence of remnants of filling material on hydroxyl ion diffusion from calcium hydroxide (CH) paste, measured by the pH value, in retreated teeth.
Materials and methods: A total of 120 single-rooted extracted teeth were prepared up to a size 35 hand file and filled. For retreatment, the specimens were divided into four groups (n = 20): ProTaper Universal Retreatment (PUR), PUR with additional instrumentation (PURA), Mtwo Retreatment (MTWR), and MTWR with additional instrumentation (MTWRA). Negative (NEG) and positive (POS) control groups were composed by 20 specimens each one. The specimens, except NEG, were filled with CH paste. The retreated groups were scanned using cone-beam computed tomography (CBCT) for analysis of filling remnants. The pH assessment was performed at the baseline, after seven, 21, 45, and 60 days of immersion in saline. Data were analyzed using Shapiro–Wilk and Levene’s test, followed by a two-way analysis of variance (ANOVA) and Tukey’s test.
Results: Additional instrumentation (PURA and MTWRA) were superior regarding removal of the filling material (p <0.05); however, without significant difference (p >0.05). The mean pH value in all groups increased (p <0.05). After 60 days, no statistical difference was observed among POS and PURA; and MTWR and MTWRA. There was less diffusion of hydroxyl ions when the amount of remnants was greater than 59%.
Conclusion: Additional instrumentation improved the ability to remove filling material in both systems. All groups presented increasing pH; however, the higher the amount of remnants, the lower the diffusion of hydroxyl ions.
Clinical significance: The amount of remnants allows less diffusion of calcium hydroxyl ions. Thus, additional instrumentation improves the ability to remove these materials.
European Society of Endodontology. Quality guidelines for endodontic treatment: Consensus report of the European Society of Endodontology. Int Endod J 2006;39(12):921–930. DOI: 10.1111/j.1365-2591.2006.01180.x.
Tabassum S, Khan FR. Failure of endodontic treatment: The usual suspects. Eur J Dent 2016;10(1):144–147. DOI: 10.4103/1305-7456.175682.
Filho FB, Ferreira EL, Fariniuk LF. Efficiency of the 0.04 taper ProFile during the re-treatment of gutta–percha-filled root canals. Int Endod J 2002;35(8):651–654. DOI: 10.1046/j.1365-2591.2002.00514.x.
Azevedo MAD, Silva TGD, Fernandes Â, et al. Endodontic retreatment using a single instrument from four nickel–titanium systems: A micro-CT study. Braz Dent J 2020;31(6):605–610. DOI: 10.1590/0103-6440202003463.
Filho FB, Zaitter S, Haragushiku GA, et al. Analysis of the internal anatomy of maxillary first molars by using different methods. J Endod 2009;35(3):337–342. DOI: 10.1016/j.joen.2008.11.022.
Virdee SS, Thomas MB. A practitioner’s guide to gutta–percha removal during endodontic retreatment. Br Dent J 2017;222(4):251–257. DOI: 10.1038/sj.bdj.2017.166.
Bhagavaldas MC, Diwan A, Kusumvalli S, et al. Efficacy of two rotary retreatment systems in removing gutta–percha and sealer during endodontic retreatment with or without solvent: A comparative in vitro study. J Conserv Dent 2017;20(1):12–26. DOI: 10.4103/0972-0707.209075.
Ali A, Saraf P, Kamatagi L, et al. Comparative assessment of canal transportation, dentin loss, and remaining root filling material by different retreatment files An in vitro cross-sectional study. Contemp Clin Dent 2021;12(1):14–20. DOI: 10.4103/ccd.ccd_31_20.
Dhaimy S, Kim HC, Bedida L, et al. Efficacy of reciprocating and rotary retreatment nickel–titanium file systems for removing filling materials with a complementary cleaning method in oval canals. Restor Dent Endod 2021;46(1):e13. DOI: 10.5395/rde.2021.46.e13.
Das S, De Ida A, Das S, et al. Comparative evaluation of three different rotary instrumentation systems for removal of gutta–percha from root canal during endodontic retreatment: An in vitro study. J Conserv Dent 2017;20(5):311–316. DOI: 10.4103/JCD.JCD_132_17.
da Silva BM, Baratto-Filho F, Leonardi DP, et al. Effectiveness of ProTaper, D-RaCe, and Mtwo retreatment files with and without supplementary instruments in the removal of root canal filling material. Int Endod J 2012;45(10):927–932. DOI: 10.1111/j.1365-2591.2012.02051.x.
Athanassiadis B, Abbott PV, Walsh LJ. The use of calcium hydroxide, antibiotics and biocides as antimicrobial medicaments in endodontics. Aust Dent J 2007;52(Suppl 1): S64–S82. DOI: 10.1111/j.1834-7819.2007.tb00527.x.
Tan JM, Parolia A, Pau AK. Intracanal placement of calcium hydroxide: A comparison of specially designed paste carrier technique with other techniques. BMC Oral Health 2013;13:52. DOI: 10.1186/1472-6831-13-52.
Mohammadi Z, Shalavi S, Yazdizadeh M. Antimicrobial activity of calcium hydroxide in endodontics: A review. Chonnam Med J 2012;48(3):133–140. DOI: 10.4068/cmj.2012.48.3.133.
de Souza–Filho FJ, Soares Ade J, Vianna ME, et al. Antimicrobial effect and pH of chlorhexidine gel and calcium hydroxide alone and associated with other materials. Braz Dent J 2008;19(1):28–33. DOI: 10.1590/s0103-64402008000100005.
Mori GG, Ferreira FC, Batista FR, et al. Evaluation of the diffusion capacity of calcium hydroxide pastes through the dentinal tubules. Braz Oral Res 2009;23(2):113–118. DOI: 10.1590/s1806-83242009000200004.
Misra P, Bains R, Loomba K, et al. Measurement of pH and calcium ions release from different calcium hydroxide pastes at different intervals of time: Atomic spectrophotometric analysis. J Oral Biol Craniofac Res 2017;7(1): 36–41. DOI: 10.1016/j.jobcr.2016.04.001.
Cai M, Abbott P, Salgado JC. Hydroxyl ion diffusion through radicular dentine when calcium hydroxide is used under different conditions. Materials (Basel) 2018;11(1):152. DOI: 10.3390/ma11010152.
Guerreiro–Tanomaru JM, Chula DG, de Pontes Lima RK, et al. Release and diffusion of hydroxyl ion from calcium hydroxide-based medicaments. Dent Traumatol 2012;28(4):320–323. DOI: 10.1111/j.1600-9657.2011.01112.x.
Zancan RF, Vivan RR, Lopes MRM, et al. Antimicrobial activity and physicochemical properties of calcium hydroxide pastes used as intracanal medication. J Endod 2016;42(12):1822–1828. DOI: 10.1016/j.joen.2016.08.017.
Nerwich A, Figdor D, Messer HH. pH changes in root dentin over a 4-week period following root canal dressing with calcium hydroxide. J Endod 1993;19(6):302–306. DOI: 10.1016/s0099-2399(06)80461-9.
Plataniotis E, Abbott P. A comparison of hydroxyl ion diffusion through root dentine from various calcium hydroxide preparations. Aust Endod J 2018. DOI: 10.1111/aej.12281. Online ahead of print.
Nagendrababu V, Murray PE, Ordinola–Zapata R, et al. PRILE 2021 guidelines for reporting laboratory studies in Endodontology: A consensus-based development. Int Endod J 2021;54(9):1482–1490. DOI: 10.1111/iej.13542.
Rossi–Fedele G, Ahmed HM. Assessment of root canal filling removal effectiveness using micro-computed tomography: A systematic review. J Endod 2017;43(4):520–526. DOI: 10.1016/j.joen.2016.12.008.
Mustafa M, Alaajam WH, Azeim AA, et al. Diffusion of calcium hydroxide through dentinal tubules of retreated root canals: An in vitro study. Eur J Dent 2018;12(3):386–392. DOI: 10.4103/ejd.ejd_77_18.
Kazemipoor M, Tabrizizadeh M, Dastani M, et al. The effect of retreatment procedure on the pH changes at the surface of root dentin using two different calcium hydroxide pastes. J Conserv Dent 2012;15(4):346–350. DOI: 10.4103/0972-0707.101899.
de Almeida Barbosa M, de Oliveira KV, Santos VRD, et al. Effect of vehicle and agitation methods on the penetration of calcium hydroxide paste in the dentinal tubules. J Endod 2020;46(7):980–986. DOI: 10.1016/j.joen.2020.03.026.
Grover C, Shetty N. Evaluation of calcium ion release and change in pH on combining calcium hydroxide with different vehicles. Contemp Clin Dent 2014;5(4):434–439. DOI: 10.4103/0976-237X.142803.
Chamberlain TM, Kirkpatrick TC, Rutledge RE. pH changes in external root surface cavities after calcium hydroxide is placed at 1, 3 and 5 mm short of the radiographic apex. Dent Traumatol 2009;25(5):470–474. DOI: 10.1111/j.1600-9657.2009.00806.x.
Heward S, Sedgley CM. Effects of intracanal mineral trioxide aggregate and calcium hydroxide during four weeks on pH changes in simulated root surface resorption defects: An in vitro study using matched pairs of human teeth. J Endod 2011;37(1):40–44. DOI: 10.1016/j.joen.2010.09.003.
Thaler A, Ebert J, Petschelt A, et al. Influence of tooth age and root section on root dentine dye penetration. Int Endod J 2008;41(12):1115–1122. DOI: 10.1111/j.1365-2591.2008.01486.x.
Foster KH, Kulild JC, Weller RN. Effect of smear layer removal on the diffusion of calcium hydroxide through radicular dentin. J Endod 1993;19(3):136–140. DOI: 10.1016/S0099-2399(06)80508-X.
dos Santos LG, Felippe WT, Teixeira CS, et al. Endodontic re-instrumentation enhances hydroxyl ion diffusion through radicular dentine. Int Endod J 2014;47(8):776–783. DOI: 10.1111/iej.12217.
Madani ZS, Simdar N, Moudi E, et al. CBCT evaluation of the root canal filling removal using D-RaCe, ProTaper retreatment kit and hand files in curved canals. Iran Endod J 2015;10(1):69–74. PMID: 25598814.
de Souza PF, Goncalves LCO, Marques AAF, et al. Root canal retreatment using reciprocating and continuous rotary nickel–titanium instruments. Eur J Dent 2015;9(2):234–239. DOI: 10.4103/1305-7456.156834.
Fariniuk LF, Westphalen VP, Silva–Neto UX, et al. Efficacy of five rotary systems versus manual instrumentation during endodontic retreatment. Braz Dent J 2011;22(4):294–298. DOI: 10.1590/s0103-64402011000400006.