|Year : 2014 | Volume
| Issue : 1 | Page : 27-31
Comparison of the sealing ability of different glass ionomer cements as root-end filling materials
Fuat Ahmetoglu1, K. Meltem Çolak Topçu2, Hasan Oruçoglu3
1 Department of Endodontics, Faculty of Dentistry, Institute of Health Sciences, Inonu University, Malatya, Turkey
2 Department of Endodontics, Atatürk University, Erzurum, Turkey
3 Department of Endodontics, Abant Izzet Baysal University, Bolu, Turkey
|Date of Web Publication||20-Mar-2014|
Department of Endodontics, Faculty of Dentistry, Institute of Health Sciences, Inonu University, 44280, Malatya
Source of Support: None, Conflict of Interest: None
Objectives: The purpose of this study was to compare the sealing ability of different glass ionomer cements (GIC) as root-end filling (RF) materials. Materials and Methods: One-hundred and eleven extracted human canines were cleaned and prepared using a rotary nickel titanium files with crown-down technique. All the teeth were filled with gutta-percha and then the apical third of each root was resected perpendicularly to the long axis direction. After, root-end cavity was prepared using a round bur. The specimens were randomly divided into 7 groups of 15 samples, filled with one of the test materials (Ionofil, Ketac Molar Quick Aplicap, Argion Molar AC, Photac Fil Quick Aplicap, Fuji II LC Capsule, Dyract Extra, Glasiosite Caps) and were stored at 37°C and 100% humidity for 7 days. 1-week later, apical parts of roots of 10 ± 0.05 mm were attached to the computerized fluid filtration device. The data obtained were analyzed using an ANOVA and post hoc Tukey's tests (P ≤ 0.05). Results: Statistical analysis indicated that RF with Argion molar AC (reinforced GIC) had the least micro-leakage of all and whereas Ketac Molar Quick Aplicap (conventional GIC) showed highest apical leakage than the other groups. Conclusion: This present study has shown that none of GICs, which used as a RF material unable to prevent apical leakage exactly and Argion Molar AC is used as a RF material among current GICs better than others.
Keywords: Computerized fluid filtration meter, glass ionomer cements, microleakage, root-end filling
|How to cite this article:|
Ahmetoglu F, Topçu KÇ, Oruçoglu H. Comparison of the sealing ability of different glass ionomer cements as root-end filling materials. J Res Dent 2014;2:27-31
|How to cite this URL:|
Ahmetoglu F, Topçu KÇ, Oruçoglu H. Comparison of the sealing ability of different glass ionomer cements as root-end filling materials. J Res Dent [serial online] 2014 [cited 2019 Apr 19];2:27-31. Available from: http://www.jresdent.org/text.asp?2014/2/1/27/129014
| Introduction|| |
Most of the endodontic failures occur as a result of the leakage of irritants from pathologically involved root canals. When non-surgical attempts prove unsuccessful or are contraindicated, endodontic surgery is needed to save the root. , Surgical procedures usually consist on exposure of the involved apex, periradicular curettage, root resection, preparation of root-end and placement of a filling. , The aim of the root-end filling (RF) is to provide a hermetic sealing in an apical region. Success of the surgery has been affected significantly by properties of used materials and sealing ability.  An ideal RF material should adhere and adapt to the dentin walls of the root end preparation, should prevent leakage of microorganisms and their by-products into the periradicular tissues and should be biocompatible. On the other hand, it should also be insoluble in tissue fluids, dimensionally stable and unsusceptible to the presence of moisture.  However, no material has been found, which has all or most of the ideal properties of a RF material.
Many RF materials have been used from past to present. While some of these materials are still in use, the use of some has been abandoned. As a result of the review of literature, it has been found limited studies that have comprehensive investigation about still in used glass ionomer cements (GICs) as a RF material for apical sealing and also there has not been such a study with the computerized fluid filtration technique, yet. For this reason, this study is important and aims to shed light on the clinician in root-end sealing which planned with GICs.
In development process, GICs were produced firstly as conventional GIC (C-GIC) and then the addition of metals to the filler component in order to reinforced GIC (R-GIC) has been proposed. As a result of this addition, it has been more radiopaque material to obtained facilitates post-treatment controls. , The negativity of C-GIC is sensitivity of moisture especially in the hardening time. This limitation has been addressed through the introduction of hybrid GICs (HGIC) as the resin-modified GIC (RM-GIC) and polyacid-modified composite resins (PM-CR). These materials, through both sets of polymerization and polyacid/base reactions, can be finished immediately and have a better appearance than C-GIC.  There are some advantages of frequently used GIC for many years. As regards to biocompatibility, these materials exhibit a very low cytotoxicity and they do not induce inflammatory tissue responses; they also present good sealing properties because of their ability to form a chemical bond with dentine.  Bonding chemically to dentin reduces the sealing significantly. These cements generate no heat while setting, they will not cause thermal damage to tissues and will not affect heat-labile drugs incorporated in the matrix phase of the cement.  As RF GICs have a better performance in sealing the apical portion, even when the root canal was left unfilled. 
A method of measuring microleakage by fluid filtration method  reported to have some advantages compared to other methods. Samples are not destroyed and it is possible to obtain measurements of microleakage at intervals over extended time periods. In addition, computerized, fully electronic, reliable and digital air pressure checking system is required to remove these deficiencies. 
The purpose of this study was to evaluate apical leakage of different GICs (Ionofil, Ketac Molar Quick Aplicap, Argion Molar AC, Photac Fil Quick Aplicap, Fuji II LC Capsule, Dyract Extra, Glasiosite Caps) comparatively as RF materials using a computerized fluid filtration meter with a laser system and a digital air pressure regulator.
| Materials and Methods|| |
One hundred eleven freshly extracted human non-carious maxillary and mandibular canines were used in this study. These teeth were extracted for various reasons and none had received endodontic therapy before extraction. To standardize these samples, all the selected teeth were 23-25 mm in length. All teeth were stored in 0.5% of chloramine T immediately after extraction. All the soft-tissues and calculus were removed mechanically from the teeth. Crowns of teeth were sectioned at the cemento-enamel junction using a low speed diamond saw. The working length was established 1 mm short of the point at which the file exited the apical foramen. The root canals were prepared by using a rotary nickel titanium files (Hero 642; Migro-Mega, Besancon, France) and a crown-down technique. The instrumented canals were dried with paper points and filled with laterally compacted gutta-percha (Aceonedent Korea Ind. Co., Bucheon-si, South Korea). The cervical access was sealed with a temporary filling (Cavit; ESPE, Seefeld, Germany).
Apical root resections were then performed by removing 3 mm of the apex, at a 90-degree angle to the long axis of the root. Afterward root end preparations (3 mm deep) were created using round bur #2. After that, 105 teeth were randomly divided into seven experimental groups of 15 teeth each according to the RF material to be used: Group 1, Ionofil; Group 2, Ketac Molar Quick Aplicap; Group 3, Argion Molar AC; Group 4, Photac Fil Quick Aplicap; Group 5, Fuji Ii LC Capsule; Group 6, Dyract Extra; Group 7, Glasiosite Caps [Table 1].
|Table 1: Glass ionomer cements, tips and manufacturers used in this study|
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RF materials were prepared according to the manufacturer's instructions and placed into the root-end cavities. An additional of 6 teeth was used for control (3 for positive and 3 for negative controls). Positive controls were left unfilled. But negative controls were filled any material and were totally coated with two layers of nail vanish, including the RF surface. All the other root surfaces in experimental groups and positive controls were coated with a two layer of nail varnish, avoiding the apical surface of the RF.
For leakage study, apical roots of 10.00 ± 0.05 mm were sectioned using low speed diamond saw. Root sections were inserted into the plastic tube from the apical side and connected to 18-gauge stainless steel tube. The cyanoacrylate adhesive (Zapit, Dental Venture of America Inc., Anaheim Hills, CA, USA) was applied circumferentially between the root and plastic tube. A new computerized fluid filtration meter with a laser system  used in this study have had a 25-μl micropipette (Microcaps, Fisher Scientific, Philadelphia, PA, USA) mounted in horizontally. O 2 from a pressure tank of 120 kPa (1.2 atm) was applied at the apical side. The pressure was constant throughout the experiment by means of a digital air pressure regulator added to pressure tank. A 25-μl micropipette (microcaps) connected to the pressure reservoir by polyethylene tubing (microcaps). All pipettes, syringes and the plastic tubes at the apical side of the sample were filled with distilled water. Water was sucked back with the micro syringe for approximately 2 mm. In this way, an air bubble created in the micropipette and the air bubble was adjusted to a suitable position in the syringe. The new computerized fluid filtration meter was based on basically light refraction at starting and ending position of air bubble movement inside micropipette. Through one side of the micropipette inside the device, an infrared light was passed. Two light sensitive photodiode was arranged on the opposite side of the micropipette to detect any movement of an air bubble inside micropipette. All operations were controlled with PC-compatible software (Fluid Filtration'03, Konya, Turkey). A 5-min pressurization preload of the system was completed before taking readings. Measurements of fluid movement were automatically made at 2 min during 8 min for each sample by using PC-compatible software (fluid filtration'03). The software converts minute linear movement of the bubble into nano liter movement at a rate of one measurement. This information is fed into PC-compatible software. Leakage quantity was expressed as μl/cm H 2 O/min and means determined.
The one-way ANOVA and post hoc Tukey's honestly significant difference tests were used to determine whether differences were significant at the 95% of confidence level (P < 0.05).
| Results|| |
In this study, all the root-end materials showed different levels apical leakage. Mean microleakage measurements and standard errors are shown in [Table 2] for all materials. While Argion Molar AC showed the lowest leakage, Ketac molar quick aplicap showed the maximum leakage. The positive controls demonstrated extreme amounts of apical leakage. The negative controls registered no detectable bubble movement at 1.2 atm., for a minimum of 5 min before each collected data began. No difference was found among the groups including Argion Molar AC, Photac Fil Quick Aplicap, Dyract Extra and Ionofil that showed the lowest leakage (P > 0.05). On the other hand, no statistically significant difference was found between Glasiosite Caps and Ketac Molar Quick Aplicap that showed the highest leakage (P > 0.05).
| Discussion|| |
The choice of materials to be used in periapical surgery and amount of root-end cutting angles is an important issue in terms of apical leakage. For this reason, the microleakage, which occurring after the apical resection by using various cements and the techniques tried to reduced or even eliminate completely. Although different cements have also been used, any material or method to prevent microleakage completely has not been found yet. Therefore, several studies have still remained to prevent the apical microleakage.
Conventional setting and formulations of HGICs have been used as RF materials.  GICs were investigated comparatively with different materials as RF material in many studies. ,,,,, In all this and similar studies, a type of GICs was compared with other different types RF materials. By considering the results of such assessments to say that more effective for leakage of which type of GIC may be misleading. Therefore in this study, only different types of GICs were compared with each other and tried to determine the ideal GIC, which has the value of leakage at least when it used as a RF material.
The evaluation method is as much crucial as the evaluated material. Many methods have been used to assess the leakage of RF materials. Dye, bacterial and radioisotope analysis of the penetration and the electrochemical method are among the most frequently used methods. ,,, However, most of these methods affect the tested examples, unable to give the quantitative results and cause conflict in the interpretation. In addition to this, a variety of assessment methods and differences in the parameters of evaluation also make it difficult to establish the relationship between the studies. Pommel et al.  showed that apical leakage has been tested with three different methods on the same tooth in their study and the used method have a strong impact on the results.
Wu et al. suggested the use of liquid filtration system to increase the reliability of endodontic leakage studies. When liquid filtration method compared to other methods, it has some advantages such as to obtain quantitative volumetric data, to measure in less time, prevent damage to the samples and to conduct repeatable measurements on the same sample at given time intervals. , Furthermore, the molecule size that makes up the problem of standardization depending upon the materials such as dye, bacteria or radioactive isotope, the dentin affinity or the problems associated with pH are not the problem in this method. ,,, In addition, Oruçoğlu et al. have modified the fluid filtration system and developed it that evaluates with a completely electronic system, detects movement of fluid with a laser and the results are evaluated with a computer program. In present study, due to the all features of the technique, computerized fluid filtration technique was considered to be used because it is known to have more advantages than other methods.
In this study, Argion Molar AC, which is a R-GIC showed the lowest leakage as a numeric value. R-GIC was obtained by high-temperature sintering of silver into the glass ionomer to improve the properties of C-GIC.  More spherical particles in comparison with C-GIC have been obtained as a result of this reaction It is also the setting time of R-GIC is shorter that makes moisture contamination less likely in a surgical environment.  Bühler  found that long-term performance of R-GIC is successful. Vasudev  emphasis to the same conclusion that they reported less leakage for R-GIC and suggested to use it as a RF material. The results which obtained by metal-reinforced GIC confirm the data's in our study. However, King et al. expressed that Ketac silver which is a R-GIC shows more leakage in proportion to Amalgam and Super EBA. We believe that the reason for these different results may originate from the structural differences of Argion Molar AC and Ketac Silver and used measurement method. Ionofil, which is a C-GIC showed that the second the lowest leakage, it links to dentin, but during the hardening time; disruption of its integrity of the result of moisture contamination creates the biggest disadvantage. The leakage is more than R-GIC may be connected with the disadvantages. In addition, the metal alloys that have been added to Argion Molar AC may be caused a decrease of the leakage by increasing the filling rate of GIC. However, the difference in this study is not significant statistically. In fact, Roth  indicated that C-GIC could be used as an alternative RF material.
In another present study have founded no statistically significant difference among Argion Molar AC, Photac Fil Quick Aplicap (RM-GIC) and Dyract Extra (PM-CR). Chong et al. compared the leakage rate HGIC, C-GIC and Amalgam and they determined that the leakage rate of HGIC and C-GIC is equal and more successful. This result is parallel to our study.
Sealing value of Dyract extra (a PM-CR) was found to be similar to RM-GIC. Toledano et al. compared RM-GIC and PM-CRs in terms of sealing and ultimately they did not find a statistically significant difference between the two groups. Similarly, Brackett et al. reported that the same result. In our study, we demonstrated that no difference too in terms of sealing between the groups; Dyract Extra (a PM-CR), Photac Fil Quick Aplicap (a RM-GIC) and Fuji II LC (a RM-GIC). However, Glasiosite Caps (another PM-CR) showed more leakage than Dyract Extra. Showing different values of these materials which the same kind materials may be depend upon their chemical content.
Ketac Molar Quick Aplicap (a C-GIC) showed the maximum leakage between the groups. Rossi et al. identified that Ketac Molar shows more leakage. In another study  was indicated that the material shows more leakage than RM-GIC, it is similar to our results.
Through the details of their composition vary, RM-GICs are generally able to form strong bonds to both enamel and dentin.  This is a positive impact on sealing. Rosales et al. detected that HGIC creates less leakage than C-GIC. In this study, Photac Fil Quick Aplicap (a HGIC) and Dyract Extra (a HGIC) provide more successful sealing than Ketac Molar Quick Aplicap, but they show no statistically significant difference with Ionofil. It is thought that the result is due to different chemical content of Ionofil than Ketac Molar Quick Aplicap.
In the present study, while Argion Molar AC, Photac Fil Quick Aplicap, Dyract Extra and Ionofil showed the lowest leakage respectively, Ketac Molar Quick Aplicap, Glasiosite Caps and Fuji II LC showed the maximum leakage regardless of the groups. It was found out that the difference resulted from structures of the materials, which were independent of the groups. It is reported that the difference may have resulted from the structural changes such as sensitivity characteristics of the materials to moisture on the surface of dentin, material viscosities, dust particle sizes and the differences in the dust-liquid ratio. 
| Conclusions|| |
It was concluded that none of GIC, which is used as RF material unable to prevent the apical leakage exactly. Furthermore, it was found that while Argion Molar AC, which is a R-GIC showed the lowest leakage, Ketac Molar Quick Aplicap, which is a C-GIC showed the maximum leakage in this study.
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[Table 1], [Table 2]