Lokhande P. R, Balaguru S, Dayalan D. A Comparative Mircoleakage Assessment in Root Canals Obturated by Three Obturation Techniques using Fluid Filtration System. Biomed Pharmacol J 2019;12(2).

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Manuscript received on :02-Nov-2018
Manuscript accepted on :11-April-2019
Published online on: 15-05-2019

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Plagiarism Check: Yes
Reviewed by: Mahdi Alfarawn
Second Review by: Vasudev Ballal

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Pravin R. Lokhande*¹, S Balaguru² and Deena Dayalan²  

¹Scholar, Mechanical Department, Vel Tech Rangarajan Dr. Sagunthala R and D  Institute of  Science and Technology, Chennai 600 062, India.

²Mechanical Department, Vel Tech Rangarajan Dr. Sagunthala R and D  Institute of Science and Technology, Chennai 600 062, India.

Corresponding Author E-mail: pravinrlokhande@gmail.com

DOI : https://dx.doi.org/10.13005/bpj/1709

Abstract

The aim of this study was to assess the micro leakage in three root canal obturation techniques viz. Warm vertical condensation, Cold lateral condensation and Thermafil using fluid filtration system. In this study the fluid filtration method is fabricated and used to assess the micro leakage in gutta-percha material obturated using three obturation techniques viz. Warm vertical condensation, Cold lateral condensation and Thermafil. The assessment system which can quantify the micro leakage present into the obturated root canal cavity is today's vital need to improve the further progress in endodontics and conservative dentistry. 45 No's of samples were taken for study and categorized into three, Category I: 15 No's of samples obturated using warm vertical condensation, Category II: 15 No's of samples obturated using cold lateral condensation and Category III: 15 No's of samples obturated using Thermafil. All obturated samples were tested using the fluid filtration system. The DSLR 1200D Canon and Auto CAD by Auto Desk were used to record the bubble displacement in the micropipette. The micro leakage reading are shown in Table 2  and tabulated values showed that Category II:  15 No's of samples obturated using cold lateral condensation, showed highest micro leakage value highest micro leakage followed by Category III: 15 No's of samples obturated using Thermafil and Category I: 15 No's of samples obturated using warm vertical condensation. Category III shown moderate leakage value. The study indicated that micro leakage evaluation using the fabricated fluid filtration system is most reliable quantitative method. On the basis of comparison of micro leakage assessment of three obturation techniques it is found that warm vertical condensed sample having least leakage over the Thermafil and Cold lateral condensation. The reason for micro leakage is shrinkage of gutta-percha during solidification to cause gap in between obturation material and canal wall which can be avoided by providing shrinkage allowance.

Keywords

Micro Leakage Evaluation Techniques in Endodontics; Obturation Techniques; Root Canal Obturation; Sealing Ability

Introduction

The root canal obturation is done to save the partially damaged teeth of human jawbone. The substrate from the infected canal is removed and followed by shaping of the canal to develop logical cavity. Further, the developed canal is filled with the bio-compatible filling materials. The procedure of removing the substrate from infected teeth and filling with bio-material is called as root canal obturation. Thus obturation helps in creating fluid tight seal at canal wall and filling material to avoid the percolation of the oral fluids.¹

Mircoleakage is defined as percolation of debris, oral fluids, micro-organisms or ions through the interface gap between restorative (filling material) and the wall of the tooth.² The various clinical studies mentioned the micro leakage is the vital cause for failure of the root canal treatment.³ However, the aim of any root canal treatment is complete filling of the cavity in three dimensions.⁴ There are various parameters which are responsible for creating the leakages in the obturated canal  using any obturation technique. As far as our concern and considering the outline of this investigation the shrinkage of the gutta-percha during solidification is major reason. For this reason there is need to fabricate the test rig which can quantify the micro leakage in the obturated root canal.

The various quality assessment techniques had been developed viz. dye penetration test, scanning electron microscope, micro computed tomography, cone beam computed tomography, radiography, bacterial micro leakage, computational fluid dynamics etc. The dye penetration test is less costly to perform but the results and conclusion of the test found challengeable. Scanning electron microscope is best non-destructive technique but results are limited to surface information.⁵ The micro computed tomography gives the three dimensional visualization and is qualitative technique.⁶ Radiographic information is limited to the white lines.⁷ The fluid filtration and bacterial micro leakage gives the quantification of the micro leakage. Computational fluid dynamics is a numerical tool which helps in solving the fluid dynamics equations by suitable method which can capture the essential physics of fluids.

This study fabricated the fluid filtration system to measure the micro leakage in obturated root canal using Warm vertical condensation, Cold lateral condensation and Thermafil. The fabricated fluid filtration system consist of oxygen cylinder, pressurized buffer system, micro pipette, three way control faucet, syringe and tooth test samples as constructional components. The measurement system consist of DSLR camera and Auto CAD software to record the micro leakage.

Literature Review and Consultation with Endodontic Experts

Literature Review

The gutta-percha is commonly used obturation material along with the sealer to create the fluid tight seal in root canal cavity. Amir moinzadeh et al.⁸ used lateral compaction of gutta-percha technique coupled with calcium silicate sealer. However he reported the voids and poor root fillings of cavity. The void %  calculation was based on 3D data with 10 micro meter voxel size. Daniele angerame et al.⁹ used the micro computed tomography study and void percentage and root filling related to entire canal volume was calculated. He assessed the quality of canal filling based on single point technique and continuous wave of condensation technique. Edith siu shan et al.¹⁰ conducted the density based assessment to compare the quality of root canal fillings obturated with three different techniques viz. cold lateral compaction,  ultrasonic lateral compaction and warm vertical compaction techniques. Warm  vertical compaction and ultrasonic lateral compaction gave denser filling than cold lateral compaction technique. Mothanna K. et al.¹¹ studied  quality of 259 gutta-percha filling samples of various locations using dental X-ray unit. On basis of radiographic evaluation they compared the performance of the undergraduate students at Taibah University KSA. Ugur inan et al.¹² compared three obturation techniques using electrochemical evaluation and linear dye penetration evaluation techniques. Apical sealing ability of System B, Thermafil and cold lateral condensation were compared. It was found that highest leakage reported by cold lateral condensed sample and lowest leakage reported by Thermafil and in between for System B. Saeed moradi et al.¹³ conducted study to compare there is no significant difference between Bacterial leakage and fluid filtration techniques. But bacterial leakage  technique should be replaced with fluid filtration technique since bacterial leakage technique requires more time, procedure is more complex and requires skilled micro-biologist.

Christos boutsioukis et al. conducted computational fluid dynamics analysis to evaluate the effect of needle tip on the irrigant flow inside the canal in final stage of preparation.¹³ Computational fluid dynamics proved to be powerful tool for investigation of the fluid flow behavior with its best mathematical modeling and simulation features.^14,15 It helps to simulate the various parameters with actual experimental conditions which are difficulty to perform. In some studies computational fluid dynamic model used to assess the irrigant flow behavior in root canal during preparation.¹⁶ While in some cases the same is validated using experimentation by using high speed imaging data tracking.¹⁷

Consultation with Expert of Endodontic and Conservative Dentistry

We had hours of discussion with ample of experts who are working in the Endodontic field more than decade. The purpose of consultation was to receive the various problems in the obturated root canal related to micro-leakage. We had received the consultation report summary and accordingly formulated our problems statement, scope to be worked upon etc.

Table 1: Consultation with Dentist of endodontics report summary.

The Dentists which are selected for carrying the consultation are relying on the various qualitative techniques viz. µ-CT, Cone Beam Computed tomography, CT Scans, Scanning electron microscope, Radiography etc. for assessmen