Clinical results with two different methods of root-end preparation and filling in apical surgery: mineral trioxide aggregate and adhesive resin composite. Evaluation of Marginal Adaptation of Root-End Filling Materials Using Scanning Electron Microscopy Sealing ability of a mineral trioxide aggregate when used as a root end filling material. Periradicular regeneration after endodontic surgery with calcium-enriched mixture cement in dogs. Periradicular Surgery of Human Permanent Teeth with Calcium-Enriched Mixture Cement Relationship of periapical lesion radiologic size, apical resection, and retrograde filling with the prognosis of periapical surgery. A comparative sealability study of different retrofilling materials. An ex-vivo comparative study of root-end marginal adaptation using grey mineral trioxide aggregate, white mineral trioxide aggregate, and Portland cement under scanning electron microscopy Resistance to Fracture of Dental Roots Obturated with Different Materials Periapical surgery using ultrasonic preparation and thermoplasticized gutta-percha with AH Plus sealer or IRM as retrograde root-end fillings in 160 consecutive teeth: a prospective randomized clinical study. Sealer penetration and marginal permeability after apicoectomy varying retrocavity preparation and retrofilling material. Clinical management of nonhealing periradicular pathosis. Surgery versus endodontic retreatment. 5-year results comparing mineral trioxide aggregate and adhesive resin composite for root-end sealing in apical surgery. Sealing ability of ProRoot MTA and MTA-Angelus simulating a one-step apical barrier technique--an in vitro study. One visit apicectomy technique using calcium hydroxide cement as the canal filling material combined with retrograde amalgam. The effect of smear layer on microbial coronal leakage of gutta-percha root fillings.
INTRODUCTION The aim of apical surgery is to hermetically seal the root canal system after root-end resection , thereby enabling periradicular healing . The objective of this nonr and omized prospect i ve clinical study was to report results of 2 different root-end preparation and filling methods , ie , mineral trioxide aggregate ( MTA ) and an adhesive resin composite ( Retroplast ) . METHODS The study included 353 consecutive cases with endodontic lesions limited to the periapical area . Root-end cavities were prepared with sonic microtips and filled with MTA ( n = 178 ) , or alternatively , a shallow concavity was prepared in the cut root face , with subsequent placement of an adhesive resin composite ( Retroplast ) ( n = 175 ) . Patients were recalled after 1 year . Cases were defined as healed when no clinical signs or symptoms were present and radiographs demonstrated complete or incomplete ( scar tissue ) healing of previous radiolucencies . RESULTS The overall rate of healed cases was 85.5 % . MTA-treated teeth demonstrated a significantly ( P = .003 ) higher rate of healed cases ( 91.3 % ) compared with Retroplast-treated teeth ( 79.5 % ) . Within the MTA group , 89.5%-100 % of cases were classified as healed , depending on the type of treated tooth . In contrast , more variable rates ranging from 66.7%-100 % were found in the Retroplast group . In particular , m and ibular premolars and molars demonstrated considerably lower rates of healed cases when treated with Retroplast . CONCLUSIONS MTA can be recommended for root-end filling in apical surgery , irrespective of the type of treated tooth . Retroplast should be used with caution for root-end sealing in apical surgery of m and ibular premolars and molars Introduction The importance of perfect apical seal in endodontics , more specifically in periradicular surgery , is the motivation/reason for development of root-end filling material s with favorable physical , chemical and biological characteristics . The aim of this in vitro study was to evaluate the marginal adaptation of root-end filling material s using scanning electron microscopy . Material s and Methods Twenty five human maxillary anterior teeth were prepared using a K-File # 50 to 1 mm short of the apical foramen and filled with gutta-percha and Sealapex using the lateral compaction technique . The apical 3 mm of the roots were sectioned perpendicularly to the long axis of the teeth . A 3-mm-deep root-end cavity was prepared using ultrasonic tips powered by an Enac ultrasonic unit . The teeth were r and omly assigned to five groups according to the material s tested including IRM , amalgam , ProRoot MTA , Super-EBA and Epiphany/Resilon . Root-end cavities were filled with the material s prepared according to the manufacturers ’ instructions . The root apices were carefully prepared for sputter coating and later evaluation using Scanning Electron Microscope ( SEM ) . The images of root-end fillings were divided into four quadrants and distributed into five categories according to the level of marginal adaptation between the root-end material and the root canal walls . The Fisher exact test with Bonferroni correction was used for statistical analysis . The level of significance was set at P = 0.005 . Results SEM images showed the presence of gaps in the root-end filling material s. No significant difference was observed between the tested material s ( P > 0.005 ) . Conclusion ProRoot MTA , IRM , amalgam , Super-EBA and Epiphany/Resilon showed similar marginal adaptation as root-end filling material This in vitro study used rhodamine B fluorescent dye and a confocal microscope to evaluate the sealing ability of amalgam , super EBA , and a mineral trioxide aggregate when used as root end filling material s. Thirty single-canal teeth were cleaned , shaped , and obturated with gutta-percha and root canal sealer . After application of nail polish to the external surface , the apical 3 mm of each root was resected and 3-mm deep root end preparations were made . The roots were r and omly divided into three groups and the root end preparations filled with the experimental material s. All roots were then exposed to an aqueous solution of rhodamine B fluorescent dye for 24 h , longitudinally sectioned , and the extent of dye penetration measured using a confocal microscope . Statistical analysis showed that the mineral trioxide aggregate leaked significantly less than amalgam and super EBA INTRODUCTION The aim of this in vivo study was to compare the response of periradicular tissues to mineral trioxide aggregate ( MTA ) and calcium-enriched mixture ( CEM ) cement as root-end fillings and to analyze hard tissue healing after periradicular surgery . METHODS Intentional periradicular lesions were induced in 32 premolar teeth in 4 beagle dogs . The root canals were prepared , dried , and obturated with laterally condensed gutta-percha with sealer , and the coronal access cavities were filled with amalgam . After surgical exposure of the apices , 2 - 3 mm of the apical root was resected , and root-end cavities were ultrasonically prepared . The root-end cavities were r and omly filled with MTA or CEM cement . After 2 months , the animals were killed ; tissue blocks were removed and prepared for histologic examination . Hard tissue healing including cementum and new bone formation in addition to concentration and extent of inflammation were evaluated . RESULTS Eight sample s were excluded . The major finding was the cementum deposition adjacent to MTA in 11 of 12 sample s and CEM cement in 10 of 12 sample s. With one-way analysis of variance , no significant difference was observed between the periradicular tissue response to tested material s. CONCLUSIONS CEM cement and MTA were associated with regenerative periapical tissue response when used as root-end filling bio material Introduction Root-end preparation and restoration with an endodontic material are required when nonsurgical endodontic retreatment has failed or is impossible . The present clinical study reports the treatment outcomes of periradicular surgery using calcium-enriched mixture ( CEM ) cement . Material s and Methods A prospect i ve outcome study of periradicular surgery using CEM was conducted on 14 permanent teeth with persistent apical periodontitis . Using a st and ardized surgical protocol , 2 - 3 mm of the root apex was resected ; approximately 3 mm deep root-end cavities were ultrasonically prepared and filled with CEM cement .  All patients were available for recall . Results Clinical and radiographic examination revealed complete healing of periradicular lesions , i.e. regeneration of periodontal ligament and lamina dura in 13 teeth ( 93 % success ) during a mean time of 18 months ; moreover , the teeth were functional and asymptomatic . Conclusion Favorable treatment outcomes in this prospect i ve clinical study suggested that CEM cement may be a suitable root-end filling bio material PURPOSE Periapical surgery eliminates the periradicular inflammatory tissue and seals the apical foramen . The present study relates the radiologic size of the periapical lesion , apical resection , and retro grade filling to the middle- and long-term success of periapical surgery . MATERIAL S AND METHODS In a prospect i ve study , 235 patients and 333 teeth were subjected to ultrasound instrumentation and retro grade filling with silver amalgam .  Radiographic measurements were made of the maximum and minimum diameters of 320 periapical lesions before surgery . In the 384 apicoectomized roots , calculations were made of the eliminated apical portion , and in 526 root canals the magnitude of retro grade filling was determined . The patients were subjected to a minimum follow-up period of 12 months , with a mean of 27.8 months ( range 12 months to 10 years ) . RESULTS Global evaluation showed a success rate of 73.9 % after 12 months . The mean periapical area before surgery was 37 mm(2 ) ( maximum diameter , 7.4 mm ; minimum diameter , 5 mm ) . The mean apical resection was 6.48 mm(2 ) ( height , 2.7 mm ; base , 2.4 mm ) . The mean area of the retro grade cavities was 3.05 mm(2 ) ( long side , 2.25 mm ; short side , 1.1 mm ) . A positive correlation was observed between the dimensions of the lesion and apical resection with the treatment failure . None of the dimensions of the filling cavity was related to treatment failure . CONCLUSION The prognosis of periapical surgery improves with decreasing periapical lesion size and lesser apical resection , and is not dependent on the magnitude of retro grade filling The purpose of this study was to compare the sealing ability of high-copper amalgam , glass ionomer cement , and silver glass ionomer cement as retrofilling material s when used with and without varnish . Seventy extracted human single-rooted anterior teeth were instrumented and the root canals obturated with laterally condensed gutta-percha and sealer . The apical 3 mm of each root was resected and a 2 mm-deep apical Class I preparation cut . The roots were then r and omly allocated to six groups of 10 teeth and retrofilled with one of the experiment material s. Group I comprised high-copper amalgam ; group 2 , high-copper amalgam with cavity varnish ; group 3 , glass ionomer cement without varnish ; group 4 , glass ionomer cement with varnish ; group 5 , silver glass ionomer cement without varnish ; and group 6 , silver glass ionomer cement with varnish . Two groups of five roots each were used as positive and negative controls . The root surfaces were coated with nail polish and specimens immersed in 2 % methylene blue solution for 14 days . After vertical sectioning , dye penetration was examined under a stereomicroscope . The results of the study were analysed statistically . The sealing ability of the conventional glass ionomer cement with varnish was significantly better while dye penetration was higher in silver glass ionomer cement without varnish group than the other groups ( P < 0.01 ) Context : Where nonsurgical endodontic intervention is not possible , or it will not solve the problem , surgical endodontic treatment must be considered . A major cause of surgical endodontic failures is an inadequate apical seal , so the use of the suitable substance as root-end filling material that prevents egress of potential contaminants into periapical tissue is very critical . Aims : The aim of the present ex-vivo study was to compare and evaluate the three root-end filling material s of mineral trioxide aggregate ( MTA ) family ( white MTA [ WMTA ] , grey MTA [ GMTA ] and Portl and cement [ PC ] ) for their marginal adaptation at the root-end dentinal wall using scanning electron microscopy ( SEM ) . Material s and Methods : Sixty human single-rooted teeth were decoronated , instrumented , and obturated with Gutta-percha .  After the root-end resection and apical cavity preparation , the teeth were r and omly divided into three-experimental groups ( each containing 20 teeth ) and each group was filled with their respective experimental material s. After longitudinal sectioning of root , SEM examination was done to determine the overall gap between retro grade material s and cavity walls in terms of length and width of the gap ( maximum ) at the interface . Descriptive statistical analysis was performed to calculate the means with corresponding st and ard errors , median and ranges along with an analysis of variance and Tukey 's test . Results : The least overall gap was observed in GMTA followed by PC and WMTA . While after statistically analyzing the various data obtained from different groups , there was no significant difference among these three groups in terms of marginal adaptation . Conclusion : GMTA showed the best overall adaptation to root dentinal wall compared to PC and WMTA . Being biocompatible and cheaper , the PC may be an alternative but not a substitute for MTA The aim of this study was to compare the vertical fracture resistance of roots obturated with different  root canal filling material s and sealers .  Crowns of 55 extracted m and ibular premolar teeth were removed to provide root lengths of 13 mm . Five roots were saved as negative control group ( canals unprepared and unfilled ) . Fifty root canals were instrumented and then five roots were saved as positive control group ( canals prepared but unfilled ) . The remaining 45 roots were r and omly divided into three experimental groups ( n = 15 root/group ) and obturated with the following procedures : in group 1 , glass ionomer-based sealer and cone ( ActiV GP obturation system ) ; in group 2 , bioceramic sealer and cone ( EndoSequence BC obturation system ) ; and in group 3 , roots were filled with bioceramic sealer and cone ( Smartpaste bio obturation system ) . All specimens were tested in a universal testing machine for measuring fracture resistance . For each root , the force at the time of fracture was recorded in Newtons . The statistical analysis was performed by using Kruskal-Wallis and post hoc test . There were no significant differences between the three experimental groups . The fracture values of three experimental and negative control groups were significantly higher than the positive control group . Within the limitations of this study , all material s increased the fracture resistance of instrumented roots OBJECTIVE The aim of this study was to evaluate the healing outcome after periapical surgery with an ultrasonic cleaning technique in conjunction with the use of either of 2 different retro grade root-filling material s in teeth with apical periodontitis . STUDY DESIGN One hundred sixty teeth in 139 consecutive patients were r and omly allocated into 2 groups receiving either IRM or thermoplasticized gutta-percha ( GP ) with AH Plus sealer as a retro grade root-end seal . The patients were review ed 12 months after surgery . The results were analyzed with Fisher exact test . RESULTS One hundred forty-seven teeth in 131 patients were review ed . Radiologic evaluation and clinical examination showed an 85 % success rate for the IRM group and 90 % for GP group . There was no statistical significance between the 2 groups . CONCLUSION Both tested material s , IRM and GP , are suitable as retro grade root-end filling material s in conjunction with ultrasonic root-end preparation according to the results of the healing outcome after 12 months follow-up Apicoectomy failure is generally related to inappropriate marginal sealing of the retrocavity , which allows percolation of microorganisms and their products from root canal system to periapex . This study evaluated tubular penetration of canal sealers and marginal permeability after retrocavity irradiation with Er;Cr : YSGG laser and retrofilling with MTA or cyanoacrylate .  Twenty-two single-rooted teeth were decoronated and endodontically treated , their apical 3 mm were resected and the root ends were retroprepared with a low-speed bur .  Twenty roots were r and omly assigned to 4 groups ( n=5 ) : GI and GII -- retrofilling with MTA and cyanoacrylate , respectively ; GIII and GIV -- retrocavity irradiation with Er;Cr : YSGG laser ( 2.78 microm , 4 W , 20 Hz , 70.8 J/cm(2 ) ) and retrofilling with MTA and cyanoacrylate , respectively . The remaining 2 roots served as positive and negative controls . The analysis of rhodamine B dye infiltration ( p=0.05 ) demonstrated that laser irradiation and MTA retrofilling presented significantly higher permeability rates ( p<0.05 ) . Retrofilling with cyanoacrylate showed significantly lower permeability , either when laser was used or not on retrocavity . SEM analysis depicted more cyanoacrylate penetration through dentinal tubules when compared to MTA , suggesting a more efficient marginal sealing . Based on these results , it may be concluded that cyanoacrylate provided a less permeable retrofilling regardless of the retropreparation method , suggesting a more favorable condition to the establishment of the periapical healing OBJECTIVES This prospect i ve r and omized study compared the outcome of retreatment and surgical intervention in root canal treated teeth with nonhealing periradicular pathosis . STUDY DESIGN One such tooth from each of 38 patients was r and omly allotted to retreatment or root-end resection and root-end filling . Treatment outcome after 1 year was evaluated and compared clinical ly and radiographically . RESULTS The success rate for surgery was higher than for conventional retreatment , but the difference was not statistically significant . CONCLUSIONS For management of nonhealing periradicular pathosis associated with root canal treated teeth , surgical intervention should be considered as an alternative to retreatment . In cases with a similar prognosis for both modes of treatment , the choice should be governed by consideration of intrinsic and extrinsic factors INTRODUCTION Recent meta-analyses of the outcome of apical surgery using modern techniques including microsurgical principles and high-power magnification have yielded higher rates of healing . However , the information is mainly based on 1- to 2-year follow-up data . The present prospect i ve study was design ed to re-examine a large sample of teeth treated with apical surgery after 5 years . METHODS Patients were recalled 5 years after apical surgery , and treated teeth were classified as healed or not healed based on clinical and radiographic examination . ( The latter was performed independently by 3 observers ) . Two different methods of root-end preparation and filling ( primary study parameters ) were to be compared ( mineral trioxide aggregate [ MTA ] vs adhesive resin composite [ COMP ] ) without r and omization . RESULTS A total of 271 patients and teeth from a 1-year follow-up sample of 339 could be re-examined after 5 years ( dropout rate = 20.1 % ) . The overall rate of healed cases was 84.5 % with a significant difference ( P = .0003 ) when comparing MTA ( 92.5 % ) and COMP ( 76.6 % ) . The evaluation of secondary study parameters yielded no significant difference for healing outcome when comparing subcategories ( ie , sex , age , type of tooth treated , post/screw , type of surgery ) . CONCLUSIONS The results from this prospect i ve nonr and omized clinical study with a 5-year follow-up of 271 teeth indicate that MTA exhibited a higher healing rate than COMP in the longitudinal prognosis of root-end sealing Endodontic treatment of the pulpless tooth with an immature root apex poses a special challenge for the clinician due to lack of an apical stop against which to compact an interim dressing of calcium hydroxide , or the final obturation material . A one-visit apexification protocol with MTA ( Mineral Trioxide Aggregate ) has be seen as an alternative to the traditional treatment practice s with calcium hydroxide [ Ca(OH)2 ] . The aim of this study was to investigate the use of MTA as a 5 mm apical barrier by comparing sealing ability of ProRoot MTA to that of MTA-Angelus . 50 freshly extracted Maxillary and M and ibular single canal sound human incisor teeth were used in this study , which were decoronated to st and ardized 10 mm root lengths . The root segments were prepared to simulate the clinical situation of an open apex with Gates Glidden burs # 51 and r and omly assigned into 2 experimental groups of 20 sample s each ( Group A : ProRoot MTA , Group B : MTA-Angelus ) and 10 root segments were used as control ( Group C ) where no apical barrier was used . After obturation the coronal portion of all sample s were sealed with Glass Ionomer and stored at 37 degrees C and 100 % humidity for 4 weeks . The root segments were then double coated with nail varnish except for the apical 1 mm and apical ends of all root segments were suspended vertically in methylene blue dye for 48 hours at room temperature . After removal from the dye , the sample s were sectioned longitudinally and linear dye penetration was measured using a Grid and stereomicroscope . The measurements were tabulated and statistically analyzed . The mean percentage of dye leakage for Group A was 55.5 % and for Group B was 53.25 % . The results showed no statistically significant difference in the sealing ability of ProRoot MTA and MTA-Angelus when used as apical barriers A prospect i ve study was set up to evaluate a one-visit  apicectomy technique . Calcium hydroxide cement was used as the root canal filling material . The calcium hydroxide cement set rapidly and clearly revealed the position , size and outline form of the root canals at the level of resection . This facilitated preparation of the apical cavities to a depth of 3 mm . Each cavity was varnished before placement of the amalgam .  Sixty-eight patients ( 93 teeth ) were included in the study . Five patients ( 8 teeth ) were lost to follow-up . The success rate , based on clinical and radiographic examination after a minimum of 2 years , was 91.8 per cent The aim of this in vitro study was to determine the effect of removal of the smear layer on canal obturation as measured by penetration of bacteria from a coronal direction . One hundred and twenty extracted human teeth with straight , single root canals were decoronated . The canals were prepared using the modified double-flared technique with balanced force under copious irrigation . The apical matrix was prepared to size 40 and apical patency subsequently confirmed with a size 15 file . The teeth were divided r and omly into experimental groups ( 80 teeth ) and control groups ( 40 teeth ) . The root canals of 40 experimental and 20 control teeth were rinsed with 40 % citric acid and 2 % NaOCl to remove the smear layer before obturation . In experimental groups , 20 teeth with smear layer intact and 20 teeth with smear layer removed were obturated with lateral condensation of cold gutta-percha and Apexit sealer . A further 20 teeth with smear layer intact and 20 teeth with smear layer removed were obturated with the Trifecta technique with the same sealer . In control groups , 10 teeth with smear layer intact and 10 teeth with smear layer removed were obturated with lateral condensation of cold gutta-percha and Apexit sealer . These teeth were completely sealed both coronally and apically to serve as negative controls . The remaining 20 teeth with either smear layer intact or smear layer removed were not obturated and served as the positive controls . The root surface of each tooth was sealed with nail varnish . The cut end of a polypropylene tube was sealed around the coronal part of each root canal so that bacteria placed therein could move only through the obturated canal space . Each root was placed in a glass bottle containing sterile Todd-Hewitt Broth ( THB ) and aliquots of 0.5 ml of THB were injected into the polypropylene tube . The model system was centrifuged at 168 g. An innoculum of Streptococcus sanguis in THB was placed in each coronal chamber at 5-day intervals and daily observations were made for bacterial growth in the apical reservoir for 90 days . All positive control teeth showed bacterial penetration within 24 h , while the negative control teeth remained uncontaminated throughout the test period . Leakage through the experimental teeth was variable ranging from 7 to 86 days . There was no statistical significant difference ( P > 0.05 ) in leakage between the obturated canal when the smear layer was either removed or intact
Bioceramics has significantly higher success rates than amalgam , but they were statistically similar to intermediate restorative material ( IRM ) and Super ethoxybenzoic acid ( Super EBA ) when used as retro grade filling material s in apical surgery .
However , it seems that the high success rates were not solely attributable to the type of the root-end filling material s. The surgical/microsurgical techniques and tooth prognostic factors may significantly affect treatment outcome
Introduction Periradicular surgery involves the placement of a root-end filling following root-end resection , to provide an apical seal to the root canal system .
Historically several material s have been used in order to achieve this seal .
Recently a class of material s known as Bioceramics have been adopted .