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 Table of Contents  
Year : 2022  |  Volume : 34  |  Issue : 1  |  Page : 45-49

Comparison of sealing ability of mineral trioxide aggregate, biodentine with and without bioactive glass as furcation repair materials: An ultraviolet spectrophotometric analysis

Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India

Date of Submission03-Feb-2021
Date of Decision15-Jun-2021
Date of Acceptance20-Nov-2021
Date of Web Publication25-Mar-2022

Correspondence Address:
Dr. Shaik Afreen Kamal
Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur - 522 509, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/endo.endo_116_20

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Aim: The aim of this study was to evaluate the sealing ability of mineral trioxide aggregate (MTA), Biodentine with and without Bioactive glass (BG) as furcation repair materials by ultraviolet (UV) spectrophotometric analysis.
Materials and Methods: Forty extracted human maxillary molars (n = 40) were selected and decoronated 3 mm above the cementoenamel junction and 3 mm below it and a defect in furcation was created. The samples were then divided into 4 groups of 10 (n = 10) each, Group I: MTA, Group II: Biodentine, Group III: BG + Biodentine and Group IV: BG + MTA and the defect was treated with respective furcation repair material. All the samples were then immersed in 2% methylene blue solution for 24 h and later stored in 65% nitric acid solution. The solution obtained was subjected to centrifuge at 3500 rpm for 5 min. From this solution, 100 μl of the supernatant was collected, analyzed in UV spectrophotometer at 550 nm with nitric acid as the blank and readings were recorded as absorbance units.
Results: All four groups exhibited a significant difference in dye absorbance values (P < 0.01). Group I, i.e., MTA showed the least dye absorbance values when compared with the other three groups. Data were analyzed using one-way analysis of variance and post hoc Tukey tests. The level of statistical significance was set at P < 0.05.
Conclusion: Within the limitations of the study, it can be concluded that MTA had superior sealing ability than Biodentine, whereas BG + Biodentine showed better sealing ability when compared with BG + MTA.

Keywords: Calcium silicate cement, furcation, mineral trioxide aggregate

How to cite this article:
Kamal SA, Garlapati R, Bolla N, Vemuri S, Pydiahnaidu B, Suvarna YL. Comparison of sealing ability of mineral trioxide aggregate, biodentine with and without bioactive glass as furcation repair materials: An ultraviolet spectrophotometric analysis. Endodontology 2022;34:45-9

How to cite this URL:
Kamal SA, Garlapati R, Bolla N, Vemuri S, Pydiahnaidu B, Suvarna YL. Comparison of sealing ability of mineral trioxide aggregate, biodentine with and without bioactive glass as furcation repair materials: An ultraviolet spectrophotometric analysis. Endodontology [serial online] 2022 [cited 2022 May 23];34:45-9. Available from: https://www.endodontologyonweb.org/text.asp?2022/34/1/45/340830

  Introduction Top

The physiological dentition serves as a defense against pathologies. On the other version, it also harbors diverse microbiota, which leads to the pathologies and failure of treatment progress. Endodontic mishaps occur because of iatrogenic causes. However, repair of these mishaps plays a pivotal role in the procedure's success. Furcation perforation is one such mishap.[1]

Antecedently, amalgam, gutta-percha, calcium hydroxide, calcium sulfate-based materials have been used as furcation repair materials. These materials exhibited some potential risk factors leading to the destruction of the periodontium. Some of these materials are no longer preferred as a furcation repair material. Nowadays, Glass Ionomer Cement, mineral trioxide aggregate (MTA), Biodentine, Bioactive Glass (BG), Demineralized Freeze-Dried Bone, Tricalcium Phosphate, and Dentine Chips are the most commonly used perforation repair materials.[1]

The advancements in the furcation repair material were majorly to overcome the sealing ability of the material with the tooth structure, biocompatible to promote the healing of the underlying periodontal tissue, and control of the repair material to avoid its extrusion into the periodontal tissue, antibacterial property. Furcation repair material should induce healing, bone formation, be radiopaque, induce mineralization, cementogenesis, comfortable in manipulation and placement.[2]

MTA is one of the materials of choice to repair the furcation perforation because of its superior quality of marginal adaption, sealing ability, antibacterial effects, biocompatibility, and bioactivity, which may induce the regeneration of periodontal tissue. MTA's major disadvantage is its delayed setting time, which compromises initial setting time when in contact with oral fluids and diminishes the adaptation of the MTA to tooth structure.[3] Biodentine is a calcium silicate-based material with a polycarboxylate-based hydro-soluble polymer system described as a water-reducing agent, reducing the mix's overall water content, along with calcium chloride as the setting accelerator.[4]

BG is a potentially new repair material introduced in dentistry as a root-end filling material. BG is a type of bioactive ceramic consisting of SiO2, CaO5, Na2O, P2O5. It is well suited as a repair material for a variety of endodontic treatments. BG has adequate strength and load-bearing capacity, good handling, and working properties.[5],[6] It has a faster setting time of around 15 min,[7],[8] tolerates moist environment very well, good marginal adaptation, low cytotoxicity comparable to MTA.[8]

In the present in vitro study, BG is attempted by modifying the polymer/powder part of bone cement with MTA or Biodentine. All the favorable properties of BG are retained and the potential disadvantages faced with MTA or Biodentine are overcome. The purpose of the current study was to evaluate the sealing ability of MTA, Biodentine, BG + Biodentine, BG + MTA as furcation repair materials using the dye extraction method.

  Materials and Methods Top

Forty freshly extracted human maxillary molars (n = 40) with nonfused and well-developed roots were collected for the study and stored in 0.2% thymol solution until use. The sample size was calculated using G*power software (Heinrich Heine University, Düsseldorf, North Rhine-Westphalia) at an effective size of 1.39, error probability of 5% and 95% power, a minimum sample of 16 with 4 samples in each of the four study groups is required. The teeth were made free from any calculus, soft tissue, and debris with an ultrasonic scaler. Each tooth was then decoronated 3 mm above the cementoenamel junction (CEJ) and 3 mm below the furcation. The sectioned surface and root canal were covered with sticky wax on the external root surface, in the orifice and then two layers of varnish were applied over them, a black marker pen was used to mark the location of the defect. Artificial perforation of 1 mm in diameter was created from the external surface of the tooth with the number a #2 round carbide bur (Mani Inc., Japan) mounted on a high-speed handpiece with air-water coolant. For standardization purposes, the perforation was created in the floor of the pulp chamber from the external tooth surface to ensure that each perforation is to be centered between the roots with standard dimensions, without any access deviations for all samples. The chamber and perforation were flushed with water and dried. This methodology was similar to the one that was followed by Balachandran and Gurucharan.[9]

The samples (n = 40) were then divided into four groups (n = 10) based on the furcation perforation repair material used.

Group I (n = 10): MTA: Ten molars in which perforations were repaired with Pro Root MTA (Dentsply malliefer, USA)

Group II (n = 10): Biodentine: Ten molars in which perforations were repaired with Biodentine (Septodont, Saint Maur des Fosses, France)

Group III (n = 10): BG + Biodentine = Bioactive bone cement: Ten molars in which perforations were repaired with Bioactive bone cement.

Group IV (n = 10): BG + MTA = Bioactive bone cement: Ten molars in which perforations were repaired with Bioactive bone cement.

All the materials were manipulated according to the manufacturer's recommendations and placed incrementally with the help of a plastic filling instrument. The material condensation was done with the cylindrical end of the plastic filling instrument until the repair material was extruded out of the tooth surface and extruded repair material was removed with the flat end of the plastic filling instrument.

Preparation of bioactive bone cement

To prepare the bioactive bone cement powder and liquid of both the MTA and Biodentine were modified. The ratio for MTA/Biodentine: BG was 60:40 for powder, and for liquid, it is 1 ml of monomer liquid: 1 drop of saline coupling agent. The mixing of the cement was carried out in Amalgamator (Ultramat 2, SDI, Australia). The modified powder and liquid were mixed together in the ratio of 2:1. Each sample was then repaired with the respective material in each group and stored for 24 h.

Evaluation of microleakage method

All the samples in each group were placed in separate Petri dishes containing 2% methylene blue. The teeth were immersed in dye up to the CEJ for retrograde dye challenge and dye was added to the access chamber of each tooth so that it was filled for orthograde dye challenge. All samples were stored similarly for 48 h.

All the samples were rinsed under tap water for 30 min and varnish was removed with a polishing disc. Each tooth was stored in a vial containing 5 ml of concentrated (65 wt %) nitric acid for 3 days. The solution thus obtained was subjected to centrifuge at 3500 rpm for 5 min. From this solution, 100 μl of the supernatant was collected, then analyzed in an ultraviolet spectrophotometer at 550 nm with nitric acid as the blank, and readings were recorded as absorbance units. The results thus obtained were subjected to statistical analysis. One-way ANOVA, followed by post hoc-Tukey tests were done using the statistical package SPSS (Statistical Package for Social Science, version 21, IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp).

  Results Top

Mean spectrophotometric dye absorbance values of four different experimental groups.

Meanspectrophotometric dye absorbance values of four different experimental groups have been presented in [Table 1]. The least absorbance value was obtained for MTA (Group I - 0.484), followed by Biodentine (Group II- 0.555). The highestabsorbance values were obtained for Bioactive glass + MTA (Group IV- 0.890), when compared with Bioactive glass + Biodentine (Group III- 0.706). The meandye absorbance values were comparatively higher in the Bioactive bone cement groups i.e., Group III, Group IV when compared to the MTA (Group I) and Biodentine (Group II) alone. There was no significant difference between Group I and Group II. Group III showed absorbance values slightly higher than Group I and Group II.
Table 1: Mean spectrophotometric dye absorbance values of four different experimental groups

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  Discussion Top

Endodontic mishaps consist of various procedural accidents, perforation located in any tooth region is one such accident that may be accessed cavity preparation related. Irrespective of their situation, these perforations may serve as a connection between the external and internal tooth surface, leading to a decrease in the endodontic treatment's successful outcome. Repairing these perforations immediately with biocompatible material will increase the chances of the success of the endodontic treatment.

In this in vitro study, the sealing ability was assessed by the dye extraction method, which according to Camps and Pashley, gives similar results to the fluid filtration technique; both are based on quantitative measurement of liquid passage within the interfaces.[10] In the dye extraction method, the absorbance or reflectance in the visible range directly affects the perceived color of the chemicals involved.[10]

The present study revealed the highest sealing ability for Group I, i.e., the MTA group; these observations agree with previous studies. Jeevani et al. reported that MTA resulted in superior furcation sealing ability compared to Biodentine. MTA's excellent, unique property is its ability to promote cementum regeneration, thus facilitating the periodontal apparatus's regeneration and excellent marginal adaptation to the perforation sites' external borders.[11]

In the present study, Biodentine showed sealing ability comparative to MTA. Sinkar et al. reported that MTA and Biodentine showed better sealing ability than MTA.[12] Kokate and Pawar conducted a study to compare the microleakage of glass ionomer cement, MTA, and Biodentine as retrograde filling materials and concluded that Biodentine exhibited the least microleakage when compared to other materials used.[13]

In the current study, Bioactive bone cement's sealing ability in sealing was equally effective as MTA. This property is because the BG in the presence of simulated body fluid forms a layer of apatite crystals, which nucleate and grow and occupy the space present between the bone cement and dentinal wall at the microscopic level.[10] From their study results, Demir et al. concluded that BG had shown osteostimulatory and osteoconductive properties.[14] It has been reported that it had an antibacterial effect against subgingival, supragingival bacteria. Sculean et al. stated that this material has good clinical manageability and specific hemostatic properties. They assumed that BG might be an ideal matrix in furcal perforations by considering its barrier-like properties.[15]

Balachandran and Gurucharan stated that combining two biocompatible materials could produce minimal cytotoxicity and maximum biocompatibility.[9] In the present study, MTA and Biodentine modified BG to provide a track record favoring factors of repair material. Tests done by various authors[16],[17] for cytotoxicity revealed that fibroblast cells were unaffected by bone cement and biocompatibility of bone cement was similar to MTA. According to Miyazaki et al., bioactivity can be induced in a biomaterial by incorporating silanol (Si-OH) groups and calcium (Ca+2) salts.[18] The Ca+2 salts start triggering hydroxyapatite formation, while the silane coupling agent may provide a Si-OH group after exposure to simulated body fluid.[19] The reason for the addition of a silane coupling agent (MPS) was to accelerate apatite formation, maintain mechanical properties and increase the compressive strength.[18]

The marginal sealing ability of calcium silicate-based materials is attributed to their ability to produce surface apatite crystals when in contact with the phosphates available in tissue fluids.[20] Han and Okiji compared calcium and silicon uptake by adjacent root canal dentine in the presence of phosphate-buffered saline using Biodentine and ProRoot MTA. The results showed that both materials formed a tag-like structure composed of the material itself or calcium-or phosphate-rich crystalline deposits. The thickness of the calcium and silicon-rich layers increased over time. The thickness of the calcium and silicon-rich layer was significantly larger in Biodentine than MTA after 30 and 90 days, concluding that the dentine element uptake was greater for Biodentine than for MTA. These findings lead to the notion that apatite formation contributes to leakage reduction by filling the gap with the interface and dentine interactions such as intrafibrillar apatite deposition.[21]

The setting time and handling properties for Biodentine + BG were superior compared with MTA + BG. The possible reason for the reduced sealing ability of BG + MTA might be modifying the bioactive bone cement, which affected the cement's setting time and handling properties of the cement. The exothermic reaction of polymethylmethacrylate bone cement during its setting has adverse effects. The cement required for perforation repair is significantly less and produces a smaller exothermic reaction much-reduced amount of monomer. A study conducted by Mehrvarzfar et al. stated that BG interferes with the adaptation or bonding of the MTA to the tooth structure, leading to the MTA's reduced sealing ability.[3] This explains the reason for reducing the sealing ability of the MTA bone cement in our study.

Though there are various studies on MTA, Biodentine as furcation perforation repair, our research is unique in assessing these materials in combination with BG as furcation repair materials. Additional in vitro, in vivo tests and clinical trials, are desirable to elucidate the perforation repair materials' effectiveness.

  Conclusion Top

Within the limitations of this study, it can be concluded that MTA had the superior sealing ability when compared with Biodentine, whereas BG with Biodentine showed superior sealing ability when compared with BG with MTA.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Komath M, Varma HK. Fully injectable calcium phosphate cement – A promise to dentistry. Indian J Dent Res 2004;15:89-95.  Back to cited text no. 1
Aggarwal V, Singla M, Miglani S, Kohli S. Comparative evaluation of push-out bond strength of ProRoot MTA, biodentine, and MTA plus in furcation perforation repair. J Conserv Dent 2013;16:462-5.  Back to cited text no. 2
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Mehrvarzfar P, Dahi-Taleghani A, Saghiri MA, Karamifar K, Shababi B, Behnia A. The comparison of MTA, Geristore® and Amalgam with or without Bioglass as a matrix in sealing the furcal perforations (in vitro study). Saudi Dent J 2010;22:119-24.  Back to cited text no. 3
Reyes-Carmona JF, Felippe MS, Felippe WT. Biomineralization ability and interaction of mineral trioxide aggregate and white Portland cement with dentin in a phosphate-containing fluid. J Endod 2009;35:731-6.  Back to cited text no. 4
Kokubo T, Kim HM, Kawashita M, Nakamura T. Process of calcification on artificial materials. Z Kardiol 2001;90 Suppl 3:86-91.  Back to cited text no. 5
Sluyk SR, Moon PC, Hartwell GR. Evaluation of setting properties and retention characteristics of mineral trioxide aggregate when used as a furcation perforation repair material. J Endod 1998;24:768-71.  Back to cited text no. 6
McCabe PS. Avoiding perforations in endodontics. J Ir Dent Assoc 2006;52:139-48.  Back to cited text no. 7
Weldon JK Jr., Pashley DH, Loushine RJ, Weller RN, Kimbrough WF. Sealing ability of mineral trioxide aggregate and super-EBA when used as furcation repair materials: A longitudinal study. J Endod 2002;28:467-70.  Back to cited text no. 8
Balachandran J, Gurucharan. Comparison of sealing ability of bioactive bone cement, mineral trioxide aggregate and Super EBA as furcation repair materials: A dye extraction study. J Conserv Dent 2013;16:247-51.  Back to cited text no. 9
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Camps J, Pashley D. Reliability of the dye penetration studies. J Endod 2003;29:592-4.  Back to cited text no. 10
Jeevani E, Jayaprakash T, Bolla N, Vemuri S, Sunil CR, Kalluru RS. Evaluation of sealing ability of MM-MTA, Endosequence, and biodentine as furcation repair materials: UV spectrophotometric analysis. J Conserv Dent 2014;17:340-3.  Back to cited text no. 11
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Sinkar RC, Patil SS, Jogad NP, Gade VJ. Comparison of sealing ability of ProRoot MTA, RetroMTA, and Biodentine as furcation repair materials: An ultraviolet spectrophotometric analysis. J Conserv Dent 2015;18:445-8.  Back to cited text no. 12
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Kokate SR, Pawar AM. An in vitro comparative stereomicroscopic evaluation of marginal seal between MTA, glass inomer cement and biodentine as root end filling materials using 1% methylene blue as tracer. Endodontology 2012;24:36-42.  Back to cited text no. 13
Demir B, Sengün D, Berberoğlu A. Clinical evaluation of platelet-rich plasma and bioactive glass in the treatment of intra-bony defects. J Clin Periodontol 2007;34:709-15.  Back to cited text no. 14
Sculean A, Pietruska M, Arweiler NB, Auschill TM, Nemcovsky C. Four-year results of a prospective-controlled clinical study evaluating healing of intra-bony defects following treatment with an enamel matrix protein derivative alone or combined with a bioactive glass. J Clin Periodontol 2007;34:507-13.  Back to cited text no. 15
Badr AE. Marginal adaptation and cytotoxicity of bone cement compared with amalgam and mineral trioxide aggregate as root-end filling materials. J Endod 2010;36:1056-60.  Back to cited text no. 16
High AS, Russell JL. Retrograde root filling using antibiotic-containing, radiopaque, bone cement. J Dent 1989;17:241-5.  Back to cited text no. 17
Miyazaki T, Ohtsuki C, Kyomoto M, Tanihara M, Mori A, Kuramoto K. Bioactive PMMA bone cement prepared by modification with methacryloxypropyltrimethoxysilane and calcium chloride. J Biomed Mater Res A 2003;67:1417-23.  Back to cited text no. 18
Malkondu Ö, Karapinar Kazandağ M, Kazazoğlu E. A review on biodentine, a contemporary dentine replacement and repair material. Biomed Res Int 2014;2014:160951.  Back to cited text no. 19
Nayak G, Hasan MF. Biodentine – A novel dentinal substitute for single visit apexification. Restor Dent Endod 2014;39:120-5.  Back to cited text no. 20
Han L, Okiji T. Uptake of calcium and silicon released from calcium silicate-based endodontic materials into root canal dentine. Int Endod J 2011;44:1081-7.  Back to cited text no. 21


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