EVALUATION OF DEBRIDEMENT STATUS USING BIOPURE MTAD SEM
EVALUATION OF DEBRIDEMENT STATUS USING BIOPURE- MTAD: SEM STUDY Dr. S. K. Mishra Associate Professor Deptt. of Conservative Dentistry Z. A. Dental College, AMU, Aligarh
INTRODUCTION § The success of endodontic therapy relies on proper biomechanical preparation, disinfection and three dimensional obturation. § During cleaning and shaping, mechanical instrumentation leaves a smear layer covering the dentinal walls. (Mc. Comb and smith 1975)
INTRODUCTION § Smear layer is a mixture of inorganic and organic substances that include dentinal shavings, tissue debris, odontoblastic processes, coagulated proteins, and microbial elements. § Smear layer prevents penetration of intracanal medicaments into the irregularities of the canal and dentinal tubules and also prevents complete adaptation of obturation materials.
INTRODUCTION § Most commonly used method of smear layer removal has been the chemical method using chelating agents with EDTA § The introduction of Bio. Pure MTAD (mixture of tetracycline, acid & detergent) represents an advance in endodontic irrigation research.
AIMS & OBJECTIVES • This study aimed at comparison of the smear layer removal efficacy of Bio. Pure MTAD with EDTA & Smear Clear (EDTA + a cationic & anionic surfactant), taking distilled water as a negative control.
MATERIALS AND METHODS: • • EDTA 17% solution (Canalarge, Ammdent) Smear Clear solution (Sybron Endo) Bio. Pure MTAD (Dentsply, Tulsa dental) Sterile Distilled wate(Ranbaxylaboratories) as negative control.
CANALARGE: 17% EDTA Solution (AMMDENT) Sterile Distilled Water (Ranbaxy Laboratories Limited) Bio. Pure MTAD (DENTSPLY Tulsa dental) Smear Clear Solution (Sybron Endo)
METHODOLOGY • Forty freshly extracted human single rooted maxillary and mandibular anterior teeth & premolars were selected for this study. • All specimen teeth's were randomly divided into four groups. • Each consisted of ten teeth. Groups were formed on the basis of the type of final irrigation to be received after canal preparation.
Selected specimens used in the study
Group Agent Used No. of samples Type A Distilled Water 10 Negative Control group B EDTA 17% 10 Experimental group C Smear Clear 10 Experimental group D Bio. Pure MTAD 10 Experimental group
METHODOLOGY § Access preparations. § Working lengths determination. § Canals were prepared by Pro-Taper rotary system up to F 3 size.
a Working lengths were determined by subtracting 1 mm from the length at which the tip of the file was visible at the apical foramen
METHODOLOGY • Group A: (DISTILLED WATER Group): 5 ml distilled water for 5 minutes. • Group B: (EDTA Group): 1 ml 17% EDTA for 1 minute followed by 4 ml of 17% EDTA rinse for 4 minutes. • Group C: (SMEAR CLEAR Group): 1 ml Smear Clear for 1 minute followed by 4 ml Smear Clear rinse for 4 minutes. • Group D: (MTAD Group): 1 ml Bio. Pure MTAD for 1 minute followed by 4 ml Bio. Pure MTAD rinse for 4 minutes.
METHODOLOGY • Crowns of all teeth were removed at the level of cementoenamel junction. • The decoronated teeth were then longitudinally sectioned into two halves. • The half containing the most part of the apex were selected as the representative sample and coded.
METHODOLOGY • Coded samples were dehydrated with ascending concentrations of ethyl alcohol, and placed in a desiccator for 24 hours, mounted on metallic stubs, gold sputtered and viewed under scanning electron microscope (Inca-x 50, Oxford Instruments, England 2. 0 nm@ 30 k. V 5 x to 500000 x, ) at All India Institute Of Medical Sciences (AIIMS) New Delhi.
Longitudinal grooves prepared on the buccal and lingual root surfaces of the prepared teeth without penetrating into the canal Teeth divided into two halves with the help of a chisel
Samples mounted on metallic stubs, put in the agar sputter and gold sputtered Samples after the gold sputtering
SEM EVALUATION • The entire length of the sample was divided equally into cervical, middle and apical thirds in order to be evaluated separately. • After a general survey scan of each third of the canal wall at a magnification of 250 x, 500 x & 1000 x. • The images were then analyzed for the amount of smear layer present by two independent observers without knowing which group they were analyzing.
SEM EVALUATION • The amount of smear layer remained were scored according to the following criteria used by Torabinejad et al: • Score 1= no smear layer: no smear layer was detected on the surface of root canal and all tubules were open. • Score 2= moderate smear layer: no smear layer on root canal walls but tubules contained debris. • Score 3= heavy smear layer: smear layer covered the root canal wall surface & the tubules.
Score 1= no smear layer: no smear layer was detected on the surface of root canal and all tubules were open. Score 2= moderate smear layer: no smear layer on root canal walls but tubules contained debris. Score 3= heavy smear layer: smear layer covered the root canal wall surface & the tubules
SEM images for group A (Distilled water) coronal 3 rd at magnifications 1000 x middle 3 rd at magnifications 1000 x apical 3 rd at magnifications 1000 x
SEM images for group B (EDTA) coronal 3 rd at magnifications 1000 x middle 3 rd at magnifications 1000 x apical 3 rd at magnifications 1000 x
SEM images for group C (Smear. Clear) coronal 3 rd at magnifications 1000 x middle 3 rd at magnifications 1000 x apical 3 rd at magnifications 1000 x
SEM images for group D (MTAD) coronal 3 rd at magnifications 1000 x middle 3 rd at magnifications 1000 x apical 3 rd at magnifications 1000 x
Sample no. (n) Group A (Distilled water Group) Group B (EDTA Group) Group C (Smear Clear group) Group D (MTAD Group) Coronal Middle Apical 3 rd 3 rd 3 r 3 r 3 rd 3 rd 1 3 3 3 1 1 1 1 1 2 3 3 3 1 1 1 2 1 1 1 3 3 1 2 2 4 3 3 3 1 1 3 1 2 3 1 1 1 5 3 3 3 2 2 2 1 1 2 2 6 3 3 3 1 2 2 1 1 2 2 7 3 3 3 1 1 2 2 2 3 1 1 1 8 3 3 3 1 1 3 2 2 3 1 1 1 9 3 3 3 2 1 1 2 10 3 3 3 1 2 2 1 1 2
OBSERVATIONS • The data was analyzed through Mann. Whitney U-Test and comparisons were made as follows: • Comparison of all groups with the control at coronal, middle and apical levels • Comparison all experimental groups with each other at coronal, middle and apical levels • Intra-group Comparison of each group within coronal, middle and apical level.
COMPARISON OF EXPERIMENTAL GROUPS WITH CONTROL GROUP Groups Compared ‘P’- Value Statistical Significance B vs. A <. 001 Significant C vs. A <. 001 Significant D vs. A <. 001 Significant
INTER-GROUPCOMPARISON Groups compared B vs. C B vs. D Coronal 3 rd Middle 3 rd Apical 3 rd ‘P’- Value Statistical Significance >. 05 Not significant >. 05 Not significant <. 05 Significant
INTRA-GROUPCOMPARISON Group compared B C D ‘P’- Value Statistical Significance Coronal 3 rd vs. Middle 3 rd >. 05 Not significant Coronal 3 rd vs. Apical 3 rd <. 05 Significant Middle 3 rd vs. Apical 3 rd >. 05 Not significant Coronal 3 rd vs. Middle 3 rd >. 05 Not significant Coronal 3 rd vs. Apical 3 rd <. 01 Significant Middle 3 rd vs. Apical 3 rd <. 05 Significant Coronal 3 rd vs. Middle 3 rd >. 05 Not significant Coronal 3 rd vs. Apical 3 rd >. 05 Not significant Middle 3 rd vs. Apical 3 rd >. 05 Not significant
RESULTS • The specimens irrigated with distilled water alone, showed a homogenous heavy smear layer throughout the entire length of the root canal. • The surfaces of root canals in the coronal and middle thirds of samples in group B and C were free of smear layer but there was moderate smear layer in the apical thirds. • In group B (EDTA group) & group C (Smear. Clear group), the efficacy of the agent was significantly less in the apical third of the samples compared with the coronal thirds p<. 05.
RESULTS • The smear layer removal ability of Bio. Pure MTAD was good at all thirds of the root canal and no significant difference was found when comparing the coronal, middle and apical thirds of the root canal. The canals were much cleaner than in any other group and also most of the dentinal tubules were open. • The efficacy of Bio. Pure MTAD in removing the smear layer in apical thirds of the root canals was found significantly better than Smear. Clear (p<. 05).
DISCUSSION • The generation of a smear layer is almost inevitable during root canal instrumentation. • The first researchers to describe the smear layer on the surface of instrumented root canals were Mc. Comb & Smith (1975). • Mader et al. (1984) reported that the smear layer thickness was generally 1– 2 µm. They discussed the smear material in two parts: first, superficial smear layer and second, the material, packed into the dentinal tubules. Packing of smear debris was present in the tubules to a depth of 40 µm.
DISCUSSION • Despite controversy over maintaining the smear layer, most of the investigations have focussed on its removal. The reasons in support of the removal of smear layer are: • It has an unpredictable thickness and volume, because a great portion of it consists of water. (Mc. Comb & Smith 1975, Goldberg & Abramovich 1977, Wayman et al. 1979, Yamada et al. 1983). • It contains bacteria, their by-products and necrotic tissue.
DISCUSSION • It may act as a substrate for bacteria, allowing their deeper penetration in the dentinal tubules. (Bystrom & Sundqvist 1981) • It may limit the optimum penetration of disinfecting agents. (Haapasalo & Ørstavik 1987). • It can act as a barrier between filling materials. (White et al. 1984, Yang & Bae 2002). • Its removal would facilitate canal filling. (Mader et al. 1984, Cameron 1987, Meryon & Brook 1990)
DISCUSSION • So far the most commonly used method of smear layer- EDTA • Limitations- less effective in apical regions, limited antimicrobial activity & causes tubular erosion. • Present study compared two formulations of EDTA with Bio. Pure MTAD and the results demonstrated Bio. Pure MTAD was most efficient in removing the smear layer at all levels from the root canal.
CONCLUSION • Within the experimental protocol of the present study it can be considered that Bio. Pure MTAD is the most effective agent for the purpose of smear layer removal. A combination of EDTA and sodium hypochlorite has been mostly supported so far but since EDTA has got no antimicrobial properties and also it causes erosion of the dentinal tubules so Bio. Pure MTAD can be considered as a much better alternative to EDTA.
Thank you
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