Comparative evaluation of periapical healing in response to calcium hydroxide, polydimethyl siloxane and calcium silicate based endodontic sealers using radiograph

Introduction

The ability to effectively obturate the prepared root canal space is one of the cornerstones to successful root canal therapy. Sealer and Gutta-percha can be used to effectively obturate the canal space.¹ According to “Ingle and Bakland”, 60 percent of endodontic failures are caused by improper root canal obturation. Obturation’s main goal is to accomplish 3D hermetic sealing of the pulp chamber in order to form a fluid-tight seal and inhibit the invasion of the germs and toxins into the periapical tissues. Because of the complexity of the root canal system, a variety of procedures and sealers have been developed to ensure a perfect seal. The root canal sealer’s job is to create a link between the root dentine and core material, successfully preventing leaking.²

Several sealers contain antibacterial or therapeutic substances like calcium hydroxide or corticosteroids, despite the fact that current endodontics prioritises sealing and biocompatibility characteristics of the materials. An endodontic sealer must strike a precise balance between cytotoxicity and antibacterial characteristics.³

Through the apical foramina and lateral canals, sealants placed in root canals can potentially inhibit the repair of periodontal tissue.⁴ Localized inflammation caused on by root canal obturation materials may lead to postoperative pain. It has been linked to a variety of treatment factors, including WL evaluation using an apex-locator hooked up to each of the file, the number of appointments, equipment selection, and selection of the root canal sealer.⁵ The severity of inflammatory reactions is determined by various elements, the most important of which is the sealer’s composition. Bio-ceramics are metal oxides or ceramic materials that have improved antibacterial and antifungal activity, improved sealing and also they are biocompatible, are used in dentistry and medicine.⁶ “NanoSeal-S” is a root canal sealer; polydimethyl siloxane-based that is cold flowable and contains nano silver in chemical form. It has great sealing properties as well as good radio-opacity. Silver is used as a preservative in chemical form. This study compares and evaluates the periapical healing response to calcium hydroxide, polydimethyl siloxane, and calcium silicate based endodontic sealers using radiographs.⁷

Protocol

The study will be conducted in “Sharad Pawar Dental College, in Department of Conservative Dentistry and Endodontics.” The outpatient department will pick a total of 60 people requiring endodontic treatment with Periapical radiolucency of teeth ranging from 0.5 mm – 8 mm. Patient will be informed priorly about the procedure to be done and written consent will be taken. Detailed case history will be recorded to properly evaluate the symptoms of irreversible pulpitis and the teeth with periapical radiolucency. Sixty participants who met the inclusion criteria were asked to choose a paper chit from one of three sealer groups: group I consisted of participants who chose the sealer based on calcium hydroxide, group II consisted of participants who chose the sealer based on polydimethylsiloxane, and group III consisted of participants who chose the sealer based on calcium silicate, as shown in Table 1. In this way, random sampling of the participants was done by chit picking.

Materials

Expected results

It is expected that among the material used in the study Bio-Ceramic and Nanoseal-S sealer may give better results as compared to Sealapex used in routine practice due to its ability of anti-microbial properties, optimal biocompatibility and excellent sealing ability.

Discussion

Comparison among the endodontic sealers to evaluate its efficacy and clinical results have been performed by many authors. An author conducted the study where 3 sealers were used and evaluated. The materials investigated that included Proco-Sol, an epoxy resin, AH26, and Klorperka N0, a “resin-guttapercha-chloroform sealer,” which is based on zinc oxide and eugenol. Periapical lesions’ healing was observed for three years. Despite the fact that there were no statistically significant differences between the groups, the response to Kloroperka N0 seemed to be considerably lower than the responses to the other two groups.⁸

Another researcher evaluated the clinical and radiological results of three sealers, two of which contain calcium hydroxide. At the time of root filling, 204 teeth were assigned to one of three groups: PS group gutta-percha filled teeth and Procosol sealer; CR group, gutta-percha filled teeth and sealer CRCS; and SA group, gutta-percha filled teeth and Sealapex sealer. Overall, the treatment result were equivalent to, but slightly worse than, those previously reported from patients examined at the University of Oslo’s Dental School. The total effect of the sealer on the treatment outcome was found to be minor. Although root fillings with Ca (OH)₂ may promote faster healing of the apical periodontitis or surgical damage, the subsequent results 3 to 4 years were comparable for zinc oxide-eugenol–based sealers with or without Ca (OH).^9,10

In the other study, Colombo M et al. conducted a study on 810 roots to evaluate performance of endodontic sealers 810 roots were used to examine and evaluate the experimental clinical performance of endodontic sealers: Kloroperka N-0^®, AH 26^®, and ProcoSol^®. Lateral condensation of gutta-percha and sealer by undergraduate students were done using a uniform technique. Prior to filling, the sealer was chosen at random. The patients were seen for a clinical and radiographic control assessment every year for four years, with the radiographs graded using the periapical index (PAI) grading system. Roots filled with or ProcoSol^® or AH 26^® had a better periapical state than roots filled with Kloroperka^®. After one year, the change was considerable and lasted for the whole four-year observation period. The periapical index was found to be a good discriminatory tool for assessing treatment results in endodontics, outcome of endodontic treatment depends on the choice of sealer.^11,12

George Taccio de Miranda’s investigation Canderio et al. investigated the physicochemical properties of Endosequence BC Sealer, a bio-ceramic root canal sealer.¹³ The results were compared to AH Plus cement in terms of radiopacity, pH, calcium ion release (Ca²⁺), and flow. ISO 6876/2001 criteria were used to assess radiopacity and flow. Metallic rings with a 10 mm diameter and a 1 mm in thickness were filled with cements for the investigation. The radiopacity was calculated using the radiographic density (mm Al). A flow-test was carried out using cement in 0.05 mL quantity on a glassslab. A weight of 120 grams was laid over cement with care. A computerised calliper was used to measure the greatest and smallest diameters of the discs created. With a spectrophotometer and a pH metre, the release of Ca²⁺ and pH were determined during a period of 3, 24, 72, 168, and 240 hours, respectively.¹⁴ The bio-ceramic endodontic cement has much lower radiopacity (3.84 mm Al) than AH Plus, according to their findings (6.90 mm Al). During the experimental periods, the pH and Calcium ions release of Endosequence BC Sealer was higher than those of AH Plus (P.05). AH Plus and BC Sealer had flow of 21.17 mm and 26.96 mm respectively, according to the flow test (P.05). According to ISO 6876/2001 recommendations, Endosequence BC Sealer demonstrated radiopacity and flow. The other physicochemical parameters investigated showed that a root canal sealer had favourable values.¹⁵

In our study we will be comparing the three endodontic sealers; it is expected that among the material used in the study Bio-Ceramic and Nanoseal-S sealer may give better results as compared to Sealapex used in routine practice due to its ability of anti-microbial properties, optimal biocompatibility and excellent sealing ability.

The study can provide us with the information about the best material which provide better periapical healing to get the best outcome of the root canal treatment by clinician. Further studies can be carried out using CBCT to get more accurate results over conventional intraoral periapical radiograph. Impossibility of controlling all variables such as varied healing time of patients may interfere with the results of the study.

Comparison amongst the three sealers would provide us with the information about the best material which offers better periapical healing to get the best outcome of the root canal treatment by clinician.