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Radiographs of tooth 21 in a 26-year-old male with persistent lesion 1 year after root canal therapy (RCT) and a history of swelling. a Preoperative periapical radiograph (PA). b Postoperative PA after endodontic microsurgery. c and d 6-month and 1-year follow-up respectively showing complete healing with reformation of lamina dura around the apex
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Objectives
The purpose of this study was to assess the clinical and radiographic outcome of root-end microsurgery using a premixed fast-set calcium silicate putty as root-end filling material in human teeth.Materials and methodsThis study included 50 teeth in 35 patients, whose ages ranged from 16 to 69 years. After clinical and radiographic examin...
Citations
... The population in this study, undergoing periradicular surgery, was older than the Swedish population undergoing root canal treatment (Fransson et al., 2016). Compared with previous studies on outcomes of periradicular surgery, the population in this study is substantially older (Chan et al., 2020;Huang et al., 2020;Kim et al., 2018;Liao et al., 2019;Raedel et al., 2015;Von Arx et al., 2019;Taha et al., 2021;Zhou et al., 2017). One reason might be that the oral health status of the Swedish population is considered to be comparatively good and therefore, root canal treatments and hence periradicular surgery are undertaken later in life (Norderyd et al., 2015). ...
Aim:
This historical prospective cohort study of the adult population of Sweden is based on data from a national registry: the primary aim was to evaluate the long-term survival of teeth after periradicular surgery. A secondary aim was to identify factors predictive of extraction within 10 years of registration of periradicular surgery.
Methodology:
The cohort consisted of all individuals who had undergone periradicular surgery to treat apical periodontitis, as reported to the Swedish Social Insurance Agency (SSIA) during 2009. The cohort was followed until December 31, 2020. Subsequent registrations of extractions were collected for Kaplan-Meier survival analyses and survival tables. The patients' sex, age, dental service provider and tooth group were also retrieved from SSIA. Only one tooth per individual was included in the analyses. Multivariable regression analysis was used and P < 0.05 was considered statistically significant. The reporting guidelines STROBE and PROBE were followed.
Results:
After data cleaning, and exclusion of 157 teeth, 5 622 teeth/individuals remained for analysis. The mean age of the individuals at the time of the periradicular surgery was 60.5 years (range 20-97, standard deviation 13.31); 55% were women. At the end of the follow-up, that is, up to 12 years, a total of 34.1% of the teeth had been reported as extracted. The multivariate logistic regression analysis, based on follow-up data at 10 years after registration of the periradicular surgery, included 5 548 teeth, of which 1 461 (26.3%) had been extracted. Significant associations between the independent variables tooth group and dental care setting (both P < 0.001) and the dependent variable extraction were found. The highest odds ratio (OR) for extraction applied to tooth group: compared to maxillary incisors and canines, mandibular molars were at greatest risk of extraction (OR 2.429, confidence interval 1.975-2.987, P < 0.001).
Conclusions:
After periradicular surgery in predominantly elderly people in Sweden, approximately three quarters of the teeth are retained over a 10-year period. The type of tooth is associated with extraction: mandibular molars are at greater risk of extraction than maxillary incisors and canines.
... Using the same experimental protocol, the potential to induce osteogenesis appears to be diverse among the cements, as they seemed to induce different phases of cellular differentiation [68]. Additionally, the available clinical data support a positive outcome of the CSCs [19,69,70], namely the tested formulations. Compared to the "gold standard" ProRoot ® MTA, Biodentine TM has also been thoroughly evaluated, accounting for similar or even higher positive outcomes being suggested for similar clinical conditions [71,72]. ...
... Fewer clinical studies/trials are available regarding the pre-mixed materials, namely TotalFill ® . Still, as happens with the other cements in this group, positive results have also been described [69,71]. This highlights two aspects, i.e., the overall performance of the CSCs as a group and/or the need for further fundamental and clinical assessment, validating efficacy in specific clinical applications. ...
Calcium silicate-based cements are used in a variety of clinical conditions affecting the pulp tissue, relying on their inductive effect on tissue mineralization. This work aimed to evaluate the biological response of calcium silicate-based cements with distinct properties—the fast-setting Biodentine™ and TotalFill® BC RRM™ Fast Putty, and the classical slow-setting ProRoot® MTA, in an ex vivo model of bone development. Briefly, eleven-day-old embryonic chick femurs were cultured for 10 days in organotypic conditions, being exposed to the set cements’ eluates and, at the end of the culture period, evaluated for osteogenesis/bone formation by combining microtomographic analysis and histological histomorphometric assessment. ProRoot® MTA and TotalFill® extracts presented similar levels of calcium ions, although significantly lower than those released from BiodentineTM. All extracts increased the osteogenesis/tissue mineralization, assayed by microtomographic (BV/TV) and histomorphometric (% of mineralized area; % of total collagen area, and % of mature collagen area) indexes, although displaying distinct dose-dependent patterns and quantitative values. The fast-setting cements displayed better performance than that of ProRoot® MTA, with BiodentineTM presenting the best performance, within the assayed experimental model.
... MTA is also currently considered the material of choice for retrograde sealing after periapical surgery as it achieves more favorable results and better clinical outcomes when compared to other traditionally used materials, such as Super EBA and amalgam [18,21]. Based on the results of studies focused on physical properties, biocompatibility and clinical performance, both TF and BD seem to be favorable alternatives to MTA when performing periapical surgery and endodontic treatment of immature teeth [12,14,[22][23][24][25][26][27]. However, there are still certain aspects in their mechanical performance that have not been thoroughly contrasted yet. ...
Background
The aim of this study was to compare the pushout bond strength (POBS) of three hydraulic cements, when used at thicknesses of 3 and 5 mm.
Methods
78 root slices of 3 and 5 mm of thickness were obtained from human teeth. Cylindrical cavities of 1.4 mm of diameter were drilled and filled with Biodentine (BD), Totalfill Root Repair paste (TF) or ProRoot MTA White (PMTA). Pushout tests were performed 21 days later. The fracture pattern of each sample was also analyzed. POBS data were analyzed with Welch and Brown-Forsythe and Tamhane’s post hoc tests and a Weibull analysis was also performed.
Results
In the 3 mm group, TF showed significantly lower bond strength than BD and PMTA. In the 5 mm group, BD showed significantly higher bond strength than TF. Both BD and TF showed higher bond strength when the thickness of the sample increased, while PMTA did not.
Conclusions
TF and BD achieve higher pushout bond strength resistance when used at a thickness of 5 mm than at 3 mm, while the mean resistance of PMTA is less influenced by the thickness. At 5 mm of thickness, BD and PMTA exhibit similar resistance to displacement. However, the behavior of BD is more predictable than that of its predecessor. BD is a reliable hydraulic cement for clinical situations where thick cavities need to be filled and displacement resistance plays an important role. Clinicians need to consider choosing specific hydraulic cements according to the thickness of material to be used.
... Zirconium oxide and tantalum oxide are added as the radiopacifier agents to the putty form without any other additives. Bioceramics are available as a premixed material that hydrate in contact with moisture (TotalFill) (Fast Set Putty, FKG, La-Chaux-de-Fonds, Switzerland), with favorable handling properties and short setting time that make it resistant to washout and ideal for root repair and VPT procedures [14][15][16]. ...
Objectives
This study aimed to randomly compare in vivo coronal discoloration at 6 and 12 months after full pulpotomy in mature permanent molars using MTA, Biodentine, and TotalFill and to investigate the effect of variables such as remaining buccal wall thickness and time to achieve hemostasis.
Materials and methods
One hundred eight teeth that met the inclusion criteria received full pulpotomy and were randomly divided into 3 groups via a block randomization technique according to the calcium silicate cement (CSC): ProRoot WMTA, TotalFill, or Biodentine. Assessment of tooth color was carried out using a spectrophotometric device (VITA Easyshade Compact) after composite placement (T0), at 6- and 12-month follow-up. Buccal wall thickness and time to hemostasis were recorded. The primary outcome measure (color change ΔE) was calculated, and the results were analyzed by three-way ANOVA and crosstabulations in relation to material type and effect of variables.
Results
Four cases were excluded after pulpotomy failure; 81 teeth were evaluated at 6 months and 95 teeth at 12 months. All CSCs caused tooth discoloration (defined as ΔE > 3.7); MTA significantly caused the highest color change at 6- and 12-month follow-up (76% (19/25) and 87.5% (28/32), respectively) compared to Biodentine (41% (9/22), 48% (13/27)) and TotalFill (44% (15/34), 53% (19/53)) (p = 0.022, p = 0.002), while no significant difference was found between the Biodentine and TotalFill groups (p = 0.813, p = 0.8). Buccal wall thickness (above or below 2.7 mm) had a significant effect on the degree of discoloration (p = 0.004).
Conclusions
The 3 CSCs caused tooth discoloration based on the threshold of ΔE > 3; the remaining buccal wall thickness was a significant factor. The use of Biodentine and TotalFill instead of MTA is encouraged to minimize discoloration.
Clinical relevance
While experimental studies report coronal discoloration after CSCs use, clinical data is lacking. This study assessed discoloration using a spectrophotometric device. The use of materials with lower discoloration potential in pulpotomy is encouraged.
Trial registration
The study was registered with clinical trial registration number: NCT04346849 on 14.4.2020.
... Root repair material (EndoSequence BC RRM-fast set putty) is a relatively new bioceramic material. The indications are like those of MTA, including retrofilling of root-endings, vital pulp therapy, apexification, sealing of resorptions, and root perforations (6,(8)(9)(10)(11)(12)(13)(14)(15)(16). According to the manufacturer, it consists of calcium silicates, zirconium oxide, tantalum pentoxide, and monobasic calcium phosphate, besides bulking agents. ...
... BC RRM showed a proliferative effect on osteogenic and odontogenic cells and induced osteoblastic and cementoblastic differentiation in those cells (32). Although no human studies have compared the two materials in terms of surgical outcomes, two recent studies, one prospective with a one-year follow-up (16) and the other retrospective with a three-year follow-up (33), found that premixed tricalcium silicate putty was associated with high repair rates in patients who had undergone endodontic surgery based on clinical and radiographic evaluation. Among other factors, the good clinical outcomes reported for these materials are potentially related to their sealing ability, as shown in the present study. ...
Objective: To compare, in vitro, the bioceramic materials (MTA and BC RRM-fast set putty) capacity to prevent
microleakage of Enterococcus faecalis over time.
Methods: An experimental design was made with forty extracted human teeth, coronally cut, and prepared
to be placed in a leakage system under sterile conditions. They were randomly divided into two experimental
groups: thirty teeth (fifteen for each of retrograde filling material MTA and BC RRM-fast set putty) and a
control group: ten teeth (five positive control, five negative control). The 3 mm root-ends were submerged in
a brain-heart infusion broth with a red phenol indicator. The coronal access of each sample was inoculated
with E. faecalis every seven days to maintain bacterial viability. The lower chamber was evaluated daily for
30 days to observe the turbidity of the culture medium and establish the presence and day of the filtration.
Calculation of the colony-forming units (CFU) was performed for each leaked sample. Fisher's Exact Test was
used to verify the association between the presence or absence of leakage of the samples by type of bioceramic
material used and the Mann-Whitney U test to verify the existence of a difference between the average
of CFU by type of bioceramic material used. The significance level used was α=0.05 and a 95% confidence
level, as a decision rule for rejecting the null hypothesis.
Results: Of the total samples prepared for each group, leakage was found in 60.0% (9/15) of the MTA group and
40.0% (6/15) of the BC RRM-fast set putty group. All positive controls filtered on the first day of evaluation, while
20% (1/5) of the negative control leaked in the second week. There was no significant difference in leakege
between the two groups, nor concerning the bacterial count (P=0.101) and the type of cement used (P=1.000).
Conclusion: BC RRM-fast set putty was comparable to MTA in resisting bacterial microleakage during the observation time.
... Aside from microsurgical instruments, ultrasonic tips, and magnification, contemporary techniques include the use of biocompatible root-end filling materials, such as Mineral Trioxide Aggregate and Biodentine [6,10,18,[21][22][23]. Moreover, fast-set, puttylike, premixed, calcium silicate-based cements are currently available, which may help to reduce intervention time [10,24]. ...
Intentional replantation (IR) may offer a solution for persistent periapical lesions associated with endodontically treated teeth. A 35-year-old male patient presented with pain associated with the left mandibular second molar and hypoesthesia. Upon clinical examination, increased probing pocket depth in the mid-buccal surface was detected. Cone beam computed tomography revealed a previous non-surgical root canal treatment, with root canal filling material extrusion adjacent to the inferior alveolar nerve, a fractured instrument in the mesial root, and a large periapical radiolucency involving both teeth 37 and 36. A diagnosis of symptomatic post-treatment apical periodontitis was established. After discussing treatment options with the patient, an IR of tooth 37 was performed. Extra-oral procedures were completed in 17 min. At 9 months, hypoesthesia resolution was reported, and apical healing was radiographically observed. After 2.5 years, the replanted tooth showed extensive root resorption. An extraction with alveolar ridge preservation, using leukocyte-platelet rich fibrin (L-PRF), was performed. Six months after tooth extraction and regeneration, implant placement surgery was carried out. IR presents a valid treatment modality for the management of post-treatment apical periodontitis. When orthograde retreatment or apical microsurgery prove to be unfeasible, IR is a unique procedure with the potential to promote tooth preservation in properly selected cases. Although unsuccessful after 2.5 years, the IR of tooth 37 allowed for bone regeneration, the maintenance of tooth 36 vitality, and hypoesthesia resolution.
... Recently, a new calcium silicate-based bioceramic material named TotalFill Putty became available. It is a premixed bioceramic material with biological properties [15], it contains nano-particles and its manufacturer claims that it is highly resistant to washout and ideal for all types of root repair and pulp capping treatments [16][17][18]. More recently, a new version Fast Set Putty (TotalFill FS) has been introduced into the market and has all the properties of the original putty but with a faster setting time of only 20 min [16]. ...
Objectives:
Variations between the material compositions and the presence of a smear layer on the dentin surface may influence the bond strength of the material, thus this study evaluated the push-out bond strength of different calcium silicate materials to root dentin in the presence or absence of smear layer.
Materials and methods:
The palatal canal of sixty maxillary first premolars were prepared and divided into three groups according to the materials to be used: ProRoot WMTA, Biodentine, and TotalFill FS. Each group was then divided into two subgroups; with and without a smear layer. Roots were sectioned into three slices and filled with the tested materials. Push-out bond strength of materials was measured by universal machine.
Results:
Bond strength of Biodentine was significantly higher than the MTA and TotalFill FS in the presence or absence of smear layer. Overall, removing the smear layer reduced the bond strength of the three materials. The reduction was significant for MTA and TotalFill FS but not for Biodentine.
Conclusions:
Biodentine demonstrated the highest bond strength to radicular dentin followed by MTA, and then TotalFill FS. Overall, removal of the smear layer from dentin surface reduced the bond strength of the calcium silicate root repair materials.
... It is easy to handle, robust, has a relatively short setting time (within 1 h) and has been reported to be highly biocompatible and osteogenic (Papadopoulou et al., 2020). There is a limited number of reports available in the literature on using this fast setting putty in VPT procedures on permanent teeth although its application in other endodontic procedures have been shown to be favourable (Ree & Schwartz, 2015;Taha et al., 2021). Yang et al. (2020) reported favourable outcome of using iRoot BP Plus in partial pulpotomy of young immature permanent teeth with traumatic pulp exposure. ...
... Preoperative pain intensity was recorded using the Numerical Pain Distress Scale (NPDS) from 0-10 (Taha et al., 2021). All patients were informed about the details of the treatment, materials used, possible complications, follow-up dates and alternative treatment. ...
Aim:
To compare the outcome of full pulpotomy using 2 calcium silicate-based materials compared to MTA in symptomatic mature permanent teeth with carious pulp exposure.
Methodology:
This study was designed as a parallel, double blind, randomized controlled trial where symptomatic mature permanent teeth with carious pulp exposure meeting the inclusion criteria were randomly treated with full pulpotomy using one of 3 calcium silicate-based materials (ProRoot MTA, Biodentine, and TotalFill). Full pulpotomy was performed and haemostasis was achieved via a cotton pellet moistened with 2.5% NaOCl. A 3-mm layer of the calcium silicate-based material was randomly placed as the pulpotomy agent through a block randomization process followed by a resin-based composite restoration. Postoperative periapical radiograph was taken. Clinical and radiographic evaluation was completed after 6 months and 1 year. The patient and evaluator were blinded to the type of materials used. Pain levels were scored preoperatively and 7 days after treatment. Effect of potential prognosis factors including gender, age, diagnosis, bleeding time and type of caries were also analyzed.
Results:
One hundred and sixty-four teeth in 146 patients received full pulpotomy and were randomly assigned to either the tested or control material through block randomization technique; (50 MTA, 50 Biodentine, 64 TotalFill). The age ranged from 10-70 years. The diagnosis was irreversible pulpitis in 112 teeth (72%) and reversible pulpitis in 28 teeth (28%). The majority of patients presented with severe pain, during the first week 96.9% reported complete relief of pain or mild pain. Four cases had immediate failure. At six months the overall success rate was 92.2%, over 1 year 156/164 teeth attended follow up with 12 failures (2 restorative failures and 10 endodontic failures), the overall success of pulpotomy at 1 year was 92.3 % (144/156); 91.8% in MTA, 93.3% in Biodentine and 91.9 % in TotalFill with no significant difference among the groups and no side-effects observed. No significant association was evident between outcome and the investigated variables.
Conclusions:
The 1-year success rate of full pulpotomy did not differ significantly between Biodentine pulpotomy, TotalFill pulpotomy, and MTA pulpotomy.
... Amongst the contemporary retrograde filling materials, Endosequence bioceramic root repair material (BC RRM) available as premixed fast set putty (Brasseler, USA) was reported to have a rapid setting time (within 60 minutes) and high cell adhesion ability facilitating faster healing (9,10). Endosequence BC RRM putty has shown increased cementum formation compared to MTA retro-filling and presented with 92% successful clinical outcome during endodontic microsurgeries (11). ...
... These calcium silicate-based materials can form and deposit hydroxyapatite into the dentine collagen matrix by biomineralization and seals the root apex (6). Several in-vivo studies reported excellent periradicular healing with cellular cementum formation over the resected and retro-filled teeth with BC RRM putty (10,11,25). The nanoparticles (0.35μm size) of Endosequence BC RRM putty create a stronger bond to root dentine with enhanced penetration and interaction with moisture in the dentinal tubules. ...
Objective: To assess and compare the fracture strength of endodontically treated teeth when the retrograde
preparations were restored either with Biodentine or Endosequence BC RRM Fast set putty or Geristore.
Methods: One hundred and twenty human mandibular premolars were used and allocated randomly into
five groups (n=24 each). Following conventional root canal treatment, and apical root resection, retrograde
cavities of 3 mm were prepared using ultrasonic tips. Group 1 (intact, sound teeth), Group 2 (without rootend filling), Groups 3, 4 and 5were allocated for Biodentine, Endosequence BC RRM putty, and Geristore respectively. Thermo-mechanical cyclic loading (TMC) was performed for one section of samples in each group
(n=12 each) following which immediate and after TMC fracture resistance was evaluated using the Instron
machine. One-way ANOVA followed by Tukey's multiple post-hoc procedures was used for data analysis.
Results: Intact teeth had shown the highest fracture strength values than all other four groups (P<0.05) and
resected roots without root-end filling group exhibited the lowest resistance to fracture. Amongst the test
groups, Endosequence BC RRM putty displayed improved fracture strength, and Geristore exhibited the least
resistance to fracture. Fracture strength values were not statistically different among Endosequence fast set
putty and Biodentine group samples immediately and after thermo-mechanical cyclic loading (P=0.5987
and 0.9999 respectively). The fracture strength was notsignificantly different between Geristore and without
root-end filling groups (P=0.3530).
Conclusion: Endodontically treated teeth with Endosequence BC RRM putty or Biodentine root-end filled
teeth had shown better fracture resistance compared to Geristore. Retrofilling with Geristore was not able to
improve fracture strength of root canal-treated teeth.
... Amongst the contemporary retrograde filling materials, Endosequence bioceramic root repair material (BC RRM) available as premixed fast set putty (Brasseler, USA) was reported to have a rapid setting time (within 60 minutes) and high cell adhesion ability facilitating faster healing (9,10). Endosequence BC RRM putty has shown increased cementum formation compared to MTA retro-filling and presented with 92% successful clinical outcome during endodontic microsurgeries (11). ...
... These calcium silicate-based materials can form and deposit hydroxyapatite into the dentine collagen matrix by biomineralization and seals the root apex (6). Several in-vivo studies reported excellent periradicular healing with cellular cementum formation over the resected and retro-filled teeth with BC RRM putty (10,11,25). The nanoparticles (0.35μm size) of Endosequence BC RRM putty create a stronger bond to root dentine with enhanced penetration and interaction with moisture in the dentinal tubules. ...
Objective:
To assess and compare the fracture strength of endodontically treated teeth when the retrograde preparations were restored either with Biodentine or Endosequence BC RRM Fast set putty or Geristore.
Methods:
One hundred and twenty human mandibular premolars were used and allocated randomly into five groups (n=24 each). Following conventional root canal treatment, and apical root resection, retrograde cavities of 3 mm were prepared using ultrasonic tips. Group 1 (intact, sound teeth), Group 2 (without rootend filling), Groups 3, 4 and 5were allocated for Biodentine, Endosequence BC RRM putty, and Geristore respectively. Thermo-mechanical cyclic loading (TMC) was performed for one section of samples in each group (n=12 each) following which immediate and after TMC fracture resistance was evaluated using the Instron machine. One-way ANOVA followed by Tukey's multiple post-hoc procedures was used for data analysis.
Results:
Intact teeth had shown the highest fracture strength values than all other four groups (P<0.05) and resected roots without root-end filling group exhibited the lowest resistance to fracture. Amongst the test groups, Endosequence BC RRM putty displayed improved fracture strength, and Geristore exhibited the least resistance to fracture. Fracture strength values were not statistically different among Endosequence fast set putty and Biodentine group samples immediately and after thermo-mechanical cyclic loading (P=0.5987 and 0.9999 respectively). The fracture strength was notsignificantly different between Geristore and without root-end filling groups (P=0.3530).
Conclusion:
Endodontically treated teeth with Endosequence BC RRM putty or Biodentine root-end filled teeth had shown better fracture resistance compared to Geristore. Retrofilling with Geristore was not able to improve fracture strength of root canal-treated teeth.
