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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 11  »  Comparison of Diaket and MTA when used as root-end filling materials to support regeneration of the periradicular tissues
Comparison of Diaket and MTA when used as root-end filling materials to support regeneration of the periradicular tissues
Discussion - References.



Discussion.
The two materials chosen for this evaluation have been shown to support varying degrees of regeneration under different experimental conditions (Torabinejad et al. 1995a,b,c, Snyder Williams & Gutmann1996a, Moretton et al. 2000). Diaket is a polyvinyl resin that was initially formulated as a root-canal sealer, whilst used as a root-canal sealer and empirically as a root-end filling material for over two decades, Tetsch (1986) first documented the use of Diaket as a root-end filling material, suggesting that it be mixed to a very thick consistency.
As a root-canal sealer, the material was mixed in a ratio of 1:1, powder to liquid. Walia et al. (1995) showed that Diaket used in a ratio of two to three parts powder to one part liquid produced a material that provided better apical seal than either IRM or Super-EBA in both1and 3-mm deep root-end preparations. The tissue response to Diaket mixed in this manner was evaluated by Nencka et al. (1995).They found the material to be biocompatible with bone. This same favourable response was noted by SnyderWilliams & Gutmann (1996a,b), Douthitt (1996) and Witherspoon & Gutmann (2000) when Diaket was used as a root-end filling material in a dog model. An ‘osteoid’ type material was consistently formed adjacent to the Diaket root-end filling (Fig. 4). This material has not yet been fully characterized using immuno-histochemical techniques or specific matrix antigens and these evaluative tests remain to be performed.
Based on previous animal studies using the dog model, it would appear that 60 days is an appropriate time to wait between completion of experimental procedure and sacrifice. Previous dog studies have evaluated healing at intervals shorter than 60 days (Craig & Harrison 1993, Torabinejad et al. 1995a,b,c, Douthitt et al. 2001), equal to 60 days (Regan et al. 1999, SnyderWilliams & Gutmann 1996b) and more than 60 days (Torabinejad et al.1995a,b,c,Trope et al.1996, Ne 2001).
MTA was developed ‘to seal communications between the tooth and the external surface’ (Lee et al. 1993). The main constituents of this material are tricalcium silicate (CaSiO4), bismuth oxide (Bi2O3), dicalcium silicate (2CaOSiO2), calcium sulphate (CaSO4), tricalcium aluminate (3CaOAl2O3), tetra calcium aluminoferrite (4CaOAl2O3FeO3) and an amorphous structure consisting of 33% calcium, 49% phosphate, 2% carbon, 3% chloride and 6% silica (Torabinejad et al.1995a,b,c). Torabinejad et al. (1993;1994a,b) further recommended the use of MTA as a root-end filling material based on its sealing properties when compared to amalgam, IRM and Super-EBA. In a series of in vitro and in vivo experiments, investigating the physical properties and biocompability of MTA, the same group reported that MTA compared favourably with both Super-EBA and IRM (Torabinejad et al.1994a,b; 1995a,b,c). Further studies have confirmed the biocompability of the MTA in cultures of osteoblasts (Koh et al. 1998, Mitchell et al. 1999, Zhu et al. 2000). In response to the material, cell growth was favourable and the expression of IL-6 and IL-8 suggests that it may promote healing through the stimulation of bone metabolism. The presence of IL-8 has been shown to stimulate angiogenesis, which is necessary for connective tissue healing (Hu et al.1993).
Takata et al. (1998) have shown that transforming growth factor-b1 (TGF-b1) influences the development, remodelling and regeneration of cells. MacNeil et al. (1995) noted that the phosphorylated glycoproteinosteopontin is expressed and localized to the root surface during cementogenesis. Ne (2001) demonstrated marked immunoreactivity for both TGF-b1 and osteopontin in response to the presence of MTA when used as a root end filling in a dog model. Whilst these studies may suggest that MTA is osteoinductive, Moretton et al. (2000) found that subcutaneous and intraosseous implants of EBA and MTA were not osteoinductive but rather osteoconductive.
Clinically, both materials are markedly different. Whilst the MTA material is easily mixed, its handling characteristics are not ideal. It can be difficult to place and compact in many root-end preparations. Diaket, on the other hand is very easy to place and compact as a root-end filling in virtually all prepared root ends. It sets hard in a short time, after which it can be polished with a fine diamond rotary instrument to produce a smooth finish. It is also more radiopaque than MTA, providing a clear radiographic image of the final restoration.
Ideally, the healing responses both in the presence or absence of superimposed infection and inflammation should be evaluated. However, in practical terms, this is not always possible owing to financial and temporal constraints. In addition, surgery is occasionally performed in the absence of an active infection (e.g. multirooted teeth, in teeth with root fractures, perforations, fractured instruments).
The evidence collected during this histological study would suggest that formation of a complete cemental coverage over both the root end and the root-end filling material was possible, though not predictable. However, this indicates that it is feasible to promote ‘a double seal’ following root-end surgery, incorporating both a physical and biological covering or ‘seal’of the resected root end.

References.

Andreasen JO, Munksgaard EC, FredeboL, Rud J (1993) Periodontal   tissue regeneration including cementogenesis adjacent to dentin-bonded retrograde   composite fillings in humans. Journal of Endodontics 19, 151-3.
ndreasen JO, Rud J, Munksgaard EC (1989) Retrograde root filling with resin   and a dentin bonding agent: preliminary histologic study of tissue reactions   in monkeys. Danish Dental Journal 93, 195-7.
ukhil I (1991) Biology of tooth-cell adhesion. Dental Clinics of North   America 35, 459-67.
Buckley JA, Ciancio SG, McMullen JA (1984) Efficacy of epinephrine concentration   in local anesthesia during periodontal surgery. Journal of Periodontology   55, 653-7.
Cambruzzi JV, Marshall FJ (1983) Molar endodontic surgery. Journal of   the Canadian Dental Association 49, 61-6.
Craig KR, Harrison JW (1993) Wound healing following demineralization of   resected root ends in periradicular surgery. Journal of Endodontics 19,   339-47.
Craig RG, Zuroff M, Rosenberg PA (1997)The effect of endodontic materials   on periodontal ligament cell proliferation, alkaline phosphatase activity, and   extracellular matrix protein synthesis in vitro. Journal of Endodontics   23, 494-8.
Douthitt JC (1996) Management of Marginal Alveolar Bone Defects During Periradicular   Surgery Using the Guidor Bioresorbable Matrix Barrier. Doctoral Thesis.Waco,   Texas: Baylor University.
Douthitt JC, Gutmann JL, Witherspoon DE (2001) Histologic assessment of healing   after the use of a bioresorbable membrane in the management of buccal bone loss   concomitant with periradicular surgery. Journal of Endodontics 27, 404-10.
Gutmann JL (1993) Parameters of achieving quality anesthesia and hemostasis   in surgical endodontics. Anesthesia and Pain Control in Dentistry 2, 223-6.
Gutmann JL, Harrison JW (1994) Surgical Endodontics. St. Louis: Ishiyaku   EuroAmerica Inc.
Hu DE, Hori Y, Fan TP (1993) Interleukin-8 stimulates angiogenesis in rats.   In£ammation17, 135-43.
Koh ET, McDonald F, Pitt Ford TR, Torabinejad M (1998) Cellular response   to Mineral Trioxide Aggregate. Journal of Endodontics 24, 543-7.
Lee SJ, Monsef M, Torabinejad M (1993) Sealing ability of a Mineral Trioxide   Aggregate for repair of lateral root perforations. Journal of Endodontics19,   541-4.
MacNeil RL, Berry J, D'Errico J, Strayhorn C, Somerman MJ (1995) Localization   and expression of osteopontin in mineralized and nonmineralized tissues of the   periodontium. Annals of the New York Academy of Sciences 760, 166-76.
Man Y, Marshallbeck J (1995) A fast way to prepare sections for H & E   and immunostains. Histologic 1, 3-5.
Mitchell PJC, Pitt Ford TR, Torabinejad M, McDonald F (1999) Osteoblast biocompatibility   of mineral trioxide aggregate. Biomaterials 20, 167-73.
Moretton TR, Brown CE, Legan JJ, Kafrawy AH (2000) Tissue reaction after   subcutaneous and intraosseous implantation of mineral trioxide aggregate and   ethoxybenzoic acid cement. Journal of Biomedical Material Research 52, 528-33.
Ne RF (2001) Immunohistochemical comparison of TGF-a1, TGF-a2, TGF-a3 and   osteopontin in periradicular tissue response to root-end surgery using original   versus commercial MTA formulations. Doctoral Thesis. College Station, Texas:   Baylor College of Dentistry, Texas A&M University System Health Sciences   Center.
Nencka D, Walia H, Austin BP (1995) Histologic evaluation of the biocompability   of Diaket. Journal of Dental Research 74, 101.
Polson AM, Proye MP (1982) Fibrin linkage. Aprecursor for new attachment.   Journal of Periodontology 54, 141-7.
Regan JD, Gutmann JL, Iacopino AM, Diekwisch T (1999) Response of periradicular   tissues to growth factors introduced into the surgical site in the root-end   filling material. International Endodontic Journal 32, 171-82.
Register AA (1975) Bone and cementum induction by dentine demineralization   in situ. Journal of Periodontology 44, 49-54.
Rud J, RudV (1998) Surgical endodontics of upper molars: relation to the   maxillary sinus and operation in acute state of infection. Journal of Endodontics   24, 260-1.
Rud J, Rud V, Munksgaard EC (1996a) Retrograde root filling with dentin-bonded   modified resin composite. Journal of Endodontics 22, 477-80.
Rud J, Rud V, Munksgaard EC (1996b) Long-term evaluation of retrograde root   filling with dentin-bonded resin composite. Journal of Endodontics 22, 90-3.
Rud J, Rud V, Munksgaard EC (1997) Effect of root-canal contents on healing   of teeth with dentin-bonded resin composite seal. Journal of Endodontics   23, 535-41.
SnyderWilliams S, Gutmann JL (1996a) Periradicular healing in response to   Diaket root-end filling material with and without tricalcium phosphate.   International Endodontic Journal 29, 84-92.
SnyderWilliams S, Gutmann JL (1996b) Periradicular healing in response to   Diaket root-end filling materialw ith and without tricalcium phosphate. Erratum.   International Endodontic Journal 29, 216-7.
Takata T, D'Errico JA, Atkins KB, Berry JE, Strayhorn C, Taichman RS, Somerman   MJ (1998) Protein extracts of dentin affect proliferation and differentiation   of osteoprogenitor cells in vitro. Journal of Periodontology 69, 1247-55.
Tetsch P (1986) Wurzelspitzenresectionen. Munich, Germany: Carl Hanser   Verlag, 96-100.
Torabinejad M, Higa RK, McKendry DJ, Pitt Ford TR (1994a) Dye leakage of   four root-end filling materials: effects of blood contamination. Journal   of Endodontics 20, 159-63.
Torabinejad M, Hong CU, Lee SJ, Monsef M, Pitt Ford TR (1995a) Investigation   of mineral trioxide aggregate for root-end filling in dogs. Journal of Endodontics   21, 603-8.
Torabinejad M, Hong CU, McDonald F, Pitt Ford TR (1995b) Physical and chemical   properties of a new root-end filling material. Journal of Endodontics 21,   349-53.
Torabinejad M, Lee SJ, Hong CU (1994b) Apical marginal adaptation of orthograde   and retrograde root-end fillings: a dyeleakage and scanning electron microscopic   study. Journal of Endodontics 20, 402-7.
Torabinejad M, Rastegar AF, Kettering JD, Pitt Ford TR (1995c) Bacterial   leakage of mineral trioxide aggregate as a root end filling material. Journal   of Endodontics 21, 109-12.
Torabinejad M, Watson TF, Pitt Ford TR (1993) Sealing ability of a mineral   trioxide aggregate when used as a root-end filling material. Journal of   Endodontics 19, 591-5.
Trope M, Lost C, Schmitz HJ, Friedman S (1996) Healing of apical periodontitis   in dogs after apicoectomy and retrofilling with various filling materials.   Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology & Endodontics   81, 221-8.
Walia HD, Newlin S, Austin BP (1995) Electrochemical analysis of retrofilling   microleakage in extracted human teeth. Journal of Dental Research 74, 101.
Witherspoon DE, Gutmann JL (2000) Analysis of the healing response to gutta-percha   and Diaket when used as root-end filling materials in periradicular surgery.   International Endodontic Journal 33, 37-45.
Zhu Q, Haglund R, Safavi KE (2000) Adhesion of human osteblasts on root-end filling materials. Journal of Endodontics 26, 404-6.