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Effect of Root Dentin Conditioning On The Pushout Bond Strength of Biodentine
Effect of Root Dentin Conditioning On The Pushout Bond Strength of Biodentine
Abstract
Introduction: Sodium hypochlorite (NaOCl) is the main
irrigant to clean root canals. Decalcifying agents are
advocated as additional means to condition the root
T he essential part for
endodontic success is
proper cleaning of the
Significance
Irrigation with 2.5% NaOCl/9% Dual Rinse HEDP
can improve the pushout bond strength of Bio-
dentin. The aim of this study was to evaluate the effect root canal system (1).
dentine to the root canal dentin.
of alternating (EDTA) or continuous 1-hydroxyethane Studies have shown that
1,1-diphosphonic (HEDP) chelation in conjunction with large areas of root canal
NaOCl irrigation on the pushout bond strength of Bio- walls remain untouched by hand and rotary instruments during canal preparation.
dentine (Septodont, Saint Maur des Fosses, France). This shows the importance of cleaning and disinfecting the root canal system using
Methods: Single root canals of 50 extracted, mature hu- chemical means. To this end, the combined use of 2 or more irrigating solutions in
man teeth were divided into 5 groups (n = 10) and a specific sequence can be used to predictably achieve the goals of safe and optimal
enlarged using rotary instruments. Canals were irrigated irrigation.
with 5 mL irrigant after each instrument and then with During mechanical preparation, a smear layer is produced in the root canal
5 mL after mechanical preparation as follows: 2.5% system on instrumented canal walls, whereas the noninstrumented area can be
NaOCl during and then 2.5% NaOCl, 17% EDTA, or covered by dentin mud and debris (2). Studies have shown that these entities
17% EDTA followed by 2.5% NaOCl after preparation. can impede sealer penetration into the dentinal tubules, thereby compromising
Continuous chelation with 2.5% NaOCl/9% Dual Rinse the seal of obturating materials (3). In some cases, the smear layer and debris
HEDP (Medcem GmbH, Weinfelden, Switzerland) during can be infected, thereby protecting the microorganisms within the dentinal tubules
and after preparation. The control group was irrigated and in isthmus areas (4). Furthermore, the infiltration of root canal irrigants and
with water during and after preparation. Canals were intracanal medicaments into the dentinal tubules can be impeded (5), and micro-
then filled with Biodentine. A horizontal section of leakage can occur.
1.5-mm thickness was taken from the middle root third, Sodium hypochlorite (NaOCl) is the most widely used irrigant in endodontics
and a pushout bond test was performed. Data were because of its potential to dissolve organic tissue as well as its antimicrobial properties
statistically analyzed using 1-way analysis of variance/ (6). In addition to NaOCl, the following chemical agents that aid in the elimination of the
Tukey honest significant different test. Results: smear layer and debris have been proposed and used in clinics: EDTA and its various
The pushout bond strength of Biodentine was signifi- formulations, tetracycline, a mixture of a tetracycline isomer, an acid and a detergent,
cantly higher when the root canal was irrigated with organic acids such as maleic and citric acid, tannic acid, and 20% polyacrylic acid.
2.5% NaOCl/9% Dual Rinse HEDP (19.6 2.3 MPa) EDTA is a polyaminocarboxylic acid that is water soluble in a neutral or alkaline pH.
than with NaOCl alone (15.5 1.5 MPa) or the It is used in endodontics because of its chelating property whereby it interacts with cal-
NaOCl/EDTA sequences (15.7 2.2 MPa and cium ions present in dentin to form soluble chelates of calcium. It is the most widely
16.9 2.9 MPa) (P < .05), which did not differ among used chelating agent in endodontics (7). However, it has various drawbacks including
each other (P > .05). The lowest pushout bond reduced efficacy in the elimination of the smear layer in the apical third (8), a reduction
strength values were found with water irrigation in dentin microhardness (9), and cytotoxicity (10). Furthermore, it also reduces the
(11.5 0.5 MPa) (P < .05 to all other groups). Conclu- bond strength of resin cements (11), brings about a reduction in active chlorine
sions: Irrigation with 2.5% NaOCl/9% Dual Rinse HEDP when combined with NaOCl (12), and forms a precipitate in combination with chlor-
significantly improved the pushout bond strength of Bio- hexidine (13).
dentine to the root canal dentin. (J Endod 2018;-:1–5) Etidronic acid (also known as 1-hydroxyethane 1,1-diphosphonic [HEDP]) is a
biocompatible chelator that can be used in conjunction with NaOCl. It is a ‘‘soft’’
Key Words chelator that is less aggressive on dentin than EDTA (14). Studies have shown that it
Biodentine, dual rinse HEDP, EDTA, pushout bond has a weak chelating capacity when used alone (15). This property can be used to
strength, smear layer, sodium hypochlorite the advantage of using NaOCl and HEDP as a single irrigant during and after root canal
From the Departments of *Conservative Dentistry and Endodontics and †Dental Materials, Manipal College of Dental Sciences, Manipal Academy of Higher Edu-
cation, Manipal, Karnataka, India.
Address requests for reprints to Dr Nidambur Vasudev Ballal, Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal-
576 104, Manipal Academy of Higher Education, KA, India. E-mail address: drballal@yahoo.com
0099-2399/$ - see front matter
Copyright ª 2018 American Association of Endodontists.
https://doi.org/10.1016/j.joen.2018.04.009
Figure 2. Representative stereomicroscopic images of the types of bond failures. (A) Adhesive failure, (B) cohesive failure, and (C) mixed failure.
current study, the dentin discs of 1.5 mm were used for the purpose of References
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Acknowledgments 11. Mitzi DM, Lee KW, Agee KA, et al. Effects of sodium hypochlorite and RC-Prep on
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Switzerland, for his expertise and suggestions in this study. 12. Grawehr M, Sener B, Waltimo T, Zehnder M. Interactions of ethylenediaminetetra-
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The Dual Rinse used in this study was kindly supplied free of 411–7.
charge by Medcem GmbH, Weinfelden, Switzerland. 13. Rasimick BJ, Nekich M, Hladek MM, et al. Interaction between chlorhexidine digluc-
The authors deny any conflicts of interest related to this study. onate and EDTA. J Endod 2008;34:1521–3.