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Year : 2020  |  Volume : 8  |  Issue : 2  |  Page : 70-74

Comparative evaluation of sealing ability of two different biocompatible materials in repair of furcal perforation: An In vitro study

Department of Pediatric and Preventive Dentistry, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar, Punjab, India

Date of Submission28-Jun-2020
Date of Decision09-Jul-2020
Date of Acceptance21-Jul-2020
Date of Web Publication23-Sep-2020

Correspondence Address:
Buneet Kaur
Department of Pediatric and Preventive Dentistry, Sri Guru Ram Das Institute of Dental Sciences and Research, Amritsar - 143 001, Punjab
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/dmr.dmr_32_20

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Purpose: The purpose of this study was to evaluate the sealing ability and microleakage of Biodentine and mineral trioxide aggregate (MTA) Repair HP as furcal perforation repair materials. Materials and Methods: Twenty permanent mandibular molars were divided for ten samples each in Group I – Biodentine and Group II – MTA Repair HP. After access cavity preparation, artificial perforation was created and sealed with the repair material. Specimens were suspended in 2% methylene blue dye for 24 h and then split into longitudinal sections. After examining the depth of dye penetration under stereomicroscope, microleakage was calculated. Results: A higher mean microleakage was recorded in MTA Repair HP as compared to Biodentine. Conclusion: The study showed that Biodentine shows maximum sealing ability and least microleakage when compared with MTA Repair HP.

Keywords: Biodentine, furcal perforation repair, mandibular molars, microleakage, mineral trioxide aggregate Repair HP

How to cite this article:
Grover R, Sadana G, Gupta S, Gupta T, Mehra M, Kaur B. Comparative evaluation of sealing ability of two different biocompatible materials in repair of furcal perforation: An In vitro study. Dent Med Res 2020;8:70-4

How to cite this URL:
Grover R, Sadana G, Gupta S, Gupta T, Mehra M, Kaur B. Comparative evaluation of sealing ability of two different biocompatible materials in repair of furcal perforation: An In vitro study. Dent Med Res [serial online] 2020 [cited 2021 Apr 11];8:70-4. Available from: https://www.dmrjournal.org/text.asp?2020/8/2/70/295866

  Introduction Top

It is important to maintain the integrity of natural dentition to maintain its form, function, and natural esthetics. Root canal therapy or endodontic therapy helps in achieving this goal. However, prognosis of the treatment can be affected by some mishaps that occasionally occur during this treatment.[1] Among them, perforation of root canal wall, being the second most common mishaps, significantly impacts the prognosis of the tooth. Perforation is termed as a pathological/mechanical/iatrogenic communication between the root canal system and the surrounding periodontal tissues. Furcal perforation, being mid-curvature opening into the periodontal ligament space, is the worst possible outcome for endodontic treatment. It may be caused during a pathological process such as dental caries and internal/external root resorption or due to mechanical or iatrogenic cause, during endodontic treatment or postplacement.

The correction of furcation perforation can be achieved using intracoronal surgical approach and by nonsurgical coronal approach. Nonsurgical process, being the most favorable process, involves the immediate placement of a repair material in the perforation to avoid potential bacterial infection.[2] Its long-term prognosis depends on many factors, such as the location/size of perforation, the time delayed before repair, the contamination before placement of repair material, the sealing ability of the material, and the periodontal status of the tooth.

An ideal perforation repair material should include following inherent properties: it should be providing an adequate seal, should be biocompatible with the oral tissue, should not be affected by blood contamination, should be bactericidal, and should induce bone formation and healing. It should be radiopaque enough to be seen radiographically. It should induce mineralization and cementogenesis. Further, it should be easy to manipulate and place in the cavity. Several materials were proposed for sealing of perforations.[3] These materials include zinc oxide-eugenol cement, glass-ionomer cement, resin cement, and resin-modified glass-ionomer cement. However, so far, no material has satisfied all the above-required properties.

Nowadays, most preferred furcation repair materials are bioactive materials such as mineral trioxide aggregate (MTA), Biodentine, and a newer variant of MTA, MTA Repair HP. The aim of thisin vitro study was to evaluate the sealing ability of Biodentine and the newer variant MTA Repair HP as a furcal repair material, in permanent molars, according to the properties of the ideal perforation repair material.

  Materials and Methods Top

Twenty freshly extracted, permanent mandibular molars were used. Immediately after extraction, the roots of each tooth were cleaned of soft tissues or bone remnants, disinfected with 3% NaOCl for 10 min, and stored in normal saline solution until usage [Figure 1].
Figure 1: Twenty samples

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Inclusion criteria

Intact permanent mandibular molars extracted purely for periodontal reasons were included in the study.

Exclusion criteria

Teeth with the presence of any type of carious lesions, restorations, or any defects, hypoplastic/fractured teeth, or teeth with fused roots were discarded.

Specimen preparation

  1. Access cavities were prepared with a round diamond bur under copious irrigation with water spray, and root canal orifices were located
  2. Artificial perforation was created using a round diamond bur [Figure 2]
  3. Sticky wax was applied on canal orifices
  4. Molars were divided into two experimental groups of 10 samples each and were kept in moistened cotton to stimulate clinical conditions
  5. Perforation repair: Group 1 – In 10 molars, perforations were sealed with Biodentine and Group 2 – In 10 molars, perforations were sealed with MTA Repair HP [Figure 3]
  6. After perforation repair, access cavity was sealed with composite restoration
  7. The samples were kept in Petri dish and placed in incubator for 24 h at 37°C.
  8. After 24 h, nail varnish was applied to the specimen except around the perforation area and allowed to dry [Figure 4]
  9. Specimens were suspended in 2% methylene blue dye for 24 h and subsequently rinsed in tap water for 15 min
  10. All the specimens were then split into longitudinal sections using diamond disc, and the depth of dye penetration was examined under stereomicroscope and microleakage associated was calculated.
Figure 2: Artificial perforation

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Figure 3: Perforation repair

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Figure 4: Varnish application

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The scores were given according to dye penetration as follows.
Figure 5: Score 0

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Figure 6: Score 1

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{Figure 7}

  1. 0 – no leakage detected
  2. 1 – Leakage extending to ¼ of repair material
  3. 2 – Leakage extending to ½ of repair material
  4. 3 – Leakage extending to — of repair material
  5. 4 – Leakage extending beyond — of repair material.

  Results Top

The sealing ability of MTA Repair HP against Biodentine as furcal repair material was compared. A higher mean microleakage was recorded in MTA Repair HP as compared to Biodentine. The Mann–Whitney U-test was used to check differences in mean scores between the groups. The difference in proportions was evaluated by Chi-square test.

The analysis done by Mann–Whitney U-test showed statistically significant differences (significant at P < 0.05 [P = 0.032]). The MTA Repair HP has a high mean leakage score of 1.10 ± 0.87 against Biodentine which had a score of 0.30 ± 0.48 [Graph 1].

The Chi-square test showed statistical significant differences in proportions of leakage scores among the groups (P < 0.05 [P = 0.049]). The MTA group had 30.0%, 30.0%, and 40.0% scores for 1, 2, and 3, respectively. The Biodentine group had 70.0% and 30.0% scores for 1 and 2, respectively. Both the MTA and Biodentine groups had 0.0% score for 4 and 5, respectively [Graph 2].[INLINE:2xs]

  Discussion Top

The most common endodontic failures are due to perforations, file fracture, zipping, canal transportation, ledging, and sodium hypochlorite accidents. According to Ingle, perforations being the second most common reason, they account for 9.6% of all mishaps. Postplacement causes 53% of iatrogenic perforations and routine endodontic treatment causes the remaining 47%. Among these, maximum cases are of perforations occurring in furcation areas of multirooted teeth when removing dentin from the pulp chamber while searching for canals.[4] A perforation should be sealed with a biocompatible material as soon as possible. The material should be compatible enough to withstand the mechanical forces of condensation of restorative materials as well as tooth function over the perforation repair site. The success of the furcation repair also depends on maintaining the effective seal and prevention of microleakage between the root canal and the periodontal ligament.[5] Cementogenesis, being a vital process in dentoalveolar formation and the cementum formed by this process, acts as a biological barrier against the microbial irritants within the root canal system.

Among all the available materials, MTA and Biodentine are few among others which are capable of causing complete regeneration of the adjacent dentoalveolar tissue, especially in permanent teeth due to which they are used in furcal perforation repair.[6] MTA, being developed by Torabinejad in the early 1990s, consists of fine hydrophilic particles of tricalcium silicate, tricalcium aluminate, tricalcium oxide, and silicon oxide. Its mixture with water causes the formation of colloidal gel. The setting time of MTA is approximately 3–4 h. During the initial stages, the pH is 10.2, and later, when the material has set, it becomes 12.5.[7] However, it has several drawbacks such as prolonged setting time, difficult handling characteristics, potential discoloration of tooth, and gingiva. It was also found that blood contamination had adverse effects on the retention characteristics of MTA.[8]

A newer variant of MTA, MTA Repair HP, has been introduced which claims to be superior for the abovementioned drawbacks. It is silicate-based cement material, which was developed based on properties of calcium silicate cement, claiming improved performance compared with traditional MTA. MTA HP powder is composed mainly of tricalcium silicate, dicalcium silicate, tricalcium aluminate, calcium oxide, calcium carbonate (filler material), and calcium tungstate (radiopacifier), whereas the liquid consists of water and a plasticizing agent. According to the manufacturer, this new material has high-plasticity and improved physical properties.[9]

Biodentine, introduced as a dentine substitute, exhibited lowest microleakage as it is a Calcium silicate-based material. It also includes CaCl2 as a setting accelerator. It bonds with the dentin in chemo mechanical way. It forms tag-like structure at its interface with tooth structure. These structures where the alkaline caustic are formed as the calcium silicate degrades the collagenous component of interfacial dentine.[10]

Han and Okiji (2011) showed that calcium and silicon ion uptake into dentin leading the formation of tag-like structures in Biodentine was higher than MTA. Better seal with Biodentine can also be attributed to its modified powder composition which is the introduction of setting accelerators and softeners.[11] A new predosed capsule formulation for use in a mixing device largely improves the physical properties including sealing ability of the material. The smaller particle size of Biodentine leads to sealing interface porosity and pore volume in set Biodentine material being less than MTA, which could be a reason for better sealing ability.[7]

Compared to MTA Repair HP, Biodentine has better handling and mechanical properties and reduced setting time, thereby sealing the interface to avoid further risk of bacterial contamination. Unlike other Portland cement-based products, it is sufficiently stable so that it can be used both for pulp protection and temporary fillings.[12]

Clinically, MTA is used for creating an apical plug during apexification, repairing root perforations during root canal therapy, and treating internal root resorption as a root-end filling material and pulp capping material, whereas Biodentine can be clinically used for pulp capping, pulpotomy, apexification, in root perforation, and as a root-end filling material in periapical surgery.

  Conclusion Top

Within the limitations of this study, it was found that Biodentine showed better sealing ability than MTA Repair HP. Therefore, Biodentine can be used as a replacement for MTA Repair HP as a furcal repair material. However, furtherin vitro andin vivo studies are recommended to confirm and correlate this study's findings to a clinical scenario.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Jeevani E, Jayaprakash T, Bolla N, Vemuri S, Sunil CR, Kalluru RS. Evaluation of sealing ability of MM-MTA, endosequence, and biodentine as furcation repair materials: UV spectrophotometric analysis. J Conserv Dent 2014;17:340-3.  Back to cited text no. 1
[PUBMED]  [Full text]  
Pathak S, Sharma D. A comparative analysis of sealing ability and micro leakage of different materials as a furcation repair material: An ex vivo study. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 2018;17:41-50.  Back to cited text no. 2
Kakani AK, Veeramachaneni C, Majeti C, Tummala M, Khiyani L. A review on perforation repair materials. J Clin Diagn Res 2015;9:ZE09-13.  Back to cited text no. 3
Arens DE, Torabinejad M. Repair of furcal perforations with mineral trioxide aggregate: two case reports. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:84-8.  Back to cited text no. 4
Sinkar RC, Patil SS, Jogad NP, Gade VJ. Comparison of sealing ability of ProRoot MTA, RetroMTA, and Biodentine as furcation repair materials: An ultraviolet spectrophotometric analysis. J Conserv Dent 2015;18:445-8.  Back to cited text no. 5
[PUBMED]  [Full text]  
Samuel A, Asokan S, Priya PG, Thomas S. Evaluation of sealing ability of Biodentine™ and mineral trioxide aggregate in primary molars using scanning electron microscope: A randomized controlledin vitro trial. Contemp Clin Dent 2016;7:322-5.  Back to cited text no. 6
[PUBMED]  [Full text]  
Camilleri J. The chemical composition of mineral trioxide aggregate. J Conserv Dent 2008;11:141-3.  Back to cited text no. 7
[PUBMED]  [Full text]  
Rahimi S, Ghasemi N, Shahi S, Lotfi M, Froughreyhani M, Milani AS, et al. Effect of blood contamination on the retention characteristics of two endodontic biomaterials in simulated furcation perforations. J Endod 2013;39:697-700.  Back to cited text no. 8
Silva EJ, Carvalho NK, Zanon M, Senna PM, DE Deus G, Zuolo ML, et al. Push out bond strength of MTA HP, a new high plasticity calcium silicate based cement. Braz Oral Res 2016;30(1):e84  Back to cited text no. 9
Malkondu Ö, Karapinar Kazandaǧ M, Kazazoǧlu E. A review on biodentine, a contemporary dentine replacement and repair material. Biomed Res Int 2014;2014:160951.  Back to cited text no. 10
Han L, Okiji T. Uptake of calcium and silicon released from calcium silicate-based endodontic materials into root canal dentine. Int Endod J 2011;44:1081-7.  Back to cited text no. 11
Priyalakshmi S, Ranjan M. Review on biodentine-a bioactive dentin substitute. J Dent Med Sci 2014;13:51-7.  Back to cited text no. 12


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7)]


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