The Effect of Temporary Filling Materials on the Microleakage in Endodontically Treated Teeth

Transcription

1 ORIGINAL ARTICLE / ORIGINALNI RAD Serbian Dental Journal, vol. 57, N o 2, UDC: : DOI: /SGS D The Effect of Temporary Filling Materials on the Microleakage in Endodontically Treated Teeth Aleksandra Djeri 1, Nataša Gajić 1, Slava Sukara 2, Valentina Veselinović 3, Sanja Ilić 4 1 Clinic for Restorative Dentistry, Dental Department, University of Banja Luka, Banja Luka, Bosnia and Herzegovina; 2 Clinic for Preventive and Pediatric Dentistry, Dental Department, University of Banja Luka, Banja Luka, Bosnia and Herzegovina; 3 Clinic for Dental Prosthetics, Dental Department, University of Banja Luka, Banja Luka, Bosnia and Herzegovina; 4 Health Centre, Dental Department, Banja Luka, Banja Luka, Bosnia and Herzegovina SUMMARY Introduction Besides anatomo-morphological characteristics of the root canal system, instrumentation techniques, obturation materials as well as temporary filling materials can influence the coronal microleakage. The aim of this study was to assess in vitro coronal microleakage of temporary filling materials in endodontically treated teeth by the method of colored solutions. Material and Methods Forty extracted human teeth (single-rooted and multi-rooted) divided into two groups of (intact and caries affected) were used. The root canals were instrumented by step-back preparation technique and 2.5% NaOCl as irigant solution. Obturation was performed by lateral condensation technique with Apexit paste and gutta-percha. Cavit and Glass Ionomer Cement were used as temporary filling materials. The solution of 50% AgNO 3 was used for microleakage assessment. The penetration of the color was evaluated using Light Microscope. Results Of intact teeth, 60% temporarily filled by Cavit showed the color penetration, while only 25% of the teeth temporarily filled by combination of GIC and Cavit. The difference was statistically significant (p<0.05). In caries affected teeth, the penetration of the color was observed in 55% of the samples when Cavit was used and in 32% when combination of GIC and Cavit was used as temporary filling material. The difference was statistically significant (p<0.05). Less color penetration occured in single-rooted than in multi-rooted teeth in both groups, but the differences were not statistically significant. Conclusion Glass Ionomer Cements in combination with Cavit provide better sealing of endodontically treated teeth. The least color penetration was observed in intact single-rooted teeth. Keywords: coronal microleakage; temporary filling materials; Glass Ionomer Cement; Cavit INTRODUCTION For a long time, apical microleakage was considered as a main issue in endodontically treated teeth. In the recent decades, many published articles have been dealing with the quality of the proximal as well as coronal sealing of the root canal space after obturation [1, 2]. The purpose of endodontic treatment is satisfactory cleaning and shaping of the root canal as well as good quality three-dimensional obturation. Besides anatomo-morphological characteristics of the root canal system, paste for obturation, instrumentation and obturation techniques, temporary filling materials can also influence the coronal microleakage [3]. Caries removal, access cavity preparation, instrumentation and cavity preparation for the final tooth restoration often require extensive removal of the tooth substance. Coronal part of the tooth is usually weak and the walls are thin, therefore it is necessary to choose an appropriate material for restoration which will also provide good coronal sealing. Minimum thickness of the temporary material should be 4 mm but sometimes in clinical conditions due to great loss of tooth substance it is difficult to achieve [4]. Coronal microleakage by inadequate temporary material or inadequate obturation of the root canal is directly related to the failure of endodontic therapy. If the temporary material is not placed properly or it is fractured during mastication, due to penetration of saliva and microorganisms from the oral cavity, apical periodontal inflammation can occur. For these reasons it is considered that endodontically treated teeth should be reconstructed by direct filling or by prosthetic crown within 30 days after the root canal obturation. The aim of this study was to assess in vitro coronal microleakage of temporary filling materials Cavit and combination of Glass Ionomer Cement (GIC) and Cavit by the method of colored solutions in endodontically treated teeth. Address for correspondence: Aleksandra DJERI, Mihaila Pupina 6, Banja Luka, Bosnia and Herzegovina; djeri9@gmail.com

2 70 Djeri A. et al. The Effect of Temporary Filling Materials on the Microleakage in Endodontically Treated Teeth MATERIAL AND METHODS Experiments were done using 40 intact and caries affected human teeth (single-rooted and multi-rooted) extracted for various reasons. Any tissue remnants and calculi were removed from the teeth. The teeth were rinsed under the tap water and kept in alcohol up to the start of the experiments. Access cavity was prepared in each tooth, in the teeth affected by caries; first, it was removed using carbide drill and then access cavity was formed. Instrumentation of the coronary third of the canals was done by Gates Glidden instruments sizes from 1 to 4 (VDW GmbH Munich, Germany) [5, 6]. Endodontic procedure was the same for all experimental groups. After access cavity preparation, remained pulp tissue was removed by barbedbroaches. Working length was determined 1 mm shorter than the length of the reamer #15 when its tip came to the apex of the tooth. Instrumentation of the canals was done by STEP BACK technique using manual instruments (reamers and files) followed by copious irrigations with 2.5% NaOCl solution. After instrumentation and irrigation was done, root canals were dried using paper points. Obturation was performed using lateral condensation technique and Apexit paste. The teeth were divided into two experimental groups A (intact) and B (carious) with 20 teeth in each. Two subgroups of 10 single-rooted teeth and 10 multi-rooted teeth were formed. After gutta-percha and paste removal from the root canal opening, Cavit or combination of Cavit and GIC were used as temporary filling materials. After temporary reconstruction of the coronal part of the tooth, all the teeth were kept at 37 C in humid conditions. After 7 days, all the teeth were coated with two layers of nail polish, except the belt of 1 mm width on the junction of temporary filling material Cavit and the cavity wall. Coronal part of the teeth was immersed in 50% solution AgNO 3 for 6 hours, then they were rinsed under running water and immersed into the film developer for 2 hours. The teeth were longitudinally split by 6 mm diameter diamond disc, in mesio-distal direction. The results were obtained using micrometer ruler under 6 times magnification. RESULTS The average color penetration in the intact single-rooted teeth when Cavit was used as temporary filling material was 40 μm while in the teeth where combination of GIC and Cavit was used, it was 12 μm. This difference was statistically significant (p<0.05) (Table 1). The average penetration of the color in the intact multi-rooted teeth when Cavit was used as temporary filling material was 34 μm while it was 15 μm in the teeth where combination of GIC and Cavit was used. The results suggested significant difference between the two tested groups (p<0.05) (Table 1). Analysis of the results also showed the color penetration was present in 30% of the single-rooted intact teeth and 60% of the multi-rooted intact teeth. This difference was statistically significant (p<0.05). The results showed that the penetration of the color in the intact teeth, temporarily closed by Cavit was observed in 60% of the teeth while in the corresponding group of the teeth temporarily closed by combination of GIC and Cavit it was seen in 25% of the samples. The difference was statistically significant (p<0.05). The average penetration of the color in the caries affected single-rooted teeth temporarily closed with Cavit was 26 μm while in the teeth where combination of GIC and Cavit was used, it was 23 μm. The difference was not statistically significant (Table 2). The average penetration of the color in the caries affected multi-rooted teeth where Cavit was used as temporary filling material was 33 μm while in the teeth when combination of GIC and Cavit Table 1. The average color penetration in the intact teeth depending on the type of teeth and type of temporary filling material. Tabela 1. Prosečan prodor boje kod intaktnih zuba u zavisnosti od vrste zuba i vrste privremenog ispuna. Teeth Zubi Single-rooted Jednokoreni Multi-rooted Višekoreni Table 2. The average penetration of the color of teeth affected by caries depending on the type of tooth and type of temporary material. Tabela 2. Prosečan prodor boje kod zuba zahvaćenih karijesom u zavisnosti od vrste zuba i vrste privremenog ispuna. Teeth Zubi Single-rooted Jednokoreni Multi-rooted Višekoreni Material Materijal N X SD SE Med Min Max Cavit GIC + Cavit Cavit GIC + Cavit N number of teeth; X mean value; SD standard deviation; SE standard error; Med median; Min minimal value; Max maximal value; GIC glass ionomer cement N broj uzoraka; X srednja vrednost; SD standardna devijacija; SE standardna greška; Med medijana; Min najmanja vrednost; Max najveća vrednost; GIC glasjonomer-cement Material Materijal N X SD SE Med Min Max Cavit GIC + Cavit Cavit GIC + Cavit N number of teeth; X mean value; SD standard deviation; SE standard error; Med median; Min minimal value; Max maximal value; GIC glass ionomer cement N broj uzoraka; X srednja vrednost; SD standardna devijacija; SE standardna greška; Med medijana; Min najmanja vrednost; Max najveća vrednost; GIC glasjonomer-cement

3 Stomatološki glasnik Srbije. 2010;57(2): was used it was 17.5 μm. This difference was not statistically significant (Table 2). Analysis of the results showed that in single-rooted teeth affected by dental caries, the color penetration was observed in 40% of the samples and in multi-rooted caries affected teeth in 50% of the teeth. The obtained difference was not statistically significant. Analysis of the results showed the penetration of the color in 55% of the caries affected samples where Cavit was used, while in the caries affected teeth where combination of Cavit and GIC was used as temporary filling material, it was noted in 32% of the teeth. This difference was statistically significant (p<0.05). DISCUSSION Despite the anatomical differences between apical and coronal part of the root canal, research regarding coronal microleakage is quite behind those on the quality of apical sealing. The quality of coronal sealing depends on different factors, primarily on the quality of a temporary filling which should appropriately seal the cavity, the canal system anatomy, preparation technique [7, 8, 9], obturation method [10] and type of the sealer [1, 11, 12]. This study evaluated coronal microleakage of endodontically treated teeth whose crowns were temporarily sealed with Cavit only or combination of GIC and Cavit. The results showed that the linear penetration of the color was the shortest in single-rooted teeth either intact or caries affected. This could be attributed to the configuration of the pulp cavity, especially coronal part that affected the passive penetration of color. Single-rooted teeth have wider canals, accessible to instrumentation and irrigation as well as obturation while in the multi-rooted teeth, endodontic treatment is more difficult because of the presence of multiple canals which affect not only the quality of obturation but also microleakage [13, 14]. Size of the access cavity also plays a big role in coronal microleakage. Single-rooted teeth have smaller access cavity and slighter surface is exposed to microbial agents from the oral environment while in the multi-rooted teeth, wider access cavity is necessary, in order to provide better instrumentation and easier manipulation by manual or rotary instruments [15]. The analysis of the results showed the shortest linear penetration of the color in coronal part of intact teeth. This can be explained by the fact that the access cavity has satisfactory thickness and height of walls, thus providing a good retention of temporary filling. That way, good quality coronal sealing is obtained with temporary filling even when the layer is thinner than 4 mm. Lateral condensation, used in this study, is the most commonly used technique because it gives satisfactory results in clinical conditions. De-Deus et al. [16] examined whether the method of obturation in oval shaped canals affects the marginal microleakage. Obturation was done by method of lateral condensation, system B and Thermafil technique. The samples were subjected to the influence of saliva and observed for 15 weeks. Microscopic analysis, after cutting teeth, showed microleakage in 30% of the samples when lateral condensation and System B were used and in 20% of the samples when Thermafil was used, respectively. A significant difference between the experimental groups (obturation techniques) was not observed. Complex techniques and systems for permanent obturation that are demanding to perform can lead to errors during manipulation and therefore can give worse quality of the obturation. The least penetration of the color was observed in intact single-rooted teeth after application of GIC and then application of Cavit of 4 mm thickness. In the teeth where it was not possible to provide the necessary thickness of the temporary filling due to caries tissue loss or access cavity preparation, the color penetration was much greater. The difference was statistically significant only between intact teeth, temporarily closed by a combination of GIC and Cavit and intact teeth temporarily closed by Cavit only, which points to the importance of GIC as a barrier against penetration of oral fluids and microorganisms [17]. Material for temporary restorations should provide a permanent airtight seal until permanent restoration is placed. Numerous studies assessed a various features of the temporary materials to reduce coronal microleakage as much as possible. Chailertvanitkul et al. examined the effect of resin-reinforced glass ionomer Vitrebond as liner above obturation material in endodontically treated teeth. The teeth were tested for coronary microleakage using a microbiological marker that contains anaerobic bacteria, Streptococcus and Fusobacterium nucleatum. The teeth were tested each day during 60 days for coronal microleakage. Samples that had Vitrebond liner did not show coronal microleakage within 60 days, while in the other teeth where Vitrebond was not placed, microleakage was registered in all 60 samples. It was concluded that the resin modified GIC is good barrier against bacterial penetration after obturation [6]. Imura et al. examined coronal microleakage of the three commonly used temporary filling materials: gutta-percha, Cavit and IRM. The results showed that none of these three materials can prevent coronal microleakage and bacterial penetration for more than 22 days. Conclusion was that Cavit was superior to gutta-percha and IRM [17]. Pisano et al. examined the ability of Cavit, IRM and Super-EBA to prevent liquid leaking into the canal. After chemomechanical instrumentation, the teeth were obturated by lateral condensation technique. Gutta-percha was removed 3.5 mm from the canal orifice and one of the three materials (Cavit, IRM, Super-EBA) was placed. After 90 days in the Cavit group, bacterial penetration was found in 15% of the samples while in the groups with IRM and Super-EBA in 35% of the samples [18]. It was confirmed that the permanent filling must be placed within 30 days of obturation and must provide good coronal sealing [3]. Yatsushiro et al. have done a longitudinal study in which, by the fluid filtering system, investigated the ability of MTA (mineral trioxide aggregate) and amalgam to provide adequate coronal sealing. They prepared cavity class I with the depth of 3mm on 33 teeth, removed guttapercha from the canal (2 mm) and placed MTA or amalgam. They followed liquid penetration after 1, 2, 3, 4, 8,

4 72 Djeri A. et al. The Effect of Temporary Filling Materials on the Microleakage in Endodontically Treated Teeth 12, 16, 20 and 24 weeks. It was concluded that amalgam had greater microleakage after 4 weeks and greater variability compared to the MTA [19]. CONCLUSION The results of the study showed that the Glass Ionomer Cement in combination with the Cavit provides better coronal sealing in endodontically treated teeth compared to the teeth temporarily filled by Cavit only. The lowest penetration of the color was observed in intact single-rooted teeth. REFERENCES 1. Stoll R, Betke K, Stachniss V. The influence of different factors on the survival of root canal fillings:a 10 year retrospective study. J Endod. 2005; 31: Živković S, Mijušković D. Endodontic treatment of the chronic periapical lesions. Beograd: Danubius-Dental; Živković S. The effect of smear layer in endodontically treated teeth. Stomatološki glasnik Srbije. 2001; 48: Turner JE, Anderson RW, Pashley DH, Pantera EA. Microleakage of temporary endodontic restorations in teeth restored with amalgam. J Endod. 1990; 16: Cohen S, Burns RC. Pathways of the Pulp.7th ed. St Louis: CV Mosby Co Chailertvanitkul P, Saunders WP, Saunders EM, Mackenzie D. An evaluation of microbial coronal leakage in the restored pulp chamber of root-canal treated multirooted teeth. Int Endod J. 1997; 30: Vassiliadis L, Liolios E, Kouvas V, Economides N. Effect of smear layer on coronal microleakage. Oral Surg Oral Med Oral Path Oral Radiol Endod. 1996; 82: McComb S, Smith DC. A preliminary SEM study of rooth canals after endodontic procedures. J Endod. 1975; 1: Mader CL, Baumgartner JC, Peters DD. SEM investigation of the smear layer on root canal walls. J Endod. 1984; 10: Kytridou V, Gutmann JL, Nunn MH. Adaptation and seal ability of two contemporary techniques in the absence of the dentinal smear layer. Int Endod J. 1999; 32: Rohde TR, Bramwell DJ, Hutter JW, Roahen JO. An in vitro evaluation of microleakage of a new root canal sealer. J Endod. 1996; 22: Sauaia ST, Gomes B, Pinheiro TE, Zaia AA, Ferazz CCR, Souta-Filho FJ. Microleakage evaluation of intraorifice sealing materials in endodontically treated teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102: Economides N, Kokoris I, Gogos C, Kolokouris I, Staurianos C. Comparative study of sealing ability of two root-end-filling materials with the use of dentin bonding agents. J Endod. 2003; 30: Camps J, Pashley D. Reliabilty of the dye penetration studies. J Endod. 2003; 29: Britto LR, Grimaudo JN, Vertucci JF. Coronal microleakage assessed by polimicrobial markers. J Contempt Dent Pract. 2003; 3: De-Deus G, Murad C, Paciornik S, Reis CM, Coutinho-Filho T. The effect of the canal-filled area on the bacterial leakage of oval-shaped canals. Int Endod J. 2008; 41: Imura N, Otani SM, Campos MJA, Jardim EG, Zuolo ML. Bacterial penetration through temporary restorative materials in root canal treated teeth in vitro. Int Endod J. 1997; 30: Pisano DM, DiFiore PM, McClanahan SB, Lautenschlager EP, Duncan JL. Intraorifice sealing of gutta-percha obturated root canals to prevent coronal microleakage. J Endod. 1998; 24: Yatsushiro JD, Baumgartner JC, Tinkle JS. Longitudinal study of the microleakage of two root end filling materials using a fluid conductive system. J Endod. 1998; 24: Received: 02/02/2010 Accepted: 30/04/2010

5 Stomatološki glasnik Srbije. 2010;57(2): Uticaj sredstava za privremeno zatvaranje na kruničnu mikropropustljivost endodontski lečenih zuba Aleksandra Đeri 1, Nataša Gajić 1, Slava Sukara 2, Valentina Veselinović 3, Sanja Ilić 4 1 Klinika za bolesti zuba, Stomatološki odsjek, Univerzitet u Banjaluci, Banjaluka, Bosna i Hercegovina; 2 Klinika za preventivnu i dječiju stomatologiju, Stomatološki odsjek, Univerzitet u Banjaluci, Banjaluka, Bosna i Hercegovina; 3 Klinika za stomatološku protetiku, Stomatološki odsjek, Univerzitet u Banjaluci, Banjaluka, Bosna i Hercegovina; 4 Dom zdravlja, Banjaluka, Bosna i Hercegovina KRATAK SADRŽAJ Uvod Osim ana tom sko-mor fo lo ških oso bi na ka nal nog si ste ma, na ko ro nar no mi kro pro pu šta nje mo gu uti ca ti i teh ni ke pre pa raci je ka na la ko re na, sred stva za op tu ra ci ju i iz bor sred sta va za pri vre me no za tva ra nje ka vi te ta. Cilj ra da je bio da se me to dom boje nih ras tvo ra kod en do dont ski le če nih zu ba u uslo vi ma in vi tro is pi ta kva li tet kru nič ne mi kro pro pu stlji vo sti sred sta va za pri vreme no za tva ra nje ka vi te ta. Ma te ri jal i me to de ra da U stu di ji je ko ri šće no 40 eks tra ho va nih (jed no ko re nih i vi še ko re nih) hu ma nih zu ba (in takt nih i ka ri jesno pro me nje nih). U pre pa ra ci ji ka na la je ko ri šće na teh ni ka step-back, a kao iri gans dvo i po pro cent ni ras tvor Na OCl. Op tu ra ci ja je ura đe na me to dom la te ral ne kom pak ci je pri me nom pa ste Ape xit i gu ta per ke. Za pri vre me no za tva ra nje zu ba ko ri šće ni su Cavit i gla sjo no mer-ce ment. Za pro ce nu mi kro pro pu stlji vo sti ko ri šćen je pe de se to pro cent ni ras tvor Ag NO 3. Pro dor bo je je pro cenji van na sve tlo snom mi kro sko pu. Re zul ta ti Kod in takt nih zu ba pri vre me no za tvo re nih Ca vit-om pro dor bo je uočen je u 60% uzo ra ka, dok je kod zu ba pri vre me no za tvo re nih kom bi na ci jom gla sjo no mer-ce men ta i Ca vit-a bio 25%. Raz li ka je bi la sta ti stič ki zna čaj na (p<0,05). Kod zu ba za hva ćenih ka ri je som či ja je kru ni ca pri vre me no za tvo re na Ca vit-om pro dor bo je je uočen u 55% uzo ra ka, dok je kod uzo ra ka pri vre me no za tvo re nih kom bi na ci jom gla sjo no mer-ce men ta i Ca vit-a pro dor bo je za be le žen u 32% uzo ra ka. Raz li ka je bi la sta ti stič ki zna čaj na (p<0,05). Pro dor bo je kod jed no ko re nih zu ba bio ma nji ne go kod vi še ko re nih u obe gru pe, ali raz li ke ni su bi le sta ti stič ki zna čaj ne. Za klju čak Gla sjo no mer-ce men ti u kom bi na ci ji sa Ca vit-om obez be đu ju bo lje kru nič no zap ti va nje en do dont ski le če nog zu ba. Najma nji pro dor bo je je uočen kod in takt nih jed no ko re nih zu ba. Ključ ne re či: kru nič na mi kro pro pu stlji vost; sred stva za pri vre me no za tva ra nje; gla sjo no mer-ce ment UVOD Za pri mar ni pro blem en do dont ski le če nih zu ba du go se smatra lo api kal no mi kro pro pu šta nje. Me đu tim, po sled njih de ceni ja do sta je ob ja vlje nih ra do va ko ji se ba ve kva li te tom ka ko boč nog, ta ko i kru nič nog zap ti va nja ka nal nog pro sto ra na kon op tu ra ci je ka na la [1, 2]. Svr ha en do dont skog le če nja je do bro či šće nje i ob li ko va nje ka na la ko re na zu ba, ko je uz kva li tet nu tro di men zi o nal nu op tu ra ci ju ka na la tre ba da obez be di efi kasnu en do dont sku in ter ven ci ju. Osim ana tom sko-mor fo lo ških oso bi na ka nal nog si ste ma, na ko ro nar no mi kro pro pu šta nje mo gu uti ca ti i pa ste za op tu ra ci ju ka na la, teh ni ke pre pa ra ci je i pu nje nja ka na la, od no sno iz bor sred sta va za pri vre me no zatva ra nje ka vi te ta [3]. Ukla nja nje ka ri je sa, pre pa ra ci ja pri stup nog ka vi te ta, in strumen ta ci ja ka na la i pri pre ma ka vi te ta za ko nač nu re sta u ra ci ju kru ni ce zu ba če sto zah te va ju op se žno ukla nja nje zub ne supstan ce. Kru ni ca zu ba je ti me obič no veoma osla blje na i zi do vi is ta nje ni, pa je neo p hod no oda bra ti od go va ra ju ći ma te ri jal za re sta u ra ci ju kru ni ce ko ji će obez be di ti do bro kru nič no zap ti vanje. Mi ni mal na de blji na sred stva za pri vre me no za tva ra nje kavi te ta tre ba lo bi da bu de 4 mm, što je ne kad u kli nič kim uslovi ma, zbog ve li kog gu bit ka zub ne sup stan ce, te ško ostva ri ti [4]. Ko ro nar no mi kro pro pu šta nje pre ko ne a de kvat nog pri vreme nog is pu na za re sta u ra ci ju kru ni ce ili ne a de kvat ne op tu raci je ka na la u di rekt noj je ve zi s ne u spe hom en do dont skog le čenja. Uko li ko pri vre me ni ma te ri jal ni je do bro po sta vljen ili dođe do lo mlje nja to kom žva ka nja usled pro do ra plju vač ke i mikro or ga ni za ma iz usne du plje, po sle di ca mo že bi ti upa la api kalnog pe ri o don ci ju ma. Sto ga se sma tra da en do dont ski le če ni zub tre ba kon zer va tiv no ili pro te tič ki zbri nu ti u ro ku od 30 da na od ko nač ne op tu ra ci je ka na la. Cilj ra da je bio da se me to dom bo je nih ras tvo ra u uslo vima in vi tro pro ve ri kva li tet kru nič nog mi kro pro pu šta nja en dodont ski le če nih zu ba na kon pri vre me nog za tva ra nja Ca vit-om, od no sno kom bi na ci jom gla sjo no mer-ce men ta (GJC) i Ca vit-a. MATERIJAL I METODE RADA Is pi ti va nja su oba vlje na na 40 in takt nih i ka ri je som za hva će nih zu ba hu ma nog po re kla (jed no ko re ni i vi še ko re ni zu bi) eks traho va nih iz raz li či tih raz lo ga. Sa zu ba su uklo nje ni osta ci me kog tki va i ka men ca. Zu bi su is pra ni pod mla zom vo de i do po četka eks pe ri men ta ču va ni u al ko ho lu. Kod svih zu ba su for mi rani pri stup ni ka vi te ti, pri če mu je kod zu ba za hva će nih ka ri jesom pr vo okru glim kar bid nim svr dlom ukla njan ka ri jes, a zatim for mi ran pri stup ni ka vi tet. Ko ro nar na tre ći na ko ren skih ka na la je in stru men ti ra na Gejts Gli de no vim (Ga tes Glid den) svr dli ma ve li či ne od 1 do 4 (VDW GmbH München, Ger many) [5, 6]. En do dont ski po stu pak je bio isti za sve eks pe ri men tal ne gru pe. Na kon for mi ra nog pri stup nog ka vi te ta za o sta lo pulp no tki vo je uklo nje no eks tir pa to ri ma. Rad na du ži na je od re đi vana ta ko da je bi la za 1 mm kra ća od du ži ne pro ši ri va ča br. 15 ka da se nje gov vrh po ja vio na apek su zu ba. Bi o me ha nič ka obra da ka na la je iz ve de na pri me nom teh ni ke step-back po mo ću ruč nih pro ši ri va ča i tur pi ja uz obil nu iri ga ci ju dvo i po pro centnim ras tvo rom Na OCl. Ta ko pri pre mlje ni ka na li su po su ši va ni pa pir nim po e ni ma i po tom op tu ri ra ni me to dom la te ral ne kompak ci je uz pri me nu pa ste Ape xit.

6 74 Djeri A. et al. The Effect of Temporary Filling Materials on the Microleakage in Endodontically Treated Teeth Zu bi su po tom svr sta ni u dve eks pe ri men tal ne gru pe: 20 intakt nih zu ba u gru pu A, a 20 ka ri je snih zu ba u gru pu B. Svaka gru pa je ob u hva ti la po dve pod gru pe s jed no ko re nim (10) i vi še ko re nim zu bi ma (10). U svim is pi ti va nim gru pa ma privre me no za tva ra nje zu ba je ura đe no sa mo Ca vit-om ili kombi na ci jom GJC i Ca vit-a na kon ukla nja nja pu nje nja 2-3 mm od ula za u ka nal. Po sle pri vre me ne re kon struk ci je kru nič nog de la zu ba, svih 40 uzo ra ka je ču va no na tem pe ra tu ri od 37 C u uslo vi ma re la tiv ne vla žno sti. Se dam da na ka sni je svi zu bi su pre ma za ni sa dva slo ja la ka za nok te, iz u zev po ja sa ši ri ne 1 mm na spo ju Ca vit-a i zi da ka vi te ta. Zu bi su za tim uro nje ni kru nič nim de lom u pe de se to pro cent ni ras tvor Ag NO 3 u tra janju od šest sa ti, na kon če ga su is pra ni pod mla zom vo de i poto plje ni u fo to ra zvi jač u tra ja nju od dva sa ta. Svi uzor ci zu ba su za tim uz du žno pre se ca ni di ja mant skim di skom preč ni ka 6 mm u me zi o di stal nom prav cu. Oči ta va nje re zul ta ta je vr še no ste re o lu pom s mi kro me tar skim raz mer ni kom u oku la ru i pri uve ća nju od šest pu ta. REZULTATI Pro se čan pro dor bo je kod in takt nih jed no ko re nih zu ba za tvore nih Ca vit-om bio je µm, a kod zu ba za tvo re nih kom bina ci jom GJC i Ca vit-a 12 µm; ova raz li ka je bi la sta ti stič ki značaj na (p<0,05) (Ta be la 1). Pro se čan pro dor bo je kod in taktnih vi še ko re nih zu ba za tvo re nih Ca vit-om bio je µm, a kod zu ba za tvo re nih kom bi na ci jom GJC i Ca vit-a 15 µm. Dobi je na raz li ka je uka za la na to da po sto ji sta ti stič ka zna čaj nost (p<0,05) iz me đu dve gru pe is pi ta nih zu ba (Ta be la 1). Ana li za re zul ta ta je ta ko đe po ka za la da je pro dor bo je za be le žen u 30% in takt nih jed no ko re nih zu ba i 60% vi še ko re nih zu ba. Ova razli ka je bi la sta ti stič ki zna čaj na (p<0,05). Re zul ta ti po ka zu ju da je pro dor bo je kod in takt nih zu ba ko ji su pri vre me no za tvore ni Ca vit-om uočen u 60% uzo ra ka, dok je kod zu ba iste grupe pri vre me no za tvo re nih kom bi na ci jom GJC i Ca vit-a pro dor bo je za be le žen u 25% uzo ra ka. I ova raz li ka je bi la sta ti stič ki zna čaj na (p<0,05). Pro se čan pro dor bo je kod jed no ko re nih zu ba za hva će nih kari je som ko ji su za tvo re ni Ca vit-om bio je µm, a kod zu ba za tvo re nih kom bi na ci jom GJC i Ca vit-a 23 µm. Raz li ka u do bije nim re zul ta ti ma ni je bi la sta ti stič ki zna čaj na (Ta be la 2). Prose čan pro dor bo je kod vi še ko re nih zu ba za hva će nih ka ri je som ko ji su za tvo re ni Ca vit-om bio je µm, a kod zu ba za tvo renih kom bi na ci jom GJC i Ca vit-a 17,5 µm. Ni ova raz li ka ni je bila sta ti stič ki zna čaj na (Ta be la 2). Ana li za re zul ta ta je po ka za la i da je kod jed no ko re nih zu ba za hva će nih ka ri je som pro dor bo je uočen u 40% uzo ra ka, a kod vi še ko re nih u 50%, ali raz li ka nije bi la sta ti stič ki zna čaj na. Ana li za do bi je nih re zul ta ta je po kaza la pro dor bo je u 55% uzo ra ka pri vre me no za tvo re nih Ca vitom, dok je kod zu ba či ja je kru ni ca za tvo re na kom bi na ci jom GJC i Ca vit-a pro dor bo je za be le žen u 32% uzo ra ka. Ova raz lika je, me đu tim, bi la sta ti stič ki zna čaj na (p<0,05). DISKUSIJA Upr kos ana tom skim raz li ka ma iz me đu apek snog i kru nič nog de la ka na la ko re na zu ba, is tra ži va nja kru nič nog mi kro propu šta nja zu ba znat no za o sta ju za oni ma o kva li te tu apek snog zap ti va nja. Na kva li tet kru nič nog mi kro pro pu šta nja uti ču mnogi fak to ri, ali pre sve ga spo sob nost pri vre me nog is pu na da herme tič ki za tvo ri ka vi tet, za tim ana to mi ja ka nal nog si ste ma, tehni ka pre pa ra ci je [7, 8, 9], me to da op tu ra ci je ka na la [10], te vrsta ko ri šće nog si le ra [1, 11, 12]. U na šem is tra ži va nju je ana li zi ra na kru nič na mi kro pro pustlji vost en do dont ski le če nih zu ba či je su kru ni ce pri vre me no za tvo re ne sa mo Ca vit-om ili GJC i Ca vit-om. Re zul ta ti su poka za li da je li ne ar ni pro dor bo je bio naj ma nji kod jed no ko renih zu ba, bi lo da pri pa da ju gru pi in takt nih ili zu ba za hva će nih ka ri je som. Ovo bi se mo glo pri pi sa ti kon fi gu ra ci ji ka vu ma pulpe, po go to vo ko ren skog de la, ko ji uti če na pa siv ni pro dor boje. Kod jed no ko re nih zu ba ka na li su ši ro ki, pri stu pač ni za meha nič ko-he mij sku ob ra du i op tu ra ci ju, dok je kod vi še ko re nih zu ba to ote ža no zbog po sto ja nja vi še ka na la i mo že ima ti uti caja na kva li tet op tu ra ci je, a ti me i na mi kro pro pu šta nje [13, 14]. Ve li či na pri stup nog ka vi te ta ta ko đe igra ve li ku ulo gu u mi krocu re nju. Jed no ko re ni zu bi ima ju ma nje pri stup ne ka vi te te, te je ma nja po vr ši na iz lo že na mi krob nim agen si ma iz oral ne sredi ne, dok je kod vi še ko re nih zu ba neo p hod no pre pa ri ra ti ši ri pri stup ni ka vi tet, ne šte de ći zub nu sup stan cu, ka ko bi se obezbe di le kva li tet na ob ra da ka na la i lak ša ma ni pu la ci ja ruč nim ili ma šin skim in stru men ti ma [15]. Ana li zom do bi je nih re zul ta ta utvr đen je naj ma nji li ne arni pro dor bo je u kru nič nom de lu in takt nih zu ba. Ovo se obja šnja va či nje ni com da pri stup ni ka vi tet ima po treb nu de bljinu i vi si nu zi do va, či me se obez be đu je do bra re ten ci ja pri vreme nog is pu na za zi do ve ka vi te ta. Na taj na čin se osi gu ra va dobro ko ro nar no zap ti va nje pri vre me nim is pu nom čak i ka da je sloj ta nji od 4 mm. Teh ni ka la te ral ne kom pak ci je, ko ja je pri me nje na u ovoj studi ji, naj če šće je ko ri šće na teh ni ka jer da je za do vo lja va ju će re zulta te u kli nič kim uslo vi ma. De De us (De-De us) i sa rad ni ci [16] su u svo jim is tra ži va nji ma is pi ti va li da li na čin op tu ra ci je kod oval no in stru men ti ra nih ka na la uti če na ivično mi kro pro pu štanje. Zu bi su op tu ri ra ni me to dom la te ral ne kom pak ci je i teh nika ma si stem B i Ther ma fil. Uzor ci su pod vrg nu ti uti ca ju pljuvač ke i po sma tra ni 15 nedelja. Mi kro skop skom ana li zom do bije nih pre pa ra ta na kon se če nja zu ba mi kro pro pu šta nje je uočeno u 30% uzo ra ka op tu ri ra nih me to dom la te ral ne kon den zaci je i teh ni kom si stem B, od no sno u 20% uzo ra ka op tu ri ra nih teh ni kom Ther ma fil. Zna čaj na raz li ka iz me đu eks pe ri men talnih gru pa (op tu ra ci o nih teh ni ka) ni je uoče na. Teh ni ke i si ste mi ko nač nog pu nje nja ko ji su slo že ni za prime nu mo gu do ve sti do gre ša ka u iz vo đe nju op tu ra ci je, što za po sle di cu ima ne kva li tet no pu nje nje. Naj ma nji pro dor bo je je uočen kod in takt nih jed no ko re nih zu ba po sle pri me ne GJC i po tom pri vre me nog za tva ra nja Ca vit-om de blji ne 4 mm. Kod zu ba kod ko jih ni je bi lo mo gu će obez be di ti po treb nu de blji nu pri vre me nog is pu na zbog iz gu blje nog tki va usled ka ri je sa i prepa ra ci je pri stup nih ka vi te ta pro dor bo je je bio znat no ve ći. Razli ka je bi la sta ti stič ki zna čaj na sa mo iz me đu in takt nih zu ba ko ji su pri vre me no za tvo re ni kom bi na ci jom GJC i Ca vit-a i in taktnih zu ba pri vre me no za tvo re nih sa mo Ca vit-om, što uka zu je na va žnost GJC kao ba ri je re pro tiv pro do ra oral nih flu i da i mi kroor ga ni za ma [17]. Pri vre me ni ma te ri jal za re sta u ra ci ju kru ni ce tre ba da obez be di traj no her me tič ko zap ti va nje ka vi te ta dok se ne za me ni ko nač nim is pu nom. Broj ne stu di je su is pi ti va le osobi ne ra znih pri vre me nih ma te ri ja la, ka ko bi se kru nič no mi kropro pu šta nje sve lo na naj ma nju mo gu ću me ru.

7 Stomatološki glasnik Srbije. 2010;57(2): Ša i ler van ti kul (Cha i ler tvan ti kul) i sa rad ni ci [6] su is pi ti vali efe kat gla sjo no mer Vi tre bon da oja ča nog smo lom kao laj nera kod op tu ri ra nih ka na la. Zu bi su is pi ta ni na ko ro nar no mikro pro pu šta nje ko ri šće njem mi kro bi o lo škog mar ke ra ko ji je sasta vljen od ana e rob nih strep to ko ka i bak te ri je Fu so bac te ri um nuc le a tum. Uzor ci su sva ko dnev no is pi ti va ni na kru nič no mikro pro pu šta nje to kom 60 ana. Uzor ci sa laj ne rom Vi tre bond nisu po ka za li mi kro pro pu šta nje to kom 60 da na, dok je kod drugih zu ba gde ni je ko ri šćen ovaj gla sjo no mer mi kro pro pu šta nje uoče no kod svih 60 uzo ra ka. Za klju če no je da je smo lom modi fi ko van gla sjo no mer do bra ba ri je ra pro do ru bak te ri ja na kon op tu ra ci je ka na la. Imu ra (Imu ra) i sa rad ni ci [17] su is pi ti va li kru nič nu pro pustlji vost tri naj če šće ko ri šće na pri vre me na is pu na gu ta per ke, Ca vit-a i IRM-a na kon op tu ra ci je me to dom la te ral ne kompak ci je. Re zul ta ti su po ka za li da ni je dan od ova tri ma te ri ja la ne mo že spre či ti kru nič no mi kro pro pu šta nje i pro dor mi kroor ga ni za ma du že od 22 da na. Za klju če no je da je Ca vit znat no bo lji od gu ta per ke i IRM-a. Pi za no (Pi sa no) i sa rad ni ci [18] su is pi ti va li spo sob nost Cavit-a, IRM-a i Su per-eba da spe če cu re nje teč no sti u ka nal kore na. Na kon he mo me ha nič ke ob ra de zu bi su op tu ri ra ni me todom la te ral ne kom pak ci je. Gu ta per ka je ukla nja na 3,5 mm iz ka na la i po sta vljan je je dan od tri ma te ri ja la. Na kon 90 da na u gru pi sa Ca vit-om utvr đen je pro dor mi kro or ga ni za ma u 15% uzo ra ka, a u gru pa ma sa IRM-om i Su per-eba u 35% uzo raka. Po tvr đe no je ta ko đe da ko nač ni is pun mo ra bi ti po sta vljen u ro ku od 30 da na od za vr šet ka op tu ra ci je, te da mo ra obez bedi ti do bro kru nič no zap ti va nje [3]. Ja cu ši ro (Yat sus hi ro) i sa rad ni ci [19] su iz ve li du go roč nu stu di ju u ko joj su po mo ću fluid-fil tra ci o nog si ste ma is pi ta li spo sob nost mi ne ral nog tri ok sid nog agre ga ta (MTA) i amal gama da obez be de do bro kru nič no zap ti va nje. Oni su na 33 zuba pre pa ri ra li ka vi te te pr ve kla se du bo ke 3 mm, za tim uklanja li gu ta per ku iz ka na la (2 mm) i po sta vlja li MTA ili amalgam. Pro dor teč no sti su pra ti li na kon 1, 2, 3, 4, 8, 12, 16, 20 i 24 nedelje. Za klju če no je da amal gam po ka zu je vi sok ste pen mi kro pro pu šta nja po sle če ti ri sed mi ce i vi so ku va ri ja bil nost u po re đe nju s MTA. ZAKLJUČAK Re zul ta ti is tra ži va nja su po ka za li da GJC u kom bi na ci ji s Cavit-om obez be đu ju bo lje kru nič no zap ti va nje en do dont ski leče nih zu ba u od no su na zu be pri vre me no za tvo re ne sa mo Cavit-om. Naj ma nji pro dor bo je je uočen kod in takt nih jed noko re nih zu ba.