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2 See This presentation on Video

3 Coimbra Vienna

4 INTRODUCTION Root resorption Pulp Capping Furcal repair Root end filling Repair of root perforation Apexification Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review Part I: chemical, physical, and antibacterial properties. Journal of endodontics. 2010;36(1):16-27.

5 INTRODUCTION New Materials To improve MTA drawbacks Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review Part III: clinical applications, drawbacks, and mechanisms of action. Journal of endodontics. 2010;36(1):

6 MATERIALS & METHODS GMTA WMTA

7 MATERIALS & METHODS X X X X X X X X X X X X X X

8 MATERIALS & METHODS

9 MATERIALS & METHODS CRITERIA 1. Extracted by periodontal reasons 2. No carious lesion 3. Single Rooted Teeth 4. Fully developed apexes 5. One Straight Root Canal

10 117 TEETH

11 MATERIALS & METHODS OBJECTIVE Standardization of root sample sizes 16mm 1000 rpm Wa t e r c o o l e d d i a m o n d s a w Progression: 0.5mm per second

12 BIOMECHANICAL PREPARATION STEP BY STEP NaOCl # 10 NaOCl NaOCl NaOCl # 15 # 20 # 25 NaOCl # 30 WORKING LENGHT - 15 MM

13 BIOMECHANICAL PREPARATION STEP BY STEP GG1 NaOCl PATENCY FILE GG2 NaOCl PATENCY FILE GG3 NaOCl PATENCY FILE GG4 NaOCl PATENCY FILE GG5 NaOCl PATENCY FILE WORKING LENGHT - 15 MM

14 MATERIALS & METHODS GROUP 1 ProRoot MTA n = 39 GROUP 2 Biodentine n = 39 GROUP 3 MM-MTA n = 39

15 FINAL IRRIGATION PROTOCOL SUBGROUP A SUBGROUP B SUBGROUP C PBS BLOOD Butyric Acid 3mL of 3mL Butyric of NaOCl Acid - 2.5% - ph = 5

16 armamentarium FOR ROOT FILLING Paper Points Condensation and Wall Cleaning Dry of root canal system MTA GUN Placement of material MicroBrush Condensation and Wall Cleaning Pluggers Condensation and MTA Placement

17 armamentarium FOR ROOT FILLING Paper Points Condensation and Wall Cleaning Dry of root canal system MTA GUN Placement of material MicroBrush Condensation and Wall Cleaning Pluggers Condensation and MTA Placement

18 armamentarium FOR ROOT FILLING Surgical Microscope Improve your vision Paper Points Condensation and Wall Cleaning Dry of root canal system tested MATERIALS Mixer and Spatula Preparation of material

19 MATERIALS & METHODS SUBGROUP A SUBGROUP B SUBGROUP C PBS BLOOD Butyric Acid Placement Condensation of blood root with canal in a root plugger sealers canal

20 MATERIALS & METHODS Subgroups A and B 15 ml of PBS Subgroup C 15 ml of Butyric acid

21 MATERIALS & METHODS DAYS LATER 37 º C 100% of relative humidity

22 MATERIALS & METHODS 351 ROOT SLICES Average size 2,003 ± 0,157

23 LET S RESUME 117 TEETH GROUP 1 ProRoot MTA GROUP 2 Biodentine GROUP 3 MM-MTA n = 39 teeth 1A. PBS 2A. PBS 3A. PBS 1B. Blood 2B. Blood 3B. Blood n = 351 root slices 1C. Butyric acid 2C. Butyric acid 3C. Butyric acid

24 MATERIALS & METHODS CROSSHEAD SPEED: 0.5mm Per Minute Chen WP, Chen YY, Huang SH, Lin CP. Limitations of push-out test in bond strength measurement. Journal of endodontics. 2013;39(2):283-7.

25 RESULTS By Material Two-way analysis of variance (ANOVA) Statistically significant difference was found between the 3 groups (F= , p <0.001)

26 RESULTS By Material Mann-Withney test followed by Tukey's Test for pairwise comparisons Statistically significant difference was found between all groups when analyzed two by two (p <0.001)

27 RESULTS Setting Environment Two-way analysis of variance (ANOVA) Statistically significant differences Bond Strenght Values [MPa] (F=3.512, p=0.031) Mann-Withney test with correction for pairwise comparisons - Tukey's Test Butyric Acid PBS VS VS Blood Blood PBS Blood Butyric Acid PBS VS Butyric Acid

28 RESULTS Material and Setting Environment Bond Strenght Values [MPa] PBS Blood Butyric Acid

29 RESULTS Material and Setting Environment Bond Strenght Values [MPa] PBS Blood Butyric Acid

30 RESULTS Sample Location Root canal thirds Mean values Coronal Third ± Middle Third ± Apical Third ± Only statistically significant differences were found between apical and coronal third

31 RESULTS Sample Location Root canal thirds Mean values Coronal Third ± Middle Third ± Apical Third ± Only statistically significant differences were found between apical and coronal third

32 RESULTS Sample Location Root canal thirds Mean values Coronal Third ± Middle Third ± Apical Third ± Only statistically significant differences were found between apical and coronal third

33 FAILURE MODES ALL SAMPLES MIXED 34 samples 9.6% MIXED 82.1% ADHESIVE COHESIVE Within the filling material 29 samples 8.3% COHESIVE Between the filling material and dentin interface 288 samples ADHESIVE

34 RESULTS FAILURE FAILURE MODES MODES MIXED COHESIVE ADHESIVE Material VS Type of failure Setting environment VS Type of failure

35 DISCUSSION This studies are in accordance with our results

36 DISCUSSION???

37 DISCUSSION Statistically significant differences The interaction of MTA/dentine with PBS positively influenced the bond strength of MTA So, why not place PBS on contact with MTA instead of a moisted cotton pellet?

38 DISCUSSION In our study Statistically significant difference was found between apical and coronal third WHY? Perhaps Variations of tubules density along root canal Removal of smear layer Placement of materials in apical third is more difficult

39 DISCUSSION LOW PH Affects hydration of silicate based materials Surface alterations

40 DISCUSSION Lower ph values have effect on MTA

41 DISCUSSION

42 DISCUSSION

43 DISCUSSION Higher bond strength of BD WHY? Differences between the composition of two materials

44 DISCUSSION Radiopacifier influences material bond strenght

45 DISCUSSION Decrease bond strength

46 DISCUSSION The only study That evaluate MM-MTA bond-strenght

47 DISCUSSION The only study That evaluate MM-MTA bond-strenght Data is not consistent with our study Detailed evaluation of material components More research is required

48 CONCLUSION Under the conditions of this study Biodentine than ProRoot MTA Biodentine rather than ProRoot MTA in acidic environment Blood bond-strength

49 INFLUENCE OF SETTING ENVIRONMENT ON THE BOND STRENGTH OF THREE CALCIUM SILICATE-BASED MATERIALS TO ROOT DENTIN THANK YOU.. DANKE SCHON OLAVO GUERREIRO VIEGAS DIANA SERRA; PAULO PALMA; MIGUEL PATRÍCIO; JOSÉ DOMINGOS COSTA; JOÃO MIGUEL DOS SANTOS DMD, MSc, FACULTY OF MEDICINE, COIMBRA, PORTUGAL

50 INFLUENCE OF SETTING ENVIRONMENT ON THE BOND STRENGTH OF THREE CALCIUM SILICATE-BASED MATERIALS TO ROOT DENTIN Vienna, Austria 4-6 December 2014