Endodontik tedavi görmüş dişlerde farklı kanal patı ve doldurma tekniğinin vertical kök kırığı direnci üzerine etkisinin kaldırılması

Amaç: Bu çalışmanın amacı açılı tek kon veya lateral kompaksiyon teknikleri kullanılarak iki farklı kök kanal dolgu patının, Apexit ve AH Plusın, vertikal kök kırığı üzerine etkilerinin in vitro incelenmesidir. Materyal ve Metot: 60 adet, çekilmiş tek kanallı insan premolar dişi seçilmiştir. Mine-sement birleşim bölgesinden kronlar uzaklaştırılmış ve kök uzunlukları 13 mm olacak şekilde ayarlanmıştır. Bukkolingual ve meziodistal çaplar ölçülmüş ve dişler rastgele olarak 6 gruba ayrılmıştır. Kontrol 1de instrumantasyon ve kanal dolgusu yapılmamıştır. Diğer kökler nikel-titanyum ProTaper rotary aletler ile çalışma boyunda F3 boyutuna kadar kemomekanik olarak hazırlanmıştır. Kontrol 2 doldurulmadan bırakılmıştır. Grup 1 ve 2 sırasıyla uygun açıda tek kon ve lateral kondenzasyon tekniği ile Apexit kullanılarak doldurulmuştur. Grup 3 ve 4te Apeksit yerine AH Plus kullanılmıştır. Tüm kökler 9 mmlik koronal kısımları dışarıda kalacak şekilde vertikal olarak otopolimerize akrilik rezin bloklar içerisine gömülmüştür. Ardından, köklere vertikal yönde kuvvet (1 mm/dk) uygulanmıştır. Fraktür oluşması için gerekli olan kuvvet değeri Newton cinsinden kaydedilmiştir. Veriler Kruskal- Wallis ve Conover çoklu karşılaştırma testleri ile analiz edilmiştir (p=0,05). Bulgular: Kontrol 1 ve Kontrol 2, deney gruplarından anlamlı olarak farklılık göstermiştir. AH Plus ile doldurulan köklerin fraktür dirençleri Apexit kullanılarak doldurulanlardan önemli derecede daha yüksekti (p0,05). Sonuçlar: Endodontik işlemler sırasında yapılan instrumantasyon ve irrigasyon diş yapısında zayıflamaya neden olur. Rezin içerikli patlarla yapılan kanal dolgusu kırılmaya karşı kök direncini artırmaktadır.

Effects of different root canal sealers and filling techniques on resistance to vertical root fracture in endodontically treated teeth

Background: The aim of this study was to evaluate in vitro influence of two different root canal sealer, Apexit and AH Plus, using either taper single cone or lateral condensation technique on resistance to vertical root fracture. Materials and Metods: Sixty extracted human single canal mandibular premolar teeth were selected. Crowns were sectioned at the cementoenamel junction and the length of the roots were adjusted to 13 mm. The buccolingual and mesiodistal diamaters were measured and the teeth were randomly divided into 6 groups. In control 1, no instrumentation or obturation was performed. The rest of the roots were chemomecha- nically prepared with nickel-titanium ProTaper rotary instruments up to size F3 at the working length. Control 2 was left unobturated. Groups 1 and 2 were obturated with Apexit used with the matched-taper single-cone and lateral condensation techniques, respectively. In groups 3 and 4, AH Plus was used instead of Apexit. All of the roots were mounted vertically in self-curing acrylic resin blocks that exposed 9 mm of the coronal part. Then, the roots were subjected to a vertical loading force (1 mm/min). The force required to produce a fracture was recorded in newtons. The data were analyzed by using KruskalWallis and Conover multiple comparison tests (p=0.05). Results: Control 1 and Control 2 showed a significant difference in comparison with the test groups. Fracture strength of roots filled with AH Plus was significantly greater than those filled using Apexit (p<0.05). There were no significant differences between the groups single cone and lateral kondenzation technique (p>0.05). Conclusions: The instrumentation and irrigation steps of the root canals during endodontic treatment weaken the tooth structure. Root canal filling with resin-based sealers may increase the fracture resistance of the roots.

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1. Pitts DL, Natkin E. Diagnosis and treatment of vertical root fractures. Journal of Endodontics 1983;9:338-46.
2. Meister F, Lommel TJ, Gerstein H. Diagnosis and possible causes of vertical root fractures. Oral Surgery, Oral Medicine and Oral Pathology 1980;49:243-53.
3. Sornkul E, Stannard JG. Strength of roots before and after endodontic treatment and restoration. Journal of Endodontics 1992;18:440-3.
4. Bender IB, Freedland JB. Adult root fracture. Journal of the American Dental Association 1983;107:413-9.
5. Teixeira FB, Teixeira EN, Thompson JY, Trope M. Fracture resistance of roots endodontically treated with a new resin filling material. J Am Dent Assoc 2004;135:64652.
6. Jainaen A, Palamara JE, Messer HH. Effect of dentinal tubules and resin- based endodontic sealers on fracture properties of root dentin. Dent Mater 2009;25:7381.
7. Jainaen A, Palamara JE, Messer HH. The effect of resin based sealers on fracture properties of dentine. Int Endod J 2009;42:136-43.
8. Sousa-Neto MD, Silva Coelho FI, Marchesan MA, Alfredo E, Silva-Sousa YT. Ex vivo study of the adhesion of an epoxybased sealer to human dentine submitted to irradiation with Er:YAG and Nd:YAG lasers. Int Endod J 2005;38:866-70.
9. Saleh IM, Ruyter IE, Haapasalo MP, Orstavik D. Adhesion of endodontic sealers: scanning electron microscopy and energy dispersive spectroscopy. Journal of Endod 2003;29:595-601.
10. Belli S, Cobankara FK, Eraslan O, Eskitascioglu G, Karbhari V. The effect of fiber insertion on fracture resistance of endodontically treated molars with MOD cavity and reattached fractured lingual cusps. J Biomed Mater Res B Appl Biomater 2006;79:35-41.
11. Selden HS. Repair of incomplete vertical root fractures in endodontically treated teeth in vivo trials. Journal of endodontics 1996;22: 426-9.
12. Trope M, Ray H Jr. Resistance to fracture of endodontically treated roots. Oral surgery Oral Medicine Oral Pathology 1992;73:99-102.
13. Versluis A, Messer HH, Pintado MR. Changes in compaction stress distributions in roots resulting from canal preparation. Int Endod J 2006; 39:931-9.
14. Weiger R, Heuchert T, Hahn R, Lost C. Adhesion of a glass ionomer cement to human radicular dentine. Endod Dent Traumatol 1995;11:214-9.
15. White RR, Goldman M, Lin PS. The influence of the smeared layer upon dentinal tubule penetration by plastic filling materials. J Endod 1984;10: 558-62.
16. White RR, Goldman M, Lin PS. The influence of the smeared layer upon dentinal tubule penetration by endodontic filling materials. Part II. J Endod 1987;13:369-74.
17. Ersev H ,Yılmaz B ,Pehlivanoğlu E, Çalışkan E , Erişen Fr. Resistance to vertical root fracture of endodontically treated teeth with Metaseal, Journal of Endodontics 2012;38:653-6.
18. Holcomb JQ, Pitts DL, Nichols Jı. Further investigation of spreader loads required to cause vertical root fracture during lateral cendensation Journal of Endodontics 1987;13:277-84.
19. Haragushiku GA, Sousa-Neto MD, Silva-Sousa YT, Alfredo E, Silva SC, Silva RG. Adhesion of endodontic sealers to human root dentine submitted to different surface treatments. Photomedicine And Laser Surgery 2010; 28:405-10.
20. Kayaoğlu G, Erten H, Alaçam T, Orsavik D. Short-term antibacterial activity of root canal sealers towards Enterococuc faecalıs. Int Endodont J 2005;38,483-8.
21. Willershausen B. Marroquin B. Schafer D. Schulze R. Cytotoxicity or foot canal filling materials to three different human cell lines. J Endodont 2000;26:703-7.
22. Sousa-Neto MD, Marchesan MA, Pecora JD, Junior AB, Silva-Sousa YT, Saquy PC. Effect of Er:YAG laser on adhesion of root canal sealers. J Endod 2002;28:185-7.
23. Karapinar Kazandag M, Sunay H, Tanalp J, Bayirli G. Fracture resistance of roots using different canal filling systems. Int Endod J 2009; 42:705-10.
24. Hurmuzlu F, Serper A, Siso SH, Er K. In vitro fracture resistance of root-filled teeth using new-generation dentine bonding adhesives. Int Endod J 2003;36:770-3.