JICDRO is a UGC approved journal (Journal no. 63927)

   Table of Contents      
ORIGINAL RESEARCH
Year : 2021  |  Volume : 13  |  Issue : 2  |  Page : 124-128

An In vitro comparative evaluation of effect of novel irrigant Qmix and 17% ethylenediaminetetraacetic acid on the push-out bond strength of biodentine and endosequence bioceramic root repair material


1 Department of Conservative Dentistry and Endodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
2 Department Of Dentistry, Apollo Hospital, Hyderabad, Telangana, India
3 Department of Prosthodontics and Crown and Bridg, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
4 Department of Conservative Dentistry and Endodontics, V.Y.W.S. Dental College and Hospital, Amravati, Maharashtra, India

Date of Submission31-Dec-2020
Date of Decision06-Apr-2021
Date of Acceptance18-Apr-2021
Date of Web Publication17-Jan-2022

Correspondence Address:
Dr. Vandana J Gade
Plot No BA2, Shreenath Sai Nagar, Near Omkar Nagar Square, Manewada Ring Road, Nagpur - 440 027, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jicdro.jicdro_82_20

Rights and Permissions
   Abstract 


Background: Perforations can occur during any endodontic procedure which may affect prognosis if not repaired immediately. During perforation repair, various irrigating solutions were used which may affect the bond strength of repair materials. Methods: In this study, sixty dentin slices of 2 mm thickness were prepared with lumen 1.3 mm. Samples were divided into two groups. Biodentine and EndoSequence Root Repair Material (RRM) were placed in the respective samples and incubated for 24 h. Subdivision of groups into three was done: control, 17% ethylenediaminetetraacetic acid (EDTA), and QMix. Immersion was done for 30 min, followed by incubation for 48 h. The samples were then tested for compressive strength through a push-out test. The mean, standard deviation, median, and range of bond strength of EndoSequence Bioceramic RRM and Biodentine were obtained. One-way analysis of variance was used to determine the statistical significance of difference in the mean push-out strengths of each material across decalcifying agents. Paired analysis of push-out strength between decalcifying agents for each material was performed using Tukey's post hoc test. All the analyses were performed using R-3.0.0 programming language, and the statistical confidence was tested at 95%. Results: Results showed that EndoSequence RRM had superior bond strength than Biodentine. 17% EDTA and QMix showed negative influence on the bond strength. However, QMix samples had more bond strength than 17% EDTA. Conclusion: QMix showed less negative influence than EDTA on Biodentine and EndoSequence RRM.

Keywords: 17% ethylenediaminetetraacetic acid, Biodentine, EndoSequence root repair material, perforation root repair material, QMix irrigant


How to cite this article:
Gade VJ, Gangrade A, Gade JR, Rahul N. An In vitro comparative evaluation of effect of novel irrigant Qmix and 17% ethylenediaminetetraacetic acid on the push-out bond strength of biodentine and endosequence bioceramic root repair material. J Int Clin Dent Res Organ 2021;13:124-8

How to cite this URL:
Gade VJ, Gangrade A, Gade JR, Rahul N. An In vitro comparative evaluation of effect of novel irrigant Qmix and 17% ethylenediaminetetraacetic acid on the push-out bond strength of biodentine and endosequence bioceramic root repair material. J Int Clin Dent Res Organ [serial online] 2021 [cited 2022 May 28];13:124-8. Available from: https://www.jicdro.org/text.asp?2021/13/2/124/335879




   Introduction Top


Perforations are procedural complication that can occur due to caries, resorption, or accidently during endodontic treatment or post space preparation of teeth. Perforation is an artificial communication between root canal system and the supporting tissues of teeth or the oral cavity.[1],[2]

The prognosis of perforation repair depends on a number of factors including the location and size of the perforation, time of occurrence, and the material used for the repair of perforation.[2] Ideally, perforations should be immediately repaired with a biocompatible material to halt the passage of fluids from within to outside the tooth and vice versa.[3],[4]

Properties of an ideal repair material for perforations should include biocompatibility, adhesion to cavity walls, adequate seal, resistance to dislodgement, antimicrobial effect, and induction of osteogenesis and cementogenesis.[1],[3]

Endosequence Root Repair Material (ERRM) (Brasseler USA, Savannah, GA, USA) is a calcium phosphate silicate cement, which is a newer generation bioactive cement. It consists of phosphate salts in addition to hydraulic calcium silicates. The reason for its development was the expectation that its unique hydration characteristics would enhance the cement's mechanical properties and biocompatibility. Its major inorganic components include tricalcium silicate, dicalcium silicate, and calcium phosphates. The introduction of premixed EndoSequence RRM eliminates the possibility of heterogeneous consistency during chairside mixing. It contains water-miscible carriers and hence it will not set during storage but will harden after exposure to an aqueous environment, i.e., dentinal fluid. It has good handling property, its working time is more than 30 min, and their setting time is 4 h.[5]

Biodentine (Septodont, Saint-Maur-des-Fosses, France) is a high-purity calcium silicate-based dental material composed of tricalcium silicate, calcium carbonate, zirconium oxide, and a water-based liquid containing calcium chloride as the setting accelerator and water-reducing agent.[1]

Following the repair of root perforation, nonsurgical endodontic treatment must be performed. During endodontic treatment, various endodontic irrigants and chelating agents were used. Chelating agents are believed to aid root canal irrigation by removing inorganic smear layer, and it chemically softens the dentin due to which instrumentation of calcified canal is possible. Ethylenediaminetetraacetic acid (EDTA) is most commonly used as a chelating agent, but this agent affects the mechanical properties of perforation repair materials.[3],[6]

QMix™ 2 in 1 (Dentsply Tulsa Dental Specialties, Johnson City, TN) solution contains a mixture of a bisbiguanide antimicrobial agent, a polyaminocarboxylic acid calcium chelating agent, and a surfactant. QMix is a clear, ready-to-use solution with no chairside mixing. QMix is effective against biofilms due to the presence of antimicrobial agent and EDTA.[6],[7]

This study aims to evaluate the effect of QMix™ 2 in 1 solution against conventional 17% EDTA on the push-out bond strength of Biodentine and EndoSequence Bioceramic RRM Fast Set Putty (ERRM Putty).


   Methods Top


Sixty single-rooted teeth were selected and stored in 10% buffered formalin. All teeth were decoronated and mid-root dentin were sectioned horizontally into slices of 2 mm thickness. In each sample, canal space was prepared by Gates-Glidden bur # 1 through # 5 to a diameter of 1.3 mm to a standardized cavity. Dentin slices were thoroughly irrigated with 3% NaOCl for 5 min and washed with distilled water.

The dentin slices were randomly divided into two groups of thirty each according to the repair material. EndoSequence RRM was placed in lumen of thirty slices, and Biodentine was mixed according to the manufacturer's instructions and placed in lumen of the remaining thirty slices.

All samples were wrapped in wet gauze and placed in incubator and allowed to set at 37°C and 100% humidity. The samples were then randomly divided into three subgroups on the basis of final irrigant used. Each subgroup contained ten samples.

  1. Group 1 – (control) a wet cotton pellet, without irrigation
  2. Group 2 – 17% EDTA (Canalarge, AMMDENT, India)
  3. Group 3 – QMix (DENTSPLY Tulsa Dental Specialties).


Samples were submerged in the respective irrigants for 30 min and washed with distilled water. These samples were kept in incubator for another 48 h. These samples were embedded in self-cured acrylic to a dimension of 15 mm ×15 mm and further these samples were sent for push-out testing. Push-out bond strength values were measured by using universal testing machine (Star Testing System-248, India). The plunger of 1 mm diameter was used at a crosshead speed of 1 mm/min. The samples were placed on a metal slab with a central hole to allow for free movement of the plunger. Maximum force applied to materials at the time of dislodgement was recorded in newton (N) and converter into megapascals by the formula, N/2π rh.


   Results Top


[Table 1] provides the descriptive statistics of push-out bond strength of Biodentine and EndoSequence RRM in the presence of different decalcifying agents. The results of the study how that EndoSequence RRM has superior bond strength than Biodentine in control group as well as in EDTA and QMix groups.
Table 1: Descriptive statistics for push-out bond strength of Biodentine and EndoSequence Root Repair Material in presence of different decalcifying agents

Click here to view


[Table 2] shows the paired comparison of push-out bond strength of Biodentine and EndoSequence using different decalcifying agents, whereas the comparison of push-out bond strength of EndoSequence and Biodentine for each decalcifying agent is shown in [Table 3]. The results show that there is a significant difference between the RRM s used, and the decalcifying agents have an adverse effect on the bond strength of both materials.
Table 2: Paired comparison of push-out bond strength of Biodentine and EndoSequence Root Repair Material aerial using different decalcifying agents

Click here to view
Table 3: Comparison of push-out bond strength of EndoSequence and Biodentine materials for each decalcifying agents

Click here to view



   Discussion Top


Unintended perforations of pulpal floor during endodontic management of a tooth affect the prognosis of the treatment. The prognosis is affected by various elements such as the size, location, and time of perforation as well as the potential of the material used to seal the defect. These perforations can be mended nonsurgically with suitable biocompatible, nontoxic, radiopaque, nonabsorbent material, thus preventing bacterial contamination.[8],[9]

The main aim of an endodontic repair material is to avert the movement of the bacteria and diffusion of bacterial products from periapical tissues into the root canal and vice versa.[10] It should also endure the condensation forces of the restorative materials after the endodontic therapy is completed.[11] Hashem et al.[11] stated that the average condensation pressure applied was 9.2 MPa and 5.5 MPa for small- and medium-sized condensers, respectively.[12] Hence, mechanical strength is an essential property of materials used for perforation repair material in the root canal.[13]

The push-out test aims to evaluate the bond strength of a restorative material to dentin.[14] This test measures the interfacial shear strength developed between different surfaces. It provides information about the adhesiveness of the material tested.[15]

The push-out test has been shown to be efficient and reliable to assess the bond strength of a dental material. Therefore, in the present study, the adhesion of Biodentine and EndoSequence Bioceramic RRM to root dentin was evaluated using the push-out bond strength test.

Guneser et al. in 2013[1] reported that Biodentine had considerable performance as a repair material even after being exposed to various endodontic irrigation solutions including NaOCl and chlorhexidine (CHX), whereas MTA had the lowest push-out bond strength to root dentin.[1] Elnaghy reported that Biodentine had superior dislodgment resistance as compared to White MTA after being exposed to various final rinse decalcifying agents including EDTA and newer irrigant QMix.[6]

Shokouhinejad et al. evaluated the push-out bond strength of ERRM against Bioaggregate and MTA and found higher strength of ERRM against the other two repair materials.[16]

However, no study has been performed on the compressive strength of ERRM after being exposed to various final rinse chelating agents such as EDTA and QMix as compared to Biodentine.

This study was aimed to evaluate the push-out bond strength of ERRM and Biodentine after being treated with 17% EDTA and QMix irrigant.

In the present study, the mean bond strength of EndoSequence Bioceramic RRM is 13.40 MPa ± 1.30 MPa. EndoSequence Bioceramic RRM has got the highest result which is similar to the findings of Guo et al., 2016.[5] The results are also similar to the findings of Walsh et al., 2014, where they found higher bond strength of EndoSequence Bioceramic RRM.[17]

Higher bond strength of EndoSequence Bioceramic RRM may be because it is a premixed material and it is more homogenous than mechanically or manually mixed Biodentine.[18] EndoSequence Bioceramic RRM has slow hydration process and has been reported to have small size of porosity. It has been reported that porosity has a significant role in mechanical properties such as the compressive strength and modulus of elasticity.[19] EndoSequence Bioceramic RRM has been reported to have the lowest porosity.[5]

In the present study, the mean bond strength of Biodentine was 9.94 MPa ± 2.16 MPa. It is similar to the finding of Cechella et al. who reported that the mean bond strength of Biodentine after 24 h was 8.06 ± 3.14 MPa.[14] Uzunoglu et al. found lesser bond strength values of Biodentine during manual mixing (4.57 ± 1.99 MPa) as compared to mechanical mixing (5.44 ± 1.54 MPa). This may be due to the difference in the thickness of the sample.[20] Similar findings were seen by Üstün et al., 2015 (3.58 ± 1.49 MPa and 4.36 ± 2.55 MPa in the presence and absence of blood, respectively).[12]

In the present study, the mean bond strength of EndoSequence Bioceramic RRM was significantly higher than the mean bond strength of Biodentine, which is similar to the findings of Shokouhinejad et al., 2013, where the bond strength of EndoSequence Bioceramic RRM (11.7 and 17.79 MPa) was significantly higher than Biodentine (2.1 and 7.25 MPa) at both 1-week and 2-month incubation periods, respectively.[16]

In the present study, the mean bond strength of Biodentine after being exposed to QMix 2 in 1™ solution was 6.51 MPa with standard deviation of 1.03 MPa and that of EndoSequence Bioceramic RRM was 8.94 MPa with standard deviation of 0.66 MPa.

Pairwise test again indicates highly significance in the values after treating with QMix 2 in 1™ solution. QMix is composed of EDTA, CHX, and a surfactant, which consequently enhanced the demineralization of radicular dentin due to the chelating effect of EDTA, while disinfecting at the same time.[6]

CHX has a unique property of substantivity, which is the ability to be adsorbed in the dentin and gradually released over time. In the present study, CHX was used in liquid form as part of QMix. Another underlying principle of including surfactant in QMix is to lower the surface tension of solution and increase its wettability, thus enhancing the flow of the irrigant into the root canal and its contact with the smear layer and underlying dentin. This may also be a reason for reduced bond strength of both materials when affected by Q Mix.[6],[21]

High negative significant can be attributed to the presence of EDTA and CHX together having a synergistic effect along with a detergent for better wettability. Elnaghy reported similar findings, the mean push-out bond strength of Biodentine after exposure to QMix, however, it was insignificant. Reason can be due to the different thickness of dentin sample taken in their study.[6]

In the present study, the mean and standard deviation values for EDTA-exposed Biodentine are 5.13 MPa and 1.30 MPa, respectively. Moreover, for EndoSequence Bioceramic RRM, the mean values and standard deviation are 5.89 MPa and 0.79 MPa, respectively.

Pairwise test indicated high negative significance for both the materials. These findings are similar to the findings of previous authors. EDTA has been reported to have a strong negative influence on the compressive strength of Biodentine. Govindaraju et al., 2017, reported that Biodentine showed a reduction in compressive strength following exposure to EDTA but not NaOCl. This may be due to its chelating action, which interferes with the formation of calcium silicate hydrate gel.[22],[23]

It has been reported by Camilleri in 2014 that the surface of Biodentine exhibited peaks for calcium and silicon and it leaches high amount of calcium in the immediate vicinity.[24] EDTA has six potential sites (four carboxyl groups and two amino groups) available to bond with calcium to form highly stable bonds. The residual EDTA in the root canal system may chelate with calcium ions released from Biodentine during hydration and disturb the precipitation.[2],[25] However, the findings of previous study by Elnaghy show that EDTA does not affect the compressive strength of Biodentine, which are contradictory to the results of current study.[6]


   Conclusion Top


Within the limitations of this in vitro study, it can be concluded that

  1. EndoSequence Bioceramic RRM has significantly higher bond strength than Biodentine
  2. EDTA and QMix™ both chelating agents have significant negative influence on the push-out bond strength value of both EndoSequence Bioceramic RRM and Biodentine
  3. QMix irrigant has less negative influence as compared to EDTA.


More studies with large number of samples are required to study the effects of QMix on perforation repair materials.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Guneser MB, Akbulut MB, Eldeniz AU. Effect of various endodontic irrigants on the push-out bond strength of biodentine and conventional root perforation repair materials. J Endod 2013;39:380-4.  Back to cited text no. 1
    
2.
Aggarwal V, Singla M, Miglani S, Kohli S. Comparative evaluation of push-out bond strength of ProRoot MTA, Biodentine, and MTA Plus in furcation perforation repair. J Conserv Dent 2013;16:462-5.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Nagas E, Cehreli ZC, Uyanik MO, Durmaz V, Vallittu PK, Lassila LV. Bond strength of mineral trioxide aggregate to root dentin after exposure to different irrigation solutions. Dent Traumatol 2014;30:246-9.  Back to cited text no. 3
    
4.
Fuss Z, Trope M. Root perforations: Classification and treatment choices based on prognostic factors. Endod Dent Traumatol 1996;12:255-64.  Back to cited text no. 4
    
5.
Guo YJ, Du TF, Li HB, Shen Y, Mobuchon C, Hieawy A, et al. Physical properties and hydration behavior of a fast-setting bioceramic endodontic material. BMC Oral Health 2016;16:23.  Back to cited text no. 5
    
6.
Elnaghy AM. Influence of QMix irrigant on the micropush-out bond strength of biodentine and white mineral trioxide aggregate. J Adhes Dent 2014;16:277-83.  Back to cited text no. 6
    
7.
Chandrasekhar V, Amulya V, Rani VS, Prakash TJ, Ranjani AS, Gayathri C. Evaluation of biocompatibility of a new root canal irrigant Q Mix TM 2 in 1 – An in vivo study. J Conserv Dent 2013;16:36.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
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 controlled in vitro trial. Contemp Clin Dent 2016;7:322-5.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Ramazani N, Sadeghi P. Bacterial leakage of mineral trioxide aggregate, calcium-enriched mixture and biodentine as furcation perforation repair materials in primary molars. Iran Endod J 2016;11:214-8.  Back to cited text no. 9
    
10.
Ajas A, Babu A, Varughese JM, Amal S, Thaha KA. Biodentine - An alternative to MTA. Arch Dent Med Res 2016;2:26-33.  Back to cited text no. 10
    
11.
Hashem AA, Wanees Amin SA. The effect of acidity on dislodgment resistance of mineral trioxide aggregate and bioaggregate in furcation perforations: An in vitro comparative study. J Endod 2012;38:245-9.  Back to cited text no. 11
    
12.
Üstün Y, Topçuoğlu HS, Akpek F, Aslan T. The effect of blood contamination on dislocation resistance of different endodontic reparative materials. J Oral Sci 2015;57:185-90.  Back to cited text no. 12
    
13.
Alzraikat H, Taha NA, Salameh A. A comparison of physical and mechanical properties of biodentine and mineral trioxide aggregate. J Res Med Den Sci 2016;4:121-6.  Back to cited text no. 13
    
14.
Cechella BC, Almeida JD, Felippe MC, Teixeira CD, Bortoluzzi EA, Felippe WT. Influence of phosphate buffered saline on the bond strength of endodontic cement to dentin. Braz J Oral Sci 2015;14:126-9.  Back to cited text no. 14
    
15.
Singh S, Podar R, Dadu S, Kulkarni G, Vivrekar S, Babel S. An in vitro comparison of push-out bond strength of biodentine and mineral trioxide aggregate in the presence of sodium hypochlorite and chlorhexidine gluconate. Endodontology 2016;28:42-5.  Back to cited text no. 15
  [Full text]  
16.
Shokouhinejad N, Razmi H, Nekoofar MH, Sajadi S, Dummer PM, Khoshkhounejad M. Push-out bond strength of bioceramic materials in a synthetic tissue fluid. J Dent (Tehran) 2013;10:540-7.  Back to cited text no. 16
    
17.
Walsh RM, Woodmansey KF, Glickman GN, He J. Evaluation of compressive strength of hydraulic silicate-based root-end filling materials. J Endod 2014;40:969-72.  Back to cited text no. 17
    
18.
Akbulut MB, Bozkurt DA, Terlemez A, Akman M. The push-out bond strength of BIOfactor mineral trioxide aggregate, a novel root repair material. Restor Dent Endod 2019;44:e5.  Back to cited text no. 18
    
19.
Barralet JE, Gaunt T, Wright AJ, Gibson IR, Knowles JC. Effect of porosity reduction by compaction on compressive strength and microstructure of calcium phosphate cement. J Biomed Mater Res 2002;63:1-9.  Back to cited text no. 19
    
20.
Uzunoglu E, Aktemur Turker S, Uyanik MO, Nagas E. Effects of mixing techniques and dentin moisture conditions on push-out bond strength of ProRoot MTA and Biodentine. J Adhes Sci Technol 2016;30:1891-8.  Back to cited text no. 20
    
21.
de Souza Matos F, da Silva FR, Paranhos LR, Moura EB, Valera C. The effect of 17% EDTA and QMiX ultrasonic activation on smear layer removal and sealer penetration: Ex vivo study. Sci Rep 2020;10:10311.  Back to cited text no. 21
    
22.
Govindaraju L, Neelakantan P, Gutmann JL. Effect of root canal irrigating solutions on the compressive strength of tricalcium silicate cements. Clin Oral Investig 2017;21:567-71.  Back to cited text no. 22
    
23.
Zinge PR, Saraf PA, Ratnakar P, Karan S, Saraf SP, Hazari P. Assessment of effect of 1% phytic acid and 17% ethylenediaminetetraacetic acid on calcium ion loss of radicular dentin: An ex vivo study. J Conserv Dent 2020;23:137-40.  Back to cited text no. 23
    
24.
Camilleri J. Hydration characteristics of biodentine and theracal used as pulp capping materials. Dent Mater 2014;30:709-15.  Back to cited text no. 24
    
25.
Kakani AK, Veeramachaneni C. Sealing ability of three different root rapair materials for furcation perforation repair: An in vitro study. J Conserv Dent 2020;23:62-5.  Back to cited text no. 25
  [Full text]  



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Methods
   Results
   Discussion
   Conclusion
    References
    Article Tables

 Article Access Statistics
    Viewed416    
    Printed18    
    Emailed0    
    PDF Downloaded52    
    Comments [Add]    

Recommend this journal