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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE,KARNATAKA. ANNEXURE-II PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1 NAME OF THE DR. SYLVIA WESTERN.J. CANDIDATE AND POST GRADUATE STUDENT, ADDRESS DEPARTMENT OF CONSERVATIVE DENTISTRY AND ENDODONTICS, GOVERNMENT DENTAL COLLEGE AND RESEARCH INSTITUTE, BANGALORE-560002. 2 3 4 NAME OF THE GOVERNMENT DENTAL COLLEGE AND RESEARCH INSTITUTION INSTITUTE, BANGALORE-560002. COURSE AND STUDY MASTER OF DENTAL SURGERY IN CONSERVATIVE OF SUBJECT DENTISTRY AND ENDODONTICS. DATE OFADMISSION 1-6- 2011 TO THE COURSE 5 TITLE OF THE “A COMPARATIVE MICROLEAKAGE EVALUATION OF TOPIC AMALGAM, INTERMEDIATE RESTORATIVE MATERIAL, MINERAL TRIOXIDE AGGREGATE AND BIODENTINE AS ROOT END FILLING MATERIALS – AN IN VITRO STUDY.” 1 6. BRIEF RESUME OF THE INTENDED WORK 6.1 NEED FOR THE STUDYThe ultimate aim of all endodontic procedures is to obtain a hermetic seal between the periodontium and root canal foramina. When this is not possible by an orthograde approach, retrograde root end filling technique is used. An ideal root end filling material should prevent intrusion of microorganisms and their by-products into the periradicular tissues. Over the years, many root end filling materials like Amalgam, zinc oxide eugenol, IRM, glass ionomer cement, composite resins and MTA have been introduced.Amalgam is the most extensively used retro-filling material in the past seven decades. Newer modifications of zinc oxide eugenol compounds, such as IRM and Super EBA provide a better apical seal1. Amongst all recent root end filling materials, MTA has received crescent interest due to its good biocompatibility and favourable tissue response. A possible disadvantage that prevents MTA from being acceptable as "the ideal root-end filling material" is its longer setting time2. Biodentine is a fast setting calcium-silicate based dentin replacement material that is bioactive, biocompatible and has excellent sealing properties3. The purpose of this study was to evaluate the sealing ability of four different retro filling materials (Amalgam, IRM , MTA and Biodentine) by dye penetration. 6. 2. Review of literature An in vitro study evaluated the effect of cavity preparation with microburs and diamond coated ultrasonic tips on the microleakage and marginal fit of six root -end filling materials (Amalgam, IRM, Glass ionomer, Compomer, MTA, and Clearfil). Dye penetration and SEM studies concluded that Clearfil and MTA obtained a hermetic seal due to their excellent marginal fit and ultrasonic cavity preparation is preferable because it improves the seal and marginal fit of materials that do not achieve a hermetic seal(Amalgam, IRM, Glass ionomer and compomer)4. An in vitro study evaluated the effect of different apicoectomy angles, instruments used in rootend preparation, and dental materials used in retrofilling on apical sealing .Dye penetration studies and stereomicroscopic evaluation concluded that the type of apicoectomy and 2 instrument used in root-end preparation were not significant factors and teeth filled with gray MTA showed lower microleakage5. An in vitro SEM study evaluated the root end cavities following ultrasonic and bur preparation and the sealing ability of three retro filling materials (Amalgam, IRM and Giomer). Dye penetration studies and SEM evaluation concluded that the sealing ability of Intermediate restorative material was significantly better than that of amalgam and Giomer and ultrasonic cavity preparation showed cleaner cavity and less smear layer on the prepared cavity walls6 An in vitro study to compare the microleakage of three root end filling materials, Mineral trioxide aggregate (MTA), Glass ionomer cement (GIC) and Silver GIC(Miracle Mix) using dye penetration technique under stereomicroscope concluded that MTA is a better material as root end filling material to prevent microleakage, in comparison to GIC and Miracle Mix7 An in vitro study evaluated the apical microleakage of retrograde cavities filled with Portland cement, MTA and Sealapex. Dye penetration studies concluded that all the materials tested were unable to avoid dye penetration completely8. 6.3 OBJECTIVE OF THIS STUDY: Objective of this study is to evaluate the apical microleakage of retrograde cavities filled with Amalgam, IRM, MTA and Biodentine by determining linear dye penetration with a stereomicroscope. 7. MATERIALS AND METHODS: 7.1 SOURCE OF DATA: Freshly extracted 60, intact, non-carious single rooted human maxillary upper central incisors and canines that are extracted for periodontal reasons within six month period of start of the study will be collected from the department of Oral and Maxillofacial Surgery,Government Dental College and Research Institute,Bangalore.. All soft tissue and debris will be removed using ultrasonic tips. The selected teeth will be stored in normal saline at room temperature. 3 SELECTION CRITERIA Inclusion criteria: Single rooted teeth upper central incisors and canines with single root canal Teeth with intact apex Exclusion Criteria Teeth with Cracks Teeth with resorption of root Teeth with dilacerations 7.2METHODS AND COLLECTION OF DATA: The 60 selected specimens will be decoronated at the CEJ and standard endodontic access cavities will be prepared and the patency of the apical foramen will be determined with a size 10 K file. Working length will be established using Grossman’s method of working length determination. The teeth are instrumented to a size 50 master apical file. The step back technique will be used to flare the canal. l0 ml of 2.5% sodium hypochlorite will be used as an irrigant in between successive files. Recapitulation will be done using 25 size file during biomechanical preparation. The smear layer will be removed by irrigation with a combination of 10 ml of 17% EDTA solution and 10 ml 2.5% sodium hypochlorite, each for 3 minutes. Final rinse will be done with 10 ml of sterile distilled water. All canals will be dried with paper points and obturated using the lateral condensation technique with guttapercha and AH Plus. The access cavities will be sealed with glass ionomer cement. Root end cavities of depth 3mm and 90 degree resection bevel will be prepared using carbide bur or ultrasonic retrotip under continuous sterile distilled water irrigation. The external surfaces of all specimens are coated with two coats of nail polish and divided into four experimental groups Group 1-consists of 15 teeth which will be restored with zinc free Silver Amalgam in the prepared root end cavities. 4 Group 2-consists of 15 teeth which will be restored with Intermediate Restorative Material in the prepared root end cavities. Group 3-consists of 15 teeth which will be restored with MTA in the prepared root end cavities. Group 4-consists of 15 teeth which will be resored with Biodentine in the prepared root end cavities. After retrofilling, the teeth will be suspended so that only apical part of the root is immersed in methylene blue dye. The roots will be washed and split longitudinally with a diamond disc using a water coolant. The depth of dye penetration will be examined under a stereomicroscope to evaluate the roots for the extent of microleakage. The greatest depth of dye penetration along one of the cavity walls will be taken and measured in millimeters. The results will then be analyzed using ANOVA statistical test. 7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS IF SO, PLEASE DESCRIBE BRIEFLY. Patients consent will be obtained for using their teeth for experimental purpose. 7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3. Will be obtained 5 8. LIST OF REFERENCES 1. Vasudev SK, Goel BR, Tyagi S. Root end Filling Materials- A Review. Endodontology 2003;15:12-18. 2. Perinpanayagam H. Cellular response to mineral trioxide aggregate root-end filling materials. J Can Dent Assoc.2009 Jun;75(5):369-72. 3. S Koubi ,A Elmerini, G Koubi, H Tassery, J Camps. Quantitative evaluation by glucose diffusion of microleakage in aged calcium silicate-based open-sandwich restorations.International Journal of Dentistry (in press). 4. Rosales-Leal JI, Olmedo-Gaya V, Vallecillo-Capilla M, Luna-del Castillo J D. Influence of cavity preparation technique (rotary vs. ultrasonic) on microleakage and marginal fit of six end-root filling materials. Med Oral Patol Oral Cir Bucal. 2011 Mar 1;16 (2):e185-9. 5. Post LK, Lima F G, Xavier CB, Demarco FF, Gerhardt-Oliveira M. Sealing Ability of MTA and Amalgam in Different Root-End Preparations and Resection Bevel Angles: An In Vitro Evaluation Using Marginal Dye Leakage. Braz Dent J .2010);21(5): 416-419. 6. Harikaran D, Kavitha D, . DLN. SEM Evaluation of two different root-end preparations and a Comparative Microleakage evaluation of three different Retrofilling materials using two different root-end preparations by Dye Penetration method - an in vitro study . JIADS. 2010; 1(3): 1-6. 7. Saini ,G. Nadig ,R. Saini. A comparative analysis of microleakage of three root end filling materials – an in vitro study. Archives of Orofacial Sciences.2008; 3(2): 43-47. 8. Valera MC, Camargo CH, Carvalho AS, Gama ER. In vitro evaluation of apical microleakage using different root-end filling material. J Appl Oral Sci. 2006 Jan;14(1):49-52. 6 9. SIGNATURE OF THE CANDIDATE 10. REMARKS OF THE GUIDE 11.NAME AND DESIGNATION OF Dr. (Mrs.) M.KALA, GUIDE (IN BLOCK LETTERS) Professor and HOD, Department of Conservative Dentistry and Endodontics, Government Dental College and Research Institute, Bangalore-560002. 11.1 SIGNATURE 11.2 CO-GUIDE IF ANY 11.3 SIGNATURE 7 11.4 HEAD OF THE DEPARTMENT Dr. (Mrs.) M.KALA, Professor and HOD, Department of Conservative Dentistry and Endodontics, Government Dental College and Research Institute, Bangalore-560002. 11.5 SIGNATURE 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL 12.2 SIGNATURE 8 9