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Apically Extruded Sealers: Fate and Influence on Treatment Outcome

Published:December 24, 2015DOI:https://doi.org/10.1016/j.joen.2015.11.020

      Abstract

      Introduction

      This retrospective study evaluated cases of unintentional overfillings for the fate of the extruded sealers and their influence on treatment outcome.

      Methods

      One hundred five teeth treated by a single operator and exhibiting overfillings in the postobturation radiograph were included in the study. Seventy-five teeth exhibited apical periodontitis lesions at the time of treatment. Sealers included Pulp Canal Sealer (Sybron Dental, Orange, CA), PCS Extended Working Time-EWT (Sybron Dental), Tubli-Seal (Sybron Endo), Endomethasone (Septodont, Saint-Maur-des-Fossés, France), AH Plus (DeTrey GmbH, Konstanz, Germany), and Apexit (Ivoclar Vivadent, Schaan, Lichtenstein). Recall radiographs were compared with immediate postobturation films for removal of the extruded material and status of the periradicular tissues. Data were grouped as 1-, 2- and >4-year recall and statistically analyzed using the chi-square and Fisher exact tests.

      Results

      As for the sealers' fate, the only statistically significant differences at the 1-year recall were observed when comparing Tubli-Seal with AH Plus, Apexit, and Endomethasone (P < .05). At both the 2- and 4-year recalls, frequency of complete removal of AH Plus and Apexit was significantly lower when compared with all the other sealers (P < .05). No other significant differences were observed between groups. As for the influence on treatment outcome, there were no statistically significant differences between sealers at all follow-up periods (P > .05). Data from the >4-year recall revealed that 79% of the teeth with apical periodontitis lesions at the time of treatment had healed in comparison with 100% of the teeth with no apical periodontitis (P < .01).

      Conclusions

      Not all extruded sealers were predictably removed from the periradicular tissues. Treatment outcome was not significantly affected by the type of extruded sealer. A significantly better outcome was observed for teeth with no lesion in comparison with teeth with apical periodontitis.

      Key Words

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      References

        • Siqueira Jr., J.F.
        Treatment of Endodontic Infections.
        Quintessence Publishing, London2011: 313-340
        • Ricucci D.
        • Langeland K.
        Apical limit of root canal instrumentation and obturation, part 2. A histological study.
        Int Endod J. 1998; 31: 394-409
        • Schaeffer M.A.
        • White R.R.
        • Walton R.E.
        Determining the optimal obturation length: a meta-analysis of literature.
        J Endod. 2005; 31: 271-274
        • Sjögren U.
        • Hagglund B.
        • Sundqvist G.
        • Wing K.
        Factors affecting the long-term results of endodontic treatment.
        J Endod. 1990; 16: 498-504
        • Ricucci D.
        • Russo J.
        • Rutberg M.
        • et al.
        A prospective cohort study of endodontic treatments of 1,369 root canals: results after 5 years.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112: 825-842
        • Schilder H.
        Filling root canals in three dimensions.
        Dent Clin North Am. 1967; 11: 723-744
        • Muruzábal M.
        • Erasquin J.
        • DeVoto F.C.H.
        A study of periapical overfilling in root canal treatment in the molar of rat.
        Arch Oral Biol. 1966; 11: 373-383
        • Nair P.N.
        • Sjögren U.
        • Krey G.
        • Sundqvist G.
        Therapy-resistant foreign body giant cell granuloma at the periapex of a root-filled human tooth.
        J Endod. 1990; 16: 589-595
        • Ricucci D.
        • Siqueira Jr., J.F.
        • Bate A.L.
        • Pitt Ford T.R.
        Histologic investigation of root canal-treated teeth with apical periodontitis: a retrospective study from twenty-four patients.
        J Endod. 2009; 35: 493-502
        • Sjögren U.
        • Figdor D.
        • Persson S.
        • Sundqvist G.
        Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis.
        Int Endod J. 1997; 30: 297-306
        • Byström A.
        • Happonen R.P.
        • Sjögren U.
        • Sundqvist G.
        Healing of periapical lesions of pulpless teeth after endodontic treatment with controlled asepsis.
        Endod Dent Traumatol. 1987; 3: 58-63
        • Lin L.M.
        • Skribner J.E.
        • Gaengler P.
        Factors associated with endodontic treatment failures.
        J Endod. 1992; 18: 625-627
        • Siqueira Jr., J.F.
        • Rôças I.N.
        • Ricucci D.
        • Hülsmann M.
        Causes and management of post-treatment apical periodontitis.
        Br Dent J. 2014; 216: 305-312
        • Fristad I.
        • Molven O.
        • Halse A.
        Nonsurgically retreated root filled teeth–radiographic findings after 20-27 years.
        Int Endod J. 2004; 37: 12-18
        • Augsburger R.A.
        • Peters D.D.
        Radiographic evaluation of extruded obturation materials.
        J Endod. 1990; 16: 492-497
        • Ørstavik D.
        • Qvist V.
        • Stoltze K.
        A multivariate analysis of the outcome of endodontic treatment.
        Eur J Oral Sci. 2004; 112: 224-230
        • Huumonen S.
        • Lenander-Lumikari M.
        • Sigurdsson A.
        • Ørstavik D.
        Healing of apical periodontitis after endodontic treatment: a comparison between a silicone-based and a zinc oxide-eugenol-based sealer.
        Int Endod J. 2003; 36: 296-301
        • Eriksen H.M.
        • Ørstavik D.
        • Kerekes K.
        Healing of apical periodontitis after endodontic treatment using three different root canal sealers.
        Endod Dent Traumatol. 1988; 4: 114-117
        • Waltimo T.M.
        • Boiesen J.
        • Eriksen H.M.
        • Ørstavik D.
        Clinical performance of 3 endodontic sealers.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 92: 89-92
        • Strindberg L.Z.
        The dependence of the results of pulp therapy on certain factors.
        Acta Odontol Scand. 1956; 14: 1-175
        • Faria-Junior N.B.
        • Tanomaru-Filho M.
        • Berbert F.L.
        • Guerreiro-Tanomaru J.M.
        Antibiofilm activity, pH and solubility of endodontic sealers.
        Int Endod J. 2013; 46: 755-762
        • Schäfer E.
        • Zandbiglari T.
        Solubility of root-canal sealers in water and artificial saliva.
        Int Endod J. 2003; 36: 660-669
        • Marin-Bauza G.A.
        • Silva-Sousa Y.T.
        • da Cunha S.A.
        • et al.
        Physicochemical properties of endodontic sealers of different bases.
        J Appl Oral Sci. 2012; 20: 455-461
        • Spångberg L.S.
        • Barbosa S.V.
        • Lavigne G.D.
        AH 26 releases formaldehyde.
        J Endod. 1993; 19: 596-598
        • Barbosa S.V.
        • Araki K.
        • Spångberg L.S.
        Cytotoxicity of some modified root canal sealers and their leachable components.
        Oral Surg Oral Med Oral Pathol. 1993; 75: 357-361
        • Ørstavik D.
        • Mjör I.A.
        Histopathology and x-ray microanalysis of the subcutaneous tissue response to endodontic sealers.
        J Endod. 1988; 14: 13-23
        • Ricucci D.
        • Siqueira Jr., J.F.
        Endodontology. An Integrated Biological and Clinical View.
        Quintessence Publishing, London2013: 239-291
        • Langeland K.
        Root canal sealants and pastes.
        Dent Clin North Am. 1974; 18: 309-327
        • Spångberg L.S.W.
        • Haapasalo M.
        Rationale and efficacy of root canal medicaments and root filling materials with emphasis on treatment outcome.
        Endod Topics. 2002; 2: 35-58
        • Siqueira Jr., J.F.
        Aetiology of root canal treatment failure: why well-treated teeth can fail.
        Int Endod J. 2001; 34: 1-10
        • Vier F.V.
        • Figueiredo J.A.
        Prevalence of different periapical lesions associated with human teeth and their correlation with the presence and extension of apical external root resorption.
        Int Endod J. 2002; 35: 710-719
        • Yusuf H.
        The significance of the presence of foreign material periapically as a cause of failure of root treatment.
        Oral Surg Oral Med Oral Pathol. 1982; 54: 566-574
        • Ricucci D.
        • Siqueira Jr., J.F.
        • Lopes W.S.
        • et al.
        Extraradicular infection as the cause of persistent symptoms: a case series.
        J Endod. 2015; 41: 265-273
        • Molven O.
        • Halse A.
        • Fristad I.
        • MacDonald-Jankowski D.
        Periapical changes following root-canal treatment observed 20-27 years postoperatively.
        Int Endod J. 2002; 35: 784-790
        • Ricucci D.
        • Lin L.M.
        • Spångberg L.S.
        Wound healing of apical tissues after root canal therapy: a long-term clinical, radiographic, and histopathologic observation study.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: 609-621
        • Vieira A.R.
        • Siqueira Jr., J.F.
        • Ricucci D.
        • Lopes W.S.
        Dentinal tubule infection as the cause of recurrent disease and late endodontic treatment failure: a case report.
        J Endod. 2012; 38: 250-254
        • Gonzalez-Martin M.
        • Torres-Lagares D.
        • Gutierrez-Perez J.L.
        • Segura-Egea J.J.
        Inferior alveolar nerve paresthesia after overfilling of endodontic sealer into the mandibular canal.
        J Endod. 2010; 36: 1419-1421
        • Brkic A.
        • Gurkan-Koseoglu B.
        • Olgac V.
        Surgical approach to iatrogenic complications of endodontic therapy: a report of 2 cases.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 107: e50-e53
        • Alves F.R.
        • Coutinho M.S.
        • Gonçalves L.S.
        Endodontic-related facial paresthesia: systematic review.
        J Can Dent Assoc. 2014; 80: e13