|Year : 2016 | Volume
| Issue : 1 | Page : 42-45
An in vitro comparison of push-out bond strength of biodentine and mineral trioxide aggregate in the presence of sodium hypochlorite and chlorhexidine gluconate
Shishir Singh, Rajesh Podar, Shifali Dadu, Gaurav Kulkarni, Snehal Vivrekar, Shashank Babel
Department of Conservative Dentistry and Endodontics, Terna Dental College, Navi Mumbai, Mumbai, Maharashtra, India
|Date of Web Publication||21-Jun-2016|
Department of Conservative Dentistry and Endodontics, Terna Dental College, Sector 22, Nerul, Navi Mumbai - 400 706, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
Aim: The aim of this in vitro study was to compare the push-out bond strength of Biodentine (Septodont, Saint Maur des Fosses, France) and mineral trioxide aggregate (MTA) (Angelus, Londrina, PR, Brazil) when treated with 3% sodium hypochlorite (NaOCl) and 2% chlorhexidine gluconate (CHX).
Materials and Methods: Forty-six single canal premolars were selected for this study, and the canal spaces were prepared with #5 Gates glidden drill (1.3 mm diameter). The dentin of these teeth was horizontally sectioned into 1-mm-thick slices at the mid-root level. The samples were divided into two groups (n = 20). Biodentine and MTA were placed into the canal space of dentin slices. The samples were wrapped in wet gauze for 10 min and divided into two subgroups (n = 10) to be immersed into 3% NaOCl and 2% CHX for 30 min. No irrigation was performed in the controls (n = 3). After incubation for 48 h, the dislodgement resistance of the samples was measured using a universal testing machine. The samples were examined under a stereomicroscope to determine the nature of the bond failures.
Results: Biodentine showed significantly higher push-out bond strength than MTA (P < 0.05) in the presence of both NaOCl and CHX. Within the MTA group, CHX further reduced the push-out bond strength when compared with NaOCl.
Conclusion: Push-out bond strength is the force needed for the displacement of the dental material tested. The various irrigants used during the root canal therapy may increase or decrease the push-out bond strength of a material.
Keywords: Biodentine; chlorhexidine gluconate; mineral trioxide aggregate; push-out bond strength; sodium hypochlorite.
|How to cite this article:|
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
|How to cite this URL:|
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 [serial online] 2016 [cited 2019 Nov 20];28:42-5. Available from: http://www.endodontologyonweb.org/text.asp?2016/28/1/42/184339
| Introduction|| |
Push-out test is a test to measure the interfacial shear strength developed between different surfaces. It provides information about the adhesive property of the material tested  and helps to understand the resistance of the tested material to dislodgement, that is how well the material can bind to the tooth structure. Greater the push-out strength, greater is the adhesion between the tested material and the tooth surface. In endodontics, the push-out bond strength is done for root end filling, perforation repair, obturation, and root canal sealer materials, to study their resistance to dislodgement. ,
Furcation perforation is a procedural complication that can occur during endodontic treatment or teeth postspace preparation.  An ideal perforation repair material provides a tight seal between the oral environment and periradicular tissues. It should also remain in place under dislodging forces, such as mechanical loads of occlusion or the condensation of restorative materials over it. ,,,
Mineral trioxide aggregate (MTA) has been widely used as a perforation repair material.  Despite the numerous favorable properties of MTA that support its clinical use when compared with other materials, there are several critical drawbacks such as the prolonged setting time, difficult handling characteristics, high cost, and potential of discoloration. ,,, A variety of new calcium silicate-based materials have been developed recently aiming to improve MTA shortcomings. , Biodentine (Septodont, Saint Maur des Foss-es, 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. Biodentine is recommended for use as a dentin substitute under resin composite restorations and an endodontic repair material because of its good sealing ability, high compressive strengths, short setting time, , biocompatibility, bioactivity, and biomineralization properties. ,,
Clinically, the operator should immediately repair the furcation perforations with an endodontic material to minimize the bacterial contamination and the irritation of periodontal tissues because of the usage of endodontic irrigants.  After repairing the furcal perforation, endodontic treatment should be performed where various irrigants including sodium hypochlorite (NaOCl) and 2% chlorhexidine gluconate (CHX) are used to disinfect the root canal system.  However, this procedure causes unavoidable contact of irrigants with the repair materials. Thus, the purpose of this study was to compare the push-out bond strength of Biodentine (Septodont, Saint Maur des Foss_es, France) and MTA (Angelus, Londrina, PR, Brazil) in the presence of 3% NaOCl and 2% CHX.
There is no difference in the push-out bond strength between MTA and Biodentine treated with different irrigants.
| Materials and Methods|| |
Forty-six freshly extracted single-canal decoronated human premolars were used. The canal spaces of all the teeth were prepared with number 5 gates glidden drill (1.3 mm diameter). The specimens were sectioned horizontally at the mid-root level dentin into 1.0 mm thick slices. These root sections were randomly divided into two groups [Table 1], and the following tests were used:
- Group 1: Biodentine (Septodont, Saint Maur des Foss_es, France) liquid from a single-dose container was emptied into a powder-containing capsule and mixed 30 s at 4000-4200 rpm as per manufacturer's instructions
- Group 2: MTA (Angelus, Londrina, PR, Brazil) was mixed with sterile water at a powder to liquid ratio of 3:1 as per manufacturer's instructions.
|Table 1: Mean values of push-out bond strength (MPa) for the subgroups of each test material|
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The test materials were incrementally placed into the canal spaces of the dentin slices and condensed. Excess material was trimmed from the surface of the samples with a scalpel. Subsequently, the samples were wrapped in wet gauze, placed in an incubator, and allowed to set for 10 min at 37°C with 100% humidity. Immediately after incubation, the samples in each group were divided into three subgroups to be immersed into 3% NaOCl (Comet, India) (n = 10), 2% CHX (Amdent, Jodhpur, Rajasthan, India) (n = 10) and control group (n = 3) with no irrigation performed. After 30 min of immersion, all samples of Group 1 and Group 2 were removed from the test solutions, rinsed with distilled water, and allowed to set for 48 h at 37°C with 100% humidity in an incubator. For the control group, a wet cotton pellet was placed over each test material without any irrigation and allowed to set for 48 h (n = 3).
The push-out bond strength values were measured by using a universal testing machine (Star Testing System, Mumbai, Maharashtra, India, Model no. STS 248, accuracy of the machine: ±1%). The samples were placed on an acrylic block with a central hole to allow the free motion of the plunger. The compressive load was applied by exerting a downward pressure on the surface of the test material in each sample with probe moving at a constant speed of 1 mm/min. The plunger had a clearance of approximately 0.2 mm from the margin of the dentinal wall to ensure contact only with the test materials. The maximum force applied to materials at the time of dislodgement was recorded in newtons. The push-out bond strength in megapascals (MPa) was calculated by dividing this force by the surface area of test material (N/2 prh ), where P is the constant = 3.14, r is the root canal radius, and h is the thickness of the root dentin slice in millimeters.
Nature of bond failure
The nature of the bond failure was assessed under a stereomicroscope at ×10 magnification. Each sample was categorized into one of the three failure modes: Adhesive failure at test material and dentin interface, cohesive failure within test material, or mixed failure [Figure 1].
|Figure 1: Bond failure under stereomicroscope (×10). (a) Adhesive failure. No material left on lumen. (b) Cohesive failure. Material present on entire lumen wall. (c) Mixed failure. Material in patches on lumen wall|
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Data were analyzed by using independent t-test and ANOVA (Levene's test). The significance level was established at 5% (P = 0.05) for all analyses.
| Results|| |
The mean values of push out bond strength (MPa) for the subgroups of each test material is presented in [Table 1] and [Graph 1 [Additional file 1]]. Exposure to NaOCl or CHX did not affect the resistance to displacement of Biodentine (P > 0.05). MTA lost strength after exposure to CHX solution, and the bond strength of the CHX-treated MTA group was the lowest.
There was a significant difference between (Group 1) Biodentine + NaOCl and MTA + NaOCl as well as (Group 2) Biodentine + CHX and MTA + CHX.
Within Group 1 (Biodentine group), there was no significant difference between the subgroups that is Biodentine + NaOCl compared with the control, and Biodentine + CHX compared with the control. Within Group 2 (MTA group), there was a significant difference between the subgroups MTA + NaOCl and MTA + CHX but no significant difference between MTA + NaOCl compared with the control and MTA + CHX compared with the control.
Hence, the null hypothesis that is "there is no difference in the push-out bond strength between MTA and Biodentine treated with different irrigants" was rejected.
Nature of bond failure
After push-out test was carried out and the test materials (Biodentine or MTA) got dislodged from the lumen of slices of teeth, these sections of teeth were viewed under stereomicroscope at ×10 magnification and it was found that in the Biodentine group maximum number of samples showed cohesive failure, whereas in the MTA group, adhesive failure was predominant [Table 2] and [Figure 1]. These findings also indicate that Biodentine can form a stronger adhesive bond with the tooth structure as compared to that formed by MTA.
| Discussion|| |
The study showed that push-out bond strength of Biodentine is better as compared to MTA which is in accordance with the study conducted by Guneser et al.  The biomineralization ability of Biodentine, most likely through the formation of tags, may be the reason of the greater dislodgement resistance of Biodentine than MTA. CHX reduced the push-out bond strength of both Biodentine and MTA. This result was consistent with the results of Hong et al.,  who showed that 2% CHX reduced the push-out strength of accelerated MTA. Exposure to 2% CHX, even though it is not an acid, may result in a reduced surface hardness, a decreased sealing ability, a slower setting time, and a lower resistance to dislodgement force.  Nandini et al.  showed that 2% CHX decreased the surface hardness of set white MTA significantly and suggested that CHX irrigation within 24 h of placement of white MTA should be avoided. Aggarwal et al.  found that 2% CHX reduced the microhardness and flexural strength of MTA.
The study showed that NaOCl has an effect on the higher push-out bond strength values of MTA, which is in accordance with various studies. , This effect was not statistically significant in case of Biodentine.
Biodentine displayed a remarkably consistent performance even after exposure to 3% NaOCl and 2% CHX. Almost all Biodentine samples revealed a cohesive bond failure, whereas most MTA samples showed an adhesive failure. The smaller particle size and uniform components might have a role in better interlocking of Biodentine with the dentin, which finally causes cohesive failure inside the cement.
| Conclusion|| |
The force needed for the displacement of Biodentine from root dentin was significantly higher than MTA in the presence of both NaOCl and CHX. CHX reduced the push-out bond strength of MTA. However, NaOCl and CHX did not influence the resistance to the dislodgement of Biodentine.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Thompson JI, Gregson PJ, Revell PA. Analysis of push-out test data based on interfacial fracture energy. J Mater Sci Mater Med 1999;10:863-8.
Shokouhinejad N, Nekoofar MH, Iravani A, Kharrazifard MJ, Dummer PM. Effect of acidic environment on the push-out bond strength of mineral trioxide aggregate. J Endod 2010;36:871-4.
Assmann E, Scarparo RK, Böttcher DE, Grecca FS. Dentin bond strength of two mineral trioxide aggregate-based and one epoxy resin-based sealers. J Endod 2012;38:219-21.
Hartwell GR, England MC. Healing of furcation perforations in primate teeth after repair with decalcified freeze-dried bone: A longitudinal study. J Endod 1993;19:357-61.
Gancedo-Caravia L, Garcia-Barbero E. Influence of humidity and setting time on the push-out strength of mineral trioxide aggregate obturations. J Endod 2006;32:894-6.
Kogan P, He J, Glickman GN, Watanabe I. The effects of various additives on setting properties of MTA. J Endod 2006;32:569-72.
Bogen G, Kuttler S. Mineral trioxide aggregate obturation: A review and case series. J Endod 2009;35:777-90.
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.
Roberts HW, Toth JM, Berzins DW, Charlton DG. Mineral trioxide aggregate material use in endodontic treatment: A review of the literature. Dent Mater 2008;24:149-64.
Chng HK, Islam I, Yap AU, Tong YW, Koh ET. Properties of a new root-end filling material. J Endod 2005;31:665-8.
Torabinejad M, Parirokh M. Mineral trioxide aggregate: A comprehensive literature review - part II: Leakage and biocompatibility investigations. J Endod 2010;36:190-202.
Johnson BR. Considerations in the selection of a root-end filling material. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:398-404.
Hardy I, Liewehr FR, Joyce AP, Agee K, Pashley DH. Sealing ability of one-up bond and MTA with and without a secondary seal as furcation perforation repair materials. J Endod 2004;30:658-61.
Asgary S, Shahabi S, Jafarzadeh T, Amini S, Kheirieh S. The properties of a new endodontic material. J Endod 2008;34:990-3.
Han L, Okiji T. Uptake of calcium and silicon released from calcium silicate-based endodontic materials into root canal dentine. Int Endod J 2011;44:1081-7.
Laurent P, Camps J, De Méo M, Déjou J, About I. Induction of specific cell responses to a Ca (3)SiO(5)-based posterior restorative material. Dent Mater 2008;24:1486-94.
Koubi G, Colon P, Franquin JC, Hartmann A, Richard G, Faure MO, et al.
Clinical evaluation of the performance and safety of a new dentine substitute, Biodentine, in the restoration of posterior teeth - A prospective study. Clin Oral Investig 2013;17:243-9.
Loxley EC, Liewehr FR, Buxton TB, McPherson JC 3 rd
. The effect of various intracanal oxidizing agents on the push-out strength of various perforation repair materials. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:490-4.
Yan P, Peng B, Fan B, Fan M, Bian Z. The effects of sodium hypochlorite (5.25%), chlorhexidine (2%), and Glyde File Prep on the bond strength of MTA-dentin. J Endod 2006;32:58-60.
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.
Hong ST, Bae KS, Baek SH, Kum KY, Shon WJ, Lee W. Effects of root canal irrigants on the push-out strength and hydration behavior of accelerated mineral trioxide aggregate in its early setting phase. J Endod 2010;36:1995-9.
Holt DM, Watts JD, Beeson TJ, Kirkpatrick TC, Rutledge RE. The anti-microbial effect against enterococcus faecalis and the compressive strength of two types of mineral trioxide aggregate mixed with sterile water or 2% chlorhexidine liquid. J Endod 2007;33:844-7.
Nandini S, Natanasabapathy V, Shivanna S. Effect of various chemicals as solvents on the dissolution of set white mineral trioxide aggregate: An in vitro
study. J Endod 2010;36:135-8.
Aggarwal V, Jain A, Kabi D. In vitro
evaluation of effect of various endodontic solutions on selected physical properties of white mineral trioxide aggregate. Aust Endod J 2011;37:61-4.
[Table 1], [Table 2]