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Loyola University ChicagoLoyola eCommons
Master's Theses Theses and Dissertations
1976
A Quantitative Analysis of Microleakage inEndodontic Reverse FillsJerome PisanoLoyola University Chicago
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Recommended CitationPisano, Jerome, "A Quantitative Analysis of Microleakage in Endodontic Reverse Fills" (1976). Master's Theses. Paper 2799.http://ecommons.luc.edu/luc_theses/2799
micromarginal leakage, £luid exchange, liquid di££usion, or
capillary penetration (Going, 1972). The major problems with
the studies to date is that all materials that have demonstrated
marginal leakage have not been ideally compared. Quantitative
autoradiography is di££icult to attempt, and di££icult to analyze
in order to draw valid comparisons £rom (Baserga, 1969). Auto
radiography is a qualitative tool that has been £orced into action
as a method 0£ answering what appears to be a quantitative ques
tion. Scintillation counting provides a much more reliable
method 0£ leakage detection with highly reproducible data
41
42
collection as shown in this study. The selection of the isotope
appears to be critical. Tritiated water proposed problems here
and has a history of difficulties associated with its use.
Burke (1975) successfully used tritium to study the diffusion
fluxes across human enamel. A diaphragm of enamel was placed
between two diffusion cells, and different rates of diffusion
were measured for canine versus incisor teeth. This penetrability
and diffusion potential of tritium across enamel membranes could
well be established some day across cementum or dentin in like
manner. Leakage data using tritiated water therefore could be
masked by diffusion through the tooth structure as well as around
and through the restorative material. The penetration of glass
by tritiated water in this study should be considered a clear
contraindication for its use in leakage potential studies. As
early as 1937, Bodecker demonstrated this porosity of tooth
structure using dyes. Wainwright (1953) believes cementum and
enamel are permeable to some substances selectively, but not all
14 substances. Calcium chloride, C -labelled urea and radioiodine
were all shown to penetrate intact tooth structure and reach the
pulp. He also stated that the dentinal tubules and cellular
cementum near the root apex are probably more permeable than the
acellular cementum more occlusally on the root surface.
The results of this study using c14-labelled glucose showed
no through penetration of the root itself as indicated by the
coated and plain samples. At least on the forty-eight hour
short term basis, all the radioactivity detected in the wash
baths came from around or through the restoration placed at the
apex of the root. This fact can be attributed to the molecular
size and other physical and chemical properties of the glucose
molecule. Also, that most porous apical portion 0£ the roots
had already been removed in the apicoectomy procedure prior to
the preparation and filling.
Results showing that amalgam and Cavit sealed considerably
better than gutta percha alone seem to agree with most previous
qualitative studies. It should be noted that amalgam sealed
better than gutta percha at a level of significance higher than
that of Cavit. Parris (1964) stated that Cavit and amalgam were
equally superior to gutta percha in sealing ability. This was
found not to be true. Comparison with Yee's study (1975) is
difficult in that his model differed considerably; the tooth's
crown acted as the reservoir of radioactive material and the
canals were filled their entire length.
Finally, of concern were the attempts at quantitative
recovery 0£ the isotope used. One-hundred percent recovery was
never realized, and rarely were recovery values consistent.
The possibility of bacteria present in the canals breaking down
the glucose to some other form and ingesting or processing any
of the test solution was ruled out by the pilot study on auto
claved teeth handled aseptically. Recovery for this group was
the same--irregular and never near one-hundred per cent.
44
Two explanations seem plausible but have not been proven.
The oxidation temperature 0£ ·.the samples in the Tri Carb 0
Oxidizer is said to be between 600-1000 C. Is this temperature
su££icient to break down the carbon in the compact, highly
intricate tubular and calci£ied structure 0£ the dental root £or
quantitative conversion to co2 ? I£ it is, is a temperature .0£
0 1000 C actually realized in the combustion chamber, and are the
combustion times long enough? Nixon (1964) said,
n ••• radioisotopes have been used to show that transport
of ions takes place through dental tissues. This trans
port is two way and occurs £rom the pulp through dentin
and enamel and also £rom saliva through enamel and dentin.
Substances like glucose can be labelled and made radio
active and its passage through the enamel studied."
Going (1960) stated that isotopes, because 0£ their differ-
ent ion charges, have distinctive chemical a£finities and there-
£ore particular adsorption potentials and diffusion patterns
through and around tooth substances and restorative materials.
14 Wainwright (1953) showed the passage 0£ C -labelled urea through
tooth roots in twenty-four hours. With these documented conclu-
14 sions, is it not practical to assume that C -labelled glucose
could be held in a bound or converted state somewhere in the
root structure that does not allow it to be volatilized and
measured? Could diffusion through and adsorption to the walls of
the dentinal tubules account £or such results? It was shown in
14 · pilot studies prior to this £inal experiment that C -labelled
45
glucose injected into teeth and oxidized immediately showed the
highest recovery values of all. Possibly tubular penetration,
binding or adsorption was not allowed to occur in such a short
time. At any rate, the work of Zurbriggen (1975) would be highly
suspect to error in light of the results of this experiment.
14 . He instrumented canals with a C -labelled chelating agent and
measured, by combustion analysis and subsequent l_iquid scintilla-
tion counting, the amount of labelled material retained in the
canals after irrigation with sodium hypochlorite. Only 3.8% of
the initial activity was recovered as retained in the roots. It
can now be shown that a considerably higher percentage may have
been retained but never counted.
All studies to date could be termed only exercises unless
some significance is attached to microleakage potential.
Molecules of various substanc~s surely diffuse around or through
restorative materials. Whether this phenomenon can potentiate
endodontic failures or failures of endodontic reverse fills is
still only speculation. An in vivo study demonstrating this --potential might add more credence to this argument, but so many
factors would be involved that attributing a certain percentage
of failure to one shortcoming would be impossible. It can be
said that if all considerations are weighed, the best apical seal
possible with a material well tolerated by living tissue should
be the filling material of choice in endodontic reverse filling
46
techniques. Silver amalgam seems to meet these requirements
better than any other material tested including Cavit.
SUMMARY AND CONCLUSIONS
Seventy-two extracted human central incisors were reverse
filled with silver amalgam, Cavit and warm gutta percha in an
attempt to quantitatively investigate the differences between
the marginal sealing capabilities of these materials and the
possible relationship between this factor and the treatment of
endodontic failures. 14
A C -labelled solution of glucose was
measured and injected into each sample and scintillation counting
and sample oxidation were performed to measure the amount of
radioactive material lost around or through the test materials.
The experiment clearly showed the following:
a) That microleakage of molecular size particles does occur
a~ound what appears to be clinically adequate fills.
b) That a quantitative measurement of this microleakage is
possible and can be used to compare materials used as endo-
don tic reverse frll:1-ng agents.
c) That amalgam appears to be superior to Cavit and gutta
percha as an endodontic reverse filling material.
d) Tritiated water is not suitable for the. measurement of
microleakage in this technique.
47
48
Further experimentation is necessary to consider the problem of
quantitative recovery of test solutions as it pertains to this
study and as it pertains to the structure and function of the
tooth.
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I
ii 'I
APPENDIX
FIGURE A
Plugger f'itted into prepared canal
59
FIGURE B
Apical. filling placed and pl.ugger removed
60
FIGURE C
The Closed System
FIGURE D
One Lambda Syringe
FIGURE E
A One Lambda Sample
62
FIGURE F
Platinum Wire Combustion Basket
63
2 Total sums of' squares = x
{Ix)2 N
Between sums of'
Within sums of'
(319.6)2
= 2048.6 - 64
= 2048.62 - 1596
squares (Ix1
) 2
~~x2) 2
= + Nl N2
= 228
squares Total - Between =
= 224.6
Sums of'
(~x)2 + etc. --N
Variance Degrees of' Freedom Sguares Mean Sguare
Between
Within
5 228.0 45.6
58 224.6 3.9
F value is 3.36 at the 0.01 level;
therefore, there are significant di:ff'erences
because 11.7 is greater than 3.36.
FIGURE G. Example Between Within Statistics Total Study
F
11.7
. APPROVAL SHEET
The thesis submitted by Jerome V. Pisano, D.D.S., has been read and approved by the following committee:
Dr. Joesph M. Gowgiel Associate Professor and Chairman Department of Anatomy, Loyola
Dr. Walter E. Kisieleski Clinical Associate Professor, Oral Pathology, Loyola
Dr. Marshall H. Smulson Professor and Chairman Department of Endodontics, Loyola
Dr. Norman K. Wood Associate Professor and Chairman Oral Diagnosis, Loyola
Dr. James L. Sandrik Assistant Professor, Dental Materials, Loyola
The final copies h.a:ve been examined by the director of the thesis and the signature which appears below verifies the fact that any necessary changes have been incorporated and that the thesis is now given final approval by the Committee with reference to content and form.
The thesis is therefore accepted in partial fulfillment of the requirements for the degree of Master of Science.