|Year : 2020 | Volume
| Issue : 3 | Page : 178-182
Comparison of the effect of sodium hypochlorite, EDTA, and etidronic acid on wettability of root canal sealers using contact angle goniometer: An in vitro study
Sravanthi Tammineedi1, Sudha Kakollu2, Murali Mohan Thota3, Lakshman Chowdary Basam4, Ram Chowdary Basam1, Shoba Chinthamreddy2
1 Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
2 Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India
3 Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, RIMS, Kadapa, Andhra Pradesh, India
4 Department of Orthodontics and Dentofacial Orthopedics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India
|Date of Submission||12-Jun-2020|
|Date of Acceptance||25-Aug-2020|
|Date of Web Publication||30-Sep-2020|
Dr. Sravanthi Tammineedi
Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Aim: To evaluate and compare the effect of Sodium hypochlorite, etidronic acid, and ethylenediamine tetraacetic acid (EDTA) on the contact angle of AH Plus and MTA Fillapex root canal sealers.
Materials and Methods: 45 freshly extracted single rooted teeth were selected and decoronated. They were then split longitudinally to obtain two halves which were trimmed as flat dentin bars of 2 mm thickness. They were randomly assigned to 3 groups of 30 each. The samples were surface treated with 2.5% sodium hypochlorite in Group A, 2.5% sodium hypochlorite followed by 17% EDTA in Group B, and a combination of 2.5% sodium hypochlorite and 18% etidronic acid in Group C. Each group was subdivided into two subgroups based on the sealer used, i.e., Subgroup 1-AH Plus and Subgroup 2-MTA Fillapex. The contact angle was analyzed using Rame Harte Goniometer.
Results: AH Plus has significantly lesser contact angles than MTA Fillapex. The contact angle values showed the order of C1 < B1 < A1 < C2 < B2 < A2.
Conclusion: Irrigating solutions affect the wettability of rootcanal sealers. AH Plus showed better wettability compared to MTA Fillapex. Irrigation with a combination of sodium hypochlorite and etidronic acid significantly decreased the contact angle, thereby increasing the wettability of sealers.
Keywords: AH Plus, contact angle, etidronic acid, MTA Fillapex, wettability
|How to cite this article:|
Tammineedi S, Kakollu S, Thota MM, Basam LC, Basam RC, Chinthamreddy S. Comparison of the effect of sodium hypochlorite, EDTA, and etidronic acid on wettability of root canal sealers using contact angle goniometer: An in vitro study. J NTR Univ Health Sci 2020;9:178-82
|How to cite this URL:|
Tammineedi S, Kakollu S, Thota MM, Basam LC, Basam RC, Chinthamreddy S. Comparison of the effect of sodium hypochlorite, EDTA, and etidronic acid on wettability of root canal sealers using contact angle goniometer: An in vitro study. J NTR Univ Health Sci [serial online] 2020 [cited 2020 Nov 26];9:178-82. Available from: https://www.jdrntruhs.org/text.asp?2020/9/3/178/296830
| Introduction|| |
Irrigation of the root canal system provides gross debridement, lubrication, destruction of microbes, dissolution of tissues and helps in cleaning areas that are inaccessible for mechanical cleansing. Interestingly, irrigation protocols seem to influence the adhesion of sealers to root dentin. Root dentin is differentially affected by proteolytic sodium hypochlorite and calcium chelating agents. Sodium hypochlorite (NaOCl) presents capacity of dissolution of organic tissues, saponification of fats, and neutralization of toxic products as well as antimicrobial and deodorizing action. The type of decalcifying agent has a significant impact on the root dentine wall. 17% ethylenediamine tetraacetic acid (EDTA) will cause a complete demineralization of the root dentin wall, while organic acids cause a gradual demineralization. The latter dentine condition may provide improved resin infiltration. An irrigation protocol with 18% etidronic acid (1-hydroxyethylidene-1,1-biphosphonate, called HEBP) also known as etidronate has been suggested as an alternative to 17% EDTA because of its chelating ability. The tendency of a liquid to spread on a solid surface is expressed with the formation of a contact angle. Contact angle measurements provide a better understanding of the interactions between solids and liquids. There are several studies evaluating the effect of different irrigating solutions on the wettability of root canal sealers. However, there is few literature evaluating the effect of etidronic acid on the wettability of root canal sealers.
Hence, the need of the study was to evaluate the effect of dentin chemical pretreatment using 2.5% NaOCl, 17% EDTA, and 18% etidronic acid on the wettability of AH Plus and MTA Fillapex sealers.
| Methodology|| |
The study was approved by Institutional Ethical Committee of Government Dental College and Hospital and the approval number is No. 3/A/IEC-GDCH-VJA/2016. In the present study, 45 freshly extracted anterior teeth with fully developed roots and without previous root canal treatment were collected and all of them were stored in 0.9% normal saline solution until preparation. Decoronation was performed. The teeth were sectioned longitudinally with slow speed micromotor and diamond saw to obtain two halves which were trimmed as flat dentin bars of 2 mm thickness. Surfaces were smoothed under distilled water with polishing disks (Soflex; 3M ESPE St Paul, MN, USA). The prepared samples were divided into 3 groups of 30 each.
Group A: Samples were treated with 10 mL of 2.5% sodium hypochlorite solution for 5 min, rinsed with 10 mL of distilled water and blot dried.
Subgroup A1-AH Plus (DeTrey-Dentsply, Konstanz, Germany)
Subgroup A2-Mineral Trioxide Aggregate Fillapex (Angelus, Londrina, Brazil)
Group B: Samples were treated with 10 mL of 2.5% sodium hypochlorite for 5 min followed by rinsing with 10 mL of distilled water. They were then irrigated with 10 mL of 17% EDTA solution for 5 min. Because of the self-limiting effect of EDTA, solutions were renewed every minute thus achieving more effective action, final rinse with 10 mL of distilled water and then blot dried.
Subgroup B1-AH Plus
Subgroup B2-Mineral Trioxide Aggregate Fillapex
Group C: Fresh 1: 1 mixture of 2.5% NaOCl and 18% etidronic acid was prepared immediately before the experiments. Samples were treated with 20 mL of 2.5% sodium hypochlorite and 18% etidronic acid for 5 min, rinsed with 10 mL of distilled water and then blot dried.
Subgroup C1-AH Plus
Subgroup C2-Mineral Trioxide Aggregate Fillapex
A Rame Hart Goniometer was used to measure the contact angle between sealers and dentin samples treated with different irrigant solutions. The sealers were manipulated according to manufacturer's instructions and a drop (0.1 mL) of sealer was deposited on the dentin surface using a 0.5 mL ultrafine syringe. Specimens were photographed 5 min after dispensing the sealer droplet. Images of the drop were analyzed to provide the values of contact angle [Figure 1].
|Figure 1: Representative images of sessile drops of sealers after dentin treatment with different irrigating solutions: A) Group A1 (NaOCl-AH Plus), B) Group A2 (NaOCl-MTA Fillapex), C) Group B1 (NaOCl and EDTA-AH Plus) D), Group B2 (NaOCl and EDTA-MTA Fillapex), E) Group C1 (NaOCl + etidronic acid-AH Plus), and F) Group C2 (NaOCl + etidronic acid-MTA Fillapex)|
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The results were statistically analyzed using one-way ANOVA and the multiple comparisons among the groups were carried out by the post hoc Tukey's test and t-test for intragroup comparisons. The level of significance was fixed at P < 0.05.
| Results|| |
Comparison of the contact angle values of all the groups with the AH Plus sealer showed that Group A1 (NaOCl-AH Plus) had the highest contact angle followed by Group B1 (NaOCl and EDTA-AH Plus) and Group C1 (NaOCl + etidronic acid-AH Plus) [Table 1]. Group C1 had the lowest contact angle values which were statistically significant (P < 0.01) when compared with Group A1 and insignificant (P = 0.08) when compared with Group B1 [Table 2].
|Table 1: Mean Score and Standard Deviation Comparing the Contact Angle Among the Groups A1, B1, and C1|
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|Table 2: Comparison of Mean Between Groups A1, B1 and C1 By Using Tukey'S Post Hoc Test|
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Comparison of the contact angle values of all the groups with the MTA Fillapex sealer showed that Group A2 (NaOCl-MTA Fillapex) had the highest contact angle values followed by Group B2 (NaOCl and EDTA-MTA Fillapex) and Group C2 (NaOCl + etidronic acid-MTA Fillapex) [Table 3]. Group C2 had the lowest contact angle values which were statistically significant (P < 0.01) when compared with Group A2 and insignificant (P = 0.07) when compared with Group B2 [Table 4].
|Table 3: Mean Score and Standard Deviation Comparing the Contact Angle Among the Groups A2, B2, and C2|
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|Table 4: Comparison of Mean Between Groups A2, B2 and C2 By Using Tukey'S Post Hoc Test|
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Intragroup comparison showed that AH Plus had lesser contact angle compared to MTA Fillapex. The order of contact angle values C1 < B1 < A1 < C2 < B2 < A2 [Graph 1] indicating that irrigation with a combination of sodium hypochlorite and etidronic acid significantly decreased the contact angle of sealers, thereby increasing the wettability. According to the one-way ANOVA comparison of mean contact angle values of six groups, calculated P values indicated a significant difference between the groups.
| Discussion|| |
Optimum adhesion requires intimate contact between the sealer and the substrate to facilitate molecular attraction and allow either chemical adhesion or penetration for micromechanical surface interlocking. The adhesion process is mainly influenced by the relative surface free energy (wetting ability) of the solid surface. Adhesion of a root canal sealer depends on the wetting ability of the sealer. Irrigation protocols seem to influence the adhesion of sealers to root canal wall.
When an attempt is made to remove the smear layer, the use of chemicals in conjunction with sodium hypochlorite is not straightforward, as hypochlorite reacts with most moieties that can be oxidized (Lottanti et al. 2006). Consequently, it has been recommended that a sodium hypochlorite irrigant be used during instrumentation of the root canal to prolong disinfection and tissue dissolution time and then a chelator solution be administered to clean the canal system of inorganic debris.
There are two ways to simplify this protocol: i) to use a chelator that does not interfere with sodium hypochlorite or ii) to use a chelator with a strong disinfecting capacity as final irrigant. Etidronic acid (also known as 1-hydroxyethylidene-1, 1-bisphosphonate or HEBP) is a biocompatible chelator that can be used in combination with sodium hypochlorite without short-term loss of the desired properties of either compounds (Girard et al. 2005). This could have the advantage that a sodium hypochlorite and etidronic acid combination could be used as a single irrigant during and after instrumentation. It was also noted that when the mixture is used during biomechanical preparation, the smear layer is not formed (Girard et al. 2005, Lottanti et al. 2009)., In addition, hard-tissue debris accumulation in the isthmus area is reduced (Paque et al. 2012).
Contact angle measurement is a useful indicator of wetting behavior of any liquid tested. This angle is formed by a liquid at the three-phase boundary where a liquid, gas, and solid intersect. If the value of contact angle is less than 90°, the liquid (sealer) wets the substrate; if it is more than 90°, it is said to be non-wetting. A zero contact angle represents complete wetting. Thus, the contact angle provides an inverse measure of wettability meaning that the lower the contact angle, the better the wettability.
The factors affecting the contact angle on the liquid side include the surface tension, and those on the solid side include the hydrophobic effect caused by changes in the porosity as a result of surface roughness and the surface energy effect based on the changes in the 3-dimensional structure of the surface molecules. Polishing the dentin surface was done to reduce the influence of roughness on the surface energy of the root dentine wall, thus affecting the contact angle measurement.
The contact angle can be measured using a captive bubble or a sessile drop technique. In the present study, the sessile drop method was used. With this approach, the contact angles of a liquid drop on flat surfaces can be maintained in a dry environment. The state of hydration of the dentin surface is also shown to affect the contact angle. Hence, the specimens were blot dried to keep the dentin surface sufficiently hydrated after the final rinse with distilled water. All measurements were conducted by using a controlled volume (0.1 mL) of each sealer. This was done because any volumetric change could affect the value of contact angle. Also, the entire experimental procedure was performed under standard environmental conditions because the surface tension coefficient of liquids is influenced by temperature change and humidity.
Intergroup comparison showed that surfaces treated with combination of sodium hypochlorite and etidronic acid presented least contact angles compared with EDTA and sodium hypochlorite but the difference was not statistically significant between etidronic acid and EDTA. The reason for etidronic acid and EDTA treated surfaces presenting better wettability could be the intimate contact of the sealer with the dentin surface and the penetration of the sealer into the dentinal tubules as a result of the removal of the smear layer.
Intragroup comparison revealed that irrespective of irrigating solution, AH Plus showed least contact angle values compared to MTA Fillapex. Superior wetting of AH Plus sealer on the root dentin surface could be because of its ability to penetrate into the micro irregularities better. The investigations by Nunes et al. and Eldeniz
et al. showed the good adhesive property of AH Plus sealer, which support the result in the present study., MTA Fillapex had a lower flow than AH Plus (Vitti et al. (2013).
The present study showed contradictory results compared to the study conducted by Telles et al. They stated that EDTA and Q Mix showed better wettability compared to etidronic acid. The possible explanation for this could be the difference in the irrigation time. They performed irrigation for 3 min; however, etidronic acid requires 5 min to show complete action (De-Deus et al.).
The use of etidronic acid as a potential alternative for EDTA without fearing the loss of NaOCl activity and because of the moderate decalcifying effect of etidronic acid, the creation of preparation errors might be less than with EDTA.
| Conclusion|| |
Within the limitations of the present study, the following conclusions were drawn:
- AH Plus showed significantly lesser contact angles and, hence, better wettability than MTA Fillapex.
- Surface treatment of dentin bars with irrigating solutions affected the wettability of root canal sealers. Greater wettability was achieved with a combination of sodium hypochlorite and etidronic acid group followed by EDTA and sodium hypochlorite.
Limitations of the study
Oral cavity temperature, surface roughness of the instrumented root canal surface, method of sealer placement differ in clinical situations compared to the experimental scenario of this in vitro study. These factors might affect the contact angle values in vivo. Further in vivo studies are recommended to evaluate the efficacy of these irrigating solutions in the root canal system.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]