Endodontology

Table 1: One-way ANOVA
Parameter
Mean±SD
F
P
Pro MTA Group 1
Biodentine Group 2
EndoSequence RRM Group 3
Control Group 4
Baseline OD
0.058±0.006
0.039±0.007
0.021±0.007
0.452±0.014
4970.516
0.000
OD at 1
st
week
0.071±0.008
0.049±0.008
0.039±0.007
0.606±0.067
642.907
0.000
OD at 2
nd
week
0.073±0.008
0.058±0.006
0.0490±0.009
0.649±0.027
3655.926
0.000
OD at 3
rd
week
0.074±0.007
0.060±0.004
0.0590±0.009
0.678±0.0139
10974.010
0.000
OD at 4
th
week
0.074±0.007
0.060±0.004
0.0590±0.009
0.688±0.010
15294.013
0.000
OD at 5
th
week
0.074±0.007
0.060±0.004
0.0590±0.009
0.7010±0.014
11334.745
0.000
OD at 6
th
week
0.074±0.007
0.060±0.004
0.0590±0.009
0.7060±0.0117
14425.342
0.000
OD: Optical density, SD: Standard deviation, MTA: Mineral trioxide aggregate, RRM: Root Repair Material
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19
Antony, et al.: Bacterial microleakage of bioceramic root‑end filling materials
Endodontology / Volume 34 / Issue 1 / January‑March 2022
In the 3
rd
, 4
th
, 5
th
, and 6
th
weeks, the leakage values were 
significantly higher for ProRoot MTA when compared to 
both Biodentine and ESRRM putty. Both the materials 
demonstrated comparable sealing ability in this study. Sealing 
ability of MTA‑Angelus, Biodentine, and EndoSequence 
RRMputty in furcation perforations was studied using protein 
leakage assessment and concluded that Biodentine had 
the least leakage followed by EndoSequence, and MTA had 
the highest leakage (Kakani and Veeramachaneni).
[21]
The 
methodologies used in these studies could have contributed 
to the variation in the results.
In this in vitro analysis, ProRoot MTA showed the highest 
leakage. The composition of Biodentine and MTA was 
analyzed by Camilleri et al. and it was found that tricalcium 
silicate was the main constituent of Biodentine and no 
dicalcium silicate or calcium oxide was detected.
[22]
Density and porosity are critical factors which determine 
the amount of leakage and outcome of the treatment 
because a larger pore diameter results in increased leakage 
which corresponds to the ingress and transmission of 
microorganisms and hence compromised three‑dimensional 
seal.
[23]
Porosity is an intrinsic characteristic of tricalcium 
silicate‑based cements and occurs as a result of the spaces 
between the un‑hydrated cement grains. These spaces 
are filled with water once the material hydrates. As the 
hydration reaction progresses, the hydration products fill 
these gaps and the porosity decreases. However, if the 
water‑to‑cement ratio is too high during mixing, excess 
water eventually dries off and leaves voids that are not 
filled by hydration products. Thus, porosity is found to 
increase with an increase in water‑to‑cement ratio and 
decreases as the cement ages.
[24,25]
A significant increase in 
solubility and porosity of ProRoot MTA with the increase 
in water‑to‑powder ratio has been reported.
[26]
This may 
be a reason for the leakage values which was increasing 
up to the 3
rd
week in all groups, after which it became 
static, whereas it continued to increase in the control 
group up to the 6
th
week. When the porosity of Biodentine 
and ProRoot MTA was compared using micro‑computed 
tomography characterization, no significant differences 
were found in porosity between the two materials. But 
due to low water content in the mixing stage, Biodentine 
exhibited lower porosity than MTA.
[27]
It was demonstrated 
that ambient conditions and material additives such as 
calcium carbonate in Biodentine affect the porosity and 
root dentine to material interface of root‑end filling 
materials (Camilleri et al.). Furthermore, it was found 
that dry storage of Biodentine resulted in changes in the 
material microstructure and cracks at the root dentine to 
Biodentine interface, and to reduce this, the specimens 
were stored in moisture before inoculation. Evaluation of 
solubility of RRMs can also give some information about 
their sealing ability. High levels of Ca
2+
ions release have 
been found in different bioceramic RRMs, and this could 
be a reason for the high solubility observed for these 
materials.
[27]
Marginal adaptation has correlation with the sealing ability 
of dental material and, hence effect on clinical success 
rate.
[28]
In the interface between MTA, Biodentine, and 
dentine, tag‑like microstructures were detected in the 
fractured samples in both confocal and scanning electron 
microscopy studies.
[29]
Confocal studies of Biodentine 
demonstrated a “mineral infiltration zone” (MIZ), which may 
be associated with an altered intertubular microstructure 
leading to a change in the optical properties of the 
interfacial dentin (Atmeh et al.). This may be due to 
the high alkalinity (pH 12) of hydrated Biodentine that 
induces a caustic denaturation and formation of a porous 
dentin structure which facilitates the permeation of high 
concentrations of Ca
2+
, OH
−
, and (CO
3
)
2−
ions, leading 
to increased mineralization in this region. This alkaline 
caustic effect or “caustic etching” has virtually no effect 
on the highly mineralized peritubular dentin due to its 
lower collagen content. This “MIZ” along dentin‑cement 
interface helps to impart a better seal. Biodentine has a 
more prominent biomineralization ability than MTA, with 
wider calcium and silicon‑rich layer at the materialdentine 
interface (Han and Okiji).
[29]
The better marginal adaptation 
of Biodentine was attributed to the small size of Biodentine