| Background:Endodontic-periodontic lesions(EPL)occures commonly in patients with serious periodontitis.Due to the anatomical communication between periodontal tissue and pulp and the pathogenesis of periodontaldisease and pulp disease,bacteria and other microorganisms in the periodontal pocket can cause pulp infection.In turn,the diseased pul-p tissue will further aggravate the periodontal disease through the same pathway.Therefore,root canal therapy plays an important role in promoting the healing of periodontal tissues with EPL.The root filling paste,with the role of sealing the root canal,is the key factor of root canal treatment.Compared with healthy teeth,the root surface of periodontally compromised teeth often has a variety of changes,including exposure of dentin tubules due to cementum resorption and pathologic enlargement of apical foramina due to resorption at the apical foramina.In addition,after subgingival scaling,the exposure rate of dentin tubules in the root surface may increase,thus the dentin tubule channels between the periodontal tissue and pulp are more likely to promote the exchange of bacteria and their metabolites.Therefore,in the root canal treatment of patients with EPL,the sealing requirements of root filling materials are higher.The sealing of the root canal should not only be emphasized in the apical area,but also in the whole root canal.A number of studies have shown that iRoot SP and AH Plus have good apical closure and are widely used as sealers in root canal therapy.However,the comparison of the sealing effect of these two sealants on the root canal treatment in periodontitis patients has not yet been reported.Objectives:1.To study whether iRoot SP and AH Plus root filling paste has different effect on root canal microleakage in teeth extracted due to periodontitis by dye penetration method.At the same time,whether the dentin tubule pathway plays an important role in the periodontal-pulp pathway will be also explored.2.To compare the effect of iRoot SP and AH Plus plus gutta-percha root filling on periodontal healing,completed by initial periodontal therapy in periodontitis patients acompanied with EPL.Methods:1.Comparison of the effects of iRoot SP and AH Plus on root canal microleakage in teeth extracted due to periodontitis1.1 Teeth collection and group division With ethical approval and informed co nsent of the patients,28 single root anterior teeth extracted due to severe periodontitis were selected from the Department of Stomatology,Third People’s Hospital of Shizui shan City.Hand curettage instruments were used for thorough debridement of the dent al calculus,plaque,granulation tissue and residual periodontal membrane on the root sur face.According to the age of the patients and the size of the teeth,the teeth were di vided into two groups,namely Group A and Group B,with 14 teeth in each group which included 13 experimental teeth and 1 negative control tooth.All teeth were cut off the crown at the level of 2mm above the CEJ.All roots were processed for root canal filling with paste and gutta percha by cold lateral condensation technique.All te eth was performed by one same dentist,and the paste ued is iRoot SP(group A)or AH Plus(group B)according to the group division.1.2 Specimen sealing The specimens in both groups were cut across the middle section with emery needle,and were divided into coronal segment and apical segment.The coronal section and apical section of the coronal segment of the experimental group(group Al and B1,13 specimens in each group)were sealed with self-etching adhesive and fluid resin,and then covered with melted casting wax twice.The apical segment of the experimental group was further divided into two subgroups,namely,the unsealed apical foramen group(Group A2 and Group B2,7 specimens in each group)and the sealed apical foramen group(Group A3 and Group B3,6 specimens in each group).In group A2 and group B2,only the coronal section was sealed as mentioned above.While in group A3 and B3,both the coronal section and apical foramen were sealed.The whole surface of the speinmens in negative control group were all wraped as the above method.1.3 Staining measurement and statistical analysis The samples were immersed vertically in 1%methylene blue dye solution for 14d,then they were longitudinally cut in half along the tooth long axis.Vernier caliper was used to measure the penetration length of the dye solution along the inner wall of each root canal(accurate to 0.1mm)using a magnifying glass(2.5 times magnification).The sample sections were all photographed under the same condition,and the Image pro plus software was used to measure the penetration area of the dye solution in dentin tubule.The intra-group and inter-group differences of group A and B were analyzed by one-way analysis of variance with intra-group LSD method analysis.2.Comparison of the effect of iRoot SP and AH Plus on periodontal initial therapy for teeth with EPL in periodontitis patients.2.1 Patient selection and group processing Under ethical approval and signed informed consent,8 patients(12 teeth)with EPL caused by periodontitis in the Third People’s Hospital of Shizuishan City were selected in this study.According to patient’s age,lesion severity and their position in the arch,patients were divided into iRoot SP group and AH Plus group with 6 cases in each group.All roots were processed for root canal filling with paste and gutta percha by cold lateral condensation technique.All teeth was performed by one same dentist,and the paste used was iRoot SP(group A)or AH Plus(group B)according to the group division.All patients received oral hygiene instruction,subgingival scaling anf root planning,and necessary occlusal adjustment.Oral health education was carried out once again at the return visit 1 month later,and periodontal review was carried out at the return visit 3 months later.2.2 Data recording and analysis Periodontal pocket depth(PD),attachment loss(AL),bleeding index(B1),and the tooth mobility were recorded at baseline before treatment and at 3 months after treatment by the same physician without any knowledge about the group division.Univariate analysis of variance and intragroup least significant difference(LSD)were used to analyze the differences of periodontal indexes between the two groups.Results:1.Comparison of the effects of iRoot SP and AH Plus on root canal microleakage in periodontitis patients.1.1 Observation under magnifying glass No infiltration of dye solution was observed in the negative control group.In the experimental group,the dye liquid penetrated into the dentin tubule and entered into inner surface of root canal.Both groups showed that the dentin tubule staining was light in the coronal segment,and the stain in the apical segment moderate.The dentin tubule staining was deepest in the unsealed apical foramen group.1.2 Analysis of root canal penetration measurement The microleakage in root canals of group Al,A2 and A3 were 1.30±1.28(mm),2.13±1.08(mm),0.74±0.69(mm)respectively,and there were significant differences between group A2 and A1,group A2 and A3(P<0.05).The microleakage lengths of root canals of group B1,B2 and B3 were 1.37±1.05(mm),2.89±1.88(mm),0.93±0.85(mm)respectively.There were significant differences between group B2 and B1,group B2 and B3(P<0.05).However,there were no significant differences in the length of microleakage in the root canal of group A1 and B1,group A2 and B2,and group A3 and B3(P>0.05).1.3 Measurement and analysis of dentin tubule penetration of dye solution The dye stained area of dentin tubule(present as percentage)in group A1,A2 and A3 were 16.96 ± 10.10,48.62±21.88 and 37.15±13.46,respectively,and there were statistical differences between group A1 and A2 and group A1 and A3(P<0.05).The dye stained area of dentin tubule in group B1,B2 and B3 were 19.15±8.81,42.15±15.00 and 48.41±20.01,respectively,and there were significant differences between group B1 and B2 and between group B1 and B3(P<0.05).2.2.Comparison of the effect of iRoot SP and AH Plus on initial therapy for teeth with EPL in periodontitis patients.There were no significant differences in age,tooth position distribution and other indexes between the two groups before treatment(P>0.05).PD in group A and Group B after treatment was decreased compared with those before treatment,but only PD in group A had a significant decrease(P<0.05).PD in group A after treatment was significantly lower than that of group B(P<0.05).AL in group A was significantly decreased compared with before treatment,while AL in group B was significantly increased compared with before treatment(P<0.05),and AL in group A was significantly decreased compared with group B after treatment(P<0.05).B1 in group A and Group B after treatment was decreased than that before treatment,but there was no significant difference between before and after treatment(P>0.05),and also there was no statistical significance in B1 between the two groups after treatment(P>0.05).After treatment,there were significant differences in the improvement of the tooth mobility of group A and Group B compared with before treatment(P<0.05),but there was no statistical significance in the improvement of the tooth mobility between group A and group B after treatment(P>0.05).Conclusion:1.Our study firstly indicates that for periodontally compromised teeth,iRoot SP and AH Plus paste combined with gutta-percha by cold lateral condensation technique could not completely seal the root canal and microleakage may occur in the whole length of the root canal Apical foramina is the most important pathway for microleakage.There is no significant difference between iRoot SP and AH Plus paste on root canal microleakage in teeth from periodontitis patients.2.Dentin tubules are not the main pathway of periodontal tissue and pulp communication.The pathway in the apical 1/2 segment of the root plays a more important role in the occurence of EPL.3.For teeth with EPL of periodontal disease origin,root canal therapy combined with periodontal initial treatment can improve the periodontal healing.iRoot SP is more effective than AH Plus in decreasing the depth of periodontal pocket and improving attachment loss. |
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