|Year : 2018 | Volume
| Issue : 1 | Page : 71-75
A comparative In vivo efficacy of three spiral techniques versus incremental technique in obturating primary teeth
Shalini Chandrasekhar1, Madu Ghanashyam Prasad1, Ambati Naga Radhakrishna1, Kaniti Saujanya2, N V K Raviteja1, B Deepthi1, J Ramakrishna1
1 Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College, Eluru, India
2 Department of Pedodontics and Preventive Dentistry, Sree Sai Dental College and Research Institute, Srikakulam, Andhra Pradesh, India
|Date of Web Publication||28-Mar-2018|
Dr. Madu Ghanashyam Prasad
Department of Pedodontics and Preventive Dentistry, St. Joseph Dental College, Eluru, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: The aim of this study was to evaluate the efficiency of four different obturating techniques in filling the radicular space in primary teeth. Materials and Methods: This clinical trial was carried out on 34 healthy, cooperative children (5–9 years) who had 63 carious primary teeth indicated for pulpectomy. They were divided into four groups, such that in each group, a total of 40 canals were allotted for obturation with respective technique. The root canals of selected primary teeth were filled with Endoflas obturating material using either bi-directional spiral (Group 1); incremental technique (Group 2), past inject (Group 3) or lentulo spiral (Group 4) according to the groups assigned. The effectiveness of the obturation techniques was assessed using postoperative radiographs. The assessment was made for a depth of fill in the canal, the presence of any voids using Modified Coll and Sadrian criteria. The obtained data were analyzed by using ANOVA test and unpaired t-test. Results: Bi-directional spiral and lentulo spiral were superior to other techniques in providing optimally filled canals (P< 0.05). The bi-directional spiral was superior to lentulo spiral in preventing overfill (P< 0.05). Conclusion: Based on the present study results, bi-directional spiral can be recommended as an alternate obturating technique in primary teeth.
Keywords: Bi-directional spiral, incremental technique, lentulo spiral, past inject, primary teeth
|How to cite this article:|
Chandrasekhar S, Prasad MG, Radhakrishna AN, Saujanya K, Raviteja N V, Deepthi B, Ramakrishna J. A comparative In vivo efficacy of three spiral techniques versus incremental technique in obturating primary teeth. J Indian Soc Pedod Prev Dent 2018;36:71-5
|How to cite this URL:|
Chandrasekhar S, Prasad MG, Radhakrishna AN, Saujanya K, Raviteja N V, Deepthi B, Ramakrishna J. A comparative In vivo efficacy of three spiral techniques versus incremental technique in obturating primary teeth. J Indian Soc Pedod Prev Dent [serial online] 2018 [cited 2020 Jan 23];36:71-5. Available from: http://www.jisppd.com/text.asp?2018/36/1/71/228751
| Introduction|| |
A thorough understanding of the pulpal morphology, root formation and resorption in primary teeth along with different materials and techniques used, is essential for a successful pulp therapy. The success of endodontic treatment and the vitality of the tooth are compromised if any step in the endodontic and restorative procedure is inadequate. It was reported that obturations that are of inadequate length or nonhomogenous have been associated with a significantly increased presence of periapical disease when assessed within 1 year posttreatment. The mixing technique of the obturating material as well as obturation procedure also significantly influences the success rate.
The success of endodontic treatment and the vitality of the tooth are compromised if any step in the endodontic and restorative procedure is inadequate. The ideal technique should provide without overfilling's or with minimal or no voids in the root canal system. Studies have been carried out to determine ideal root canal obturation material for primary teeth, but not too many techniques of obturation of primary tooth root canal have been described in the literature.
Although the incremental technique is a widely used method for obturation in primary teeth and lentulo spiral technique has proved to be an ideal technique so far in obturating primary teeth, but they have potential disadvantages which may affect the success of pulpectomy. Past inject is a specially designed paste carrier which helps material placed into the root canal. It is made of the flattened blade which is twisted into shape.
An obturation procedure with bi-directional spiral was introduced by Musikant BL (1998). It was made up of coronal grooved spirals traveling in the apical direction and apical reverse spirals traveling in a coronal direction which carries the cement coronally at the point of collision, cement is forced to travel laterally the walls  so that a minimal amount of root canal material will past the apex. The present study was aimed at comparing the efficacy of bi-directional spiral, lentulo spiral, and past inject techniques with the incremental technique in obturating primary teeth.
| Materials and Methods|| |
The study was carried out on children who were referred to the Department of Pedodontics and preventive dentistry, St. Joseph Dental College. A full mouth dental examination was conducted on 49 healthy and cooperative children (5–9 years) who had carious lesions. Out of which 34 children with 63 pulpectomy indicated primary teeth were selected and divided into four groups to obturate 40 canals per group. The protocol of the study was approved, and ethical clearance was taken from the Institutional Ethical Committee. All the procedures were explained and informed written consent was obtained from parents/guardians of the selected children participating in the study.
Before initiating the treatment, standardized baseline intraoral periapical radiographs were taken. All pulpectomy procedures were performed by one investigator. Local anesthesia was given and the teeth requiring endodontic treatment were isolated using rubber dam. Before gaining access, all caries was excavated by a large round bur. The pulp chamber's roof was removed by using no. 330 tungsten carbide burs which were followed by working length estimation. The biomechanical preparation was done using K-files from size 10 to 40 with frequent saline irrigation. The canals were then dried and obturated by using either of the four different techniques mentioned.
A homogenous mixture of Endoflas FS (Sanlor and Cia. S. en C. S., Colombia) according to manufacturer's instructions, was used for filling the root canals. Canals were filled using either bi-directional spiral (Group 1); incremental technique (Group 2), past inject (Group 3) or lentulo spiral (Group 4) according to the groups assigned.
Group 1 – bi-directional spiral technique
Endoflas FS (Sanlor and Cia. S. En C. S., Colombia), endodontic filling material, was filled in 40 prepared canals using bi-directional spiral (EZ-Fill ® Essential Dental System, USA). A rubber stopper which was provided by the manufacturer was used to keep the bi-directional spiral 1 mm short of working length. It was coated with Endoflas FS, inserted into the canal and then rotated in a clockwise direction. Additional amounts of paste were gradually introduced until the root canals were filled to the orifice.
Group 2 – incremental technique
A total of 40 canals were obturated with Endoflas using the incremental technique. A small increment of thickly mixed Endoflas was rolled into flame shape, corresponding to the size and shape of the canal. It was carried into the root canal and gently tapped into the apical area using Endodontic plugger (Mani Inc., Japan) with a rubber stop 2 mm short of working length respective to the size of the canal followed by the placement of additional 2 mm thick Endoflas blocks until the canals were filled to the orifice.
Group 3 – past inject technique
Endoflas FS was delivered to 40 prepared canals using past inject. Pastinject (MicroMega, France) coated with Endoflas FS was inserted into the canal, rotated in an anticlockwise direction and withdrawn gently from the canal. Additional amounts of paste were gradually introduced until the canals were filled to the orifice. It was kept at 1 mm short of working length using a stopper.
Group 4 – lentulo spiral technique
Forty prepared canals in primary teeth were filled with Lentulospiral (size 25, Dentsply, Maillefer, Switzerland). A rubber stopper was used to keep the lentulo spiral 1 mm short of the working length. It is rotated in a clockwise direction after dipping in the Endoflas filling material. Then, it was inserted into the canal and withdrawn gently from the canal while still rotating. Additional amounts of paste were gradually introduced until the canal was filled to the orifice.
All the selected teeth were filled with either of the endodontic filling instrument mounted on slow speed handpiece or incremental technique. The procedure was repeated 4–6 times for each canal until they are completely filled with the paste. A wet cotton pellet was used to lightly tamp the material into the canals and the pulp chamber was filled with a thick mixture of ZOE. The effectiveness of the obturation techniques was assessed using immediate postoperative radiographs.
Postoperative radiographs were obtained for each tooth using the same radiographic settings described for the preoperative radiographs. Each radiograph was mounted in a slide frame and projected onto a screen.
Two evaluators, blinded to the filling technique, assessed the presence of voids and canal obturation quality using Modified Coll and Sadrian criteria:
- Underfilling – canals filled more than 2 mm short of the apex
- optimal filling – canals having Endoflas ending at the radiographic apex or up to 2 mm short of the apex
- Overfilling – canals showing Endoflas outside the root.
Voids –Radiographic presence or absence of voids was evaluated in each canal and tabulated.
When any disagreement occurred, the radiograph was reevaluated, and a diagnostic consensus was reached. The obtained data were subjected to statistical analyses and analyzed using ANOVO test and unpaired t-test.
| Results|| |
Interpretation of results from [Table 1]:
|Table 1: Extent of fill and presence of voids following the 4 obturating techniques and P value calculated using ANOVA test|
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- With respect to overfill, the obturating material was not extruded out of the canal when bi-directional spiral (Group 1) was used. The highest number of canals which were overfilled was when incremental technique (Group 2) was used followed by lentulo spiral (Group 4) and past inject (Group 3)
- Underfilled canals were more when incremental technique (Group 2) was used, which was followed bypast inject (Group 3), bi-directional spiral (Group 1) and lentulo spiral (Group 4) in descending order
- With respect to optimal fi ll, almost similar results were seen when lentulo spiral (Group 4) and bi-directional spiral (Group 1) were used, which was followed by Past inject (Group 3) and least with incremental technique (Group 2)
- With respect to the presence of voids, Past inject (Group3) showed higher number of canals with voids, followed by incremental (Group 2), bi-directional spiral (Group 1) and lentulo spiral (Group 4) in descending order.
Observations from [Table 2]:
|Table 2: Pairwise comparisons between the four obturating techniques with respect to the type of fill and the presence of voids using t-test|
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- With respect to overfill, there was a statistically significant result when comparing bi-directional spiral (Group 1) and lentulo spiral (Group 4), with bi-directional spiral (Group 1) giving superior results. There was no statistically significant difference when other techniques were compared
- With respect to optimal fill, there was the statistically significant difference when the four techniques were compared except bi-directional spiral (Group 1) and lentulo spiral (Group 4), which showed similar results. They were superior to past inject (Group 3) and incremental technique (Group 2)
- There was no statistically significant difference between the 4 techniques with respect to under filled canals and presence of voids.
Observations from [Table 3]:
|Table 3: Significance values of types of fill when comparing maxillary and mandibular teeth|
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- With respect to underfill, incremental (Group 2), past inject (Group 3), and lentulo spiral (Group 4) techniques exhibited no statistically significant difference when compared to maxillary and mandibular teeth, but in bi-directional spiral (Group 1), the results showed statistical significance
- In relation to voids bi-directional spiral (Group 1), lentulo spiral (Group 4) and incremental (Group 2) showed nonsignificant difference while past inject (Group 3) showed the statistically significant difference.
| Discussion|| |
There is a discrepancy in the literature regarding obturation techniques in primary teeth. There are many studies to determine the ideal root canal obturating material for primary teeth, but only a few are directed on determining an effective delivery system for same. A need has always persisted to evaluate the optimum technique of obturating the primary teeth, to obtain a compact and dense filling of the root canal system.
The methods selected by practitioners to fill the pulpectomized canals of primary teeth are numerous and varied. The obturation materials can be:
- Carried to the canals by spiral filling techniques which are rotated within the canal to deliver the material
- Placed in bulk and pushed into the canals with an endodontic plugger or small amalgam condenser
- Applied by using an endodontic pressure syringe, disposable tuberculin syringe, local anesthetic syringe, or NaviTip syringe.
In this study, three spiral filling and incremental techniques have been compared and results of this investigation showed no statistically significant differences among the techniques tested when optimal fill, overfilling and the presence of voids were evaluated, except for underfill.
Lentulo spiral is one of the most effective, widely accepted and successful technique for coating root canal sealers and calcium hydroxide into the permanent tooth or for carrying pastes into the primary tooth., Simple design and flexibility of the lentulo spirals will carry the paste uniformly through the narrow and curved canals in primary molars. Aylard and Johnson stated that lentulo spiral was an instrument of choice for filling curved canals. However, disadvantages like difficulty with fitting the rubber stop, instrument fracture, and tendency for extrusion beyond the apex are disadvantages of the lentulo spiral instruments.
In the present study, apical extrusion of material was not observed with the bi-directional technique. Musikant BL et al. (1998) observed that bi-directional spiral prevents the extrusion of the sealer from the apical end of the root canals of permanent teeth. The coronal end of the instrument spin the material down the shaft toward the apex, while the spirals at the apical end spin the material upward toward the coronal end where they meet (about 3–4 mm from the apical end of the shaft), the material is thrown out laterally which gives controlled coverage.
Parikh et al. who investigated four methods of sealer placement in permanent teeth: Guttapercha point, files, lentulo spiral and bi-directional spiral, and stated that the lentulo spiral caused extrusion of the sealer while the bi-directional technique prevented the apical extrusion of the obturation material. He also stated that apical reverse spirals are able to prevent apical extrusion. Similar findings were observed when the obturation material was expressed into the root canals with the bi-directional spiral and lentulospiral in the present study.
Zarra et al. compared different techniques of intra-canal placement of calcium hydroxide and concluded that extrusion of calcium hydroxide was observed in patent canals when lentulo spiral and past inject were inserted 1 mm short of working length. Similarly, in the present study, apical extrusion was with lentulo spiral and the past inject.
Grover et al. stated that pastinject was superior in filling primary teeth which was not in accordance with the present study wherein the highest number of overfill and the presence of voids were observed with this technique. In the present study, the effi cacy of past inject was not consistent. This may be because past inject was easily distorted, fractured and also unwinding of spirals were seen which occurred in higher frequency when used in curved canals.
Aylard and Johnson and Dandashi et al. observed in primary teeth root canals with different obturation methods in vitro and concluded that lentulo spiral which is mounted on a slow speed handpiece was more superior in filling the straight and curved canals.,
Ravindranath stated no significant differences among incremental filling, lentulospiral and pressure syringe techniques used for teeth canals. Kumar concluded that the NaviTip system was more reliable than the plugger and the lentulo spiral techniques, when compared for voids and obturation quality, significant. Pandranki stated that motor driven lentulo spiral and pluggers were almost equally efficient to fill Endoflas to an optimal level, devoid of voids, and both were considered NaviTip system.
In the present study, lentulo spiral technique was more effective in filling the root canals with the highest number of optimally filled canals. Bi-directional spiral also showed similar efficacy. Least number of optimal fill was seen with incremental technique.
In this study, the presence of voids in the canals was a constant finding. Highest numbers of voids were seen in canals fi lled with past inject and lentulospiral showed least amount of voids. Torres et al. also showed similar results that calcium hydroxide radio-opacity was significantly using a lentulo spiral technique.
In the present study, no statistically significant difference was observed when the four techniques were used in either maxilla or mandible except with regard to underfill when bidirectional spiral was used. With regard to the presence of voids, only past inject had statistically significant difference. These techniques had no statistically significant difference in providing optimally filled canals in both maxilla and mandible which proves that they can be safely used for both jaws.
Bawazir and Salama evaluated in vivo two different obturation techniques, lentulo spiral mounted in a slow speed handpiece and hand-held in primary teeth. Authors concluded that there was no statistically significant difference between the two techniques of obturation, according to the quality of the root canal filling or success rate. In the present study, spiral instruments which were mounted on slow speed handpiece was used which improved dexterity, decreased operator fatigue and ease of placement was observed. Further research can be directed toward comparing the spiral filling techniques with other injection filling techniques and comparing the efficacy of spiral filling techniques in anterior and posterior teeth, curved and straight canals of primary teeth.
| Conclusion|| |
Bi-directional spiral technique has proved to be superior to lentulo spiral technique in preventing overfilled canals in primary teeth. Efficacies of past inject and incremental technique in obtaining optimal filled canals were less compared to other techniques. Bi-directional spiral and lentulo spiral techniques can be used in both maxilla and mandible with equal efficacy except for the past inject technique which showed a significant difference in producing voids.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]