Evaluating the effects of different protocols applied to resected root end on apical

Abstract

S urgical endodontic treatment (SET) is considered when nonsurgical treatment (NSET) is impossible or unanswered. Root-end resection, apical cavity preparation, and apical seal are recommended for successful SET. [1] Root-end resection with no bevel is recommended because a bevel causes more opened dentinal tubules and apical permeability. [1,2] Apical cavity preparation is considered as a class I cavity with 3 mm depth and parallel walls. [3] To make an apical cavity, a microhandpiece with rotating burs, ultrasonic device with special tips, and different lasers can be used. Ultrasonic tips allow to open smaller and deeper cavities, cuts with no bevel, and facilitates better preparation of root canals with abnormal anatomic structure; [4] however, on the other hand, they cause more microcracks, leading to failure of SET. [5] Er, Cr: YSGG lasers have been used in the preparation of apical cavity because of the following advantages: less microcracks, [6] less dentin permeability, [7] no vibration, [8] and disinfection. [9] Objective: This study aimed to investigate the effects of different protocols applied to the resected root end on apical sealing. Methods: In this study, 35 permanent lower premolars were chemomechanically prepared and obturated. Three mm of the root end was resected, and a 3-mm retro cavity was prepared using an erbium, chromium: yttrium-scandium-gallium-garnet (Er, Cr: YSGG) laser. The roots were randomly divided into four groups according to the protocol applied: group 1 (control group): no treatment was performed (n=5), group 2: Biodentine sealing (n=10), group 3: Biodentine sealing + Er, Cr: YSGG application, and group 4: only Er, Cr: YSGG application. The fluid filtration model was tested. The results were evaluated using one-way analysis of variance. Results: All groups showed leakage. No statistically significant difference was found between the groups (p≤0.05). The largest leak average was observed in group 1 (0.000373640±0.000135817 Lp) and the smallest leak (0.000270134±0.000136416 Lp) in group 3. Conclusion: The protocols applied did not completely prevent leakage of the resected root end; however, the use of Biodentine and the Er, Cr: YSGG laser led to less leakage.