Obturation quality of calcium silicate-based cements placed
with different techniques in teeth with perforating internal
root resorption: a micro-computed tomographic study
Selen Küçükkaya Eren
Sevinc Askerbeyli Örs
Hakan Hamdi Çelik
Received: 7 February 2018 /Accepted: 30 May 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
Objectives To evaluate and compare the obturation quality of mineral trioxide aggregate (MTA) and Biodentine placed with hand
condensation or indirect ultrasonic activation technique in teeth models simulating perforating internal root resorption (IRR)
using micro-computed tomographic (micro-CT) imaging.
Materials and methods Standardized models with perforating IRR cavities were created using 40 extracted single-rooted human
teeth and randomly divided into four groups (n = 10). The specimens were obturated with either MTA or Biodentine and the
placement technique applied was either hand condensation or indirect ultrasonic activation. Micro-CT scans were performed for
the volumetric analysis of voids and filling materials in the resorption cavities and apical portion of the specimens. Data were
analyzed using one-way analysis of variance and paired t test.
Results No significant difference was observed between the groups in terms of the percentage volume of filling materials (p >
0.05). The apical portion of the specimens significantly presented less percentage volume of filling materials than the resorption
cavities in each group (p<0.05).
Conclusions No placement technique produced void-free fillings in teeth with perforating IRR. There was no significant differ-
ence between the obturation quality of Biodentine and MTA. The obturation quality in the apical portion of the root canals was
inferior than that in the resorption cavities.
Clinical relevance The obturation of the apical region of teeth with perforating IRR is challenging irrespective of the material type
and placement technique.
Internal root resorption (IRR) is a clinical condition which is
characterized by progressive destruction of dentin along the
root canal walls and is generally caused by chronic infection
or trauma [1, 2]. The resorption process is sustained by infec-
tion of necrotic pulp tissue coronal to the area where the re-
sorption takes place and apical to which the pulp is vital .
Therefore, the removal of any vital and necrotic tissue by root
canal treatment is required to arrest the destructive process
when the tooth is restorable . If untreated, the lesion could
progress and eventually perforate the root canal wall . In
cases of perforation, the elimination of infection and obtura-
tion of the root canal system can be more challenging .
Different treatment models can be applied in the endodon-
tic management of a perforating IRR including surgical and
non-surgical approaches . In the prior approach, the repair
can be performed surgically using an external approach
through the periradicular tissues. However, this approach is
not generally preferable because the size and location of the
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00784-018-2502-2) contains supplementary
material, which is available to authorized users.
* Selen Küçükkaya Eren
Department of Endodontics, Faculty of Dentistry, Hacettepe
University, Sıhhiye, 06100 Ankara, Turkey
Department of Anatomy, Faculty of Medicine, Hacettepe University,
Clinical Oral Investigations