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MTA and F-doped MTA cements used as sealers with warm gutta-percha. Long-term study of sealing ability.

AIM
To evaluate the long-term sealing ability (up to 6 months) of two experimental calcium silicate MTA cements used as root canal sealers in association with warm gutta-percha.


METHODOLOGY
Calcium silicate (MTA) and calcium-fluoro-silicate powders were prepared. Sodium fluoride was included in FMTA (Fluoride-doped Mineral Trioxide Aggregate) as an expansive and retardant agent. Single-rooted teeth were instrumented with NiTi rotary instruments, filled with warm gutta-percha in association with one of the experimental sealers or with AH Plus as a control (n = 20 for each sealer) and stored at 37 °C. Sealing was assessed at 24, 48 h, 1, 2 weeks and 1, 3, 6 months by a fluid filtration method. Scanning electron microscopy with energy dispersive analysis (SEM/EDX) was used to study the dentine/sealer interface of roots stored for 6 months and the surface of cement disks stored for 24 h.


RESULTS
All sealers revealed a statistically significant reduction (P < 0.05) in fluid filtration after the first 2 weeks. No statistically significant differences were observed between FMTA and AH Plus at all analysis times. At short times (24, 48-h), no statistically significant differences were found between the experimental cements and AH Plus. At long-term evaluations (1, 3, 6 months), FMTA and AH Plus sealed significantly better (P < 0.05) than MTA. FMTA was associated with lower fluid filtration rates, and the seal was stable from 48 h to 6 months, thus proving the most effective material. Scanning electron microscopy with energy dispersive analysis of root sections filled with calcium silicate sealers revealed the formation of a blend layer of gutta-percha and cement consequent to the warm gutta-percha condensation technique. Scanning electron microscopy with energy dispersive analysis of 24-h-stored disks identified a Ca-rich coating on the outer surface consisting of globular particles (calcium hydroxide and calcium carbonate), and a deeper internal Ca- and Si-rich region consisting of needle-like ettringite crystals and round formations of calcium silicate hydrate gel.


CONCLUSION
Fluoride-doped MTA demonstrated stable sealing during a period of up to 6 months and significantly better than conventional calcium silicate MTA cements and comparable to AH Plus. The study supports the suitability of calcium silicate MTA cements as sealers in association with warm gutta-percha for root filling.