The effect of radiotherapy delivery time and obturation materials on the fracture resistance of mandibular premolars

Abstract

Objectives

This ex vivo study was performed to investigate the effect of radiotherapy (RT) delivery time on fracture resistance of mandibular premolars filled with Biodentine or gutta-percha/sealer (GPS).

Materials and methods

Seventy-two mandibular premolars were used in this study. Randomly selected 24 teeth were kept intact for the control groups (with and without irradiation). Then, the remaining 48 teeth were randomly assigned into 4 groups (n = 12) according to RT delivery time (irradiated before or after root canal treatment) and obturation materials as follows: Group RT + GPS, Group: GPS + RT, Group RT + Biodentine and Group Biodentine + RT. The samples were either initially endodontically treated and then irradiated or initially irradiated and then endodontically treated with one of the abovementioned materials. The samples were irradiated at 2 Gy per fraction, 5 times a week for a total dose of 60 Gy in 30 fractions over 6 weeks. The roots were embedded in self-polymerizing acrylic resin. The fracture resistance was evaluated in a universal testing machine. Data was analyzed by one-way ANOVA and Games-Howell post hoc test at p < 0.05.

Results

Radiation therapy significantly reduced fracture resistance of intact teeth (p < 0.05). The highest fracture resistance was observed in intact/non-irradiated teeth and the lowest fracture resistance in Biodentine + RT group (p < 0.05). The effect of RT delivery time was insignificant when GPS was preferred as the root canal filling material (p > 0.05); it was significant when preferring Biodentine (p < 0.05). When RT was applied to the teeth after Biodentine obturation, the fracture resistance decreased significantly compared to the teeth that were obturated with GPS after or before RT application (p < 0.05).

Conclusion

Both RT time and obturation materials (Biodentine or gutta-percha/sealer) affect the fracture resistance of the endodontically treated teeth.

Clinical relevance

Endodontic treatment could be completed with both materials after RT; however, when the endodontic treatment was initially completed and the teeth were subsequently exposed to RT, it was shown that the reinforcement effect of Biodentine decreased.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Otmani N (2007) Oral and maxillofacial side effects of radiation therapy on children. J Can Dent Assoc 73:257–261

    PubMed  Google Scholar 

  2. 2.

    Rosales AC, Esteves SC, Jorge J, Almeida OP, Lopes MA (2009) Dental needs in Brazilian patients subjected to head and neck radiotherapy. Braz Dent J 20:74–77

    Article  Google Scholar 

  3. 3.

    Campos Velo MMA, Farha ALH, da Silva Santos PS, Shiota A, Sansavino SZ, Souza ATF, Honório HM, Wang L (2017) Gamma radiation increases the risk of radiation-related root dental caries. Oral Oncol 71:184–185

    Article  Google Scholar 

  4. 4.

    Lieshout HF, Bots CP (2014) The effect of radiotherapy on dental hard tissue--a systematic review. Clin Oral Investig 18:17–24

    Article  Google Scholar 

  5. 5.

    Madrid CC, de Pauli PM, Line SR, Vasconcelos KG, Brandão TB, Lopes MA, Santos-Silva AR, De Goes MF (2017) Structural analysis of enamel in teeth from head-and-neck cancer patients who underwent radiotherapy. Caries Res 51:119–128

    Article  Google Scholar 

  6. 6.

    McGuire JD, Gorski JP, Dusevich V, Wang Y, Walker MP (2014) Type IV collagen is a novel DEJ biomarker that is reduced by radiotherapy. J Dent Res 93:1028–1034

    Article  Google Scholar 

  7. 7.

    Velo MMAC, Farha ALH, da Silva Santos PS, Shiota A, Sansavino SZ, Souza AT, Honório HM, Wang L (2018) Radiotherapy alters the composition, structural and mechanical properties of root dentin in vitro. Clin Oral Investig 22:2871–2878

    Article  Google Scholar 

  8. 8.

    Soares CJ, Roscoe MG, Castro CG, Santana FR, Raposo LH, Quagliatto PS, Novais VR (2011) Effect of gamma irradiation and restorative material on the biomechanical behaviour of root filled premolars. Int Endod J 44:1047–1054

    Article  Google Scholar 

  9. 9.

    Hürmüzlü F, Kiremitçi A, Serper A, Altundaşar E, Siso SH (2003) Fracture resistance of endodontically treated premolars restored with ormocer and packable composite. J Endod 29:838–840

    Article  Google Scholar 

  10. 10.

    Elnaghy AM, Elsaka SE (2016) Fracture resistance of simulated immature teeth filled with biodentine and white mineral trioxide aggregate - an in vitro study. Dent Traumatol 32:116–120

    Article  Google Scholar 

  11. 11.

    EL-Ma AM, Qualtrough AJ, Watts DC (2014) Resistance to vertical fracture of MTA-filled roots. Dent Traumatol 30:36–42

    Article  Google Scholar 

  12. 12.

    Ulusoy OI, Paltun YN (2017) Fracture resistance of roots with simulated internal resorption defects and obturated using different hybrid techniques. J Dent Sci 12:121–125

    Article  Google Scholar 

  13. 13.

    Girish K, Mandava J, Chandra RR, Ravikumar K, Anwarullah A, Athaluri M (2017) Effect of obturating materials on fracture resistance of simulated immature teeth. J Conserv Dent 20:115–119

    Article  Google Scholar 

  14. 14.

    Thanatvarakorn O, Prasansuttiporn T, Thittaweerat S, Foxton RM, Ichinose S, Tagami J, Hosaka K, Nakajima M (2018) Smear layer-deproteinizing improves bonding of one-step self-etch adhesives to dentin. Dent Mater 34:434–441

    Article  Google Scholar 

  15. 15.

    Tay FR, Pashley DH (2004) Resin bonding to cervical sclerotic dentin: a review. J Dent 2:173–196

    Article  Google Scholar 

  16. 16.

    Soares CJ, Castro CG, Neiva NA, Soares PV, Santos-Filho PC, Naves LZ, Pereira PN (2010) Effect of gamma irradiation on ultimate tensile strength of enamel and dentin. J Dent Res 89:159–164

    Article  Google Scholar 

  17. 17.

    Soares CJ, Pizi EC, Fonseca RB, Martins LR (2005) Influence of root embedment material and periodontal ligament simulation on fracture resistance tests. Braz Oral Res 19:11–16

    Article  Google Scholar 

  18. 18.

    Missau T, De Carlo BM, Michelon C, Mastella Lang P, Kalil Pereira G, Baldissara P, Valandro LF, Souza Bier CA, Pivetta Rippe M (2017) Influence of endodontic treatment and retreatment on the fatigue failure load, numbers of cycles for failure, and survival rates of human canine teeth. J Endod 43:2081–2087

    Article  Google Scholar 

  19. 19.

    de Miranda RR, Silva ACA, Dantas NO, Soares CJ, Novais VR (2019) Chemical analysis of in vivo-irradiated dentine of head and neck cancer patients by ATR-FTIR and Raman spectroscopy. Clin Oral Investig 23:3351–3358

    Article  Google Scholar 

  20. 20.

    Novais VR, Soares PB, Guimarães CM, Schliebe LR, Braga SS, Soares CJ (2016) Effect of gamma radiation and endodontic treatment on mechanical properties of human and bovine root dentin. Braz Dent J 27:670–674

    Article  Google Scholar 

  21. 21.

    Rodrigues RB, Soares CJ, Junior PCS, Lara VC, Arana-Chavez VE, Novais VR (2018) Influence of radiotherapy on the dentin properties and bond strength. Clin Oral Investig 22:875–883

    Article  Google Scholar 

  22. 22.

    Campi LB, Lopes FC, Soares LES, de Queiroz AM, de Oliveira HF, Saquy PC, de Sousa-Neto MD (2019) Effect of radiotherapy on the chemical composition of root dentin. Head Neck 41:162–169

    PubMed  Google Scholar 

  23. 23.

    Martins CV, Leoni GB, Oliveira HF, Arid J, Queiroz AM, Silva LA, Sousa-Neto MD (2016) Influence of therapeutic cancer radiation on the bond strength of an epoxy- or an MTA-based sealer to root dentine. Int Endod J 49:1065–1072

    Article  Google Scholar 

  24. 24.

    Gonçalves LM, Palma-Dibb RG, Paula-Silva FW, Oliveira HF, Nelson-Filho P, Silva LA, Queiroz AM (2014) Radiation therapy alters microhardness and microstructure of enamel and dentin of permanent human teeth. J Dent 42:986–992

    Article  Google Scholar 

  25. 25.

    Franzel W, Gerlach R, Hein HJ, Schaller HG (2006) Effect of tumor therapeutic irradiation on the mechanical properties of teeth tissue. Zeitschrift fur medizinische Physik 16:148–154

    Article  Google Scholar 

  26. 26.

    Springer IN, Niehoff P, Warnke PH, Böcek G, Kovács G, Suhr M, Wiltfang J, Açil Y (2005) Radiation caries - radiogenic destruction of dental collagen. Oral Oncol 41:723–728

    Article  Google Scholar 

  27. 27.

    da Cunha SR, Ramos PA, Haddad CM, da Silva JL, Fregnani ER, Aranha ACC (2016) Effects of different radiation doses on the bond strengths of two different adhesive systems to enamel and dentin. J Adhes Dent 18:151–156

    PubMed  Google Scholar 

  28. 28.

    Sheen CY, Dong JK, Brantley WA, Han DS (2019) A study of fracture loads and fracture characteristics of teeth. J Adv Prosthodont 11:187–192

    Article  Google Scholar 

  29. 29.

    Biswas BK, Bag S, Pal S (2013) Biomechanical analysis of normal and implanted tooth using biting force measurement. Int J Eng Appl Sci 4:17–23

    Google Scholar 

  30. 30.

    Chan T, Küçükkaya Eren S, Wong R, Parashos P (2018) In vitro fracture strength and patterns in root-filled teeth restored with different base materials. Aust Dent J 63:99–108

    Article  Google Scholar 

  31. 31.

    Subash D, Shoba K, Aman S, Bharkavi SKI, Nimmi V, Abhilash R (2017) Fracture resistance of endodontically treated teeth restored with biodentine, resin modified GIC and hybrid composite resin as a core material. J Clin Diagn Res 11:ZC68–ZC70

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Sevinç Aktemur Türker.

Ethics declarations

This in vitro study was approved by the Ethics Committee of Istanbul Medipol University (Registration Number 478).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This in vitro study was approved by the Ethics Committee of Istanbul Medipol University (Registration Number 478). This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Aktemur Türker, S., Kaşıkçı, S., Uzunoğlu Özyürek, E. et al. The effect of radiotherapy delivery time and obturation materials on the fracture resistance of mandibular premolars. Clin Oral Invest 25, 901–905 (2021). https://doi.org/10.1007/s00784-020-03378-2

Download citation

Keywords

  • Biodentine
  • Endodontic treatment
  • Fracture resistance
  • Obturation materials
  • Radiotherapy