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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (1): 77-82. doi: 10.19723/j.issn.1671-167X.2022.01.012

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Application of cold flowable gutta-percha in root canal obturation after apexification

YAN Wen-juan,ZHONG Jie,LIN Bi-chen,DING Mei-li,CHEN Xiao-xian()   

  1. First Clinical Division, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2021-10-11 Online:2022-02-18 Published:2022-02-21
  • Contact: Xiao-xian CHEN E-mail:chenxiaox2007@126.com

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Abstract:

Objective: To evaluate the clinical effect of root canal obturation therapy using cold flowable gutta-percha on young permanent teeth after apexification. Methods: Ninety cases of young permanent teeth with pulp necrosis or periapical periodontitis treated by apexification were randomly divided into two groups. The cases in each group were divided into single root canal and multiple root canal according to the number of the root canal, and divided into classifications Ⅰ, and Ⅱ/Ⅲ/Ⅳ according to Frank’s classification of root development after apexification. Cold flowable gutta-percha and warm gutta-percha obturation techniques were used for root canal obturation of the two groups. The operation time was recorded, and the patients’ therapy pain degree was evaluated by visual analog scale (VAS) immediately after operation. Periapical X-ray was performed after operation to evaluate the effect of the root canal filling. The total length of the root was divided into equal three parts on the X-ray film, and three-dimensional tightness of the apical, middle, and coronal region of the root canals were statistically analyzed respectively. Clinical examinations and X-ray examination were performed 6 and 12 months after the operation to evaluate the treatment success rate. Results: The operation time of cold flowable gutta-percha group was significantly lower than that of the control group, which were 51 s and 74 s (P<0.05); The percentages of pain and discomfort in the two groups were 26.67% and 40.00%, respectively. There were two cases of underfilling and no overfilling in both groups. The percentages of proper filling and tight three-dimensional obturation in the experimental and control groups were 71.11% and 60.00% respectively; and the percentages of tight three-dimensional obturation in the apical third areas were 86.67% and 66.67%, the difference was significant (P<0.05). There was no significant difference in the three-dimensional tightness between the two groups in the middle and coronal third areas. The percentages of tight three-dimensional obturation in classification Ⅰ groups were 86.67%, 83.33%, 93.33% and 76.67%, 90.00%, 96.67% in experimental and control group, respectively; The percentages of classification Ⅱ/Ⅲ/Ⅳ groups were 86.67%, 86.67%, 100.00% and 46.67%, 86.67%, 100.00%, respectively, and the difference was significant (P<0.05). There were no apical lesions that occurred in either group during the one-year review period. Conclusion: The application of cold flowable gutta-percha on young permanent teeth root canal obturation after apexification can achieve good obturation effect. The root obturation effect in the apical third area is significantly better than that of warm gutta-percha obturation techniques. Cold flowable gutta-percha can shorten the clinical treatment time and ameliorate the patients’ therapy comfort.

Key words: Cold flowable gutta-percha, Root canal obturation, Young permanent teeth, Apexification

CLC Number: 

  • R783.1

Figure 1

Evaluation the effect of root canal obturation A, there was no X-ray transmission image between root filling material and calcification barrier, and the obturation was considered as a proper filling; B, each canal was divided into three regions, apica l/3, middle 1/3 and upper 1/3 of the root canal; C, there was a gap between the root filling material and the root canal wall; D, there was a small bubble between filling materials in middle 1/3 of the root."

Table 1

Average root canal obturation time ($\bar{x}\pm s$)"

Group Number of root canals Frank classification Total
Single canal Multiple canals Classification Ⅰ Classification Ⅱ/ Ⅲ/ Ⅳ
Experimental n
Time/s		 28 17 30 15 45
53±11 49±6 52±10 51±11 51±10
Control n
Time/s		 22 23 30 15 45
78±18 71±19 76±18 70±20 74±19

Table 2

VAS scores in different groups"

Group VAS scores Total Average score and percentage of pain and discomfort cases
0 1 2 3 4 5 6-10
Experimental, n (%) 33 (73.33) 5 (11.11) 3 (6.67) 3 (8.89) 1 (2.22) 0 (0.00) 0 (0.00) 45 0.533 (26.67)
Control, n (%) 27 (60.00) 7 (15.56) 5 (11.11) 4 (11.11) 1 (2.22) 1 (2.22) 0 (0.00) 45 0.844 (40.00)

Table 3

Overall evaluation of root canal obturation"

Group Tight three-dimensional root canal obturation Underfilling Proper filling and tight
three-dimensional obturation
In the apical third
region of root canal		 In the middle third
region of root canal		 In the coronal third
region of root canal
Experimental, n (%) 39 (86.67) 38 (84.44) 43 (95.56) 2 (4.44) 32 (71.11)
Control, n (%) 30 (66.67) 40 (88.89) 44 (97.78) 2 (4.44) 27 (60.00)
P value 0.025* 0.535 0.557 1.000 0.267

Table 4

Evaluation of root canal obturation (classification by number of root canals)"

Group number of
root canals		 n Tight three-dimensional root canal obturation Underfilling Proper filling and tight three-dimensional obturation
In the apical third
region of root canal		 In the middle third
region of root canal		 In the coronal third
region of root canal
Experimental Single canal 28 24 (85.71) 24 (85.71) 26 (92.86) 2 (7.14) 20 (71.43)
Multiple canals 17 15 (88.24) 14 (82.35) 17 (100.00) 0 (0.00) 12 (70.59)
Control Single canal 22 17 (77.27) 18 (81.82) 22 (100.00) 1 (4.55) 15 (68.18)
Multiple canals 23 13 (56.52) 22 (95.65) 22 (95.65) 1 (4.35) 12 (52.17)
P value Single canal 0.441 0.709 0.201 0.701 0.418
Multiple canals 0.030* 0.166 0.384 0.384 0.150

Table 5

Evaluation of root canal obturation (classification by Frank classification)"

Group Frank
classification		 N Tight three-dimensional root canal obturation Underfilling Proper filling and tight
three-dimensional obturation
In the apical third
region of root canal		 In the middle third
region of root canal		 In the coronal third
region of root canal
Experimental Ⅰ 30 26 (86.67) 25 (83.33) 28 (93.33) 2 (6.67) 24 (80.00)
Ⅱ/ Ⅲ/ Ⅳ 15 13 (86.67) 13 (86.67) 15 (100.00) 0 (0.00) 11 (73.33)
Control Ⅰ 30 23 (76.67) 27 (90.00) 29 (96.67) 2 (6.67) 20 (66.67)
Ⅱ/ Ⅲ/ Ⅳ 15 7 (46.67) 13 (86.67) 15 (100.00) 0 (0.00) 7 (46.67)
P value Ⅰ 0.317 0.448 0.554 1.000 0.243
Ⅱ/ Ⅲ/ Ⅳ 0.020* 1.000 1.000 1.000 0.136
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