RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1.

NAME OF THE CANDIDATE

AND ADDRESS (in block
letters)

DR. ABHISHEK D. BARMEDA

2.

NAME OF THE INSTITUTION

DR. SYAMALA REDDY DENTAL

COLLEGE, HOSPITAL & RESEARCH
CENTRE.

3.

COURSE OF STUDY AND

SUBJECT

MASTER OF DENTAL SURGERY IN

PEDODONTICS AND PREVENTIVE
DENTISTRY

4.

DATE OF ADMISSION TO
THE COURSE

5.

DEPARTMENT OF PEDODONTICS AND

PREVENTIVE DENTISTRY,
DR. SYAMALA REDDY DENTAL
COLLEGE, HOSPITAL & RESEARCH
CENTRE,
#111/1, SGR MAIN ROAD,
MUNNEKOLALA,
MARATHAHALLI, BANGALORE- 560037

20 APRIL 2009

TITLE OF THE TOPIC

COMPARISON OF THREE DELIVERY
SYSTEMS FOR OBTURATION IN
PRIMARY ANTERIOR TEETH - AN IN
VITRO STUDY

6.

BRIEF RESUME OF INTENDED WORK:

6.1 NEED FOR THE STUDY:
Pulpectomy of primary teeth consists of extirpation/debridement of the
pulp tissue, filing of the canal(s) to remove organic debris and obturation with an
antibacterial, resorbable filling paste. The goal of this procedure is to maintain arch
length and function by preserving primary teeth that are essential to proper
guidance of the permanent dentition1 and maintain the integrity and health of the
tooth and their supporting tissues.2
Many studies have been done to determine the ideal root canal obturation
material for primary teeth, but few studies are there to quote an effective delivery
system for obturation of primary teeth. A need has always persisted to evaluate the
optimum technique of obturation of primary teeth, so as to obtain a compact and
dense filling of the root canal.
The aim of this study is to comparatively evaluate in vitro the effectiveness
of three different techniques of obturation in primary anterior teeth.

6.2 REVIEW OF LITERATURE:

This study 3 was conducted on fifty four extracted primary maxillary
central incisors, which had no more than twenty five percent root resorption, or
any root anomalies. Author compared the effectiveness of three obturation
techniques; using pressure syringe, lentulospiral and endodontic plugger. He found
that the obturating technique using endodontic plugger yielded the best apical seal,
while pressure syringe resulted in fewer voids; the technique using lentulospiral
yielded the least extrusion. He concluded that there was no statistically significant
difference among the three techniques tested when apical seal, voids and extrusion
was evaluated from both antero-posterior and lateral radiographs.
This study 4 compared the effectiveness of three obturation techniques in
sixty primary mandibular molars of fifty children of both sexes in the age group of

five to nine years. The three techniques used were hand-held lentulospiral,
endodontic pressure syringe and tuberculin syringe. Zinc oxide eugenol was used
as the obturating material in all the three techniques. The criteria for evaluation
were depth of canal fill, presence or absence of voids and canal overfill. It was
found that lentulospiral was superior for depth of canal fill upto the apex; the
endodontic pressure syringe and tuberculin syringe were better than lentulospiral
in controlling voids; and endodontic pressure syringe was superior in controlling
extrusion of zinc oxide eugenol cement.
In this study 5 the author conducted an in-vitro study to compare
pulpectomies in primary incisors using three delivery systems. Seventy extracted
primary incisors were collected; ten of which were used for technique calibration.
The remaining sixty teeth were divided into four groups of fifteen teeth each. In
group I, obturation was done using zinc oxide eugenol with lentulospiral mounted
on a slow speed handpiece. Group II was filled with the Vitapex syringe system.
Group III was obturated with Endoseal using NaviTip. Group IV was filled with
Vitapex paste using lentulospiral. Assessment was made for radiopacity, presence
of voids and canal obturation quality with the help of radiographs. The results
obtained revealed no significant differences between the radiopacity of zinc oxide
eugenol and Vitapex pastes, regardless of the delivery method used. Endoseal
delivered with NaviTip showed significantly less radiopacity than the other groups.
A comparison of the presence of voids among the four groups indicated that the
NaviTip obturation technique had fewer voids (66.7%) compared to the
lentulospiral with both materials (93.3%) and Vitapex syringe (100%). With regard
to depth of fill for assessing canal obturation quality, NaviTip was found to be
better than the other delivery methods. It was concluded from the study that the
NaviTip system demonstrated the highest number of flush or complete fillings. The
author also reported the technique fast and user friendly.
The one drawback of this study is that evaluation of obturation techniques
using different materials was done. It could have been more standardized if single
obturation material having same radiopacity and consistency was used in
determining the effectiveness of these techniques. Also, the difference in root
anatomy between maxillary and mandibular primary anterior teeth is not

considered, prompting the need for the current study.

In this study 6 the author evaluated, in vivo, two different obturation
techniques in primary teeth; that is lentulospiral mounted in a slow speed
handpiece and hand-held. This study was carried out on twenty four children who
had received 50 single visit zinc oxide eugenol pulpectomies in primary molars.
64% (16/25) of the cases evaluated showed optimal filling (if one or more of the
canals having zinc oxide eugenol ended at the radiographic apex or upto 2 mm
short of apex) when lentulospiral mounted on a slow speed handpiece was used;
and 96% success rate was observed for this obturation technique. Conversely, only
48% (12/25) of the cases showed optimal filling with the use of hand-held
lentulospiral; 92% success rate was observed with this technique. However, there
was no statistically significant difference between the two techniques studied, in
the quality of root canal filling. The author noted that there was a tendency for
optimal filling when lentulospiral mounted in a slow speed handpiece was used;
however, there were more overfills and fewer underfills with this technique
compared to the use of hand-held lentulospiral.
6.3 OBJECTIVES OF THE STUDY :
To comparatively evaluate in vitro, the effectiveness of lentulospiral
mounted in a handpiece, NaviTip and reamer for obturating primary anterior
teeth by accessing the depth of the canal filled.
To compare the effectiveness of these techniques in obturating maxillary
and mandibular primary anterior teeth.
7.

MATERIALS AND METHODS

7.1 Source of Data:
Forty five maxillary and forty five mandibular extracted primary anterior teeth
will be collected.
Sample selection- The following criteria will be followed for selection of sample.5
-

Teeth having at least two-thirds remaining root.

7.2 Method of collection of data(including sampling procedure, if any):

Study design- In vitro.

Sampling technique to be used- purposive sampling.
The collected teeth will be divided into two groups asGroup A- extracted maxillary primary anterior teeth; and
Group B- extracted mandibular primary anterior teeth.
These two groups will be randomly divided into six sub-groups asGroup A1 - Lentulospiral mounted in a slow speed handpiece
Group A2 - NaviTip
Group A3 - Reamer
Group B1 - Lentulospiral mounted in a slow speed handpiece
Group B2 - NaviTip
Group B3 - Reamer
Size of each sub-group: 15 samples per sub-group.
Instruments and Materials required:
Modelling wax
cellotape
cold cure acrylic powder and liquid
Burs
High speed air turbine handpiece
Slow speed contra-angle handpiece
Barbed broaches
K- files
Normal saline
Absorbent paper points
Zinc oxide eugenol cement
Lentulospiral
NaviTip
Reamer
Modelling wax, cellotape and cold cure acrylic powder and liquid will be
used for specimen preparation.

Pre-operative radiograph will be taken.

Access cavity will be prepared using standardized method and working length
will be determined.
K-file will be used to enlarge the root canal.
Normal saline will be used to irrigate the root canals.
Obturation will then be performed with standardized mix of zinc oxide
eugenol in the six test groups using lentulospiral mounted in a slow speed
handpiece, NaviTip and reamer.
Effectiveness of the three obturation techniques will be assessed using post
operative radiographs. Assessment will be made for depth of fill in canal.
Recording of the data- two evaluators, blinded to the filling technique, will
assess the radiographs based on the depth of canal filled.
The quality of the root canal filling will be defined as:6
1. Underfilling all the canals filled more than 2 mm short of the apex;
2. Optimal filling canals having zinc oxide eugenol ending at the
radiographic apex or up to 2 mm short of apex; and
3. Overfilling any canal showing zinc oxide eugenol outside the root.
The obtained data will be statistically analyzed and results will be drawn using the
appropriate statistical tests.
7.3 Does the study require any investigation or intervention to be conducted on
patients or other Humans or Animals? If so, please describe briefly.
No
7.4 Has ethical clearance been obtained from your institution in case of 7.3
Not applicable
8.

List of references:
1. Thomas A, Satish C, Shaleen C, Pandey RK. Elimination of infection in
pulpectomized deciduous teeth: A short-term study using iodoform paste. J
Endod 1994;20:233-235.
2. Pinkham JR, Casamassimo PS, Fields HW, McTigue DJ, Nowak A, eds.

Pediatric Dentistry: Infancy through adolescence. 4th ed. Philadelphia:

WB Saunders; 2005.
3. Dandashi MB, Nazif MM, Zullo T, Elliot MA, Schneider LG,
Czonstkowsky M. An in vitro comparision of three endodontic techniques
for primary incisors. Pediatr Dent 1993;15(4):254-256.
4. Reddy VVS, Shakunthala B. Comparative assessment of three obturating
techniques in primary molars: An in vitro study. Endod 1997;9:13-16.
5. Guelmann M, McEachern M, Turner C. Pulpectomies in primary incisors
using three delivery systems: an in vitro study. J Clin Pediatr Dent
2004;28:323-326.
6. Bawazir OA, Salama FS. Clinical evaluation of root canal obturation
methods in primary teeth. Pediatr Dent 2006;28(1):39-47.

9.

Signature of the candidate:

10.

Remarks of guide:

11.

Name and designation of :

(in block letters)

DR. ABHISHEK D. BARMEDA

This study is approved.

11.1 Guide:

DR. K.S. KANNAN

PROFESSOR AND HOD
DEPARTMENT OF PEDODONTICS AND
PREVENTIVE DENTISTRY,
DR. SYAMALA REDDY DENTAL COLLEGE,
HOSPITAL & RESEARCH CENTRE,
BANGALORE- 560037

11.2 Signature:

11.3 Co- guide (if any):

DR. ELIZABETH JOSEPH

PROFESSOR
DEPARTMENT OF PEDODONTICS AND
PREVENTIVE DENTISTRY,
DR. SYAMALA REDDY DENTAL COLLEGE,
HOSPITAL & RESEARCH CENTRE,
BANGALORE- 560037

11.4 Signature:

11.5 Head of the

Department:

DR. K.S. KANNAN

PROFESSOR AND HOD
DEPARTMENT OF PEDODONTICS AND
PREVENTIVE DENTISTRY,
DR. SYAMALA REDDY DENTAL COLLEGE,
HOSPITAL & RESEARCH CENTRE,
BANGALORE- 560037

11.6 Signature:
12.

12.1 Remarks of the

Chairman and Principal
12.2 Signature:

This study is approved.