Measuring the Radiopacity of Luting Cements, dowels, and Core Build-up Materials with a Digital Radiography System Using a CCD Sensor

PURPOSE: This study assessed the radiopacity of five luting cements, five dowels, and five core build-up materials using two target distances. MATERIALS AND METHODS: Materials were analyzed using a modified version of ISO protocol 4049. samples 1 mm thick were digitally radiographed alongside a stepwedge of aluminum alloy 1100 using a Trophy RVG-4 CCD sensor and 70 kVp X-ray generator. The gray-scale values of the stepwedge and sample were converted to X-ray absorbencies. The relationship between X-ray absorbance and aluminum thickness was linear for thicknesses less than 10 mm and followed a power-law relationship above 10 mm. These relations were used to convert the absorbencies of the samples into aluminum thicknesses. The radiopacity data was subjected to ANOVA/Student-Newman-Keuls testing. RESULTS: All materials were more radiopaque than equivalent thicknesses of aluminum. Each product category contained a wide range of radiopacities. Syringe-dispensed materials tended to be less radiopaque than materials dispensed by mechanically assisted syringe or mixed by hand (p < 0.01). Target distance did not affect the measured radiopacity so long as the exposure time was suitably adjusted (p= 0.86). CONCLUSIONS: All luting cements and core materials met or exceeded the ISO minimums. The tested metal-reinforced glass ionomer core build-up materials were extremely radiopaque. Some publications suggest that excessively radiopaque core materials can hinder a clinician's ability to spot voids or marginal defects.     

Radiopacity of root filling materials using digital radiography

AIM: To evaluate radiopacity of root filling materials using digital radiography. METHODOLOGY: The sealers tested were AH Plus, Endofill, EndoREZ and Epiphany. Gutta-percha (Dentsply Maillefer) and Resilon cones were also tested. Acrylic plates, containing six wells, measuring 1 mm in depth and 5 mm in diameter, were prepared for the test, and filled with the materials. The test samples were radiographed together with an aluminium stepwedge calibrated in millimetres, according to ANSI/ADA Specification 57. For the radiographic exposures, digital imaging plates and an X-ray machine at 70 kVp and 8 mA were used. The object-to-focus distance was 30 cm, and the exposure time, 0.2 s. After the laser optic reading process, the software determined the radiopacity of the standardized areas, using grey-scale values, calculating the average radiographic density for each material. RESULTS: The decreasing values of radiopacity of the studied materials, expressed in millimetres of aluminium equivalent, were: Resilon (13.0), AH Plus(TM) (11.2), gutta-percha (9.8), Epiphany (8.0), Endofill (6.9) and EndoREZ (6.6). CONCLUSION: All materials had radiopacity values above 3 mm of aluminium recommended by ANSI/ADA Specification 57.     

Radiopacity evaluation of Portland and MTA-based cements by digital radiographic system

Objective

The aim of the present study was to evaluate the radiopacity of Portland and MTA-based cements using the Digora TM digital radiographic system.

Material and Methods

The performed tests followed specification number 57 from the American National Standard Institute/American Dental Association (2000) for endodontic sealing materials. The materials were placed in 5 acrylic plates, especially designed for this experiment, along with a graduated aluminum stepwedge varying from 1 to 10 mm in thickness. The set was radiographed at a 30 cm focus-object distance and with 0.2 s exposure time. After the radiographs were taken, the optical laser readings of radiographs were performed by Digora TM system. Five radiographic density readings were performed for each studied material and for each step of the aluminum scale.

Results

White ProRoot MTA (155.99±8.04), gray ProRoot MTA (155.96±16.30) and MTA BIO (143.13±16.94) presented higher radiopacity values (p<0.05), while white non-structural Portland (119.76±22.34), gray Portland (109.71±4.90) and white structural Portland (99.59±12.88) presented lower radiopacity values (p<0.05).

Conclusions

It was concluded that MTA-based cements were the only materials presenting radiopacity within the ANSI/ADA specifications.     

A comparative study of physicochemical properties of AH Plus, Epiphany, and Epiphany SE root canal sealers

Aim  To assess the physicochemical properties and the surface morphology of AH Plus, Epiphany, and Epiphany SE root canal sealers.
Methodology  Five samples of each material were employed for each test according to ANSI/ADA specification 57. The samples were assigned to four groups: (i) AH Plus; (ii) Epiphany; (iii) Epiphany + Thinning Resin; (iv) Epiphany SE. The distilled water used during the solubility test was submitted to spectrometry to verify the release of calcium ions. The morphologies of the external surface and the cross-section of the samples were analysed by means of a scanning electron microscope (SEM). Statistical analysis was performed by using One-Way anova and post hoc Tukey–Kramer tests with the null hypothesis set as 5%.
Results  Setting time, flow and radiopacity results were in accordance with ANSI/ADA requirements whereas the dimensional change of all sealers and solubility of Epiphany did not fulfil ANSI/ADA protocols. AH Plus and Epiphany SE were similar in terms of flow, radiopacity, solubility and dimensional change. The spectrometry test revealed significant calcium ion release from Epiphany with and without the thinning resin. SEM analysis revealed essentially a homogeneous surface with compact layer and some rough areas.
Conclusions  Setting time, flow, and radiopacity tests conformed to ANSI/ADA standardization. The dimensional change in all groups and the solubility of Epiphany were greater than values considered acceptable, with higher amounts of calcium ion release. Epiphany SE revealed more organized, compacted, and homogeneous polymers in a reduced resin matrix when compared with the other groups.     

Evaluation of the radiopacity of new root canal paste/sealers by digital radiography

The aim of the present study was to assess the radiopacity of new polydimethylsiloxane-based root canal filling paste (GuttaFlow; Coltène/Whaledent, Langenau, Germany) and resin-based root canal sealer (Adseal; Meta Biomed Co, Cheongju, Korea) and compare their radiopacity with three currently used root canal sealers (AH Plus [Dentsply DeTrey GmbH, Konstanz, Germany], Epiphany [Pentron, Wallingford, CT], and Diaket [3M ESPE AG, Seefeld, Germany]) by means of direct digital radiography. Six specimens, 5 mm in diameter and 1 mm high, were performed for each material tested. After the material set, radiographs were made by using a digital sensor and a graduated aluminum stepwedge varying in thickness from 1 to 14 mm. These samples were tested according to the international standards to compare their radiodensity to that of the aluminum stepwedge. Data were analyzed using analysis of variance and Tukey tests. The millimeters of aluminum values reported in this study were 10.41, 8.20, 6.50, 4.90, and 3.09 for AH Plus, Epiphany, Diaket, GuttaFlow, and Adseal, respectively. Although the materials evaluated had different radiopacities, all of them showed radiopacity above the minimum recommended by the International Organization for Standardization and the American National Standards/American Dental Association.     

Radiopacity of Portland Cement Associated With Different Radiopacifying Agents

This study evaluated the radiopacity of Portland cement associated with the following radiopacifying agents: bismuth oxide, zinc oxide, lead oxide, bismuth subnitrate, bismuth carbonate, barium sulfate, iodoform, calcium tungstate, and zirconium oxide. A ratio of 20% radiopacifier and 80% white Portland cement by weight was used for analysis. Pure Portland cement and dentin served as controls. Cement/radiopacifier and dentin disc-shaped specimens were fabricated, and radiopacity testing was performed according to the ISO 6876/2001 standard for dental root sealing materials. Using Insight occlusal films, the specimens were radiographed near to a graduated aluminum stepwedge varying from 2 to 16 mm in thickness. The radiographs were digitized and radiopacity compared with the aluminum stepwedge using Digora software (Orion Corporation Soredex, Helsinki, Finland). The radiographic density data were converted into mmAl and analyzed statistically by analysis of variance and Tukey-Kramer test (α = 0.05). The radiopacity of pure Portland cement was significantly lower (p < 0.05) than that of dentin, whereas all cement/radiopacifier mixtures were significantly more radiopaque than dentin and Portland cement alone (p < 0.05). Portland cement/bismuth oxide and Portland cement/lead oxide presented the highest radiopacity values and differed significantly from the other materials (p < 0.05), whereas Portland cement/zinc oxide presented the lowest radiopacity values of all mixtures (p < 0.05). All tested substances presented higher radiopacity than that of dentin and may potentially be added to the Portland cement as radiopacifying agents. However, the possible interference of the radiopacifiers with the setting chemistry, biocompatibility, and physical properties of the Portland cement should be further investigated before any clinical recommendation can be done.     

Radiopacity evaluation of calcium aluminate cement containing different radiopacifying agents

Introduction

The aim of this study was to evaluate the radiopacity of calcium aluminate cement (EndoBinder) with 3 different radiopacifiers (bismuth oxide, zinc oxide, or zirconium oxide) in comparison with gray mineral trioxide aggregate (GMTA), white MTA, and dental structures (enamel and dentin).

Methods

Eighteen test specimens of each cement with thicknesses of 0.5, 1.0, 1.5, 2.0, 2.5, and 3.0 mm (n = 3) were made by using a stainless steel matrix and were adapted to a standardizing device (8 × 7 cm) with a graduated aluminum stepwedge varying from 2.0-16.0 mm in thickness. To compare the radiopacity of the cements with that of dental structures, slices of first molars with a thickness increasing from 0.5-3.0 mm were obtained and placed on the standardizing device. One occlusal radiograph for each tested cement was taken, with exposure time of 0.1 seconds and focus-film distance of 20 cm. Films were processed in an automatic device, and the mean radiopacity values were obtained by using a photodensitometer.

Results

Mean values showed that the thicker the specimen was, the greater was its radiopacity. Only EndoBinder + bismuth oxide (EBBO) and GMTA demonstrated radiopacity values greater than 3.0 mm of the aluminum scale for all thicknesses. When zinc oxide was used as radiopacifier agent, EndoBinder only reached the desired radiopacity with a thickness of 2.0 mm, and with zirconium oxide it was 2.5 mm.

Conclusions

Bismuth oxide was the most efficient radiopacifier for EndoBinder, providing adequate radiopacity in all studied thicknesses, as recommended by ISO 6876, being similar to GMTA.     

Radiopacity of direct esthetic restorative materials

This study determined the radiopacity of 21 commercially available direct esthetic restorative materials with reference to an aluminum step wedge and an equivalent thickness of enamel and dentin. A total of 168 samples measuring 6 mm in diameter and 1 mm in thickness, with eight samples of each material, were prepared from restorative materials. Enamel and dentin samples 1-mm thick were also prepared by longitudinally sectioning eight extracted human permanent molars using a microslicing machine. The optical densities of each restorative material, along with one tooth section and an aluminum step wedge were measured from radiographic images using a transmission photodensitometer. The optical density values of the specimens were used to determine the aluminum thickness equivalent values. The data were analyzed with one-way analysis of variance (ANOVA) and Duncan's multiple range tests. The results showed statistically significant differences among materials. Tetric Ceram had the greatest radiopacity value and was higher than enamel. All materials except for the microfilled resin composite Filtek A 110 had radiopacity values greater than dentin and possessed sufficient radiopacity to meet ISO 4049 standard. Significant differences were found among materials of the same composition when compared to enamel.     

RADIOPACITY EVALUATION OF ROOT-END FILLING MATERIALS BY DIGITIZATION OF IMAGES

The purpose of this study was to evaluate the radiopacity of 5 root-end filling materials (white MTA-Angelus, grey MTA-Angelus, IRM, Super EBA and Sealer 26). Five specimens (10 mm diameter X 1 mm thickness) were made from each material and radiographed next to an aluminum stepwedge varying in thickness from 2 to 16 mm. Radiographs were digitized and the radiopacity of the materials was compared to that of the aluminum stepwedge using VIXWIN 2000 software in millimeters of aluminum (mm Al). Data were analyzed statistically by ANOVA and Tukey''s test at 5% significance level. Radiopacity values varied from 3 mm Al to 5.9 mm Al. Sealer 26 and IRM presented the highest radiopacity values (p<0.05), while white/grey MTA and Super EBA presented the lowest radiopacity values (p<0.05). The tested root-end filling materials presented different radiopacities, white/grey MTA and Super EBA being the least radiopaque materials.     

Radiopacity of endodontic materials on film and a digital sensor

The purpose of this study was to compare the radiographic appearance of 12 endodontic materials as visualized on either Kodak Ultra-speed D speed film (Eastman Kodak Company, Rochester, NY) or a Gendex eHD digital sensor (Gendex Dental Systems, Milan, Italy). Ten discs of each material were radiographed alongside an aluminum alloy 1100 (Alcoa, Pittsburgh, PA) stepwedge that was used for reference. For every radiograph, the average grayscale value of the material was converted into absorbance notation and compared with that of the reference stepwedge in order to determine the equivalent radiopacity in terms of millimeters of Al 1100 per millimeter of material. Two-way repeated-measures analysis of variance testing detected significant differences with respect to imaging system, material, and the interaction of the two factors (p < 0.001). The difference in a material's radiopacity as measured on the digital sensor compared with film was greater than 10% for 4 of the 12 materials and over 40% for InnoEndo (Heraus Kulzer, Armonk, NY). It was speculated that barium fillers cause this effect.     

Radiopacity of zirconia-based all-ceramic crown systems

The aim of this study was to evaluate the radiopacity of the core and veneer ceramics in four zirconia-based crown systems: In-Ceram Zirconia, In-Ceram YZ, Procera Zirconia, and Cercon. Two-millimeter-thick restoration slices were prepared and digitally radiographed alongside an aluminum stepwedge. The grayscale data were converted into millimeters of aluminum by an image analysis program. The two-way analysis of variance test detected significant differences with respect to all-ceramic system, layer ceramic, and the interaction of the two factors (P = .0001). All materials presented radiopacity values above the minimum recommended by the International Organization for Standardization.     

Radiopacity of endodontic sealers: development of a new method for direct measurement

Radiopacity is an essential attribute of endodontic filling materials. It is important to see clearly the root canal filling to detect its presence, extent, and apparent condensation. National and international standards require a minimal radiopacity equivalent to 3 or 4 mm of aluminum, yet some products made by reputed companies do not meet this requirement. The result may be unjustified downgrading of clinical cases. The purpose of this investigation was 2-fold: to develop a novel and easily reproducible technique for assessing the radiopacity of endodontic sealers and to apply it to measure the opacity of 21 current cements poured in 6- x 1-mm wells. As in the currently recommended technique, the standardized samples are radiographed alongside an aluminum stepwedge but instead of using an optical densitometer to measure the density and then calculate the radiopacity, the image is digitized. The gray pixel value of the test material is compared with the stepwedge, using computer software, to find the corresponding step. The opacity of the samples ranged from 1.6 mm to more than 11 mm of aluminum. The technique can be advanced to a dry, chemical-less variant by using radiation captors, as for periapical X-rays, instead of film.     

Radiographic and rheological properties of a new endodontic sealer

A new dual-cured resin sealer has recently been proposed as an innovative endodontic filling material. Being a new endodontic material, no in vitro research has been published yet on Real Seal's (RS) physical properties. Therefore, the aim of the present study was to evaluate and compare radiopacity and rheological properties of the RS sealer with those of currently available endodontic sealers (Roeko Seal Automix and Bioseal). All tests strictly followed American National Standards Institute/American Dental Association (ANSI/ADA) specification No. 57, which indicates test methods and establishes minimal requirements of flow, film thickness and radiopacity of endodontic sealers. Results showed that significant differences were found among sealers in the different test methods. However, RS showed values complying with ANSI/ADA specification No. 57 requirements in all tests. Hence, the new RS sealer exhibited radiographic and rheological properties suitable for clinical use.     

Radiopacity of composite dental materials using a digital X-ray system

The aim of this study was to evaluate the radiopacity of 32 current dental composite materials with digital technique. Digital radiographs with CCD sensor along with an aluminum step wedge, 1-mm-thick tooth slice and 1mm thick composite specimen were taken in five different combinations of exposition/voltage. The radiopacity in pixels was determined using Digora 2.6. software. The equivalent in thickness of aluminum for each material was then calculated from the calibration curve. 74.9% of all tested materials in all exposure combinations had radiopacity between 2 mm and 4 mm aluminum equivalent. The radiopacity of composites ranged from 0.61 mm Al (Gradia Direct Anterior) to 4.78 mm Al (Te-Econom). The average radiopacity for enamel and dentine was 2.05 and 1.11 mm Al. The use of digital technique for radiopacity is an easy, reliable, fast and precise way to analyze different dental materials. Most of the tested composite materials fulfill the requested criteria for radiopacity with a few exceptions.     

A comparative study of physicochemical properties of AH Plus and Epiphany root canal sealants

AIM: To evaluate setting time, solubility and disintegration, flow, film thickness, and dimensional change following setting in a dual-cured resin root canal sealer Epiphany compared with an epoxy-resin-based sealer AH Plus. METHODOLOGY: The experiments were performed according to ANSI/ADA Specification 57 which tests the physicochemical properties of endodontic sealing materials. Five samples of each material were tested for each of the properties. In addition, deionized distilled water from the solubility test of Epiphany was submitted for analysis of the cations Fe, Ni, Ca, Mg, Zn, Na, and K in an atomic absorption spectrometer. Three samples were analysed. RESULTS: There were no statistical differences (P>0.05) in flow (AH Plus: 38.57 mm; Epiphany: 35.74 mm) and film thickness (AH Plus: 10.6 microm; Epiphany: 20.1 microm). The solubility (AH Plus: 0.21%; Epiphany: 3.41%) and dimensional alterations following setting (AH Plus: expansion of 1.3%; Epiphany: expansion of 8.1%) were statistically different (P<0.05). The setting times of both sealants were in accordance with ANSI/ADA requirements. CONCLUSIONS: Setting time, flow, and film thickness tests for both cements conformed to ANSI/ADA standards. Dimensional alteration test for both cements were greater than values considered acceptable by ANSI/ADA. Epiphany values regarding solubility were also greater than values considered acceptable by ANSI/ADA.     

Radiopacity of potential root-end filling materials

ObjectivesIn recent years various root-end filling materials have been suggested for clinical use. The purpose of this study was to assess the radiopacity of some potential materials according to ISO specification 6876.Study designRadiographs were taken of 1-mm thick specimens of eight materials (amalgam, Kalzinol, IRM, Super EBA,Vitrebond, Fuji II LC, Chemfil, gutta-percha); light transmission was assessed densitometrically and related to equivalent thickness of aluminum.ResultsCommercial glass ionomer cements (Vitrebond, Fuji II LC, Chemfil) had radiopacities below the international standard for root canal sealers (<3-mm aluminum); three zinc oxide-eugenol cements (Kalzinol, Super EBA, IRM) had radiopacities equivalent to 5 to 8 mm aluminum; and gutta-percha had a radiopacity equivalent to 6.1-mm aluminum.ConclusionsWe recommend that root-end filling materials should have a radiopacity greater than that for root canal sealers.     

Radiopacity of compomers, flowable and conventional resin composites for posterior restorations.

The objective of this study was to densitometrically determine the relative radiopacity (aluminum [Al]-equivalent values) of dentin, enamel, and 20 resin composite materials currently used for posterior restorations. Specimens 5 mm in diameter and 2 mm thick were fabricated from 20 materials (n = 7) for a total of 140 specimens. Human molars were longitudinally sectioned 2.0 mm thick to include both enamel and dentin. The optical densities of enamel, dentin, restorative materials, lead, and aluminum step wedge were obtained from radiographic images, using a transmission photodensitometer. The Al equivalent (mm) for each material was calculated from the linear regression equation of the log of normalized optical density and Al mm thickness obtained from the step wedge. A linear regression of the logarithm of normalized optical density and Al mm thickness was plotted (r2 = 0.9953), and the relative radiopacities, expressed as equivalent thickness of Al, were ranked ordinally. All materials tested, with the exception of an unfilled resin adhesive, complied with ISO Standard 4049, being at least as radiopaque as a 2.0 mm thickness of 99.6% pure Al. Four of six flowable composites had radiopacity values that fell between that of dentin and enamel, while two materials were more radiopaque than enamel. The three compomers tested had radiopacities greater than enamel. In addition, all traditional light- and chemical-cure resin composite materials tested were more radiopaque than enamel. All materials tested, with the exception of one adhesive resin, were at least as radiopaque as dentin and complied with ISO Standard 4049. Clinicians should be able to distinguish these restorative materials radiographically from recurrent decay, voids, gaps, or other defects that lead to clinical failure. Utilization of materials ranked more radiopaque than enamel would enable clinicians to distinguish the restorative material from tooth structure.     

RADIOPACITY OF RESTORATIVE MATERIALS USING DIGITAL IMAGES

The radiopacity of esthetic restorative materials has been established as an important requirement, improving the radiographic diagnosis. The aim of this study was to evaluate the radiopacity of six restorative materials using a direct digital image system, comparing them to the dental tissues (enamel-dentin), expressed as equivalent thickness of aluminum (millimeters of aluminum). Five specimens of each material were made. Three 2-mm thick longitudinal sections were cut from an intact extracted permanent molar tooth (including enamel and dentin). An aluminum step wedge with 9 steps was used. The samples of different materials were placed on a phosphor plate together with a tooth section, aluminum step wedge and metal code letter, and were exposed using a dental x-ray unit. Five measurements of radiographic density were obtained from each image of each item assessed (restorative material, enamel, dentin, each step of the aluminum step wedge) and the mean of these values was calculated. Radiopacity values were subsequently calculated as equivalents of aluminum thickness. Analysis of variance (ANOVA) indicated significant differences in radiopacity values among the materials (P<0.0001). The radiopacity values of the restorative materials evaluated were, in decreasing order: TPH, F2000, Synergy, Prisma Flow, Degufill, Luxat. Only Luxat had significantly lower radiopacity values than dentin. One material (Degufill) had similar radiopacity values to enamel and four (TPH, F2000, Synergy and Prisma Flow) had significantly higher radiopacity values than enamel. In conclusion, to assess the adequacy of posterior composite restorations it is important that the restorative material to be used has enough radiopacity, in order to be easily distinguished from the tooth structure in the radiographic image. Knowledge on the radiopacity of different materials helps professionals to select the most suitable material, along with other properties such as biocompatibility, adhesion and esthetic.     

Physical Properties of AH Plus with Chlorhexidine and Cetrimide

Introduction

The use of root canal filling materials with antibacterial activity could be considered beneficial to reduce any remaining microorganisms and prevent recurrent infection. The aim of this study was to evaluate the physical properties of AH Plus (Dentsply DeTrey, Konstanz, Germany) alone and mixed with 1% or 2% chlorhexidine (CHX); 0.1%, 0.2%, 0.3%, and 0.5% of cetrimide (CTR); and combinations of both.

Methods

Setting time, flow, solubility, and radiopacity of AH Plus and modified AH Plus were evaluated following the American National Standards Institute/American Dental Association's requirements (ANSI/ADA Specification No. 57/2000). Five samples of each material were tested for each property. The hypothesis of equality among groups was rejected by an analysis of variance test, and then a post hoc Tukey test was performed.

Results

AH Plus and modified AH Plus gave values that are within the required standards. Overall, results indicate that CTR increased setting time, but CHX alone and CHX + CTR reduced it. CHX increased the flow, whereas CTR reduced it, and their combinations gave intermediate values comparable with those of AH Plus. Concerning solubility, the weight loss in all samples was under the 3% limit set by the ANSI/ADA. In comparison with AH Plus alone, radiopacity gave slightly lower values with CHX, higher values with CTR, and similar values with combinations.

Conclusions

The addition of CHX, CTR, and combinations of both to AH Plus did not alter the physical properties specified by ANSI/ADA requirements.     

Evaluation of the radiopacity of calcium hydroxide- and glass-ionomer-based root canal sealers

AIM: To evaluate the radiopacity of calcium hydroxide-based root canal sealers (Acroseal, Sealapex and Sealer 26), a glass-ionomer-based sealer (Activ GP Sealer) and a zinc oxide and eugenol-based sealer (Intrafill). METHODOLOGY: Five disc-shaped specimens (10 x 1 mm) were fabricated from each material, according to the International Organization for Standardization (ISO) 6876/2001 standard. After setting of the materials, radiographs were taken using occlusal films and a graduated aluminum step-wedge varying from 2 to 16 mm in thickness. The dental X-ray unit (GE1000) was set at 50 Kvp, 10 mA, 18 pulses s(-1) and distance of 33.5 cm. The radiographs were digitized and the radiopacity compared with that of the aluminum step-wedge, using WIXWIN-2000 software (Gendex). Data (mm Al) were submitted to ANOVA and Tukey test. RESULTS: Intrafill was the most radiopaque material (7.67 mm Al) followed by Sealer 26 (6.33 mm Al), Sealapex (6.05 mm Al) and Acroseal (4.03 mm Al). Activ GP was the least radiopaque material (1.95 mm Al, P < 0.05). CONCLUSIONS: The sealers evaluated in this study had different radiopacities. However, except for the glass-ionomer-based sealer, all materials had radiopacity values above the minimum recommended by the ISO standard.