Effect of two different materials in sealing vertical root fractures of intentional replantation on epithelial thickness of periradicular tissue


Raphael Tri Endra Untara(1), Widjijono Widjijono(2), Widya Asmara(3), Diatri Nari Ratih(4*)

(1) Department of Conservative Dentistry, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta
(2) Department of Biomaterial, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta
(3) Department of Microbiology, Faculty of Veterinary Medicine, Universitas Gadjah Mada, Yogyakarta
(4) Department of Conservative Dentistry, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author


Vertical root fractures of intentional replantation need a material capable of binding the fragments of the fracture line tightly and encouraging the regeneration of periradicular tissue. One of the indicators that regeneration of periradicular tissue takes place is epithelial thickness. This study aimed to investigate the effect of mineral trioxide aggregate (MTA) and self-adhesive resin cement as the adhesive materials in sealing vertical root fractures of intentional replantation on the epithelial thickness of periradicular tissue. This study used 27 male New Zealand rabbits with the age range of 8-12 weeks. The mandibular incisor was extracted, and the tooth was cut from the cervical border to the 2/3 apical third. The samples were assigned randomly into three groups of 9 each, namely Group 1 with no application of any material in the fracture line (control group), Group 2 with MTA, and Group 3 with self-adhesive resin cement. All the teeth in all the groups were then inserted back into the socket. Each group was further divided into three subgroups based on the observation time, namely days 7, 14, and 21. Histological observations of the epithelial thickness were carried out under the light microscope (400x magnification). Data were analyzed using a two-way ANOVA and LSD post hoc test with a confidence level of 95%. The two-way ANOVA analysis showed that the materials used for sealing the fracture lines had a significant effect on the epithelial thickness (p<0.05), while the observation time did not affect the epithelial thickness (p>0.05). No interaction occurred between the material used and observation times (p>0.05). It can be concluded that MTA generated a greater epithelial thickness of periradicular tissue compared than self-adhesive resin cement in sealing vertical root fractures of intentional replantation.


epithelial thickness; Intentional replantation; MTA; Regeneration of periradicular tissue; Self-adhesive resin cement

Full Text:



1. Benoist FL, Seck A, Benoist HM. 42-Month follow-up of double root fracture of a lateral mandibular incisor. Eur Endod J. 2017; 2(1): 1-5. doi: 10.5152/eej.2017.17021

2. Khasnis SA, Kidiyoor KH, Patil AB, Kenganal SB. Vertical root fractures and their management. J Conserv Dent. 2014; 17(2): 103–110. doi: 10.4103/0972-0707.128034

3. Dhawan A, Gupta S, Mittal R. Vertical root fractures: An update review. J Rest Dent. 2014; 2(3): 107-113.

4. Kumar ARP, Shemesh H, Jothilatha S, Vijayabharathi R, Jayalakshmi S, Kishen A. Diagnosis of vertical root fractures in restored endodontically treated teeth: A time-dependent retrospective cohort study. J Endod. 2016; 42(8): 1175-1180. doi: 10.1016/j.joen.2016.04.012

5. Unver S, Onay EO, Ungor M. Intentional re‐plantation of a vertically fractured tooth repaired with an adhesive resin. Int Endod J. 2011; 44(11): 1069–1078.
doi: 10.1111/j.1365-2591.2011.01922.x

6. Becker BD. Intentional replantation techniques: a critical review. J Endod. 2018;
44(1): 14-21. doi: 10.1016/j.joen.2017.08.002.

7. Liying Y, Beiyun X, Bin W, Qing C, Fang YR, Yamamoto K, Inoue M, Suwa F. Clinical
research on treatment of vertically fractured posterior teeth by intentional replantation
using dentin bonding and composite resin. J Osaka Dent Univ. 2004; 38(2): 101-107.
doi: 10.18905/jodu.38.2_101

8. Kamalak H, Taghizadehghalehjoughi A, Kamalak A. The biocompatibility of resin
composite materials on different stem cells. Biomedical Research. 2019; 30(1): 32-41.
doi: 10.35841/biomedicalresearch.30-18-1162

9. Maño EP, Algarra RM, Fawzy A, Leitune VCB, Collares FM, Feitosa V, Sauro S. In vitro
bonding performance of modern self-adhesive resin cements and conventional resinmodified
glass ionomer cements to prosthetic substrates. Appl Sci. 2020; 10(22): 1-15.
doi: 10.3390/app10228157

10. Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature reviewpart
III: Clinical applications, drawbacks, and mechanism of action. J Endod. 2010; 36(3): 400-413. doi: 10.1016/j.joen.2009.09.009

11. Nagmode PS, Satpute AB, Patel AV, Ladhe PL. The effect of mineral trioxide aggregate
on the periapical tissues after unintentional extrusion beyond the apical foramen. Case
Reports in Dentistry. 2016; 2016: 1-5. doi: 10.1155/2016/3590680

12. Maddaluno L, Urwyler C, Werner S. Fibroblast growth factors: Key players in regeneration
and tissue repair. Development. 2017; 144(22): 4047-4060. doi: 10.1242/dev.152587

13. Addis R, Cruciani S, Santaniello S, Bellu E, Sarais G, Ventura C, Maioli M, Pintore G.
Fibroblast proliferation and migration in wound healing by phytochemicals: evidence for a
novel synergic outcome. Int J Med Sci. 2020; 17(8): 1030-1042. doi:10.7150/ijms.43986

14. Shah R, Domah F, Shah N, Domah J. Surgical wound healing in the oral cavity: a review.
Dental Update. 2020; 47(2): 135-143. doi: 10.12968/denu.2020.47.2.135

15. Paul J, D’Lima PJ, Thomas S, Karim S, Thomas P, Bindhu PK, Paul B, Salma R.
Histological evaluation of epithelial thickness, microvasculature and number of mast cells in
the gingiva of smokers and non-smokers with chronic periodontitis. Journal of Clinical and
Diagnostic Research. 2017; 11(11): ZC18-ZC21. doi: 10.7860/JCDR/2017/29112.10886

16. Szabo Z, Bradley K, Cahalane AK. Rabbit soft tissue surgery. Vet Clin North Am Exot Anim
Pract. 2016; 19(1): 159–188. doi: 10.1016/j.cvex.2015.08.007

17. Marouane O, Turki A, Oualha L, Douki N. Tooth replantation: an update. Med Buccale
Chir Buccale. 2017; 23(2): 103-110. doi: 10.1051/mbcb/2016056

18. Prabhu P, Julius A, Elumalai M, Prabhu MN. Wound healing in periodontic. Biosciences,
Biotechnology Research Asia. 2014; 11(2): 791-796. doi: 10.13005/bbra/1339.

19. Meilawaty Z, Chriestedy R, Recky F. Cassava leaf flavonoid extract on enhancing the gingival
epithelium thickness of lipopolysaccharide induced rats. Journal of International Dental and Medical Research. 2020; 13(3): 909-914.

20. Pastar I, Stojadinovic O, Yin NC, Ramirez H, Nusbaum AG, Sawaya A, Patel SB, Khalid L,
Isseroff R, Tomi-Canic M. Epithelialization in wound healing: a comprehensive review. Adv
Wound Care. 2014; 3(7): 445-464. doi: 10.1089/wound.2013.0473

21. Velnar T, Bailey T, Smrkolj V. The wound healing process: an overview of the cellular
and molecular mechanisms. J Int Med Res. 2009; 37(5): 1528-1542.
doi: 10.1177/147323000903700531

22. Lillo C, Quesada B, Lorente A. Biocompatibility of regular and white MTA and a grey portland
cement in human dental pulp cells. Open Journal of Dentistry and Oral Medicine. 2018;
6(2): 1-5. doi: 10.13189/ojdom.2018.060202

23. Solanki NP, Venkappa KK, Shah NC. Biocompatibility and sealing ability of mineral
trioxide aggregate and biodentine as root-end filling material: a systematic review. J Conserv
Dent. 2018; 21(1): 10-15. doi: 10.4103/JCD.JCD_45_17

24. Suprastiwi E. Material bioaaktif dalam ruang lingkup perawatan konservasi gigi. Jakarta:
Departemen Ilmu Konservasi Gigi FKG UI; 2018. 39-50.

25. Upadhyay A, Pillai S, Khayambashi P, Sabri H, Lee KT, Tarar M, Zhou S, Harb I, Tran SD.
Biomimetic aspects of oral and dentofacial regeneration. Biomimetics. 2020; 5(4): 51.
doi: 10.3390/biomimetics5040051.

26. Şişmanoğlu S, Demirci M, Schweikl H, Ozen- Eroglu G, Cetin-Aktas S, Kuruca S, Tuncer
S, Tekce N. Cytotoxic effects of different self-adhesive resin cements: cell viability and
induction of apoptosis. J Adv Prosthodont. 2020; 12(2): 89-99. doi: 10.4047/jap.2020.12.2.89

DOI: https://doi.org/10.22146/majkedgiind.66092

Article Metrics

Abstract views : 223 | views : 206


  • There are currently no refbacks.

Copyright (c) 2021 Majalah Kedokteran Gigi Indonesia

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Currently, Majalah Kedokteran Gigi Indonesia indexed by:







 View My Stats

time web analytics