Evaluation of dentinal adaptation of calcium silicate-based biocompatible materials applied with different techniques in strip perforation repair using micro-CT

Strip perforation refers to lateral root perforations that occur as a result of excessive preparation in the dangerous zone on the furcation-facing surface of the mesial roots of maxillary and mandibular teeth. The location of strip perforation and the difficulties in accessing it during clinical procedures can make achieving effective sealing challenging. Therefore, new approaches are being investigated for simpler and more successful application of current perforation repair materials that are difficult to manipulate. In this regard, the amounts of internal and external voids were evaluated after the placement of certain calcium silicate-based cements with favorable properties as repair materials using manual condensation and indirect ultrasonic activation. In our study, strip perforation was created in the mesial roots of extracted mandibular first molar teeth. Calcium silicate-based materials such as ProRoot MTA, MTA White Flow, and Biodentine were placed in the perforation area using manual condensation and indirect ultrasonic activation techniques, and the amount of porosity in their structures and the external voids formed between them and dentin were comparatively evaluated using micro-CT. As a result of the study, ProRoot MTA showed the highest amount of internal and external voids. While no statistically significant difference was found in terms of internal porosity between MTA Flow White and Biodentine, MTA Flow White material exhibited a lower amount of external voids. Indirect ultrasonic activation reduced the internal and external voids of ProRoot MTA, while it reduced the amount of external voids in the MTA Flow White group, although it did not create a statistically significant difference in internal porosity. Indirect ultrasonic activation did not result in a statistically significant difference in internal and external porosity in the Biodentine groups. Within the limitations of our study, it was concluded that indirect ultrasonic activation is an appropriate method for reducing the amounts of internal and external porosity in strip perforation repair for all materials. MTA Flow White, which is a more recent material with different consistency and application form, was found to have better dentinal adaptation compared to other materials in our study. However, due to the limited number of studies available in the literature, further research is needed on MTA Flow White.