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Assessment of Marginal Adaptation After Apicoectomy and Apical Sealing with Nd:YAG Laser

OBJECTIVE Recurrent periapical disease poses a substantial challenge to the dental practitioner. However, the use of novel methods and materials in periapical surgery has increased the success rates of treatment. The objective of this study was to assess the effects of mineral trioxide aggregate (MTA) retrofilling and apical sealing with Nd:YAG laser (at 10 Hz, 150 mJ, 1.5 W, in 60 sec pulses) as adjuncts to apicoectomy. METHODS Perpendicular root end resection was performed with diamond-coated burs on 40 canine teeth previously subjected to endodontic treatment. Teeth were randomly allocated into four groups: group A, apicoectomy alone; group B, apicoectomy+Nd:YAG laser; group C, apicoectomy+MTA retrofilling; group D, apicoectomy+MTA retrofilling+Nd:YAG laser. Specimens were embedded in epoxy resin and sliced lengthwise and crosswise. RESULTS Scanning electron microscopy (SEM) analysis showed more homogeneous and canaliculi-free apical surfaces in groups B and D (p<0.01). Marginal gaps between the dentin surface and filling material were observed in decreasing order of gap size in groups B, A, D, and C (p<0.01) for cross-sectional analysis. Energy-dispersive X-ray spectrometry (EDS) revealed greater phosphorus (p<0.01) and lower calcium (p<0.01) ion content in the Nd:YAG-irradiated groups. CONCLUSIONS In this study, Nd:YAG laser irradiation had a positive effect on dentin surface sealing, despite an untoward dimensional effect when associated with MTA retrofilling.