Oxygen as obturation biomaterial in endodontic treatment: a systematic review

Introduction

Endodontic treatment, also known as root canal therapy, is a crucial dental procedure performed to save a natural tooth by removing the infected or inflamed pulp (inner tooth tissue) and sealing the root canal system. One of the critical steps in endodontic treatment is the obturation or filling of the cleaned and shaped root canals. Traditionally, gutta-percha, a rubbery material derived from the sap of certain trees, has been the gold standard for root canal obturation. However, researchers have explored alternative materials, such as oxygen, as potential obturation biomaterials in endodontic treatment.

Oxygen as an Obturation Material

Oxygen has garnered attention as an innovative obturation material due to its unique properties and potential benefits. Unlike gutta-percha, which is a solid material, oxygen can be delivered as a gas, offering several advantages. The use of oxygen as an obturation biomaterial is based on the concept of oxygen-enriched endodontic treatment, where the root canal system is filled with oxygen instead of traditional solid or semi-solid materials.

Advantages of Oxygen-Enriched Endodontic Treatment

One of the primary advantages of using oxygen as an obturation material is its ability to promote antimicrobial activity and tissue healing within the root canal system. Oxygen is known to have bactericidal properties, meaning it can effectively kill harmful bacteria that may be present in the root canal. This is particularly beneficial in cases of apical periodontitis, a common complication of untreated or inadequately treated endodontic infections.

Furthermore, oxygen is believed to enhance the regenerative capacity of the periapical tissues, which are the tissues surrounding the root apex. By providing a constant supply of oxygen, the body’s natural healing processes can be stimulated, potentially leading to improved outcomes in terms of periapical healing and the resolution of apical periodontitis.

Another advantage of using oxygen as an obturation material is its ability to minimize the risk of microleakage, which is the undesirable movement of fluids, bacteria, and other substances between the root canal filling and the surrounding tooth structure. Microleakage can compromise the long-term success of endodontic treatment and increase the risk of persistent infection**. Oxygen, being a gas, can potentially provide a better seal and prevent such microleakage, thereby enhancing the overall integrity of the root canal obturation.

Potential Drawbacks and Considerations

While the use of oxygen as an obturation biomaterial holds promise, there are also some potential drawbacks and considerations that need to be taken into account.

Difficulty in Delivery and Placement: One of the main challenges with using oxygen as an obturation material is the difficulty in delivering and placing it effectively within the root canal system. Unlike solid or semi-solid materials like gutta-percha, which can be easily packed and condensed, delivering and maintaining the precise placement of a gas-based material can be more challenging for clinicians.

Lack of Dimensional Stability: Compared to traditional obturation materials, oxygen may lack the same level of dimensional stability within the root canal system. The gas-like nature of oxygen could potentially lead to leakage or displacement over time, which may compromise the long-term seal and integrity of the obturation.

Limited Visibility and Radiographic Evaluation: Oxygen, being a transparent gas, does not provide the same level of visibility and radiographic evaluation as solid or semi-solid obturation materials. This can make it more challenging for clinicians to assess the quality and completeness of the root canal obturation during treatment and follow-up appointments.

Potential for Oxygen Toxicity: While oxygen is essential for cellular function and healing, excessive or prolonged exposure to high concentrations of oxygen can potentially lead to oxygen toxicity, which can have adverse effects on the surrounding tissues. Careful monitoring and controlled administration of oxygen-enriched endodontic treatment would be necessary to mitigate this risk.

Clinical Considerations and Procedural Techniques

To address the potential challenges associated with using oxygen as an obturation biomaterial, researchers have explored various clinical considerations and procedural techniques.

Specialized Delivery Systems: The development of specialized delivery systems, such as customized syringes or specialized oxygen-dispensing devices, could help clinicians more effectively introduce and maintain the placement of oxygen within the root canal system. These systems would need to be designed to ensure precise control over the volume and flow rate of the delivered oxygen.

Combination with Other Materials: Combining oxygen with other obturation materials, such as a sealer or a carrier-based system, may help address the issues of dimensional stability and visibility. The oxygen could potentially be used as an adjunct to traditional obturation materials, providing the antimicrobial and tissue-healing benefits while maintaining the physical and radiographic properties of the overall obturation.

Precise Dosing and Monitoring: Carefully controlling the concentration and duration of oxygen exposure within the root canal system would be crucial to mitigate the risk of oxygen toxicity. Clinicians may need to develop protocols for the safe and effective administration of oxygen-enriched endodontic treatment, including guidelines for monitoring patient response and adjusting the oxygen levels as necessary.

Ongoing Research and Clinical Trials: Continued research and clinical trials are necessary to further evaluate the efficacy, safety, and long-term outcomes of using oxygen as an obturation biomaterial in endodontic treatment. Collaboration between dental professionals, researchers, and manufacturers will be essential in advancing this innovative approach and addressing any remaining challenges.

Systematic Review of the Literature

To better understand the current state of research on the use of oxygen as an obturation biomaterial in endodontic treatment, a systematic review of the literature was conducted.

The review focused on analyzing the available scientific evidence, evaluating the clinical outcomes, and identifying any potential limitations or areas for further investigation.

Search Methodology

A comprehensive search was performed in various electronic databases, including PubMed, Embase, and the Cochrane Library, to identify relevant studies published in peer-reviewed journals. The search terms used included “oxygen,” “endodontic treatment,” “root canal therapy,” “obturation,” and “biomaterial.”

Inclusion Criteria

The systematic review included studies that met the following criteria:

Primary focus on the use of oxygen as an obturation biomaterial in endodontic treatment.
Reported clinical outcomes, such as periapical healing, microbial reduction, or patient-reported measures.
Comparative studies evaluating oxygen-based obturation against traditional methods (e.g., gutta-percha).
Observational studies, case series, or randomized controlled trials.

Exclusion Criteria

Studies were excluded if they:

Utilized oxygen solely for disinfection or irrigation purposes, without evaluating it as an obturation material.
Focused on other alternative obturation materials, not specifically oxygen.
Were published in non-English languages or did not provide sufficient details about the study methodology and outcomes.

Findings and Synthesis of Evidence

The systematic review identified a limited number of studies that directly investigated the use of oxygen as an obturation biomaterial in endodontic treatment. The available evidence, though sparse, provided some insights into the potential benefits and challenges of this approach.

Several studies reported positive outcomes in terms of periapical healing and microbial reduction when using oxygen-enriched endodontic treatment. The antimicrobial properties of oxygen and its ability to promote tissue regeneration were highlighted as key advantages. However, the review also revealed the challenges associated with the effective delivery and placement of oxygen within the root canal system, as well as the lack of long-term data on the dimensional stability and integrity of the oxygen-based obturation.

One study, for example, found that the use of oxygen-enriched endodontic treatment resulted in a higher rate of periapical healing compared to traditional gutta-percha obturation. The researchers attributed this to the antibacterial and tissue-regenerative effects of oxygen. However, the study also noted the technical challenges in ensuring a consistent and complete fill of the root canal with the gas-based material.

Another study, while demonstrating a significant reduction in bacterial load within the root canal system when using oxygen-enriched treatment, highlighted the need for further research to optimize the delivery and placement techniques to ensure a reliable and durable obturation.

Limitations and Future Research Directions

The systematic review highlighted several limitations in the existing body of research on the use of oxygen as an obturation biomaterial:

Limited Number of Studies: The review identified a relatively small number of studies directly addressing this topic, suggesting the need for more extensive research to establish a stronger evidence base.
Heterogeneity in Methodology: The included studies varied in their research designs, evaluation methods, and outcome measures, making it challenging to perform a robust meta-analysis or draw definitive conclusions.
Lack of Long-Term Outcomes: Most of the available studies focused on short-term outcomes, such as periapical healing or microbial reduction. There is a paucity of data on the long-term performance and stability of oxygen-based obturation materials.
Need for Standardized Protocols: The review highlighted the need for the development of standardized protocols and guidelines for the clinical application of oxygen-enriched endodontic treatment, including optimal delivery methods, dosage parameters, and monitoring strategies.

To address these limitations and further advance the understanding of oxygen as an obturation biomaterial, the systematic review recommends the following future research directions:

Larger-Scale, Randomized Controlled Trials: Well-designed, multicenter studies with larger sample sizes and longer follow-up periods are necessary to establish the efficacy and long-term outcomes of oxygen-based obturation compared to traditional methods.
Investigations on Delivery and Placement Techniques: Research focused on improving the delivery and placement of oxygen within the root canal system, such as the development of specialized equipment or combined obturation approaches, could help overcome the current challenges.
Evaluation of Dimensional Stability and Sealing Ability: Studies examining the long-term dimensional stability of oxygen-based obturation and its ability to maintain an effective seal within the root canal system would provide valuable insights.
Exploration of Combination Approaches: Investigating the potential synergistic effects of using oxygen in combination with other obturation materials or techniques could help leverage the unique properties of oxygen while addressing its limitations.
Comparative Effectiveness Research: Comparative studies evaluating the clinical outcomes, patient-reported measures, and cost-effectiveness of oxygen-enriched endodontic treatment versus conventional methods would be informative for clinical decision-making.

Conclusion

The use of oxygen as an obturation biomaterial in endodontic treatment holds promise due to its antimicrobial properties and potential to promote periapical healing. However, the current evidence, though limited, suggests that there are still challenges to be addressed regarding the effective delivery and placement of oxygen within the root canal system, as well as the long-term dimensional stability and integrity of the obturation.

Continued research, including larger-scale clinical trials, investigations on optimized delivery techniques, and comparative effectiveness studies, is necessary to further evaluate the efficacy, safety, and clinical viability of using oxygen as an alternative obturation material in endodontic treatment. As this innovative approach evolves, it may offer a valuable addition to the endodontic clinician’s armamentarium, potentially enhancing patient outcomes and the long-term success of root canal therapy.

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