根管充填におけるガッタパーチャの適合性の比較評価：円錐ビームCTを用いたランダム化比較試験

Three-dimensional obturation is vital for successful root canal treatment. Poor adaptation of gutta-percha (GP) with voids compromises the seal and may lead to treatment failure. Therefore, assessing the quality of its adaptation is essential for optimizing endodontic outcomes.

To compare GP adaptation using four different obturation techniques, cold lateral compaction (CLC), warm lateral compaction (WLC), warm vertical compaction (WVC), and thermoplasticized injection (TPI), in permanent posterior teeth using cone-beam computed tomography (CBCT).

This double-blinded, randomized controlled trial enrolled 120 patients aged 18-65 years, each requiring root canal treatment in posterior teeth. The trial was prospectively registered with the Clinical Trials Registry-India (CTRI/2024/06/068522; 06-06-2024). Patients were randomly allocated using a computer-generated sequence into four groups (n = 30 each): CLC (control), WLC, WVC, and TPI (experimental). All received standardized endodontic treatment. Following obturation, CBCT scans were evaluated using a validated void scoring system.

Fisher's exact test was applied for overall group comparisons, with Bonferroni correction for pairwise analysis. TPI showed the best adaptation with 83.33% scoring 1. CLC had the poorest results, with only 40% achieving Score 1. WLC and WVC yielded moderate results, with 66.67% and 60% scoring 1, respectively. Group differences were statistically significant (P = 0.012), and pairwise comparison revealed a significant difference between TPI and CLC (P = 0.001).

TPI demonstrated significantly superior adaptation and minimal void formation. CLC had the highest void incidence. WLC and WVC performed better than CLC but were inferior to TPI, suggesting that thermoplasticized techniques may improve obturation quality and outcomes.