|Year : 2017 | Volume
| Issue : 1 | Page : 23-26
Comparative evaluation of apical leakage in roots filled with guttapercha/ah plus sealer and resilon/epiphany se sealer using cold lateral condensation technique: An In-vitro study
Manoj Chandak1, Fresca Adwani1, Krishna Veni Vyas2, Anuja Ikhar1, Rakhi Chandak3
1 Department of Conservative Dentistry and Endodontics, Sharad Pawar Dental College, Sawangi (Meghe), Wardha, Maharashtra, India
2 Department of Conservative Dentistry and Endodontics, Maitri Dental College, Anjora, Bhilai, Chattisgrah, India
3 Department of Oral Medicine and Radiology, Swargiya Dadasaheb Kalmegh Dental College and Hospital, Nagpur, Maharashtra, India
|Date of Web Publication||29-May-2017|
Sharad Pawar Dental College, Sawangi (Meghe), Wardha - 442 001, Maharashtra
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: This in vitro study was conducted with an aim to compare apical leakage between root canals filled with Gutta-percha/AH Plus and Resilon/Epiphany SE Sealer using cold lateral condensation technique. Materials and Methods: Eighty recently extracted human mandibular permanent premolars with straight roots with single canals were used in this study. Out of eighty samples, 40 were randomly divided into 2 experimental groups of 20 teeth each (n = 20). Samples in Group I were obturated with cold lateral condensation technique using Gutta-percha/AH Plus, in Group II were obturated by cold lateral condensation using Resilon/Epiphany SE Sealer. Forty teeth saved as controls positive (n = 20) and 20 negative (n = 20). Results: When comparison of leakage was done between Group I (Gutta-percha/AH Plus-cold lateral condensation) and Group II (Resilon/Epiphany SE Sealer-cold lateral condensation) by Mann–Whitney U-test, P = 0.001, which is statistically significant (P < 0.05). Conclusion: Gutta-percha exhibited an overall significantly lower percentage of apical dye penetration.
Keywords: Apical dye penetration, obturation techniques, Resilon/Epiphany SE Sealer
|How to cite this article:|
Chandak M, Adwani F, Vyas KV, Ikhar A, Chandak R. Comparative evaluation of apical leakage in roots filled with guttapercha/ah plus sealer and resilon/epiphany se sealer using cold lateral condensation technique: An In-vitro study. J Interdiscip Dentistry 2017;7:23-6
|How to cite this URL:|
Chandak M, Adwani F, Vyas KV, Ikhar A, Chandak R. Comparative evaluation of apical leakage in roots filled with guttapercha/ah plus sealer and resilon/epiphany se sealer using cold lateral condensation technique: An In-vitro study. J Interdiscip Dentistry [serial online] 2017 [cited 2017 Oct 21];7:23-6. Available from: http://www.jidonline.com/text.asp?2017/7/1/23/207153
| Clinical Relevance to Interdisciplinary Dentistry|| |
Detection of apical leakage is of utmost importance for accessing a material for Endodontics to provide a fluid tight seal.
| Introduction|| |
Complete obliteration of root canal system with development of a fluid tight seal is one of the foremost important factors for a successful endodontic treatment. This fluid-tight seal should serve three principle functions: entombing most surviving bacteria; stopping the influx of periapical tissue-derived fluid from reaching surviving bacteria in the root canal system; acting as a barrier, thereby preventing reinfection of the root canal.
Common failure of the root canal obturation process mainly occurs because of gaps and porosities which are usually present between the sealer and dentinal tubules.
Although lateral condensation is most commonly used technique, we have reported that a homogenous mass of obturation is difficult to achieve through lateral condensation as accessory cones and master cones are laminated and remain separate.
For over 100 years, Gutta-percha has been the preferred root canal filling material because it possesses many favorable properties which include biocompatibility, dimensional stability, thermoplasticity, easy placement, and removal and radioopacity.
Conventional endodontic treatment has a high success rate of up to 95%, but failures have been noted in 5%–10% of cases. Most endodontic failures occur as a result of leakage of irritants from pathologically involved root canals.
Microleakage is the clinically undetectable passage of fluids, molecules, ions or bacteria between the root canal wall and the obturating material, inability to obtain hermetic seal, which is often cited as a major goal of root canal treatment leads to microleakage. Apart from procedural errors in preparation, errors in obturation such as loss of working length, voids, and inability of the obturation material to seal to the dentinal walls are the most important contributing factors for microleakage. Hence, different obturation techniques and materials have been introduced to increase the quality of the obturation and apical seal of the root canal.
As microleakage at the apical foramen leads to nearly 60% of root canal failure, evaluation of microleakage is very important in the field of assessment of new endodontic materials and methods used for obturation of the root canal. These include subjective methods such as colored dye penetration, bacterial leakage, analysis of radiolabeled tracer penetration, and may involve the dissolution of hard tissue or clearing of teeth and objective methods such as spectrometry of radioisotopes, electrochemical methods, and gas chromatography. Out of which, dye is one of the oldest and most commonly used methods for detection of microleakage.
Clearing technique, longitudinal or vertical sectioning of the roots could be used for apical microleakage assessment.
Hence, the purpose of this in vitro study was to compare apical leakage between root canals filled with Gutta-percha/AH Plus and Resilon/Epiphany SE Sealer using cold lateral condensation technique by accessing apical microleakage by clearing technique.
| Materials and Methods|| |
Selection of samples
Eighty recently extracted human mandibular permanent premolars with straight roots with single canals were used in this study according to the Occupational Safety and Health Administration rule. The selected samples were free of any obvious resorptive defect, caries, hypercementosis, cracks, open apices, and previous restorations or root canal treatments. Examination of all teeth was done under ×8 magnification with a stereomicroscope (Carl Zeiss, Germany) to rule out any teeth with existing root fracture.
Preparation of the specimens
Immediately after extraction, the teeth were washed under running tap water. Taking all aseptic precautions, they were cleaned with a hand scaler to remove any calculus or soft tissue debris. The teeth were stored in normal saline at room temperature until further use.
The prepared teeth were decoronated with a diamond disc (Brasseler Dental Products, Savannah, Georgia, USA) to obtain uniform 14 mm length to avoid anatomic variations and to obtain standardization for the leakage measurements. Patency of the canal was verified with the use of size 15 K-file (Mani, Inc., Japan). The working length was determined by introducing a size 15 K-file (Mani, Inc., Japan) into the canal up to the apical foramen and then withdrawn to the extent of 1 mm, which has been confirmed from the intraoral periapical radiographs. Biomechanical preparation was done by step back technique using hand Kerr files (Mani, Japan) up to a caliber of 45. Final flaring in the cervical 10 mm of the canal was done with gates Glidden drill (Mani, Inc., Japan) number 2, 3, 4 to establish standard preparation of all roots. During cleaning and shaping, 15% ethylenediaminetetraacetic acid (EDTA) gel (Glyde File Prep-Maillefer Dentsply, France) was used as a lubricant with each instrument. After use of each instrument, canal was irrigated with 2 ml of 3% sodium hypochlorite (Vishal Dentocare Pvt. Ltd., India) using a syringe and a 27-gauge needle (Dispovan). Before obturation, each canal was irrigated with 1 ml of 17% aqueous EDTA solution (Dent Wash-Prime Dental, India) for 60 s followed by 10 ml of 3% sodium hypochlorite (Vishal Dentocare, Pvt. Ltd., India) to remove smear layer. 10 ml of normal saline (Nirlife Healthcare, Nirma Pvt. Ltd., India) was used for the final rinse. The canals were dried with sterile paper points. Out of eighty samples, 40 were randomly divided into 2 experimental groups of 20 teeth each (n = 20) [Table 1]. Samples in Group I were obturated with cold lateral condensation technique using Gutta-percha/AH Plus, in Group II were obturated by cold lateral condensation using Resilon/Epiphany SE Sealer. Forty teeth saved as controls positive (n = 20) and negative (n = 20).
In positive control group (n = 20), cervical sealing by Z-100 composite resin was done and obturation was not done. In negative control (n = 20), cervical sealing by Z-100 composite resin and apical sealing by Filtek Supreme XTE Flowable composite resin (3MESPE, Germany) were done and obturation was not done [Table 1].
After biomechanical preparation, storage of all root specimens was done at 37°C and 100% humidity (hot air oven, Cosmo Laboratory Equipment, India) for 2 weeks to allow sealer to set completely. The experimental and positive control groups were coated with two layers of varnish all over the surface except apical 2 mm was left so that dye could penetrate the canal through apical region. All the groups are immersed in India ink (Hi Media, RM 5259) and kept in hot air oven for 7 days. Sealing coats of nail varnish removed with scalpel blade and subjected to clearing technique.
Decalcification and cleaning
The specimens were decalcified for 3 days in 5% nitric acid (SD Fine Chcm1c. IMI) G: 8/l I) at room temperature. The nitric acid solution was changed daily and agitated three times each day. After completion of decalcification, the teeth were rinsed in running tap water for 4 h. The dehydration process consisted of a series of ethyl alcohol (SD Fine 58051) rinses starting with 80% solution overnight, followed by a 90% solution for an hour and three rinses of 100% ethyl alcohol for an hour each. The dehydrated teeth then were placed in methyl salicylate (SD Fine 39256) which made the teeth transparent after approximately 2 h.
Measurement of apical linear extent of dye penetration
These transparent teeth were directly examined under a stereomicroscope (SZ 40 Olympus, Japan) at ×8 magnification. Measurement of the linear extent of dye penetration was done from the apical end of the preparation coronally using a calibrated ocular scale. Samples were subjected to statistical analysis.
[Table 2] shows that when comparison of leakage was done between Group I (Gutta-percha/AH Plus-cold lateral condensation) and Group II (Resilon/Epiphany SE Sealer-cold lateral condensation) by Mann–Whitney U-test, P = 0.001, which is statistically significant (P < 0.05).
|Table 2: Comparison of leakage was done between Group I (Gutta-percha/AH Plus-cold lateral condensation) and Group II (Resilon/Epiphany SE Sealer-cold lateral condensation)|
Click here to view
| Discussion|| |
In the present study, AH Plus and Epiphany Sealers were used as both the sealers have got longer setting time and low viscosity with enhanced flow, which may result in less cracking and separation from the dentinal walls on setting as well as allow for better flow into accessory canals and other irregularities, which is in agreement with the study by Fransen et al.
Lateral condensation techniques were chosen as obturation technique in the present study as it is a proven, classic technique, one of the most widely used techniques, this technique remains the gold standard and most of the studies of new obturation system use lateral condensation for comparison purpose.
Out of total of 20 samples, in Group I (Gutta-percha/AH Plus, cold lateral condensation), leakage was observed in 15 samples with a mean value of 0.880 mm. In Group II (Resilon/Epiphany SE Sealer, cold lateral condensation), leakage was observed in 20 samples with a mean value of 2.315 mm. Comparison of the presence of apical dye penetration between Group I and Group II was statistically significant with P = 0.001 (P < 0.05).
In the present study to measure the apical microleakage, clearing technique was chosen. The biggest advantage of the clearing technique is that it examines the leakage without destroying the root specimens. Other techniques such as longitudinal or vertical cut of a tooth could also be assessed, but both the techniques are more destructive with loss of some tooth structure and quality of root canal filling could not be assessed as only one plane could be examined.
Results of the present study are in agreement with Gulsahi et al., Gogos et al., Hammad et al.
Gulsahi et al. compared the cross-sectional area of sealer plus voids surrounding root fillings completed with Resilon cones and Gutta-percha by lateral compaction. We explained that Gutta-percha is more compactable than Resilon and concluded that the quality of apical seal achieved with the Gutta-percha/AH Plus combination was superior to Resilon/Epiphany system.
In the present study, despite of theoretical monoblock concept with epiphany sealers, AH Plus performed better in preventing microleakage, may be probably due to better physical properties and enhanced flow which fills the irregularities. These results were in agreement with the study by Gogos et al. in which authors explained in theory, the methacrylate resin-based sealer of the system is able to firmly adhere to the Resilon core material.
Hammad et al. measured percentage of volume of voids and gaps in root canals obturated by cold lateral condensation with Gutta-percha and Resilon as obturation materials using microcomputed tomography. It was concluded that the Gutta-percha exhibited an overall significantly lower percentage of voids and gaps.
In contrast to the results of the present study, Tunga et al. and Nielsen and Baumgartner  observed that Resilon or Epiphany showed superior properties than Gutta-percha/AH Plus.
Versiani et al. demonstrated that the solubility of epiphany sealer was higher than that established by ANSI/ADA specification, which might lead to microleakage.
| Conclusion|| |
The apical leakage between root canals filled with Gutta-percha/AH Plus and Resilon/Epiphany SE system, using cold lateral condensation obturation techniques were compared which showed that the Gutta-percha exhibited an overall significantly lower percentage of apical dye penetration.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ozata F, Erdilek N, Tezel H. A comparative sealability study of different retrofilling materials. Int Endod J 1993;26:241-5.
Shipper G, Dent M, Teixeira FB, Arnold RR, Trope M. Periapical inflammation after coronal microbial inoculation of dog roots filled with gutta-percha or Resilon. J Endod 2005;31:91-6.
Luccy CT, Weller RN, Kulild JC. An evaluation of the apical seal produced by lateral and warm lateral condensation techniques. J Endod 1990;16:170-2.
Epley SR, Fleischman J, Hartwell G, Cicalese C. Completeness of root canal obturations: Epiphany techniques versus gutta-percha techniques. J Endod 2006;32:541-4.
Britto LR, Borer RE, Vertucci FJ, Haddix JE, Gordan VV. Comparison of the apical seal obtained by a dual-cure resin based cement or an epoxy resin sealer with or without the use of an acidic primer. J Endod 2002;28:721-3.
Haïkel Y, Wittenmeyer W, Bateman G, Bentaleb A, Allemann C. A new method for the quantitative analysis of endodontic microleakage. J Endod 1999;25:172-7.
Fransen JN, He J, Glickman GN, Rios A, Shulman JD, Honeyman A. Comparative assessment of ActiV GP/glass ionomer sealer, Resilon/Epiphany, and gutta-percha/AH plus obturation: A bacterial leakage study. J Endod 2008;34:725-7.
Gulsahi K, Cehreli ZC, Onay EO, Tasman-Dagli F, Ungor M. Comparison of the area of resin-based sealer and voids in roots obturated with Resilon and gutta-percha. J Endod 2007;33:1338-41.
Gogos C, Theodorou V, Economides N, Beltes P, Kolokouris I. Shear bond strength of AH-26 and epiphany to composite resin and Resilon. J Endod 2008;34:1385-7.
Hammad M, Qualtrough A, Silikas N. Evaluation of root canal obturation: A three-dimensional in vitro
study. J Endod 2009;35:541-4.
Tunga U, Bodrumlu E. Assessment of the sealing ability of a new root canal obturation material. J Endod 2006;32:876-8.
Nielsen BA, Baumgartner JC. Spreader penetration during lateral compaction of resilon and gutta-percha. J Endod 2006;32:52-4.
Versiani MA, Carvalho-Junior JR, Padilha MI, Lacey S, Pascon EA, Sousa-Neto MD. A comparative study of physicochemical properties of AH plus and Epiphany root canal sealants. Int Endod J 2006;39:464-71.
[Table 1], [Table 2]