ENDODONTOLOGY

Original Research

Evaluation of root canal sealers on the fracture resistance

of root canal treated teeth - An in vitro study
K. K. WADHWANI *
SARITA GURUNG **

ABSTRACT
Objectives : To compare the fracture toughness of the instrumented roots after obturating it with three different
sealers and comparing it with the control group (where the roots were first instrumented but not restored). Study
Design: Forty freshly extracted human maxillary central incisor teeth were selected. Crowns were removed at
cemento-enamel junction and the length of the roots were adjusted to 13 mm. Following canal preparation 10
roots in group I were filled with using Resilon with Epiphany sealer. Ten in group II were filled using guttapercha and AH plus sealer. Similarly group III were filled with gutta-percha and Endomethasone sealer. Ten
canals were left unrestored to be used as control group. Tests for fracture toughness were performed under Instron
Machine and force at the time of fracture was recorded in Newtons. The results were evaluated with ANOVA and
Tukey Honestly significant difference tests. Results : The mean force of fracture values recorded were 1283.60 N,
1197.40 N, 1098.40 N and 574.80 N respectively. There was a significant difference (p<0.001) between the
three experimental groups to that of the control group. But no significant differences were found among the three
experimental groups. Conclusions: All the materials used for the study reinforced the prepared root canals.
Key words: Fracture resistance, root canal sealers, Resilon, Epiphany, AH Plus Sealer, Endomethasone sealer.

INTRODUCTION

root canal after the root canal treatment. Similarly

There is a clinical impression that

Lert Chirakarn et al., (1999) reported fractures

endodontically treated teeth are more friable and

results from excessive lateral compaction forces

fracture easily thus may have to be removed (Steele

during the root filling. But the root canal

and Johnson, 1999). Similarly many studies have

instrumentation is an unavoidable step in

suggested that as removal of tooth structure

endodontic therapy. Therefore any material that can

increases fracture resistance decreases. Vertical root

compensate for this weakening effect could be

fractures are severe complications that are seen in

useful. Thus to reinforce the instrumented teeth

root filled teeth, which often leads to extraction

against fracture sealers are used in conjunction with

(Fuss et al., 2001). The incidence of vertical root

a core filling material. As gutta-percha with various

fracture was higher in root filled teeth than teeth

sealers has been the best combinations available

without filling (Chan et al., 1999). Cohen et al.,

till date but along with the old, experiment with

2003 observed that vertical root fracture results

the new should also be done. In the present study

largely from operative procedures performed in the

gutta-percha and AH plus sealer (epoxy resin based

* Professor & Head, ** P. G. Student, Department of Operative Dentistry & Endodontics, Chhatrapati Shahuji Maharaj Medical University, Lucknow.

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ENDODONTOLOGY

K. K. WADHWANI, SARITA GURUNG

sealer), gutta-percha with endomethasone sealer

Lentulo spiral filler. A master Resilon cone was

(zinc oxide eugenol based sealer) and recently

placed into the root canal and with cold lateral

introduced new obturation material Resilon with

compaction technique filled using accessory

Epiphany sealer was used (Resilon is synthetic

Resilon points. The excess was seared off with the

polycarplactone polymer based polyster and

help of plugger 1 mm below the canal opening

epiphany sealer contains methacrylate or HEMA).

and coronally cured for 40 seconds and canal

According to the manufacturer the epiphany sealer

opening was sealed with cavit.

bonds both to the Resilon cores and root dentin

Group-II

creating a Mono block that has good adaptation

Ten root canals were filled using gutta-percha

to the canal walls. The aim of the present study

with AH plus sealer. The master cone was dipped

was to evaluate the fracture resistance of root canals

in the sealer and placed in the canal and filled with

filled with Resilon and Epiphany, gutta-percha and

gutta-percha of smaller sizes. Excess gutta-percha

AH plus, gutta-percha with Endomethasone sealer

was seared off and condensed 1 mm below the

and instrumented but unrestored control group.

canal opening with a plugger and the opening was

MATERIALS AND METHODS

sealed with cavit.

Forty freshly extracted human maxillary central

Group-III

incisor teeth that were approximately of similar

Likewise here also ten numbers of root canals

dimension were selected, cleaned and stored in

were filled using gutta-percha with Endomethasone

physiological normal saline until required. The

sealer rest is similar as done in group II.

crowns were removed at cemento-enamel junction

Group-IV

and all the roots were adjusted to 13 mm. The

Here ten root canals were left unrestored. Only

patency of the apical foramen was determined with

the canal opening was sealed with cavit and was

a size 15 k file (Dentsply). The working length

used as control group. Then cylindrical moulds of

was established 1 mm short of apical foramen. Root

20 mm in diameter and 20 mm in length were

canals were instrumented to a size 40 K file and

prepared using elastomeric impression material

flared using 2, 4, 6 Gates-Glidden drills. Throughout

(Provil P Soft, Heraeus Kulzer, Domagen,

the instrumentation 1 ml. of 5.25% sodium

Germany) and then self cure acrylic was placed in

hypochlorite was used and a final rinse with 1 ml

the mould and apical 6 mm of the root were

of 17% EDTA was done in order to remove the

embedded individually with 7 mm remaining

smear layer. And finally root canals were flushed

exposed. The acrylic blocks

with 1 ml of saline solution and dried with paper

including the

specimen was placed on the lower plate of the

points and divided into four groups of ten teeth

machine (Universal Testing Machine, Instron), the

each.

upper plate of the machine included a round tip

Group-I

that had a diameter of 4 mm. This round tip

Ten root canals were filled with Resilon and

contacted the coronal surface of the specimen and

Epiphany sealer. The sealer was placed using

was subjected to slowly increasing vertical force

54

ENDODONTOLOGY

EVALUATION OF ROOT CANAL SEALERS ON THE FRACTURE RESISTANCE OF

ROOT CANAL TREATED TEETH - AN IN VITRO STUDY

of 1 mm per minute until the fracture occured and the values were recorded in Newtons.

RESULTS
Table I : Graphical Presentation of fracture resistance of specimens from Group I to IV
The mean forces of fracture was 1283.60 N,
1197.40 N, 1098.40N for Resilon and Epiphany,
Gutta-percha with AH plus, gutta-percha with
Endomethasone sealer respectively. For the control
group the mean force was 574.80 N. There was a
significant difference between group I and the
control group (p <0.001), group II and the control
group (p<0.001) and group III and the control
group (p <0.001). But no statistical differences
were found amongst the three experimental groups.

Table II : Descriptive statistics of the Fracture Resistance to the Force of Fracture of

Four different Experimental groups
Group

Sample size

Maximum

Minimum

Mean

SDS

Resilon with Epiphany Sealer

(Group I)

10

1727.00 N

998.00 N

1283.40 N

217.86 N

Guttapercha with AH Plus sealer

(Group II)

10

1563.00 N

933.00 N

1197.40 N

193.82 N

Guttapercha with Endomethasonse

sealer (Group III)

10

1415.00 N

640.00 N

1098.40 N

200.10 N

Control Group (Group IV)

10

690.00 N

420.00 N

574.80 N

96.54 N

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ENDODONTOLOGY

K. K. WADHWANI, SARITA GURUNG

DISCUSSION

those induced by a testing machine because forces

As root canal therapy has become well

generated intraorally during function vary in

established as a viable clinical treatment to retain

magnitude, speed and duration. Therefore in several

a tooth where by the dental pulp has become

studies tests of fracture strength was done using

necrotic, irreversibly inflamed or infected . But it is

the cyclic loading (Heydecke et al., 2001, Eakkinga

generally accepted that several endodontic

et al., 2005) i.e. applying the forces from different

procedures such as access preparation,

direction thus to simulate the clinical conditions.

instrumentation and even irrigation with

But again in many studies it has been reported

sodiumhypochlorite lead to reduction in fracture

applying the forces vertically to the long axis of

resistance of instrumented teeth (J.C. Knowles, J.

the tooth transmits the force uniformly (Chen et

Shelton et al., 2001, Cobankara et al., 2002). As

al., 2000, Lindemuth et al., 2002,Dias DeSouza

Zandbiglari et al.,(2006) and E. Schafer et al.,(2007)

et al., 2002). Hence for this study also force applied

expressed Enlarged but unfilled roots are

was vertically like for other studies that evaluated

significantly weaker than filled roots thus more

the effect of root canal sealer on the fracture

susceptible to fracture. Therefore, there is a general

resistance of root filled teeth (Apicella et al., 1999,

trend of restoring Endodontically prepared teeth to

Cobankara et al., 2002, Lertchirakarn et al., 2002,

reinforce them against fracture (Ausiello et al.,

Teixiera et al., 2004 a,b). For the current study the

1997, Pilo et al., 1998). For the current study to

ability of different sealers to reinforce the root canal

create uniformity of the samples and hence to avoid

treated teeth was evaluated. AH plus sealer is epoxy

difficulty in obtaining uniform fracture strength, all

resin based sealer hence reported to have highest

the controllable factors like length and size were

bond strength to dentin and gutta-percha (K.W. Lee

standardized i.e. roots were kept at 13 mm and

et al., 2002, Cobankara et al., 2003).

enlarged upto size 40. Although many differences

Endomethasone sealer is zinc oxide eugenol based

exists between fracture occurring intraorally and

sealer having good flow and recently introduced

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ENDODONTOLOGY

EVALUATION OF ROOT CANAL SEALERS ON THE FRACTURE RESISTANCE OF

ROOT CANAL TREATED TEETH - AN IN VITRO STUDY

Resilon with Epiphany sealer. Resilon is a synthetic

the filling materials increased the fracture toughness

polymer core material and epiphany is dual curable

of the prepared teeth but there was a significant

resin composite sealer which provides both

difference between the restored roots to that of

mechanical and chemical adhesion (Nakabayashi

unrestored roots of control group. This result

et al., 1992). Here Resilon with epiphany sealer

corroborate the previous studies by (J.C. Bakkel et

showed high resistance to fracture compared to

al., 1985, F.K. Cobankara et al., 2002, T.

control group. This may be due to mono-block

Zandbiglari et al., 2006, and B. Sagsen et al., 2007).

created because of Resilon filling closely adapting

But the study of M.J. Apicella et al., 1999, found

to epiphany sealer and in turn epiphany sealer

no statistical difference between the restored and

adhering to the dentin walls thus holds the root

unrestored groups using Ketac Endosealer. But the

together and reduce microleakage as compared to

study of M. Trope et al., 1992 using the same

gutta-percha fillings. This bond between polyester

material found restored group significantly stronger

core material to dual cure methacrylate based sealer

than the unrestored group. This may have resulted

helps to keep Resilon filled roots to increase its

due to variables in sample selection because for

fracture toughness.

the study of M.J. Apicella they had used randomly

selected maxillary and mandibular incisors, molars

Supporting this observation is studies of

and canines where as for the study of M. Trope

(Teixiera et al., 2004 a,b) reported teeth filled with

they had tried to standardize the samples by using

Resilon and Epiphany were more resistant to

only the maxillary and mandibular canines of

fracture. Similarly roots filled with gutta-percha with

similar dimension of 7 to 8 mm. Similarly in the

AH plus sealer also showed greater fracture

study of Teixeira et al., 2004 a,b they found no

resistance than control group. This may be due to

significant differences between the restored and just

its adhesive properties, as the epoxy resin based

instrumented but unrestored control group. This

sealer is found to have good adhesion to dentin

may have resulted due to the length of specimen

and gutta-percha and is characterized by low

exposed to the force of fracture during mechanical

shrinkage and high dimensional stability. This

testing. For the current study 7 mm of roots were

finding was similar to the studies of (F.K. Cobankara

exposed whereas in the study of Teixiera et al.,

et al., 2002 and B. Sagsen et al., 2007). They

2004 a,b 9 mm of roots was exposed to the force.

observed roots obturated with epoxy resin based

Further the high standard deviation values obtained

sealers with lateral compaction technique was

in the present study may be due to the variations

significantly stronger than just instrumented roots.

between the structure of root dentin of the tested

The roots obturated with Endomethasone sealer also

samples related to age or dentinal sclerosis.

showed higher resistance to fracture than the just

CONCLUSIONS

instrumented but unrestored roots of the control

group. This maybe due to its flow and was able to

For the current study all the tested materials

penetrate into the dentinal tubules thus creating

significantly increased the fracture toughness of the

adhesion resulting in reinforcement of the

instrumented roots after obturation. Therefore the

weakened roots. Hence for the current study all

ability of these materials i.e., Resilon and Epiphany

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ENDODONTOLOGY

K. K. WADHWANI, SARITA GURUNG

8. E. Schafer et al., Influence of resin based adhesive root

canal fillings on the resistance to fracture of endodontically
treated roots. An in vitro preliminary study. Oral Surg, Oral
Med and Oral Path. 2007; 103 : 274 279.

sealer, Gutta-percha and AH plus sealer, guttapercha and Endomethasone sealer to reinforce the
Endodontically treated teeth looks very promising
but further long-term clinical studies are necessary

9. P.Ausiello et al., Fracture resistance of endodontically

treated premolars adhesively restored. American Journal of
Dentistry. 1997; 10: 237 241.

to collect evidence based data thus to be able to

support the confident use of these materials in day

10. Guido Heydecke et al., Fracture strength and survival rate

of endodontically treated maxillary incisors with approximal
cavities after restoration with different post and core systems.
An in vitro study. Journal of Dentistry. 2001; 29: 427 433.

to day practice.
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