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Original Article

Evaluation of fracture resistance of roots obturated

with resilon and thermoplasticized gutta-percha:
An in vitro study
Pravin Kumar, Navsangeet Mangat Kaur, Saurabh Arora, Seema Dixit
Department of Conservative Dentistry and Endodontics, Seema Dental College and Hospital, Rishikesh, Pashulok, Uttarakhand, India

Abstract
Aim: To investigate and compare the fracture resistance of resilon and realseal filled root canals with those that were obturated
with thermoplasticized gutta-percha and AH-plus endodontic sealer.
Materials and Methods: Eighty extracted human mandibular single-rooted premolars stored in 10% formalin were used in this
study. They were prepared by using a crown-down technique, debrided and irrigated with NaOCl, EDTA, and normal saline and
divided into four groups. Group I = Negative control, canals prepared but no obturation was done; Group II = Positive control
obturated with dual cure composite resin; Group III = Obturated with thermoplasticized GP and AH-plus; Group IV = Obturated
with resilon and realseal. All root specimens were stored for two weeks in 100% humidity to allow for complete setting of
the sealer. Each specimen was mounted in acrylic in a polyvinyl ring and tested for fracture resistance with a universal testing
machine. The loading fixture of the machine was mounted with its spherical tip aligned with the center of the access opening of
each root. A vertical loading force was applied until it fractured the root. The force values were subjected to statistical analysis:
Kruskall-Wallis H-test and Mann-Whitney U-test.
Results: Group comparison revealed that Group II (positive control) had significantly higher values of resistance to fracture as
compared to all the other groups. While Group IV (resilon with realseal) had significantly higher values of resistance to fracture
as compared to Group I (negative control).
Conclusion: On the basis of our findings, it can be concluded that filling the root canals with resilon and realseal increased the
in vitro resistance to fracture of single-canal extracted teeth. resilon and realseal demonstrated high fracture-resistance values
and could be an alternative to the conventional gutta-percha.
Keywords: Resilon, realseal, thermoplasticized gutta-percha, AH-plus, fracture resistance

INTRODUCTION (Suheel Manzoor et al., 2010). If a dental material could be

American association of endodontists defined and
characterized root canal obturation as a “three-
dimensional filling of the entire root canal system as
close to the cemento-dentinal junction as possible”. So
far as gutta-percha is the most popular and commonly
used root canal filling material. It has been taken as the
gold standard for root canal filling materials. Despite its
many advantages gutta-percha still has its limitations
like, its inability to strengthen the root as it does not
bond to the dentine.2 The concept of obturating root
canals using injection-molded thermoplasticized dental
gutta-percha was introduced by Yee et al. They found
injected thermoplasticized gutta-percha could produce
an effective apical seal, especially when used with sealer
Address for correspondence:
Dr. Navsangeet Kaur, Mangat Nursing Home, Chandigarh Road,
Katani Kalan, Ludhiana - 141 113, Punjab, India.
E-mail: navsangeet.mangat566@gmail.com
Date of submission : 25.02.2014
Review completed : 29.04.2014
Date of acceptance : 06.05.2014
developed that ought to bond to the dentinal walls of the
root canal, theoretically the material will not only provide
a good seal but also reinforce the endodontically treated
tooth (Williams et al., 2006). In 2004, a new obturating
system resilon was introduced containing polycaprolactone
core material with difunctional methacrylate resin along
with resin-based sealer. The rationale behind the product
was to create a monoblock consisting of a resin sealer
with resin tags that enter into dentinal tubules and bond
to dentine on canal walls as well as adhesively to the
core material. Such a monoblock effect reduces ingress
pathways and reinforces the strength of root canal system
and the tooth per se. Vertical root fractures are one of the
most common and serious complications of the root canal
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DOI:
10.4103/0972-0707.136510

354 Journal of Conservative Dentistry | Jul-Aug 2014 | Vol 17 | Issue 4

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treated teeth. In 1999, Fuss et al., showed that vertical
root fracture following endodontic treatment represented
10.9% of treated teeth (Williams et al., 2006). It has been
reported that when the canals are filled with resilon in
combination with epiphany oral bonding agent, it forms
a monoblock within the canals that bonds to the dentinal
walls. Because the resin core, sealant and dentinal wall
all are “attached,” it appears logical that they have the
potential to strengthen the root against fracture (Teixeira
et al., 2004).
MATERIALS AND METHODS
80 extracted mandibular single rooted first and second
premolars collected from the department of Oral and
Maxillofacial Surgery, Seema Dental College and Hospital,
Rishikesh were used in this study.
Tooth were decoronated with the help of a diamond disk
mounted on a DFS mandrel in a straight hand piece at
30,000 rpm. Each root had a minimum length of 14 mm
and a maximum buccolingual diameter of (5 ± 1) mm
(measured with a vernier caliper). Patency of the canals was
checked and the glidepath established.
Estimation of the provisional working length was made
by placing size 15 K-file (Dentsply Mallefer) into the root
canal until it was observed at the apex. The final working
length was ascertained after subtracting 1mm from this
length.
The canals were instrumented with ProTaper (Dentsply
Tulsa Dental, Maillefer, OK) rotary instruments by using a
16:1 reduction handpiece (X-SMART; Dentsply Maillefer) at
a speed of 250 rpm.
Shaping file S1 was carried into the canal short of working
length, followed by file Sx that was used with a brush
stroke. File S1 was then used up till the working length,
followed by S2. Next, finishing file F1 was taken to working
length and withdrawn. The size of the apical foramen
was then gauged by using an ISO #20 hand K-File, after
which finishing file F2 was used. The size of the apical
foramen was then gauged with an ISO #25 hand K-file,
after which file F3 was used to working length. Only those
teeth that required finishing with file F3 constituted the
final sample of teeth.
Throughout the entire sequence of operations,
irrigation was performed with an endodontic irrigating
needle and syringe by using 3% sodium hypochlorite.
Recapitulation was performed with an ISO #15 K-file,
subsequent to the use of each ProTaper file. After
completion of instrumentation, all specimens received
a flush of sodium hypochlorite (Pyrex, 3%) followed
Journal of Conservative Dentistry | Jul-Aug 2014 | Vol 17 | Issue 4
Kumar, et al.: Fracture resistance: Thermoplasticized vs resilon
by 17% ethylene diamine tetraacetic acid (EDTA)
[PrevestDenPro] for 1 minute. All specimens were
finally irrigated with normal saline. The canals were
dried with paper points.
Distribution of groups
The selected teeth specimens (N = 80) were then randomly
assigned into 4 experimental group (N = 20 for each group)
by using a simple random sampling method.
Group I: This group comprised of 20 prepared teeth and
was left unfilled. (Negative Control)
Group II: This group comprised of 20 teeth and were
obturated with flowable, dual cure composite
resin (Para Core Dual Cure, ColteneWhaledent.
Switzerland) (Positive Control)
Group III: This group comprised of 20 teeth and were
obturated with thermoplasticised gutta-percha
(Calamus, Dentsply Maillefer, Switzerland) and
AH-plus sealer (Dentsply Maillefer, Switzerland)
(Experimental Group)
Group IV: This group comprised of 20 teeth and were
obturated with resilon and realseal sealer
(Sybron Endo) (Experimental Group)
All procedures for the 4 groups were performed
according to manufacturer’s instructions. The root
canal openings of all specimens were sealed with a non-
eugenol temporary filling material, cavit G (ESPE, 3M,
St. Paul, MN).
Subsequent to obturation, all root specimens were stored
for 2 weeks in an incubator (Obromax) at 370C in 100%
humidity to allow the sealer to set completely. Each apical
root end was then embedded in a polyvinyl ring, leaving
9mm of the root exposed and 5mm embedded. Acrylic
resin was poured into polyvinyl ring, on a stable and
smooth base. Each root was mounted when the acrylic
resin was in dough stage.
Evaluation of fracture resistance
Each polyvinyl ring containing a root specimen was
mounted for evaluation of fracture resistance. A loading
fixture was mounted with its spherical tip (r = 2mm) aligned
with the center of the access opening of each specimen.
A vertical loading force was applied at a crosshead speed
of 1.25 mm per minute (for all samples) until it fractured
the roots. Fracture was defined as the point at which
a sharp and instantaneous drop greater than 25% of the
applied load was observed. The test was terminated at this
point, and the recorded force was measured on the dial
gauge of the Universal strength-testing machine (Enkay,
computerized universal testing machine) and was obtained
as a micrograph. The mean load to fracture for all groups is
given in Table 1. The statistics analysis is given in Table 2.
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Kumar, et al.: Fracture resistance: Thermoplasticized vs resilon

Table 1: Mean and standard deviation of yield load of Amongst clinicians, the loss of dentin is commonly
all the four groups believed to create an increased susceptibility to fracture
Group No. of Mean yield SD Min Max of endodontically treated teeth (Calt and Serper 2002).
cases load (KN) Study by Ekkasak et al., showed that a non-prepared
I 20 239.24 1.94 237.55 244.43 root has a greater resistance to fracture than any current
II 20 243.12 2.51 238.80 245.68
III 20 238.30 0.87 237.55 239.42 mode of restoration following endodontic treatment.
IV 20 239.42 0.00 239.42 239.42 Root canal instrumentation is an unavoidable step in
endodontic treatment. However, it is understood that as
Table 2: Between group comparison of yield load for dentine is removed during the instrumentation phase, a
different group combinations (Mann-Whitney U-test) weakening effect on root is inevitable. Any material that
Comparison Z P can compensate for this weakening effect would be useful
I vs II 3.758 <0.001
(Teixeira et al., 2004).
I vs III 0.515 0.620
I vs IV 3.114 0.003 Calt and Serper in 2002 compared the smear layer
II vs III 3.590 <0.001 removal capability and the structural effects of EDTA
II vs IV 3.193 0.002
III vs IV 1.943 0.102 on root dentin with respect to duration of application.
Between group comparison revealed that Group II had significantly higher values as Their results showed that EDTA followed by NaOCl
compared to all the other groups except Group IV, while Group IV had significantly completely removed the smear layer in 1 minute.
higher values as compared to Group I. On the basis of above evaluation, the
following order of differences in yield load were observed in different groups: Group
When EDTA was applied for 10 min, excessive erosive
II > Group IV > Group I ~ Group III effects were observed with dissolution of peritubular
and intertubular dentin. According to their findings, to
RESULTS inhibit the erosion on dentin, EDTA solution must not
be applied for longer than 1 minute. Therefore in the
All the samples were subjected to fracture resistance present study EDTA was used for 1 minute to irrigate all
measurement using Universal Testing Machine. The the samples as a final rinse.
following physical property was noted:
Gutta-percha has been considered as the “gold standard”
Yield load (KN) = Force required for fracture of a specimen filling material and for many years has been used as core
material with zinc oxide eugenol based or Ca(OH)2 based
DISCUSSION sealers (Patil et al., 2013). But, limitations of gutta-percha
i.e. inability to reinforce endodontically treated roots
Root filled teeth are reported to be more prone to and coronal micro leakage have lead to the development
biomechanical failure. Most clinical failures can be ascribed of alternatives. Because of absence of complete seal, it
to physiologic masticatory or Para functional forces when produces a poor barrier to bacterial micro-leakage and is
repeated over long periods of time, also known as fatigue considered to be one of the weakest points in root canal
stress. Stress is produced within a structure as a result therapy (SV Ravi et al., 2014).
of internal resistance generated to counter the applied
force. The nature of the distribution of stress within the Few studies have evaluated the potential of using dentin
structural load changes because of the direction of the load bonding agents and resins as obturating material in
applied and the shape of the structure. Concentrations of non-surgical root canal treatment. Reasons for not using
stresses from a biomechanical perspective indicate regions resin for root canal obturation have centered around
of potential failure. Therefore, biomechanical studies are questionable results, difficult and unpredictable methods
necessary to highlight the behavior of a treated tooth to of delivery into the root system and the inability to
functional forces (Belli et al., 2011). re-treat the canal if necessary (Baba et al., 2010). However,
Mubashir et al., (2012) found that xylene, refined orange oil
The aim of the present study was to investigate and and tetrachloroethylene can be used for softening resilon
compare the fracture resistance of resilon and realseal during retreatment with various techniques. Xylene being
filled root canals with those that were obturated with the best solvent.
thermoplasticised gutta-percha and AH-plus endodontic
sealer. Endodontically treated teeth are widely considered Resilon is a thermoplastic synthetic polymer. Resilon is
to be more susceptible to fracture than the vital teeth. The based on polymers of polyester and contains bioactive and
reasons most often reported have been the dehydration highly radiopaque fillers. The polymer has an improved
of dentin after endodontic therapy, excessive pressure flexural strength and when used in conjunction with a
during obturation and removal of tooth structure during resin-based sealer offers improved bonding potential, as
endodontic treatment (Teixeira et al., 2004). compared to gutta-percha.

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Primary components of resilon are:
1. Resilon core material containing bioactive glass,
bismuth oxychloride and barium sulfate;
2. Real seal, the resin sealer is a dual cure, resin based
composite sealer. The resin matrix is composed
of bisphenol-A-glycidyldimethacrylate (BisGMA),
ethoxylated BisGMA, urethanedimethacrylate (UDMA),
and hydrophilic difunctional dimethacrylates. It
contains fillers of calcium hydroxide, barium sulfate,
barium glass, and silica. The total filler content is
approximately 70% by weight;
3. Self-etch primer that contains sulfonic acid-terminated
functional monomer, 2-hydroxyyethyl methacrylate
(HEMA), water and a polymerization initiator.
HEMA enhances the bonding of resin to dentin (Baba
et al., 2010). The penetration into dentinal tubule of the
self-etching primer and composite sealer may prevent
shrinkage of the resin filling away from the dentine wall and
aid in sealing roots. These materials have been shown to
be biocompatible, non-toxic and non-mutagenic and have
been approved for endodontic use by the Food and Drug
Administration of the United States (SV Ravi et al., 2014).
Resilon/Epiphany showed better results of sealing ability
than gutta-percha/AH-plus, when post space preparation
was delayed (Dhanded et al., 2013).
There has been much controversy regarding the relative
bonding power of the resilon system compared with AH26
and gutta-percha. Ozgur et al., 2007, in their study found
a lower resistance with the Resilon system compared with
the AH26 and gutta-percha group. Teixeira et al., reported
that dual-curing resin-based root canal sealers increased
the fracture strength more than AH26.
In the current study between group comparisons of yield
load revealed that Group II (i. e. obturated with flowable,
dual cure composite resin) had significantly higher values
as compared to all the other groups. Group IV (i. e.
obturated with resilon and realseal sealer) had significantly
higher values as compared to Group I. There was not much
difference in values of Group I and Group III.
Thus, it may be inferred that Resilon increased the fracture
resistance of roots as compared to Thermoplasticized
gutta-percha. This is in agreement with the results of study
done by Jeanne Monteiro et al., 2011, Teixeira et al., 2004
and Baba et al., 2010 where filling the canals with Resilon
increased the resistance to fracture of endodontically
treated teeth when compared with gutta-percha root
canal fillings.
The better performance of resilon in context with fracture
resistance is attributed to its thermoplastic nature, which
is because of incorporation of polycaprolactone, a bio-
degradable aliphatic polyester that has a low glass transition
Journal of Conservative Dentistry | Jul-Aug 2014 | Vol 17 | Issue 4
Kumar, et al.: Fracture resistance: Thermoplasticized vs resilon
temperature of 620C. It is bondable to methacrylate based
resin as it contains dimethacrylate resins. This radio-
opaque root-filling material couples with resin based
sealers like realseal or epiphany. The adjunctive use of self
etch adhesives and methacrylate based resin sealer with
resilon purportedly creates a monoblock between the
intraradicular dentin and the root-filling material that is
more resistant to both bacterial leakage and root fracture
when compared with similar teeth that were root-filled with
gutta-percha and conventional sealers (Teixeira et al., 2004).
The materials that constitute a monoblock should have the
ability to bond strongly and mutually to one another, as
well as to the substrate that the monoblock is intended
to reinforce. Resilon is the only bondable root filling
material that may be used for either lateral or warm
vertical compaction technique. As resilon is applied using
a methacrylate-based sealer to self etching primer-treated
root dentine, it contains two interfaces, one between the
sealer and primed dentin and the other between the sealer
and Resilon, hence may be classified as a type of secondary
monoblock (Tay et al., 2007).
Gutta-percha does not chemically bond to the dentinal wall,
so they do not form the monoblock system (Hammad et al.,
2007). According to Teixeira et al., gutta-percha does not
form a monoblock even with the use of a resin-based sealer
such as AH-plus, because the sealer does not bind to gutta-
percha. The modulus of elasticity of gutta-percha points
(ca.80 MPa) is 175-230 times lower than that of dentin (ca.
14,000-18,000 MPa), making them too plastic to reinforce
root after endodontic therapy. (Franklin et al., 2007)
CONCLUSION
On the basis of the findings of present study, it can be
concluded that filling the root canals with resilon and
realseal increased the in vitro resistance to fracture of
single-canal extracted teeth. Resilon along with realseal
demonstrated high-fracture-resistance values, and could be
an alternative to the conventional gutta-percha.
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358 Journal of Conservative Dentistry | Jul-Aug 2014 | Vol 17 | Issue 4