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Leakage along apical root fillings with and without
smear layer using two different leakage models: a
two-month longitudinal ex vivo study

H. Shemesh, M.-K. Wu & P. R. Wesselink
Department of Cariology Endodontology Pedodontology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The

Abstract between the groups in glucose concentrations and fluid
transport were statistically analysed with the Kruskal–
Shemesh H, Wu M-K, Wesselink PR. Leakage along apical
Wallis and the Mann–Whitney tests. The level of
root fillings with and without smear layer using two different
significance was set at a ¼ 0.05.
leakage models: a two-month longitudinal ex vivo study.
Results Glucose penetration was significantly differ-
International Endodontic Journal, 39, 968–976, 2006.
ent between the three groups after the first 8 days
Aim To compare two different experimental models (P < 0.05). Resilon leaked the most throughout the
when measuring leakage along root fillings with or experiment period. No significant difference (P > 0.05)
without smear layer. existed between the two gutta-percha groups at all time
Methodology One hundred and twenty single- intervals (Mann–Whitney test). In the fluid transpor-
rooted teeth were prepared to size 50 and allocated to tation model, no statistically significant differences
two groups: fluid transport model (n ¼ 60) and glucose were observed between all three experimental groups
penetration model (n ¼ 60). The roots in each group (P > 0.05) at either 1 or 8 weeks after filling (Kruskal–
were divided into three subgroups of 20 teeth each. Wallis test).
Smear layer was left in place in group 1 but removed in Conclusions Under the conditions of this study, the
groups 2 and 3. In groups 1 and 2 canals were filled glucose penetration model was more sensitive in
with laterally compacted gutta-percha cones and AH detecting leakage along root fillings. Removing the
26. Group 3 was laterally compacted with Resilon smear layer before filling did not improve the sealing of
cones and Epiphany sealer. The coronal portion of the the apical 4 mm of filling. Resilon allowed more glucose
filling was removed to assure only 4 mm of filling penetration but the same amount of fluid transport as
remained in the canal. Leakage of glucose was evalu- the gutta-percha root fillings.
ated by measuring its concentration once a week for a
Keywords: gutta-percha, leakage, Resilon, root
total period of 56 days using a glucose penetration
canal filling, smear layer.
model. Fluid transport was evaluated by measuring the
movement of an air-bubble using a fluid transport Received 20 March 2006; accepted 13 June 2006
model, 1 and 8 weeks after canal filling. Differences

between the canal and periapical tissues (Sundqvist
et al. 1998).
The purpose of a root filling is to prevent bacterial A variety of laboratory-based experimental models
growth and penetration of fluid and antigenic agents are used to detect and measure leakage along root
fillings. Dye leakage, fluid transport and bacterial
penetration are currently the methods used most often.
Correspondence: H. Shemesh, Department of Cariology Endo-
dontology Pedodontology, ACTA, Louwesweg 1, 1066 EA
Recently Xu et al. (2005) discussed a new model that
Amsterdam, The Netherlands (Tel.: 3120 518 8549; fax measures the leakage of glucose molecules. The model
3120 669 2881; e-mail: consists of a tube containing concentrated glucose

968 International Endodontic Journal, 39, 968–976, 2006 ª 2006 International Endodontic Journal

2005). Wu et al. achieving a One hundred and sixty recently extracted single-rooted potentially greater adherence to the canal wall (Kokkas human teeth were selected and stored in 0. (1993) reported that all different experimental models in measuring leakage root canals filled with laterally or vertically condensed along apical root fillings with and without the smear gutta-percha were contaminated in less than 30 days layer. Wallingford. Torabinejad et al. 1985). portion of the canal was instrumented to a size 50 Recently. Shemesh et al. 2003. whilst the apical region is dipped in water. tooth. All procedures and provide a leak-free seal (Wu & Wesselink 1993. self-etching of the canal wall) is claimed to form a tion through root fillings. Pre- (Kennedy et al. 2004). This material resembles gutta-percha in appearance. Darmstadt. master file using the balanced force technique (Roane & based root filling material was introduced (Resilon. Systems like warm injection and carrier-coated root fillings have been developed but have been shown The working length was determined by subtracting to leak to a certain extent (Mannocci et al. Glucose has a low molecule weight corresponding sealer (Pentron Clinical Technologies) is of 180 Da. Galvan et al. Two gain straight-line entry to the root canal. 2004. This has been claimed to improve sealer penetration inside the dentinal tubules. USA). single canal. A size 20 review articles on the clinical implications of the smear K-Flexofile (Dentsply Maillefer. All samples were examined under a microscope the removal of smear layer before filling. some studies that investigated the azide. 1994. the Nether- removal of the smear layer on the seal and stated that lands) to form an acrylic cylinder around the root and the mechanisms leading to successful root canal enable intimate contact between the rubber tube used to treatment remained to be determined. The Gulabivala et al. Germany) to exclude cracks. 968–976. 1 mm from the total length of the root. ‘Epiphany’ system (Resilon and sealer combined with Leakage studies consistently show bacterial penetra. Germany) at +4 C removal of the smear layer concluded that a better seal until use. 39. A diamond bur grow inside the dentinal tubules (Pashley et al. Germany) was used to Drake et al. Dentimex BV. Zeist. after exposure to human saliva. et al. Berlin. Leakage of apical root fillings solution that is connected to the coronal aspect of the Pentron Clinical Technologies. 2005). Torabinejad et al. Çobankara et al. Love 1996). 1995. NaN3 (E. Teixeira et al. reported that 50% of filled single-rooted teeth were prevents leakage and increases resistance to fracture contaminated along the whole length of the canal after (Shipper et al. 1994. More recently (Zeiss Stemi SV6. smear layer increases dentine permeability and might The coronal portions of all teeth were removed so that impair the sealing ability. Indeed. Chu et al. Clark-Holke et al. Switzerland) layer in endodontics (Şen et al. Sabala 1985) with K-Flexofiles (Dentsply Maillefer). 1999. was inserted into the canal to verify patency (Kuttler 2002) confirmed the uncertainty and debate relating to 1955). Gutta-percha is the most popular filling material and has been used for this purpose for many Instrumentation and obturation of root canals years. (2005) discussed the effects of coronal 4 mm of the root specimens were then embed- mechanical and chemical procedures including the ded in acryl (Vertex. Ballaigues. 1986. connect the specimen during the leakage phase of the Current filling materials and techniques fail to study and the root specimen. Jena. CT. and may be used as an indication for toxins a dual curable dental resin composite.2% sodium et al. 1981. 1987. A ª 2006 International Endodontic Journal International Endodontic Journal. Mandibular incisors were excluded because of was achieved when the smear layer was removed their morphological diversity (Kaffe et al. and even allow bacteria to each root specimen was 15 mm long. 2006 969 . Teeth with open apices or large carious 2004). 19 and 42 days of exposure depending on the infecting The purpose of this study was to compare two microorganism. Selection and preparation of teeth 2003). Wu treatments were preformed by one individual. (FG 173 Horico. a new thermoplastic synthetic polymer. Cergneux et al. 2003. 1993). Khayat et al. (1990) ‘monoblock’ which adheres to the dentine walls. Other studies have suggested that removing the lesions were excluded. Glucose that accumulates in the apical chamber is has similar handling properties and is available both in measured with a spectrophotometer following an cone format and in pellets for warm injection. Taylor molars were used only when a radiograph indicated a et al. The enzymatic reaction. 1997. This so-called that might penetrate the canal (Xu et al. 2004). One of the methods previously described for improv- Materials and methods ing the seal and for minimizing leakage is the removal of the smear layer before filling (Clark-Holke et al. The apical Abarca et al. 2001. Merck.

The prepared roots percha cones without any sealer. subjected to the leakage test (Fan et al.5 cm · 0. The resin block around the coronal part of each root was connected to a rubber tube with stainless steel Group 2 wires. Acton. such that the root samples All canals were rinsed with 5 mL 17% EDTA for 3 min were immersed in the solution. The tip of each accessory cone was lightly coated with sealer. The filling was removed from overcome the variation in natural morphology. 39. gauge needle. MA. NaN3 was used to and then with 5 mL deionized water. leaving the apical 4 mm of root filling concentration measurements. canal with sealer and bring the cone to full working glucose penetration and fluid transport. The process was repeated until glucose penetration model and the original model cones could not be inserted more than 10 mm into the introduced by Xu et al. The tracer used in the Technologies) was placed into the canal with a 26. 2003) and then rinsed with 5 mL and sealed with sticky wax. way as group 1. (2005) lies mainly in the canal.173 Horico. The assembly was 5 mL 17% EDTA for 3 min to remove the smear layer then placed in a sterile glass bottle with a screw cap (Hülsmann et al. placed and The difference between the current version of the compacted laterally. length. Germany) to assure an open system at all times (Fig.2 mm mm)1 then filled with lateral compaction of Resilon cones and (Wu et al. paper point size 50. Lateral compaction was achieved using a size C finger spreader (Dentsply Maillefer) and size 25 acces- Glucose penetration model – preparation and sory gutta-percha cones that initially reached to within measurements 1 mm of the working length. Each the coronal portion of the canal in the same manner as canal was irrigated with freshly prepared 2% NaOCl group 1. 1). An estimation of the total amount of sealer used environment in which the equipment was stored: in was achieved by using a 0. Specimens in each group were then canal. 968–976. Group 1 Negative control group After preparation was completed. were placed in a closed jar with 100% humidity. 2002). The filling was completed in the same in the screw cap with a diamond bur (No. A minimum of 10 mL NaOCl Canals were filled using lateral compaction of gutta- solution was used for each root. From The coronal gutta-percha was removed with a hot a pilot study it was concluded that this method would plugger (0.5 mm diameter. a inhibit the growth of microorganisms that might self-etching primer (Epiphany primer. Dentsply Maillefer) and eliminate the effect of fluid evaporation on glucose vertically packed. 1999). with a 27-gauge needle after every instrument and ensuring patency by extrusion of the solution beyond Positive control group the apical foramen. step-back flaring technique was then performed at root. which was in itself connected to a 16 cm long After completion of preparation canals were rinsed with pipette (Pyrex. remained. Pentron Clinical influence the glucose readings. No warm vertical were randomly divided into three experimental groups forces were used and the whole length of the filling of 40 roots. Berlin. A uniform hole was drilled deionized water. Leakage of apical root fillings Shemesh et al. specimens mixed sealer for each tooth. After drying. Two millilitres of 0. Each canal was dried using and completely covered with nail varnish.5 cm square of order to overcome evaporation of fluids. Three paper points size 50 were used to remove 1 mm increments with Gates Glidden burs number 2–6 excess primer after 1 min from each root. Two drops of primer were used for each Glucose has a low molecular weight and is hydrophilic 970 International Endodontic Journal. canals were rinsed All roots were sealed with laterally compacted gutta- with an additional 5 mL 2% NaOCl solution and then percha and AH 26 for the whole length of the canal with 5 mL deionized water. leaving 4 mm of the apical filling intact. 2006 ª 2006 International Endodontic Journal . present study was 1 mol L)1 glucose solution (pH 7. Light pumping motions were used to fill the divided equally between the two different models. Roots were (Dentsply Maillefer) making the taper 0. and two control groups of 20 roots each. USA). The purpose of this preparation Epiphany sealer (Pentron Clinical Technologies) in the regimen was to create a uniform size of canal and to same way as in group 1.2% NaN3 solution were Group 3 inserted into the glass bottle. After filling all specimens were maintained for A size 50 gutta-percha master cone coated with AH 1 week at 37 C and 100% humidity to allow the 26 sealer (Dentsply Maillefer) was inserted into the materials to set.0).

Concentrations smaller than this were thus ignored. (1993).003 mmol L)1 which derives from an absorbance difference of 0.3 atm) and after 3 h the volume of fluid created a hydrostatic pressure of 1. (Fig. About 4. Wicklow. was injected into the a water bath at 20 C. All specimens were then returned to lL min)1.2% NaN3 was added to the glass bottle reservoir to maintain a constant volume of 2 mL. 968–976.2% NaN3. and results are subject to greater error Rubber tube from technique variables. Ireland) in a spectrophotometer (Molecular Devices. Shemesh et al. 2004). The results were expressed as (Xu et al.5 kPa or 15 cm H2O transport was recorded. Megazyme. Leakage of apical root fillings Glucose solution 33. once leakage excee- Acrylic cylinder ded 21 mmol L)1 samples were no longer observed as the glucose concentration in the lower chamber Metal wire suggested substantial leakage had occurred. disconnected from the assembly. Below this level. 13. The pipettes used were 22 mm long 1 mL glass pipettes (Witeg. 20. Glass tube Spectra max 384 plus) at a wavelength of 340 nm. The lowest glucose level for which the current Open system procedure is believed to be accurate is 0.5 mL of the glucose tightly closed by twisting pieces of stainless steel wire in solution. placed in 0. 39. Root specimen Fluid transport model – preparation and 0.2% NaN3 vation period. Similarly. A total of 25 lL of solution was drawn solution and returned to the incubator for a period of from the glass bottle using a micropipette at 8. 2006 971 . Wire connections ª 2006 International Endodontic Journal International Endodontic Journal. 8 weeks. The sample was then analysed with a Glucose kit (Megazyme. After measurements teeth were carefully the incubator at 37 C for the duration of the obser. Concentrations of glucose in the lower chamber were presented in mmol L)1 at each time interval following filling. The same amount of fresh 0. the absorbance readings become relatively small. 2005). 48 and 56 days. Germany). 2) previously described by Wu et al. All connections were and chemically stable.2% NaN3 solution measurements Roots were mounted in the fluid transport device Figure 1 Glucose penetration model. Fluid transport along the root pipette until the top of the solution was 14 cm higher filling was measured under a headspace pressure of than the top of gutta-percha in the canal.02 14 cm (d-Glucose-HK assay procedure. The medium was changed with a fresh NaN3 Headspace pressure Silicon tube Water bath (20°) Filled root Standard capillary Air bubble Silicon tube Figure 2 Fluid transport model. Wertheim. 40. containing 0. which 30 kPa (0.

2 (6.0) 4.05. In the negative Percent leakaing samples control group no glucose was detected in the apical 100 90 reservoirs throughout the experiment. After 2 weeks all samples had SL present Negative control removed Positive control Epiphany maximum leakage (21 mmol L)1).4) 12. P > 0.0 (7.0) 6.2 (0–21) 12. after no movement of the bubble. Table 1 Mean and median of glucose leakage in mmol L)1 at different times after obturation Day Group 8 13 20 33 40 48 56 GP AH 26 (smear layer present) Mean (SD) 3.4 (0–21) 7. no significant difference 0 existed between the two gutta-percha groups (Mann– –10 0 10 20 30 40 50 60 Whitney test.5 (0–21) Percentage leaking 30 35 40 40 55 55 55 Resilon–Epiphany (smear layer removed) Mean (SD) 3. GP+AH26.9 (0–21) Percentage leaking 55 90 90 90 90 90 90 972 International Endodontic Journal.9 (0–21) 4.2 (7.8) 4. Glucose concen.2 (0–21) Percentage leaking 30 40 40 45 50 50 70 GP AH 26 (smear layer removed) Mean (SD) 3. SPSS. GP+AH26.8 (7. The Day after obturation statistical significance of the differences between all Figure 4 Percentage of leaking samples in the glucose penet- three groups is summarized in Table 2. 6 tically analysed with the Kruskal–Wallis and the 2 Mann–Whitney tests (version 12.6) 3. Chicago.5) 6.0 (0–21) 2.6 (7.1 (7.1 (6. After 8 weeks the roots were GP+AH26. 26 22 18 Statistical analysis 14 The differences between the groups with regard to 10 glucose concentrations and fluid transport were statis. The results for the glucose model are shown in Table 1 and Figs 3 and 4.4 (0–13. The negative control group had groups at both time intervals. SL Resilon- increased over time.5 (8. The positive control group had substantial leakage of glucose from the first day which GP+AH26.0) 7. 2006 ª 2006 International Endodontic Journal .2 (0–21) 0.9) Median (range) 1.5 (0–21) 2. The results of the fluid transport model are shown in Table 3.2) 9.6 (7.05) existed between the three experimental impossible to measure. SL Resilon-Epiphany SL present removed Glucose concentration mmol L–1 mounted again and checked for fluid transport in the Negative control Positive control same way.3) 4.05) at all time intervals.0. IL.6 (7. solution every week. 80 70 trations in the experimental groups revealed that after 60 the first 8 days the difference between the three groups 50 40 was significant (Kruskal–Wallis test.3 (8.8 (7.0) Median (range) 0 (0–21) 0 (0–21) 0 (0–21) 0 (0–21) 1.6) 6. No significant difference filling (Kruskal–Wallis test).5 (7. 0 10 20 30 40 50 60 Days after obturation Figure 3 Median glucose penetration in mmol L)1 after Results 2 months.8 (9.1 (7.05).5) 2.8 (0–21) 2.0 (8.0) 6.7) Median (range) 0 (0–21) 0 (0–21) 0 (0–21) 0 (0–21) 0.4 (0–21) 2.6 (6.1.0) 12.0 (9. ration model – after 2 months.3) 4. 968–976.5 (5.9) 5.9) 5. However. P < 0.4) 7.0) 8.0 (8.3 (8.3 (0–21) 12. 30 Resilon laterally compacted had the most leakage at 20 10 all time intervals. The positive control group had bubble move- ment that exceeded the pipette length after 3 h and was (P > 0. Leakage of apical root fillings Shemesh et al. USA). The level of significance was set at a ¼ 0. 39. 1 and 8 weeks.7) 6.

799 0. n ¼ 20) the apical and the coronal chambers.012 0.738 0.5 (20) 0. two different models were used: the fluid The effect of the removal of smear layer before transport model (Wu et al.799 0. Evaporation will GP/AH26 (smear layer 0. Clark-Holke et al. n ¼ 20) cannot be closed hermetically in order to allow leakage to occur. A total of 30 teeth were used. In the present and proved to be effective in initial pilot studies. not affect the seal with gutta-percha and AH 26 in the tion concept: both measure passage of fluid along root apical 4 mm.035 0. summated glucose leakage during 2 months Average fluid transport was measured whereas fluid transportation was meas- in lL (percentage ured for 3 h and observed at two different time leaking samples) intervals. Group 1 week 8 weeks Evaporation of fluids during the 56 days experiment GP/AH26 (smear layer 0. (2005) refers only to evaporation from the apical chamber. The method used Discussion here. glucose penetration model the tooth is continuously Although dye-leakage results have debatable relevancy subjected to the pressure of the glucose solution in the (Wu & Wesslink 1993) they were the most frequently coronal chamber for a period of 2 months.020 0. In contrast penetration model detects leakage after subjecting the to these findings.415 – – – 13 0. The glucose who found no significant difference in dye leakage after test might be more sensitive than the measurement of 4 months between root fillings when the smear layer air-bubble movement.0 (0) layer removed. study.026 0. amongst which ª 2006 International Endodontic Journal International Endodontic Journal. and Evans & Simon (1986) also found no difference in paring the results from the two different models. Leakage of apical root fillings Table 2 P values – statistical signifi- Kruskal–Wallis test Mann–Whitney test cance of the difference in glucose con- centrations between the groups at Time after P (groups P (groups 1 P (groups 1 P (groups 2 specific time intervals filling (days) 1–3) and 2) and 3) and 3) 8 0. not only because the detected was removed or present. 1993) and the glucose obturation has been the subject of extensive debate.015 0. 39.033 33 0.0 (0) 0. (2003) checked a filling to pressure for 3 h. The fluid used to assess the influence of smear layer.024 Table 3 Average fluid transportation and percentage of leak. mixed culture of bacteria penetrating through root ence might result in detection of smaller voids in the fillings.038 0.031 0. Xu et al.2 (10) duration could alter the glucose concentrations both in present. when checked with the fluid transport or filled teeth after subjecting them to constant pressure.030 48 0. the glucose model allows measurements of agreement with those of Saunders & Saunders (1994a) diffusion of the marker molecules as well.013 20 0. In the leakage when the smear layer was removed or not.026 56 0. filling. the glucose penetration models. but also because the convective condensed gutta-percha with glass–ionomer sealer no fluid transport was combined with glucose molecule significant difference was observed after 4 months diffusion.035 0. The latter can be According to the current findings. Fur- ing samples 1 and 8 weeks after obturation thermore. penetration model (Xu et al. 2006 973 . storing the models in a closed humid jar. compensating it with water according to a representative sample. Shemesh et al. the smear layer did seen as a further development of the fluid transporta. Saunders & Saunders (1994b) threshold measurement by eye is higher than that of assessed dye leakage of Thermafil fillings and laterally the spectrophotometer. 968–976.023 0. making the glucose test more sensitive. 1 and 8 weeks after filling.020 0. n ¼ 20) have an opening to release pressure build-up and Resilon/Epiphany (smear 0. between any of the groups.034 0.989 0.026 40 0.820 0.799 0. 2005). Madison & Krell (1984) Time difference is an important factor when com. Several test methods have been described to evaluate addresses the evaporation factor from both chambers the sealing quality of filled root canals.05 (5) inevitably occur as these two compartments have to removed. This enormous time differ.013 0. These results are in However.1 (15) 0.

Pentron Clinical Technologies) that the colour dis- (2005a). Resilon to degradation in two different studies: in the Shipper et al. compared with Resilon–Epiphany during a period of The treated discs were then examined with a 31 days when the whole length of the root canal was scanning electronic microscope and dispersive X-ray filled with laterally or vertically compacted material. These conflicting addressed. the width from 0. (1987) observed that smear The dimensional stability of Resilon should also be layer removal reduced dye leakage. In a Class I cavity. In spite of the small filled roots. it may films. Leakage of apical root fillings Shemesh et al. July 2005. The dentinal tubules configuration gutta-percha discs were unaffected. assessed for its colour properties when it is immersed in Resilon is a new root filling material that consists of a fluid for an extended period.c) discussed the susceptibility of allowed more glucose penetration than gutta-percha. whilst 60% of the specimen might occur when it polymerizes. ration models. 1995). 15 mm diameter Resilon and gutta-percha discs leakage in gutta-percha and AH 26 fillings when were immersed in sodium etoxide for 20 and 60 min. (1993) and more recently by Tay et al. 10 served as controls. Kennedy et al. These leakage could occur after the 2-month observation imperfections in the bonding to the walls of the canal period. In analysis. gutta-percha and polycaprolactone that were bonding apically.2 to more than may be greater in the current setting than in that of 10 lm. the results were not smear layer on dye penetration through root dentine. the C-factor becomes much higher. that may and removing the smear layer and different laboratory affect the measurements of optical density. (1986) and Cergneux et al. as in a root canal. as the aver. Lipase PS transmission electron micrograph gaps of about 2 lm or cholesterol esterase. should be smear layer that influences penetrability. • The glucose penetration model is a sensitive method The probability of imperfect dentine bonding in a root to detect leakage along root fillings. on the other hand. The surface of the Resilon discs was the current experiment only the 4 apical mm of filling hydrolysed after 20 min exposing the filler. gaps were observed between the dentine number of specimen and the authors’ own claim that and the Epiphany layer (Tay et al. it was suggested that removing the smear layer might be too small to be detected by bacterial penet- decreased bacterial leakage. compromised. The latter study simulated different scenarios charge from Resilon cones is only food grade dye and appraised the C-factors that arise from thin resin ‘leaching out into the tooth’. whilst were checked. The detected by bacterial penetration models. In cross-sections of having a smear layer leaked. 2006 ª 2006 International Endodontic Journal . 39. did not show any colour discharge Results from the current experiment indicate that the when soaked in water. Gutta-percha and AH 26 composite that may be bonded to the wall of the canal. (2004) because of the longer observa- The influence of the geometric variables involved in tion period. These discs had significant weight loss and surface thinning imperfections in the bonding might be too small to be when compared with the gutta-percha discs. Feilzer et al. and a high volumetric shrinkage of the sealer smear layer was removed.5 lm (Hobot 2002). As this procedures to check the leakage (Şen et al. More colour (pink) is not absorbed at the same wavelength recently. (2005a) observed in a incubated with phosphate-buffered saline. Resilon and polycaprolactone between the root dentine and the Resilon primer. Similarly. As the unbonded surface area becomes smaller. 2005a). influence of this phenomenon on glucose penetration age length of bacteria varies from 0. The second which is less dense in the apical part than the coronal experiment examined 15 mm diameter discs of Resi- part (Fogel et al. 1988) might lead to compromised lon. (2006) found no effect of the that is assessed by the glucose kit. Conclusions there is insufficient stress relief by flow and a high probability that one or more bonded areas will debond. 5). Shipper et al. 968–976.2 to 1. However. 974 International Endodontic Journal. the bonded surface area is five provide an explanation for the increased leakage in times more than the unbonded surface area (C-factor is the Resilon group. the method of producing substance to the surrounding medium it. These results challenge the claims of the the use of adhesive sealers was previously discussed by manufacturer (‘Epiphany Newsletter’. Preliminary unpublished studies have reports might be attributed to difference in the type of shown that Resilon cones discharged a coloured sealer and filling technique. Paqué et al. (2005b. Tay et al. every new material that is and suggested that tubular sclerosis rather than the about to be checked with this method. During the 2-month observation canal during polymerization might exceed the bond period. leakage was not observed in the group where strength. (2004) detected more rapid bacterial first. However. apical 4 mm of Resilon–Epiphany root canal fillings Tay et al.

Journal of Endodontics 30. Luder HU. transportation was observed along the 4 mm apical Endodontic Topics 10. Wesselink PR. Kennedy WA. 18–25. Wu MK. Endodontics 20. Lo EC. UK: Academic Press. Lee SJ. Zehnder M (2006) Tubular Evans JT. Dietschi JM. Lazarson A (1985) Radio- filled teeth in the fluid transportation model either at 1 graphic study of the root canal system of mandibular or 8 weeks. International Endodontic Journal 20. Bertelli E. Patel B. treatment using Thermafil and cold lateral condensation Journal of the American Dental Association 50. Kulild JC. Ciarlone AE. cause of failure in root-canal therapy: a review. composites for two different curing modes. Chu CH. Evans G. influence of smear layer on the apical and coronal sealing Mannocci F. Ng YL (2005) Effects of significant difference in glucose penetration or fluid mechanical and chemical procedures on root canal surfaces. Simon JH (1986) Evaluation of the apical seal sclerosis rather than the smear layer impedes dye penetra- produced by injected thermoplasticized Gutta-percha in the tion into the dentine of endodontically instrumented root absence of smear layer and root canal sealer. Primack PD. Pashley DH. Paqué F. Hülsmann M. Krell KV (1984) Comparison of ethylenediamine cally treated teeth in the presence or absence of the smear tetraacetic acid and sodium hypochlorite on the apical seal layer. Sabala CL (1985) The balanced force concept for 15. Belli S (2004) Evaluation of the 499–503. Endodontics and Dental Traumatology Roane JB. 670–2. Lennon A (2003) Chelating • Canals filled with Resilon had more glucose penetra- agents in root canal treatment: mode of action and tion than gutta-percha and AH 26 during a period of indications for their use. p. Vassiliadis LP. Journal of Endodontics 12. Journal of canals. 100–7. lateral condensation techniques. leakage and SEM study of roots obturated with Thermafill Drake DR. International Endodontic Journal 39. space preparation. not the smear layer was removed prior to filling. 253–9. 108–12. 275–81. Wiemann AH. 968–976. anterior teeth. 103–22. Boutsioukis Ach. Saunders EM (1994a) Coronal leakage as a 9. Journal 28. Feilzer AJ. Çobankara FK. Saunders EM (1994b) Influence of smear layer of human radicular dentin. of endodontically treated teeth. 60–4. Innocenti M. GP root fillings with a glass ionomer sealer. Heckendorff M. whilst no statistically significant difference 36. Madison S. de Gee AJ. Navia M (2001) A comparison of Khayat A. Rivera EM. smeared and nonsmeared dentine. Gough RW (1986) Smear layer removal effects on apical leakage. 141–8. Pashley DH. Drake D. Holz J (1987) The (2004) The influence of the smear layer on dentinal tubule influence of the smear layer on the sealing ability of canal penetration depth by three different root canal sealers: an in obturation. Simpson MD (1994) Effect of smear layer removal on the Şen BH. was observed between the Resilon and gutta-percha Kaffe L. Türkün M (1995) The smear layer: a diffusion permeability of human roots. 228–32. Journal of Endodontics phenomenon in root canal therapy. 406–9. ª 2006 International Endodontic Journal International Endodontic Journal. Stavrianos CK Cergneux M. 105–8. on the coronal leakage of Thermafil and laterally condensed 1381–5. Bustos A. 810–30. Journal of Endodontics 30. 83–6. Marshall FJ. Endodontics 12. Michelich V. Adanr N. Littner MM. International Endodontic 20. no statistically Gulabivala K. Walton RE (1994) and dentin bonding agent. 2006 975 . Shemesh et al. root filling with gutta-percha and AH 26 whether or Hobot JA (2002) Molecular Medical Microbiology. vitro study. Abarca AM. Rivera E. International Endodontic Journal 38. Journal of Endodontics 11. International Endodontic Clark-Holke D. 27. International Endodontic Journal 56 days. International Endodontic Journal 18. Kehl T (1981) Dentin permeability: Fan B. Journal of Galvan DA. 531–7. Journal of Endodontics Journal of Endodontics 19. Ciucchi B. Pashley DH (1988) Effects of distance and Dental Traumatology 10. London. Journal of Endodontics 10. 544–52. Davidson CL (1993) Setting stresses in 203–11. References 21–7. 100–2. 155–8. Journal of Dentistry 31. 2–5. 124–6. Walton R. 7. Dental Materials Saunders WP. layer. Journal of Dental Research 67. Sener B. Kaufman A. Torabinejad M (1993) Human saliva apical sealing and extrusion between Thermafil and penetration of coronally unsealed obturated root canals. from the pulp and thickness on the hydraulic conductance Saunders WP. Endodontics Fogel HM. 458–61. 179– Love RM (1996) Adherence of Streptococcus gordonii to 85. Journal of Endodontics 20. Leakage of apical root fillings • Under the conditions of this study. Walker WA Jr. 39. 78–82. Ferrari M (1999) Dye ability of two sealers. filling techniques. (2003) Bacterial penetration through canals of endodonti. Journal of Prosthetic Dentistry apical root fillings after immediate and delayed post 46. Kokkas AB. Wesselink PR (1999) Coronal leakage along effects of smear layer removal. Endodontics and Dental Trauma- Bacterial retention in canal walls in vitro: effect of smear tology 15. Cheung GS (2005) Outcome of root canal Kuttler Y (1955) Microscopic investigation of root apexes. instrumentation of curved canals. Guthmiller JM Journal 29.

application and rele- Tay FR. Kettering JD (1990) In vitro bacterial evaluation of microbial leakage in roots filled with a penetration of coronally unsealed endodontically treated thermoplastic synthetic polymer-based root canal filling teeth. Oral Radiology and Endodontics 85. reconsidered. Wu MK. Oral Radiology and Endodontics 4. II. Pashley DH. International Endodontic Journal 26. 107–11. Oral Pathology. polycaprolactone-based root canal filling material to degra. Oral surgery. 508–12. Teixeira FB. Bakland LK Sundqvist G. Hu HL (2005) A new Journal of Endodontics 23. (2005b) Susceptibility Wu MK. Wu MK & Wesselink PR (1993) Endodontic leakage studies 86–93. Torabinejad M. Oral surgery. 203–8. new resin filling material. Oral Pathology. Journal of Endo. Fluid movement along the coronal two-thirds of root fillings Journal of Endodontics 31. Oral Pathology. 976 International Endodontic Journal. Medicine. Oral Oral Radiology and Endodontics 94. Persson S. Oral Medicine. Oral 31. Khademi AA. Fan B. 968–976. quantitative method using glucose for analysis of endodon- Teixeira FB. the outcome of conservative re-treatment. Methodology. Weller RN. (2005c) Susceptibility of a 499–502. transport and bacterial penetration along root canal fillings. 593–98. placed by three different GP techniques. (2005a) Geometric factors affecting dentin bonding in root Wu MK. obturation technique. I. Journal of the American Dental Association 135. 737–41. Handysides R. International Endo- Taylor JK. Oral surgery. Gravimetric evaluation of enzymatic hydrolysis. Figdor D. Oral Pathology. Wesselink PR (2003) dation. Cheung GS. 658–66. Jeansonne BG. (2002) Clinical implications of the smear layer in endod- ologic analysis of teeth with failed endodontic treatment and ontics: a review. 2006 ª 2006 International Endodontic Journal . Tay FR. Journal of Endodontics 16. Oral Medicine. van der Sluis LW. effects of smear layer. Journal of Endodontics RoekoSeal: a leakage study in vitro. Trope M (2004) An Torabinejad M. Pashley DH. and Endodontics 99. International Endodontic Journal 26. Lambrechts P. dontics 31. RSA degradation. Lemon RR (1997) Coronal leakage: dontic Journal 36. Oral Fracture resistance of roots endodontically treated with a Radiology. Tigos E. Ung B. Shipper G. De Gee AJ. 646–52. and sealer. Yiu CK et al. Loushine RJ. Part I. Ardila CN. Pashley DH vance. Xu Q. Sjögren U (1998) Microbi. 342–7. Oral surgery. Tay FR. Leakage of apical root fillings Shemesh et al. Wesselink PR. Moorer WR (1993) Fluid canals: a theoretical modeling approach. Journal of Endodontics 30. 533–40. Alkaline hydrolysis. 584–9. 37–43. Medicine. Teixeira EC. Ørstavik D. Thompson JY. Williams MC et al. Wesselink PR (2002) An 18-month of a polycaprolactone-based root canal filling material to longitudinal study on a new silicon-based sealer. 566–9. Fan MW. material (Resilon). 39. Trope M (2004) tic leakage.

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