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JOURNAL OF ENDODONTICS
Copyright 9 1985 by The American Association of Endodontists
Microleakage of Retrograde Amalgams
Microfiltracion de Amalgamas Retrogradas
Gordon D. Mattison, OMD, MS, J. Anthony von Fraunhofer, PhD, MSc, Phillip D. Delivanis, DMD, MS, and
Arthur N. Anderson, BS
In this two-part in vitro investigation, apical leakage
was electrochemically analyzed in teeth with differ-
ent thicknesses and compositions of dental amal-
gam. In part 1, the apices of 10 teeth each were
filled with zinc-containing amalgam to a depth of 1
mm or 3 mm. Part 2 consisted of filling the apices of
10 teeth each with zinc-containing amalgam follow-
ing varnish application, zinc-free amalgam, or zinc-
free amalgam and varnish. All 30 teeth were filled
to a depth of 3 mm. Measurements of leakage of
each sample were obtained at 24-h intervals for 30
days.
A two-way analysis of variance showed that 3 mm
of amalgam significantly reduced apical leakage as
compared with the 1-mm filling. Leakage was sig-
nificantly reduced when varnish was used regard-
less of amalgam composition.
En las dos partes de esta investigacion in vitro fue
analizada electroquimicamente la filtracion apical
en dientes con diferente espesor y composicion de
amalgama dental. En la primer parte fueron obtura-
dos los apices de 10 dientes con amalgama conten-
iendo zinc hasta una profundidad de 1 a 3 mm. La
segunda parte consistio en la obturacion de los
apices, en grupos de 10 dientes, el primero con
amalgama conteniendo zinc seguido de una apli-
cacion de barniz, el segundo con amalgama sin zinc,
y el tercero con amalgama sin zinc y barniz. Los 30
dientes fueron obturados hasta una profundidad de
3 mm. La medida de la filtracion de cada ejemplar
fue obtenida desde las 24 horas hasta 30 dias.
El analisis de la variacion mostro que 3 mm de
amalgama reduce la filtracion apical significativa-
mente comparado con la obturacion de amalgama
de 1 mm. La filtracion se redujo significativamente
cuando se utilizo barniz, sin considerar la composi-
cion de la amalgama.
The primary objectives of endodontic therapy are the
hermeticsealing of the apical foramen and total obtu-
340
Printed in U.~.A,
VOL. 11, No. 8, AUGUST1985
ration of the root canal space. In situations (1,2) where
the canal cannot be sealed by nonsurgical endodontic
therapy, sealing the canal by means of a direct apical
approach is the only alternative. This necessitates sur-
gical exposure and preparation of the root apex, fol-
lowed by the placement of an inert, nontoxic material.
In order to fulfill the requirements for a retrograde
filling, a material should be well tolerated by the periap-
ical tissues, nonresorbable, and have adequate sealing
qualities (3). Although various cements and cement-like
materials have been suggested, amalgam appears to
be the most widely used material for retrograde filling
(4, 5).
Clinical and histopathological studies (5, 6) show that
amalgam, implanted subcutaneously and adjacent to
bone, is well tolerated by periapical tissues. In addition,
amalgam has been shown to have very good sealing
properties when it is used in restorative dentistry (7).
However, a recent study suggests that dental amalgam
gives a poor seal when used as a retrograde filling
material (8). The use of varnish as a sealing agent to
inhibit initial marginal leakage is well documented in the
operative dentistry literature (7, 9). Subsequent studies
(4, 10) found the apical seal to be significantly improved
when a varnish was applied to the cavity prior to the
placement of a retrograde amalgam filling.
Marginal leakage of the retrograde amalgam filling
has received little attention in the literature. In particular,
there are few studies that correlate marginal leakage
with the level (thickness) of the retrograde amalgam or
that correlate marginal leakage with the composition of
the retrograde amalgam. The thickness and composi-
tion of amalgam were uncontrolled variables in most
previous studies; therefore, the results obtained may
be inconclusive.
Dye penetration and autoradiography have been
used to evaluate and compare different filling materials
and methods in their ability to seal the apical foramen
and root canal space (4, 10, 11). Despite the wide use
and acceptance of dyes and radioisotopes for evaluat-
ing marginal leakage, they do have significant limitations
(12). The margin of error is great. If not precisely
Vol. 11, No. 8, August 1985
controlled, a number of variables could significantly
change the results. Jacobson and von Fraunhofer (13)
described an electrochemical technique for measuring
microleakage in which rapid quantitative results can be
obtained. This technique has been found to be an
effective and reliable method (14, 15).
The purpose of this in vitro study is to assess and
compare apical microleakage in teeth with different
thicknesses and compositions of amalgams as retro-
grade filling materials.
MATERIALS AND METHODS
Part 1. Sealing Ability of Different Levels of
Amalgam
Twenty recently extracted single-rooted teeth (ca-
nines) were selected for this study. Two radiographs,
one mesiodistal and the other buccolingual, were made
of each tooth to eliminate teeth with curved canals,
accessory canals, or both. The anatomical crowns were
resected and the remaining roots stored in 5% sodium
hypochlorite for 24 h. The canals were prepared to a
#70 Hedstrom file with 5% sodium hypochlorite solu-
tion used as an irrigant. After instrumentation, a #20
file was passed through the foramen to ensure patency.
An apicoectomy was performed on all 20 teeth with a
#701 high-speed fissure bur. A flat preparation was
used as opposed to a beveled preparation to enhance
measurement accuracy. All teeth received an apical
preparation using a # 2 slow-speed round bur. To assist
in proper amalgam condensation, files were fitted very
tightly at two specific levels. Ten teeth each were filled
to the 1-mm and 3-mm level (Fig. 1) with Dispersalloy
(Johnson & Johnson, East Windsor, NY) according to
FtG 1. Prepared roots with retrograde amalgams placed. A, 1-mm
thickness; B, 3-mm thickness.
Retrograde Amalgams 341
the manufacturer's directions. Three additional teeth
were used as controls. One tooth, used as a negative
control, was prepared in the same manner as the
experimental specimens, but was painted completely
with fingernail polish including the apical foramen. The
two teeth used as positive controls, were instrumented,
resected, and prepared, but not filled.
Part 2. Sealing Ability of Different Amalgam
Compositions
Thirty teeth were radiographed, resected, and instru-
mented as described in part 1. Ten teeth were filled
with zinc-containing amalgam (DispersaUoy), and cavity
varnish (Copalite; Colley& Colley, Ltd., Houston, TX),
10 with zinc-free amalgam (Sybraloy; Sybron/Kerr, Ro-
mulus, MI), and 10 with zinc-free amalgam (Sybraloy)
plus cavity varnish (Copalite). The varnish was applied
with a small cotton pellet. Slight glazing of the amalgam
preparation indicated saturation. After drying, a second
coat was applied. All teeth were filled to the 3-mm level
with amalgam according to the manufacturer's direc-
tions. Three additional teeth were prepared for positive
and negative controls as described in part 1.
ELECTROCHEMICAL METHOD
The electrochemical test method is based on the
principle that an electric current will flow between two
pieces of metal when both are immersed in an electro-
lyte and are connected to an external power source.
The tooth root, with its filled apex and a detector
electrode in the coronal position, is immersed in a 1%
solution of KCI. If leakage occurs, the solution will
penetrate beyond the apical seal (retrograde filling ma-
terial) and reach the detector electrode in the coronal
opening into the canal (Fig. 2). The detector electrode
wire is connected to one output of a power supply. The
stainless steel wire, connected to the other output of
the power supply through a standard resistor, is sub-
merged in the KCI solution and acts as the second
electrode in the cell. A current flows in this system only
when there has been leakage into the root canal and
the solution has reached the detector electrode to
establish a continuous electrolytic pathway. The time
elapsed between immersion and current flow accurately
denotes the rate of KCI penetration and the magnitude
of the current indicates the degree of leakage.
EVALUATION OF THE APICAL SEAL
Four-inch long insulated wires were sectioned for
each tooth in both parts of this study. Approximately
0.5 inch of the insulation was stripped off both ends of
each wire. One end of the wire was placed through the
occlusal opening to 1 mm short of contact with the
retrograde filling material (Fig. 3). Absence of contact
was confirmed radiographically. A small piece of red
342 Mattison et al.
Power Supply
I WAX
' I
l I /coIM~TIN~G
V- Digital Volt Test C~II
Meter
A-
B .
C-
Test Celt
FIG 2. Schematic drawing of electrochemical test system.
sticky wax was adapted around the wire at the occlusal
portion of the tooth to stabilize the wire after proper
placement (Figs. 3 and 4). The root of each tooth was
coated with two coats of fingernail polish to leave only
the foramen in a patent condition. Dentin that was
exposed during apical preparation was coated in a
similar manner to ensure against dentinal leakage. The
other end of the wire was connected to the power
source.
A potential of10 V was applied between each spec-
imen and the stainless steel wire. Measurements of the
current flow, recorded as voltage drop across the 100
ohm standard resistance, were obtained at 24-h inter-
vals for 30 days. A two-way analysis of variance was
used to analyze the data.
RESULTS
Part 1. Sealing Ability of Different Thicknesses of
Amalgam
In Figure 5, mean leakage currents are plotted as a
function of immersion time in days. The degree of
leakage of the 1-mm group was significantly greater (p
< 0.001) than the 3-mm group during the 1- to 8-day
time period. The 11- t o 25-day period showed the
leakage patterns of the 1-mm group+to be significantly
greater (p < 0.01) than the 3-mm group. No significant
Journal of Endodontics
~~/fTOPOWERSUPPLY
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.MATERIAL
Rlml'll~ll.~E
FIG 3, Schematic drawing of test specimen with sealed apex and
detector electrode in position.
FIG 4. Test system illustrating emersion technique.
difference (p > 0.05) was found between the 1-mm and
3-mm groups at the 27- to 30-day time interval. A two-
way analysis of variance was performed with the thick-
ness of amalgam and immersion time used as the
independent variables. The dependent variable was the
amount of apical leakage. The analysis revealed a
significant overall difference (p < 0.001) in leakage
patterns between the 1- and 3-mm groups.
Part 2. Sealing Ability of Different Compositions of
Amalgam
Initial leakage patterns for the 3-mm zinc-containing
amalgam group and the 3-mm zinc-free amalgam group
were 2.67 mV and 2.86 mV, respectively (Fig. 6). The
maximum mean leakage patterns between the 3-mm
zinc-containing amalgam group and the 3-mm zinc-free
group were also found to be very similar. No significant
difference (p > 0.05) was found between the leakage
patterns of the 3-mm zinc-containing amalgam group
and the 3-mm zinc-free amalgam group.
Vol. 11, No. 8, August 1985 Retrograde Amalgams 343

7,5

7.0 r --.~ I mm

3mm
6.5
..__._____---.e
6.0

5.5
P_
J 5.r -

- 4.5
J
J
4.C
3.5
3.(:
2.51

2.0i
i i i i i i i i i i i i i i i i i i i i i i i i 216 i 218
2 4 6 8 IO 12 14 16 18 20 22 24 3JO
IMMERSION TIME/DAYS
FIG 5. Mean leakage patterns for different thicknesses of amalgam.

7.O
6.5

6.0 [Z}.~Z3 3 m m ZINC-FREE

5.5

5.0
4.5

4.0

~
> 3,5
J
J 3.0
2.5

Z.C
1.5

1.0
0.5

I [ I I = J = = = = = J = J I I I = = 2/ I = = = I 216 I 218 I 3=0

2 4 6 8 IO 12 14 16 18 0 22 24
IMMERSION TIME/DAYS

FIG 6. Mean leakage patterns for different compositions of amalgam.

Although the initial mean leakage was much lower in dental materials. Quantitative objective results are im-
the amalgam groups that used varnish (Fig. 6), there possible to obtain and degrees of leakage are assigned
was no significant difference (p > 0.05) between leak- arbitrary values. This form of leakage evaluation is
age patterns of the 3-mm zinc-free amalgam with var- based on subjective qualitative judgment. There are
nish group and the 3-mm zinc-containing amalgam with other factors that affect the reliability and, thus, the
varnish group. A two-way analysis of variance did show results of the autoradiographic technique (12). These
a significant difference (p < 0.001 ) in leakage observed factors are (a) choice of isotope; (b) distance between
in the 3-mm zinc-containing amalgam group and the 3- source and emulsion; and (c) length of exposure of the
mm zinc-containing amalgam with varnish. A similar film.
level of significance was also found in the difference Organic dye penetration is another technique for
between the 3-mm zinc-free amalgam group and the 3- evaluating marginal leakage. Maloff et al. (16) theorize
mm zinc-free amalgam with varnish group. that dye studies for leakage done without vacuum are
All of the test specimens showed low initial leakage not reliable due to the possibility of trapping air, there-
that increased throughout the test period. The positive fore, adversely affecting marginal penetration, rn addi-
controls showed high leakage patterns throughout the tion, dye studies have the same limitations as autora-
test period, with no leakage being observed in the diography in the evaluation of results since no quanti-
negative controls. tative measurements can be obtained.
Electrochemical measurement of microleakage has
DISCUSSION proven to be advantageous in obtaining quantitative
measurements that are easily analyzed and compared
Autoradiography has been found to have several (12-15). The electrochemical method offers continuous
limitations when used in marginal leakage studies of monitoring of leakage over a period of time. With dye
344 Mattison et al.
or radioisotopic methods, this is not possible since
leakage measurements can only be obtained on the
day the teeth are removed from the solutions. Although
electrochemistry appears to be less susceptible to mis-
takes in laboratory preparation, the concentration of
KCI in the solution must be carefully measured because
very small changes greatly affect the voltage scores.
The concentration of KCI was of little concern in this
study due to the short observation period and the use
of an air-tight plastic container; both of which negated
electrolyte change via evaporation. For this method to
measure leakage, it requires leakage penetration the
entire length of the material. It does not measure leak-
age that is not of sufficient magnitude to completely
penetrate the entire length of the material.
Amalgam thickness has varied from 1 to 3 mm in
many studies (10) on retrograde amalgam leakage.
Abdal et al. (10) used a fluorescent dye technique to
study marginal leakage at the apical filling/root canal
interface; approximate values of amalgam thicknesses
were used in this study. In a study by Kimura (11) on
apical seal of zinc and nonzinc alloys, thickness values
were not given. Tronstad et al. (4) studied the sealing
ability of the retrograde amalgam and, again, conclu-
sions were made without regard to amalgam thickness.
Weine (3) suggests a minimum amalgam thickness of
1 mm in class I reverse filling procedures. A 2- to 3-mm
thickness of amalgam has been advocated by Chivian
(17) and Arens (18) in endodontic surgical techniques
using class I preparations. Our study found that a 3-
mm thickness of amalgam has a sealing efficacy that is
significantly superior to a 1-mm thickness.
Amalgam composition is an important variable in
marginal leakage studies. High copper-containing alloys
are commonly used in restorative dentistry and endo-
dontic retrograde procedures because of their superior
physical properties and greater corrosion resistance. In
addition, in vitro studies by Tronstad and Wennberg
(19) and Abdal et al. (10) demonstrate that high copper-
containing amalgams have minimal cytotoxic effects.
Because of the wide acceptance of high copper-con-
taining amalgam, this type of amalgam was used in this
study.
The characteristics of zinc-containing and zinc-free
amalgams have been studied extensively. There are
two concerns about zinc in retrograde amalgam, its
cytotoxic effects and effects on sealing efficacy of the
amalgam.
The elimination of zinc in the retrograde amalgam is
based on a histological report of a single case by Omnell
(20). More recent studies (5, 19) provide strong evi-
dence that zinc-containing and zinc-free amalgam are
equally well tolerated by periapical tissues. Therefore,
cytotoxicity should not be a factor in determining
whether zinc-free or zinc-containing amalgam should
be used as a retrograde filling material. Our study tested
both compositions of amalgam.
Journal of Endodontics
Controversy continues over the long-term dimen-
sional change of zinc-containing and zinc-free retro-
grade amalgams and its effect on marginal leakage.
The present study found no significant difference in
leakage between zinc-containing and zinc-free amal-
gams up to 30 days after placement. Absence of mois-
ture contamination might explain why the two different
amalgams had similar leakage patterns. Skinner and
Phillips (21) state that zinc-containing amalgam, which
is contaminated with moisture, may expand as much
as 400 #m (4%). However, this contamination must
take place during the trituration or condensation phase.
All specimens in the present study were thoroughly
dried and care was taken not to incorporate moisture
during the trituration or condensation phases.
Swartz and Phillips (9) and Smith et al. (22) have
shown that amalgam restorations in the crowns of teeth
exhibit initial marginal leakage that decreases with time.
This reduction in leakage has been found to be asso-
ciated with corrosion products derived from the "y2
phase, and it takes 6 months for this process to fully
develop. In this present study, the short observation
period (1 month) might explain why leakage increased
throughout the test period. A long-term study (6
months) may have resulted in decreased leakage pat-
terns. In both studies (9, 22) this initial marginal leakage
was found to be inhibited with an application of varnish
to the cavity preparation prior to amalgam insertion.
Applications of this procedure have been recently stud-
ied in retrograde amalgam techniques. Abdal et al. (10)
found that when varnish was applied to cavity prepa-
rations prior to insertion of high copper-containing
retrograde amalgams, microleakage was significantly
reduced. These findings were confirmed by Tronstad
et al. (4). They concluded that regardless of the material
used, the apical seal was improved when a varnish was
applied to the cavity before the placement of the retro-
grade amalgam. The ability of varnish to decrease
microleakage was confirmed in the present study. Initial
leakage was significantly lower when varnish was ap-
plied to the retrograde preparations before amalgam
insertion as compared with those specimens where no
varnish was used. These significantly lower leakage
patterns continued throughout the test period.
SUMMARY AND CONCLUSIONS
Apical leakage was electrochemically analyzed in
vitro in teeth with different thicknesses and composi-
tions of amalgam. A significant difference in leakage
was observed between the 1- and 3-mm groups. Leak-
age patterns between zinc-containing amalgam and
zinc-free amalgam were not significantly different.
There was a significant difference in leakage between
amalgam groups with and amalgam groups without
varnish.
This data suggest that 3 mm of amalgam should be
Vol. 11, No. 8, August 1985
used in conjunction with varnish in retrograde proce-
dures to decrease apical leakage.
Dr. Mattison is associate professor, Department of Endodontics, College of
Dentistry, University of Florida, Gainesville, FL. Dr. yon Fraunhofer is professor,
Department of Restorative Dentistry, School of Dentistry, University of Louis-
ville, Louisville, KY. Dr. Delivanis is associate professor, Department of Endo-
dontics, School of Dentistry, University of Louisville. Dr. Anderson is a senior
dental student, University of Louisville. Address requests for reprints to Dr.
Gordon D. Mattison, Department of Endodontics, Box J-436, JHMHC, School
of Dentistry, University of Florida, Gainesville, FL 32610.
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