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35]

Original Article

Comparison of the sealing ability of

different glass ionomer cements as
rootend filling materials
Fuat Ahmetoglu, K. Meltem olak Topu1, Hasan Oruolu2
Departments of Endodontics, Faculty of Dentistry, Institute of Health Sciences, Inonu University, Malatya, 1Atatrk University, Erzurum, 2Abant Izzet Baysal University,
Bolu, Turkey

Address for correspondence: Dr.Fuat Ahmetoglu, Department of Endodontics, Faculty of Dentistry, Institute of Health Sciences, Inonu University, 44280, Malatya,
Turkey. Email:fuat.ahmetoglu@inonu.edu.tr

ABSTRACT

Objectives: The purpose of this study was to compare the sealing ability of different glass ionomer
cements (GIC) as rootend filling (RF) materials. Materials and Methods: Onehundred and
eleven extracted human canines were cleaned and prepared using a rotary nickel titanium files with
crowndown technique. All the teeth were filled with guttapercha and then the apical third of each root
was resected perpendicularly to the long axis direction. After, rootend cavity was prepared using a
round bur. The specimens were randomly divided into 7 groups of 15samples, filled with one of the
test materials(Ionofil, Ketac Molar Quick Aplicap, Argion Molar AC, Photac Fil Quick Aplicap, Fuji II
LC Capsule, Dyract Extra, Glasiosite Caps) and were stored at 37C and 100% humidity for 7days.
1week later, apical parts of roots of 100.05mm were attached to the computerized fluid filtration
device. The data obtained were analyzed using an ANOVA and post hoc Tukeys tests(P0.05).
Results: Statistical analysis indicated that RF with Argion molar AC(reinforced GIC) had the least
microleakage of all and whereas Ketac Molar Quick Aplicap(conventional GIC) showed highest apical
leakage than the other groups. Conclusion: This present study has shown that none of GICs, which
used as a RF material unable to prevent apical leakage exactly and Argion Molar AC is used as a RF
material among current GICs better than others.

Keywords: Computerized fluid filtration meter, glass ionomer cements, microleakage,

rootend filling

INTRODUCTION
Most of the endodontic failures occur as a result of the
leakage of irritants from pathologically involved root
canals. When nonsurgical attempts prove unsuccessful
or are contraindicated, endodontic surgery is needed to
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DOI:

10.4103/2321-4619.129014

save the root.[1,2] Surgical procedures usually consist on

exposure of the involved apex, periradicular curettage,
root resection, preparation of rootend and placement
of a filling.[1,3] The aim of the rootend filling(RF) is to
provide a hermetic sealing in an apical region. Success of
the surgery has been affected significantly by properties
of used materials and sealing ability.[4] An ideal RF
material should adhere and adapt to the dentin walls
of the root end preparation, should prevent leakage
of microorganisms and their byproducts into the
periradicular tissues and should be biocompatible. On
the other hand, it should also be insoluble in tissue fluids,
dimensionally stable and unsusceptible to the presence of
moisture.[1] However, no material has been found, which
has all or most of the ideal properties of a RF material.
Journal of Restorative Dentistry / Vol - 2 / Issue - 1 / Jan-Apr 2014 27

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Ahmetoglu, etal.: Sealing ability of glass ionomer cements as rootend filling materials

Many RF materials have been used from past to present.

While some of these materials are still in use, the use of
some has been abandoned. As a result of the review of
literature, it has been found limited studies that have
comprehensive investigation about still in used glass
ionomer cements (GICs) as a RF material for apical
sealing and also there has not been such a study with
the computerized fluid filtration technique, yet. For this
reason, this study is important and aims to shed light on
the clinician in rootend sealing which planned with GICs.
In development process, GICs were produced firstly
as conventional GIC (CGIC) and then the addition of
metals to the filler component in order to reinforced GIC
(R-GIC) has been proposed. As a result of this addition,
it has been more radiopaque material to obtained
facilitates posttreatment controls.[5,6] The negativity
of CGIC is sensitivity of moisture especially in the
hardening time. This limitation has been addressed
through the introduction of hybrid GICs(HGIC) as the
resinmodified GIC (RMGIC) and polyacidmodified
composite resins(PMCR). These materials, through both
sets of polymerization and polyacid/base reactions, can be
finished immediately and have a better appearance than
CGIC.[7] There are some advantages of frequently used
GIC for many years. As regards to biocompatibility, these
materials exhibit a very low cytotoxicity and they do not
induce inflammatory tissue responses; they also present
good sealing properties because of their ability to form
a chemical bond with dentine.[5] Bonding chemically to
dentin reduces the sealing significantly. These cements
generate no heat while setting, they will not cause thermal
damage to tissues and will not affect heatlabile drugs
incorporated in the matrix phase of the cement.[6] As
RF GICs have a better performance in sealing the apical
portion, even when the root canal was left unfilled.[8]
A method of measuring microleakage by fluid filtration
method[9] reported to have some advantages compared to
other methods. Samples are not destroyed and it is possible
to obtain measurements of microleakage at intervals over
extended time periods. In addition, computerized, fully
electronic, reliable and digital air pressure checking
system is required to remove these deficiencies.[10]
The purpose of this study was to evaluate apical leakage
of different GICs(Ionofil, Ketac Molar Quick Aplicap,
Argion Molar AC, Photac Fil Quick Aplicap, Fuji II LC
Capsule, Dyract Extra, Glasiosite Caps) comparatively as
RF materials using a computerized fluid filtration meter
with a laser system and a digital air pressure regulator.

MATERIALS AND METHODS

One hundred eleven freshly extracted human noncarious
maxillary and mandibular canines were used in this
28 Journal of Restorative Dentistry / Vol - 2 / Issue - 1 / Jan-Apr 2014

study. These teeth were extracted for various reasons

and none had received endodontic therapy before
extraction. To standardize these samples, all the selected
teeth were 2325mm in length. All teeth were stored in
0.5% of chloramine T immediately after extraction. All
the softtissues and calculus were removed mechanically
from the teeth. Crowns of teeth were sectioned at the
cementoenamel junction using a low speed diamond
saw. The working length was established 1mm short
of the point at which the file exited the apical foramen.
The root canals were prepared by using a rotary nickel
titanium files(Hero 642; MigroMega, Besancon, France)
and a crowndown technique. The instrumented canals
were dried with paper points and filled with laterally
compacted guttapercha (Aceonedent Korea Ind. Co.,
Bucheonsi, South Korea). The cervical access was
sealed with a temporary filling (Cavit; ESPE, Seefeld,
Germany).
Apical root resections were then performed by
removing 3 mm of the apex, at a 90degree angle
to the long axis of the root. Afterward root end
preparations(3mm deep) were created using round
bur #2. After that, 105 teeth were randomly divided into
seven experimental groups of 15 teeth each according
to the RF material to be used: Group1, Ionofil; Group2,
Ketac Molar Quick Aplicap; Group3, Argion Molar AC;
Group4, Photac Fil Quick Aplicap; Group5, Fuji Ii LC
Capsule; Group 6, Dyract Extra; Group 7, Glasiosite
Caps[Table1].
RF materials were prepared according to the
manufacturers instructions and placed into the
rootend cavities. An additional of 6 teeth was used
for control(3 for positive and 3 for negative controls).
Positive controls were left unfilled. But negative controls
were filled any material and were totally coated with two
layers of nail vanish, including the RF surface. All the
other root surfaces in experimental groups and positive
controls were coated with a two layer of nail varnish,
avoiding the apical surface of the RF.
Table1: Glass ionomer cements, tips and manufacturers
used in this study
Product
Ionofil
Ketac Molar
Quick Aplicap
Argion Molar AC
Photac Fil Quick
Aplicap
Fuji II LC Capsule
Dyract extra
Glasiosite caps

Tip
Conventional GIC
Conventional GIC
Reinforced GIC
Resinmodified GIC
Resinmodified GIC
Poliacidmodified
composite resin
Poliacidmodified
composite resin

GIC=Glass ionomer cement

Manufacturer
Voco, Germany
Espe, Seefeld,
Germany
Voco, Germany
Espe, Germany
GC Corporation, Japan
Dentsply, Germany
Voco, Germany

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Ahmetoglu, etal.: Sealing ability of glass ionomer cements as rootend filling materials

For leakage study, apical roots of 10.000.05mm were

sectioned using low speed diamond saw. Root sections
were inserted into the plastic tube from the apical
side and connected to 18gauge stainless steel tube.
The cyanoacrylate adhesive (Zapit, Dental Venture of
America Inc., Anaheim Hills, CA, USA) was applied
circumferentially between the root and plastic tube.
A new computerized fluid filtration meter with a
laser system[10] used in this study have had a 25l
micropipette(Microcaps, Fisher Scientific, Philadelphia,
PA, USA) mounted in horizontally. O2 from a pressure
tank of 120 kPa(1.2 atm) was applied at the apical side.
The pressure was constant throughout the experiment
by means of a digital air pressure regulator added
to pressure tank. A 25l micropipette (microcaps)
connected to the pressure reservoir by polyethylene
tubing(microcaps). All pipettes, syringes and the plastic
tubes at the apical side of the sample were filled with
distilled water. Water was sucked back with the micro
syringe for approximately 2 mm. In this way, an air
bubble created in the micropipette and the air bubble
was adjusted to a suitable position in the syringe. The
new computerized fluid filtration meter was based
on basically light refraction at starting and ending
position of air bubble movement inside micropipette.
Through one side of the micropipette inside the device,
an infrared light was passed. Two light sensitive
photodiode was arranged on the opposite side of the
micropipette to detect any movement of an air bubble
inside micropipette. All operations were controlled
with PCcompatible software (Fluid Filtration03,
Konya, Turkey). A 5min pressurization preload of
the system was completed before taking readings.
Measurements of fluid movement were automatically
made at 2min during 8min for each sample by using
PCcompatible software(fluid filtration03). The software
converts minute linear movement of the bubble into
nano liter movement at a rate of one measurement. This
information is fed into PCcompatible software. Leakage
quantity was expressed as l/cm H2O/min and means
determined.
The oneway ANOVA and post hoc Tukeys honestly
significant difference tests were used to determine
whether differences were significant at the 95% of
confidence level(P<0.05).

RESULTS
In this study, all the rootend materials showed different
levels apical leakage. Mean microleakage measurements
and standard errors are shown in Table2 for all materials.
While Argion Molar AC showed the lowest leakage,
Ketac molar quick aplicap showed the maximum leakage.
The positive controls demonstrated extreme amounts
of apical leakage. The negative controls registered no

Table2: Mean microleakage value and SD for experimental

groups
Groups Cements
1
2
3
4
5
6
7

No. of
Mean
SD
teeth microleakage
Ionofil
15
0.0128cd
0.0051
Ketac Molar Quick Aplicap
15
0.0162a
0.0064
Argion Molar AC
15
0.0114d
0.0035
Photac Fil Quick Aplicap
15
0.0122d
0.0051
Fuji II LC Capsule
15
0.0142bc
0.0057
Dyract extra
15
0.0123cd
0.0046
Glasiosite caps
15
0.0152ab
0.0054

*Means with different superscript symbols indicate significant differences(P<0.05),

SD=Standard deviation

detectable bubble movement at 1.2 atm., for a minimum

of 5min before each collected data began. No difference
was found among the groups including Argion Molar
AC, Photac Fil Quick Aplicap, Dyract Extra and Ionofil
that showed the lowest leakage(P>0.05). On the other
hand, no statistically significant difference was found
between Glasiosite Caps and Ketac Molar Quick Aplicap
that showed the highest leakage(P>0.05).

DISCUSSION
The choice of materials to be used in periapical surgery
and amount of rootend cutting angles is an important
issue in terms of apical leakage. For this reason, the
microleakage, which occurring after the apical resection
by using various cements and the techniques tried
to reduced or even eliminate completely. Although
different cements have also been used, any material or
method to prevent microleakage completely has not been
found yet. Therefore, several studies have still remained
to prevent the apical microleakage.
Conventional setting and formulations of HGICs have
been used as RF materials.[6] GICs were investigated
comparatively with different materials as RF material
in many studies.[3,1115] In all this and similar studies, a
type of GICs was compared with other different types RF
materials. By considering the results of such assessments
to say that more effective for leakage of which type of
GIC may be misleading. Therefore in this study, only
different types of GICs were compared with each other
and tried to determine the ideal GIC, which has the value
of leakage at least when it used as a RF material.
The evaluation method is as much crucial as the
evaluated material. Many methods have been used
to assess the leakage of RF materials. Dye, bacterial
and radioisotope analysis of the penetration and the
electrochemical method are among the most frequently
used methods.[1619] However, most of these methods
affect the tested examples, unable to give the quantitative
results and cause conflict in the interpretation. In addition
to this, a variety of assessment methods and differences
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Ahmetoglu, etal.: Sealing ability of glass ionomer cements as rootend filling materials

in the parameters of evaluation also make it difficult to

establish the relationship between the studies. Pommel
etal.[20] showed that apical leakage has been tested with
three different methods on the same tooth in their study
and the used method have a strong impact on the results.
Wu et al. [21] suggested the use of liquid filtration
system to increase the reliability of endodontic leakage
studies. When liquid filtration method compared to
other methods, it has some advantages such as to
obtain quantitative volumetric data, to measure in less
time, prevent damage to the samples and to conduct
repeatable measurements on the same sample at given
time intervals.[22,23] Furthermore, the molecule size that
makes up the problem of standardization depending
upon the materials such as dye, bacteria or radioactive
isotope, the dentin affinity or the problems associated
with pH are not the problem in this method.[21,2426] In
addition, Oruolu et al.[10] have modified the fluid
filtration system and developed it that evaluates with a
completely electronic system, detects movement of fluid
with a laser and the results are evaluated with a computer
program. In present study, due to the all features of the
technique, computerized fluid filtration technique was
considered to be used because it is known to have more
advantages than other methods.
In this study, Argion Molar AC, which is a R-GIC
showed the lowest leakage as a numeric value. R-GIC
was obtained by hightemperature sintering of silver into
the glass ionomer to improve the properties of CGIC.[27]
More spherical particles in comparison with CGIC have
been obtained as a result of this reaction It is also the
setting time of R-GIC is shorter that makes moisture
contamination less likely in a surgical environment.[8]
Bhler[28] found that longterm performance of R-GIC is
successful. Vasudev[29] emphasis to the same conclusion
that they reported less leakage for R-GIC and suggested
to use it as a RF material. The results which obtained by
metalreinforced GIC confirm the datas in our study.
However, King et al.[30] expressed that Ketac silver
which is a R-GIC shows more leakage in proportion to
Amalgam and Super EBA. We believe that the reason for
these different results may originate from the structural
differences of Argion Molar AC and Ketac Silver and used
measurement method. Ionofil, which is a CGIC showed
that the second the lowest leakage, it links to dentin, but
during the hardening time; disruption of its integrity of
the result of moisture contamination creates the biggest
disadvantage. The leakage is more than R-GIC may be
connected with the disadvantages. In addition, the metal
alloys that have been added to Argion Molar AC may
be caused a decrease of the leakage by increasing the
filling rate of GIC. However, the difference in this study
is not significant statistically. In fact, Roth[31] indicated
that CGIC could be used as an alternative RF material.
30 Journal of Restorative Dentistry / Vol - 2 / Issue - 1 / Jan-Apr 2014

In another present study have founded no statistically

significant difference among Argion Molar AC, Photac
Fil Quick Aplicap(RMGIC) and Dyract Extra(PMCR).
Chong etal.[32] compared the leakage rate HGIC, CGIC
and Amalgam and they determined that the leakage rate
of HGIC and CGIC is equal and more successful. This
result is parallel to our study.
Sealing value of Dyract extra(a PMCR) was found to be
similar to RMGIC. Toledano etal.[33] compared RMGIC
and PMCRs in terms of sealing and ultimately they did not
find a statistically significant difference between the two
groups. Similarly, Brackett etal.[7] reported that the same
result. In our study, we demonstrated that no difference
too in terms of sealing between the groups; Dyract Extra(a
PMCR), Photac Fil Quick Aplicap(a RMGIC) and Fuji
II LC (a RMGIC). However, Glasiosite Caps (another
PMCR) showed more leakage than Dyract Extra. Showing
different values of these materials which the same kind
materials may be depend upon their chemical content.
Ketac Molar Quick Aplicap (a CGIC) showed the
maximum leakage between the groups. Rossi et al.[34]
identified that Ketac Molar shows more leakage. In
another study[35] was indicated that the material shows
more leakage than RMGIC, it is similar to our results.
Through the details of their composition vary, RMGICs
are generally able to form strong bonds to both enamel
and dentin.[36] This is a positive impact on sealing. Rosales
et al.[5] detected that HGIC creates less leakage than
CGIC. In this study, Photac Fil Quick Aplicap(a HGIC)
and Dyract Extra (a HGIC) provide more successful
sealing than Ketac Molar Quick Aplicap, but they show
no statistically significant difference with Ionofil. It
is thought that the result is due to different chemical
content of Ionofil than Ketac Molar Quick Aplicap.
In the present study, while Argion Molar AC, Photac
Fil Quick Aplicap, Dyract Extra and Ionofil showed the
lowest leakage respectively, Ketac Molar Quick Aplicap,
Glasiosite Caps and Fuji II LC showed the maximum
leakage regardless of the groups. It was found out that
the difference resulted from structures of the materials,
which were independent of the groups. It is reported
that the difference may have resulted from the structural
changes such as sensitivity characteristics of the materials
to moisture on the surface of dentin, material viscosities,
dust particle sizes and the differences in the dustliquid
ratio.[37]

CONCLUSIONS
It was concluded that none of GIC, which is used as RF
material unable to prevent the apical leakage exactly.

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Ahmetoglu, etal.: Sealing ability of glass ionomer cements as rootend filling materials

Furthermore, it was found that while Argion Molar AC,

which is a R-GIC showed the lowest leakage, Ketac Molar
Quick Aplicap, which is a CGIC showed the maximum
leakage in this study.

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How to cite this article: Ahmetoglu F, Topu K, Oruoglu H.
Comparison of the sealing ability of different glass ionomer cements as
root-end filling materials. J Res Dent 2014;2:27-31.

Source of Support: Nil, Conflict of Interest: Nil.

Journal of Restorative Dentistry / Vol - 2 / Issue - 1 / Jan-Apr 2014 31