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K. K. WADHWANI *
SARITA GURUNG **
ABSTRACT
Objectives : To compare the fracture toughness of the instrumented roots after obturating it with three different
sealers and comparing it with the control group (where the roots were first instrumented but not restored). Study
Design: Forty freshly extracted human maxillary central incisor teeth were selected. Crowns were removed at
cemento-enamel junction and the length of the roots were adjusted to 13 mm. Following canal preparation 10
roots in group – I were filled with using Resilon with Epiphany sealer. Ten in group – II were filled using gutta-
percha and AH plus sealer. Similarly group – III were filled with gutta-percha and Endomethasone sealer. Ten
canals were left unrestored to be used as control group. Tests for fracture toughness were performed under Instron
Machine and force at the time of fracture was recorded in Newtons. The results were evaluated with ANOVA and
Tukey Honestly significant difference tests. Results : The mean force of fracture values recorded were 1283.60 N,
1197.40 N, 1098.40 N and 574.80 N respectively. There was a significant difference (p<0.001) between the
three experimental groups to that of the control group. But no significant differences were found among the three
experimental groups. Conclusions: All the materials used for the study reinforced the prepared root canals.
Key words: Fracture resistance, root canal sealers, Resilon, Epiphany, AH Plus Sealer, Endomethasone sealer.
* Professor & Head, ** P. G. Student, Department of Operative Dentistry & Endodontics, Chhatrapati Shahuji Maharaj Medical University, Lucknow.
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ENDODONTOLOGY K. K. WADHWANI, SARITA GURUNG
sealer), gutta-percha with endomethasone sealer Lentulo spiral filler. A master Resilon cone was
(zinc oxide eugenol based sealer) and recently placed into the root canal and with cold lateral
introduced new obturation material Resilon with compaction technique filled using accessory
Epiphany sealer was used (Resilon is synthetic Resilon points. The excess was seared off with the
polycarplactone polymer based polyster and help of plugger 1 mm below the canal opening
epiphany sealer contains methacrylate or HEMA). and coronally cured for 40 seconds and canal
According to the manufacturer the epiphany sealer opening was sealed with cavit.
bonds both to the Resilon cores and root dentin
Group-II
creating a ‘Mono – block’ that has good adaptation
Ten root canals were filled using gutta-percha
to the canal walls. The aim of the present study
with AH plus sealer. The master cone was dipped
was to evaluate the fracture resistance of root canals
in the sealer and placed in the canal and filled with
filled with Resilon and Epiphany, gutta-percha and
gutta-percha of smaller sizes. Excess gutta-percha
AH plus, gutta-percha with Endomethasone sealer
was seared off and condensed 1 mm below the
and instrumented but unrestored control group.
canal opening with a plugger and the opening was
MATERIALS AND METHODS sealed with cavit.
Forty freshly extracted human maxillary central Group-III
incisor teeth that were approximately of similar Likewise here also ten numbers of root canals
dimension were selected, cleaned and stored in were filled using gutta-percha with Endomethasone
physiological normal saline until required. The sealer rest is similar as done in group II.
crowns were removed at cemento-enamel junction
Group-IV
and all the roots were adjusted to 13 mm. The
Here ten root canals were left unrestored. Only
patency of the apical foramen was determined with
the canal opening was sealed with cavit and was
a size 15 – k file (Dentsply). The working length
used as control group. Then cylindrical moulds of
was established 1 mm short of apical foramen. Root
20 mm in diameter and 20 mm in length were
canals were instrumented to a size 40 – K file and
prepared using elastomeric impression material
flared using 2, 4, 6 Gates-Glidden drills. Throughout
(Provil P – Soft, Heraeus – Kulzer, Domagen,
the instrumentation 1 ml. of 5.25% sodium
Germany) and then self cure acrylic was placed in
hypochlorite was used and a final rinse with 1 ml
the mould and apical 6 mm of the root were
of 17% EDTA was done in order to remove the
embedded individually with 7 mm remaining
smear layer. And finally root canals were flushed
exposed. The acrylic blocks including the
with 1 ml of saline solution and dried with paper
specimen was placed on the lower plate of the
points and divided into four groups of ten teeth
machine (Universal Testing Machine, Instron), the
each.
upper plate of the machine included a round tip
Group-I that had a diameter of 4 mm. This round tip
Ten root canals were filled with Resilon and contacted the coronal surface of the specimen and
Epiphany sealer. The sealer was placed using was subjected to slowly increasing vertical force
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ENDODONTOLOGY EVALUATION OF ROOT CANAL SEALERS ON THE FRACTURE RESISTANCE OF
ROOT CANAL TREATED TEETH - AN IN VITRO STUDY
of 1 mm per minute until the fracture occured and the values were recorded in Newtons.
RESULTS
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ENDODONTOLOGY K. K. WADHWANI, SARITA GURUNG
56
ENDODONTOLOGY EVALUATION OF ROOT CANAL SEALERS ON THE FRACTURE RESISTANCE OF
ROOT CANAL TREATED TEETH - AN IN VITRO STUDY
Resilon with Epiphany sealer. Resilon is a synthetic the filling materials increased the fracture toughness
polymer core material and epiphany is dual curable of the prepared teeth but there was a significant
resin composite sealer which provides both difference between the restored roots to that of
mechanical and chemical adhesion (Nakabayashi unrestored roots of control group. This result
et al., 1992). Here Resilon with epiphany sealer corroborate the previous studies by (J.C. Bakkel et
showed high resistance to fracture compared to al., 1985, F.K. Cobankara et al., 2002, T.
control group. This may be due to “mono-block” Zandbiglari et al., 2006, and B. Sagsen et al., 2007).
created because of Resilon filling closely adapting But the study of M.J. Apicella et al., 1999, found
to epiphany sealer and in turn epiphany sealer no statistical difference between the restored and
adhering to the dentin walls thus holds the root unrestored groups using Ketac Endosealer. But the
together and reduce microleakage as compared to study of M. Trope et al., 1992 using the same
gutta-percha fillings. This bond between polyester material found restored group significantly stronger
core material to dual cure methacrylate based sealer than the unrestored group. This may have resulted
helps to keep Resilon filled roots to increase its due to variables in sample selection because for
fracture toughness. the study of M.J. Apicella they had used randomly
selected maxillary and mandibular incisors, molars
Supporting this observation is studies of
and canines where as for the study of M. Trope
(Teixiera et al., 2004 a,b) reported teeth filled with
they had tried to standardize the samples by using
Resilon and Epiphany were more resistant to
only the maxillary and mandibular canines of
fracture. Similarly roots filled with gutta-percha with
similar dimension of 7 to 8 mm. Similarly in the
AH plus sealer also showed greater fracture
study of Teixeira et al., 2004 a,b they found no
resistance than control group. This may be due to
significant differences between the restored and just
its adhesive properties, as the epoxy resin based
instrumented but unrestored control group. This
sealer is found to have good adhesion to dentin
may have resulted due to the length of specimen
and gutta-percha and is characterized by low
exposed to the force of fracture during mechanical
shrinkage and high dimensional stability. This
testing. For the current study 7 mm of roots were
finding was similar to the studies of (F.K. Cobankara
exposed whereas in the study of Teixiera et al.,
et al., 2002 and B. Sagsen et al., 2007). They
2004 a,b 9 mm of roots was exposed to the force.
observed roots obturated with epoxy resin based
Further the high standard deviation values obtained
sealers with lateral compaction technique was
in the present study may be due to the variations
significantly stronger than just instrumented roots.
between the structure of root dentin of the tested
The roots obturated with Endomethasone sealer also
samples related to age or dentinal sclerosis.
showed higher resistance to fracture than the just
instrumented but unrestored roots of the control CONCLUSIONS
group. This maybe due to its ‘flow’ and was able to For the current study all the tested materials
penetrate into the dentinal tubules thus creating significantly increased the fracture toughness of the
adhesion resulting in reinforcement of the instrumented roots after obturation. Therefore the
weakened roots. Hence for the current study all ability of these materials i.e., Resilon and Epiphany
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ENDODONTOLOGY K. K. WADHWANI, SARITA GURUNG
sealer, Gutta-percha and AH plus sealer, gutta- 8. E. Schafer et al., Influence of resin based adhesive root
canal fillings on the resistance to fracture of endodontically
percha and Endomethasone sealer to reinforce the treated roots. An in vitro preliminary study. Oral Surg, Oral
Endodontically treated teeth looks very promising Med and Oral Path. 2007; 103 : 274 – 279.
but further long-term clinical studies are necessary 9. P.Ausiello et al., Fracture resistance of endodontically
treated premolars adhesively restored. American Journal of
to collect evidence based data thus to be able to
Dentistry. 1997; 10: 237 – 241.
support the confident use of these materials in day
10. Guido Heydecke et al., Fracture strength and survival rate
to day practice. of endodontically treated maxillary incisors with approximal
cavities after restoration with different post and core systems.
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