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 »  Home  »  Endodontic Articles 12  »  A quantitative evaluation of apical leakage of four root-canal sealers
A quantitative evaluation of apical leakage of four root-canal sealers
Results - Discussion - References.

The results of the quantitative evaluation of the sealing properties of the four root-canal sealers are shown in Table 2.
All of the sealers gave better seal after 21 days than 7 days (P < 0.05). Sultan showed significantly more leakage when compared to the other sealers at all time periods (P < 0.05). Although RoekoSeal showed better sealing values after 21 days when compared to Ketac-Endo and AH Plus, there was no statistically significant difference (P > 0.05).

Table 2. Microleakage of four sealers used to obturate the root canals.

Microleakage of four sealers used to obturate the root canals

Leakage studies still have a place in evaluating factors involved in root-canal sealing. In this study, an endodontic fluid transport model proposed by Wu et al. (1993) was used to evaluate the sealing ability of root fillings incorporating four different root-canal sealers (AH Plus, RoekoSeal, Ketac-Endo and Sultan). This method has been shown to be more sensitive than dye penetration for the detection of full length voids along root canals and to be highly reproducible (Wu et al. 1993, 1994a). This type of system overcomes some of the disadvantages of previous studies. A major advantage of the method is the ability to measure microleakage without destroying the root specimens. Repeated observation of the same specimens over time to reveal changes in sealing ability is, therefore, possible (Wu et al. 1995, Belli et al. 2001). The model uses positive pressure to help rule out problems caused by entrapped air or fluid which may skew outcomes in dye penetration studies (Goldman et al. 1989). The sensitivity of the system can be adjusted by altering the pressure used and altering the diameter of the micropipette (Fogel 1995).
In order to avoid anatomical variations and to obtain standardization for the leakage measurements in this study, the length of the specimens was kept same. Wu et al. (1993) also advised controlling the length of the samples, canal diameter, and canal anatomy used to reduce the variability of these studies. The use of hand instrumentation and laterally condensed gutta-percha technique was a realistic clinical approach.
A wide variety of root-canal sealers are available commercially, and they are divided into groups according to their chemical composition. There is no consensus on which materials seal most effectively. Sealers based on organic resin (AH Plus), zinc oxide-eugenol (Sultan), glass ionomer (Ketac-Endo) and polyvinylsiloxane (RoekoSeal) were included in our study.
Endodontic sealers based on ZnOE have been used clinically for several decades because they have satisfactory physicochemical properties (Benatti et al. 1978). But in the present study the ZnOE-based sealer (Sultan) showed significantly more leakage when compared to the polydimethylsiloxane (RoekoSeal), glass ionomer (Ketac-Endo), and epoxy resin (AH Plus)-based sealers after 21 days (P < 0.05).
The glass ionomer sealers were introduced into rootcanal treatment because of their adhesion to dental hard tissues (Powis et al. 1982, Aboush & Jenkins 1986). Ketac-Endois specially formulated as a root-canal sealer. In an in vitro study, Kochet al. (1994) demonstrated better sealing with Ketac-Endo than with ZnOE sealer (Grossman’s sealer).Wu et al. (1994b) also found better sealing with Ketac-Endo. On the other hand, Smith & Steiman (1994) and Rohde et al. (1996) observed more leakage with Ketac-Endo than with sealers based on ZnOE. Timpawat & Sripanaratanakul (1998) showed that there is no clear difference between using a ZnOE sealer and Ketac-Endo.
Excellent apical sealing has been found with epoxy resin-based sealers (Grossman1976, Limkangwalmongkol et al.1991). Recently, AHPlus, a sealer based on epoxy resin, was introduced to the market. According to the manufacturer, it has excellent sealing properties without the release of formaldehyde. In an in vitro study, De Almeida et al. (2000) observed that leakage with AHPlus was significantly less than that with the ZnOE sealer (Fill Canal) as well as the glass ionomer sealer (Ketac-Endo). Greater measured leakage for sealers based on ZnOE compared with epoxy resin-based sealers was also found by other authors (Limkangwalmongkol et al.1991, Oguntebi & Shen1992). DeGee et al. (1994) also showed the apical seal of resin-based cements to be superior to that of glass ionomer-based cements.
In this study, statistical analysis showed that all the tested materials showed less leakage after 21 days than 7 days (P < 0.05).
De Gee et al. (1994) and Wuet al. (1994b) indicated that AH26 showed diminished leakage by the time. De Gee et al. (1994) explained this as a result of the slow setting properties of the material. They reported that this property may allow sufficient time for the development of adhesion to dentine but the shrinkage stress may fracture the still weak unset sealer cohesively. On the other hand, the improving seal of Ketac-Endo was explained by the ability of glass ionomer cement to ‘self-repair’ (Davidson & Abdalla 1993). This material expansion (Wiener & Schilder1971) or self-repair may compensate for the volumetric change caused by the setting shrinkage or dissolution of the material (Wu et al.1994b).
RoekoSeal is a recently marketed polydimethylsiloxane- based material. Limited data are available with regard to its sealing or other properties. Bartuskova & Perinka (2001) found that there were no significant differences between the apical leakage of RoekoSeal and AH26. In our study, whenthe1-week results were evaluated, it was noted that root fillings with RoekoSealwere leaking more than others, but after 21 days, the situation was reversed. The slow setting properties of this material could be an explanation for diminished leakage. The clinical significance of these findings is not clear and further studies are needed to clarify the sealing ability of this new material and evaluate its clinical performance.


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