Med Oral Patol Oral Cir Bucal. 2011 Jan 1;16 (1):e105-9.

Topical corticoids in oral pathology

Journal section: Clinical and Experimental Dentistry doi:10.4317/medoral.16.e105

Publication Types: Research http://dx.doi.org/doi:10.4317/medoral.16.e105

Intraorifice sealing ability of different materials in

endodontically treated teeth

María-Estela Bailón-Sánchez 1, Silvia González-Castillo 1, María-Paloma González-Rodríguez 1, Rafael Poya-

tos-Martínez 2, Carmen-María Ferrer-Luque 1

1
BDS, BDS, Graduate in Dentistry, Department of Dental Pathology and Therapeutics, School of Dentistry, University of
Granada (Spain)
DDS, PhD, Contracted Professor, Department of Dental Pathology and Therapeutics, School of Dentistry, University of Granada
(Spain)
DDS, MD, PhD, Associate Professor, Department of Dental Pathology and Therapeutics, School of Dentistry, University of
Granada (Spain)
2
PhD, Clinical Analysis Service, Hospital Virgen de las Nieves, Granada (Spain)

Correspondence:
Department of Dental Pathology and Therapeutics,
School of Dentistry, University of Granada, Spain,
Campus de Cartuja, Bailón-Sánchez ME, González-Castillo S, González-Rodríguez MP,
Colegio Maximo s/n, Poyatos-Martínez R, Ferrer-Luque CM. Intraorifice sealing ability of dif-
18071 Granada, Spain ferent materials in endodontically treated teeth. Med Oral Patol Oral Cir
[email protected] Bucal. 2011 Jan 1;16 (1):e105-9.
http://www.medicinaoral.com/medoralfree01/v16i1/medoralv16i1p105.pdf

Article Number: 16862 http://www.medicinaoral.com/

© Medicina Oral S. L. C.I.F. B 96689336 - pISSN 1698-4447 - eISSN: 1698-6946
Received: 23-02-2010 eMail: [email protected]
Accepted: 31-05-2010 Indexed in:
Science Citation Index Expanded
Journal Citation Reports
Index Medicus, MEDLINE, PubMed
Scopus, Embase and Emcare
Indice Médico Español

Abstract
Objectives: To evaluate Cavit™ G, ProRoot™ MTA and Tetric® EvoFlow as intraorifice barriers to prevent coro-
nal microleakage in root canal treatment.
Study Design: Forty-two human single rooted teeth were divided randomly in three experimental groups of 10
specimens each and two control groups. The experimental groups were prepared with hand instrumentation and
cold lateral condensed technique of the gutta-percha. Four millimetres of coronal gutta-percha were removed and
replaced by one of the following filling materials: Cavit™ G, Tetric® EvoFlow or ProRoot™ MTA. In the experi-
mental groups, leakage was measured by the concentration of leaked glucose in the apical reservoir at 1, 7, 30,
and 45 days, using the enzymatic glucose oxidase method. Data were analyzed by means of Mann-Whitney U and
Kruskal-Wallis tests at α=0.05.
Results: The glucose penetration results of three experimental groups increased gradually over time. No signifi-
cant differences were found among groups at 24 hours and 1 week. At thirty and forty-five days, Cavit™ and
Tetric® EvoFlow values were significantly different (p=0.007 and p=0.023, respectively).
Conclusions: The sealing ability of the Cavit™ G, ProRoot™ MTA and Tetric® EvoFlow used as intraorifice ma-
terials tends to be similar over time.

Key words: Cavit™ G, coronal microleakage, glucose penetration model, intraorifice barrier, Tetric® EvoFlow,
ProRoot™ MTA.

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Introduction Root canals preparation

The basic purpose of filling root canals is to obtain total All the teeth were instrumented by the same operator.
root canal system isolation from the oral environment, in After removal of the pulp tissue using a barbed broach, a
order to prevent bacterial leakage (1). Prevention of coro- #15 K file (Dentsply-Maillefer, Ballaigues, Switzerland)
nal leakage in root canal therapy can be accomplished by was introduced into the root canal until the tip was just
temporary restorative materials. However, a loss of the visible at the major apical foramen. The working length
temporary material of restoration, a delay in placing the was determined by subtracting 1 mm from this length.
definitive restoration or an alteration of the coronal seal Apical patency was confirmed by inserting a #15 file
of both restorations would promote the coronal leakage through the apical foramen before and after preparation.
of bacteria (2). Complete bacterial penetration has been The root canals were prepared sequentially until #15 to
demonstrated in vitro (3) and in vivo (4) through root ca- #40 K-Flexofile file (Dentsply Maillefer Instruments,
nal filling in teeth without temporary restoration. Ballaigues, Switzerland) and were irrigated with 2 mL
According to the type of material used and exposure freshly prepared 2.5% sodium hypochlorite solution af-
time to the oral cavity, all temporary materials leak to ter each change of instrument. A final rinse with 5 mL
some extent (5-8), and the degree to which different of 25% citric acid and 5 mL purified water was used to
temporary filling materials are capable of establishing remove the other irrigants, and the specimens were then
and maintaining a good coronal seal is often questioned dried with paper points.
(9). The use of a material to seal the orifice, in addi- The experimental root canals (n=30) were filled us-
tion to temporary restoration after root canal filling, has ing the cold lateral condensed gutta-percha technique
been recommended as a supplementary layer of protec- (Dentsply Maillefer Instruments, Ballaigues, Swit-
tion for the obturated canal (7). Different studies have zerland) and AH Plus™ Jet Mixing Syringe (DeTrey/
shown that materials such as Cavit™, Composite, Pro- Dentsply Konstanz, Germany) sealer, mixed according
Root™ MTA, IRM®; Super-Eba®, etc., placed at a depth to manufacturers´ instructions. The accessory gutta-
from 1 to 4 mm, are beneficial in preventing coronal percha cones were lightly coated with sealer and placed
microleakeage because they act like intraorifice barri- in the canal, using cold lateral compaction. The process
ers in root canal filling (4-7,10). was repeated until the cone could not be inserted more
Recently, a model that effectively measures the leak- into the canal. The excess of gutta-percha was removed
age of glucose molecules has been proposed (11,12). It with a hot plugger (0.5 mm diameter, Dentsply Maillefer
is based on measurements of glucose concentrations in Instruments, Ballaigues, Switzerland) and vertically
an apical chamber using a sensitive enzymatic reaction. compacted. In the positive control group (n=6) canals
A coloured substance is produced, and optical density were filled using gutta-percha cones without sealer
(OD) is determined by a spectrophotometer, translated or intraorifice barriers. Negative controls (n=6) were
later to concentration units. The advantages of this mod- sealed with laterally compacted gutta-percha and AH
el are its ease of assembly and operation, the availability Plus™, and intraorifice barriers and were completely
of the materials and equipment, and the high sensitivity covered with nail polish varnish.
of the test (12). Orifice plug placement
The purpose of this study was to evaluate the sealing A System B heat source with a 40/06 plugger (Sybro-
ability of Cavit™ G, ProRoot™ MTA and Tetric® Evo- nEndo, Orange, CA) was used to remove the four coronal
Flow as intraorifice barriers using a leakage glucose millimetres of the filling material, and depth was veri-
model. The null hypothesis to be tested is that there are fied using a periodontal probe (Hu-Friedy Europe, Lei-
no differences in microleakage values when using the men, Germany). Excess sealer was removed with cotton
different tested materials at various time periods. pellets soaked in 70% isopropyl alcohol. The ProRoot™
MTA original (DeTrey/Dentsply, Konstanz, Germany),
Material and Methods Cavit™ G (3M ESPE, Seefeld, Germany) materials
Selection and preparation of teeth were put into the orifice according to manufacture´s
Forty-two extracted teeth were selected for this study. directions. For the Tetric® EvoFlow (Ivoclar/Vivadent,
Roots with cracks, open apices, resorptive defects, or Schaan, Liechtenstein), the specimens were etched with
large carious lesions approaching the pulp were ex- 37% phosphoric acid for 15 seconds, washed for 10 sec-
cluded. After removal of debris, calculus and soft tis- onds, then gently dried with cotton pellets. Afterwards,
sues on the root surface, the teeth were stored in 2% Primer&Bond® NT (DeTrey/Denstply. Konstanz, Ger-
thymol solution until use. Crowns were removed at the many) was applied to the dentin using a saturated dis-
cementum-enamel junction level using an Accutom- posable brush. The excess was removed by an air spray
50 diamond cutter (Accutom Hard Tissue Microtome, (5 seconds), and it was then cured with a visible light ac-
Struers, Ballerup, Denmark) under copious water cool- tivator (Bluephase. Ivoclar/Vivadent. Schaan, Liechten-
ing, to obtain root specimens 15 mm in length. stein) for 10 seconds. Tetric® EvoFlow was condensed

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until the cavity was filled, after which it was cured with wise comparisons of the mean glucose leakage values.
a visible light activator for 30 seconds. Each root was The level of statistical significance was set at p<0.05.
placed in a coded container and stored at humidity for All statistical analyses were performed using SPSS 15.0
48 hours to allow the materials to set. software (SPSS Inc, Chicago, IL).
Glucose penetration model
The roots (thirty experimental teeth and twelve controls) Results
were mounted on a glucose leakage modified model (12). The microleakage results are presented in Table 1 and
Then, 100 μl of solution was drawn from a glass bottle Fig. 1. The amount of glucose penetration of the three
using a micropipette immediately afterwards, and at experimental groups increased gradually over time.
24 hours, 7, 30 and 45 days. The same amount of fresh The lowest glucose leakage that the current procedure
sterile water was added to the glass bottle to maintain is able to detect is 2mg/dL (0.11 mmol L-1), lower read-
a constant volume of 2 mL. The sample was then ana- ings were not reported (missing values).
lysed using a Glucose kit (Gluco-quant Glucose/HK, At the first day, the leaked glucose values ranged be-
Roche/Hitachi 917/ACN 549. Roche Diagnostics, Basel, tween 2.75 mmol/L-1 for Cavit™ G and 3.38 mmol/L-1
Switzerland), in a Modular System Autoanalyzer (Ro- for ProRoot™ MTA. At the end of the evaluation pe-
che Diagnostics, Basel, Switzerland), at a wavelength riod, the microleakage values detected with the three
of 340 nm. The concentrations of the glucose were ex- intraorifice sealing materials were 8.26 mmol/L-1
pressed in mmol L-1 at each time interval. (Cavit™ G), 8.44 mmol/L-1 (Tetric® EvoFlow) and 8.61
Statistical analysis mmol/L-1 (ProRoot™ MTA). No significant differences
Mean and standard deviations were determined for each were found among materials at 24 hours and 1 week. At
group. The Shapiro-Wilk test was used to check the nor- thirty and forty-five days, the values of glucose penetra-
mality of data distribution. As the results for each group tion differed significantly among the three groups: for
did not follow a normal distribution, the variables were both evaluation times, Cavit™ G and Tetric® EvoFlow
analyzed using a nonparametric test. After Kruskal- results showed significant differences (p=0.007 and
Wallis test the Mann-Whitney U test was used for pair- p=0.023, respectively).

Table 1. Penetration glucose values in mmol L-1 at different time periods (mean and
standard deviations).

Glucose leakage

Materials 1 day 7 days 30 days 45 days

ProRoot™ MTA 3.38±3.72 7.21±3.67 8.49±0.01 8.61±0.01

Cavit™ G 2.75±3.50 7.62±2.28 8.50±0.00a 8.26±0.57a

Tetric® EvoFlow 3.08±2.92 6.32±3.82 7.20±2.08a 8.44±1.01a

Fig. 1. Mean glucose penetration in mmol L-1 over time.

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Med Oral Patol Oral Cir Bucal. 2011 Jan 1;16 (1):e105-9. Topical corticoids in oral pathology

Discussion Cavit™ G sealed better at 24 hours of its application, a

The maintenance of a durable seal of the root canal sys- finding that might be attributed to water absorption and
tem is necessary to prevent leakage, and coronal resto- its expansion during setting (19). Sauaia et al. (8) also
ration is an important requisite for long-term endodon- reports Cavit™ G to provide the best intraorifice seal-
tic success (2,3). Restorative materials should provide ing according to stereomicroscope evaluation, as com-
a permanent, leak-proof seal. Defective temporary or pared with Vitremer™ and flowable composite Flow-It,
permanent restoration during or after root canal treat- after 5 days of immersion in dye. Using bacterial filtra-
ment is a main cause of coronal leakage (13). tion and a greater time of evaluation (90 days), Pisano et
Traditionally, the prevention of coronal leakage while al. (5) found that Cavit™ sealed significantly better than
the final coronal restoration is underway is achieved us- Intermediate Restorative Material (IRM®) and Super-
ing temporary materials, which have their limitations. Eba® when used, as intraorifice filling materials.
For this reason the coronal part of the root canal must In this study, Tetric® EvoFlow gave the lowest glucose
be sealed as closely as possible. The use of a material as penetration values at 7 and 30 days, in line with the re-
an intraorifice barrier could mitigate bacterial filtration sults of Jenkins et al. (7). These authors evaluated the
if the restoration were lost or unsuitable (7). sealing capacity of Cavit™, ProRoot™ MTA and Tet-
A variety of experimental models may be used to meas- ric®, at thicknesses of 1, 2, 3 or 4mm, with Indian ink
ure the filtration through filled roots; they include dye during seven days. It was shown that Tetric® leaked less
penetration (14), fluid transport (15) and bacterial pen- than Cavit™ or ProRoot™ MTA, regardless of the ap-
etration (16). In the present study, glucose penetration plied thickness, and the ProRoot™ MTA did not attain
(11) was used. Benefits of the glucose penetration model better results than the others materials after intraorifice
are attributed to the tracer, the possibility of quantitative sealing evaluation. Shemesh et al. (20) argued that one
measurements, reproducibility, and sensitivity (11,12). of the ProRoot™ MTA components (Ca(OH)2) could re-
Glucose is used as a tracer because it is hydrophilic, act directly with glucose and thus mask leakage, though
has a molecular weight lower than bacteria (MW=180 we did not find lower ProRoot™ MTA values with this
Da) and serves as a nutrient for bacteria (17). With model.
this method, the cumulative amount of glucose leak-
ing through the interface of intraorifice barriers in root Conclusion
canal fillings may be monitored at various time points Within the limitations of the present study, using the
(18). We measured the levels of glucose penetration at 1, glucose penetration model, Cavit™ G, Tetric® EvoFlow
7, 30 and 45 days, frequent time intervals for endodontic or ProRoot™ MTA attained similar leakage values
treatment or when permanent restoration is carried out when used as intraorifice barriers regarding of the test-
after root canal treatment (10). ing period.
Although previous research supports the effectiveness
of intraorifice barriers, there is no consensus as to the References with links to Crossref - DOI
References
protocol or material used as the coronal barrier after 1. Schwartz RS, Fransman R. Adhesive dentistry and endodontics:
root canal treatment (6). Different depths have been materials, clinical strategies and procedures for restoration of access
cavities: a review. J Endod. 2005;31:151-65.
tested, and the studied materials include Cavit™, IRM®, 2. Saunders WP, Saunders EM. Coronal leakage as a cause of
TERM® and Tetric® EvoFlow (5,8). The intraorifice failure in root-canal therapy: a review. Endod Dent Traumatol.
barrier thickness most recommended to date is 3 to 4 1994;10:105-8.
millimetres (5,6,8). This depth would seal the canal ap- 3. Swanson K, Madison S. An evaluation of coronal microleak-
age in endodontically treated teeth. Part I. Time periods. J Endod.
propriately without limiting the volume or compromise 1987;13:56-9.
retention of the final restoration. 4. Galvan RR Jr, West LA, Liewehr FR, Pashley DH. Coronal mi-
The null hypothesis should be only partially accepted croleakage of five materials used to create an intracoronal seal in
as the three materials tested in our study exhibited very endodontically treated teeth. J Endod. 2002;28:59-61.
5. Pisano DM, DiFiore PM, McClanahan SB, Lautenschlager EP,
similar behaviour over the 45 days period. An increase Duncan JL. Intraorifice sealing of gutta-percha obturated root canals
of glucose penetration is observed during the first week. to prevent coronal microleakage. J Endod. 1998;24:659-62.
Then, between day 7 and day 45, glucose penetration 6. Wolcott JF, Hicks ML, Himel VT. Evaluation of pigmented
values showed few changes. Tetric® EvoFlow was the intraorifice barriers in endodontically treated teeth. J Endod.
1999;25:589-92.
material that showed the least penetration between 7 7. Jenkins S, Kulild J, Williams K, Lyons W, Lee C. Sealing ability
and 30 days; but after 30 days it showed a progressive of three materials in the orifice of root canal systems obturated with
increase in filtration, reaching the values of the other gutta-percha. J Endod. 2006;32:225-7.
two materials at 45 days. Although there were signifi- 8. Sauáia TS, Gomes BP, Pinheiro ET, Zaia AA, Ferraz CC, Souza-
Filho FJ. Microleakage evaluation of intraorifice sealing materials in
cant differences between Tetric® EvoFlow and Cavit™ endodontically treated teeth. Oral Surg Oral Med Oral Pathol Oral
at 30 and 45 days, the clinical significance of these dif- Radiol Endod. 2006;102:242-6.
ferences, in terms of absolute values, is not relevant. 9. Barrieshi-Nusair KM, Hammad HM. Intracoronal sealing com-

e108
Med Oral Patol Oral Cir Bucal. 2011 Jan 1;16 (1):e105-9. Topical corticoids in oral pathology

parison of mineral trioxide aggregate and glass ionomer. Quintes-

sence Int. 2005;36:539-45.
10. Mavec JC, McClanahan SB, Minah GE, Johnson JD, Blundell RE
Jr. Effects of an intracanal glass ionomer barrier on coronal micro-
leakage in teeth with post space. J Endod. 2006;32:120-2.
11. Xu Q, Fan MW, Fan B, Cheung GS, Hu HL. A new quantitative
method using glucose for analysis of endodontic leakage. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod. 2005;99:107-11.
12. Shemesh H, Wu MK, Wesselink PR. Leakage along apical root
fillings with and without smear layer using two different leak-
age models: a two-month longitudinal ex vivo study. Int Endod J.
2006;39:968-76.
13. Chong BS. Coronal leakage and treatment failure. J Endod.
1995;21:159-60.
14. Camilleri J, Pitt Ford TR. Evaluation of the effect of tracer pH
on the sealing ability of glass ionomer cement and mineral trioxide
aggregate. J Mater Sci Mater Med. 2008;19:2941-8.
15. Cobankara FK, Orucoglu H, Sengun A, Belli S. The quantita-
tive evaluation of apical sealing of four endodontic sealers. J Endod.
2006;32:66-8.
16. Celik EU, Yapar AG, Ateş M, Sen BH. Bacterial microleakage of
barrier materials in obturated root canals. J Endod. 2006;32:1074-6.
17. Wu MK, Wesselink PR. Endodontic leakage studies reconsid-
ered. Part I. Methodology, application and relevance. Int Endod J.
1993;26:37-43.
18. Xu Q, Ling J, Cheung GS, Hu Y. A quantitative evaluation of seal-
ing ability of 4 obturation techniques by using a glucose leakage test.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104:e109-
13.
19. Lai YY, Pai L, Chen CP. Marginal leakage of different temporary
restorations in standardized complex endodontic access prepara-
tions. J Endod. 2007;33:875-8.
20. Shemesh H, Souza EM, Wu MK, Wesselink PR. Glucose reactiv-
ity with filling materials as a limitation for using the glucose leakage
model. Int Endod J. 2008;41:869-72.

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