JABFM
eISSN 2280-8000
J Appl Biomater Funct Mater 2016; 14(3): e307-e313
DOI: 10.5301/jabfm.5000273
Original research Article
Comparison between gutta-percha and resin-coated
gutta-percha using different obturation techniques
Nashwan A. Al-Afifi1, Mariam Abdullah1, Samah M. Al-Amery2, Mohamed Abdulmunem1
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Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Lembah Pantai, Kuala Lumpur - Malaysia
Department of Diagnostic and Integrated Dental Practice, Faculty of Dentistry, University of Malaya, Lembah Pantai, Kuala Lumpur - Malaysia
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Abstract
Background: The aim of this study was to evaluate and compare the obturation quality between canals obturated
with gutta-percha/AH Plus sealer (GP group) and resin-coated GP/EndoREZ® sealer (ER group).
Methods: A total sample of 90 mandibular premolar teeth was divided into 2 groups (2 × 45 canals): the GP group
and ER group. Each group was further divided into 3 subgroups (n = 15): cold lateral compaction (CLC), warm
lateral compaction (WLC) and single cone (SC). The teeth were subsequently embedded in resin and sectioned
horizontally at 1, 3, 6 and 9 mm. All sections were then viewed with a stereomicroscope at ×40 magnification. The
area occupied by core filling materials was determined using Cell^D software.
Results: With CLC, the percentage of core filling materials in the ER group was significantly higher than in the GP
group at the 1- and 3-mm levels. Similarly, with WLC, the percentage of core filling material in the ER group was
significantly higher than in the GP group at the 1-, 3- and 9-mm levels. With SC, the percentage of core filling
materials in the ER group was significantly higher than in the GP group at all levels.
Conclusions: It can be concluded that the resin-coated GP/EndoREZ® sealer is superior to the gutta-percha/AH
Plus in the percentage of core filling material.
Keywords: AH Plus, EndoREZ, Gutta-percha, Obturation
Introduction
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Obturation of the root canal system is one of the important steps in root canal treatment. Obturation is considered
as a function in which portals of entry between the canal and
the periodontium are eliminated (1). In general, obturation involves a combination of core material, such as gutta-percha
(GP) and a sealer (2). A good root canal obturating material
should be well adapted to the canal walls and its irregularities.
Thus, the entire length of the canal is densely compacted with
a homogeneous mass of core filling material. Consequently,
the quantity of core material should be maximized while the
quantity of sealer should be minimized (3, 4). GP has been
accepted as the gold standard root filling material (5), and
the material against which most others are compared (6-8).
Although GP and root canal sealers are used to obturate the
Accepted: January 8, 2016
Published online: May 2, 2016
Corresponding author:
Dr. Nashwan A. Al-Afifi
Faculty of Dentistry
University of Malaya
50603 Lembah Pantai
Kuala Lumpur, Malaysia
[email protected]
© 2016 Wichtig Publishing
root canals, they are ­incapable of accomplishing a good seal
along the dentinal walls of the root canal (9). Because the adhesive potential of GP with canal sealers has been shown to
be unsatisfactory, resin-coated GP points (EndoREZ® Points
[ER Points]) have been introduced (10). ER Points facilitate a
chemical bond with any resin-based sealer, thus creating a
monoblock (11, 12). The term monoblock refers to the production of a single unit; however, recently it has been used for the
introduction of adhesive root canal obturation ­materials (13).
The cold lateral compaction (CLC) of GP is considered as
one of the most widely accepted canal obturation techniques
and is taught in many dental schools (14). This is because of
its advantages of controlled placement of GP in the root canal and low cost (15). With this technique, specially designed
spreaders are placed as far apically as possible, and the master core filling is laterally compacted against the canal walls.
Then, additional accessory points are inserted and compacted
laterally around the master cone (16). The disadvantages of
this technique include an increased risk of dentinal damage
and vertical root fracture. Additionally, nonfilled spreader
tracks are recurrently present in the filling which decreases
the obturation quality (17). In contrast, the thermoplasticized
GP technique can easily move GP into the canal irregularities,
thus replicating the particulars of the root canal system (18).
Warm lateral compaction (WLC) of GP is a modification of CLC,
which, at the same time, thermoplasticizes the entire GP obturation mass (19). In this technique, a heated spreader is used
Obturation quality of gutta-percha and resin-coated gutta-percha
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Materials and methods
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Canal obturation
A total of 90 mandibular premolar teeth were randomly
divided into 2 main groups (2 × 45 canals): the GP group and
the ER group. A total of 45 canals in each group was randomly
divided into 3 subgroups (n = 15) according to different obturation techniques (CLC, WLC and SC).
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Tooth collection, storage and selection
of that position. All root canals were prepared with the size
15 K-Files (Colorinox; Dentsply Maillefer) and Mtwo® NiTi rotary instrument (VDW, München, Germany).
Initially, the size 15 K-File (Colorinox; Dentsply Maillefer)
was introduced into each root canal to produce a glide path,
and then to complete the root canal preparation, the Mtwo®
NiTi rotary instruments were used according to the manufacturer’s instructions, starting with size 15/0.05 to size 35/0.04,
which was used as the master apical file (MAF). All rotary root
canal instruments were used to the full working length of the
canals, employing a cyclical in-out brushing motion. After each
instrument, the canal was irrigated with 2.0 mL of 5.25% sodium hypochlorite (NaOCl) delivered using Ultradent® 5-mL
syringe ­(Ultradent Products Inc., USA) with a 27-gauge needle
(Ultradent). The apical patency was established throughout the
preparation by passing a size 10 K-File 1.0 mm beyond the apical
foramen. Once root canal preparation was completed, each canal was then irrigated in the following sequence: 3.0 mL 5.25%
NaOCl, 3.0 mL 18% ethylenediaminetetraacetic acid (EDTA) to
remove the smear layer and finally 3.0 mL distilled water to ensure complete removal of the irrigation solutions from the root
canal. Each irrigation solution was used for 1 minute.
Each specimen was then dried with a paper point (VDW,
München, Germany) prior to the application of the obturation materials.
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to soften the GP inside the canal, and then a cold spreader
is inserted to create sufficient space for accessory points (16,
20). To allow better adaptation of the GP points to the canal
walls during the thermoplasticized GP technique, GP points
with different tapers, 0.04-0.08, were introduced, which correspond to the taper of the rotary nickel-titanium (NiTi) instruments. Reports in the literature, however, suggest there
is no advantage of 0.06 taper GP points over the 0.02 taper
(21). Therefore, single cone (SC) obturation of root canals, a
noncompaction technique, has recently been revitalized as a
result of the introduction of a greater taper master core point
(22). The SC technique may, moreover, produce an adequate
root canal obturation without the use of more complicated
and time-consuming techniques, such as lateral compaction
or warm vertical compaction (23). Nevertheless, this technique relies on the original canal tapered circular preparation.
Therefore, only small diameter and minimally curved roots are
suitable for this technique (24).
There are many obturation materials and techniques that
could be used to obturate the root canal space; however,
studies that have investigated the root canal obturation quality using resin-coated GP points are sparse. Therefore, the
aim of this study was to evaluate and compare the obturation
quality of different obturation materials – GP points/AH Plus
sealer and resin-coated GP/EndoREZ® sealer – using different
obturation techniques (CLC, WLC and SC).
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Two hundred extracted single-rooted mandibular premolar teeth were collected regardless of age and race. The
teeth were stored in 0.5% chloramine-T trihydrate solution
for 1 week. Ultrasonic scaler (Densply® Cavitron® Bobcat®
Pro, USA) was used to remove both calculus deposits and residual periodontal tissues. Throughout this study, the teeth
were kept hydrated in distilled water to maintain dentine permeability. The storage solution was changed regularly every
1 week, and the teeth were stored at 4°C.
A total of 90 of the 200 teeth had a single root canal, which
was relatively straight, with a well-developed root and completely formed canal with patent foramen and teeth, with a
canal diameter smaller or equal to a size 15 K-File (Colorinox;
Dentsply Maillefer) at 4-5 mm from the radiographic apex,
and these were used for the purposes of this study. In addition, an attempt was made to standardize the size and shape
of the selected teeth (diameters at cervix were 5.0-5.5 mm
mesiodistally and 7.5-8.0 mm buccolingually).
Canal preparation
The teeth were decoronated with a sectioning machine
(Metkon® Micracut® 125 Low Speed Precision Cutter) at the level of 16 mm from the apex perpendicular to the long axis of the
root canal, to relatively standardize the length for all specimens.
The working length was determined by insertion of size
15 K-File (Colorinox; Dentsply Maillefer) into the root canal until it was visible in the apical foramen, and then the
­working length of each canal was calculated to 1.0 mm short
CLC technique
CLC of GP
An ISO-standardized GP point size 35/0.02 (VDW, München,
Germany) which fitted to the working length was chosen as the
master cone. AH Plus sealer was placed into the canal using
a paper point. The master cone was then placed to working
length. A size 25 finger spreader (VDW, München, Germany)
was advanced to within 1 mm of the working length, rotated
and removed. Then, a GP accessory point size 25/0.02 (VDW,
München, Germany) was placed into the prepared space. This
was repeated until the spreader could not be inserted 2-3 mm
into the canal. The excesses of the GP points were removed
with a heat plugger standard BeeFill® 2in1 device (VDW,
München, Germany). Following this, the GP in the coronal portion was vertically compacted using a root canal plugger, size 4.
CLC of ER
An ISO-standardized ER master cone size 35/0.02 (Ultradent) was chosen as a master cone. The ER sealer (Ultradent)
was applied in the canal according to the manufacturer’s instructions, by inserting the delivery NaviTip (Ultradent) into
the root canal to within 2-4 mm short of the apex. The tip was
­withdrawn slowly while expressing ER sealer coronally to the
© 2016 Wichtig Publishing
Al-Afifi et al
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WLC of GP
Sectioning of specimens
First, each specimen was fixed in a plastic cuvette using
baseplate wax, and then embedded in epoxy resin. The epoxy resin was allowed to set for 24 hours. Next, the specimens were ground from the root tip with a grinding machine
(METASERV® 2000 GRINDER POLISHER) until obturation material was visible.
All specimens in each subgroup were then sectioned horizontally perpendicular to the long axis with a sectioning machine (Metkon® Micracut® 125 Low Speed Precision ­Cutter).
Each section was made using a diamond rotary blade with
copious coolant irrigation to minimize smearing of the obturation material (GP or ER) at 4 levels: 1 mm (L1), 3 mm (L3),
6 mm (L6) and 9 mm (L9); as illustrated in Figure 1.
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An ISO-standardized GP point size 35/0.02 (VDW, München,
Germany) which fitted to the working length was chosen as the
master cone. AH Plus sealer was placed into the canal using a
paper point. The master cone was then placed to the working
length. A heat plugger standard BeeFill® 2in1 device was then
introduced 2.0 mm short of the working length at 100°C (the
lowest power setting). Next, the cold spreader was inserted
1 mm short of the working length, rotated and removed. Then,
the first GP accessory point size 25/0.02 was inserted into the
prepared space. This was repeated until the cold spreader
could not be inserted 2-3 mm into the canal. The excess of the
GP points was removed with a heat plugger standard BeeFill®
2in1 device. Next, the GP in the coronal portion was vertically
compacted using a root canal plugger, size 4.
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WLC technique
was inserted into the canal to remove excess sealer. An ER
master cone size 35/0.04 was placed to the working length,
and ER accessory points 25/.02 were placed passively in the
root canal. The excess of the ER Points was removed with
a heat plugger standard BeeFill® 2in1 device. Next, the ER
Points in the coronal portion were vertically compacted using
a root canal plugger, size 4.
In each GP and ER group, following the obturation technique, the access cavities of the specimens were restored
with IRM (Dentsply Caulk, Milford, USA). Additionally, in the
ER group, prior to placement of IRM, the coronal surface was
light cured for 40 seconds to produce an immediate coronal
seal, as recommended by the manufacturer.
All specimens were then kept in an incubator (Memmert,
Germany) at 37°C in 100% humidity for 1 week, to allow complete setting of the sealer.
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canal orifice. A paper point, size 35, was then inserted to the
working length and smeared onto the canal walls to remove excess sealer from the canal. Then the paper point was removed.
The same steps were followed as described in the section “CLC
of GP” to obturate the canals, except that the ER accessory
point size 25/0.02 (Ultradent) was used instead of a GP point.
WLC of ER
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SC technique
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An ISO-standardized ER point size 35/0.02 (Ultradent)
which fitted to the working length was chosen as a master
cone. The ER sealer (Ultradent) was then applied in the canal
according to the manufacturer’s instructions as described in
the section “CLC of ER.” The master cone was inserted to the
working length. A heat plugger standard BeeFill® 2in1 device
was then introduced 2.0 mm short of the working length at
100°C. Next, the cold spreader was inserted 1 mm short of
the working length, rotated and removed. The first ER accessory point size 25/0.02 was inserted into the prepared space.
This was repeated until the cold spreader could not be inserted 2-3 mm into the canal. The same steps were followed
as described in the section “WLC of GP.”
Assessment of percentage of core filling material
All sections were then viewed under a stereomicroscope
(Olympus szx7; Olympus Corp., Tokyo, Japan) at ×40 magnification, and microscopic images were obtained.
The area occupied by core filling materials (GP or ER) was
determined using Cell^D software (Olympus Soft Imaging Solutions GmbH, Münster, Germany). Next the percentage of
core filling material in the canal filled area was calculated, as
illustrated in Figure 2.
SC of GP
Results
AH Plus sealer was placed into the canal using a paper
point. A standardized GP master cone size 35/0.04 (VDW,
München, Germany) was placed to the working length, and
GP accessory points size 25/0.02 were inserted passively into
the canal. The excess of the GP points was removed with a
heat plugger standard BeeFill® 2in1 device (VDW, München,
Germany). Next, the GP in the coronal portion was vertically
compacted using a root canal plugger, size 4.
Data were entered and analyzed using SPSS 12 for
Windows (SPSS Inc., Chicago, IL, USA). The assumption of the
outcome not being normally distributed and equality of variances were checked.
The differences between groups in the measurements
of the core filling material in the canal filled area were compared using a nonparametric test (Mann-Whitney test). The
significance level in this study was set at a p value <0.05.
SC of ER
Percentage of core filling material (GP and ER)
with CLC technique
A skinny syringe with a NaviTip was inserted 2-4 mm
short of the apex, and ER sealer was introduced slowly while
­withdrawing the NaviTip from the canal space. A paper point
© 2016 Wichtig Publishing
Table I shows that the percentage of core filling material
was higher for the ER group at all levels than the GP group.
Obturation quality of gutta-percha and resin-coated gutta-percha
e310
TABLE I - Comparison of percentage of core filling material between
GP and ER groups, using CLC
Level
GP median, % (IQR)
ER median, % (IQR)
p value*
L1
83 (19)
94 (16)
0.005
L3
93 (10)
100 (6)
0.023
L6
93 (15)
97 (8)
0.110
L9
92 (10)
94 (7)
0.051
TABLE II - Comparison of percentage of core filling material
­between GP and ER groups, using WLC
Level
L1
L3
ER median, % (IQR)
p value*
88 (18)
100 (9)
0.029
97 (6)
100 (0)
0.006
100 (3)
100 (0)
0.055
97 (4)
100 (2)
0.007
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L6
GP median, % (IQR)
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Fig. 1 - Diagram illustrating serial sections in each specimen at 4 different levels: L1, L3, L6 and L9. WL = working length.
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CLC = cold lateral compaction; ER = resin-coated GP; GP = gutta-percha; IQR
= interquartile range.
* Mann-Whitney test.
L9
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ER = resin-coated GP; GP = gutta-percha; IQR = interquartile range; WLC =
warm lateral compaction.
* Mann-Whitney test.
GP group, the highest percentage (median 100%) was only
at L6, and the lowest percentage (median 88%) was at L1.
However, the ER group showed significantly higher percentages at the L1, L3 and L9 levels than the GP group (p = 0.029,
p = 0.006 and p = 0.007, respectively).
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Fig. 2 - Cross-section at L6 of cold lateral compaction (CLC)/gutta-percha (GP). The green line represents the total canal area,
whereas the yellow line represents the area of GP magnifications =
200×.
The highest percentage (median 100%) of core filling material
in the ER group was at L3, and the lowest percentages (median 94%) were at L1 and L9. In the GP group, the highest
percentages (median 93%) were observed at L3 and L6, and
the lowest percentage (median 83%) was at L1. However, the
ER group showed significantly higher percentages at L1 and
L3 than the GP group (p = 0.005 and p = 0.023, respectively).
Percentage of core filling material (GP and ER)
with WLC technique
Table II shows that the percentages of core filling material were higher for the ER group at the L1, L3 and L9 levels
than the GP group. The highest percentages (median 100%)
of core filling material in the ER group were at all levels. In the
Percentage of core filling material (GP and ER)
with SC technique
Table III shows that the percentages of core filling material
were higher for the ER group at all levels than the GP group.
The highest percentage (median 94%) of core filling material
in the ER group was at L9, and the lowest percentage ­(median
74%) was at L1. In the GP group, the highest percentage
(median 82%) was shown at L9, and the lowest percentages
(median 57% and 66.23%) were observed at L1 and L3, respectively. However, the ER group showed a significantly
higher percentage at L1 (p = 0.001) and at L3, L6 and L9
(p = 0.000 for all) than the GP group.
Discussion
Lower premolar teeth were used in this study as samples, because they are known to have variations in root canal morphology, and some have an oval canal shape (25).
Ingle et al described the shape of these canals in each third,
as ovoid at the cervical third, round or ovoid at the middle
third and round at the apical third. The preparation and
© 2016 Wichtig Publishing
Al-Afifi et al
e311
GP median, % (IQR)
ER median, % (IQR)
p value*
L1
57 (22)
74 (17)
0.001
L3
66.23 (14)
90 (6)
0.000
L6
78 (14)
91 (8)
0.000
L9
82 (6)
94 (3)
0.000
ER = resin-coated GP; GP = gutta-percha; IQR = interquartile range; SC = single
cone.
* Mann-Whitney test.
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obturation of these canals have been considered to pose a
challenge (25).
For many years, dye leakage studies have been the most
commonly used method to evaluate the quality of root canal
fillings. However, the reliability of those results has been questioned (26). This is due to the fact that the dye penetration may
be hindered by entrapped air and may not be visible because
the dye can lose its color when in contact with some root filling
materials (24, 27). In general, good obturation should consist of
a large amount of core material and minimal amount of sealer
(28). This is because the sealer will be dissolved with time, thus
creating spaces, which can act as a venue for a potential leakage area (25). Consequently, the percentage of GP-filled canal
area has been used as a measure of obturation quality (29).
A high percentage of core filling material with a low percentage of sealer plus voids indicates good obturation quality (27).
Therefore, a cross-sectioning method was used in this study
to evaluate the quality of 2 different materials (GP and ER) for
each obturation technique.
The aim of root canal obturation is to provide a complete
filling of the canal in all dimensions (3). A variety of materials and techniques have been developed to improve the
sealing quality and reinforcing effect of root canal obturation
(30). With the CLC technique, it has been shown that the apical seal is best produced when the spreader can be placed
close to the working length (31). The spreader’s shape and
its depth of penetration are considered to be important factors in producing a more homogenous root canal filling (32).
In the current study, however, with the CLC technique, the
percentage of ER core filling material was significantly higher
than the percentage of GP core filling material, at L1 and L3
(p < 0.05). This might be due to the fact that with this technique, it was apparent that the depth of spreader penetration in the ER group was better than that in the GP group.
This result is in agreement with a study performed by Nielsen
and Baumgartner (33), who evaluated spreader penetration
with Resilon® (a resin-based material) and GP using CLC. They
found that spreader penetration was better with Resilon®
than with GP. Improved penetration of a spreader may allow
better placement of accessory points into the canals even to
the apical third of the canal area, as observed in the ER group
in this present study. However, there has not been an earlier
study to investigate spreader penetration using the ER Points,
thus no direct comparison can be made.
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Level
With the WLC technique, the percentage of core filling
material in the ER group at the L1, L3 and L9 levels was higher than that in the GP group, with a significant difference for
L1, L3 and L9 (p < 0.05). This might be associated with better
plasticity and flow rate of the softened core filling material
of the ER group compared with that of the GP group. This
result was in agreement with that in a study performed by
Epley et al (3), who evaluated obturation of lateral canals
and found that the penetration of filling material was a
function of the viscoelastic properties of the filling material.
Moreover, Gurgel-Filho et al (34), who assessed the ability
of different GP brands to fill simulated lateral canals, suggested that the brand of GP point had an influence on the
length of filling within lateral canals. The flow rate capacity
was affected directly by the variation in the amounts of zinc
oxide and GP in the products. Higher amounts of GP in the
composition of some commercial brands demonstrated a
better ability to fill simulated accessory canals, wide canals
and other anatomical irregularities (35). GP is a natural polymer that undergoes an industrial process prior to its use in
the patient. This may influence its thermoplasticity behavior (3). However, one should take into consideration the fact
that the thermal properties of the ER Points have yet to be
determined.
The SC technique was included in the present study based
on the information mentioned by the manufacturer of ER to
the effect that SC is the preferred technique. They mentioned
that in large canals, additional ER point size 25/0.02 may be
inserted as a “harpoon.” No “condensation” is necessary. With
the SC technique, the ER group showed a higher percentage
of core filling material than the GP group, with a statistically
significant difference at all levels (p < 0.05). This might be due
to the monoblock formation in the ER group. The monoblock
concept refers to “the creation of a solid, bonded, continuous
material from one dentine wall of the canal to the other” (36).
Another research finding showed that a monoblock in ER obturation materials is created by deep penetration of the sealer
into dentinal tubules and a chemical bond between ER sealer
and ER Points (37).
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TABLE III - Comparison of percentage of core filling material
­between GP and ER groups, using SC
© 2016 Wichtig Publishing
Conclusions
Under the experimental conditions of the present study,
the ER group was superior to the GP group in maximizing the
percentage of core filling material occupying the canal area.
Based on the different obturation techniques, the following
conclusions can be reached:
1. CLC technique: the ER group was better than the GP
group for maximizing the amount of filling core material
at all levels, with a statistically significant difference at
the 1- and 3-mm levels.
2. WLC technique: the ER group was better than the GP
group for maximizing the amount of core filling material
at L1, L3 and L9, with a statistically significant difference
at the 1-, 3- and 9-mm levels.
3. SC technique: the ER group was better than the GP
group for maximizing the amount of core filling material, with a statistically significant difference at all
levels.
Obturation quality of gutta-percha and resin-coated gutta-percha
In conclusion, we can obviously note that with the SC technique, the amount of core filling material was higher than in
the GP group. Therefore, if dental practitioners want to use
a simple and fastest obturation technique (i.e., SC), they can
select resin-coated GP/EndoREZ® sealer to obturate the root
canal space. However, in this study, the SC technique was
performed with a gentle “harpooning” motion using a
greater tapered point with passive insertion of additional
accessory points.
13.
14.
15.
Acknowledgement
The authors would like to express their appreciation and deepest
gratitude to the Faculty of Dentistry, University of Malay (postgraduate research grant no. PS 169/2010B) for their support during all
steps of this project.
16.
17.
Disclosures
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References
18.
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Financial support: A postgraduate research grant (PPP) from the
­Faculty of Dentistry, University of Malay (grant no. PS 169/2010B)
was received by Nashwan A. Al-Afifi and Mariam Abdullah.
Conflict of interest: There are no conflicts.
EndoREZ Points and AH Plus sealer/conventional gutta-percha
points. Stomatologija. 2009;11(1):21-25.
de Sousa Menezes M, Queiroz EC, Soares PV, Faria-e-Silva AL,
Soares CJ, Martins LR. Fiber post etching with hydrogen peroxide: effect of concentration and application time. J Endod.
2011;37(3):398-402.
Gençoğlu N. Comparison of 6 different gutta-percha techniques: Part II: Thermafil, JS Quick-Fill, Soft Core, Microseal,
System B, and lateral condensation. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod. 2003;96(1):91-95.
Hale R, Gatti R, Glickman GN, Opperman LA. Comparative
analysis of carrier-based obturation and lateral compaction: a
retrospective clinical outcomes study. Int J Dent. 2012;2012:
954675.
Wesselink P. Root filling technques. In: Bergenholtz G, HörstedBindslev P, Reit C, eds. Textbook of endodontology. 2nd ed.
Chichester, UK: Wiley-Blackwell. 2009;219-233.
Wu MK, Bud MG, Wesselink PR. The quality of single cone and
laterally compacted gutta-percha fillings in small and curved
root canals as evidenced by bidirectional radiographs and fluid
transport measurements. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod. 2009;108(6):946-951.
Gilhooly RMP, Hayes SJ, Bryant ST, Dummer PM. Comparison
of lateral condensation and thermomechanically compacted
warm alpha-phase gutta-percha with a single cone for obturating curved root canals. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod. 2001;91(1):89-94.
Ulusoy Öİ, Yılmazoğlu MZ, Görgül G. Effect of several thermoplastic canal filling techniques on surface temperature
rise on roots with simulated internal resorption cavities: an
infrared thermographic analysis. Int Endod J. 2015;48(2):
171-176.
Ingle John I, Newton Carl W, West John D, et al. Obturation of
the radicular space. In: Ingle JI, Bakland LK, eds. Endodontics.
5th ed. Hamilton, ON: PMPH/BC Decker. 2002;571-667.
Al-Hadlaq SM, Al-Rabiah AA. In vitro evaluation of three techniques to obturate 0.06 taper canal preparations. Aust Endod
J. 2005;31(2):63-65.
Royer K, Liu XJ, Zhu Q, Malmstrom H, Ren YF. Apical and root
canal space sealing abilities of resin and glass ionomer-based
root canal obturation systems. Chin J Dent Res. 2013;16(1):
47-53.
Pitout E, Oberholzer T. Leakage of teeth root-filled with GuttaFlow and a single GP cone compared to lateral condensation and warm vertical condensation. South African Dental
Journal. 2009;64(3):104-108.
Topçuoğlu HS, Demirbuga S, Tuncay Ö, Arslan H, Kesim B,
Yaşa B. The bond strength of endodontic sealers to root dentine exposed to different gutta-percha solvents. Int Endod J.
2014;47(12):1100-1106.
Rodrigues A, Bonetti-Filho I, Faria G, Andolfatto C, Camargo
Vilella Berbert FL, Kuga MC. Percentage of gutta-percha in mesial canals of mandibular molars obturated by lateral compaction or single cone techniques. Microsc Res Tech. 2012;75(9):
1229-1232.
De Deus G, Murad CF, Reis CM, Gurgel-Filho E, Coutinho Filho
T. Analysis of the sealing ability of different obturation techniques in oval-shaped canals: a study using a bacterial leakage
model. Braz Oral Res. 2006;20(1):64-69.
Kierklo A, Tabor Z, Pawińska M, Jaworska M. A microcomputed
tomography-based comparison of root canal filling quality following different instrumentation and obturation techniques.
Med Princ Pract. 2015;24(1):84-91.
Taşdemir T, Er K, Yildirim T, et al. Comparison of the sealing ability of three filling techniques in canals shaped with
two different rotary systems: a bacterial leakage study. Oral
co
py
e312
Kuçi A, Alaçam T, Yavaş O, Ergul-Ulger Z, Kayaoglu G. Sealer
penetration into dentinal tubules in the presence or absence
of smear layer: a confocal laser scanning microscopic study.
J Endod. 2014;40(10):1627-1631.
2. Onay EO, Ungor M, Ozdemir BH. In vivo evaluation of the biocompatibility of a new resin-based obturation system. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104(3):
e60-e66.
3. Epley SR, Fleischman J, Hartwell G, Cicalese C. Completeness
of root canal obturations: epiphany techniques versus guttapercha techniques. J Endod. 2006;32(6):541-544.
4. Hammad M, Qualtrough A, Silikas N. Evaluation of root ­canal
obturation: a three-dimensional in vitro study. J Endod. 2009;
35(4):541-544.
5. Monteiro J, de Ataide IN, Chalakkal P, Chandra PK. In vitro resistance to fracture of roots obturated with Resilon or gutta-percha.
J Endod. 2011;37(6):828-831.
6. Prado M, de Assis DF, Gomes BP, Simão RA. Effect of disinfectant solutions on the surface free energy and wettability of filling
­material. J Endod. 2011;37(7):980-982.
7. Tuncer K, Aysun ST, Selçuk Gökyay S. Correlation between
sealer penetration into dentinal tubules and bond strength
of two new calcium silicate-based and an epoxy resinbased, endodontic sealer. J Adhes Sci Technol. 2014;28(7):
702-710.
8. Mohammadi Z, Shalavi S. Clinical applications of glass
ionomers in endodontics: a review. Int Dent J. 2012;62(5):
244-250.
9. Stiegemeier D, Baumgartner JC, Ferracane J. Comparison of
push-out bond strengths of Resilon with three different sealers. J Endod. 2010;36(2):318-321.
10. Kim YK, Grandini S, Ames JM, et al. Critical review on methacrylate resin-based root canal sealers. J Endod. 2010;36(3):
383-399.
11. Shanahan DJ, Duncan HF. Root canal filling using Resilon: a
review. Br Dent J. 2011;211(2):81-88.
12. Drukteinis S, Peciuliene V, Maneliene R, Bendinskaite R. In vitro
study of microbial leakage in roots filled with EndoREZ sealer/
19.
20.
Au
th
or
pe
r
1.
21.
22.
23.
24.
25.
26.
27.
28.
© 2016 Wichtig Publishing
Al-Afifi et al
30.
31.
33. Nielsen BA, Baumgartner JC. Spreader penetration during lateral compaction of resilon and gutta-percha. J Endod.
2006;32(1):52-54.
34. Gurgel-Filho ED, Feitosa JP, Gomes BP, Ferraz CC, Souza-Filho FJ,
Teixeira FB. Assessment of different gutta-percha brands during
the filling of simulated lateral canals. Int Endod J. 2006;39(2):
113-118.
35. Ghorpade RR., Aglawe PS, Phakatkar HG. Experimental and
FEA based modal analysis of scaled up dental pin (plugger): a
case study in endodontics. International Journal of Research in
Advent Technology. 2013;1(5):270-280.
36. Garg N, Kapoor R. Obturation of root canal system. In: Garg
N, Garg A, eds. Textbook of endodontics. 2nd ed. New Delhi:
Jaypee Brothers Medical. 2010;265-300.
37. Silva LAB, Barnett F, Pumarola-Suñé J, Cañadas PS, Nelson-Filho
P, Silva RA. Sealapex Xpress and RealSeal XT feature tissue compatibility in vivo. J Endod. 2014;40(9):1424-1428.
Au
th
or
pe
r
so
n
al
32.
Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(3):
e129-e134.
Wolf M, Küpper K, Reimann S, Bourauel C, Frentzen M. 3D
analyses of interface voids in root canals filled with different
sealer materials in combination with warm gutta-percha technique. Clin Oral Investig. 2014;18(1):155-161.
Shaheen N, Farag AM, Alhadainy HA, Darrag AM. Fracture
resistance of endodontically treated roots using different
preparation–obturation combinations. Tanta Dental Journal.
2013;10(2):97-102.
Chang J, Baek S-H, Lee I-B. Rheological characterization of
thermoplasticized injectable gutta percha and resilon. Journal of Korean Academy of Conservative Dentistry. 2011;36(5):
377-384.
Beer R, Baumann M, Kielbassa A. Filling the root canal. In:
Pocket atlas of endodontics. 1st ed. New York: Thieme Medical.
2006;176-189.
co
py
29.
e313
© 2016 Wichtig Publishing