Inuence of Ultrasonic Activation of 4 Root Canal Sealers

on the Filling Quality

Bruno Martini Guimar~ aes, DDS, MSc, Pablo Andres Amoroso-Silva, DDS, MSc,
Murilo Priori Alcalde, DDS, Marina Angelica Marciano, DDS, MSc,
Flaviana Bombarda de Andrade, DDS, PhD, and Marco Antonio Hungaro Duarte, DDS, PhD
Abstract
Introduction: The purpose of this study was to evaluate
the effects of ultrasonic activation onthe lling quality (in-
tratubular sealer penetration, interfacial adaptation, and
presence of voids) of 4 epoxy resinbased sealers.
Methods: Eighty-four extracted human canines were
divided into 4 groups (n = 20) according to the sealer
used to obturate the root canals instrumented with F5 Pro-
Taper instruments (50/05) (Dentsply Maillefer, Ballaigues,
Switzerland). The canals were lled by the lateral compac-
tion technique. Previously, the sealers were labeled with
rhodamine B dye to allow analysis under a confocal micro-
scope. At the time of obturation, the specimens were
divided again into 2 groups (n=10) according to the ultra-
sonic activation of the sealers: ultrasonically activated and
nonultrasonically activated groups. All samples were
sectionedat 2, 4, and6mmfromthe apex. The percentages
of voids, gaps, and dentinal sealer penetration segments of
the canal were analyzed. Results: Regarding the sealer
penetration segments, there was a signicant increase
for the AH Plus (Dentsply Maillefer), Acroseal (Specialites
Septodont, Saint Maur-des-Fosses, France), and Sealer 26
(Dentsply Maillefer) at the 4-mm level and the AH Plus
and Sealer 26 at the 6-mm level with ultrasonic activation
(P < .05). Concerning the gaps, the ultrasonic activation
promoted a smaller presence for all sealers at the 4- and
6-mm levels (P < .05). No statistical signicant differences
were found for the percentages of voids (P < .05).
Conclusions: The use of ultrasonic activation of an
epoxy resinbased sealer promoted greater dentinal
sealer penetration and less presence of gaps. (J Endod
2014;40:964968)
Key Words
Confocal microscopy, epoxy resin sealers, root canal
lling, ultrasound
T
he complete sealing of the root canal system after a biomechanical procedure can
determine the long-termsuccess of an endodontic treatment by preventing oral path-
ogens from colonizing and reinfecting the root and periapical tissues (1, 2). Because
gutta-percha does not adhere to the dentinal walls, the sealer must ll the irregularities
and the dentinal tubules of the root canal system.
Epoxy resinbased sealers were introduced in endodontics by Schroeder (3) and
have since been used because of their reduced solubility (4), apical seal (5), and
microretention to the root dentin (6). One of these sealers is AH Plus (Dentsply Mail-
lefer, Ballaigues, Switzerland), which has been extensively evaluated for its physico-
chemical properties, biological response, and interfacial adaptation (79). The
Adseal (Meta Biomed, Cheongju, South Korea) is another epoxy resin sealer with
reports in the literature about its radiopacity value and physical properties (9, 10).
Acroseal (Specialites Septodont, Saint Maur-des-Fosses, France) is a sealer that
contains 28% calcium hydroxide in its composition. Previous studies have shown its
sealing ability, antimicrobial activity against Enterococcus faecalis, and adaptation
to the root canal walls (9, 11, 12). Sealer 26 (Dentsply Maillefer) is an epoxy resin
based material containing calcium hydroxide and has also shown good sealing
ability and antimicrobial activity (13, 14).
Ultrasound is an instrument that was rst introduced to endodontics by Richman
in 1957. Currently, it has been widely used in different endodontic procedures, ranging
from coronal opening to endodontic surgery (15). A greater agitation of irrigating
solutions promoted by ultrasound intensies the penetration in an area of anatomic
complexity such as the dentinal tubules and consequently improves the cleaning ability
(16). The activation of root canal sealers can possibly favor its penetration inside the
dentinal tubules, providing an increase in sealability (17) and antimicrobial effects
(18). The effects of ultrasonic activation of the sealer into the root canal and the lling
quality have not been explored sufciently.
The aim of this study was to evaluate the effect of ultrasonic activation on 4 epoxy
resinbased sealers regarding their lling quality. The null hypothesis that was tested is
that ultrasonic activation improves the lling quality of epoxy resinbased sealers.
Materials and Methods
Eighty-four maxillary human canines with a root curvature less than 5

were used
(19). The ethics committee approved the use of extracted teeth for the research (CEP
079/2011). The crowns were removed at the cementoenamel junction using a 0.3-mm
low-speed diamond saw(Isomet, Buehler, Lake Bluff, IL), and the root canal length was
established at 15 mm. The working length was established by measuring the penetration
of a size 10 K-le (Dentsply Maillefer) until it reached the apical foramen and then sub-
tracting 1 mm. Root canal shaping was performed using ProTaper rotary instruments
(Dentsply Maillefer) at the working length until a F5 (50.05) instrument. After the use of
each instrument, the canals were irrigated using 2 mL 2.5% sodium hypochlorite.
Passive ultrasonic irrigation was performed at the end of the shaping as described by
van der Sluis et al (20). A nal ush of 2 mL 17% EDTA (pH = 7.7) (Biodin^amica,
Ibipor~a, Parana, Brazil) was applied for 3 minutes to eliminate the smear layer.
Then, the canals were washed with 5 mL saline solution and dried with paper points
(Dentsply Maillefer).
From the Department of Operative Dentistry, Endodontics
and Dental Materials, Bauru School of Dentistry, University of
S~ao Paulo, Bauru, S~ao Paulo, Brazil.
Address requests for reprints to Dr Bruno Martini
Guimar~aes, Al Octavio Pinheiro Brisolla, 9-75-CEP 17012-901,
Bauru School of Dentistry, University of S~ao Paulo, Bauru, SP,
Brazil. E-mail address: brunomgui@usp.br
0099-2399/$ - see front matter
Copyright 2014 American Association of Endodontists.
http://dx.doi.org/10.1016/j.joen.2013.11.016
Basic ResearchTechnology
964 Guimar~aes et al. JOE Volume 40, Number 7, July 2014
The specimens were randomly divided into 4 groups (n = 20)
according to the sealer used to obturate the root canals:
Group 1: AH Plus (Dentsply Maillefer)
Group 2: Acroseal (Septodont, Saint Maur des Fosses, France)
Group 3: AdSeal (Meta, Biomed, Cheongju, South Korea)
Group 4: Sealer 26 (Dentsply Maillefer)
The sealers were manipulated according to the manufacturers in-
structions. To allow visualization under a confocal laser microscope
(TCS-SPE; Leica Microsystems GmbH, Mannheim, Germany), the
sealers were mixed with uorescent rhodamine B dye (Sigma-Aldrich,
St Louis, MO) to an approximate concentration of 0.1% (21). The
sealers were placed in each root canal by using a size 30 rotary lentulo
spiral (Dentsply Maillefer), maintaining the instrument 4 mm from the
apex. Then, the specimens were divided into 2 groups (n =10) accord-
ing to the ultrasonic activation of the sealers: ultrasonically activated (A)
and nonultrasonically activated (NA) groups. The activation in group A
was performed using a size A nickel-titanium nger spreader (Dentsply
Maillefer) adapted into an ultrasonic device (Jet-Sonic Four Plus; Gna-
tus, Ribeir~ao Preto, SP, Brazil) in endo mode (50% potency) using a
no. A-120 insert (Gnatus) (Fig. 1). Because the ultrasonic oscillates in a
single plane, the spreader was activated for 20 seconds in the buccolin-
gual direction and another 20 seconds in the mesiodistal direction of
the root canal, 2 mm short of the working length as a standardization
procedure. Next, a 50.02 gutta-percha cone (Dentsply Maillefer) was
inserted into the full working length, and the root canal obturation
was completed using the lateral compaction technique with a size B
nger spreader (Dentsply Maillefer) inserted 2 mm short of the work-
ing length and accessory gutta-percha points size 20.02 (Dentsply Mail-
lefer). The cervical portion of the specimens was sealed using a
provisional lling material (Coltosol, Coltene, Switzerland). The speci-
mens were stored in 100% humidity at 37

C for 1 week to allow the

sealers to set.
Voids Area, Interfacial Adaptation (Gaps),
and Segment of Sealer Penetration
The samples were sectioned using a 0.3-mmIsomet saw(Buehler,
Lake Bluff, IL) at 200 rpmwith continuous water cooling to prevent fric-
tional heat. Horizontal sections were performed at the 2-, 4-, and 6-mm
levels from the apical foramen and polished with sandpaper (Politriz;
Arotec, Cotia, SP, Brazil). To calculate the void area (mm
2
) percent-
ages, a stereomicroscope (Stemi 2000C; Carl Zeiss, Jena, Germany)
and the Axiovision software (Carl Zeiss) were used (Fig. 2A). First,
the total area of each cross-section image of the canal and the visible
voids were measured. With both values obtained, the percentage of
voids in relation to the total area of each canal section was calculated.
The segments of the root canal in which the sealer penetrated into
the dentinal tubules, and the interfacial adaptation (gaps) were analyzed
on an inverted Leica TCS-SPE confocal laser scanning microscope
(Leica Microsystems GmbH) by the similar method described by
Moon et al (22). For the correct visualization of all images, the sections
were analyzed 10 mmbelowthe surface using the 10lens. The respec-
tive absorption and emission wavelengths for the rhodamine B were set
to 540 and 590 nm, respectively. Then, the images were recorded at
100 magnication using the uorescent mode to a size of 1024
1024 pixels and a scale set to 100 mm (Fig. 2B). Analysis of all images
was performed with the Image J V1.46r software (National Institutes of
Health, Bethesda, MD). The total circumference of the canal was ob-
tained rst. Then, segments of sealer penetration into the dentinal tu-
bules and interfacial adaptation (gaps) of the total circumference
were measured, and the values were converted into percentages
(Fig. 2C and D).
Statistical Analysis
Because of the absence of normal distribution, which was
observed using the Shapiro-Wilk test. Statistical analysis was performed
by using the nonparametric Kruskal-Wallis and Dunn tests (P < .05).
The nonparametric Mann-Whitney test was used to analyze the inuence
of ultrasonic activation individually in each sealer (P < .05).
Results
Median and range of voids, interfacial adaptation (gaps), and
dentinal sealer penetration segments of the canal can be found in
Table 1. With regard to the sealer penetration segments, there was a sig-
nicant increase for the AH Plus (Fig. 2E and F), Acroseal, and Sealer 26
at the 4-mm level, and the AH Plus and Sealer 26 at the 6-mm level when
the ultrasonic activation was performed (P < .05). Regarding the gaps,
the ultrasonic activation promoted a smaller presence for the AH Plus at
the 2-mmlevel and for all sealers at the 4- and 6-mmlevels (P <.05). The
voids percentage revealed no signicant differences between the A or NA
groups at all levels (P < .05).
Discussion
The null hypothesis tested was conrmed because the ultrasonic
activation improved the lling quality of the 4 epoxy resinbased
sealers. The transmission of acoustic microstreaming energy from an
oscillating le by the use of ultrasonic activation can promote the pene-
tration of irrigants in an area of anatomic complexity and the dentinal
tubules, resulting in a greater cleaning ability (16). With regard to the
intracanal medication, Duarte et al (23) analyzed the inuence of ultra-
sonic activation of calcium hydroxide pastes on the pH and calcium
release in simulated external root resorptions. The authors showed
that the ultrasonic activation favored a higher pH level and calcium
release describing that ultrasonic activation could promote a greater
tubular penetration of the calcium hydroxide pastes. In accordance
with the results mentioned previously, the present study showed that
the ultrasonic activation also favored a greater dentinal sealer penetra-
tion and improved the interfacial adaptation between the sealer and the
root canal walls, which can promote a higher contact and connement
of microorganisms present in the dentinal tubules (22).
Figure 1. Finger spreader adapted into an ultrasonic device using a no. A-120
insert.
Basic ResearchTechnology
JOE Volume 40, Number 7, July 2014 Ultrasonic Activation of 4 Root Canal Sealers 965
The percentage of segments in which the sealer penetrated into the
dentinal tubules may be more meaningful and clinically relevant
compared with the maximum depth of sealer penetration (24), and it
can be considered benecial for preventing reinfection because of
the sealers antibacterial activity and by locking the residual microor-
ganisms into the dentinal tubules (22, 25). Additionally, it has been
suggested that the sealer inside the tubules promotes a mechanical
interlocking, improving the material retention (22, 26). Meanwhile,
De-Deus et al (27) reported that there was no signicant correlation
between the intratubular sealer penetration and the sealing ability. In
this study, the sealers were placed by a rotary lentulo spiral for stan-
dardization procedures. A previous study showed that the distribution
of sealer in the canal walls is not affected by the sealer placement
method (28), which support the hypothesis that the ultrasonic activa-
tion of the sealer could enhance the root lling quality.
AH Plus, Acroseal, and Sealer 26 presented a signicant increase
of segments of sealer penetration at the 4-mm level. AH Plus and Sealer
26 also had a signicance difference at the 6-mm level when ultrasonic
activation was performed. No signicant differences were found at the
2-mm level. These ndings are similar to other studies (24, 29, 30),
which showed that the sealer penetration in the dentinal tubules was
signicantly greater in the coronal and middle levels of the root canal
Figure 2. (A and B) Representative correlative stereomicroscopic/confocal pictures of canal lled with Acroseal sealer and lateral compaction technique. A thin
layer of sealer is evident just in the confocal picture, which promotes a clear visualization of adaptation without evidence of voids and gaps. (C and D) Segments of
the root canal in which the sealer penetrated into the dentinal tubules (white dots) and an evident gap (arrows) at the interfacial adaptation, respectively. (E and F)
Representative picture at 4-mm sections of canal lled with AH Plus ultrasonically and nonultrasonically activated, respectively. A remarkable dentinal sealer pene-
tration is evident when the ultrasonic activation was promoted.
Basic ResearchTechnology
966 Guimar~aes et al. JOE Volume 40, Number 7, July 2014
than the apical (31). This could be because of the fact that a superior
removal of the smear layer in the coronal and middle levels and the inef-
fective delivery of irrigant to the apical region of the canal occurs (32).
Another factor may be that the apical level contains less tubules, and
when present, the diameter is smaller or they are more frequently
closed (33).
In relation to the interfacial adaptation (gaps), none of the groups
showed a total adaptation to the root canal walls. However, the ultra-
sonic activation promoted a smaller presence of gaps for the AH Plus
at the 2-mm level and for all sealers at the 4- and 6-mm levels with a
statistical signicance (P < .05). The present results are relevant
because the gap regions can increase potential microbial leakage
(34). Epoxy resinbased sealers like AH Plus are correlated with a
higher adhesion to dentin and gutta-percha, and this might explain
the appropriate interfacial adaptation of the tested sealers (35). These
results are in agreement with previous studies (9, 34).
The stereomicroscope analysis revealed voids at all groups (A and
NA) and levels, presenting no signicant difference between them (P <
.05). The ultrasonic activation of the sealer did not seemto inuence the
presence of voids, which probably is more related to the inability of the
lateral compaction technique to allowa homogeneous layer of sealer on
the entire root canal wall (36).
Conclusions
The use of ultrasonic activation of an epoxy resinbased sealer
promoted greater dentinal sealer penetration and less presence of gaps.
Acknowledgments
Supported by the State of S~ao Paulo Research Foundation
FAPESP (2011/03973-4).
The authors deny any conicts of interest related to this study.
References
1. Buckley M, Spangberg LS. The prevalence and technical quality of endodontic treat-
ment in an American subpopulation. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 1995;79:92100.
2. Bouillaguet S, Shaw L, Barthelemy J, et al. Long-term sealing ability of Pulp Canal
Sealer, AH-Plus, GuttaFlow and Epiphany. Int Endod J 2008;41:21926.
3. Schroeder A. Endodontics: Science and PracticeA Textbook for Student and
Practioner. Chicago: Quintessence; 1981.
4. Carvalho-Junior JR, Guimaraes LF, Correr-Sobrinho L, et al. Evaluation of solubility,
disintegration, and dimensional alterations of a glass ionomer root canal sealer.
Braz Dent J 2003;14:1148.
5. Sousa-Neto MD, Passarinho-Neto JG, Carvalho-Junior JR, et al. Evaluation of the ef-
fect of EDTA, EGTA and CDTA on dentin adhesiveness and microleakage with
different root canal sealers. Braz Dent J 2002;13:1238.
6. Tagger M, Tagger E, Tjan AH, et al. Measurement of adhesion of endodontic sealers
to dentin. J Endod 2002;28:3514.
7. Leonardo MR, Flores DS, de Paula ESFW, et al. A comparison study of periapical
repair in dogs teeth using RoekoSeal and AH plus root canal sealers: a histopath-
ological evaluation. J Endod 2008;34:8225.
8. Duarte MA, Ordinola-Zapata R, Bernardes RA, et al. Inuence of calcium hydroxide
association on the physical properties of AH Plus. J Endod 2010;36:104851.
9. Marciano MA, Guimaraes BM, Ordinola-Zapata R, et al. Physical properties and
interfacial adaptation of three epoxy resin-based sealers. J Endod 2011;37:141721.
10. Tasdemir T, Yesilyurt C, Yildirim T, et al. Evaluation of the radiopacity of new root
canal paste/sealers by digital radiography. J Endod 2008;34:138890.
11. de Vasconcelos BC, Bernardes RA, Duarte MAH, et al. Apical sealing of root canal
llings performed with ve different endodontic sealers: analysis by uid ltration.
J Appl Oral Sci 2011;19:3248.
12. Pinheiro CR, Guinesi AS, Pizzolitto AC, et al. In vitro antimicrobial activity of Acroseal,
Polil and Epiphany against Enterococcus faecalis. Braz Dent J 2009;20:10711.
13. Oliveira AC, Tanomaru JM, Faria-Junior N, et al. Bacterial leakage in root canals
lled with conventional and MTA-based sealers. Int Endod J 2011;44:3705.
14. Cavalcanti AL, Limeira FI, Sales EA, et al. In vitro antimicrobial activity of root canal
sealers and calcium hydroxide paste. Contemp Clin Dent 2010;1:1647. T
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Basic ResearchTechnology
JOE Volume 40, Number 7, July 2014 Ultrasonic Activation of 4 Root Canal Sealers 967
15. Plotino G, Pameijer CH, Grande NM, et al. Ultrasonics in endodontics: a review of the
literature. J Endod 2007;33:8195.
16. Wiseman A, Cox TC, Paranjpe A, et al. Efcacy of sonic and ultrasonic activation for
removal of calcium hydroxide from mesial canals of mandibular molars: a micro-
tomographic study. J Endod 2011;37:2358.
17. Wu MK, de Gee AJ, Wesselink PR. Effect of tubule orientation in the cavity wall on the
seal of dental lling materials: an in vitro study. Int Endod J 1998;31:32632.
18. Heling I, Chandler NP. The antimicrobial effect within dentinal tubules of four root
canal sealers. J Endod 1996;22:2579.
19. Schneider SW. A comparison of canal preparations in straight and curved root ca-
nals. Oral Surg Oral Med Oral Pathol 1971;32:2715.
20. van der Sluis LW, Shemesh H, Wu MK, et al. An evaluation of the inuence of passive
ultrasonic irrigation on the seal of root canal llings. Int Endod J 2007;40:35661.
21. DAlpino PHP, Pereira JC, Svizero NR, et al. Use of uorescent compounds in assess-
ing bonded resin-based restorations: a literature review. J Dent 2006;34:62334.
22. Moon YM, Kim HC, Bae KS, et al. Effect of laser-activated irrigation of 1320-nano-
meter Nd:YAG laser on sealer penetration in curved root canals. J Endod 2012;38:
5315.
23. Duarte MA, Balan NV, Zeferino MA, et al. Effect of ultrasonic activation on pH and
calcium released by calcium hydroxide pastes in simulated external root resorption.
J Endod 2012;38:8347.
24. Bolles JA, He J, Svoboda KK, et al. Comparison of Vibringe, EndoActivator, and nee-
dle irrigation on sealer penetration in extracted human teeth. J Endod 2013;39:
70811.
25. Kokkas AB, Boutsioukis A, Vassiliadis LP, et al. The inuence of the smear layer on
dentinal tubule penetration depth by three different root canal sealers: an in vitro
study. J Endod 2004;30:1002.
26. White RR, Goldman M, Lin PS. The inuence of the smeared layer upon dentinal
tubule penetration by plastic lling materials. J Endod 1984;10:55862.
27. De-Deus G, Brandao MC, Leal F, et al. Lack of correlation between sealer penetration
into dentinal tubules and sealability in nonbonded root llings. Int Endod J 2012;45:
64251.
28. Hall MC, Clement DJ, Dove SB, et al. A comparison of sealer placement techniques in
curved canals. J Endod 1996;22:63842.
29. Balguerie E, van der Sluis L, Vallaeys K, et al. Sealer penetration and adaptation
in the dentinal tubules: a scanning electron microscopic study. J Endod 2011;37:
15769.
30. Chadha R, Taneja S, Kumar M, et al. An in vitro comparative evaluation of depth of tubular
penetration of three resin-based root canal sealers. J Conserv Dent 2012;15:1821.
31. Chandra SS, Shankar P, Indira R. Depth of penetration of four resin sealers into
radicular dentinal tubules: a confocal microscopic study. J Endod 2012;38:
14126.
32. Kara Tuncer A, Tuncer S. Effect of different nal irrigation solutions on dentinal tu-
bule penetration depth and percentage of root canal sealer. J Endod 2012;38:
8603.
33. Mjor IA, Smith MR, Ferrari M, et al. The structure of dentine in the apical region of
human teeth. Int Endod J 2001;34:34653.
34. De-Deus G, Reis C, Di Giorgi K, et al. Interfacial adaptation of the Epiphany self-
adhesive sealer to root dentin. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2011;111:3816.
35. Lee KW, Williams MC, Camps JJ, et al. Adhesion of endodontic sealers to dentin and
gutta-percha. J Endod 2002;28:6848.
36. Wu MK, Ozok AR, Wesselink PR. Sealer distribution in root canals obturated by three
techniques. Int Endod J 2000;33:3405.
Basic ResearchTechnology
968 Guimar~aes et al. JOE Volume 40, Number 7, July 2014