ENDODONTOLOGY

Original Research

A comparative study of vertical fracture of roots

obturated with new obturating systems - An in vitro study
Vimmi Singh #
Neeta Shetty ##
Kundabala M. ##

ABSTRACT
Introduction : The purpose of this invitro study was to evaluate the post obturation fracture resistance of endodontically
treated teeth obturated with new obturating systems such as Realseal system, GuttaFlow obturation system, conventional
lateral compaction technique and Microseal obturation system.
Materials and Methods : Fifty extracted single rooted teeth were selected and sectioned at the CEJ. The root canals
were instrumented using EasyRace files. The teeth were randomly divided into 5 groups of 10 teeth each. Group I
served as negative control and was instrumented and not obturated. The other groups were obturated with new
obturating systems. The specimens were evaluated for vertical fracture resistance using Instron universal testing machine.
Results : According to the study it was found that the Resilon with Realseal displayed higher mean fracture load in
comparison to other experimental groups.
Conclusion : Obturation of roots with a resin based obturation material increased the fracture resistance of root
canal filled tooth to vertical fracture.
Key words : Vertical fracture, obturation, monoblock, Resilon, GuttaFlow, Microseal

Introduction

endodontically treated root is still controversial.6 It

The objectives of root canal treatment are

is suggested that bonding of endodontic adhesive

removal of diseased pulp, shaping and cleaning of

sealers to root dentin and also to the obturating

the root canal and three dimensional obturation with

material may enhance the fracture resistance of root

an inert material to obtain a fluid tight seal to

filled teeth, so their use has been suggested to

prevent re-infection.1, 2, 3 Vertical root fractures are

reinforce the root canal walls.7

complications that are mostly seen in root canal

The concept of sealing and tooth strengthening

obturated teeth and often lead to extractions.4

by using adhesive root canal obturating materials

Schilder 5 suggested that the ideal root canal

is known as monoblock effect.8,9 To achieve this

obturating material should be well adapted along

monoblock effect ,an obturation system was

the entire length of the root canal walls and produce

introduced in 2004, known as Epiphany (Pentron

a homogenous mass. Currently with the application

clinical Technologies.LLC Wallingford CT.USA)

of adhesive dentistry in endodontics, the present

which contained Resilon cones and resin based

concept of obturation of the root canal is not just

sealer. Resilon cones are thermoplastic synthetic

the three dimensional filling of root canal and

polymer based root canal filling materials and

accessory canals, but also the reinforcement of the

polymers of polyester. GuttaFlow (Coltne/

root. The ability of gutta percha to reinforce an

Whaledent Inc. 235 Ascot Parkway Cuyahoga Falls,

# Conservative Dentistry and Endodontics, Nepal, ## Dept. of Conservative Dentistry and Endodontics, Manipal University, Manipal College of Dental Sciences,
Mangalore

85

ENDODONTOLOGY

VIMMI SINGH, NEETA SHETTY, KUNDABALA M.

Ohio 44223 / USA) is a cold flowable root canal

17% EDTA (B.N laboratories,India) and dried with

filling paste system. It is said to offer excellent flow,

paper points ( DentsplyMaillifer. CH-1338

good adaptability to root canal walls, ease of use,

Ballaigues)

low setting time within 10 minutes and slight

Obturation of the root canals:

expansion on setting (0.2%).10 The Microseal system

Groups I - Served as negative control group.

(Analytic Endodontics ,Glendora,CA 91740) is a

Roots were not instrumented and not obturated.

thermomechanical filling technique that uses a

laterally compacted master gutta-percha cone and

Groups II (Realseal obturation system) A

placement of gutta-percha to backfill the canal.

size 40, #.04 taper Resilon cone was inserted to

Microseal is a recent obturating system for which

the working length with tug-back. The primer and

the resistance to vertical fracture is not known.

sealer were applied according to manufacturers

Hence this study was conducted to evaluate

instructions. Then, the master Resilon cone of was

and compare the effect of different obturation

gently seated into the canal and obturated with

systems on the fracture resistance of endodontically

lateral compaction method. Coronal aspect of

treated tooth, such as RealSeal obturating system

material was light cured for 40 seconds.

(SybronEndo,Orange,CA) GuttaFlow system,

Group III- (GuttaFlow obturation system) A master

conventional lateral compaction technique and

GuttaFlow gutta percha point of size 40,#.04 taper is

Microseal system.

selected and obturated using lateral compaction

Materials and Methods :

method, following manufacturers instruction for

Preparation of the specimens

manipulating GuttaFlow. Excess obturating material

Fifty freshly extracted single rooted human teeth

was removed with a heated hand instrument.12

were selected & stored in saline solution. The teeth

were sectioned at the cementoenamel junction with

Group IV (Conventional lateral compaction

a diamond wheel saw (Mani,Japan) The sectioned

technique.) Canals were obturated using lateral

teeth were randomly divided into 5 groups

compaction technique with master gutta percha cone

consisting of 10 teeth each.Access cavities were

(SureDent Corporation, Korea) of size 40, #.04 taper

prepared using an airotor hand piece and endo-

is selected and coated with the zinc oxide eugenol

access bur. (Dentsply Maillefer CH-1338

sealer (Deepti, Vishal Dental products, India).

Ballaigues). The working length was determined by

Group V-( Microseal obturation system) A

according to Ingles working length technique . 11

Microseal master gutta percha cone of size 40,#.04

The roots were prepared by using #.04 taper

taper is selected and obturated using lateral

EasyRaCe nickel-titanium rotary files.(FGK Dentaire

compaction method, following manufacturers

Swiss dental products) according to manufacturers

instruction for manipulating Microseal compactor.13

instructions along with the use of 1ml of 2.5%

sodium hypochlorite (Novo dental products Ptv .Ltd

The access cavity was sealed with glass

,India) and normal saline (Goa Formulation Ltd,

ionomer restorative cement (GC Corporation

India) as irrigants, and were finally flushed with

Tokyo,Japan).All the specimens were kept at 37c

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ENDODONTOLOGY

A COMPARATIVE STUDY OF VERTICAL FRACTURE OF ROOTS

OBTURATED WITH NEW OBTURATING SYSTEMS - AN IN VITRO STUDY

with 100% humidity for at least 72 hours to allow

the resistance ( p value-0.000) to fracture compared

the sealers to set completely.The roots were fitted

to other groups. Inter group comparison between

into tight-fitting rubber tubing to simulate the

group I and group II is significant with Z value is -

periodontal ligament Epoxy resin was mixed to a

3.908 and (P value 0.000 is significant). Inter group

thin consistency and poured into plastic blocks in

comparison between group II and group III, group

which the roots were vertically placed. Instron

IV and group V is significant with Z value -3.78

universal testing machine (Model no.3366 U.K). A

-3.78 and -3.79 respectively . The other groups were

special device/Jig (fig 1) was fabricated with stainless

not significantly different from each other.

steel to hold the finger spreader with frictional grip

Compressive Load at Max Compressive Extension

latch, which was attached to the unit of the

universal testing machine with the help of

COMPARISON

screw.The access cavity restoration was removed

GI vs. GII

-3.908

0.000

GI vs. GIII

-0.782

0.434

A size 40, length 25mm 0.02% taper hand stainless

GI vs. GIV

-1.641

0.101

steel spreader is placed on the universal testing

GI vs. GV

-2.66

0.008

GII vs. GIII

-3.78

0.000

material. The machine was calibrated to vertically

GII vs. GIV

-3.78

0.000

drive the spreader into the root canal at a speed of

GII vs. GV

-3.79

0.000

10mm/min. Force was applied to the root until it

GIII vs. GIV

-0.303

0.762

vertically was recorded and data from all

GIII3 vs. GV

-1.37

0.170

experimental groups were collected and statistiscally

GIV vs. GV

-2.05

0.04

and then the blocks with embedded roots were

mounted onto the Instron universal testing machine.

machine fixture and placed directly above the root

canal orifice,to penetrate through the obturatng

fractured. The force applied to fracture the tooth

analysed using Kruskal-Wallis test and intergroup

Table1- Inter group comparison performed by

Mann- Whitney U test. (Z)

comparison was done by Mann-Whitney U test.

Results :
Compressive load at max compressive
extension is shown in table 1. Due to unusual
distribution of the data, nonparametric tests were
applied to check the statistical significance between
the groups. According to the results (graph 1), group
II showed the maximum resistance to fracture
(median value-259.425) and group IVshowed the
minimum resistance to fracture (median value28.15).The root canals obturated with Resilon and

Graph 1- Compressive load at maximum compressive

extension for all the experimental groups.

RealSeal sealer resulted in significant increase in

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ENDODONTOLOGY

VIMMI SINGH, NEETA SHETTY, KUNDABALA M.

Fig 1: Special jig fabricated to hold speraders

Fig 2: Specimen mounted on universal testing machine

Discussion :

forces of the spreader driven into the canal without

resistance could be the reason for the highly

The present study found that the resistance to

significant values.14

fracture of the obturated teeth was better in case of

teeth obturated with the adhesive obturating system

Resilon obturating material - Epiphany as the

RealSeal . The traditional obturating material gutta

bonding agent (sealer) attaches the resin core to the

percha does not provide chemical bonding to the

dentinal wall , thus forms monoblock.9 All the other

root canal wall, so recent research in obturation

materials in the present study created mechanical

materials is focused on the introduction of resins

bond between the sealer and dentinal wall. The

into the cones and the sealer .Inter group

adhesion and mechanical interlocking between the

comparison between group I (instrumented and

material and the root canal dentin prevents

unobturated root canals) and group II is significant

microleakage and reduce the risk of fracture. The

with Z value is -3.908 and (P value 0.000 is

results regarding Resilon in our study were in

significant),which shows the importance of

accordance with some previous studies.14,15 Sagsen

obturating the canals after disinfection .Root canal

et.al7, in their study concluded that root canals

instrumentation is an unavoidable step in

obturated with Resilon cones and epiphany sealer

endodontic treatment,dentin is removed during this

were able to reinforce the prepared root canals.

phase,thus a weaking effect on the root is

inevitable.14 Also clinically one never leaves an

The bondability of Resilon to methacrylate

root canal unfilled ,so group I was considered as a

resin based root canal sealers is supposed to be

negative control group and showed least resistance

derived from the inclusion of the urethane

when compared with the other groups.The wedging

dimethacrylate resin. It contains two interface one

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ENDODONTOLOGY

A COMPARATIVE STUDY OF VERTICAL FRACTURE OF ROOTS

OBTURATED WITH NEW OBTURATING SYSTEMS - AN IN VITRO STUDY

between the sealer and primed dentin, another

fracture. To reconfirm the result of the present study

between the sealer and Resilon, hence may be

further studies have to be undertaken with more

classified as a secondary type monoblock.9 So this

number of samples, under ultrastructural scanning

property of Resilon could be the reason for the

microscope and also other required properties have

positive result in our study and the nonadhesive

to be confirmed.

obturating materials showed poorer result

Conclusions :

compared to it. Contrary, Ulusoy etal

16

in their

The present study concluded-

study found that the use of AH 26 and gutta

.Grande NM etal

17

1. Resilon with RealSeal sealer is the best material

concluded that the currently

among the experimental groups to resist the post

available endodontic-filling materials and their

obturation vertical fracture.

recommended adhesive procedures are not able to

influence the mechanical properties of root canal

2. Gutta Flow, Microseal and Gutta percha with

dentin and that the flexural properties of Resilon

zinc oxide sealer cannot resist vertical fracture as

and gutta-percha are too low to reinforce roots.

well as Resilon.
References :

According to studies by Tay FR etal Resilon

1.Walton RE, Torabinejad M. Principal and practice of

endodontics.3rded. Philadelphaia;Saunders ,2002.

seems to be biodegradable under the attack of

hydrolytic ester bond cleaving enzymes or as

2. Schilder H. Cleaning and Shaping the root canal. Dent

Clin North Am 1974;18:269-96.

extracellular enzymes from endodontically relevant

pathogens .Resilon is also susceptible to alkaline

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Louis:Mosby, 2002.

hydrolysis, therefore long term studies are

4. Fuss Z,Lustig J,Katz A,Tamse A.An Evaluation of

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18.Tay FR,Pashley DH,Yiu CKY,Yau JYY,Yiu-fai M,Loushine

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14.Teixeira FB,Teixeira EC,Thompson JY,Trope M..Fracture

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