An evaluation of the sealing ability of a polycaprolactone-based

root canal filling material (Resilon) after retreatment

Zheng-Mei Lin, DDS, PhD,a Ashroy Jhugroo, BDS, DDS,b and Jun-Qi Ling, DDS, MD, PhD,c
Guangzhou, China
DEPARTMENT OF ENDODONTICS AND CONSERVATIVE DENTISTRY, GUANGHUA COLLEGE OF
STOMATOLOGY, SUN YAT-SEN UNIVERSITY

Objective. The aim of this study was to evaluate the sealing ability of Resilon after retreatment.
Study design. Sixty-six single-rooted mandibular premolars were enlarged to apical size 45 and then obturated with
Resilon. The roots were randomly divided into 3 groups (n ⫽ 22/group). In group 1 no further treatment was done.
Groups 2 and 3 were reinstrumented to apical size 60 using K-files and ProFile, respectively. In each group, 4 samples
were kept for environmental scanning electron microscopy (ESEM) analysis. The remaining roots from groups 2 and 3
were refilled with Resilon. Sixteen roots from each group were then evaluated for microleakage; two roots served as
controls. Data were analyzed statistically by Kruskall-Wallis test.
Results. There were no significant differences between the experimental groups (P ⬎ .05). The ESEM showed new
attachment of resin tags on the dentin surface of retreated roots.
Conclusion. Resilon can be used for retreatment, but it still allowed microleakage. (Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 2007;104:846-51)

During the past few decades the number of patients
seeking nonsurgical endodontic retreatment has in-
creased considerably. Teeth with inadequate obtura-
tion, unfilled root canals, or underextended root fillings
may require retreatment before coronal restoration.1
The main goal of orthograde retreatment is regaining
access to the apical foramen by complete removal of
the root canal filling material, thus facilitating sufficient
cleaning and shaping of the complete root canal system
and final obturation.2
Recently, a new thermoplastic synthetic polymer–
based root canal filling material, Resilon (RealSeal;
SybronEndo, Orange, CA), has been developed to per-
form like gutta-percha with the same handling proper-
ties. For retreatment purposes, it may be softened with
heat or dissolved with a solvent such as chloroform. Based
on polymers of polyester, Resilon contains bioactive
glass, bismuth oxychloride, and barium sulphate.3 It is
supplied in varying tapers and as pellets for heated obtu-
ration methods. A primer is used for conditioning of the
dentinal wall surface of the canal. A dual-curing resin
sealer that bonds to the primer and the soft resin filling
material creates a secondary monoblock system.4
a
Associate Professor.
b
Resident.
c
Dean and Head of Department.
Received for publication Mar 6, 2007; returned for revision Apr 28,
2007; accepted for publication May 15, 2007.
1079-2104/$ - see front matter
© 2007 Mosby, Inc. All rights reserved.
doi:10.1016/j.tripleo.2007.05.020
The most commonly used root filling material is
gutta-percha in combination with a sealer. Many mate-
rials have been assessed as root canal fillings. However,
none fulfills all the requirements for an ideal material.
Resilon may have properties superior to gutta-per-
cha,3,5-11 but not much is known about its capacity to
undergo retreatment. For Resilon to be considered as a
superior root filling material, it is essential that it be
easily removed from the root canal and retains its
bonding capacity to the canal wall and the core resin
material during retreatment. Recently published articles
have suggested that Resilon, along with its sealer, were
removed more effectively than gutta-percha and AH
Plus sealer.7,11 To date, there has been no publication
evaluating the sealing capacity of Resilon after retreat-
ment.
The aims of the present study were to compare the in
vitro microleakage of root canal fillings and to analyze
the extent of resin tags formation at the resin-dentin
interface by environmental scanning electron micros-
copy (ESEM) before and after retreatment with Resi-
lon.
MATERIALS AND METHODS
A total of 66 single-rooted mandibular premolars
were selected and stored for less than 1 month in 0.02%
sodium azide containing isotonic saline (0.9% NaCl).
All teeth were examined under a microscope for root
fractures and cracks. The crowns were removed at the
cementoenamel junction by means of a diamond saw
(Isomet; Buehler, Lake Bluff, IL). The length was

846
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Volume 104, Number 6
determined by inserting a size #15 Flex-o-file (Dentsply
Maillefer, Tulsa, OK) into the root canal until it was
visible at the apex. The working length was established
by subtracting 1 mm from the real length. The initial
apical size of the each tooth was gauged by identifying
the first instrument that fitted snugly at the working
length. Those that had apical root canal diameters more
than ISO size #25 were rejected. The roots were then
instrumented in a crown-down fashion with ProFile
nickel-titanium rotary instruments with 0.04 taper
(Dentsply Maillefer). The apical third was prepared
with a ProFile hand instrument up to size #45, 0.04
taper (Dentsply Maillefer). The patency of the canals
was maintained with ISO size #15 Flex-o-files. Each
root canal was irrigated with 10 mL 1.25% sodium
hypochlorite followed by 5 mL 17% EDTA. Repeated
recapitulations were made to keep the canals patent.
After final instrumentation all teeth received a final
irrigation of 15 mL 1.25% sodium hypochlorite and 5
mL EDTA. The canals were then flushed with 10 mL
sterile water to remove any remaining sodium hypo-
chlorite (per the instructions of the manufacturer).
When all the teeth were dried with paper points, the
self-etching RealSeal Primer was introduced into the
canals to working length with the microbrush supplied
by the manufacturer. Excess primer was removed with
dry paper points. Then the dual sealer was spread into
the canal walls with a lentulo spiral at low rpm. A
master cone, size #45, 0.02 taper RealSeal point, was
fitted to working length with the use of a spreader, and
the medium-fine accessory cones coated in resin sealer
were used for lateral condensation. Excess material was
removed and condensation accomplished with a plug-
ger. Regardless of the tooth length, the root canal
fillings were limited to 15 mm so that the volume of
Resilon filling was uniform in each tooth.
After the procedure, the coronal portion of the obtu-
ration was light cured for 40 seconds (3M curing light
2500; ESPE Dental Products, St. Paul, MN), and ra-
diographs were taken to verify the quality and apical
extent of the root fillings. The teeth were randomly
divided into 3 groups, and the samples were kept at
100% humidity for 1 month.
Experimental groups
Group 1: Original Resilon obturation. The first
group consisted of 22 roots of teeth filled with Resilon.
Of these, 16 were selected for microleakage evaluation
and 4 for ESEM analysis; the remaining 2 served as
controls.
Group 2: Reinstrumentation with a K-file and chlo-
roform and refilling with Resilon. The original Resilon
filling material was removed from each of the roots
(n ⫽ 22) with a K-file and chloroform totaling 1.0 mL.
Lin et al 847
The coronal portions of the canals were filled with
chloroform and a size #15 K-type file (Dentsply
Maillefer) was used to remove the softened material,
thus creating a larger space for chloroform. This pro-
cess proceeded until sufficient space was available for
use of larger-size files. With the serial use of larger
files, the chemically softened Resilon in the apical
portion of the root filling was reached. Removal of the
Resilon was considered to be complete when no mate-
rial was evident on the files. The roots were then
instrumented up to a size #60 K-file to remove all
residual Resilon sealer or filling materials that might
have remained in the irregularities of the canal walls.
Two roots were selected at this stage for ESEM eval-
uation. The root canals were then refilled with Resilon
following the initial procedure. All the samples were
kept in 100% humidity for 1 month. Two roots were
then selected at this stage for ESEM evaluation, 2 roots
served as controls, and the remaining 16 roots were
used for the microleakage test.
Group 3: Reinstrumentation with ProFile 0.04 taper
Ni-Ti rotary instruments and chloroform and refilling
with Resilon. Removal of Resilon from the roots (n ⫽
22) was conducted using crown-down technique with
ProFile 0.04 taper Ni-Ti rotary instruments (Dentsply
Maillefer). The coronal part was removed with a size
#40 file to allow for the creation of the reservoir for the
chloroform. A total of 1.0 mL chloroform was used in
each tooth. By decreasing sequentially to size #35, size
#30, and size #25 files, the full working length of canal
could be instrumented. The files were cleaned each
time before being reintroduced in the canal. One series
of ProFile instruments was used for this group. A final
instrumentation size #60, 0.04 taper ProFile was used to
remove any material potentially remaining on the canal
wall. Two samples were selected for ESEM analysis.
The remaining roots were then refilled with Resilon
following the initial procedure and were kept at 100%
humidity for 1 month. Two roots were then selected for
ESEM evaluation, 2 roots served as controls, and the
remaining 16 roots were used for the microleakage test.
Control group. The control group consisted of 6
roots obtained from the 3 experimental groups. They
were sealed with layers of nail varnish covering the root
canal orifices, as well as the apical foramen, and eval-
uated for microleakage.
Regardless of the tooth length, the root canal fillings
were limited to 15 mm so that the volume of Resilon
filling was uniform in each of the teeth. All teeth were
prepared and retreated by the same experienced oper-
ator. The roots of the experimental groups were also
covered with sticky wax, except for the canal orifices
and the apical 2 mm.

848 Lin et al
Fig. 1. Model used to assess microleakage.
Description of the leakage model
The device for evaluating leakage was based on the
filtration of glucose along the root canal filling, as
described by Xu et al.12 The device was composed of 2
parts (Fig. 1). The lower part consisted of an Eppendorf
vial in which a small hole had been prepared to receive
the coronal portion of the root. The tooth was inserted
into the vial in such a way that half of it protruded
through the vial. A hole was made in the cap of the vial
to accommodate a 15-mm-long plastic tube. All junc-
tions in the model were sealed with cyanoacrylate and
sticky wax and ensured to be airtight by means of
compressed air forced from the opened end of the tube.
The vial and the plastic tube were filled with 5 mL of
1 mol/L glucose solution maintained at a pH of 7.0 and
density of 1.09 ⫻ 103 g/L. The solution also contained
0.01% NaN3 to inhibit the growth of microorganisms.
The assembly was then placed in a small sterile glass
bottle so that at least 2 mm of the tip of the root was
immersed in 1 mL of distilled water.
The preparations were maintained in an incubator at
a constant temperature of 37°C and 100% humidity.
From each glass vial, 10 ␮L of the solution was re-
moved on the 1st, 3rd, 4th, 7th, 10th, 15th, 20th, and
30th days. Then 10 ␮L distilled water was added into
the bottle so that a constant volume of 1.0 mL of
solution was maintained. The samples were analyzed
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December 2007
with a glucose kit (Diasys, Shanghai, China) in a UV-
Vis recording spectrophotometer (Schimadzu, Kyoto,
Japan).
Differences between the means of each group were
analyzed using the Kruskall-Wallis test for analysis of
variance. When the difference of leakage in term of
glucose concentration among groups was significant,
further comparisons by use of the Nemenyi test were
performed.
ESEM
The specimens selected from groups 1, 2, and 3 were
analyzed by use of the Philips XL 30 ESEM (Eind-
hoven, The Netherlands). Using a slow-speed saw
(Isomet) under water cooling, each specimen was cut
longitudinally into 2 parts. One part was examined
under ESEM without prior decalcification. The other
part had its exposed dentin-filling interface polished
with 1200-grit silicon carbide paper and brought into
relief by etching with 10% phosphoric acid for 15 seconds
followed by deproteinization in 5% sodium hypochlorite
for 10 minutes, as described by Tay et al.13 The specimens
were examined wet and uncoated for penetration of resin
into the dentinal tubules and for presence of gaps in the
resin-dentin interface. Most of the ESEM images were
taken in the apical regions of the samples, because these
were the most inaccessible regions for instrumentation,
irrigation, and sealer application and were most likely to
show differences in sealing.
RESULTS
All of the samples from each of the experimental
groups (1, 2, and 3) leaked from the first day of the
experiment. The leakage gradually increased with time.
The control (nail varnish) teeth showed no leakage.
Comparison of groups by the Kruskall-Wallis test
showed no significant differences between the reinstru-
mentation/refilling groups and the original Resilon
group (P ⬎ .05). The Nemenyi test also indicated that
there were no significant differences among the exper-
imental groups (P ⬎ .05). The mean microleakage
values from the different groups are summarized in
Table I and Fig. 2.
A low-magnification view of specimens from group
1 (no reinstrumentation/refill) showed intimate contact
between the Resilon, the sealer, and the dentinal wall
(Fig. 3, A). A decalcified sample from group 1 revealed
that long and uniform resin tags with lateral branches
were evident upon higher magnification (Fig. 3, B).
Resilon and sealer clearly appeared to bind together,
with resin tags penetrating the dentin. The presence of
Resilon/sealer deep within the dentinal tubules in roots
was also observed in samples from groups 2 and 3 (Fig.
3, C). Refilled samples clearly showed the presence of
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Volume 104, Number 6 Lin et al 849

Table I. Mean microleakage values from the different 0.01% of NaN3 was preferred.15 This was in accor-
experimental groups dance with ISO standard 6876:2001(E).
Reinstrumentation Resinstrumentation Similar to previous studies,3,6,8-10 Resilon-filled
with K-file and with ProFile and roots demonstrated leakage. Removal of Resilon from
Time Original refilling with refilling with the specimens in the retreatment groups and enlarge-
(days) Resilon Resilon Resilon
ment of the apical diameter of all the roots in the
1 0.05 ⫾ 0.07 0.07 ⫾ 0.08 0.06 ⫾ 0.07
experimental groups to ISO size #60 ensured that al-
2 0.11 ⫾ 0.08 0.15 ⫾ 0.09 0.12 ⫾ 0.10
3 0.26 ⫾ 0.10 0.30 ⫾ 0.16 0.27 ⫾ 0.27 most all existing root fillings were removed. The
4 0.36 ⫾ 0.14 0.42 ⫾ 0.11 0.38 ⫾ 0.23 method for removal of the filling material from the root
7 0.64 ⫾ 0.13 0.72 ⫾ 0.19 0.68 ⫾ 0.21 canals did not appear to affect the extent of the leakage,
10 0.84 ⫾ 0.19 0.90 ⫾ 0.71 0.84 ⫾ 0.32 because the rates for the 2 retreatment groups were
15 1.56 ⫾ 0.31 1.72 ⫾ 0.33 1.66 ⫾ 0.54
essentially the same. There were no statistical differ-
20 2.03 ⫾ 0.52 2.63 ⫾ 0.78 2.38 ⫾ 0.66
30 3.60 ⫾ 0.77 4.01 ⫾ 1.09 3.95 ⫾ 0.89 ences between the groups. However, there was a con-
tinuous and increasing leakage in all of the experimen-
tal groups during the 30 days experimental period. A
consistent hermetic seal was not achieved when roots
were filled or refilled with Resilon using this microleak-
new microtags deep within the dentinal tubules (Fig. 3, age model. Apart from possible reasons such as natu-
D and E). Gap-containing regions were not seen in the rally occurring irregularities, root canal spaces that
ESEM images from any of the different experimental were untouched during chemomechanical preparation,
groups. This suggests that roots subjected to instrumen- apical deltas, and variability of the thickness of the
tation and refill form seals similar to those formed sealer during obturation, microleakage could be ex-
during the preliminary root canal filling. plained by the high solubility and dimensional changes
of the sealer.16 Polymerization shrinkage may also be
DISCUSSION responsible for possible formation of gaps leading to
The superior sealing capacity of Resilon may be increasing apical leakage, even though we could not
attributed to the adhesion of the Resilon cone/sealer clearly identify these gaps in the ESEM images.17
into the dentin walls and tubules of the root canal Environmental scanning electron microscopy allows
system. While this property of Resilon indicates that it the examination of fully hydrated specimens in their
can be used for primary root canals, it was previously natural state with no prior specimen preparation. This
unknown whether this material would form an effective procedure eliminates artifacts caused by vacuum des-
seal in retreated teeth. iccation during conventional SEM.13 The ESEM im-
Leakage tests are an accepted method for comparing ages of the sections confirmed the creation of a new
the seal formed by filling materials, although a univer- resin sealer bonding/tag layer after retreatment. The
sally accepted procedure does not exist.14 Glucose was resin tags were well extended into the dentinal wall,
used as the tracer because of its size and physicochem- and new resin tags meshed with remnants could be
ical properties. It is sensitive and nondestructive and seen. This indicates that Resilon is able to penetrate the
can be used repeatedly.12 However, a glucose solution dentin after reinstrumentation to form a seal, as seen in
without any preservative presents a risk of contamina- specimens from group 1.
tion by bacteria and subsequent decomposition of the For reinstrumentation and complete Resilon material
glucose. Xu et al.12 used the glucose solution contain- removal in groups 2 and 3, the apical third was pre-
ing 0.2% NaN3 in their microleakage model. At this pared to ISO size #60. This is 2 sizes larger than that
concentration, however, the glucose solution was alka- used for initial instrumentation of the roots. Masiero
line (pH 7.83). Preliminary tests were performed to and Barietta18 enlarged the apical sizes of mandibular
determine the concentration of NaN3 most suitable for premolars by only 0.05 mm during retreatment. Re-
the present experiment. Small disks of the core material moval of condensed Resilon from the dentinal walls
and sealer were prepared and placed in glucose solu- with hand files was more time consuming and difficult
tions containing different concentrations of NaN3 for than with rotary instruments. With both methods, there
30 days. With a concentration of 0.01% NaN3, there were areas on the dentinal surface where the removal of
was only slight degradation of the Resilon core material the material was not complete during reinstrumenta-
(⬍0.1% of its weight) and bacterial growth could be tion. However, visible gap-containing regions were not
prevented. The pH value of the solution was essentially seen in the ESEM samples from any of the experimen-
neutral (pH 6.96). Because of possible degradation of tal groups.
the Resilon in an alkaline medium, a concentration of The main advantage of Resilon is its ability to adhere
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850 Lin et al December 2007

Fig. 2. Graph showing microleakage of the experimental and control groups.

Fig. 3. Esem micrographs showing attachment of resin tags before (A-C) and after re-treatment (D, E).

to the dentin walls, but Shipper et al.3 questioned its
capacity to withstand retreatment. The aim of the
present study was to compare the sealing capacity of
canals filled with Resilon and of canals refilled with
Resilon. We found no statistical difference between the
experimental groups, which suggests that the sealing
capacity after reinstrumentation and refilling of root
canals with Resilon is almost the same as the initial
filling. Because in the different groups glucose leaked
at approximately the same rate, we concluded that the
capacity of Resilon to form resin tags was retained after
retreatment. The presence of gaps could be expected
because of the presence of residual sealer on the den-
tinal surface after reinstrumentation. However, none of
the specimens showed regions that could clearly be
identified as gaps.
Although Resilon/Epiphany system may to be a good
root filling material, recent studies have shown that the
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Volume 104, Number 6
seal obtained may be no better than gutta-percha/seal-
er.19,20 In the present study, a continuous and increas-
ing rate of leakage occurred from the first day onward
in all of the experimental groups. However, the clinical
significance of in vitro microleakage has been ques-
tioned.21 The amount of leakage in in vitro studies
comparing the sealing ability of endodontic materials
does not take into consideration the tissue response
expected in an in vivo situation. Moreover, the amount
of leakage in vivo may also be influenced by the pres-
ence or absence of coronal restorations, quality of root
canal filling, and number and virulence of the micro-
organisms.22 Because of limitations of in vitro studies,
these results should be treated with caution. Further
studies should be performed to compare in vivo the
sealing ability of Resilon/Epiphany and gutta-percha/
sealer systems after retreatment.
CONCLUSION
Under the present experimental conditions, Resilon
could be successfully used to refill root canals. There
were no statistical differences in leakage between roots
after preliminary Resilon filling and refilling after re-
instrumentation. However, this new filling material also
allowed leakage to occur before and after retreatment.
REFERENCES
1. Friedman S, Stabholz A. Endodontic retreatment— case selection
and technique. Part 1: criteria for case selection. J Endod
1986;12:28-33.
2. Stabholz A, Friedman S. Endodontic retreatment— case selection
and technique. Part 2: treatment planning for retreatment. J
Endod 1988;14:607-14.
3. Shipper G, Ørstavik D, Teixeira FB, Trope M. An evaluation of
microbial leakage in roots filled with a thermoplastic synthetic
polymer– based root canal filling material (Resilon). J Endod
2004;30:342-7.
4. Tay FR, Pashley DH. Monoblocks in root canals: a hypothetical
or a tangible goal. J Endod 2007;33:391-8.
5. Teixeira FB, Teixeira EC, Thompson JY, Trope M. Fracture
resistance of roots endodontically treated with a new resin filling
material. J Am Dent Assoc 2004;135:646-52.
6. Shipper G, Teixeira FB, Arnold RR, Trope M. Periapical inflam-
mation after coronal microbial inoculation of dog roots filled
with gutta-percha or Resilon. J Endod 2005;31:91-6.
7. Ezzie E, Fleury A, Solomon E, Spears R, He J. Efficacy of
retreatment techniques for a resin-based root canal obturation
material. J Endod 2006;32:362-4.
8. Stratton RK, Apicella MJ, Mines P. A fluid filtration comparison
of gutta-percha versus Resilon, a new soft resin endodontic
obturation system. J Endod 2006;32:642-5.
9. Tunga U, Bodrumlu E. Assessment of the sealing ability of a new
root canal obturation material. J Endod 2006;32:876-8.
Lin et al 851
10. Bodrumulu E, Tunga U. Apical leakage of Resilon obturation
material. J Contemp Dent 2006;7:45-52.
11. Schirrmeister JF, Meyer KM, Hermanns P, Altenburger MJ,
Wrbas KT. Effectiveness of hand and rotary instrumentation for
removing a new synthetic polymer-based root canal obturation
material (Epiphany) during retreatment. Int Endod J 2006;39:
150-6.
12. Xu Q, Ming-wen F, Bing F, Gary SPC, Han-lin H. A new
quantitative method using glucose for analysis of endodontic
leakage. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2005;99:107-11.
13. Tay FR, Loushine RJ, Weller RN, Kimbrough WF, Pashley DH,
Mak YF, et al. Ultrastructural evaluation of the apical seal in
roots filled with a polycaprolactone-based root canal filling ma-
terial. J Endod 2005;31:514-9.
14. Wu MK, Wesselink PR. Endodontic leakage studies reconsid-
ered. Part I. Methodology, application and relevance. Int Endod
J 1993;26:37-43.
15. Tay FR, Pashley DH, Williams MC, Raina R, Loushine RJ,
Weller RN, et al. Susceptibility of a polycaprolactone-based root
canal filling material to degradation. I. Alkaline hydrolysis. J
Endod 2005;31:593-8.
16. Versiani MA, Carvalho-Junior JR, Padilha MI, Lacey S, Pascon
EA, Sousa-Neto, MD, et al. A comparative study of physico-
chemical properties of AH Plus and Epiphany root canal sealants.
Int Endod J 2006;39:464-471.
17. Tay FR, Sidhu SK, Watson TF, Pashley DH. Water-dependent
interfacial transition zone in resin-modified glass-ionomer ce-
ment-dentin interfaces. J Dent Res 2004;83:644-9.
18. Masiero AV, Barietta FB. Effectiveness of different techniques
for removing gutta-percha during retreatment. Int Endod J
2005;38:2-7.
19. Biggs SG, Knowles KI, Ibarrola JL, Pashley DH. An in vitro
assessment of the sealing ability of Resilon/Epiphany using fluid
filtration. J Endod 2006;32:759-61.
20. Aptekar A, Ginnan K. Comparative analysis of microleakage and
seal for 2 obturation materials: Resilon/Epiphany and gutta-
percha. J Can Dent Assoc 2006;72:245a-d.
21. Karagenç B, Gençoǧlu N, Ersoy M, Cansever G, Külekçi G. A
comparison of four different microleakage tests for assessment of
leakage of root canal fillings. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod 2006;102:110-3.
22. Siqueira JF Jr, Rocas IN, Faviere A, Abad EC, Castro AJ,
Gahyva SM. Bacterial leakage in coronally unsealed root canals
obturated with 3 different techniques. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2000;90:647-50.
Reprint requests:
Jun-Qi Ling, DDS, MD, PhD
Endodontics and Conservative Dentistry
Guanghua College of Stomatology
Sun Yat-sen University
56, Ling Yuan west road
Guangzhou 510055
China
lingjun_qi@yahoo.co.uk