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Comparison of Seal After Obturation Techniques Using a

Polydimethylsiloxane-Based Root Canal Sealer

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Basic Research—Technology
Comparison of Seal After Obturation Techniques Using a
Polydimethylsiloxane-Based Root Canal Sealer
Martha G. Brackett, DDS,* Rebecca Martin, BS,† Jeremy Sword, BS,‡ Cindy Oxford, BS,*
Frederick A. Rueggeberg, DDS, MS,* Franklin R. Tay, BDSc (Hons), PhD,‡
and David H. Pashley, DMD, PhD‡
Abstract
A polydimethylsiloxane-based sealer (GuttaFlow) was
used for filling single-rooted teeth with four obturation
techniques. Prefitted gutta-percha master-cones were
employed in groups 1 to 3 with backfilling of the sealer.
Apical third of the roots were first filled with GuttaFlow,
and sealer-coated master cones were seated with up-and-
down motion (group 1) or rotated to place (group 2).
Master-cones were used as carriers for introducing Gut-
taFlow into the canals (group 3). Canals were filled with
GuttaFlow without master-cones (group 4). Canals were
filled with AH Plus/gutta-percha using warm vertical com-
paction (control group 5). All obturated canals were tested
for leakage after 1, 6, and 12 weeks using the fluid
filtration technique. All groups exhibited equivalent seal
regardless of time except for more extensive leakage in
group 3. The use of GuttaFlow with a single gutta-percha
master cone creates an apical seal that is equivalent to
that produced with gutta-percha/AH Plus sealer using
warm vertical compaction. (J Endod 2006;32:1188–1190)
Key Words
AH Plus sealer, fluid filtration, GuttaFlow, leakage
From the *Department of Oral Rehabilitation, †Dental
Student, ‡Department of Oral Biology & Maxillofacial Pathol-
ogy, School of Dentistry, Medical College of Georgia, Augusta,
Georgia.
Address requests for reprints to Dr. David H. Pashley,
Department of Oral Biology & Maxillofacial Pathology, School
of Dentistry, Medical College of Georgia, 1120 15th Street,
CL-2112, Augusta, GA 30912-1129. E-mail address: dpashley@
mail.mcg.edu.
0099-2399/$0 - see front matter
Copyright © 2006 by the American Association of
Endodontists.
doi:10.1016/j.joen.2006.07.009
1188 Brackett et al.
M any different endodontic obturation techniques, materials, and sealers are avail-
able (1–10). The ideal materials should be biocompatible with periapical tissues,
easy to use, opaque to X-rays, expand slightly on setting, easily removed, and provide an
excellent seal over time.
Recently, a polydimethylsiloxane-based root canal sealer has been introduced.
The initial version was called RoekoSeal (Colténe/Whaledent, Altstätten, Switzerland).
Several studies have reported excellent biocompatibility and apical sealing using this
material (11–14). RoekoSeal has been improved by adding nanosilver particles and
powdered gutta-percha to create a new material called GuttaFlow (Coltène/Whaledent).
An initial report on film thickness and flow properties of this gutta-percha containing
sealer has been positive (15).
The purpose of this study was to compare the sealing quality of GuttaFlow that
was employed with different gutta-percha single-cone techniques, with that of
warm vertically compacted gutta-percha/AH Plus sealer using the fluid filtration
technique (16 –18). The null hypothesis was that there are no differences in the ability
of GuttaFlow to seal root canals compared to a conventional warm vertical compaction
technique. It was further hypothesized that the sealing qualities of GuttaFlow using an
injection technique versus that when using a master-cone to carry GuttaFlow to the apex
are not different, and that these sealing qualities would not be compromised over
12 weeks of water storage.
Materials and Methods
Fifty-four single-rooted, extracted anterior human teeth were used under a pro-
tocol approved by the IRB of the Medical College of Georgia. The crowns were sectioned
so that all roots were approximately 17 mm long. Cleaning and shaping and canal
obturation were performed under an operating microscope (OPMI Pico, Carl Zeiss
Surgical, Inc., Thornwood, NY), with radiographic documentation of the preoperative
specimens, working lengths, cone-fit, and postoperative condition of the root fillings.
Canal patency was achieved with an ISO #15 file (Flex-O-File, DentsplyTulsa, Tulsa,
OK). The working length was established 0.5 mm short of the apex. Instrumentation was
performed with a crown-down technique, using Gates Glidden drills and 0.06 taper
nickel-titanium rotary instruments (Sequence, Brasseler, Savannah, GA) to ISO #40.
The canals were alternately irrigated with 10 ml of 6.15% sodium hypochlorite (NaOCl)
(Clorox, Oakland, CA) and 10 ml of 17% ethylenediaminetetraacetic acid (EDTA)
(Pulpdent Corporation, Watertown, MA) in between instrumentation, with the latter
employed for 1 min as the final rinse. The canals were dried with multiple paper points
and then randomly divided into five groups (n ⫽ 10). Two additional roots were used
as the positive control and another two as the negative control.
Filling Techniques
Group 1: GuttaFlow Obturation Using Master-Cone With
Up-and-Down Movement
A nonstandardized 0.06 taper gutta-percha master-cone (Hygienic Inc., Cuyahoga
Falls, OH) was trimmed with a gutta gauge (DentsplyTulsa) to ISO size #40 and prefitted with
tug-back. A capsule of GuttaFlow was triturated for 20 sec in an amalgamator. A small
quantity of GuttaFlow was placed on a mixing pad for coating master-cones. Using a special
tip and syringe provided by the manufacturer, GuttaFlow was injected to fill the apical-third
JOE — Volume 32, Number 12, December 2006
 Basic Research—Technology
Group 5: AH Plus Obturation With Warm Vertical Compaction
An epoxy resin-based sealer (AH Plus, DentsplyTulsa) was placed
into the root canal using the pretrimmed gutta-percha master cone as a
carrier. Root canals were obturated with the continuous wave conden-
sation technique using a heat source (System B, SybronEndo, Orange
CA) and then backfilled with an Obtura II unit (Spartan, Fenton, MO)
using 23 gauge needle tips.

Positive Control
A pretrimmed master cone was inserted to within 1 mm of the
working length with tug back without the use of a sealer. The gutta-
percha was seared off from the canal orifice with the System B heat
source so that it was flush with the canal orifice.

Figure 1. Schematic of fluid flow apparatus for measuring leakage of obturated
root canals. The movement of a tiny air-bubble in a microcapillary tube indi-
cates the volumetric leakage rate (␮l/min⫺1).
Negative Control
The canals were filled in the manner described in group 5. After
obturation, the entire root was dipped into molten sticky wax (Kerr
Sybron, Emerville, CA) to seal the root surface and apex. After cooling,
sticky wax was removed from the cut coronal surface of each root to
provide a clean surface for attachment to the Plexiglass block for fluid
filtration.

of the roots. The prefitted master-cone was coated with additional Gutta-
Flow, introduced into the canal, and moved up and down twice to ensure
complete sealer coverage of the canal walls. The remaining space was back-
filled by reinserting the GuttaFlow syringe tip into, and slowly withdrawing it
from the middle-third of the partially filled canal.
Group 2: GuttaFlow Obturation Using Master-Cone Rotated
to Place
The canals were filled in a similar manner as in group 1, except
that the GuttaFlow-coated, trimmed master-cone was rotated 180 de-
grees upon insertion to ensure complete wetting of the cone and the
canal wall.
Group 3: GuttaFlow Obturation With the Master-Cone
as Carrier
In this group, the apical third of the canals was not prefilled with
the sealer. Instead, the pretrimmed ISO #40, 0.06 taper master cone
was used as a carrier to introduce the GuttaFlow to the apical third. This
was followed by backfilling of the middle and coronal third of the canal
in the manner described in group 1.
Group 4: GuttaFlow Only
In this group, the GuttaFlow was injected into the root canal by
placing the delivery tip to within 3 mm of the root apex. After filling the
entire root canal with GuttaFlow, a lentulo spiral was used to remove
radiographically detected air voids that were trapped within the root
canal during the injection of the GuttaFlow (19).
Fluid Filtration Technique
All the teeth were stored in distilled water for one week. After
removing the coronal 2 mm of gutta-percha from the root, the filled root
was inverted on a Plexiglass block penetrated by an 18-gauge stainless
steel tube (Fig. 1). The mounted roots were connected to a fluid-filled
pressure system (Fig. 1) that measured water movement through obtu-
rated roots under a constant pressure of 69 kPa by monitoring the
movement of an in-line bubble.
Specimen seal (as denoted by measured movement of the in-line
air bubble, Fig. 1) was evaluated longitudinally after 1, 6, and 12 weeks
of storage at 37°C in artificial saliva containing 0.02% sodium azide.
Statistics
The fluid flow results were evaluated by a two-way repeated-mea-
sures ANOVA with time as the repetition factor. Multiple comparisons
were done using the Holm-Sidak multiple comparison at a ⫽ 0.05.
Results
The fluid flow rates in the positive control was 8.5 ⫾ 1.1 ␮l min⫺1
and the negative control was zero (Table 1). The intrinsic permeability
of the fluid filtration apparatus pressurized to 69 kPa with a hemostat
closing the polyethylene tubing to the mounted roots was between zero
and 0.004 ␮l min⫺1.
The results indicate that the initial seal of 17 mm-long roots by
GuttaFLow/gutta-percha was not technique-sensitive in that after one
week storage, the leakage of all groups were not significantly different
(Fig. 2, Table 1). After 6 and 12 weeks of storage, there were no statis-

TABLE 1. Summary of the effects of storage time on leakage of root canal fillings
Group 1 Group 2 Group 3 Group 4 Group 5
Storage
GuttaFlow & MC GuttaFlow & MC GuttaFlow & MC GuttaFlow AH Plus &
Time
Up and Down Rotated as Carrier Only GP (control)
1 week 0.070aA ⫾ 0.048 0.050aA ⫾ 0.029 0.039aA ⫾ 0.027 0.018aA ⫾ 0.009 0.012aA ⫾ 0.011
6 weeks 0.080aA ⫾ 0.053 0.076aA ⫾ 0.028 0.190bB ⫾ 0.155 0.021aA ⫾ 0.019 0.026aA ⫾ 0.025
12 weeks 0.077aA ⫾ 0.036 0.094aA ⫾ 0.119 0.280bB ⫾ 0.437 0.064aA ⫾ 0.069 0.052aA ⫾ 0.066
Values are means (␮l min⫺1) ⫾ SD (n ⫽ 10). Each horizontal row represents the fluid filtration results obtained from the five treatment techniques at one particular time interval. Means identified by different
lower case letters in the horizontal rows are significantly different (p ⬍ 0.05). Each vertical row represents the fluid filtration results obtained for one particular technique at different time intervals. Means identified
by different upper case letters in the vertical columns are significantly different (p ⬍ 0.05). Filtration pressure was 69 kPa.
Abbreviations: MC, master cone; GP, gutta-percha.

JOE — Volume 32, Number 12, December 2006 Comparison of Seal After Obturation Techniques 1189
Basic Research—Technology
Figure 2. Summary of the leakage of all groups over time. At 1 week, there were
no significant differences between any of the groups. By 6 weeks, group 3 (use
of master-cone as a carrier) began to leak more than any other group. This was
also the case after 12 weeks. Groups identified by different lower case letters are
significantly different (p ⬍ 0.05).
tically significant increases from the 1 week flow rates except for group
3 (compare upper case letters in vertical columns in Table 1). Group 5
(AH Plus/ gutta-percha, warm vertical compaction) had the lowest leak-
age at all time periods, although the results were not significantly dif-
ferent from groups 1, 2, and 4 (p ⬎ 0.05).
Discussion
The results of this study support the null hypothesis that there is no
difference in the ability of GuttaFlow to seal root canals using a single-cone
technique compared to warm vertical compaction of gutta-percha with a
conventional epoxy resin-based sealer, at least 1 week after obturation. The
second null hypothesis, that GuttaFlow application method does not affect
flow rate (sealing) must be rejected because group 3 began to demonstrate
higher flow rates after 6 and 12 weeks. The design of group 3 by using a
master gutta-percha cone as the GuttaFlow carrier was based on the initial
perception that such a technique would prevent inadvertent sealer extrusion
through patent apical foramen when the sealer was inserted with the
Colténe/Whaledent into the apical third of the root canal. Compared with
groups 1, 2, and 4, relatively less sealer was employed in group 3, which
could have accounted for the more extensive leakage observed in this group
after 6 and 12 weeks of water storage.
Group 4, in which no master-cone was used and the entire canal
filled with GuttaFlow, showed the lowest flow rates of all GuttaFlow
groups. The result paralleled that reposted by Whitworth and Baco (14)
who found that the use of both AH Plus and RoekoSeal Automix sealers
only as backfills provided leak-proof coronal seals. These authors sug-
gested further validation of their results with a longitudinal study using
the fluid filtration method, as was used in the current work.
The use of sealer alone is an intriguing but radical concept. The results
in this study indicated such treatment provided low leakage (good sealing),
but were obtained using single-rooted, straight teeth. It remains to be de-
termined whether similar positive results may be obtained with the use of
sealers only in posterior teeth with curved roots. The mechanism(s) under-
lying the good performance of use of sealer only to fill the root canal space
may be because of the homogeneity of the material (19). When gutta-percha
points are used in conjunction with sealer, there are more material inter-
faces than if sealer alone is used. That is, there is an interface between the
sealer and dentin and a second interface between the sealer and gutta-
1190 Brackett et al.
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percha. By eliminating gutta-percha, the second interface, and its potential
for leakage, is eliminated. In addition, by eliminating gutta-percha, the en-
tire seal may be because of an increased volume of sealer. This increased
volume of material will undergo significantly more expansion when it sets
than will a thin film. Both AH Plus and GuttaFlow have been reported to
expand slightly during setting (20). These promising results obtained in
vitro under ideal conditions need to be examined over longer time periods
and in curved canals.
Nevertheless, it is prudent to point out that when root canals are
filled only with sealer that is inserted with an injector or with a lentulo
spiral, there is danger of extrusion of the sealer beyond the apex and
difficult length control. To take advantage of the sealing quality of GuttaFlow,
a more viable clinical protocol is to employ GuttaFlow with a single-cone
technique up to the middle third of the canal, followed by the use of
sealer only for backfilling the coronal third of the root canal (14, 21).
Of significant clinical interest is that the lowest leakage values were
obtained in the AH Plus/gutta-percha control group. This remains the
gold standard against which all new sealers and bondable root filling
materials must be measured.
Acknowledgments
This work was supported by Coltène/Whaledent, the manufac-
turer of GuttaFlow.
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JOE — Volume 32, Number 12, December 2006