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Table 1.—Mean, Standard Deviation, and Minimum also had significantly different resistance values.

and Maximum Values of Forces for Experimental the fracture resistance of the Ketac-Endo Aplicap þ gutta-
Groups (in Newtons) percha group did not differ significantly from that of
Groups n Mean SD Min Max
1 (AH26 þ gutta-percha) 15 1021.04 226.74 684.31 1365.01
Discussion.—The greatest fracture resistance was
2 (Resilon þ Epiphany) 15 886.33 175.15 600.00 1223.96
achieved with the AH26 þ gutta-percha obturation combi-
3 (Ketac-Endo Aplicap þ 15 741.38 175.46 426.73 1053.56
gutta-percha) nation. Gutta-percha also has the properties of availability,
4 (No obturation) 15 831.40 163.07 598.00 1202.00 ease of manipulation, and relative reinforcement effect,
making it still an attractive first choice for root canal
(Courtesy of Ulusoy Ö_IA, Genç Ö, Arslan S, et al: Fracture resistance of roots obturation.
obturated with three different materials. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 104:705-708, 2007.)

Clinical Significance.—Root fracture is a com-

Methods.—The tested combinations were AH26 þ mon mode of failure for root canal filled teeth.
gutta-percha, Resilon þ Epiphany, and Ketac-Endo Aplicap Of the three filling techniques analyzed here,
þ gutta-percha. AH26 is an epoxy resin sealer, Resilon is AH26 D gutta-percha was the most resistant to
a dual-curable thermoplastic synthetic resin material, and fracture. The effect of post placement on
Ketac-Endo Aplicap is a glass ionomer-based sealer. Fifteen strength with these materials was not addressed
root canals that had been instrumented were treated with in this study.
each of the combinations, forming three treatment groups;
another 15 root canals had no obturation. All were sub-
jected to gradually increasing force until they fractured.
Ulusoy Ö_IA, Genç Ö, Arslan S, et al: Fracture resistance of roots ob-
turated with three different materials. Oral Surg Oral Med Oral
Results.—All of the roots fractured, and most fractures Pathol Oral Radiol Endod 104:705-708, 2007
were oriented vertically (Table 1). The groups differed sig-
nificantly, with higher resistance for the AH26 þ gutta-per- Reprints available from Ö_IA Ulusoy, Dept of Operative Dentistry and
cha group than for the other three groups. The Resilon þ Endodontics, Gazi Univ Dental Faculty, 8.St, Emek, Ankara, Turkey;
Epiphany and Ketac-Endo Aplicap þ gutta-percha groups e-mail:

Shrinkage of endodontic sealers

Background.—In root canal therapy, three-dimensional bonded disk method was used for 60 specimens tested at
obturation is carried out to prevent leakage and reinfection. 23 C and 37 C. Samples underwent tests for 24 hours,
Leakage from apical and coronal sites may cause more fail- with the dual cure resin-based sealers tested as chemically
ure of endodontically treated teeth than any other factor. cured only and as dual cured. Polymerization shrinkage be-
The methacrylate resin systems developed bond to tooth havior and polymerization shrinkage-strain were measured.
structure better than traditional gutta-percha, which should
minimize leakage. However, resin materials suffer from Results.—At 23 C all of the sealers except GuttaFlow
polymerization shrinkage, which can lead to stress on the demonstrated polymerization shrinkage (Table 2). The
root canal walls, marginal gaps, microleakage, and clinical highest shrinkage-strain value of 7.81% was noted for En-
failure. Polymerization shrinkage causing strain is time- doRez dual cure; the lowest value of 0.14% was found
dependent and not fully understood. The most recently with Tubli-Seal. At 37 C the shrinkage-strain values were
developed root canal sealers were investigated to deter- comparable to those at 23 C except for Tubli-Seal. With
mine their polymerization shrinkage behavior. increased temperature there was a decline in setting time
for all groups. Overall, Tubli-Seal was dimensionally stable,
Methods.—The EndoRez, RealSeal, and GuttaFlow with polymerization shrinkage-strain values that were very
products were tested. The first two are dual cure resin- low at both temperatures. GuttaFlow was also quite stable
based materials and the last is silicon based. Tubli-Seal but showed a slight expansion, as expected. EndoRez dual
(a zinc-oxideeugenol-based material) was used as a stan- cure demonstrated higher shrinkage-strain values than
dard to which the other materials were compared. The the other materials. The working time of the Tubli-Seal

314 Dental Abstracts

Table 2.—Final Polymerization Shrinkage-Strain (%) After 24 Hours of Tested Root Canal Sealers (Standard
Deviations in Parentheses) and Time at Which the Polymerization Process of the Sealers Started (minutes)
23 C 37 C
Shrinkage-strain Start of Polymerization Shrinkage-strain Start of polymerization
Tubli-Seal 0.14% (0.06) 65.9 0.2% (0.09) 18.5
GuttaFlow 0.16% (0.14) 124.8 0.76% (0.10) 38.3
EndoRezD* 7.81% (0.30) 27.7 9.33% (0.77) 1.9
EndoRezCy 7.05% (0.13) 42.1 8.3% (1.04) 4.3
RealSealD* 2.34% (0.25) 21.1 3.54% (0.22) 1.3
RealSealCy 4.15% (0.18) 28.3 4.47% (0.15) 6.5

D, Dual cure; C, chemical cure.

(Courtesy of Hammad M, Qualtrough A, Silikas N: Extended setting shrinkage behavior of endodontic sealers. J Endod 34:90-93, 2008.)

and GuttaFlow was greater than for the resin-based sealers,

possibly helping to achieve better adaptation in the root Clinical Significance.—Resin-based sealers
canal. are enjoying popularity due to the anticipated
advantage of their bonding to tooth structure,
Discussion.—Resin-based sealers are becoming quite thus enhancing their sealing ability. However,
common in root canal therapy and offer advantages related they shrink on setting, and the forces thereby
to chemical bonding that other sealers do not have, such as generated may overcome the strength of the
increased resistance to vertical fracture. However, the bond. Further studies, especially clinical trials,
are needed to sort things out.
shrinkage associated with polymerization for these mate-
rials presents a serious disadvantage. In the comparison,
significant differences were found between the various ma-
Hammad M, Qualtrough A, Silikas N: Extended setting shrinkage
terials. The highest shrinkage-strain values were obtained behavior of endodontic sealers. J Endod 34:90-93, 2008
with EndoRez, then, in descending order, RealSeal and Tu-
bli-Seal. GuttaFlow exhibited expansion on polymerization, Reprints available from M Hammad, School of Dentistry, The Univ
which may help to prevent gap formation and decrease of Manchester, Higher Cambridge St, Manchester M15 6FH, UK;
microleakage. e-mail:

Esthetic Dentistry
Screw access hole chipping fractures
Background.—Ceramic materials are used in dentistry Methods.—A total of 20 screw-retained ceramic
because they are highly biocompatible, offer good es- veneered five-unit FPDs were prepared for a three-implant
thetic results, and show minimal accumulations of plaque. situation. After the ceramic surface was etched with hydro-
However, catastrophic failure can occur, affecting both fluoric acid for 1 minute, the SAHs were filled with a foam
function and esthetics. Various systems for repairing ce- pellet and silicone to the interface of metal and ceramic.
ramic restorations intraorally are now available. Advan- A silane coupling agent and bonding agent were applied
tages of these systems include the ability to obtain to the surface, then composite resin was used to restore
natural color blending, excellent retention, and adhesive the SAHs for 10 samples (Fig 2). These underwent adjust-
durability of the composite resin to the fractured ceramic ments of the static and dynamic occlusion and polishing.
surface. Screw-retained ceramic veneered implant fixed Ten other samples remained unrestored. All of the FPDs
partial dentures (FPDs) with restored or unrestored were loaded to the implant position for 20,000 cycles of
screw access holes (SAHs) were investigated to determine 100 N of force for 1 second, then no load for 1 second.
if dynamic loading produces more chipping fractures The FPDs were then assessed by three investigators using
on the occlusal surface of the FPDs with or without a light microscope and dental probe to determine the num-
restorations. ber of chipping fractures present in each case.

Volume 53  Issue 6  2008 315