Table 1.—Mean, Standard Deviation, and Minimum
However,
and Maximum Values of Forces for Experimental
Groups (in Newtons)
Groups n Mean SD Min
1 (AH26 þ gutta-percha) 15 1021.04 226.74 684.31 1365.01
2 (Resilon þ Epiphany) 15 886.33 175.15 600.00 1223.96
3 (Ketac-Endo Aplicap þ 15 741.38 175.46 426.73 1053.56
gutta-percha)
4 (No obturation) 15 831.40 163.07 598.00 1202.00
(Courtesy of Ulusoy Ö_IA, Genç Ö, Arslan S, et al: Fracture resistance of roots
obturated with three different materials. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 104:705-708, 2007.)
Methods.—The tested combinations were AH26 þ
gutta-percha, Resilon þ Epiphany, and Ketac-Endo Aplicap
þ gutta-percha. AH26 is an epoxy resin sealer, Resilon is
a dual-curable thermoplastic synthetic resin material, and
Ketac-Endo Aplicap is a glass ionomer-based sealer. Fifteen
root canals that had been instrumented were treated with
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.
Results.—All of the roots fractured, and most fractures
were oriented vertically (Table 1). The groups differed sig-
nificantly, with higher resistance for the AH26 þ gutta-per-
cha group than for the other three groups. The Resilon þ
Epiphany and Ketac-Endo Aplicap þ gutta-percha groups
Shrinkage of endodontic sealers
Background.—In root canal therapy, three-dimensional
obturation is carried out to prevent leakage and reinfection.
Leakage from apical and coronal sites may cause more fail-
ure of endodontically treated teeth than any other factor.
The methacrylate resin systems developed bond to tooth
structure better than traditional gutta-percha, which should
minimize leakage. However, resin materials suffer from
polymerization shrinkage, which can lead to stress on the
root canal walls, marginal gaps, microleakage, and clinical
failure. Polymerization shrinkage causing strain is time-
dependent and not fully understood. The most recently
developed root canal sealers were investigated to deter-
mine their polymerization shrinkage behavior.
Methods.—The EndoRez, RealSeal, and GuttaFlow
products were tested. The first two are dual cure resin-
based materials and the last is silicon based. Tubli-Seal
(a zinc-oxideeugenol-based material) was used as a stan-
dard to which the other materials were compared. The
314 Dental Abstracts
also had significantly different resistance values.
the fracture resistance of the Ketac-Endo Aplicap þ gutta-
percha group did not differ significantly from that of
Max
controls.
Discussion.—The greatest fracture resistance was
achieved with the AH26 þ gutta-percha obturation combi-
nation. Gutta-percha also has the properties of availability,
ease of manipulation, and relative reinforcement effect,
making it still an attractive first choice for root canal
obturation.
Clinical Significance.—Root fracture is a com-
mon mode of failure for root canal filled teeth.
Of the three filling techniques analyzed here,
AH26 D gutta-percha was the most resistant to
fracture. The effect of post placement on
strength with these materials was not addressed
in this study.
Ulusoy Ö_IA, Genç Ö, Arslan S, et al: Fracture resistance of roots ob-
turated with three different materials. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 104:705-708, 2007
Reprints available from Ö_IA Ulusoy, Dept of Operative Dentistry and
Endodontics, Gazi Univ Dental Faculty, 8.St, Emek, Ankara, Turkey;
e-mail: ilkeatasoy@yahoo.com
bonded disk method was used for 60 specimens tested at
23 C and 37 C. Samples underwent tests for 24 hours,
with the dual cure resin-based sealers tested as chemically
cured only and as dual cured. Polymerization shrinkage be-
havior and polymerization shrinkage-strain were measured.
Results.—At 23 C all of the sealers except GuttaFlow
demonstrated polymerization shrinkage (Table 2). The
highest shrinkage-strain value of 7.81% was noted for En-
doRez dual cure; the lowest value of 0.14% was found
with Tubli-Seal. At 37 C the shrinkage-strain values were
comparable to those at 23 C except for Tubli-Seal. With
increased temperature there was a decline in setting time
for all groups. Overall, Tubli-Seal was dimensionally stable,
with polymerization shrinkage-strain values that were very
low at both temperatures. GuttaFlow was also quite stable
but showed a slight expansion, as expected. EndoRez dual
cure demonstrated higher shrinkage-strain values than
the other materials. The working time of the Tubli-Seal
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
Shrinkage-strain Start of Polymerization
Tubli-Seal 0.14% (0.06)
GuttaFlow 0.16% (0.14)
EndoRezD* 7.81% (0.30)
EndoRezCy 7.05% (0.13)
RealSealD* 2.34% (0.25)
RealSealCy 4.15% (0.18)
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
canal.
Discussion.—Resin-based sealers are becoming quite
common in root canal therapy and offer advantages related
to chemical bonding that other sealers do not have, such as
increased resistance to vertical fracture. However, the
shrinkage associated with polymerization for these mate-
rials presents a serious disadvantage. In the comparison,
significant differences were found between the various ma-
terials. The highest shrinkage-strain values were obtained
with EndoRez, then, in descending order, RealSeal and Tu-
bli-Seal. GuttaFlow exhibited expansion on polymerization,
which may help to prevent gap formation and decrease
microleakage.
Esthetic Dentistry
Screw access hole chipping fractures
Background.—Ceramic materials are used in dentistry
because they are highly biocompatible, offer good es-
thetic results, and show minimal accumulations of plaque.
However, catastrophic failure can occur, affecting both
function and esthetics. Various systems for repairing ce-
ramic restorations intraorally are now available. Advan-
tages of these systems include the ability to obtain
natural color blending, excellent retention, and adhesive
durability of the composite resin to the fractured ceramic
surface. Screw-retained ceramic veneered implant fixed
partial dentures (FPDs) with restored or unrestored
screw access holes (SAHs) were investigated to determine
if dynamic loading produces more chipping fractures
on the occlusal surface of the FPDs with or without
restorations.
37 C
Shrinkage-strain Start of polymerization
65.9 0.2% (0.09) 18.5
124.8 0.76% (0.10) 38.3
27.7 9.33% (0.77) 1.9
42.1 8.3% (1.04) 4.3
21.1 3.54% (0.22) 1.3
28.3 4.47% (0.15) 6.5
Clinical Significance.—Resin-based sealers
are enjoying popularity due to the anticipated
advantage of their bonding to tooth structure,
thus enhancing their sealing ability. However,
they shrink on setting, and the forces thereby
generated may overcome the strength of the
bond. Further studies, especially clinical trials,
are needed to sort things out.
Hammad M, Qualtrough A, Silikas N: Extended setting shrinkage
behavior of endodontic sealers. J Endod 34:90-93, 2008
Reprints available from M Hammad, School of Dentistry, The Univ
of Manchester, Higher Cambridge St, Manchester M15 6FH, UK;
e-mail: Mohammad.Hammad@postgrad.manchester.ac.uk
Methods.—A total of 20 screw-retained ceramic
veneered five-unit FPDs were prepared for a three-implant
situation. After the ceramic surface was etched with hydro-
fluoric acid for 1 minute, the SAHs were filled with a foam
pellet and silicone to the interface of metal and ceramic.
A silane coupling agent and bonding agent were applied
to the surface, then composite resin was used to restore
the SAHs for 10 samples (Fig 2). These underwent adjust-
ments of the static and dynamic occlusion and polishing.
Ten other samples remained unrestored. All of the FPDs
were loaded to the implant position for 20,000 cycles of
100 N of force for 1 second, then no load for 1 second.
The FPDs were then assessed by three investigators using
a light microscope and dental probe to determine the num-
ber of chipping fractures present in each case.
Volume 53  Issue 6  2008 315