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Lea CS et al. Comparison of the obturation density of cold lateral compaction versus warm vertical compaction using the continuous wave of condensation technique. J Endod. 2005 Jan;31(1):37-9.
Warm vertical compaction using the continuous wave of condensation technique in acrylic blocks resulted in a greater gutta percha fill by weight compared with standard cold lateral compaction.
Venturi M et al. Evaluation of apical filling after warm vertical gutta-percha compaction using different procedures. J Endod. 2004 Jun;30(6):436-40.
- Aim of study was to evaluate the quality of endodontic sealing in the apical 4mm of narrow and curved canals
- Schilder’s warm vertical technique
- Schilder’s technique modified by using electric heater
- Schilder’s technique modified by compaction of apical tract at body temperature
- Modified vertical compaction with apical back filling
- GP cut 1mm short of apex
- 1-2mm increments of heated GP were progressively removed using Touch N Heat
- GP was adapted with standard pluggers to reach 2.5 to 4mm to the apex
Wong M et al. Comparison of gutta-percha filling techniques, compaction (mechanical), vertical (warm), and lateral condensation techniques, Part 1. J Endod. 1981 Dec;7(12):551-8.
- Vertical Technique was significantly better than compaction technique (P<0.001).
- Compaction technique was significantly better than lateral technique (P<0.01).
Smith RS et al. Effect of varying the depth of heat application on the adaptability of gutta-percha during warm vertical compaction. J Endod. 2000 Nov; 26.
Thermoplasticized injectable (Obtura II placed within 2mm of WL) was ranked best followed by Warm Vertical Compaction with heat applications at 3, 4, 5, and 7mm. Lateral condensationn technique received the lowest ranking.
DuLac KA et al. Comparison of the obturation of lateral canals by six techniques. J Endod. 1999 May;25(5):376-80.
Lateral condensation (LC), continuous wave of condensation (CW), warm vertical condensation (WV), carrier-based thermoplasticized gutta-percha (CB), warm lateral condensation (WL), and vertically condensed high-temperature gutta-percha (HT)
All techniques filled Coronal, Middle, and Apical Lateral canal with sealer
- WV, CB, and CW were able to fill lateral canals significantly better when sealer was used
- WV, CB, CW and HT filled coronal and middle lateral canals significantly better with GP than LC or WL
- CB and CW filled apical lateral canal significantly better with GP than HT, WV, WL, or LC
Peng L et al. Outcome of root canal obturation by warm gutta-percha versus cold lateral condensation: a meta-analysis. J Endod 2007 Feb;33(2):106-9.
10 studies evaluating post-operative pain, long-term outcomes, obturation quality, and overextension.
Warm Gutta Percha or Cold Lateral Condensation are not significantly different except in overextension. Overextension was more likely to occur in the warm GP obturation group.
Post-operative pain prevalence, long-term outcomes, and obturation quality were similar between the two groups.
Clinton K et al. Comparison of a warm gutta-percha obturation technique and lateral condensation. J Endod. 2011 Nov;27(11):692-5.
A statistically significant difference was found between the groups in each category of evaluation. Gutta-percha using Thermafil was better able to flow into lateral spaces, had fewer voids, and replicated the surface of the root better. It also, however, was extruded out the apical foramen more than in the lateral condensation group.
Budd CS et al. A comparison of thermoplasticized injectable gutta-percha obturation techniques. J Endod. 1991 Jun; 17(6):260-4.
High and Low temperature thermoplasticized injectable techniques were significantly better than lateral condensation. There was no significant difference between either of the thermoplastic obturation techniques.
Gencoglu N et al. Comparison of different gutta-percha root filling techniques: Thermafil, Quick-fill, System B, and lateral condensation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002 Mar; 93(3):333-6.
- Roots obturated with Thermafil and JS Quick-Fill contained significantly more core material than did those obturated with System B or with lateral condensation.
- The lateral condensation technique had the lowest core/sealer ratio (P < .05).
- Roots using Thermafil and Quick-Fill showed significantly less dye leakage than did the lateral condensation technique.
- Thermafil and JS Quick-Fill with carrier and System B were found to be superior to the lateral condensation technique in terms of core/sealer ratio.
- Thermafil and Quick-Fill were superior to lateral condensation in terms of dye leakage.
Bal AS et al. Comparison of laterally condensed .06 and .02 tapered Gutta-Percha and sealer in vitro. J Endod. 2001 Dec;27(12):786-8.
- .02 tapered master cone allowed for the spreader to be penetrated significantly closer to the WL than when a .06 tapered master cone was used (p<0.05).
- The difference between the groups in the number of samples that demonstrated complete bacterial penetration was not significant (p>0.05).
Schafer E et al. Effect of three different sealers on the sealing ability of both thermafil obturators and cold laterally compacted Gutta-Percha. J Endod. 2002 Sep;28(9):638—42.
- Thermafil obturators had significantly more extrusion of filling material than canals filled by lateral compaction (p < 0.01).
- Thermafil without sealer showed significantly greater dye penetration compared with all other groups both in straight and in curved canals (p < 0.05).
- As long as a sealer was used, the seal obturated with Thermafil was equivalent in terms of dye penetration to lateral compaction.
- There were no statistical differences in the mean apical dye penetration among the three sealers (RSA RoekoSeal, AH Plus, AH26).
- The differences between the dye penetration in straight and in curved canals were insignificant for all groups (p > 0.05).
- Under the conditions of this study, Thermafil obturators achieved seals comparable to lateral compaction, as long as a sealer was used.
Martin RL et al. Sealing properties of mineral trioxide aggregate orthograde apical plugs and root fillings in an in vitro apexification model. J Endod. 2007 Mar;33(3):272-5.
- MTA Apical Plug (3-5mm) vs. Complete orthograde MTA fillings
- Although MTA root fillings exhibited a better seal than MTA apical plugs at 48 hours, seals of these two groups were not significantly different after 4 weeks. Interaction of MTA with PBS (phosphate-buffered saline - solution that teeth were stored) may result in apatite deposition that improves the seal of MTA apical plugs with time.
Matt GD et al. Comparative study of white and gray mineral trioxide aggregate (MTA) simulating a one- or two-step apical barrier technique. J Endod. 2004 Dec;30(12):876-9
- Gray vs White MTA
- Immediate obturation (one-step) vs after MTA set for 24h
- Gray MTA demonstrated significantly less leakage than white MTA (p < 0.001).
- The two-step technique showed significantly less leakage than one-step (p < 0.006).
- The 5-mm thick barrier was significantly harder than the 2 mm barrier, regardless of the type of MTA or number of steps (p < 0.01).
- Results suggested that a 5 mm apical barrier of gray MTA, using two-steps, provided the best apical barrier.
Al-Kahtani A et al. In-vitro evaluation of microleakage of an orthograde apical plug of mineral trioxide aggregate in permanent teeth with simulated immature apices. J Endod. 2005 Feb;31(2):117-9.
- 2mm orthograde apical plug; canal left unfilled
- 5mm orthograde apical plug; canal left unfilled
- 2mm apical plug, second 2mm increment 24h later; canal left unfilled
- 2mm apical plug that set for 24h then back-filled with gutta percha and eugenol based sealer
- Positive control. No MTA.
- Results showed a statistically significant difference only in the 5mm apical plug, which completely prevented bacterial leakage.
- Lee KW et al. Adhesion of endodontic sealers to dentin and gutta-percha. J Endod. 2002 Oct;28(10):684-8
- Kerr ZOE based sealer
- Sealapex - CaOH2 based sealer
- AH 26 - epoxy resin-based system
- Ketac Endo - glass ionomer based sealer
- Sealant bond strength to dentin
- AH 26 > Ketac Endo > significantly different > Sealapex >Kerr
- Sealant bond strength to gutta percha
- AH 26 > significantly different > Kerr, Sealapex, Ketac endo
Lopes HP, Siqueira JF, Elias CN. Scanning electron microscopic investigation of the surface of gutta-percha cones after cutting. J Endod. 2000 Jul;26(7):418-20.
Cutting with scissors and razor blade/calibrator produced significant irregularities in the cone surface. Cutting with razor blades against a glass slab, with or without previous use of a calibrator, allowed the development of a smooth auxiliary gutta-percha cone surface.
McComb D et al. A preliminary scanning electron microscopic study of root canals after endodontic procedures. J Endod. 1975 Jul;1(7):238-42.
The use of a commercial liquid ethylenediaminetetraacetic acid (EDTA) preparation (REDTA) as an irrigant or as a chemical treatment produced the cleanest canal walls. The most effective cleaning procedure was the use of REDTA sealed in the canal for 24 hours. Canals treated in this way were free of a smeared layer and superficial debris.
Mamootil K et al. Penetration of dentinal tubules by endodontic sealer cements in extracted teeth and in vivo. Int Endod J. 2007 Nov;40(11):873-81.
The depth and consistency of dentinal tubule penetration of sealer cements appears to be influenced by the chemical and physical characteristics of the materials. Resin-based sealers (AH26) displayed deeper and more consistent penetration. Penetration depths observed for the epoxy resin-based sealer in vivo were consistent with that found in the experimental model.
Loushine BA et al. Setting properties and cytotoxicity evaluation of a premixed bioceramic root canal sealer. J Endod. 2011 May;37(5)673-7.
- Compare EndoSequence BC Sealer for cytotoxicity comparison with an epoxy resin-based sealer (AH Plus).
- Further studies are required to evaluate the correlation between the length of setting time of BC Sealer and its degree of cytotoxicity.
Zhou HM et al. Physical properties of 5 root canal sealers. J Endod. 2013 Oct;39(10):1291-6.
- The aim of this study was to evaluate pH change, viscosity, and other physical properties of 2 novel root canal sealers (MTA Fillapex and Endosequence BC) in comparison with 2 epoxy-resin based sealers (AH Plus and ThermaSeal), a silicone-based sealer (GuttaFlow), and a zinc-oxide-eugenol-based sealer (Pulp Canal Sealer).
- The tested sealers were pseudoplastic according to their viscosities as determined in this study. The MTA Fillapex and Endosequence BC sealers each possessed comparable flow and dimensional stability but higher film thickness and solubility than the other sealers tested.
Hammad M et al. Evaluation of root canal obturation: a three-dimensional in vitro study. J Endod. 2009 Apr;35(4):541-4.
- Four groups, obturated by using cold lateral compaction:
- GP and TubliSeal
- EndoRez and EndoRex sealer
- RealSeal points and RealSeal sealer
- GP and GuttaFlow sealer
- Percentage of gaps and voids was calculated. Statistical analysis showed that gutta-percha exhibited an overall significantly lower percentage (1.02%) of voids and gaps. The present study showed that none of the root canal filled teeth were gap-free. Roots filled with gutta-percha showed less voids and gaps than roots filled with the remaining filling materials.
Li GH et al. Ability of new obturation materials to improve the seal of the root canal system: a review. Acta Biomater. 2014 Mar;10(3):1050-63.
From the perspective of clinical performance, classic root filling materials have stood the test of time. Because many of the recently introduced materials are so new, there is not enough evidence yet to support their ability to improve clinical performance. This emphasizes the need to translate anecdotal information into clinically relevant research data on new biomaterials.
Waltimo TM et al. Clinical performance of 3 endodontic sealers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001 Jul;92(1):89-92
The overall influence of the sealer on treatment outcome was small. Root fillings with salicylate resin containing Ca(OH)2 may support more rapid healing of apical periodontitis or operative trauma, but the results after 3 and 4 years were as good for zinc oxide-eugenol-based sealers with or without Ca(OH)2.
Candeiro GT et al. Evaluation of radiopacity, pH, release of calcium ions, and flow of a bioceramic root canal sealer. J Endod. 2012 Jun;38(6):842-5.
EndoSequence BC Sealer - radiopacity, pH, release of calcium ions, and flow were analyzed.
Endosequence BC Sealer showed radiopacity and flow according to ISO 6876/2001 recommendations. The other physicochemical properties analyzed demonstrated favorable values for a root canal sealer.
Trope M. Flare up rate of single-visit endodontics. Int Endod J. 1991 Jan;24(1):24-6.
The purpose of the study was to compare the flare-up rate for single-visit endodontics among teeth without radiographic or clinical signs of apical periodontitis, those with radiographic or clinical signs of apical periodontitis not previously root-treated, and those with apical periodontitis where retreatment was performed.
Teeth without signs of apical periodontitis did not have any flare-ups. One flare-up occurred in 69 teeth with signs of apical periodontitis not previously root-treated. The majority of the flare-ups (3 of 22 teeth) occurred in teeth with signs of apical periodontitis requiring retreatment.
Pekruhn RB. The incidence of failure following single-visit endodontic therapy. J Endod. 1986 Feb;12(2):68-72.
- 1,140 teeth in 918 patients.
- One-year recall evaluations performed on 925 (81.8%) of teeth.
- Endodontic failure rate was found to be 5.2%.
Also, the incidence of failure was higher in those teeth with periapical extension of pulpal disease which had no prior access opening.
No significant difference was found between the tooth groups (anterior and posterior, maxillary and mandibular); however, significant differences were found among the problem code groups (teeth with pulpal pathosis, teeth with periapical extension of pulpal disease, endodontic periapical extension of pulpal disease, endodontic retreatments, and intentional devitalization cases).
Eleazer PD, Eleazer KR. Flare-up rate in pulpally necrotic molars in one-visit versus two-visit endodontic treatment. J Endod. 1998 Sep;24(9):614-6.
This retrospective study compared one-visit versus two-visit endodontic treatment. The same technique and materials were used before and after making the sole change to one-visit endodontic treatment in 1991. Treatment records of 402 consecutive patients with pulpally necrotic first and second molars were compared. In 201 patients, treatment was provided by debridement and instrumentation, followed by obturation at a second visit; whereas the second group received single visit therapy. Flare-ups were defined as either patient reports of pain not controlled with over-the-counter medication or as increasing swelling. Sixteen flare-ups (8%) occurred in the two-visit group versus six flare-ups (3%) for the one-visit group. This showed an advantage for one-visit treatment at a 95% confidence level. In a second comparison, one-visit patients who had previously received two-visit treatment for a different pulpally necrotic molar served as their own control. No significant differences were present in this subgroup of 17 patients.
Trope M et al. Endodontic treatment of teeth with apical periodontitis: single vs. multivisit treatment. J Endod. 1999 May;25(5):345-50.
When base line Periapical Index (PAI) scores were controlled for, the calcium hydroxide group showed the most improvement in PAI score (3, 4, or 5 (bad) to 1 or 2 (good)), followed by the one-step group (74% vs. 64%). The teeth that were left empty between visits had clearly inferior healing results. Power statistics were conducted to determine the numbers required for significant differences between the groups, and it was shown that large experimental groups on the order of hundreds of patients would be required to show significant differences.
Figini L et al. Single versus multiple visits for endodontic treatment of permanent teeth: a Cochrane systematic review. J Endod. 2008 Sep;34(9):1041-7.
Twelve studies were included in the review. No detectable difference was found in the effectiveness of root canal treatment in terms of radiologic success between single and multiple visits. Neither single-visit root canal treatment nor multiple-visit root canal treatment can prevent 100% of short-term and long-term complications. Patients undergoing a single visit might experience a slightly higher frequency of swelling and refer significantly more analgesic use.
Davis RD et al. Effect of early coronal flaring on working length change in curved canals using rotary nickel-titanium versus stainless steel instruments. J Endod. 2002 Jun;28(6):438-42.
WL was determined before coronal flaring, immediately after coronal flaring, and again after canal preparation. Results indicated that WL decreased for all canals as a result of canal preparation. The mean decrease in WL was significantly greater for the SS group (Gates Glidden) (-0.48 mm +/- 0.32) than for the Ni-Ti group (-0.22 mm +/- 0.26). Less change in WL occurred in both groups when initial WL was determined after coronal flaring (SS: -0.12 mm +/- 0.13, Ni-Ti: -0.14 mm +/- 0.25).