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Interfacial Adaptation of Adhesive Materials To Root Canal Dentin
Interfacial Adaptation of Adhesive Materials To Root Canal Dentin
Abstract
Extracted single-rooted maxillary teeth were endodon-
tically treated and filled with gutta-percha/AH-26 (GP),
Resilon points/RealSeal (RS), AdheSE DC/Multicore
T he goal of root canal therapy is to eliminate intracanal bacteria and to seal the root
canal system and crown access with materials that prevent reinfection (1, 2). Gutta-
percha is considered the gold standard root canal filling material (3).
Flow (ADH, self-etch control), or Excite DSC/Multicore Adhesives have been used primarily to bond restorative materials to coronal
Flow (EXC, total-etch control). Specimens were ana- enamel and dentin (4, 5). More recently, adhesives have been used in the root canal
lyzed with electron microscopy using three methods: (a) to bond posts and to strengthen endodontically treated teeth (6 –11). However,
field emission scanning electron microscopy (FESEM) of most attempts to seal the root canal system with adhesives have proved unsuccess-
the interface; (b) transmission electron microscopy ful (11–15).
(TEM) of the interface; and (c) FESEM of the material
A new root canal filling material has been recently developed (16). This material
fitting surface. The three adhesive materials (RS, ADH,
is composed of a thermoplastic polycaprolactone-based filled polymer (Resilon, Resi-
and EXC) formed a dentin hybrid layer, which nonethe-
lon Research LLC, Madison, CT) combined with proprietary self-etching adhesive and a
less resulted in interfacial separation. Gaps were more
frequent for GP, which did not hybridize dentin. The
dual-cured composite resin sealer (17). Controversy has recently emerged concerning
fitting surfaces exhibited resin tags at all levels for EXC. the use of this material. According to one research group, the Resilon system forms a
Tags were less frequent with ADH, especially in the monoblock between the root canal dentin and the respective filling material (9, 18),
apical third. For RS, resin tags were rare and virtually resulting in a lower incidence of apical leakage but strengthening the tooth (9, 18).
absent from the apical half, whereas GP did not form However, the findings of a different research group challenged both the sealing ability
tags. Despite the hybridization, a tight seal of the root of the monoblock concept (17) and its potential for reinforcing the residual tooth
canal is difficult to achieve because of the complexity structure (19).
and the mechanical challenge of the substrate. (J Endod Self-etching and total-etching dual-cured adhesive systems have been extensively
2007;33:259 –263) tested; therefore, they serve as appropriate controls to test the new polycaprolactone-
based filled polymer. The purpose of this study is to compare the interfacial ultramor-
Key Words phology and sealing ability of RealSeal sealer/Resilon points with that obtained with
Dental bonding, electron microscopy, Resilon, resin gutta-percha/AH-26 sealer, using two resin adhesive systems as controls. The null
cements, root canal obturation hypothesis tested is that the dentin penetration and sealing ability of the new root canal
filling material is not superior to that of existing materials.
JOE — Volume 33, Number 3, March 2007 Interfacial Adaptation of Adhesive Materials 259
Basic Research—Technology
Figure 1. FESEM (left) and TEM (right) microphotographs of the interfaces. (a) FESEM micrograph of Adhese DC. High magnification (⫻5,000) showing area of
separation between the top of the HL and the adhesive material; (b) TEM micrograph of Adhese DC (⫻25,000) showing a partially calcified HL without any separation
in this area; (c) FESEM micrograph of Excite DSC with an area of debonding between the adhesive and the composite MultiCore Flow and adhesive and HL. (d) TEM
micrograph of Excite DSC (⫻7,500) showing a thick HL without signs of hydroxyapatite crystals. An area of debonding occurred above the HL with remaining particles
of Multicore Flow embedded into the adhesive. (e) FESEM micrograph of gutta-percha⫹AH-26 showing a wide gap without any material infiltration into the dentinal
tubules. (f) TEM micrograph of gutta-percha⫹AH-26 (⫻10,000). The epoxy resin corresponds to an area of separation. (g) FESEM micrograph of RealSeal
sealer/Resilon points showing areas of debonding between the sealer and the HL. (h) TEM micrograph of RealSeal sealer/Resilon points (⫻25,000). The
epoxy resin corresponds to an area of debonding with residual sealant left on the HL. #Residual RealSeal sealant on the top of HL; *Areas of interfacial separation; HL, hybrid
layer; D, dentin; MF, Multicore Flow composite; RT, resin tag; P, Resilon point; RS, RealSeal sealant; Ep, epoxy embedding resin; Gp, gutta-percha; AH, AH-26.
JOE — Volume 33, Number 3, March 2007 Interfacial Adaptation of Adhesive Materials 261
Basic Research—Technology
Figure 2. Composite FESEM of the fitting surface of Excite DSC and RealSeal with Resilon points. The formation of resin tags into the dentinal tubules was much more
frequent for Excite DSC (a) than for RealSeal with Resilon points (b). Note that the number of resin tags decreases in the apical third for Excite DSC and in the apical
half for RealSeal/Resilon points.
RS and ADH resulted in a partially calcified HL (Fig. 1b), whereas shown). These air bubbles may have delayed the set of the sealer,
the HL of EXC contained no evidence of hydroxyapatite crystals (Fig. which has been described as taking up to 1 week to fully set (29).
1d). The width of the HL was 0.3 to 0.4 m for ADH, 0.5 to 0.6 m for This delay may have caused separation between the points and the
RS, and 4.0 to 7.1 m for EXC. GP did not form an HL. sealer.
The bond strengths of Resilon to a methacrylate-based resin, as
FESEM of the Fitting Surface that found in Resilon sealer, are 4 to 5 times lower than the bond
FESEM of the fitting surfaces showed dentin resin tags at all levels strengths of a composite resin to the same sealer (28). Although this low
for EXC, but less frequently in the apical third (Fig. 2). Tags were much magnitude of bond strengths with Resilon-based materials may cause
less frequent with ADH, especially in the apical third. For RS, resin tags some concern, other authors have reported a lack of correlation be-
were rare and virtually absent from the apical half. No resin tag exten- tween the sealing efficiency and the adhesive properties of root canal
sions were formed with GP. sealers (12). Factors such as shrinkage stresses and integrity of the
attachment to the sealer may play a more important role in sealing than
Discussion the respective adhesion strength. Nevertheless, the separation between
The polymerization shrinkage creates stresses that may be of the bottom of the RealSeal sealant and dentin, as observed in our study,
enough magnitude to result in detachment of the resin from the dentin would have caused leakage and potentially failure of the endodontic
of the canal walls, opening a pathway for bacterial leakage (21, 22). treatment in a clinical situation.
Bonding to root canal walls is mechanically unfavorable because of the The use of dual-cure resin-based materials to seal the root canal
higher C-factor that leads to an increase in shrinkage stresses (6). walls has been recommended (10, 13). Yet, the sealing efficiency of
Despite the proven bonding efficiency of the control adhesives ADH and dual-cure resin-based cements is inferior to that of an epoxy-based
EXC to coronal and to root dentin (23–25), the unfavorable C-factor sealer (13). Gap-free areas combined with interfacial gaps without
inside the canal may have led to high stresses that caused debonding. resin tags have been associated with a Resilon-based material and with
The resin did not have the opportunity to flow because of the con- gutta-percha/AH-Plus (17). Despite the hybridization, a perfect seal of
strained space, which resulted in accumulation of stresses that develop the root canal is difficult to achieve, which may be a result of the com-
within the polymerizing resin. A similar pattern has been found when plexity of the substrate and the high C-factor.
bonding fiber posts to root canal dentin (26). In the light of our findings, we must accept the null hypothesis; the
Concerns have been raised regarding the alkaline hydrolysis dentin penetration and sealing ability of new root canal filling material
susceptibility of Resilon points as compared to gutta-percha (27). is not superior to that of existing materials.
The sealing ability of Resilon has also been questioned (17). Our
findings are in agreement with the findings of Hiraishi et al. (28)
who reported that the gaps in the Resilon group were also observed References
between the points and the sealer. This physical separation was not 1. Ray HA, Trope M. Periapical status of endodontically treated teeth in relation to
expected in view of the philosophy behind the monoblock concept. technical quality of the root filling and the coronal restoration. Int Endod J
Sporadic air bubbles were observed in the body of the sealer (not 1995;28:12– 8.
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