Evaluation of apical sealing of three endodontic

sealers

W. A. De Almeida1, M. R. Leonardo2, M. Tanomaru Filho2 & L. A. B. Silva3

1 Department of Endodontics, Barretos School of Dentistry, Barretos; 2 Department of Endodontics, Araraquara School of
Dentistry, University of the State of SaÄo Paulo, Araraquara; and 3 Department of Clinical Pediatrics, RibeiraÄo Preto School of
Dentistry, University of SaÄo Paulo, RibeiraÄo Preto, Brazil

Abstract reduced pressure environment for 24 h. After this

De Almeida WA, Leonardo MR, Tanomaru Filho M,
Silva LAB. Evaluation of apical sealing of three endodontic
sealers. International Endodontic Journal, 33, 25±27, 2000.
Aim The apical sealing ability of three different
endodontic sealers was evaluated in extracted teeth
using dye penetration.
Methodology The root canals of 99 extracted
human maxillary central incisors were prepared se-
quentially 2 mm beyond the apical foramen with a size
55 Nitiflex file. The teeth were divided into three ex-
perimental groups and obturated by lateral condensa-
tion of cold gutta-percha and one of the following
sealers: group 1, zinc oxide and eugenol sealer (Fill
Canal); group 2, glass ionomer sealer (Ketac-Endo) and
group 3, epoxy resin sealer (AH Plus). The teeth were
covered with nail varnish to within 1 mm of the apical
foramen and immersed in 2% methylene blue in a
period, the teeth were washed and cut longitudinally
for apical leakage analysis. The values were obtained
from the maximum depth of leakage as well as the
average between the maximum and minimum values
observed for each group.
Results Statistical evaluation of the results showed
no significant difference in the leakage between Fill
Canal and Ketac-Endo (P > 0.05). Leakage with AH
Plus was significantly less (P < 0.01) than with the
other sealers.
Conclusions All three sealers allowed some leakage
to occur. Leakage with AH Plus was significantly
different than with Fill Canal or Ketac-Endo.
Keywords: apical leakage, endodontic sealers, root
canal filling.
Received 15 June; accepted 9 December 1998

Introduction Endodontic sealers based on zinc oxide and eugenol

have been used clinically for several decades, because
The complete obturation of the root canal system by
they have satisfactory physicochemical properties (Benatti
using filling materials with adequate biological and
et al. 1978). The glass ionomer sealers were introduced
physicochemical properties is one of the main goals of
into root canal treatment because of their adhesion to
root canal treatment. The filling techniques which are
dental hard tissues (Powis et al. 1982, Aboush & Jenkins
most often applied involve the use of gutta-percha
1986). Ketac-Endo (ESPE GMBH & Co., KG, Seefeld/
cones and an endodontic sealer.
Oberbay, Germany), which is based on glass ionomer, is
A great variety of endodontic sealers are available
specifically formulated as a root canal sealer.
commercially, and they are divided into groups
Excellent apical sealing has been found with epoxy
according to their chemical composition. There are
resin-based sealers (Abramovich & Goldberg 1976,
sealers based on zinc oxide and eugenol, epoxy resin,
Grossman 1976, Limkangwalmongkol et al. 1991).
calcium hydroxide and glass ionomer.
However, such sealers do not give the most favourable
biological response. Recently, AH Plus (De Trey,
Dentsply, Konstanz, Germany), a sealer based on epoxy
Correspondence: Dr Mario R. Leonardo, Departamento de Endodontia,
Faculdade de Odontologia de Araraquara, UNESP, Rua HumaitaÂ,
resin, was introduced to the market. According to the
1680, Caixa Postal 331, 14801903 Araraquara, SP, Brazil manufacturer, it has excellent sealing properties
(fax: +55 16 232 1438). without the release of formaldehyde.

q 2000 Blackwell Science Ltd International Endodontic Journal, 33, 25±27, 2000 25
 Apical sealing evaluation De Almeida et al.
The aim of this study was to evaluate in vitro the
apical seal of three endodontic sealers based on zinc
oxide and eugenol, glass ionomer or epoxy resin.
Materials and methods
Ninety-nine maxillary permanent central incisors with
straight roots, were selected after radiographic
examination, and stored in 1% sodium hypochlorite
solution. After coronal access, the root canals were
prepared with standardized Nitiflex K-type files (Maillefer,
Ballaigues, Switzerland) to size 55, 2 mm beyond the
apical foramen. Root canal preparation was performed
using copious irrigation with 0.5% sodium hypochlorite
solution. After biomechanical preparation, the root
canals were flushed copiously with 0.5% sodium hypo-
chlorite solution and dried with paper points. They were
then rinsed with 14.3% EDTA solution for 3 min.
A size 55 gutta-percha cone was selected for each
specimen and the apical excess of the gutta-percha
cone was removed with a scalpel.
The teeth were randomly divided into three groups
of 33 teeth each according to the type of endodontic
sealer used for filling. In group 1, a Grossman-type
sealer was used (Fill Canal Ð DG Ligas OdontoloÂgicas,
Rio de Janeiro, Brazil), whilst in groups 2 and 3, Ketac-
Endo (ESPE, GBMH & Co. Seefeld-Oberbay, Germany)
and AH Plus (De Trey, Dentsply, Konstanz, Germany)
were used, based on glass ionomer and epoxy resin, re-
spectively. The powder:liquid ratio of Fill Canal sealer
was 400 mg:0.125 mL (Leal 1998), and the Ketac-
Endo and AH Plus sealers were mixed according to the
manufacturers' instructions. The root canal filling was
performed by lateral condensation of cold gutta-percha
with finger spreaders (Maillefer, Ballaigues,
Switzerland). The access cavities were sealed with
Cimpat (SpeÂcialiteÂs Septodont, Saint-Maur, France).
After obturation, the teeth were coated with nail
varnish, except for 1 mm surrounding the foramen
area. After 24 h, the teeth were immersed in 2%
methylene blue solution in reduced pressure conditions
for 24 h. The reduced pressure was obtained with a
suction pump (Primar Fabbe, Ind. MecaÃnica Primar
Ltda., SaÄo Paulo, Brazil). After the period of immersion,
the teeth were washed and sectioned longitudinally
buccolingually through the centre of the root.
The penetration of the dye into each section was
evaluated 48 h after obturation with a Profile Projector
(Nikon, model 6C), at a magnification of X20. The
marginal leakage was analysed for each group in two
ways: the maximum depth of penetration of the dye
26 International Endodontic Journal, 33, 25±27, 2000
Table 1 Marginal leakage (mm) observed for three
endodontic sealers
Group Sealer Mean
1 Fill Canal 1.45
2 Ketac-Endo 1.63
3 AH Plus 1.01
along the root canal wall and the mean of the
maximum and the minimum leakage. The evaluation
of each specimen was performed by two examiners si-
multaneously, with an agreed result. The Student's t-
test was used to assess the results statistically to
compare differences in the depth of dye penetration
amongst the three groups.
Results
The mean leakage for the three experimental groups is
shown in Table 1. Statistical evaluation of the results
for both maximum and mean leakage values showed
no significant difference in the leakage between Fill
Canal and Ketac-Endo sealers (P > 0:05); however,
both sealers were statistically different from AH Plus
(P < 0:01). There was no significant difference related
to the analysis of maximum values or the mean of
maximum and minimum values for each sample.
Discussion
Adequate sealing is considered one of the main goals of
root canal treatment. Thus, several types of endodontic
sealers have been recommended to achieve this goal
and consequently, the evaluation of apical sealing
ability of the sealers is important. It is important to
point out that not only is the hermetic sealing of the
root canal of great importance but coronal sealing is of
equal importance for the success of treatment.
Different methods have been used to evaluate the
sealing of endodontic cements. Methylene blue was used
in this study because it has been used often in studies of
marginal infiltration. The adjustment of the main gutta-
percha cone after removing the apical excess allows
better adaptation and standardization of this important
factor of sealing obtained by obturation of root canals.
According to the results from the present study, no
material showed complete apical sealing and the
maximum leakage was observed for both Fill Canal
and Ketac-Endo sealers. The best apical sealing was
observed using AH Plus sealer. AH Plus is a root canal
sealer based on epoxy resin derived from AH 26,
q 2000 Blackwell Science Ltd

whose good sealing ability has been demonstrated in
previous studies (Abramovich & Goldberg 1976, Lim-
kangwalmongkol et al. 1992, De Gee et al. 1994,
Yared & Dagher 1996). In an in vitro study, Zmener
et al. (1997) observed greater apical infiltration of dye
with AH Plus sealer than with AH 26. In the present
study, AH Plus was superior to the zinc oxide and
eugenol-based sealer (Fill Canal) as well as to the glass
ionomer sealer (Ketac-Endo). Another important
property of an endodontic cement is its antimicrobial
capacity, which was reported by Leonardo et al. (1998)
for AH Plus, Ketac Endo and Fill Canal.
Greater measured leakage for sealers based on zinc
oxide and eugenol compared with epoxy resin-based
sealers was also found by other authors (Barkhordar
et al. 1989, Limkangwalmongkol et al. 1991, Oguntebi
& Shen 1992). The results obtained for both Ketac-
Endo and Fill Canal (Grossman type) sealers were
similar in the present study. However, another study
demonstrated better sealing with Ketac-Endo than
with Grossman's sealer, when obturation was done
using the cold lateral condensation technique (Koch
et al. 1994). Wu et al. (1994) also found better sealing
with Ketac-Endo, which was used in thinner layers. On
the other hand, Smith & Steiman (1994), and Rohde
et al. (1996) observed more leakage with Ketac-Endo
than with sealers based on zinc oxide and eugenol.
Results obtained in in vitro apical sealing studies
cannot be directly extrapolated clinically, but they
do permit comparisons. Taking this into considera-
tion, it was observed that apical sealing with AH
Plus was better than those of Ketac-Endo and Fill
Canal endodontic sealers, possibly because of their
different chemical compositions and physical
properties.
Conclusions
1 All sealers studied allowed leakage to occur.
2 There was no statistical difference in leakage
between Fill Canal and Ketac-Endo sealers
(P > 0.05).
3 AH Plus sealer had better sealing ability than the
other two materials tested (P < 0.01).
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