Bacterial Leakage Evaluation of Three Root Canal Sealers with Two Obturation Techniques: An in Vitro Study

Tringa Z. Kelmendi, Linda J. Dula, Shera Kosumi, Anila Kamberi, Nita Kelmendi

International Journal of Biomedicine. 2022;12(4):584-590.
DOI: 10.21103/Article12(4)_OA11
Originally published December 5, 2022


Background: The purpose of this study was to compare the quality of the coronal seal of three root canal sealers and two obturation techniques using the bacterial penetration method.
Methods and Results: A total of 132 single-rooted human teeth with fully developed apices were used. The teeth were randomly assigned to three experimental groups according to the endodontic sealer used. Group 1: Samples (n=44) were obturated using a zinc oxide eugenol-based sealer, Pulp Canal Sealer EWT. Group 2: Samples (n=44) were obturated using an epoxy resin-based sealer, AH Plus. Group 3: Samples (n=44) were obturated using a bioceramic-based root canal sealer, Well-Root ST. Each group was subdivided into 2 equal subgroups in accordance with the obturation technique being used: CLCT and ThOT. Thus, 6 subgroups were formed: Sub-1A: Pulp Canal Sealer/CLCT; Sub-2A: AH Plus/CLCT; Sub-3A: Well-ROOT ST/CLCT; Sub-1B: Pulp Canal Sealer/ThOT; Sub-2B: Ah Plus/ThOT; Sub-3B: Well-ROOT ST/ThOT. A dual-chamber device was used to evaluate bacterial leakage. Fresh medium and E. faecalis were added to the upper chamber every 4 days. The broth was monitored for color change daily for 33 days. Significant differences were found among Sub-2A vs. Sub-1B (P=0.023), Sub-1A vs. Sub-3A (P=0.014), Sub-1A vs. Sub-2B (P=0.024), Sub-1A vs. Sub-3B (P=0.002), Sub-3A vs. Sub-1B (P=0.003), Sub-2B vs. Sub-1B (P=0.005), and Sub-1B vs. Sub-3B (P<0.0001). There was no significant difference in the average occurrence of turbidity between CLCT and ThOT (P=0.718)
Conclusion: Regardless of the obturation technique, all root canal sealers exhibited leakage; however, the bioceramic-based root canal sealer appeared to perform better than the epoxy resin-based sealer and the zinc oxide eugenol-based sealer.

microleakage • cold lateral condensation techniques • thermafil obturation techniques • root canal sealer.

1. Marín-Bauza GA, Silva-Sousa YT, da Cunha SA, Rached-Junior FJ, Bonetti-Filho I, Sousa-Neto MD, Miranda CE. Physicochemical properties of endodontic sealers of different bases. J Appl Oral Sci. 2012 Jul-Aug;20(4):455-61. doi: 10.1590/s1678-77572012000400011.
2. Abdulkader A, Duguid R, Saunders EM. The antimicrobial activity of endodontic sealers to anaerobic bacteria. Int Endod J. 1996 Jul;29(4):280-3. doi: 10.1111/j.1365-2591.1996.tb01382.x.
3. Tselnik M, Baumgartner JC, Marshall JG. Bacterial leakage with mineral trioxide aggregate or a resin-modified glass ionomer used as a coronal barrier. J Endod. 2004 Nov;30(11):782-4. doi: 10.1097/00004770-200411000-00008.
4. Eldeniz AU, Ørstavik D. A laboratory assessment of coronal bacterial leakage in root canals filled with new and conventional sealers. Int Endod J. 2009 Apr;42(4):303-12. doi: 10.1111/j.1365-2591.2008.01509.x.
5. Siqueira JF Jr, Rôças IN, Ricucci D, Hülsmann M. Causes and management of post-treatment apical periodontitis. Br Dent J. 2014 Mar;216(6):305-12. doi: 10.1038/sj.bdj.2014.200.
6. Timpawat S, Amornchat C, Trisuwan WR. Bacterial coronal leakage after obturation with three root canal sealers. J Endod. 2001 Jan;27(1):36-9. doi: 10.1097/00004770-200101000-00011.
7. Pathomvanich S, Edmunds DH. The sealing ability of Thermafil obturators assessed by four different microleakage techniques. Int Endod J. 1996 Sep;29(5):327-34. doi: 10.1111/j.1365-2591.1996.tb01393.x.
8. Vitti RP, Prati C, Silva EJ, Sinhoreti MA, Zanchi CH, de Souza e Silva MG, Ogliari FA, Piva E, Gandolfi MG. Physical properties of MTA Fillapex sealer. J Endod. 2013 Jul;39(7):915-8. doi: 10.1016/j.joen.2013.04.015.
9. da Silva Neto UX, de Moraes IG, Westphalen VP, Menezes R, Carneiro E, Fariniuk LF. Leakage of 4 resin-based root-canal sealers used with a single-cone technique. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Aug;104(2):e53-7. doi: 10.1016/j.tripleo.2007.02.007.
10. Williams JM, Trope M, Caplan DJ, Shugars DC. Detection and quantitation of E. faecalis by real-time PCR (qPCR), reverse transcription-PCR (RT-PCR), and cultivation during endodontic treatment. J Endod. 2006 Aug;32(8):715-21. doi: 10.1016/j.joen.2006.02.031.
11. Sedgley C, Nagel A, Dahlén G, Reit C, Molander A. Real-time quantitative polymerase chain reaction and culture analyses of Enterococcus faecalis in root canals. J Endod. 2006 Mar;32(3):173-7. doi: 10.1016/j.joen.2005.10.037.
12. Brunton PA, Burke FJ, Sharif MO, Creanor S, Hosey MT, Mannocci F, Wilson NH. Contemporary dental practice in the UK in 2008: aspects of direct restorations, endodontics and bleaching. Br Dent J. 2012 Jan 27;212(2):63-7. doi: 10.1038/sj.bdj.2012.46.
13. Pallarés A, Faus V. A comparative study of the sealing ability of two root canal obturation techniques. J Endod. 1995 Sep;21(9):449-50. doi: 10.1016/S0099-2399(06)81526-8.
14. Siqueira JF Jr, Rôças IN. Polymerase chain reaction-based analysis of microorganisms associated with failed endodontic treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Jan;97(1):85-94. doi: 10.1016/s1079-2104(03)00353-6.
15. Sedgley C, Buck G, Appelbe O. Prevalence of Enterococcus faecalis at multiple oral sites in endodontic patients using culture and PCR. J Endod. 2006 Feb;32(2):104-9. doi: 10.1016/j.joen.2005.10.022.
16. Ma J, Wang Z, Shen Y, Haapasalo M. A new noninvasive model to study the effectiveness of dentin disinfection by using confocal laser scanning microscopy. J Endod. 2011 Oct;37(10):1380-5. doi: 10.1016/j.joen.2011.06.018.
17. Massi S, Tanomaru-Filho M, Silva GF, Duarte MA, Grizzo LT, Buzalaf MA, Guerreiro-Tanomaru JM. pH, calcium ion release, and setting time of an experimental mineral trioxide aggregate-based root canal sealer. J Endod. 2011 Jun;37(6):844-6. doi: 10.1016/j.joen.2011.02.033.
18. Tanomaru JM, Tanomaru-Filho M, Hotta J, Watanabe E, Ito IY. Antimicrobial activity of endodontic sealers based on calcium hydroxide and MTA. Acta Odontol Latinoam. 2008;21(2):147-51.
19. Santos AD, Moraes JC, Araújo EB, Yukimitu K, Valério Filho WV. Physico-chemical properties of MTA and a novel experimental cement. Int Endod J. 2005 Jul;38(7):443-7. doi: 10.1111/j.1365-2591.2005.00963.x.
20. Miletić I, Ribarić SP, Karlović Z, Jukić S, Bosnjak A, Anić I. Apical leakage of five root canal sealers after one year of storage. J Endod. 2002 Jun;28(6):431-2. doi: 10.1097/00004770-200206000-00003.
21. Inan U, Aydin C, Tunca YM, Basak F. In vitro evaluation of matched-taper single-cone obturation with a fluid filtration method. J Can Dent Assoc. 2009 Mar;75(2):123.
22. Yücel AC, Ciftçi A. Effects of different root canal obturation techniques on bacterial penetration. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Oct;102(4):e88-92. doi: 10.1016/j.tripleo.2006.02.007.
23. Gade VJ, Belsare LD, Patil S, Bhede R, Gade JR. Evaluation of push-out bond strength of endosequence BC sealer with lateral condensation and thermoplasticized technique: An in vitro study. J Conserv Dent. 2015 Mar-Apr;18(2):124-7. doi: 10.4103/0972-0707.153075.
24. Xu Q, Ling J, Cheung GS, Hu Y. A quantitative evaluation of sealing ability of 4 obturation techniques by using a glucose leakage test. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007 Oct;104(4):e109-13. doi: 10.1016/j.tripleo.2007.05.014.
25. Inan U, Aydemir H, Taşdemir T. Leakage evaluation of three different root canal obturation techniques using electrochemical evaluation and dye penetration evaluation methods. Aust Endod J. 2007 Apr;33(1):18-22. doi: 10.1111/j.1747-4477.2007.00050.x.
26. De Moor RJ, Hommez GM. The long-term sealing ability of an epoxy resin root canal sealer used with five gutta percha obturation techniques. Int Endod J. 2002 Mar;35(3):275-82. doi: 10.1046/j.1365-2591.2002.00481.x.
27. Vittoria G, Pantaleo G, Blasi A, Spagnuolo G, Iandolo A, Amato M. Thermafil: A New Clinical Approach Due to New Dimensional Evaluations. Open Dent J. 2018 Feb 22;12:173-180. doi: 10.2174/1874210601812010173.
28. Ehsani M, Dehghani A, Abesi F, Khafri S, Ghadiri Dehkordi S. Evaluation of Apical Micro-leakage of Different Endodontic Sealers in the Presence and Absence of Moisture. J Dent Res Dent Clin Dent Prospects. 2014 Summer;8(3):125-9. doi: 10.5681/joddd.2014.023.
29. Palanivelu CR, Ravi V, Sivakumar AA, Sivakumar JS, Prasad AS, Arthanari KK. An In Vitro Comparative Evaluation of Distribution of Three Different Sealers by Single-Cone Obturation Technique. J Pharm Bioallied Sci. 2019 May;11(Suppl 2):S438-S441. doi: 10.4103/JPBS.JPBS_64_19.
30. Ballullaya SV, Vinay V, Thumu J, Devalla S, Bollu IP, Balla S. Stereomicroscopic Dye Leakage Measurement of Six Different Root Canal Sealers. J Clin Diagn Res. 2017 Jun;11(6):ZC65-ZC68. doi: 10.7860/JCDR/2017/25780.10077.
31. Chotvorrarak K, Yanpiset K, Banomyong D, Srisatjaluk R. In vitro antibacterial activity of oligomer-based and calcium silicate-based root canal sealers. Mahidol Dent J. 2017;37(2):145-154.
32. Dultra F, Barroso JM, Carrasco LD, Capelli A, Guerisoli DM, Pécora JD. Evaluation of apical microleakage of teeth sealed with four different root canal sealers. J Appl Oral Sci. 2006 Oct;14(5):341-5.
33. Kocak MM, Er O, Saglam BC, Yaman S. Apical leakage of epiphany root canal sealer combined with different master cones. Eur J Dent. 2008 Apr;2(2):91-5.
34. Tay FR, Loushine RJ, Weller RN, Kimbrough WF, Pashley DH, Mak YF, Lai CN, Raina R, Williams MC. Ultrastructural evaluation of the apical seal in roots filled with a polycaprolactone-based root canal filling material. J Endod. 2005 Jul;31(7):514-9.
35. Pommel L, Camps J. In vitro apical leakage of system B compared with other filling techniques. J Endod. 2001 Jul;27(7):449-51.
36. Kelmendi T, Koçani F, Kurti A, Kamberi B, Kamberi A. Comparison of Sealing Abilities Among Zinc Oxide Eugenol Root-Canal Filling Cement, Antibacterial Bioceramic Paste, and Epoxy Resin, using Enterococcus faecalis as a Microbial Tracer. Med Sci Monit Basic Res. 2022 Jun 1;28:e936319.
37. Melo TV de, Prado MC, Hirata Junior R, Fidel SR, Silva EJNL da, Sassone LM. Improved sealing ability promoted by calcium silicate-based root canal sealers. Braz. J. Oral Sci. [Internet]. 2018 Jun. 5 [cited 2022 Oct. 22];17:e18148.
38. Prado M, Simão RA, Gomes BP. A microleakage study of gutta-percha/AH Plus and Resilon/Real self-etch systems after different irrigation protocols. J Appl Oral Sci. 2014 Jun;22(3):174-9.
39. Ashraf H, Faramarzi F, Paymanpour P. Sealing Ability of Resilon and MTA as Root-end Filling Materials: A Bacterial and Dye Leakage Study. Iran Endod J. 2013 Fall;8(4):177-81.
40. Consolaro A, Bramante CM, de Moraes IG, Ordinola-Zapata R, Garcia RB. Bacterial leakage in obturated root canals-part 2: a comparative histologic and microbiologic analyses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010 May;109(5):788-94.

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Received October 28, 2022.
Accepted December 3, 2022.
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