Coronal Microleakage and Its Impact on The Success of Endodontic Therapy: A Narrative Review

REVIEW
Sara Boshnjaku, Jetmir Morina

 
For citation: Boshnjaku S, Morina J. Coronal Microleakage and Its Impact on The Success of Endodontic Therapy: A Narrative Review. International Journal of Biomedicine. 2025;15(2):262-267. doi:10.21103/Article15(2)_RA4
 
Originally published June 5, 2025
 

Abstract: 

The primary goal of endodontic treatment should be to prevent bacterial penetration into the pulp space and root canal system, with adequate mechanical/chemical cleaning and 3D obturation, and without avoiding delays to restore the crown. In vitro and in vivo studies have shown that post-endodontic coronal leakage can allow bacteria to penetrate the obturated root canal system, thus leading to recontamination and treatment failure. A major concern for all practitioners is the speed at which the entire root canal system can become contaminated. In most cases, according to research, teeth with coronal leakage require retreatment of the root canal before a new coronal restoration is performed.

Keywords: 
endodontic treatment • root canal • coronal leakage
References: 
  1. Gilbert SD, Witherspoon DE, Berry CW. Coronal leakage following three obturation techniques. Int Endod J. 2001 Jun;34(4):293-9. doi: 10.1046/j.1365-2591.2001.00391.x. PMID: 11482141.
  2. Persoon IF, Özok AR. Definitions and Epidemiology of Endodontic Infections. Curr Oral Health Rep. 2017;4(4):278-285. doi: 10.1007/s40496-017-0161-z. Epub 2017 Nov 8. PMID: 29201596; PMCID: PMC5688219.
  3. Mostafavi AS, Rasoulzadehsheikh M, Meraji N, Pourhajibagher M. Bacterial microleakage in endodontically treated teeth following two methods of postspace preparation at two-time intervals: An in vitro study. J Indian Prosthodont Soc. 2022 Jul-Sep;22(3):233-239. doi: 10.4103/jips.jips_441_21. PMID: 36511052; PMCID: PMC9416957.
  4. Tabassum S, Khan FR. Failure of endodontic treatment: The usual suspects. Eur J Dent. 2016 Jan-Mar;10(1):144-147. doi: 10.4103/1305-7456.175682. PMID: 27011754; PMCID: PMC4784145.
  5. Siqueira JF Jr. Aetiology of root canal treatment failure: why well-treated teeth can fail. Int Endod J. 2001 Jan;34(1):1-10. doi: 10.1046/j.1365-2591.2001.00396.x. PMID: 11307374.
  6. Glassman G, Boksman L. Ensuring endodontic success – Tips for clinical success. J Oral Health. 2009; 5:18-28.
  7. Song M, Kim HC, Lee W, Kim E. Analysis of the cause of failure in nonsurgical endodontic treatment by microscopic inspection during endodontic microsurgery. J Endod. 2011 Nov;37(11):1516-9. doi: 10.1016/j.joen.2011.06.032. Epub 2011 Aug 19. PMID: 22000454.
  8. López-Valverde I, Vignoletti F, Vignoletti G, Martin C, Sanz M. Long-term tooth survival and success following primary root canal treatment: a 5- to 37-year retrospective observation. Clin Oral Investig. 2023 Jun;27(6):3233-3244. doi: 10.1007/s00784-023-04938-y. Epub 2023 Mar 18. PMID: 36933044; PMCID: PMC10264502.
  9. Ashley M, Harris I. The assessment of the endodontically treated tooth. Dent Update. 2001 Jun;28(5):247-52. doi: 10.12968/denu.2001.28.5.247. PMID: 11490636.
  10. Endo MS, Ferraz CCR, Zaia AA, Almeida JFA, Gomes BPFA. Quantitative and qualitative analysis of microorganisms in root-filled teeth with persistent infection: Monitoring of the endodontic retreatment. Eur J Dent. 2013 Jul;7(3):302-309. doi: 10.4103/1305-7456.115414. PMID: 24926210; PMCID: PMC4053619.
  11. Bodrumlu E, Tunga U. Coronal sealing ability of a new root canal filling material. J Can Dent Assoc. 2007 Sep;73(7):623. PMID: 17868513.
  12. Nagas E, Altundasar E, Serper A. The effect of master point taper on bond strength and apical sealing ability of different root canal sealers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Jan;107(1):e61-4. doi: 10.1016/j.tripleo.2008.09.020. PMID: 19101485.
  13. 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. Epub 2017 Jun 1. PMID: 28764296; PMCID: PMC5534516.
  14. Shetty K, Habib VA, Shetty SV, Khed JN, Prabhu VD. An assessment of coronal leakage of permanent filling materials in endodontically treated teeth: An in vitro study. J Pharm Bioallied Sci. 2015 Aug;7(Suppl 2):S607-11. doi: 10.4103/0975-7406.163566. PMID: 26538928; PMCID: PMC4606670.
  15. Tronstad L, Asbjørnsen K, Døving L, Pedersen I, Eriksen HM. Influence of coronal restorations on the periapical health of endodontically treated teeth. Endod Dent Traumatol. 2000 Oct;16(5):218-21. doi: 10.1034/j.1600-9657.2000.016005218.x. PMID: 11202885.
  16. Bilgrami A, Alam MK, Qazi FUR, Maqsood A, Basha S, Ahmed N, Syed KA, Mustafa M, Shrivastava D, Nagarajappa AK, Srivastava KC. An In-Vitro Evaluation of Microleakage in Resin-Based Restorative Materials at Different Time Intervals. Polymers (Basel). 2022 Jan 24;14(3):466. doi: 10.3390/polym14030466. PMID: 35160456; PMCID: PMC8838729.
  17. Mannocci F, Bitter K, Sauro S, Ferrari P, Austin R, Bhuva B. Present status and future directions: The restoration of root filled teeth. Int Endod J. 2022 Oct;55 Suppl 4(Suppl 4):1059-1084. doi: 10.1111/iej.13796. Epub 2022 Jul 19. PMID: 35808836; PMCID: PMC9796050.
  18. Madarati A, Rekab MS, Watts DC, Qualtrough A. Time-dependence of coronal seal of temporary materials used in endodontics. Aust Endod J. 2008 Dec;34(3):89-93. doi: 10.1111/j.1747-4477.2007.00079.x. PMID: 19032641.
  19. Verissimo RD, Gurgel-Filho ED, De-Deus G, Coutinho-Filho T, de Souza-Filho FJ. Coronal leakage of four intracanal medications after exposure to human saliva in the presence of a temporary filling material. Indian J Dent Res. 2010 Jan-Mar;21(1):35-9. doi: 10.4103/0970-9290.62808. PMID: 20427904.
  20. Gavriil D, Kakka A, Myers P, O Connor CJ. Pre-endodontic restoration of structurally compromised teeth: current concepts. Br Dent J. 2021 Sep;231(6):343-349. doi: 10.1038/s41415-021-3467-0. Epub 2021 Sep 24. PMID: 34561585; PMCID: PMC8463293.
  21. Abbott PV. Assessing restored teeth with pulp and periapical diseases for the presence of cracks, caries and marginal breakdown. Aust Dent J. 2004 Mar;49(1):33-9; quiz 45. doi: 10.1111/j.1834-7819.2004.tb00047.x. PMID: 15104132.
  22. Aminsobhani M, Ghorbanzadeh A, Bolhari B, Shokouhinejad N, Ghabraei S, Assadian H, Aligholi M. Coronal microleakage in root canals obturated with lateral compaction, warm vertical compaction and guttaflow system. Iran Endod J. 2010 Spring;5(2):83-7. Epub 2010 May 20. PMID: 23130032; PMCID: PMC3487501.
  23. Pane ES, Palamara JE, Messer HH. Stainless steel bands in endodontics: effects on cuspal flexure and fracture resistance. Int Endod J. 2002 May;35(5):467-71. doi: 10.1046/j.1365-2591.2002.00503.x. PMID: 12059919.
  24. Tanikonda R. Canal projection using gutta-percha points: A novel technique for pre-endodontic buildup of grossly destructed tooth. J Conserv Dent. 2016 Mar-Apr;19(2):194-7. doi: 10.4103/0972-0707.178709. PMID: 27099431; PMCID: PMC4815553.
  25. da Silva Paiva SM, Fontana CE, Pedro Rocha DG, de Martin AS, Delboni MG, da Silveira Bueno CE. Ex Vivo Evaluation of Bacterial Leakage and Coronal Sealing Capacity of Six Materials in Endodontically Treated Teeth. Iran Endod J. 2022;17(4):200-204. doi: 10.22037/iej.v17i4.32980. PMID: 36703695; PMCID: PMC9869002.
  26. Craveiro MA, Fontana CE, de Martin AS, Bueno CE. Influence of coronal restoration and root canal filling quality on periapical status: clinical and radiographic evaluation. J Endod. 2015 Jun;41(6):836-40. doi: 10.1016/j.joen.2015.02.017. Epub 2015 Mar 20. PMID: 25799533.
  27. Özcan M, Volpato CAM. Current perspectives on dental adhesion: (3) Adhesion to intraradicular dentin: Concepts and applications. Jpn Dent Sci Rev. 2020 Nov;56(1):216-223. doi: 10.1016/j.jdsr.2020.08.002. Epub 2020 Sep 17. PMID: 34188728; PMCID: PMC8216298.
  28. Buurma HA, Buurma BJ. The effect of smear layer on bacterial penetration through roots obturated using zinc oxide eugenol-based sealer. BMC Oral Health. 2020 Mar 26;20(1):88. doi: 10.1186/s12903-020-01069-8. PMID: 32216774; PMCID: PMC7098078.
  29. Shahravan A, Haghdoost AA, Adl A, Rahimi H, Shadifar F. Effect of smear layer on sealing ability of canal obturation: a systematic review and meta-analysis. J Endod. 2007 Feb;33(2):96-105. doi: 10.1016/j.joen.2006.10.007. PMID: 17258623.
  30. Sen BH, Wesselink PR, Türkün M. The smear layer: a phenomenon in root canal therapy. Int Endod J. 1995 May;28(3):141-8. doi: 10.1111/j.1365-2591.1995.tb00289.x. PMID: 8626198.
  31. Susila AV, Sai S, Sharma N, Balasubramaniam A, Veronica AK, Nivedhitha S. Can natural irrigants replace sodium hypochlorite? A systematic review. Clin Oral Investig. 2023 May;27(5):1831-1849. doi: 10.1007/s00784-023-04913-7. Epub 2023 Feb 18. PMID: 36808559.
  32. Drews DJ, Nguyen AD, Diederich A, Gernhardt CR. The Interaction of Two Widely Used Endodontic Irrigants, Chlorhexidine and Sodium Hypochlorite, and Its Impact on the Disinfection Protocol during Root Canal Treatment. Antibiotics (Basel). 2023 Mar 16;12(3):589. doi: 10.3390/antibiotics12030589. PMID: 36978457; PMCID: PMC10044599.
  33. Hassan R, Roshdy NN. Effect of continuous chelation on the dentinal tubule penetration of a calcium silicate-based root canal sealer: a confocal laser microscopy study. BMC Oral Health. 2023 Jun 9;23(1):377. doi: 10.1186/s12903-023-02995-z. PMID: 37296374; PMCID: PMC10257323.
  34. La Rosa GRM, Plotino G, Nagendrababu V, Pedullà E. Effectiveness of continuous chelation irrigation protocol in endodontics: a scoping review of laboratory studies. Odontology. 2024 Jan;112(1):1-18. doi: 10.1007/s10266-023-00835-8. Epub 2023 Jul 11. PMID: 37433927; PMCID: PMC10776731.
  35. Poggio C, Dagna A, Chiesa M, Beltrami R, Bianchi S. Cleaning Effectiveness of Three NiTi Rotary Instruments: A Focus on Biomaterial Properties. J Funct Biomater. 2015 Feb 16;6(1):66-76. doi: 10.3390/jfb6010066. PMID: 25692796; PMCID: PMC4384101.
  36. Amritha Sureshchandra B. A comparison of four nickel titanium rotary systems, quantec series, k3 endo, race and hero 642 for canal cleaning ability – An in vitro study J Endod 2013; 25:55–67.
  37. Wong J, Manoil D, Näsman P, Belibasakis GN, Neelakantan P. Microbiological Aspects of Root Canal Infections and Disinfection Strategies: An Update Review on the Current Knowledge and Challenges. Front Oral Health. 2021 Jun 25;2:672887. doi: 10.3389/froh.2021.672887. PMID: 35048015; PMCID: PMC8757850.
  38. Nair PN. Pathogenesis of apical periodontitis and the causes of endodontic failures. Crit Rev Oral Biol Med. 2004 Nov 1;15(6):348-81. doi: 10.1177/154411130401500604. PMID: 15574679.
  39. El-Kady A. In-Vitro Study Comparing the Coronal Sealing Ability of Silorane Versus Methacrylate-Based Composite Resins, with and Without Glass Ionomer Base, on the Endodontic Treatment Outcome. Egyptian Dent J. 2012; 58:1-15.
  40. Li GH, Niu LN, Zhang W, Olsen M, De-Deus G, Eid AA, Chen JH, Pashley DH, Tay FR. Ability of new obturation materials to improve the seal of the root canal system: a review. Acta Biomater. 2014 Mar;10(3):1050-1063. doi: 10.1016/j.actbio.2013.11.015. Epub 2013 Dec 7. PMID: 24321349; PMCID: PMC3939610.
  41. Maniglia-Ferreira C, Silva JB Jr, de Paula RC, Feitosa JP, Zaia AA, Ferraz CC, Gomes BP, Souza-Filho FJ. Degradation of trans-polyisoprene over time following the analysis of root fillings removed during conventional retreatment. Int Endod J. 2007 Jan;40(1):25-30. doi: 10.1111/j.1365-2591.2006.01172.x. PMID: 17209829.
  42. Leal FM, Camargo CHR, Valera MC, Silva GO, Oliveira TR, Junqueira JC. Coronal bacterial leakage in root canals filled with single cone technique and different endodontic sealers. Braz Dent Sci. 2014; 17(2):57-62.
  43. Oliveira SH, Silva GO, Cardoso FG, Vasconcelos RA, Xavier AC. Evaluation of apical leakage in root canals filled with different sealers. Braz Dent Sci. 2012;15(3):32-37.
  44. Muharsya Y, Usman M and Suprastiwi E. Comparison sealability of root canal obturation using bioceramic sealer and methacrylate resin-based sealer. J Phys Conf Ser. 2017; 884 012111
  45. Zmener O, Banegas G, Pameijer CH. Coronal microleakage of three temporary restorative materials: an in vitro study. J Endod. 2004 Aug;30(8):582-4. doi: 10.1097/01.don.0000121610.63000.f2. PMID: 15273640.
  46. Almutairi et al. Sealing Ability and Micro Leakage of AH26 and AH Plus Root Canal Sealers: A Systematic Review. Archives of Pharmacy Practice. 2023;14 (2):140-147.
  47. Kurtzman G. Endodontics: Improving Endodontic Success Through Coronal Leakage Prevention. Inside Dentistry. 2005;12.
  48. Al-Haddad A, Che Ab Aziz ZA. Bioceramic-Based Root Canal Sealers: A Review. Int J Biomater. 2016;2016:9753210. doi: 10.1155/2016/9753210. Epub 2016 May 3. PMID: 27242904; PMCID: PMC4868912.
  49. Bryan TE, Khechen K, Brackett MG, Messer RL, El-Awady A, Primus CM, Gutmann JL, Tay FR. In vitro osteogenic potential of an experimental calcium silicate-based root canal sealer. J Endod. 2010 Jul;36(7):1163-9. doi: 10.1016/j.joen.2010.03.034. Epub 2010 May 10. PMID: 20630291.
  50. Mak ST, Leong XF, Tew IM, Kumolosasi E, Wong L. In Vitro Evaluation of the Antibacterial Activity of EndoSeal MTA, iRoot SP, and AH Plus against Planktonic Bacteria. Materials (Basel). 2022 Mar 8;15(6):2012. doi: 10.3390/ma15062012. PMID: 35329464; PMCID: PMC8950277.
  51. Alghamdi F, Shakir M. The Influence of Enterococcus faecalis as a Dental Root Canal Pathogen on Endodontic Treatment: A Systematic Review. Cureus. 2020 Mar 13;12(3):e7257. doi: 10.7759/cureus.7257. PMID: 32292671; PMCID: PMC7152576.
  52. Estrela C, Silva JA, de Alencar AH, Leles CR, Decurcio DA. Efficacy of sodium hypochlorite and chlorhexidine against Enterococcus faecalis--a systematic review. J Appl Oral Sci. 2008 Nov-Dec;16(6):364-8. doi: 10.1590/s1678-77572008000600002. PMID: 19082392; PMCID: PMC4327704.
  53. Sassone LM, Souza MC, Fidel RAS, Fidel SR, Junior RH. Antimicrobial activity of sodium hypochlorite, chlorhexidine and MTAD® against Enterococcus faecalis biofilm on human dentin matrix in vitro. Rev Bras Odontol 2012; 9:143–150.  
  54. Jensen AL, Abbott PV, Castro Salgado J. Interim and temporary restoration of teeth during endodontic treatment. Aust Dent J. 2007 Mar;52(1 Suppl):S83-99. doi: 10.1111/j.1834-7819.2007.tb00528.x. PMID: 17546864.
  55. Cohen S, Hargreaves K M. Pathways of the pulp, 9th ed. Mosby Elsevier, 2006.
  56. Martinho FC, Chiesa WM, Leite FR, Cirelli JA, Gomes BP. Antigenic activity of bacterial endodontic contents from primary root canal infection with periapical lesions against macrophage in the release of interleukin-1beta and tumor necrosis factor alpha. J Endod. 2010 Sep;36(9):1467-74. doi: 10.1016/j.joen.2010.06.012. PMID: 20728711.
  57. Gomes BP, Berber VB, Kokaras AS, Chen T, Paster BJ. Microbiomes of Endodontic-Periodontal Lesions before and after Chemomechanical Preparation. J Endod. 2015 Dec;41(12):1975-84. doi: 10.1016/j.joen.2015.08.022. Epub 2015 Oct 29. PMID: 26521147; PMCID: PMC7061340.
  58. Martinho FC, de Rabello DGD, Ferreira LL, Nascimento GG. Participation of endotoxin in root canal infections: A systematic review and meta-analysis. Eur J Dent. 2017 Jul-Sep;11(3):398-406. doi: 10.4103/ejd.ejd_84_17. PMID: 28932155; PMCID: PMC5594974.
  59. Balto H. An assessment of microbial coronal leakage of temporary filling materials in endodontically treated teeth. J Endod. 2002 Nov;28(11):762-4. doi: 10.1097/00004770-200211000-00004. PMID: 12470020.
  60. Adnan S, Khan FR. Comparison of Micro-Leakage around Temporary Restorative Materials Placed in Complex Endodontic Access Cavities: An In-Vitro Study. J Coll Physicians Surg Pak. 2016 Mar;26(3):182-6. PMID: 26975947.
  61. Naebe M, Abolhasani MM, Khayyam H, Amini A, Fox B. Crack Damage in Polymers and Composites: A Review. Polym Rev. 2016;56:31–69.
  62. Khvostenko D, Salehi S, Naleway SE, Hilton TJ, Ferracane JL, Mitchell JC, Kruzic JJ. Cyclic mechanical loading promotes bacterial penetration along composite restoration marginal gaps. Dent Mater. 2015 Jun;31(6):702-10. doi: 10.1016/j.dental.2015.03.011. Epub 2015 Apr 18. PMID: 25900624; PMCID: PMC4430365.
  63. Oliveira SG, Gomes DJ, Costa MH, Sousa ER, Lund RG. Coronal microleakage of endodontically treated teeth with intracanal post exposed to fresh human saliva. J Appl Oral Sci. 2013 Sep-Oct;21(5):403-8. doi: 10.1590/1679-775720130184. PMID: 24212985; PMCID: PMC3881841.
  64. Naseri M, Ahangari Z, Shahbazi Moghadam M, Mohammadian M. Coronal sealing ability of three temporary filling materials. Iran Endod J. 2012 Winter;7(1):20-4. Epub 2012 Mar 1. PMID: 23060909; PMCID: PMC3467125.
  65. Estrela CRdA, Ribeiro RG, Moura MS, Estrela C. Infiltração microbiana em dentes portadoresde restaurações provisórias. Robrac. 2008;17(4):138–45.
  66. Fathi B, Bahcall J, Maki JS. An in vitro comparison of bacterial leakage of three common restorative materials used as an intracoronal barrier. J Endod. 2007 Jul;33(7):872-4. doi: 10.1016/j.joen.2007.03.003. Epub 2007 Apr 17. PMID: 17804333.
  67. Sachin Chadgal et.al. Coronal Sealing Ability of Three Temporary Restorative Materials Used In Endodontics: An in vitro Dye Penetration Study. International Journal of Research & Review. 2019;12(6).
  68. Prabhakar AR, Shantha Rani N, V Naik S. Comparative Evaluation of Sealing Ability, Water Absorption, and Solubility of Three Temporary Restorative Materials: An in vitro Study. Int J Clin Pediatr Dent. 2017 Apr-Jun;10(2):136-141. doi: 10.5005/jp-journals-10005-1423. Epub 2017 Jun 1. PMID: 28890612; PMCID: PMC5571381.
  69. Wuersching SN, Moser L, Obermeier KT, Kollmuss M. Microleakage of Restorative Materials Used for Temporization of Endodontic Access Cavities. J Clin Med. 2023 Jul 18;12(14):4762. doi: 10.3390/jcm12144762. PMID: 37510877; PMCID: PMC10381707.
  70. Divya KT, Satish G, Srinivasa TS, Reddy V, Umashankar K, Rao BM. Comparative evaluation of sealing ability of four different restorative materials used as coronal sealants: an in vitro study. J Int Oral Health. 2014 Jul;6(4):12-7. PMID: 25214726; PMCID: PMC4148566.
  71. Gerdolle DA, Mortier E, Droz D. Microleakage and polymerization shrinkage of various polymer restorative materials. J Dent Child (Chic). 2008 May-Aug;75(2):125-33. PMID: 18647507.
  72. Mali P, Deshpande S, Singh A. Microleakage of restorative materials: an in vitro study. J Indian Soc Pedod Prev Dent. 2006 Mar;24(1):15-8. doi: 10.4103/0970-4388.22828. PMID: 16582525.
  73. Celik EU, Tunac AT, Yilmaz F. Three-year clinical evaluation of high-viscosity glass ionomer restorations in non-carious cervical lesions: a randomised controlled split-mouth clinical trial. Clin Oral Investig. 2019 Mar;23(3):1473-1480. doi: 10.1007/s00784-018-2575-y. Epub 2018 Aug 17. PMID: 30120605.
  74. Liu Y, Tjäderhane L, Breschi L, Mazzoni A, Li N, Mao J, Pashley DH, Tay FR. Limitations in bonding to dentin and experimental strategies to prevent bond degradation. J Dent Res. 2011 Aug;90(8):953-68. doi: 10.1177/0022034510391799. Epub 2011 Jan 10. PMID: 21220360; PMCID: PMC3148178.
  75. Jensen AL, Abbott PV. Experimental model: dye penetration of extensive interim restorations used during endodontic treatment while under load in a multiple axis chewing simulator. J Endod. 2007 Oct;33(10):1243-6. doi: 10.1016/j.joen.2007.06.014. PMID: 17889699.

Download Article
Received March 5, 2025.
Accepted April 15, 2025.
©2025 International Medical Research and Development Corporation.