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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 32  |  Issue : 2  |  Page : 96-99

Comparative evaluation of flow rate of four different endodontic sealers: An in vitro study


1 Department of Dentistry, Bhimo Bhoi Government Medical College, Bolongir, Odisha, India
2 Department of Conservative Dentistry and Endodontics, Maitri College of Dentistry and Research Centre, Durg, Chhattisgarh, India
3 Private Practice - Mumbai, Maharastra, India

Date of Submission10-May-2019
Date of Decision01-Feb-2020
Date of Acceptance13-Mar-2020
Date of Web Publication18-Jun-2020

Correspondence Address:
Shanin Farista
G1, Sea Pebbles, Perry Cross Road, Bandra West, Mumbai - 400 050, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/endo.endo_33_19

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  Abstract 


Aim: The purpose of this study was to compare the flow abilities of four different root canal sealers namely, AH Plus, mineral trioxide aggregate (MTA) Fillapex, Sealapex, and Adseal.
Materials and Methods: According to the method proposed by International Organization for Standardization (ISO) specification 6876/2012 (root canal sealing materials), a volume of 0.05 ml of the cement was taken and mixed according to the manufacturer's recommendation and placed on a glass plate. At 180 ± 5 s after mixing, the second glass plate of 20 g was placed on top of the sealer, followed by the weight of mass 100 g to make a total mass on the plate of 120 ± 2 g. After 10 min from the start of mixing, the weight was removed and the diameter of the compressed disc of sealer was measured. The mean of five such values for each sealer was taken as the flow of the material.
Results: The flow obtained for the sealers are as follows: 21.84 mm for Adseal, 20.01 mm for AH Plus, 22.43 mm for MTA Fillapex, and 19.84 mm for Sealapex. The results were expressed as arithmetic means, and the statistical analysis was then performed for the mean values using ANOVA and Tukey's tests using SPSS 16.0 and a value of <0.05 was considered significant.
Conclusion: All the sealers tested conform to ISO specification that requires that a sealer should have a diameter of not < 20 mm. The MTA Fillapex achieved the greatest flow being statistically significant in comparison to other tested sealers (= 0.002), while Sealapex showed the least flow among all.

Keywords: Adseal, AH Plus, flow, International Organization for Standardization specification, mineral trioxide aggregate Fillapex, Sealapex


How to cite this article:
Dash AK, Dash A, Thakur JS, Farista S, Asrani H, Rathi S. Comparative evaluation of flow rate of four different endodontic sealers: An in vitro study. Endodontology 2020;32:96-9

How to cite this URL:
Dash AK, Dash A, Thakur JS, Farista S, Asrani H, Rathi S. Comparative evaluation of flow rate of four different endodontic sealers: An in vitro study. Endodontology [serial online] 2020 [cited 2020 Jul 7];32:96-9. Available from: http://www.endodontologyonweb.org/text.asp?2020/32/2/96/287068




  Introduction Top


Success in endodontic treatment depends on the prevention and control of root canal infection which is achieved by adequate cleaning, shaping, and filling.[1] One of the primary goals of successful endodontic treatment is the complete canal obturation.[2] Root canal filling is done by core materials like gutta percha and root canal sealers. Root canal sealer is used to fill the minute gap between the core material and root canal wall.[3] Dowsen and Garber emphasized that the paste (sealer) is an extremely important part of the filling regardless of whether silver cones, gutta-percha points, or a combination of filling materials are used.[4] According to Siskin and Coolidge, the sealer must be thin and plastic enough to fill the canal space and provide a hermetic seal.[1],[5] According to Schilder, three-dimensional seal of the root canal is provided by root canal sealer.[6]

Flow is the ability of sealer which helps to penetrate irregularities and accessory canals of the root canal system.[6] Greater the flow, the greater is the ability of a sealer to penetrate into irregularities of the root canal system. Conversely, if the flow is excessive, the risk of material leaching out to the periapex is more which could damage periodontal tissues. The composition of the sealers seems to be the main factor related to its flow characteristics. Characteristics like powder particle size in powder/liquid sealers (Weisman 1970) as well as the sealer's constituents and setting time (Grossman 1976) appears to interfere with the flow.[7],[8] The most frequently used endodontic sealers are resin-based sealers, zinc oxide-eugenol-based sealers, calcium hydroxide-containing sealers, glass ionomer-based sealers. More recently, mineral trioxide aggregate (MTA)-based sealers and biosilicate sealers are used. Some studies have been carried out to evaluate the flow property, which can vary according to the sealer composition or to the powder/liquid proportion.[1] However, there is little information to relate the composition of some newly introduced resin-based sealers to their flow properties such as MTA Fillapex.

Hence, the purpose of the present study was to evaluate the flow rate of two epoxy resin-based endodontic sealers – Adseal and AH Plus, one MTA-based-MTA Fillapex, and one calcium hydroxide-based sealer – Sealapex.


  Materials and Methods Top


Four sealers to be tested are described as under along with their composition [Table 1].
Table 1: Manufacturer and composition of endodontic sealers

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Methods

The flow abilities are measured using the simple press method [9],[10],[11],[12] and the procedure is divided into five steps for all the four groups of sealers tested having five samples each as mentioned below:

  1. Measuring the sealer: Root canal sealers were measured according to the standards of the International Organization for Standardization (ISO) specification 6876/2001[9] which includes the tests of the physicochemical properties of dental root canal sealing materials
  2. Mixing the sealer: A volume of 0.05 ml of the cement was mixed according to the manufacturer's recommendations and was placed with the help of a graduated disposable 1 ml syringe on a glass plate
  3. Determining the flow: At 180 ± 5 s after the commencement of mixing, the second glass plate measuring 40 mm × 40 mm and 5 mm thick was placed carefully and centrally on top of the sealer, followed by the weight of mass approximately 100 g to make a total mass on the plate of 120 ± 2 g to determine the flow
  4. Measuring the flow: 10 min after the start of mixing, the weight was removed and the values of the maximum and minimum diameters of the compressed discs of sealer were measured by a digital Vernier Caliper (Mitutoyo, Kawasaki, Japan). If the diameters agree to within 1 mm, the mean of the two diameters (maximum and minimum) was taken as the flow of the sample (disc). If the major and minor diameter discs were not uniformly circular or did not match within 1 mm, the test was repeated
  5. Statistical analysis: The mean of five samples for each sealer (n = 5) expressed to the nearest millimeter was taken as the flow of the material for that group. Data were recorded directly onto coding sheets and then stored in a computer. The mean values were compared statistically using ANOVA and Tukey tests. Statistical analysis was performed using SPSS 16.0 for Windows (SPSS Inc. Chicago, USA), and a value of P < 0.05 was considered significant.



  Results Top


The ISO specification 6876 requires that a sealer should have a diameter of not < 20 mm. The sealers Adseal (Meta Biomed, Korea), AH Plus (Dentsply DeTrey, Konstanz, Germany), MTA Fillapex (Angelus Brazil), and Sealapex (Dentsply DeTrey, Konstanz, Germany) conformed to ISO specification 6876 standards as the results were 21.24 (±0.52), 22.72 (±1.75), 24.90 (±1.61), and 25.15 (±1.73) mm, respectively. Only the Sealapex did not conform to ISO specification 6876, as the result for Sealapex was 19.84 (±0.55) mm [Graph 1].



Intergroup comparison showed that MTA Fillapex (22.44) has the highest flow rate among all tested sealers which was statistically better than Sealapex (19.84) and AH Plus (20.02). However, Sealapex had the lowest flow rate among all tested sealers and was statistically least as compared to MTA Fillapex (22.44) and Adseal (21.49). On comparing Adseal and MTA Fillapex, there was no statistically significant difference between them in terms of flow rate.


  Discussion Top


Root canal filling is one of the important phases of endodontic treatment which aims to completely fill the root canal system using filling materials with adequate biological and physicochemical properties.[13] One of the important properties of root canal sealers used in root canal obturation is their flow.[3] An acceptable flow within the working time is important for any endodontic sealer to reach and seal the apical foramen and lateral dentinal wall irregularities.

The flow test can be conducted by means of two international standards: American Dental Association (ADA) No. 57 (American National Standards/ADA 1983)[14] or ISO-6876 (ISO 2001).[11],[14] The differences between ADA and ISO standards are of the volume analyzed and the minimum diameter of spread. The ISO 6876 specification recommends that the volume of sealer to be taken is 0.05 ml (±0.005 ml) and each compressed disc shall have a diameter not < 20 mm.[3] In the present study, ISO 6876 specification was the standard of choice because it has been widely used. In addition, a smaller volume of the sealer taken for this test allowed an easier manipulation of the material.

Several properties of root canal sealers have been studied, such as setting time, solubility, disintegration, film thickness, and dimensional changes after setting, biocompatibility, and antimicrobial activity.[15],[16],[17],[18],[19] It is also important that a root canal sealer has a suitable flow to enter the narrow irregularities in dentin, accessory canals and voids between master and accessory cones. Less flow and working time results in inability to work effectively with a material increasing the chances of a void being created. Several factors may influence the penetration of endodontic sealers within confined areas of the root canal system. Among them, the obturation technique used, the contact area, the dimension of irregularities, accessibility to the complexities, and the sealer's flow rate seem to play an important role in allowing sealer penetration. Furthermore, the composition, particle size, shear rate, temperature, and time from mixing govern the flow characteristics of sealers.[9] It is important that the sealer should flow into accessory anatomy and between gutta-percha cones, without increasing the risk of periapical extrusion.[15]

In the present study, the flow of all the tested sealers complied with the ISO requirements, i.e., ≥20 mm. The MTA Fillapex sealer exhibited a higher flow than the other sealers tested. Better flow is attributed to the finer particle size and the gel vehicle which also improves its handling characteristics,[1] which is in accordance with results of some of the previous studies.[1],[3],[12],[20] AH Plus is a hydrophobic epoxy resin-based sealer that has been used as the gold standard for comparisons with other endodontic sealers.[20] Both AH Plus and Adseal are hydrophobic epoxy resin-based sealers that showed superior flow in comparison to Sealapex which is calcium hydroxide-based sealer. This might be due to their resin content which provides plasticity and improves flow.[1] Sealapex showed the least flow among the tested sealers which can be attributed to the lack of resin component which is responsible for providing flow to the endodontic sealers.[18]


  Conclusion Top


Within the limitation of this study, it can be concluded that all the sealers tested showed flowability that conferred to ISO specification. Among all the sealers, MTA Fillapex achieved the greatest and Sealapex showed the least flow.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Siskin M. Obturation of the root canal. Dent Clin North Am 1957;Nov:855-71.  Back to cited text no. 1
    
2.
Siqueira JF Jr., Fraga RC, Garcia PF. Evaluation of sealing ability, pH and flow rate of three calcium hydroxide-based sealers. Endod Dent Traumatol 1995; 11:225-8.  Back to cited text no. 2
    
3.
Siqueira JF Jr., Favieri A, Gahyva SM, Moraes SR, Lima KC, Lopes HP. Antimicrobial activity and flow rate of newer and established root canal sealers. J Endod 2000;26:274-7.  Back to cited text no. 3
    
4.
Dowsen J, Garber FN. A Chair Side Manual of Clinical Endodontics. 6th ed. St. Louis: C.V. Mosby Company; 1967. p. 106.  Back to cited text no. 4
    
5.
Coolidge ED. Endodontia. 1st ed. Philadelphia: Lea and Febiger; 1950. p. 191.  Back to cited text no. 5
    
6.
Schilder H. Filling root canals in three dimensions. Dent Clin North Am 1967;11:723-44.  Back to cited text no. 6
    
7.
Weisman MI. A study of the flow rate of ten root canal sealers. Oral Surg Oral Med Oral Pathol 1970; 29:255-61.  Back to cited text no. 7
    
8.
Grossman LI. Physical properties of root canal cements. J Endod 1976; 2:166-75.  Back to cited text no. 8
    
9.
American National Standards/American Dental Association. Ansi/ADA Specification No. 57: Endodontic Sealing Material. Chicago:American National Standards/American Dental Association; 2000.  Back to cited text no. 9
    
10.
International Organization for Standardization. ISO 6876: Dental Root Canal Sealing Materials. Geneva, Switzerland: International Organization for Standardization; 2001.  Back to cited text no. 10
    
11.
Versiani MA, Carvalho-Junior JR, Padilha MI, Lacey S, Pascon EA, Sousa-Neto MD.A comparative study of physicochemical properties of AH plus and epiphany root canal sealants. Int Endod J 2006;39:464-71.  Back to cited text no. 11
    
12.
Almeida JF, Gomes BP, Ferraz CC, Souza-Filho FJ, Zaia AA. Filling of artificial lateral canals and microleakage and flow of five endodontic sealers. Int Endod J 2007;40:692-9.  Back to cited text no. 12
    
13.
Bernardes RA, de Amorim Campelo A, Junior DS, Pereira LO, Duarte MA, MoraesIG, et al. Evaluation of the flow rate of 3 endodontic sealers: Sealer 26, AH Plus, and MTAObtura. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e47-9.  Back to cited text no. 13
    
14.
de Faria-Júnior NB, Massi S, Croti HR, Rivas Gutierrez JC, Dametto FR, Vaz LG. Comparative assessment of the flow rate of root canal sealers. Rev Odonto Ciênc 2010;25:170-3.  Back to cited text no. 14
    
15.
Marciano MA, Guimarães BM, Ordinola-Zapata R, Bramante CM, Cavenago BC, Garcia RB, et al. Physical properties and interfacial adaptation of three epoxy resin-based sealers.J Endod 2011;37:1417-21.  Back to cited text no. 15
    
16.
Candeiro GT, Correia FC, Duarte MA, Ribeiro-Siqueira DC, Gavini G. Evaluation of radiopacity, pH, release of calcium ions, and flow of a bioceramic root canal sealer. J Endod 2012;38:842-5.  Back to cited text no. 16
    
17.
Zhou HM, Shen Y, Zheng W, Li L, Zheng YF, Haapasalo M. Physical properties of 5 root canal sealers. J Endod 2013;39:1281-6.  Back to cited text no. 17
    
18.
Tanomaru-Filho M, Bosso R, Viapiana R, Guerreiro-Tanomaru JM. Radiopacity and flow of different endodontic sealers. Acta Odontol Latinoam 2013;26:121-5.  Back to cited text no. 18
    
19.
Silva MF, Faraoni G, do Masson MC, Aparecido Santos RM, Claudia Cimardi AC, Victorino FR. Comparative evaluation of pH and solubility of MTA Fillapex endodontic sealer. RSBO 2014;11:41-6.  Back to cited text no. 19
    
20.
Agarwal N. The physicochemical properties of root canal sealers. Endodontology 2016;28:97-101.  Back to cited text no. 20
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