Comparative in vivo analysis of the sealing ability

of three endodontic sealers in post-prepared

root canals
P. M. P. Kopper1, J. A. P. Figueiredo1, A. Della Bona2, J. R. Vanni2, C. A. Bier1 & S. Bopp1
1

Universidade Luterana do Brazil, Post-graduate Program of Dentistry, Canoas; and2Universidade de Passo Fundo, Dental School,
Passo Fundo, Brazil

Abstract
Kopper PMP, Figueiredo JAP, Della Bona A, Vanni
JR, Bier CA, Bopp S. Comparative in vivo analysis of the sealing ability of three endodontic sealers in post-prepared root canals.
International Endodontic Journal, 36, 857^863, 2003.

Aim To compare the sealing ability of the endodontic

sealers AH Plus, Sealer 26 and Endoll in premolar teeth
of dogs exposed to the oral cavity after post-preparation.
Methodology Forty teeth with two canals each underwent root canal cleaning and shaping. Before lling, the
canals were randomly distributed into three groups
according to the sealer to be used: Group 1 ^ AH Plus;
Group 2 ^ Sealer 26; and Group 3 ^ Endoll (Dentsply,
Industria e Comercio Ltda.). Immediately after lling, the
gutta percha and sealer were partially removed from the
canals, leaving material only in the apical third of the root.
The teeth were temporarily sealed with glass ionomer sealer for 72 h to ensure setting. The coronal seal was then
removed and the canals were exposed to the oral cavity
for 45 days. The animals were euthanased and their

Introduction
Studies show that the microbial contamination or recontamination of the root canal system is a decisive factor
in the prognosis of root canal treatment. Lesions refractory to root canal treatment are associated with the presence of microorganisms within the lesions and root
canal system, and these microorganisms are responsible for the continued presence of apical periodontitis
(Tronstad et al.1987, Sundqvist et al.1988, Nair et al.1990).

Correspondence: Jose Antonio Poli de Figueiredo, R. Luciana de

Abreu 20/201, Porto Alegre/RS, Zip code: 90570-060, Brazil
(Tel.: 55 51 3346 2197; e-mail: endog@terra.com.br).

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mandibles and maxillae were removed. After abundant

irrigation with distilled water, the canals were dried and
lled with India ink. The teeth were sealed again for
96 h before extraction. The roots of the extracted premolars were separated and stored in labelled test tubes. The
roots were cleared and the extent of dye penetration was
measured with a 20 stereoscopic magnifying lens.
Results Statistical analysis revealed that there were
signicant dierences between the sealers studied
(P < 0.001). Means for the extent of dye penetration for
AH Plus, Endoll and Sealer 26 were, respectively, 0.13,
2.27 and 3.08 mm.
Conclusions After 45 days exposure to the oral cavity,
none of the sealers was capable of preventing leakage
and coronal dye penetration. There were signicant differences between the sealers studied, in terms of mean
dye penetration.
Keywords: endodontic sealer, leakage, root canal
lling.
Received 5 March 2003; accepted 21July 2003

The knowledge that the infection in the canal system

is responsible for failure of root canal treatment has led
several researchers to report a direct association
between inadequate sealing of the crown and canal system and failure. Studies conducted with dierent methodologies have revealed that, once the lling material is
exposed to oral uids, coronal leakage is inevitable
(Swanson & Madison 1987, Alves et al. 1988,Torabinejad
et al. 1990, Magura et al. 1991, Khayat et al. 1993, Gish
et al. 1994, Trope et al. 1995, Barrieshi et al. 1997,
Mallmann 1997, Borba 2001).
Root-lled teeth often have little coronal tooth structure, and it is often necessary to use intraradicular retention to restore the tooth. In these cases, the risk of
exposing lling material to oral uids is high. Exposure

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In vivo sealer coronal leakage Kopper et al.

may occur if the aseptic chain is broken during the visit

when post space is prepared, the canal is shaped or the
temporary crown is made. Moreover, it may occur
between consultations, because of poor adaptation of
the temporary crown or its premature loss. Although
undesirable, the clinical situation described above is
common in dental practice. In these cases, the amount
of lling material in the root canal is reduced because
of the postspace preparation. It is important to investigate lling materials that may prevent or reduce coronal
leakage in root-lled teeth in which a postspace has been
prepared but not sealed coronally. Endodontic sealers
are materials that work as luting and sealing agents in
root llings, and should therefore have properties that
prevent the contact of oral cavity irritants with periapical tissues.
The sealing ability of dierent sealers has been investigated extensively (Madison & Wilcox 1988, Siqueira
Junior et al. 1995, Ha| kel et al. 1999, Siqueira Junior et al.
1999, De Almeida et al. 2000, Friedman et al. 2000,Valera
et al. 2000, Timpawat et al. 2001, Zucco 2001, Barroso
et al. 2002, Silva et al. 2002).
Most of the studies have been conducted in vitro, and
their experimental conditions do not fully reproduce
the ecology of the mouth. Mastication, temperature
changes, oral microbiota, variations in saliva ow and
food impaction, which may occur inside the canal when
it is not sealed, are oral cavityconditions that are dicult
to reproduce in the laboratory.
The aim of this study was to compare in vivo the
sealing ability of two resin sealers (AH Plus, Dentsply,
Industria e Comercio Ltda., Petropolis, Brazil; and
Sealer 26, Dentsply) and one zinc oxide-eugenol sealer
(Endoll, Dentsply) in premolar teeth of dogs exposed
to the oral cavity for 45 days after preparation and
lling of root canals and postspace preparation.

Materials and methods

Before the study, eight dogs of undened breed and age
were examined, treated and fed byaveterinarian.During
the period of the trial, the animals were fed watersoftened dog chow (Dog Menu, Purina, Ribeirao Preto,
Brazil).The left mandibular second, third and fourth premolars and the maxillary second and third premolars
were included, giving a total of 80 canals. The right premolars were used in a second study, not reported here,
in the same line of research.
All dogs were anaesthetized with 15 mL kg 1 intramuscular (IM) ketamine (Francotar1, Virbac do Brazil
Industria e Comercio Ltda., Roseira, Brazil), 1 mL kg 1

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xylazine hydrochloride (Virbaxyl1 2%,Virbac do Brazil

Industria e Comercio Ltda. Roslira, Brazil) and
0.044 mL kg 1 atropine sulphate (1% atropine, 1%
Fraga, Farmagr| cola S.A. Importacao e Exportacao,
Mairipora, Brazil). A venous line was placed in all dogs,
and they were administered 0.9% sodium chloride
(NaCl; Laboratorio JP, Industria Farmaceutica S.A.,
Ribeirao Preto, Brazil), then intubated and ventilated
with 100% oxygen. The animals were administered
0.9% NaCl and 100% oxygen throughout the procedure.
Anaesthesia was maintained with the IV administration of 5 mL kg 1 ketamine and 0.33 mL kg 1 xylazine
hydrochloride, approximately every 30 min.
Before coronal access, periapical radiographs were
taken of the teeth that were to be submitted to root
canal treatment and soft tissues and teeth were cleaned
and disinfected with gauze pads soaked in tincture of
iodine.
Coronal access was performed with a high-speed
rotary, No. 1012 round diamond bur (Metalurgica Fava
Industria e Comercio Ltda., Francisco da Rocha, Brazil)
with a cooling system. Coronal opening was made on
the occlusal surface to access the orice of each root
canal, and the cusp was left between the two orices.
True working length (TWL) was determined of 1 mm
short of the radiographic apex of the root. The reference
point for all cases was the cusp of the tooth being instrumented.
Canal cleaning and shaping was performed with a
step-back technique. Flexole 1 (Dentsply Maillefer
Instruments SA, Ballaigues, Switzerland) sizes 15^40
were used to preparel the root canal. The rst instrument used was the one that tted snugly at TWL, and
the last le was size 35. Canals were irrigated with
1.8 mL solution at each change of instrument with,
alternately, 1% sodium hypochlorite solution (Farmacia Escola, ULBRA, Canoas, Brazil) and 17% trisodium
EDTA (Farma cia Escola, ULBRA), pH 7.3. This procedure began and ended with 1% sodium hypochlorite
solution (So 1999). After canal cleaning and shaping,
the root canals were dried with size 25 paper points
(Dentsply).
The lateral condensation technique was used for
obturation of the root canals using master (Dentsply)
and B7 accessory (TANARI1, Tanariman Industrial
Ltda., Manacapuru, Brazil) gutta-percha cones, and
one of the following endodontic sealers:
1 Endoll ^ chemical composition: powder: zinc oxide
(40.5 g), staybelite resin (28 g), bismuth subcarbonate
(16 g), barium sulphate (15 g), sodium borate (0.5 g);
liquid: eugenol.

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Kopper et al. In vivo sealer coronal leakage

2 Sealer 26 ^ chemical composition: powder: calcium

hydroxide, bismuth oxide, hexamethylenetetramine;
resine: bisphenol A ether.
3 AH Plus ^ chemical composition: PasteA: epoxi resins,
calcium tungstate, zirconium oxide, silica, iron oxide
pigments; Paste B: amines, calcium tungstate, zirconium
oxide, silica, silicone oil.
Sealers were handled according to the manufacturers' recommendations. The choice of sealer for each
canal was agreed beforehand by stratied randomization. Before the clinical procedures, eight tables were
prepared, one for each unidentied animal. These tables
were used to panel the teeth, root canals and sealer used
in each case. In all, there were nine canals for each animal, and each of the sealers under study was used for
three of them; the tenth canal of each dog was obturated
with one of the sealers.Whentables were prepared, a uniform distribution of sealers in the groups of teeth was
assured (L2ndPM, L3rdPM, L4thPM, U2ndPM, and
U3rdPM). Therefore, the same sealer was used in six
canals in the same group of teeth, and the other two sealers, in ve canals in the same group.
After canal cleaning and shaping, a table was randomlyassigned to each dog. Randomization was assured
by means of blindly picking up a table for each dog as
their teethwere treated. After all canal llings were completed, there were 27 canals obturated with Endoll, 26
with AH Plus and 27 with Sealer 26.
A periapical radiograph was taken after lateral condensation to check whether canal lling was radiographically adequate. The gutta-percha cones where then
sectioned at the cervical point with a plastic lling
instrument (Duex, SS White Artigos Dentarios Ltda.,
Rio de Janeiro, Brazil) heated to ame red in a burner
(Standar Evang Industria e Comercio Ltda, Sao Paulo,
Brazil), and condensed apically with a size 2 Paiva condenser (Golgram Industria e Comercio de Instrumentos
Odontologicos Ltda., Pirituba, Brazil).
Immediately after the lling was completed, a postspace was prepared. The gutta-percha and sealer were
partially removed from the root canals with a no.1 Largo
bur (Moyco Union Broach, York, PA, USA). To determine
the amount of material to be removed from the canal,
the true working length was divided by 3, and the lling
was removed from the coronal two-thirds.
The teeth were then temporarily sealed with a thin
layer of gutta-percha (Odahcam, Dentsply Indu stria e
Come rcio Ltda, Petro polis, Brazil) and glass ionomer
sealer (Vidrion R ^ SS White Artigos Denta rios Ltda.,
Rio de Janeiro, Brazil) for 72 h to ensure setting of the
sealer.

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After 72 h, the dogs were anaesthetized with a single

IM dose of 15 mL kg 1 ketamine and 1 mL kg 1 xylazine
hydrochloride. The coronal seal was removed with a
high-speed rotary, No. 1012 diamond bur with cooling.
The pulp cavities were exposed to the oral cavity for
45 days.
After that period, the dogs were euthanased with an
overdose of 3% sodium pentobarbital (Hypnol, Cristalia
Produtos Qu| micos e Farmaceuticos Ltda., Itatiba, Brazil). The mandibles and maxillae were removed and sectioned.
Post spaces were abundantly irrigated with distilled
water (Farmacia Escola ^ ULBRA, Canoas, Brazil), and
aspirated with a 20-gauge cannula (Becton Dickinson
Industrias Cirurgicas Ltda, Juiz de Fora, MG). The canals
were then dried with absorbent size 70 paper points
(Dentsply Industria e Comercio Ltda., Petropolis, Brazil)
and lled with India ink (Trident S.A. Industria de Precisao, Itapu| , Brazil), and the pulp chambers sealed as previously described.
The left halves of the mandible and maxilla of each dog
were stored in a glass jar with formaldehyde tablets
(Industria Farmaceutica Bioqu| mica Ltda., Sao Jose do
Rio Preto, Brazil) wrapped in gauze. The jars were closed
and labelled. The samples were kept under these conditions for 4 days. After that, the premolar teeth under
study were extracted, and the mesial and distal roots
were separated and placed in individual 5 mL labelled
test tubes.
The clearing process was carried out according to the
technique described by Garberoglio & Bassa (1983). For
72 h, the roots were kept in 5% nitric acid solution
(Importadora Qu| mica Delaware Ltda., Porto Alegre,
Brazil), which was replaced every 24 h. The specimens
were then rinsed in running water for 4 h and dehydrated, successively, in 80% alcohol (Importadora Qu| mica Delaware Ltda., Porto Alegre, Brazil) for 12 h, in
90% alcohol for 1 h and in 99% alcohol changed every
hour for 3 h. To complete the clearing process, the teeth
were placed and stored in methyl salicylate (Importadora Qu| mica Delaware Ltda., Porto Alegre, Brazil) and
kept in it until the end of the study.
The cleared teeth were analysed under a 20 stereoscopic magnifying lens (GSZ, Zeiss, Germany) with an
eyepiece reticule.The extent of dye penetration was measured in millimetres in all aspects of the root. An experienced examiner blinded to the experimental design
analysed the results.
Quantitative data about the length of obturation, measurement of extent of dye penetration and rate of penetration in relation to length of lling were described by

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In vivo sealer coronal leakage Kopper et al.

Table 1 Comparison of means and SDs for length of obturation, measurement of extent of dye penetration and rate of penetration in
relation to length of obturation between the three study groups
Characteristic

AH Plus (N 19)

Endofill (N 22)

Sealer 26 (N 22)

P-value

Length of obturation (mm)

Measurement of extent of penetration (mm)
Rate of penetration (%)

3.45  0.58
0.13  0.16a
4.1  5.1a

3.32  0.64
2.27  1.37b
69.6  38.9b

3.45  0.58
3.08  1.05c
90.1 26.7c

0.713
<0.001
<0.001

ANOVA and rank transformation: different letters (in superscript) indicate statistically significant differences according to Duncan multiple comparisons.

means and SDs. Analysis of variance (ANOVA) was used to

compare the results for the groups, and dierences were
identied with the post hoc Duncan test. ANOVA and rank
transformation were used to analyse rate of penetration
in relation to the length of lling because these data were
asymmetrically distributed.The level of statistical significance was established at a < 0.05. Data were processed
and analysed with the software SPSS 11.0 (Statistical
Package for the Social Sciences, Adobe Systems Incorporated, San Jose, USA) and SigmaPlot 7.0 (Sigma-Aldrich
Corp., St. Louis, USA).

Results
During extraction, some roots were fractured or
damaged, and17 specimens were lost, ve in the Endoll
group, seven in the AH Plus group, and ve in the Sealer
26 group. Therefore, the Endoll and Sealer 26 groups
had 22 specimens each, and the AH Plus group had 19.
Results of statistical analysis are shown inTable 1. Statistical analysis revealed that there was no signicant
dierence in length of lling material left in the root

canal between the groups (P 0.713). The comparison

of the means for coronal dye penetration demonstrated
that there were statistically signicant dierences
between the three groups (P < 0.001). AH Plus had the
lowest degree of penetration; Endoll had less penetration than Sealer 26 and more than AH Plus. Sealer 26
had the highest penetration index.
Of the19 specimens intheAH Plus group, seven had no
dye penetration (Fig. 1a,b). In the other 12 specimens,
dye was restricted to the cervical third of the lling
(Fig. 1c).
Dye penetration was observed in all root canals in the
Endoll group. In 13 of the 22 specimens (59%), dye
penetrated through all the extent of the lling material
(Fig. 2c). In six cases, penetration was limited to the cervical third of the lled portion of the root canal (Fig. 2a).
Inthe other three specimens, the ink permeated the lled
material and reached the middle third, but did not go
beyond it (Fig. 2b).
Dye penetration was observed in all the specimens in
the Sealer 26 group; it was total in all but three of the
canals (Fig. 3a). In the other 19 specimens (86%), dye

Figure 1 Specimens in AH Plus group.

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Kopper et al. In vivo sealer coronal leakage

Figure 2 Specimens in Endoll group.

penetrated through all the extent of the lling material

(Fig. 3b,c).

Discussion
It is still a challenge to avoid contamination or recontamination of the root canal system after completion of
root canal treatment.When postplacement is necessary,
the exposure of lling materials to the oral uids is not
well controlled by most dentists. This study simulated
this clinical condition by using dogs as an experimental

model and hypothesized that the sealers under investigation varied in terms of their ability to prevent or reduce
coronal leakage.
In contrast to most in vitro studies (Swanson &
Madison 1987, Magura et al. 1991), a single period
(45 days) of exposure of the lling materials to the oral
cavity conditions was established. More than one period
would have required a larger sample and a larger number
of animals.
It is important to point out that the dogs were
administered atropine sulphate and intubated before

Figure 3 Specimens in Sealer 26 group.

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861

In vivo sealer coronal leakage Kopper et al.

the beginning of clinical procedures. Such conditions

ensured the maintenance of the aseptic chain because
the tube prevented the interference of breathing, and
atropine inhibited salivary secretion. Absolute isolation
was, thus, unnecessary.
Because of the in vivo model, it was not possible to
standardize true working length and, consequently,
length of post space.The extension of lling material that
remained in the apical third of the root canal is an important variable that might have aected the results. However, this did not occur, as shown by the statistical
(ANOVA) analysis, which showed that there were no signicant dierences between the groups (P > 0.05) when
this variable was analysed. Therefore, the specimens
from the dierent groups were similar in terms of extent
of lling material remaining inside the root canal.
The results are consistent with the ndings reported
by others (Swanson & Madison 1987, Alves et al. 1988,
Torabinejad et al. 1990, Magura et al. 1991, Khayat et al.
1993, Gish et al. 1994, Trope et al. 1995, Barrieshi et al.
1997, Mallmann 1997, Borba 2001), who indicated that
coronal leakage is inevitable when there is exposure of
lling material to oral uids.
The analysis of all results conrmed that the root
canal lling does not seal adequately after exposure to
the oral cavity for 45 days. The analysis of data revealed
that there were fewer chances of failure in post-prepared
root canals exposed to the oral cavity for 45 days when
they are obturated with gutta-percha and AH Plus than
when lled with Endoll or Sealer 26.
A high degree of dye penetration was observed in the
specimens obturated with Sealer 26. The dye penetrated
the full extent of the lling material in almost all specimens. This demonstrated that this sealer was unsatisfactory for the simulated clinical situation, and it can be
inferred that re-treatment should be considered whenever this sealer is exposed to oral uids forat least 45 days.
A number of factors could account for the dierence
between sealers. AH Plus is a paste/paste mix, and this
ensures a better dosage of its components because the
sealer is obtained from a mixture of equal parts of both
pastes. The same is not true for Endoll and Sealer 26;
their manufacturers' recommendations only address
the nal consistency after the mixture of powder and
liquid and not the exact powder-to-liquid ratio. It should
also be pointed out that Sealer 26 contains calcium
hydroxide, which may have contributed to the increased
dye penetration found when this sealer was used as a
result of its solubility.
The pattern of dye penetration in the lling material
revealed dierent patterns for the specimens in the

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International Endodontic Journal, 36, 857^863, 2003

Sealer 26 and Endoll groups. As penetration in the

teeth obturated with AH Plus was minimal, a penetration pattern could not be identied and compared with
the other groups. Figure 3 shows an image of dye inside
the lling material in the group of canals lled with Sealer 26. Speckled clumps are seen inside the material. In
the specimens with Endoll, dye penetration occurred
in a more linear fashion. Such observation suggests that
the characteristics of the sealer lm formed between
the canal wall and the gutta-percha cones, and the manner it is aected by the action of the oral uids may be
responsible for the pattern of dye permeated within the
remaining sealer.
The results reported by Siqueira Junior et al. (1995) differ from our ndings as they did not nd statistically signicant dierences between Sealer 26 and Fill Canal,
which is similar to Endoll. Similarly, Silva et al. (2002)
reported that Endoll had less sealing ability than Sealer
26.
It is important to point out that in the studies mentioned above, the lling material was exposed to the
dye immediately after the completion of canal lling,
and no time was allowed for the sealer to set. Also, canal
llings were not exposed to the oral cavity before the
penetration marker was used, and dye penetration was
evaluated in the apical-cervical direction by means of
longitudinal sections. There are, evidently, methodological dierences that may explain the dierent results.
DeAlmeida et al. (2000) also used a dierent methodology, but found results similar to those of this study. They
observed a lower degree of dye penetration in canals
obturated with AH Plus than in those with Fill Canal.
De Almeida et al. (2000) allowed time for sealer setting
before exposing the lling material to the penetration
marker.
Although the current literature contains many
reports in leakage, there is no consensus about the sealing ability of endodontic sealers. One of the drawbacks
is the fact that investigations do not follow a similar
methodological pattern, which leads to contradictions.
The present study is closer to clinical reality, and its
results may be more easily extrapolated to dental
practice.
The experimental model used in this study reects the
eect of oral conditions in root-lled teeth prepared for
post placement and left without coronal seal.When posts
are required, the ndings suggest that AH Plus should
be used in the lling of root canals. However, it is important to stress that this endodontic sealer was not capable
of preventing dye penetration, rather penetration was
limited in most specimens.

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Kopper et al. In vivo sealer coronal leakage

Conclusions
After 45 days exposure to the oral cavity, none of the sealers showed perfect sealing ability, nor did they prevent
coronal dye penetration.
There were statistically signicant dierences between the sealers studied; increasing extent and degree
of penetration were observed in the following order:
AH Plus, Endoll and Sealer 26.

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