|Year : 2013 | Volume
| Issue : 6 | Page : 514-517
|Evaluation of immediate and delayed post space preparation on sealing ability of Resilon-Epiphany and Gutta percha-AH plus sealer
Neha Dhaded1, Veerendra M Uppin1, Sunil Dhaded2, Chetan Patil3
1 Department of Conservative Dentistry and Endodontics, KLE VK Institute of Dental Sciences, Belgaum, Karnataka, India
2 Department of Prosthodontics, AMES Dental College and Hospital, Raichur, Karnataka, India
3 Maratha Mandals N.G.H.I.D.S, Belgaum, Karnataka, India
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|Date of Submission||01-May-2013|
|Date of Decision||20-Aug-2013|
|Date of Acceptance||17-Sep-2013|
|Date of Web Publication||2-Nov-2013|
| Abstract|| |
Aim: To evaluate the influence of immediate and delayed post space preparation on sealing ability of Resilon-Epiphany and Gutta percha-AH plus.
Materials and Methods: Eighty extracted permanent maxillary central and lateral incisors were decoronated. Roots canals were prepared and obturated. Samples were divided into four groups depending on the time of post space preparation and obturated material. Group I and II: Immediate and delayed post space preparation respectively with Gutta percha/AH plus as obturating material. Group III and IV: Immediate and delayed post space preparation with Resilon/Epiphany as the obturating material. The samples were kept in methylene blue dye ,sectioned and then measured under stereomicroscope and studied under SEM.
Statistical Analysis: The data was subjected to statistical analysis using unpaired t-test.
Results: There was significant difference found between immediate and delayed post space preparation in Resilon-Epiphany group (P = 0.0109) as well as in AH plus-GP group (<0.0001). Difference in the sealing ability of the two materials was seen in delayed group (P = 0.0202). No statistically significant result was found between the two obturating materials when post space was prepared immediately (P = 0.0875).
Conclusion: Within the limitations of this study, there was significantly less leakage when post space is prepared immediately in both the groups. Resilon-Epiphany shows better results when post space is delayed amongst the two whereas in immediate post space preparation there is no significant difference.
Keywords: Immediate and delayed post space preparation; Resilon-Epiphany Gutta percha-AH plus sealer; sealing ability.
|How to cite this article:|
Dhaded N, Uppin VM, Dhaded S, Patil C. Evaluation of immediate and delayed post space preparation on sealing ability of Resilon-Epiphany and Gutta percha-AH plus sealer. J Conserv Dent 2013;16:514-7
|How to cite this URL:|
Dhaded N, Uppin VM, Dhaded S, Patil C. Evaluation of immediate and delayed post space preparation on sealing ability of Resilon-Epiphany and Gutta percha-AH plus sealer. J Conserv Dent [serial online] 2013 [cited 2020 Feb 25];16:514-7. Available from: http://www.jcd.org.in/text.asp?2013/16/6/514/120962
| Introduction|| |
The success of endodontic therapy depends on the ability to establish and maintain a apical seal. One of the major factor of root canal failures is coronal leakage caused by recurrent caries, open crown margins, leakage through temporary restorations, or failure to have a provisional placed on a treated tooth in timely manner. Therefore placement of a post to retain the core if indicated and restoration without delay is the need of the hour. 
An endodontically treated tooth that has lost significant tooth structure may require a post and core for restorative rehabilitation.  But the retreatment of this procedure is extremely difficult and cumbersome. Any failure caused by apical leakage will result into a reinfected tooth making the entire procedure come to a zilch. Therefore it is deemed necessary to evaluate the sealing ability of the obturating material especially in the apical portion before making it a material of choice.
Gutta percha remains to be the golden standard,  but studies showed that when gutta percha filled canals were challenged by bacteria, 50% allowed penetration through the entire length of the canal within 30 days. Another study done with fiber post with 5-8 mm of gutta percha and resin bonding sealer, there was 50% improvement in prevention of leakage.  Eugenol containing sealers like other phenolic compounds, has the ability to collect free radicals so it interferes with polymerization reaction of resin cements. Thus resinous sealers are recommended.  Resin obturation materials right from the advent have become exceedingly popular. AH plus is an epoxy amine resin sealer, which has gained momentum because of its high flexural strength and sealing ability.
In order to replace gutta percha and traditional sealers for obturation Epiphany/Resilon was introduced. This system consists of the core material (RESILON), the dual cure sealer (bonding agent) and a self-etching primer.  Since these materials have readily gained momentum it is important to evaluate their ability as obturating materials against the benchmark extremely widely used gutta percha.
In terms of post space preparation, the required post space may be prepared either immediately after the completion of the endodontic procedure using hot pluggers or alternatively at a later stage after full setting of the sealer using rotary instruments.  Performing post space immediately after root canal obturation but before sealer cement sets may, however, mean that the apical seal remains intact.  Yet the common procedure is late removal of the coronal part of the root canal filling at a subsequent visit. 
If post space and post itself are prepared in the same session as the root canal fillings, these aseptic conditions may be easily followed with no additional efforts but in some cases the evaluation period is needed to analyze the restorability of the tooth with post and core.  Since there are different schools of thoughts regarding the critical time to carry out this procedure, this aspect is under extensive research.
Hence, the purpose of this study is to evaluate the effect of immediate and delayed post space preparation and sealing ability of Resilon and Epiphany sealer.
| Materials and Methods|| |
A total of 80 extracted, noncarious human permanent intact maxillary central and lateral incisor teeth with straight and single patent root canal, which had completely formed apices, were included and teeth with fractured roots, root cracks, incompletely formed, apex, bifurcated canals, and resorptive defects were excluded. The teeth were decoronated at the cementoenamel junction and standardized to 16 mm length. Biomechanical preparation was done with Protaper universal files up to size 40. Irrigation was performed using 2 ml of 3% NaOCl after every instrumentation with 26-guaze needle syringe. Nearly 17% Ethylenediaminetetraaetic acid rinse was used during and after instrumentation to remove the smear layer. No. 10 K file was used through the apical foramen of the canal before and after instrumentation to ensure patency followed by obturation.
Teeth were divided randomly into four groups of 20 samples each based on the obturation material and depending on the time of post space preparation
Group I : Immediate post space preparation + GUTTA PERCHA/AH PLUS
Group II : Delayed post space preparation + GUTTA PERCHA/AH PLUS
Group III : Immediate post preparation + RESILON/EPIPHANY
Group IV : Delayed post space preparation + RESILON/EPIPHANY
(GUTTAPERCHA/AH PLUS sealer + Immediate post preparation)
An ISO size 40 master gutta percha cone of 0.06 taper was taken till the working length and checked for tug back. AH Plus sealer was mixed according to manufacturer instructions and was applied to the root canal wall using a lentulospiral and obturation was done with lateral condensation technique. In this group post space was immediately made after the obturation using a peeso reamer to a depth that left 4 mm of gutta percha apically and was condensed with heated plugger. Orifice of the canal was sealed with cavit.
GUTTA PERCHA - AH PLUS sealer + delayed post space preparation
The teeth were obturated the same way as in group I. In this group the teeth were placed in saline at 37 0 c for one week after obturation and post space was prepared same as group I. Coronally it was sealed with cavit.
RESILON-EPIPHANY system + immediate post space preparation
In this group, the ISO size 40 Resilon Master cone was inserted in the canal and checked for tug back. The self-etching primer was inserted into the canal with the help of micro brush for 30 seconds and excess was removed with paper points. Epiphany sealer was placed with lentulo spiral paste carrier. The Resilon master cone coated with Epiphany was placed in the root canal and condensed. After obturation the cones were sheared of at the orifice of the root canal and were light cured for 40 seconds using a Quartz- Tungsten- Halogen curing unit. The post space was prepared immediately after the obturation with the help of a peeso reamer to a depth that will leave 4 mm of root canal filling material apically and sealed cavit-G.
RESILION-EPIPHANY system + delayed post space preparation
The samples are obturated the same way as in group III. After the obturation the teeth were sealed with cavit-G and placed in saline at 37°C for one week in an incubator and the post space was prepared same as group III.
Each tooth was radiographed after obturation and after post space preparation, specimens with voids and with excess removal of GP were discarded.
For dye leakage entire root length was painted with nail varnish except apical 4 mm and teeth were immersed in 2% methylene blue dye for 48 hours. All the samples were grooved longitudinally in bucco-lingual direction using a double diamond disc in low speed under constant cooling with distilled water without disturbing gutta-percha filling, they were split with the help of a chisel. All the samples were observed under microscope and 10 samples from each group were randomly selected for scanning electron microscopy (SEM) analysis to qualitatively analyse the leakage. The adaptation of the obturation material to dentinal walls and the interface were examined under SEM at apical 4 mm and microphotographs were taken from 50× to 300× magnification [Figure 1]. Later the obturation material was gently removed from all the samples and the specimens were viewed under stereomicroscope.
Linear measurements were recorded under 10× magnification. Leakage was measured from the apical foramen coronally till 4 mm with the help of ocular micrometer. The graduations in the microscope were converted into millimeters as follows:
|Figure 1: (a) SEM showing Resilon epiphany immediate group under 300×, (b) SEM of Guttapercha/AH PLUS showing good adaptation in immediate group under 300×, (c) SEM showing weak area in AH PLUS– Guttapercha delayed group showing poor adaptability under 300×, (d) SEM showing weak link in resilon epiphany delayed group under 300×|
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The mean of the reading was taken [Table 1] and the data was then subjected to statistical analysis using Unpaired t-test to determine whether there was significant difference between the groups (P < 0.05) [Table 2].
| Results|| |
Time of post space preparation definitely showed influence on sealing ability of the two materials [Graph 1]. There was significant difference found between immediate and delayed post space preparation in Resilon-Epiphany group (P = 0.0109) as shown in. Similarly, significant difference was seen between immediate and delayed post space preparation in AH plus-GP group (P < 0.0001).
Difference in the sealing ability of the two materials was seen in delayed group (P = 0.0202).
No statistically significant result was found between the two obturating materials when post space was prepared immediately (P = 0.0875).
| Discussion|| |
The preparation of a dovel post is known to disrupt the apical seal of gutta percha and may be affected by factors such as technique of obturation and the choice of sealers. Resinous sealers showed superior results as compared with zinc oxide eugenol sealers. Thus prompted the use of AH plus sealer.  Immediate post space preparation by the same operator, who has just finished obturating the canal, can be done under rubber dam, using the same aseptic conditions and additional advantage of this protocol is that the condensation of the remaining gutta percha can be assessed and improved if necessary. Finally the familiarity of the operator with the root canal system minimizes the risk of perforation or stripping. 
In the present study, the immediate group showed less leakage than the delayed group of Resilon/Epiphany as observed by Biggs et al. and Paque et al. , The probable reason for the result could be that if post space is created prior to the complete setting of sealer, the result should be less leakage because the sealer would less likely be disturbed during the removal of excess Resilon with rotary instruments. 
The mean value in immediate preparation of AH plus/gutta percha was similar to immediate preparation of Resilon/Epiphany, which confirms with the study by Bodrumulu et al. One of the reason of similarity with AH plus/gutta percha may be the result of filling gaps and voids caused by the post preparation through the flow of the AH plus before setting or polymerization occurred. 
Better results of Resilon/Epiphany in delayed preparation as compared with AH plus/gutta percha may be because of the better adhesion of Epiphany sealer to dentine as demonstrated by Shipper et al.  Having more tensile strength  and setting of the sealer after light curing  might have allowed it to resist crumbling caused by the rotary action of drills in both immediate and delayed post space preparations.  In case of gutta percha the rotational forces of the rotary instruments cause the movement of the gutta percha thus breaking the bond at the sealer interface. 
When immediate and delayed post preparation was compared within the AH plus/gutta percha group, the results were as observed by Solono et al.,  Prado et al.,  and Fan et al.  The present study also showed less leakage with immediate procedure as compared with delayed. The hypothesis is that when the post space is made at the time of obturation, the sealer has not formed a lasting bond to the gutta percha or canal wall. When the heated instrument or rotary instrument is introduced in the canal to remove the gutta percha, the sealer is still in its working time and allows the sealer to set within the micro fractures where the sealer is in contact with the gutta percha and canal. 
In spite of its resin-based nature few samples of Resilon/Epiphany showed leakage. This could be because during polymerization, shrinkage stresses are relieved by the "move and flow" of the unbonded surface. As the unbonded surface area becomes small, in long narrow canals, there is insufficient stress relief by flow and a high probability that one or more bonded areas will pull off or debond thus creating weak areas. ,
The results of the present study definitely gives better results in the sealing ability when post space is prepared immediately after the obturation and the very popular Resilon/Epiphany does show improved results in the delayed group. Hence, further investigations are required to overcome the drawbacks in this material. Nevertheless, these in vitro results cannot be extrapolated to in vivo situations, but they do permit reasonable comparison.
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Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2]
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