Endodontic filling Restoration, Is there any difference between Resilon and Gutta-percha?
Dr.Hicham Nuaimi and Dr. Avin Nanakali
Endodontic treatment necessitates an instrumentation of the root canal in order to eliminate infectious
debris, leaving clean canal walls. After the instrumentation and protocol irrigation of debris is complete, the root canal is filled with endodontic material filling, which inserted properly with an endodontic sealer.
The first endodontic filling materials have been used Amalgam, Asbestos, Cement, Copper, Gold Foil, Iron, Lead, Oxy- Chloride of Zinc, Paraffin, Resin, Rubber, Silverpoints, but none of them seen to be required as an ideal obturation material.
According to Grossman, Root canal filling material should have the following characteristics, (1):
(1) it should be easily introduced into a root canal
(2) it should be preferably a semisolid upon insertion and become solid afterwards; (3) it should seal the canal laterally as well as apically
(4) it should not shrink after being inserted
(5) it should be impervious to moisture
(6) it should be bacteriostatic, or at least not encourage bacterial growth
(7) it should be radiopaque
(8) it should not stain tooth structure
(9) it should not irritate periapical tissue
(10) it should be sterile, or easily and quickly sterilized immediately before insertion (11) it should be easily removable from the root canal if necessary
Subsequent, scientists discovered (Gutta-percha) as a suitable root canal filling material. Gutta-percha name is derived from (GETAH) that mean gum, while (PERTJA) from the name of the tree in that used it material. Dr. William Montogmerie, who was a medical officer in Indian service. He was the first to appreciate the potential of this material in London in 1843, (1).
However, the need for improvement and getting an ideal root canal filling material propagates during sophistication endodontic therapy. While currently used filling materials seem to afford the practitioners a high level of success and long durability. Updating in endodontic filling materials, endodontic sealer and techniques are continuing over this century.
Resilon filling material is a thermoplastic, polyester polymer-based root canal filling material. Resilon is composed of bioactive glass and radiopaque fillers. Its implementation is similar to gutta-percha in function, in addition to the same handling properties (2).
However, several studies have shown that, while using gutta-percha as a filling restoration, the canal walls may not be completely free of debris (2,3). Several procedures are used to remove gutta-percha by using either hand or rotary instruments with or without heat application. In addition, chemical solvents materials as chloroform is one of the most effective procedure for gutta-percha removal (4). chloroform solvent material has also been recommended for the removal of Resilon filling material.
In order to obtain good obturation, practioners have to use proper endodontic sealers like:
- Calcium hydroxides
- Zinc-Oxide Eugenol cements
- Glass Ionomer Cements.
Once Resilon filling materials were introduced during the recent decay, a lot of concern was stated for the proper obturation material to fill canals rivaled to gutta-percha. For gutta-percha, practioners could provide ZOE or epoxy resin root canal sealer. The proper sealer used for Resilon is a methacrylate resin sealer like:
Studies have shown the properties of Resilon endodontic material in compare to gutta-percha restoration.
ADA has focused on the cytotoxicity for selecting a dental material due to direct contact with humanity. So that it should not negatively affect the hosts cells found in the PDL.
Studies have shown that gutta-percha has no inflammatory reaction that affected the host cells. Key J et.al, 2006 showed that effect of Resilon and gutta -percha on the fibroblast cells were the same. While the sealers that used may potentially have a cytotoxic potential when setting reactions were not complete. Epiphany was found to be less cytotoxic than Grossman’s sealer (ZOE- based). On the other hand Epiphany was found to be more cytotoxic than Sealapex, which is calcium hydroxide-based (5). Sousa et.al, 2006 showed that EndoREZ produced high inflammatory reaction intraosseous bone when compared with the other sealer, while Epiphany showed the lowest inflammatory effect and high bicompatibilty when compared with others (6).
One of the major identity for success or failure of endodontic restoration is coronal leakage due to invasive of bacteria.
Microleakage remains one of the main reason for the failure of root canal therapy, wherever the challenge has been to achieve a proper seal between endodontic obturation material and interdental dentine surfaces.
Bacteria migrate apically through coronal microleakage. Khayate et.al, 1993 found that when root canal filling exposed to artificial and natural saliva, leakage appear and then bacteria contaminate to the root apex (7). Brito et.al, 2003 demonstrated that using of an adhesive sealer showed significantly slow or stop coronal-apical bacterial migration, in spite of using Gutta-percha (8).
Teixeira et.al, 2004 demonstrated that endodontic sealers form a close adhesion to the intra dentinal wall, but none is able to bond to the gutta-percha core material. During setting of sealer, shrinkage admits the sealer to pull away from the gutta-percha material that lead to create a microgap, which permits bacteria pass apically(9).
Shipper et.al, 2005 found that using gutta-percha and AH-26 sealer have more inflammatory response when compared with Resilon and Epiphany. They concluded this result due to the superior resistance of Resilon to coronal microleakage(10). Kurtzman et.al, 2006 found that teeth that were obturated using Resilon showed significant less shrinkage in compare with conventional Gutta-percha. (11)
According to the previous studies, Resilon-Epiphany system was recommend for improvement in leakage resistance compared to gutta-percha techniques.
Calcium hydroxide has been advocated as an intracanal medicament while endodontic procedure required an extra visit. It is recommended that irrigation with 17% ethylenediaminetetracitic acid (EDTA), When obturation is not occurred during single visit to remove any remnants of the calcium hydroxide. When this technique was achieved it was discovered that calcium hydroxide did not badly affect the seal of the root-canal system with Resilon(12).
Moreover, during obturation procedures, it is required to use a disinfection material as sodium hypocholorite (NaOCl) or chlorhexidine before obturation. Isci S et.al, 2006 found that a 1-minute immersion in either solution did not show any significant deterioration on the Resilon cone’s surface (13)
Nielsen et.al, 2006 showed that Resilon sealer set in 30 minutes in anaerobic environments (normally found in the canal), while in air it required 1 week to set, they concluded that the key of setting time is limiting oxygen in the canal system(14).
Using resin obturation materials are not preferable in most cases due to concern of retreatment procedure that may occur after obturation. Resilon obturation consists of a soft core material (Resilon) with a methacrylic resin sealer (Epiphany). de Oliveira et.al, 2006 showed that the ability of progression of a file through the Resilon-obturated canal. Essentially, Resilon was faster to remove than gutta-percha and resulted in cleaner canal walls in the apical third of the teeth obturated with Resilon when compared to gutta-percha(15).
Maltezos et.al, 2006 found that mineral trioxalate (MTA) does not show a significance in bacterial leakage in the apical portion of root when compared with Resilon sealer, but Resilon leaked significantly less than Super-EBA (16) So that Resilon may be a viable option as a retrograde filling material with good surgical isolation and moisture control.
- Physical Properties
Endodontically treated teeth have been stated to be more subject to fracture/ cracked because of reduction in dentinal toughness, less water content, and deeper cavities(17).
So that durability of endodontically treated teeth during function make the tooth withdraw weakness, which may lead to fracture (18). Microfractures current prior to endodontic therapy may propagate under load, leading to clinically significant cracks that can finally lead to the loss of the tooth. instrumentation process lead to weaken the tooth as the canals by enlarged and disinfect the root canal system(17).
Furthermore, the weakest portion of endodontic tooth is the cervical aspect due to significant compressive, tensile, and torsional forces during function and bruxism that may lead to the fatigue then fracture. Therefore, the key element is obturation to assist in reinforcing the remaining tooth structure (19)
Teixeira et.al, 2004 reported a significant increase in the fracture resistance of endodontically treated teeth. When restored with a composite intracoronally with routine acid-etch and bonding procedures. They found that teeth restored with Resilon showed increase resistance to tooth fracture when compared to obturations using gutta-percha (19).
Teixeira et.al, 2006 showed that using resin obturation materials in the management of endodontically treated teeth may result to get stronger and more retentive restoration. This may be a significant benefit for teeth weakened by endodontic procedures (20).
Coronal leakage has been increasingly documented as a major cause of endodontic failure. Multiple studies have verified that Resilon proposals a significant improvement in leakage resistance compared to conventional endodontic filling materials. Furthermore, resin obturation can strengthen the remaining tooth structure, improving the long-term prognosis for teeth obturated with Resilon
The picture of Resilon endodontic filling material was used from an article of Arnaldo SANT’ANNA JUNIOR.
- Grossman L(1970): Endodontic Practice, 7th ed, Philadelphia: Lea & Febiger Co., pp. 329-33.
- Shipper G, Orstavik D, Teixeira F, Trope M (2004) An evaluation of microbial leakage in roots filled with a thermoplastic synthetic polymer-based root canal filling material (Resilon). J Endod 30, 342- 347.
- Friedman S, Rotstein I, Shar-Lev S (1989) Bypassing gutta-percha root fillings with an automated device. J Endod 15, 432-437.
- Cunha R, De Martin A, Barros P, da Silva F, de Castilho Jacinto R, da Silveira Bueno CE (2007) In vitro evaluation of the cleansing working time and analysis of the amount of gutta-percha or Resilon remnants in the root canal walls after instrumentation for endodontic retreatment. J Endod 33, 1426-1428
- Key J, Rahemtulla F, Eleazer P (2006). Cytotoxicity of a new root canal filling material on human gingival fibroblasts. J Endod.;32(8):756-758.
- Sousa C, Montes C, Pascon E (2006) Comparison of the intraosseous biocompatibility of AH Plus, EndoREZ, and Epiphany root canal sealers. J Endod;32(7):656-662.
- Khayat A, Lee S, Torabinejad M (1993) Human saliva penetration of coronally unsealed obturated root canals. J Endod;19(9):458-461.
- Britto L, Grimaudo N, Vertucci F (2003) Coronal microleakage assessed by polymicrobial markers. J Contemp Dent Pract. 2003;4(3): 1-10.
- Teixeira F, Teixeira E, Thompson J (2004) Dentinal bonding reaches the root canal system. J Esthet Restor Dent;16(6):348-354.
- Shipper G, Orstavik D, Teixeira F (2004) An evaluation of microbial leakage in roots filled with a thermoplastic synthetic polymer-based root canal filling material (Resilon). J Endod;30(5):342-347.
- Kurtzman G, von Fraunhofer J, Oliveira D (2006) Endodontic Leakage Resistance of Fiber Obturators. Poster presentation AADR, Orlando, FL, #1443.
- Wang C, Debelian G, Teixeira F (2006) Effect of intracanal medicament on the sealing ability of root canals filled with Resilon. J Endod ;32(6):532-536. Epub 2006.
- Isci S, Yoldas O, Dumani A (2006) Effects of sodium hypochlorite and chlorhexidine solutions on Resilon (synthetic polymer based root canal filling material) cones: an atomic force microscopy study. J Endod;32(10):967-969.
- Nielsen B, Beeler W, Vy C, (2006) Setting times of Resilon and other sealers in aerobic and anaerobic environments. J Endod;32(2):130-132.
- de Oliveira D, Barbizam J, Trope M (2006) Comparison between gutta-percha and resilon removal using two different techniques in endodontic retreatment. J Endod;32(4):362-364.
- Maltezos C, Glickman G, Ezzo P (2006) Comparison of the sealing of Resilon, Pro Root MTA, and Super-EBA as root-end filling materials: a bacterial leakage study. J Endod;32(4):324-327.
- Madison S, Wilcox L (1988) An evaluation of coronal microleakage in endodontically treated teeth. Part III. In vivo study. J Endod;14(9):455-458.
- Gutmann J (1992) The dentin-root complex: Anatomic and biologic considerations in restoring endodontically treated teeth. J Prosthet Dent;67(4):458-467.
- Teixeira F, Teixeira E, Thompson J (2004) Fracture resistance of roots endodontically treated with a new resin filling material. J Am Dent Assoc;135(5):646-652.
- Teixeira F (2006) Ideal obturation using synthetic root-filling systems: coronal sealing and fracture resistance. Pract Proced Aesthet Dent;18(3):S7-11.