Blackwell Publishing IncMalden, USAAEJAustralian Endodontic Journal1329-1947© 2007 The Authors; Journal compilation © 2007...
Sealing Ability of Endodontic Sealers                                                                              C. D. C...
C. D. C. Pereira et al.                                                                                          Sealing A...
Sealing Ability of Endodontic Sealers                                                                              C. D. C...
C. D. C. Pereira et al.                                                                          Sealing Ability of Endodo...
Sealing Ability of Endodontic Sealers                                                                                   C....
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  1. 1. Blackwell Publishing IncMalden, USAAEJAustralian Endodontic Journal1329-1947© 2007 The Authors; Journal compilation © 2007 Australian Society of Endodontology? 2007333101106Original Research Seal- ing Ability of Endodontic SealersC. D. C. Pereira et al. Aust Endod J 2007; 33; 101–106ORIGINAL RESEARCHComparative in vivo analysis of the sealing ability of threeendodontic sealers in dog teeth after post-space preparationCharles da Cunha Pereira, DDS, MSc1,2; Elias Pandonor Motcy de Oliveira, PhD1,2; Maximiliano Schünke Gomes,DDS, MSc1,2; Alvaro Della-Bona, MMedSci, PhD1,2; José Roberto Vanni, MSc, PhD1,2; Patrícia Maria Poli Kopper, DDS,MSc1,2*; and José Antônio Poli de Figueiredo, MSc, PhD1,2†1 Department of Research and Graduate Studies, Graduate Program in Dentistry, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil2 School of Dentistry, Universidade de Passo Fundo (UPF), Passo Fundo, RS, BrazilKeywords Abstractdental leakage, dogs, root canal filling materials,root canal obturation, tooth preparation. This study compared the sealing ability of RoekoSeal, AH Plus and EndoRez in dog premolars after post-space preparation and exposure to the oral environ-Correspondence ment. Seventy-four root canals were cleaned, shaped and filled with gutta-Professor Charles da Cunha Pereira, Rua General percha and one of the sealers. Post spaces were prepared with about 4-mm rootNeto, 1241/601CEP 97050-241, Santa Maria, RS, canal filling remaining in the apex. Teeth were sealed for 24 h for sealer setting.Brazil. Email: Teeth were exposed to the oral environment for 45 days. The dogs were killeddoi: 10.1111/j.1747-4477.2007.00069.x and root canals were soaked in India ink and sealed for 96 h. The teeth were cleared, and leakage was measured under stereoscopy. The Kruskal–Wallis testPresent addresses: *School of Dentistry, was used for analysis. A significant difference was found between EndoRez andPontifícia Universidade Católica do Rio Grande do RoekoSeal groups (P < 0.05). EndoRez had lower leakage values than Roeko-Sul (PUCRS), Porto Alegre, Brazil; †Unit of Seal after 45-day exposure to the oral environment. No statistic difference wasEndodontology, Eastman Dental Institute, found in the comparison of AH Plus with the other sealers under study.London, UK. ing is substantially reduced, which increases the risks ofIntroduction leakage (6). Post-space preparation is an important stepSuccess in endodontic treatment requires that all steps in and should be carried out by specialists familiar with theendodontic treatment be followed carefully and according particular anatomic characteristics of root canals and withto well-established technical and biological standards. An the technical knowledge required to ensure asepsis duringaccurate diagnosis is useless if cleaning and shaping of root endodontic treatment (8).canals is not properly performed. Also, a root canal treated The importance of sealers in endodontic obturations iswith a sealer incapable of adequate sealing may be recon- reflected in the large number of studies that have investi-taminated and lead to a failed endodontic treatment. gated the sealing ability of different endodontic sealers. Literature shows that the prognosis of endodontic treat- New materials are often introduced in the market andment is closely associated with contamination or recon- have to be evaluated to have their physical and biologicaltamination of the root canal system. Microorganisms may properties associated with refractory periapical lesions, which may Most studies that evaluate the sealing ability of fillinglead to failed endodontic treatments (1–3). materials are conducted in vitro (9–16), which limits the Definitive restorations are, according to several authors, use of their results in clinical practice. Studies that use ani-the final step in endodontic treatment. It is know that loss mal models more closely approximate the clinical realityof coronal sealing is the cause of exposure of filling mate- (17–22).rial to oral fluids and, consequently, to microorganisms of This in vivo study compared the sealing ability ofthe oral microflora (4–7). RoekoSeal (Roeko Dental Products, batch: 002, Langenau, When the restoration of a tooth requires an intraradicu- Germany), AH Plus (Dentsply De Trey GmbH,lar post, the amount of filling material used for canal seal- batch: 0210000896, Konstanz, Germany) and EndoRez© 2007 The Authors 101Journal compilation © 2007 Australian Society of Endodontology
  2. 2. Sealing Ability of Endodontic Sealers C. D. C. Pereira et al.(Ultradent Products Inc., batch: 5 KGT, South Jordan, UT, and a bridge of dental tissue was kept between the two ori-USA) in dog teeth to evaluate cervical-apical dye leakage fices. Work length was established at 1 mm from theafter post-space preparation and exposure to the oral radiographic root apex; the central cusp was the coronalenvironment for 45 days. reference. Root canals were prepared manually with 21-mm 15– 40 K-type files (Mani Incorporation, Nakaakutsu Takan-Materials and methods ezawa-Machi Tochigi-Ken, Japan). The first file was theThis study was approved by the Ethics in Research Com- one that fit snugly at working length, and the #35 file wasmittees of Universidade Luterana do Brasil (ULBRA, the last one for all canals. Root canals were irrigated atCanoas, Brazil) and Universidade de Passo Fundo (UPF, each instrument change alternating 2.0 mL of 1% sodiumPasso Fundo, Brazil). hypochlorite solution and 17% trisodium EDTA (Novad- Eight small dogs of undefined breed were examined and erme); the last irrigation was performed with 1% sodiumtreated by a veterinarian before inclusion in the study. hypochlorite. After preparation, canals were dried withThirty-seven teeth were used: mandibular left second, #35 absorbing paper points (EndoPoints Indústria ethird and fourth premolars, and maxillary left second and Comércio Ltda., Barão de Angra, Paraíba do Sul, RJ,third premolars. The sample was composed of seventy- Brazil).four root canals because dog premolars have two roots and Canals were obturated using the lateral condensationeach root has one canal. At the same time of the study, the technique and #35 master gutta-percha conescorresponding right maxillary and mandibular sides were (EndoPoints Indústria e Comércio Ltda., batch: 139598), Bused in another study in the same line of investigation. 7 accessory gutta-percha cones (EndoPoints Indústria e Dogs received general anesthesia, which was induced Comércio Ltda., batch:003011G) and one of the followingwith s.c. injection of 0.02 mg kg−1 atropine sulfate (Vigor® sealers: RoekoSeal; EndoRez or AH Plus. Although the1%, Vigor Saúde Animal, Roje Indústria e Comércio sealers were provided in different containers, such asde Produtos Veterinários Ltda., Rio Preto, Brazil) and syringes (EndoRez), tubes (AH Plus) or single-dose enve-0.5 mg kg−1 morphine sulfate (Dimorf SP®, 1 mg mL−1, lopes (RoekoSeal), all were prepared on a smooth glassCristália Produtos Químicos Farmacêuticos Ltda., Itapira, plate; equal parts of paste A and paste B were mixed toBrazil). Ten minutes later, the animals were administered obtain a homogeneous paste.1 mg kg−1 IM xylazine hydrochloride (Virbaxyl® 2%, To select which sealer to use in each root canal, eightVirbac do Brasil Indústria e Comércio Ltda., São Paulo, tables, one for each unidentified dog, were preparedBrazil), and, after a 15-min interval, 0.1 mL kg−1 IM according to a stratified randomisation procedure. Duringtiletamine hydrochloride + zolazepam hydrochloride preparation of the tables, the sealers were uniformly dis-(Zoletil® 50, Virbac do Brasil Indústria e Comércio Ltda., tributed among dental groups – 2nd MandPM, 3rdimported from Virbac SA 06516, France). After that, the MandPM, 4th MandPM, 2nd MaxPM, 3rd MaxPM. Whendogs were administered IV 0.9% sodium chloride (Texon®, the preparation of root canals for one dog was completed,Indústria Farmacêutica Texon Ltda., Viamão, Brazil). The a table was drafted for that dog. The procedure wasanimals were intubated at this point and received 100% repeated until the last table was assigned to the last dogoxygen (White Martins, Air Liquide Brasil Ltda., Ipiranga, treated.Brazil); all through the procedure, 0.9% sodium chloride After lateral condensation, a periapical radiograph wasand 100% oxygen were administered. obtained to check the quality of the obturation. The cones Anaesthesia was maintained with 0.05 mL kg−1 IV tile- were then sectioned at the cervical end of the root withtamine hydrochloride + zolazepam hydrochloride admin- heated endodontic pluggers (Duflex – SS White Artigosistered at about 30-min intervals. As a complement to Dentários Ltda., Rio de Janeiro, Brazil), and slight pressuregeneral anesthesia, buccal infiltration of 3.6 mL 2% was applied apically (cold vertical condensation) with #2lidocaine hydrochloride (DFL – Indústria e Comércio Paiva pluggers (Golgran Indústria e Comércio de Instru-Ltda., Rio de Janeiro, Brazil) and adrenaline at 1:50 000 mentos Odontológicos Ltda., São Paulo, Brazil).concentration was used for each maxillary and mandibu- Immediately after obturation, post-space was preparedlar side under study. with a slow-speed #1 Largo bur (Moyco Union Broach, Before coronal access, periapical radiographs of teeth to York, PA, USA). The Largo bur was previously calibratedbe endodontically treated were obtained. For coronal with a silicone stopper, and filling material was progres-access, a high-speed #1012 diamond bur (KG Sorensen sively removed until about 4 mm of material remained inIndústria e Comércio Ltda., Barueri, Brazil) was used the apical third of the canal.under abundant irrigation. Coronal access was performed The teeth were sealed for 24 h for the endodontic sealeron the occlusal face to access the orifice of each root canal, to set. A cotton pellet was inserted in the orifice of root102 © 2007 The Authors Journal compilation © 2007 Australian Society of Endodontology
  3. 3. C. D. C. Pereira et al. Sealing Ability of Endodontic Sealerscanals, and glass ionomer cement (Vidrion R – SS White ysed by an observer blinded to the study and experiencedArtigos Dentários Ltda) was used to seal the coronal cavity. in this type of studies. Endodontic treatment and post-space preparation Dye leakage data were described using quartiles and awere performed by one single operator, a specialist in box-plot. The non-parametric Kruskal–Wallis test wasEndodontics. used to compare leakage for the different sealers. Signifi- After 24 h, the dogs were sedated with 0.3 to 1.5 mg kg−1 cance was established at α = 0.05.IM ketamine hydrochloride (Vetanarcol®, Köning SA,Avellaneda, Argentina) and 5 to 10 mg kg−1 IM xylazine Resultshydrochloride. Coronal sealing was removed with a high-speed 1012 diamond bur under abundant irrigation, and Two specimens in the AH Plus group were lost to the studythe root canals were exposed to the oral environment for during post-space preparation because the amount of45 days. remaining filling material was less than 4 mm. During At 45 days, the animals were killed with 25 mg kg−1 IV extraction, eight other specimens were lost: two in the3% sodium pentobarbital (Hypnol®, Cristália Produtos EndoRez group, four in the AH Plus group, and two in theQuímicos e Farmacêuticos Ltda., Itatiba, Brazil) followed RoekoSeal group. Therefore, the groups were composedby 10 mL IV 10% potassium chloride (Aster Produtos of 21 specimens in the RoekoSeal group, 21 specimens inMédicos Ltda., Sorocaba, Brazil). The mandibles and max- the AH Plus group, and 22 in the EndoRez group.illae were removed and sectioned, and the left sides were Figure 1 shows the 1st, 2nd and 3rd quartiles for inkseparated. values in RoekoSeal, AH Plus and EndoRez groups. This Post-space was abundantly irrigated with distilled water means that the higher the mean rank in the quartile, the(Novaderme). The canals were dried with an aspirating greater leakage the material allowed in the samples. Thecannula (Golgran Indústria Comércio Instrumentos mean ranks of the sealers were as follows: Roekoseal,Odontológicos Ltda., São Paulo, Brazil) and #70 absorbing 42.36; AH Plus, 32.43; Endorez, 23.16. All materialspaper points. displayed substantial degrees of dye penetration under Neutral pH India ink (Trident S.A. Indústria de Precisão the conditions of the experiment. The results of non-Ltda., batch: EB097MP, Itapuí, Brazil) was slowly intro-duced in the root canals until it was seen in the pulp cham-ber. Glass ionomer cement (Vidrion R.) was used for 1.5coronal sealing. The left halves of the maxilla and the mandible of eachdog were stored in labelled plastic containers. The contain- Leakage (mm)ers were sealed and stored for 96 h. After that, the premo- 1.0lars under study were extracted and the roots wereseparated and placed in lidded glass jars labelled accordingto the type of sealer used in the obturation. 0.5 Following the procedure described by Gaberoglio andBassa (23), the teeth were immersed in 5% nitric acid(Vetec Química Fina Ltda., Rio de Janeiro, Brazil), whichwas changed every 24 hours for 72 h. The specimens were 0.0then washed in running water for 4 h. After that, theywere dehydrated in 80% alcohol (Novaderme) for 12 h, in RoekoSeal AH Plus EndoRez90% alcohol (Novaderme) for 1 h, and in 99% alcohol Leakage (mm) p N = 21 N = 21 N = 22(Novaderme) changed every hour for 3 h. To clear thespecimens, the teeth were immersed and kept in methyl 1st quartile 0.20 0.00 0.00salicylate (Vetec Química Fina Ltda.) until the end of the 2nd quartile 0.40 0.20 0.10study. Cleared teeth were examined under a stereoscope (GSZ, 3rd quartile 0.70 0.45 0.20Zeiss, Germany) with an eyepiece reticle at 10× magnifica- Mean rank 42.36A 32.43AB 23.16B < 0.05tion. Linear leakage of India ink was measured in millime-tres on all root surfaces. A number value was assigned to Figure 1 Box-plot comparing linear dye leakage of RoekoSeal, AH Plusleakage on each surface, and only the greatest value was and EndoRez endodontic sealers. Data were described using quartiles.used for analysis. This number was divided by the magni- Mean ranks followed by different letters indicate statistically significantfication (10×) to obtain the final value. Results were anal- differences (non-parametric Kruskal–Wallis test; α = 0.05).© 2007 The Authors 103Journal compilation © 2007 Australian Society of Endodontology
  4. 4. Sealing Ability of Endodontic Sealers C. D. C. Pereira et al.parametric Kruskal–Wallis test complemented by multiple found along the entire root canal surface when positivecomparisons (α = 0.05) revealed significantly greater controls are used (4,5,7,9,25).leakage for RoekoSeal than for EndoRez. Leakage for the The sealers used in this study were distributed, withinAH Plus sealer did not differ significantly from that the limitations of an in vivo study, uniformly among theobserved for the other sealers. different dental groups – 2nd MandPM, 3rd MandPM, 4th MandPM, 2nd MaxPM and 3rd MaxPM – and also between distal and mesial roots. Possible anatomic dentalDiscussion differences – length, diameter and form of root canals –Adequate sealing of the root canal system and the main- and physiologic and behavioural variations amongtenance of its integrity have been reasons for constant dogs – masticatory force, eating habits and salivary flow –discussion among researchers. The investigation of root justified such distribution.filling materials and techniques capable of avoiding leak- Endodontic treatment could not be performed in threeage of fluids and microorganisms and their byproducts has teeth of two dogs owing to agenesis or complex internalbeen the focus of several studies. The penetration of these anatomy.materials in root canal filling may lead to contamination Post-spaces were prepared immediately after conclu-or recontamination of root canals and to failure of endo- sion of root canal obturation. Dickey et al. (26) demon-dontic treatment. strated that greater leakage occurs when root filling is Exposure of root canal filling to oral fluids owing to loss removed immediately after obturation, and other studiesof coronal sealing or a carious lesion increases the risks of in the literature do not report significant differences inbacterial penetration in root canals, particularly when time of removal (27–29).post-spaces are prepared (24). Because of this clinical This study standardised the length of remaining rootreality, the investigation of apical-cervical leakage is a canal filling to 4 mm. A similar standard was used in otherlimited alternative in the evaluation of this condition. in vitro (15,24,27–30) and in vivo (20) studies, which estab-Several studies, therefore, investigated coronal leakage lished a 4 to 5 mm length of remaining filling material.(4–6,17,20,22,24). The purpose of this choice was to control this variable. Although some variables are easier to control in in vitro Some studies of post-space preparations were conductedthan in in vivo studies, important factors that may be with removal of two-thirds of root canal filling (19,21,22),directly associated with results are only found in in vivo and remaining fillings had different lengths, which mightstudies – temperature changes, changes in salivary flow, mask the actual amount of ink impaction, mastication and oral microflora, for Root canal fillings were exposed to the oral environ-example. Therefore, animals, such as dogs, may provide ment for 45 days as in in vitro studies by Valera et al. (30)the most adequate study model to simulate the clinical and in vivo studies by Kopper et al. (22). Although somereality, although it is known that dogs’ stomatognathic studies in the literature use different evaluation timesystem is different in anatomy and physiology from that of points (4,6,9), a single time point was established for thehuman beings. Because of that, this study used dogs as a evaluation of coronal leakage in our study because thestudy model. inclusion of other time points would require a larger sam- Total isolation of the surgical field was not used in this ple. Also, this choice was supported by the fact that studiesstudy because asepsis was easily maintained with the dogs that evaluated leakage in root canal fillings after post-intubated and the salivary flow reduced by administration space preparation showed that leakage along the entireof atropine sulfate. extension of root canal fillings was observed in periods Of the materials under study, two were resin-based seal- shorter than 45 days (4).ers (EndoRez and AH Plus) and one was a silicone-based There is no consensus among authors about the lengthsealer (RoekoSeal). EndoRez and RoekoSeal have been of time that India ink should be in contact with root canalrecently introduced in the market, and, therefore, should filling. Swanson and Madison (4), Madison et al. (9), Mad-be thoroughly studied to ensure their safe and efficient ison and Wilcox (17), Magura et al. (6) and Schäfer anduse. AH Plus was used as a control sealer because it is one Olthoff (16) suggested 48 h. Hiltner et al. (28) and Martínof the most widely investigated resin-based sealers and has et al. (14) kept specimens in contact with dye for 7 days. Inshown good results in leakage studies (11,22,25). this study, contact for 96 h was chosen in agreement with The use of a positive control group with root canals more recent studies (22).obturated with gutta-percha cones would only increase Penetration of India ink in root canal fillings in thethe number of study animals. Because this was an in vivo EndoRez group had the lowest mean rank (23.16) of allstudy, we decided not to use such a control group for ethic study groups. This finding suggests that EndoRezreasons. This decision was based on reports that leakage is promotes better sealing than RoekoSeal after exposure of104 © 2007 The Authors Journal compilation © 2007 Australian Society of Endodontology
  5. 5. C. D. C. Pereira et al. Sealing Ability of Endodontic Sealersroot canal fillings to oral fluids for 45 days in teeth with 5. Torabinejad M, Ung B, Kettering JD. In vitro bacterial pen-post-space preparations. The same was not observed in etration of coronally unsealed endodontically treated teeth.the comparison of the two resin-based sealers (EndoRez J Endod 1990; 16: 566–9.and AH Plus), or when AH Plus was compared with 6. Magura ME, Kafrawy AH, Brown CE Jr, Newton CW.RoekoSeal. Human saliva coronal microleakage in obturated root Most studies that evaluated the sealing ability of endo- canals: an in vitro study. J Endod 1991; 17: 324–31.dontic sealers using dyes as leakage markers were con- 7. Trope M, Chow E, Nissan R. In vitro endotoxin penetrationducted in vitro. Two of the sealers in this study (EndoRez of coronally unsealed endodontically treated teeth. Endod Dent Traumatol 1995; 11: 90–4.and RoekoSeal) have been recently introduced in the 8. De Cleen MJH. The relationship between the root canalmarket. Therefore, the comparison of results of this in vivo filling and post space preparation. Int Endod J 1993; 26:study with findings reported in the literature is difficult. 53–8. The methods used in this study and the results of dye 9. Madison S, Swanson K, Chiles SA. An evaluation of coro-leakage in root canal fillings of the AH Plus group were nal microleakage in endodontically treated teeth: Part II:similar to those reported by Kopper et al. (22). AH Plus was Sealer types. J Endod 1987; 13: 109–12.unable to avoid India ink leakage in both studies. How- 10. Limkangwalmongkol S, Abbott PV, Sandler AB. Apicalever, none of the specimens showed leakage along the dye penetration with four root canal sealers and gutta-entire length of root canal fillings. Kopper et al. (22) percha using longitudinal sectioning. J Endod 1992; 18:showed that AH Plus had better results than those found 535–9.for Sealer 26 and Endofill. 11. Haïkel Y, Wittenmeyer W, Bateman G, Bentaleb A, Allemann C. A new method for the quantitative analysis of endodontic microleakage. J Endod 1999; 25: 172–7.Conclusion 12. Timpawat S, Amornchat C, Trisuwan W. Bacterial coronalThe endodontic sealers evaluated in this study were not leakage after obturation with three root canal sealers.fully efficient in sealing the root canal when exposed to J Endod 2001; 27: 36–9.oral fluids for 45 days. These results and other reports in 13. Çobankara FK, Adanir N, Belli S, Pashley DH. A quantita-the literature should be interpreted as a warning for the tive evaluation of apical leakage of four root-canal sealers.indication of coronal restorations in association with posts Int Endod J 2002; 35: 979–84. 14. Martín CL, Luque CMF, Rodríguez MPG, Gijón VR,because of the exposure of root canal fillings to oral fluids. Rodríguez de Mondelo JMN. A comparative study of apicalThe indication of endodontic retreatment should be based leakage of endomethasone, top seal, and roeko seal sealeron technical and scientific data because prognoses will be cements. J Endod 2002; 28: 423–6.closely dependent on its results. 15. Wu MK, Tigos E, Wesselink PR. An 18-month longitudinal EndoRez demonstrated less dye linear leakage penetra- study on a new silicon based sealer, RSA RoekoSeal: a leak-tion than RoekoSeal, and the difference was statistically age study in vitro. Oral Surg Oral Med Oral Pathol 2002; 94:significant. The same was not found for the comparison 499–502.between EndoRez and AH Plus or AH Plus and RoekoSeal. 16. Schäfer E, Olthoff G. Effect of three different sealers on the sealing ability of both thermafil obturators and cold laterally compacted gutta-percha. J Endod 2002; 28: 638–References 42. 1. Tronstad L, Barnett F, Riso K, Slots J. Extraradicular 17. Madison S, Wilcox LR. An evaluation of coronal microleak- endodontic infections. Endod Dent Traumatol 1987; 3: age in endodontically treated teeth: Part III: In vivo study. 86–90. J Endod 1988; 14: 455–8. 2. Sundqvist G, Figdor D, Persson S, Sjogren U. Microbiologic 18. Friedman S, Komorowski R, Maillet W, Klimaite R, analysis of teeth with failed endodontic treatment and the Nguyen HQ, Torneck CD. In vivo resistance of coronally outcome of conservative re-treatment. Oral Surg Oral Med induced bacterial ingress by an experimental glass ionomer Oral Pathol 1998; 85: 86–93. cement root canal sealer. J Endod 2000; 26: 1–5. 3. Nair PN, Sjogren U, Krey G, Kahnberg KE, Sundqvist G. 19. Vanni JR, Figueiredo JAP, Della Bona A, Hartmann MSM, Intraradicular bacteria and fungi in root-filled, asymptom- Garbin CA, Manfredi D. Bonding endodontically treated atic human teeth with therapy-resistant periapical lesions: root canal surfaces to prevent coronal leakage. J Dent Res a long-term light and electron microscopic follow-up study. 2001; 80: 191. J Endod 1990; 16: 580–8. 20. Barbosa HG, Holland R, de Souza V et al. Healing process of 4. Swanson K, Madison S. An evaluation of coronal dog teeth after post space preparation and exposition of the microleakage in endodontically treated teeth. Part I: time filling material to the oral environment. Braz Dent J 2003; periods. J Endod 1987; 13: 56–9. 14: 103–8.© 2007 The Authors 105Journal compilation © 2007 Australian Society of Endodontology
  6. 6. Sealing Ability of Endodontic Sealers C. D. C. Pereira et al.21. Bier CA, Figueiredo JA, Della Bona A, Kopper PM, 26. Dickey DJ, Harris GZ, Lemon RR, Luebke RG. Effect of post Vanni JR, Bopp S. In vivo analysis of post space sealing space preparation on apical seal using solvent techniques with different adhesive materials. JAOS 2003; 11: and peeso reamers. J Endod 1982; 8: 351–4. 168–74. 27. Zmener O. Effect of dowel preparation on the apical seal of22. Kopper PM, Figueiredo JA, Della Bona A, Vanni JR, Bier endodontically treated teeth. J Endod 1980; 6: 687–90. CA, Bopp S. Comparative in vivo analysis of the sealing 28. Hiltner RS, Kulild JC, Weller N. Effect of mechanical versus ability of three endodontic sealers in post-prepared root thermal removal of gutta-percha on the quality of the api- canals. Int Endod J 2003; 36: 857–63. cal seal following post space preparation. J Endod 1992; 18:23. Garberoglio R, Bassa S. O dente transparente. ARS 451–4. CVRANDI Odontologia 1983; 9: 5–7. 29. Abramovitz R, Tagger M, Tamse A, Metzger Z. The effect of24. Barrieshi KM, Walton RE, Johnson WT, Drake DR. Coronal immediate vs. delayed post space preparation on the apical leakage of mixed anaerobic bacteria after obturation and seal of a root canal filling: a study in a increased-sensitivity post space preparation. Oral Surg Oral Med Oral Pathol pressure-driven system. J Endod 2000; 26: 435–9. Oral Radiol Endod 1997; 84: 310–14. 30. Valera MC, Barbieri M, Menezes MM, Guimarães MP.25. Kardon BP, Kuttler S, Hardigan P, Dorn SO. A in vitro eval- Efeito da saliva sobre canais obturados, preparados para uation of the sealing ability of a new root-canal-obturation núcleo e impermeabilizados com cianoacrilatos. Jornal system. J Endod 2003; 29: 658–61. Brasileiro de Endo/Pério 2000; 1: 67–71.106 © 2007 The Authors Journal compilation © 2007 Australian Society of Endodontology