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Cavity configuration factor (C-factor) is the ratio of the bonded surface area in a cavity to the unbonded surface area. In a box-like class I cavity, there may be five times more bonded surface area than the unbonded surface area. During polymerization, the volume of monomers is reduced, which creates sufficient shrinkage stresses to debond the material from dentin, thereby decreasing retention and increasing leakage. The important variables influencing bonding adhesive root-filling materials to canals was examined using a truncated inverted cone model. C-factors in bonded root canals exhibit a negative correlation with sealer thickness. For a 20 mm-long canal prepared with a size 25 file, calculated C-factors ranged from 46 to 23,461 with decreasing sealer thickness (500-1 microm), compared to a C-factor of 32 when the canal was filled only with sealer. As the thickness of the adhesive is reduced, the volummetric shrinkage is reduced, which results in a reduction in shrinkage stress (S-factor). C-factors above 954 calculated with sealer thickness smaller than 25 microm are partially compensated by increases in bonding area and decreases in shrinkage volume. However, the interaction of these two geometrically related factors (C- and S-factors) predicts that bonding of adhesive root-filling materials to root canals is highly unfavorable when compared with indirect intracoronal restorations with a similar resin film thickness.

Polycaprolactone, a thermoplastic aliphatic polyester, is reportedly susceptible to both alkaline and enzymatic hydrolyzes. This screening study examined the susceptibility of Resilon, a polycaprolactone-based root filling composite, to alkaline hydrolysis. There were 15-mm diameter disks of Resilon and Obtura gutta-percha prepared by compressive molding and immersed in 20% sodium ethoxide for 20 or 60 min. Control disks were immersed in ethanol for 60 min. These disks were examined using field-emission scanning electron microscopy and energy dispersive X-ray analysis. For Resilon, the surface resinous component was hydrolyzed after 20 min of sodium ethoxide immersion, exposing the spherulitic polymer structure and subsurface glass and bismuth oxychloride fillers. More severe erosion occurred after 60 min of sodium ethoxide treatment. Gutta-percha was unaffected after immersion in sodium ethoxide. As Resilon is susceptible to alkaline hydrolysis, it is possible that enzymatic hydrolysis may occur. Biodegradation of Resilon by bacterial/salivary enzymes and endodontically relevant bacteria warrants further investigation.

This in vitro study compared the ultrastructural quality of the apical seal achieved with Resilon/Epiphany and gutta-percha/AH Plus. Single-rooted extracted human teeth were prepared using a crown-down technique, debrided with NaOCl and EDTA, and obturated with either Resilon/Epiphany or gutta-percha/AH Plus. They were examined for gaps along canal walls using SEM, and for apical leakage using a transmission electron microscopy (TEM). SEM revealed both gap-free regions, and gap-containing regions in canals filled with both materials. TEM revealed the presence of silver deposits along the sealer-hybrid layer interface in Resilon/Epiphany, and between the sealer and gutta-percha in the controls. It is concluded that a complete hermetic apical seal cannot be achieved with either root filling materials.

The purpose of this study was to compare the efficacy of sealing the coronal 2-mm of the root canals versus covering the entire pulpal floor with one of two dental-resin cements (Principle or C&B Metabond). Sixty-two molars with the occlusal half of the crowns and the apical half of the roots removed were used. Each canal was enlarged by using a #3 Gates Glidden bur and obturated with unsealed gutta-percha cones. The teeth were randomly assigned to four groups, each containing 15 teeth, plus a negative and a positive control. In group 1, 2 mm of Principle were placed over the entire pulpal floor. In group 2, Principle was placed 2 mm into each canal orifice. Groups 3 and 4 were the same as groups 1 and 2, except C&B Metabond cement was used. After the cement set, the gutta-percha was removed and the integrity of the seal was tested by fluid filtration at a pressure of 20 cm H2O at 1 h and at 1, 2, and 4 weeks. The data were analyzed by a three-way ANOVA and the Student-Newman-Keuls tests at alpha = 0.05. The controls behaved as expected. Results showed that there were no statistically significant differences among the materials used or the location (p > 0.05), but there was a significant difference with respect to time. Principle leaked significantly more than C&B Metabond at 1 h (p < 0.05), but the seal became tighter over time. C&B Metabond leaked less early (p < 0.05) but increased in leakage at 4 weeks. Both materials sealed well over the 4-week study. Principle was easier to use, and sealing the entire pulpal floor was easier than sealing only the canal orifice.

Immediate sealing of furcation perforations enhances the repair process. The purpose of this study was to longitudinally compare the ability of mineral trioxide aggregate (MTA) and Super-EBA to seal furcation perforations. Fifty-one extracted human maxillary molars were decoronated 3 mm above the CEJ, and the roots were amputated 3 mm below the furcation. A #2 high-speed round bur was used to perforate the center of the furcations. The canals were obturated with gutta-percha, and the root ends were sealed with C&B Metabond. Three experimental groups of 15 teeth each were restored with MTA, Super-EBA, or a combination of MTA in the perforation and a Super-EBA dome on the pulpal floor. Six teeth served as controls. Each tooth was affixed to a fluid filtration device and subjected to a pressure of 20 cm H2O. The integrity of the perforation seal was evaluated initially at 30 min for the Super-EBA and the combination groups and at 4 h for the MTA group. Additional measurements were then made at 24 h, 1 week, and 1 month. The controls behaved as expected. A two-way ANOVA revealed a significant difference (p = 0.01) between materials. Tukey's test isolated the difference to Super EBA as producing a superior seal but only at 24 h. There was no significant effect with time (p = 0.57) or the interaction of the materials with time (p = 0.66). All materials sealed the perforations very well. The maximum leakage of all materials was

The purpose of this study was to evaluate the sealing ability of four self-etching adhesives placed over blood-contaminated/uncontaminated resected root apices without root-end preparation. Extracted maxillary incisors and canines were randomly divided into four groups of 10 teeth each. After canal preparation and resection of the apex, four self-etching adhesives (Clearfil SE Bond, One-Up Bond F, Unifil Bond, and ABF) were applied over the control and contaminated surfaces. The roots were then subjected to 15 cm of water pressure to simulate periapical microleakage stress. Data were analyzed using a two-way repeated measures, ANOVA. Positive and negative controls responded as expected. Statistical analysis indicated that there were no significant differences in the sealing effectiveness among the adhesives applied to contaminated or uncontaminated groups. All contaminated groups had significantly higher leakage (p < 0.003) than their uncontaminated pairs.

A thorough diagnostic examination is essential before providing endodontic treatment. The sequence of diagnostic procedures must begin with a well-organized review of the medical history. In the early screening process, a health history that reveals a systemic disorder must be investigated further because it may have a significant impact on the dental diagnosis and ultimate endodontic treatment. There are a number of systemic diseases that can cause bone lesions throughout the body. Chronic renal failure is one disorder that may stimulate a secondary hyperparathyroidism that can cause a variety of bone lesions. In some instances these lesions appear in the periapical region of teeth and can lead to a misdiagnosis of a lesion of endodontic origin. The following case report of a patient referred for endodontic treatment demonstrates the importance of understanding the effects of end-stage renal disease on the dental structures.