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Push-out Bond Strength of Resilon/Epiphany andResilon/Epiphany Self-Etch to Root DentinGustavo De-Deus, DDS, MS, PhD,*  Karina Di Giorgi, DDS, MS,

† Sandra Fidel, DDS, MS, PhD,

† 

 Rivail Antonio Sergio Fidel, DDS, MS, PhD,†  and Sidnei Paciornik, DsC  ‡ 

 Abstract

Introduction: The present study was designed to inves-tigate the bond strength produced by Epiphany andEpiphany SE to root canal dentin. Methods: A sampleof 36 human upper canines was prepared and assignedto experimental groups (n = 12), designated as group 1,Resilon/Epiphany; group 2, Resilon/Epiphany SE; andgroup 3, AH Plus/gutta-percha. After the filling proce-dures, each tooth was prepared for push-out assess-ment by using root slices of 1-mm thickness. Loading

wasperformed on a universaltesting machine at a speedof 0.5 mm/min. One-way analysis of variance and Tukeytest for multiple comparisons were used to compare theresults among the experimental groups. Results: AHPlus/gutta-percha root fillings showed significantlyhigher push-out bond strength than both Resilon/Epiphany and Resilon/Epiphany SE (P  < .05). Therewas no significant difference between Epiphany/Resilonand Epiphany SE/Resilon (P > .05). Conclusions: Underthe present in vitro conditions, the adhesiveness qualityto root dentin promoted by both Epiphany sealers iscompromised even when teeth with simple anatomicfeatures were obturated under well-monitored labora-

tory conditions. (J Endod 2009;35:1048–1050)

Key WordsPush-Out Bond Strength, Resilon, Epiphany, Adhesive-ness, root dentin, root filling, endodontics

Despite its good preliminary results (1–4), the suboptimal condition of root dentinadhesive technology has recently been addressed by a series of well-conducted

studies (5–8). In a noteworthy review, Schwartz (9) highlighted the critical conditionsforan optimal intraradicularbonding or, in other words, an effective bonding in theenvi-ronment of the root canal system. This must be considered as a real challenge because of the anatomic factors linked to the well-known limitations of the current dentin adhesivematerials. Considering these challenges and limits, the effectiveness of adhesive root fill-ings is currently under scrutiny. Therefore, alternative strategies and new adhesive sealergenerations have been introduced with the clear purpose of compensating for the above

mentioned limitations and producing a reliable fluid-tight seal root filling. A few years ago, a new resin-based cement was developed and introduced to the

dental market as self-adhesive universal resincement (Rely X UniCem; 3 M ESPE Dental Products, St Paul, MN). This type of cementcombines the useof adhesive andcement inone single application. The manufacturer states that the cement is a paste/paste, fluo-ride-releasing, and radiopaque dual-cured resin luting cement that is formulated forluting crowns, bridges, inlays, onlays, and posts (10, 11). In addition, the fact that the self-adhesive resin cement is thought to bond to dentin without any kind of condi-tioning or pretreatment is a point that must be considered (10, 11). This provides theneed for a large body of scientific investigation around the self-adhesive resin cement.Recently, a new version of the Epiphany sealer, based on the self-adhesive cement concept, was introduced with the promise of optimizing the clinical performance  with a simplified application procedure. In this way, the manufacturer created the

hypothesis that the new Epiphany self-adhesive sealer (Epiphany SE; Pentron Clinical Technologies LLC,Wallingford,CT) could bondsimultaneously to bothradicular dentinand Resilon points (12). Hence, the present study was designed to investigate the bondstrength produced by Epiphany and Epiphany SE to root canal dentin. The conventional nonbonding AH Plus/gutta-percha root filling was used as a reference for comparison.The push-out test was used to test the null hypothesis that there is no difference in thepush-out bond strength to dentin produced by Epiphany, Epiphany SE, and AH Plus.

Materials and MethodsSample Selection and Specimen Preparation

 A sample of 36 extractedhuman uppercanines with straight roots and20Æ 1 mmin length were selected. This study was revised and approved by the Ethics Committee,

Nucleus of Collective Health Studies of Veiga de Almeida University. The teeth were dis-infected in 0.5% chloramine-T, stored in distilled water at 4C, and used within6 months after extraction. Standard access cavities were made, andall thecanal orifices were located. The patency of each canal was confirmed, and the working length wasestablished by deducting 1 mm from the canal length. The root canal was prepared with the conventional sequence of ProTaper Universal NiTi rotary (DENTSPLY Tulsa Dental, Tulsa, OK) until the finisher F4 instrument achieved a 0.4/0.06 apical taper. All canals were irrigated between each file with 0.5 mL of freshly prepared 2.5% NaOCl.The smear layer was removed with 3 mL of 17% ethylenediaminetetraacetic acid for3 minutes. A 3-mL flush of bi-distilled water was used as a final rinse.

The use of different root-filling materials resulted in 3 experimental groups(n = 12) that were randomly distributed with the aid of a free computer algorithm(http://www.random.org ).

From the *Department of Endodontics, Veiga de AlmeidaUniversity; †Department of Endodontics, Rio de Janeiro StateUniversity; and ‡Department of Materials Science and Metal-lurgy, Catholic University of Rio de Janeiro, Rio de Janeiro,RJ, Brazil.

Address requests for reprints to Prof Gustavo De-Deus, R.Desembargador Renato Tavares, 11, ap.102, Ipanema, Rio de

Janeiro, RJ, Brazil 22411-060. E-mail address: endogus@gmail.com.0099-2399/$0 - see front matter

Copyright ª 2009 American Association of Endodontists.doi:10.1016/j.joen.2009.04.024

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Canal FillingFor all specimens, an ISO size 40 file was used to place sealer in

large quantity  (9, 10). In group 1, a prefitted 0.4/0.06 gutta-percha cone (Diadent Group International, Chongchong Buk Do, Korea) wasused with AH Plus sealer (Dentsply-Maillefer, Ballaigues, Switzerland).The gutta-percha cone was inserted into the full working length, andlateral compaction was achieved by using 5 accessory gutta-percha cones (Diadent) and endodontic finger spreader size B (Maillefer). A 

heated instrument was used to cut the coronal surplus, after whichthe filling was vertically compacted. In group 2, Epiphany primer wasintroduced into the root canals with the aid of a microbrush, and a pre-fitted size 0.4/0.06 taper Resilon cone (Pentron Clinical TechnologiesLLC) was used in the same manner described for group 1. In group3, Epiphany SE was used in the same manner described for group 1.To createthe immediatecoronalseal in theadhesiveroot-filling groups,all specimens in group 2 and group 3 were light-cured for 40 seconds with a Coltolux LED curing light (Coltene Whaledent Product, Cuyahoga Falls, OH). The filled roots were stored at 37C and 100% humidity for14 days to allow setting of the sealers.

Push-out Assessment

Each root was horizontally sectioned into four 1Æ

0.1 mm thick serial slices by using a low-speed saw (Isomet; Buehler, Ltd, Lake Bluff,NY) with a diamond disk (Ø, 125 Â 0.20 Â 12.7 mm; 330C) undercontinuous water irrigation. The thus-created 4 slices per root resultedin 48 slices/group or 24 slices per root segment (middle and apical).

The thickness of each slice was measured with a digital caliper toan accuracy of 0.001 mm (Avenger Products, North Plains, OR), and it  was always within the 0.9–1.1 mm range. Then both apical and coronal aspects of the specimens were microscopically examined to confirma circular canal shape. The fine-tune parallelism was ensured by a laserbeam device, and the root filling of each sample was loaded witha 0.5-mm-diameter cylindrical plunger. The plunger tip was sizedand positioned to touch only the root filling. The load was alwaysapplied in an apical-coronal direction to avoid any constriction interfer-ence as a result of root canal taper during push-out testing. Loading wasperformed on a universal testing machine (EMIC DL200MF, Sa  ˜ o Jose dos Pinhais, PR, Brazil) at a speed of 0.5 mm/min until debondingoccurred. A load  time curve was plotted during the test by usinga real-time software program.To express the bondstrengthin megapas-cals, the load at failure recorded in newtons was divided by the area of the bonded interface. The operator who made the measurements wasblinded as to which samples were matched to which materials.

Statistical AnalysisThe preliminary analysis of the raw pooled data revealed a bell-

shaped distribution (D’Agostino & Person omnibus normality test).Further statistical analysis was performed by using one-way analysis

of variance (ANOVA); Tukey test for multiple comparisons was usedto isolate the differences. The alpha-type error was set at 0.05. SPSS11.0 (SPSS Inc, Chicago, IL) and Origin 6.0 (Microcal Software, Inc,Northampton, MA) were used as analytical tools.

Results All specimens showed lower but measurable adhesive properties

to root dentin. In addition, no premature failure occurred. The group-by-location interaction was not significant ( P  = .79); therefore, thegroup comparisons were not dependent on the root canal third. Asa consequence, all data were pooled to provide a single mean and stan-dard deviation per root filling material, averaging the 12 teeth pergroup.

 AH Plus/gutta-percha root fillings showed significantly higherpush-out bond strength than both Resilon/Epiphany and Resilon/ Epiphany SE ( P  < .05). There was no significant difference betweenEpiphany/Resilon and Epiphany SE/Resilon ( P = .91). Box plots illus-trating themean, minimum, andmaximum valuesas well as thevarianceof the push-out bond strength data in each experimental group areshown in Fig. 1.

Discussion As a consequence of the current results, the null hypothesis wasrejected. Essentially, it means that the present result displays to noadvantage in the use of the adhesive root fillings as a result of the signif-icantly lower push-out bond strength demonstrated by both Resilon/ Epiphany and Epiphany SE groups. This is a contradictory situationbecause the nonadhesive root fillings obtained a superior adhesivenessthan both adhesive root-filling materials. Thus, the endodontic mono-block cannot be produced by the tested adhesive root-filling materials.

The present findings are in accordance with some recent reportsthat have used a similar study designand revealed unenthusiasticresultsfor the traditional Resilon/Epiphany root fillings (8, 13, 14). The adhe-sive root fillings were able to provide just a suboptimal bonding quality to root dentin. A well-controlled study demonstrated that Resilon/ Epiphany combination showedlowerbond strength than AH Plus sealerand gutta-percha (8). The result was similar to the findings of Gesi et al (14), who used a closed push-out experimental model. Recently, thebond strength of AH Plus and Epiphany sealers to root dentin treated  with different irrigation solutions was evaluated, and the authorsconcluded that the epoxy sealer presented greater adhesion to dentinthan Epiphany, regardless of the treatment of root canal walls (15).Fisher et al (16) theorized that one potential explanation for the supe-rior adhesiveness to root dentin shown by AH Plus can be based on thecreation of a covalent bond by an open epoxide ring to exposed aminogroups in the collagen network.

It is worthwhile to mention that even the root canals filled with thenew EpiphanySE haveshown lower bondstrength. Essentially, the push-

out bond strength of Epiphany SE was comparable to that of the tradi-tional Epiphany. It is evident that these similar results are in favor of Epiphany SE as a result of its simplified application procedure. Tothe best of our knowledge, there is no further peer-reviewed informa-tion about the performance of the Epiphany SE sealer. Thus, it was not 

Figure 1. Box plots of the push-out strength data. Letters indicate significant statistical differences between groups; P < .05.

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possible to establish a comparison between the present results of Epiphany SE sealer and previous literature.

On the basis of well-designed adhesive dentistry studies, themessage fromthe accumulatedscientificknowledge is clear; an effectivebonding to a wet substrate such as root dentin is still a difficult task (9, 17–23). The root canal systemhas a well-known unfavorable geom-etry for resin bonding. Therefore, a more plausible explanation for theresults achieved in the present study is presented; it is a recognizable

fact that methacrylate-based materials undergo volumetric shrinkageduring the polymerization process (9, 18, 19). The high C-factor of the root canal space can be blamedas the key factorrelated to polymer-ization stresses created by resin-based adhesives (9, 17–23). In fact,significant volumetric polymerization shrinkage of the adhesive sealeris incompatible with an optimal bonding condition to the root dentin.

From a practical standpoint, close examination of the present results yields an interesting thought for further consideration; despitethe theoretical development reached by the introduction of current dentin adhesive technology to be used for root-filling procedures, thesimpleand cost-effective nonbonding root fillings are still themore reli-able choice. Moreover, the adhesiveness quality to root dentinpromoted by both Epiphany sealers is compromised even when teeth with simple anatomic features were obturated under well-monitored

laboratory conditions. The higher push-out bond strength found inthe AH Plus/gutta-percha root fillings reiterates the fact that the era of conventional nonbonding root filling has not yet come to an end.

 AcknowledgmentThe authors are grateful to Pentron Clinical Technologies

(Wallingford, CT) and DENTSPLY (Petropo lis, RJ, Brazil) for their donation of the test materials.

References1. Shipper G, Orstavik D, Teixeira FB, Trope M. An evaluation of microbial leakage in

roots filled with a thermoplastic synthetic polymer-based root canal filling material (Resilon). J Endod 2004;30:342–7.

2. Yamauchi S, Shipper G, Buttke T, Yamauchi M, Trope M. Effect of orifice plugs onperiapical inflammation in dogs. J Endod 2006;32:524–6.

3. Teixeira FB, Teixeira EC, Thompson JY, Trope M. Fracture resistance of rootsendodontically treated with a new resin filling material. J Am Dent Assoc 2004;135:646–52.

4. Shipper G, Trope M. In vitro microbial leakage of endodontically treated teeth usingnew and standard obturation techniques. J Endod 2004;30:154–8.

5. Paque F, Sirtes G. Apical sealing ability of Resilon/Epiphany versus gutta-percha/AHPlus: immediate and 16-months leakage. Int Endod J 2007;40:722–9.

6. De-Deus G, Namen F, Galan J Jr. Reduced long-term sealing ability of adhesive root fillings after water-storage stress. J Endod 2008;34:322–5.

7. Cotton TP, Schindler WG, Schwartz SA, Watson WR, Hargreaves KM. A retrospectivestudy comparing clinical outcomes after obturation with Resilon/Epiphany or Gutta-Percha/Kerr sealer. J Endod 2008;34:789–97.

8. Gogos C, Theodorou V, Economides N, Beltes P, Kolokouris I. Shear bond strength

of AH-26 and Epiphany to composite resin and Resilon. J Endod 2008;34:1385–7.9. Schwartz R. Adhesive dentistry and endodontics: part 2—bonding in the root canal system: the promise and the problems—a review. J Endod 2006;32:1126–34.

10. Availableat:http://solutions.3m.com/wps/portal/3M/en_US/3MESPE/dental/professionals/ produ/category/cement/relyx-unicem. Accessed August 12, 2008.

11. Radovic I, Monticelli F, Goracci C, Vulicevic ZR, Ferrari M. Self-adhesive resincements: a literature review. J Adhes Dent 2008;10:251–8.

12. Available at: http://www.pentron.com/Pentron/admindocs/fly_data_399.pdf . AccessedOctober 15, 2008.

13. Ungor M, Orucoglu H. Push-out bond strengths: the Epiphany–Resilon endodonticobturation system compared with different pairings of Epiphany, Resilon, AH Plusand gutta-percha. Int Endod J 2006;39:643–7.

14. Gesi A, Raffaelli O, Goracci C, Pashley DH, Tay FR, Ferrari M. Interfacial strength of Resilon and gutta-percha to intraradicular dentin. J Endod 2005;31:809–13.

15. Nunes V, Silva RG, Alfredo E, Sousa-Neto MD, Silva-Sousa YT. Adhesion of Epiphany and AH Plus sealers to human root dentin treated with different solutions. Braz Den J2008;19:46–50.

16. Fisher M, Bahcall J. An in vitro comparison of bond strength of various obturationmaterials to root canal dentin using a push-out test design. J Endod 2007;33:856–8.

17. Bonfante EA, Pegoraro LF, de Go es MF, Carvalho RM. SEM observation of the bondintegrity of fiber-reinforced composite posts cemented into root canals. Dent Mater2008;24:483–91.

18. Bergmans L, Moisiadis P, De Munck J, Van Meerbeek B, Lambrechts P. Effect of polymerization shrinkage on the sealing capacity of resin fillers for endodonticuse. J Adhes Dent 2005;7:321–9.

19. Franklin Tay. Monoblocks in root canals: a hypothetical or a tangible goal. J Endod2007;33:391–7.

20. Tay F, Lambrechts P, Weller RN, Pashley DH. Geometric factors affecting dentinbonding in root canals: a theoretical modeling approach. J Endod 2005;31:584–8.

21. Garcia-Godoy F, Itthagarun A, Weller N, et al. Application of biologically-orienteddentin bonding principles to the use of endodontic irrigants. Am J Dent 2005;18:

281–90.22. De Munck J, Van Landuyt K, Peumans M, et al. A critical review of the durability of 

adhesion to tooth tissue: methods and results. J Dent Res 2005;84:118–32.23. Van Meerbeek B, Vargas M, Inoue S, et al. Microscopy investigations. Techniques,

results, limitations. Am J Dent 2000;13:3–18.

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