Aust Endod J 2009; 35: 169173

ORIGINAL RESEARCH

Fluid-transport evaluation of lateral condensation,

ProTaper gutta-percha and warm vertical condensation
obturation techniques
aej_158

169..173

Fani Mahera, DDS; Nikolaos Economides, DDS, MSc, PhD; Christos Gogos, DDS, PhD; and
Panagiotis Beltes, DDS, PhD
Department of Endodontology, Faculty of Dentistry, Aristotle University, Thessaloniki, Greece

Keywords
Gutta-percher, ProTaper, sealing ability.
Correspondence
Dr Christos Gogos, Vamvaka 1,
54631 Thessaloniki, Greece.
Email: gogos@dent.auth.gr
doi:10.1111/j.1747-4477.2009.00158.x

Abstract
The purpose of this study was to compare the microleakage of four obturation
techniques (lateral condensation, lateral condensation of ProTaper Guttapercha, single ProTaper Gutta-percha and warm vertical condensation) over a
3-month period. A fluid-transport model was used to measure microleakage.
Sixty human-extracted teeth, divided into four groups, were prepared with
ProTaper rotary instruments before the root canals were filled by one of the
four examined techniques. All groups were obturated using Sultan as a root
canal sealer. Microleakage was measured 7 days, 1 month and 3 months after
the procedures. There were no statistically significant differences between the
four groups at any of examination points (P > 0.05). The leakage was increased
in all obturation techniques over the 3-month period.

Introduction
Obturation of the root canal space after cleaning and
shaping is critical for successful root canal treatment. The
various proposed methods for obturation of the radicular
space can be divided into two basic groups: cold lateral
condensation and warm vertical condensation (1,2).
Lateral condensation of gutta-percha filling material is
the most commonly taught and practiced filling technique, and is the standard procedure against which all
others are evaluated (3). Although many variations of the
technique have been proposed in terms of master cone
design, spreader design, application and accessory cone
selection, there is no clear consensus of which is ideal (4).
Lateral condensation is a safe and cost-effective technique, but it is time-consuming (5) and lacks homogeneity (6) and adaptation to the canal walls (7). Moreover, a
common criticism levelled at the technique is that it may
induce vertical root fractures (8).
Warm vertical condensation was first introduced by
Schilder in 1967 (1). The continuous wave of condensation technique (9) with the system B heat source (Analytic Sybron Dental Specialties, Orange, CA, USA) was
introduced to simplify vertical condensation. Recently, a

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Journal compilation 2009 Australian Society of Endodontology

new system (Elements Obturation Unit, SybronEndo,

Orange, CA, USA) that combines the technology of
system B and a motor-driven extruder handpiece of
thermoplasticised gutta-percha has been marketed.
Warm vertical condensation improves the homogeneity
and adaptation of gutta-percha to the dentin walls (1).
However, the procedure may result in extrusion of the
gutta-percha filling material into the periapical tissues
(10), and concerns have been raised with regard to
thermal damage to the periodontal ligament during
thermal condensation (11). The introduction of nickeltitanium (Ni-Ti) rotary instrumentation has altered root
canal treatment by reducing preparation time, minimising procedural errors associated with root canal
instrumentation and producing a predictably centred
preparation, even in curved canals (12,13). Gutta-percha
cones are now produced that match the taper of canals
prepared with Ni-Ti rotary systems.
Different leakage tests are performed to comparatively
evaluate sealing ability. Examples of such methods
include dye penetration tests, electrochemical leakage
tests, radioactive isotope studies, bacterial penetration
tests and the fluid-transport model. The fluid transportation model is a non-destructive method of leakage
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Evaluation of obturation techniques

F. Mahera et al.

measurement that offers information about the quality of

the seal of the tested material over a long period of time.
The purpose of this study was to compare the leakage
following four obturation techniques (lateral condensation, lateral condensation of ProTaper Gutta-percha
Point, single ProTaper Gutta-percha Point and warm vertical condensation) over a 3-month period, using the
fluid-transport model.

Materials and methods

Sixty human teeth with a single canal and patent
foramen were selected and stored in distilled water before
use. The coronal portion of the teeth were sectioned with
a high-speed bur and water spray so that all roots were
approximately 13 to 14 mm long. The teeth were randomly divided into four groups of 15.
The canal length was visually established by placing a
size 15 file (Dentsply, Maillefer, Ballaigues, Switzerland)
into each root canal until the tip was visible at the apical
foramen. The working length (WL) was established
0.5 mm short of the apical foramen. Apical patency was
maintained throughout instrumentation using a size 15
file (Dentsply, Maillefer). The canals were instrumented
using a crown-down technique with rotary ProTaper files
(Dentsply, Maillefer). The sequence of ProTaper instruments used in the present investigation is summarised in
Table 1.
All instruments were used in a low-torque motor with
torque control and a constant speed of 250 rpm (X-smart,
Dentsply, Maillefer). The torque was adjusted according
to the manufacturers indications. All instruments were
inserted into the root canal in a continuous in-and-out
movement and were never forced apically. Maximum
effort was made to take the files to length only one time
for no more than 1 s. Instruments were discarded after
the preparation of each group of 15 root canals.
Irrigation was performed with 1 mL NaOCl (2.5%)
after each change in instrument size using a 27-gauge
plastic syringe (Ultradent, South Jordan, UT, USA). The
syringe was inserted into the root canal as deeply as
possible. For each tooth 0.1 mL of a 17% EDTA paste was

Table 1 Instrument sequence

1.
2.
3.
4.
5.
6.
7.
WL, working length.

170

S1
Sx
S1
S2
F1
F2
F3

-6 mm WL
-4 mm WL
WL
WL
WL
WL
WL

used a chelating agent. A No. 20 file (Dentsply, Maillefer)

was passed 1 mm through the apex after instrumentation
was completed. The root canal was then flushed with
5 mL of 2.5% NaoCl, followed by 5 mL of distilled water.
The canals were dried with paper points.

Obturation techniques
Sultan (Sultan Chemist, Inc., Englewood, NJ, USA), a
typical zinc oxide-eugenol sealer, was mixed according to
the manufacturers instructions and used for four obturation procedures: lateral condensation (LC), lateral condensation of ProTaper Gutta-percha Point (P-LC), single
ProTaper Gutta-percha Point (P) and warm vertical condensation (P-OE).

Group LC
Canals were obturated using lateral condensation of
gutta-percha cones and Sultan sealer. Canal walls were
coated with a paper point (size 30) dipped in cement. The
master cone and the apical 2 mm of accessory cones were
also lightly coated with sealer. The master cone, a size 30,
0.02 tapered gutta-percha cone (Dentsply, Maillefer), was
trimmed to give tug-back at WL and then placed slowly in
the canal to full WL. Lateral condensation was achieved
in the canals using medium-fine (Hygienic, Akron, OH,
USA) accessory gutta-percha cones with an endodontic
finger spreader size B (Dentsply, Maillefer). Obturation
was considered complete when the spreader could not
penetrate more than 2 mm into the gutta-percha mass.
Excess gutta-percha was removed from the canal
entrance using a fine-medium system B plugger (Elements Obturation Unit, SybronEndo, Orange, CA, USA)
inserted 1 mm into the root canal. The gutta-percha mass
was then vertically condensed using a No. 4 Machtou
plugger (Dentsply, Maillefer) for 30 s.

Group P-LC
Canals were obturated as in group LC, except that a size
F3 ProTaper Gutta-percha Point (Dentsply, Maillefer) was
used as the master cone.

Group P
Canals were obturated using a single size F3 ProTaper
Gutta-percha Point. Canal walls were coated with a paper
point (size 30) dipped in cement. The F3 point was
trimmed to give tug-back at WL. The F3 point was lightly
coated with sealer and slowly placed in the canal to full

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Journal compilation 2009 Australian Society of Endodontology

Evaluation of obturation techniques

F. Mahera et al.

applied to force the water through the voids along the

filling, thus displacing the air bubble in the capillary tube.
The volume of fluid transport was measured after 24 h by
observing the movement of the air bubble; the displacement of the air bubble was recorded as the fluid transport
(L), expressed in mL/24 h. Six additional specimens
were used as controls. The apices of three of these teeth
were covered with two layers of nail varnish (negative
control). The other three specimens were filled with
lateral condensation of gutta-percha, without sealer
(positive control). The results were analysed by nonparametric tests (KruskalWallis test) with a selected level
of significance of P < 0.05.

WL. Excess gutta-percha was removed from the canal

entrance as in the LC group.

Group P-OE
Canals were obturated using continuous wave condensation as recommended by Buchanan (9). A fine-medium
system B plugger (Elements Obturation Unit) was marked
at its binding point with a rubber stop within 4 mm of WL.
The canal walls were coated with a paper point (size 30)
dipped in cement, and a size F3 ProTaper Gutta-percha
Point was selected as the master cone. The F3 point was
trimmed to give tug-back at WL, lightly coated with sealer
and slowly placed in the canal to full WL as in group P.
The heat source was adjusted to 200C and touch mode
was activated. The heated plugger was driven through the
gutta-percha to approximately 3 to 4 mm before the
rubber stop approached the reference point. During
the downpack, the plugger was deactivated and firm apical
pressure held for 10 s. The canal was completely backfilled
with injection-molded gutta-percha delivered from the
Extruder of Obturation Elements. Constant pressure was
then applied with a No. 4 hand Machtou plugger inserted
1 mm into the root canal for 30 s.

Results
There was no air bubble movement in the capillaries of
the negative controls. In the positive controls, the air
bubbles moved rapidly along the tube as soon as pressure
was applied. Microleakage in the root sections was measured at 7 days, 1 month and 3 months and the results
are expressed in mL/24 h (Table 2). No statistically significant differences in microleakage were observed between
the groups at any examination period (P > 0.05). The
leakage was increased in all groups over the 3-month
period. Statistically significant differences were not found
only in the P-LC group.

Leakage evaluation
Microleakage was measured 7 days, 1 month and
3 months after obturation. Between measurements, the
specimens were kept in distilled water at 37C. The
method used to measure fluid transport has been previously described in the literature (14). The root sections
were connected to a plastic tube, which was then filled
with distilled water from either side of the specimen. A
standard glass capillary tube was connected to the plastic
tube on the outlet side of the specimen. Using a syringe,
water was retracted approximately 3 mm into the open
end of the glass capillary. The whole set-up was then
placed in a water bath (20C) and, using the syringe, the
air bubble was adjusted to a suitable position within the
capillary. A pressure of 0.2 atm from the inlet side was

Discussion
Several methods have been used to assess the sealing
ability of different obturation techniques. The fluid transportation model originally proposed by Pashley et al. (15)
offers many advantages over more frequently used
methods of leakage evaluation. It has been proposed that
the fluid transportation model is more sensitive than dye
and bacterial penetration methods in detecting fulllength voids along the root canal (16,17). It is a simple,
highly reproducible (16,17) and non-destructive method
that allows the measurement of microleakage from the
same specimens over time (18,19). The fluid transporta-

Table 2 Leakage evaluation (L = mL/24 h)

7 days

LC
P-LC
P
P-OE

1 month

3 months

L=0

0 < L 10

L > 10

L=0

0 < L 10

L > 10

L=0

0 < L 10

L > 10

13
10
13
11

2
1
1
2

0
4
1
2

10
10
10
10

2
0
2
1

3
5
3
4

4
5
7
4

2
1
1
1

9
9
7
10

LC, lateral condensation; P-LC, lateral condensation of ProTaper Gutta-percha Point; P, single ProTaper Gutta-percha Point; P-OE, warm vertical
condensation.

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Evaluation of obturation techniques

tion model uses positive pressure, which solves problems

caused by entrapped air or fluid that may bias the results
of dye penetration methods (20). However, it should be
stated that penetration of pressurised water does not
equate to bacterial penetration in vivo and such leakage
studies take no account of host response. Although the
clinical implications of in vitro sealability studies are
unclear, their usefulness should be focused on the initial
comparative evaluation of the sealing ability of endodontic materials.
The unique feature of ProTaper points is that they have
changing percentage taper over their length. Obturation
with ProTaper Gutta-percha Points was as effective as
obturation with lateral condensation of gutta-percha
cones. This finding is in accordance with the results of
Zmener et al. (21) that failed to reveal any significant
differences in terms of dye leakage (2% methylene blue)
between lateral condensation and obturation with a
matching single gutta-percha cone.
Gordon et al. used simulated canals in resin blocks with
either a 30 curve or a 58 curve and curved mesio-buccal
canals of extracted maxillary first molars in order to
compare the area occupied by gutta-percha, sealer or void
in fillings with a single 0.06 gutta-percha point and sealer
or lateral condensation of multiple 0.02 gutta-percha
points and sealer (22). Canals were prepared using 0.06
profiles. The 0.06 taper single-cone technique was found
comparable with lateral condensation in the amount of
gutta-percha occupying a prepared 0.06 tapered canal.
Moreover, the 0.06 taper single-cone technique was
faster than lateral condensation.
Pommel and Camps used a fluid filtration system to
compare the apical microleakage of roots filled with
system B, single-cone technique or lateral condensation
(23). After 1 month of storage, the specimens filled using
the single-cone technique leaked significantly more than
the specimens filled with system B or lateral condensation. These results are in contrast to the findings of the
present study, and may be attributed to the fact that 0.02
tapered gutta-percha points were used to fill 0.06 taper
prepared canals in the single-cone group. In the present
study, the taper of the gutta-percha points used in the
single-cone group matched that of the prepared root
canals. For accuracy, the conclusion is that single-cone
techniques should only be considered with obturation
techniques that use a single gutta-percha point with a
taper that matches that of the preparation.
Ycel and ifti evaluated bacterial penetration in
single straight canals prepared with ProTaper rotary files
and obturated with lateral condensation, system B, Thermafil, ProTaper Gutta-percha Point and laterally compacted ProTaper Gutta-percha Point (24). Their results
showed that after 30 days the lowest ration of penetra172

F. Mahera et al.

tion was observed in groups obturated with system B and

laterally compacted ProTaper Gutta-percha Point and the
highest ration of penetration was observed in groups
obturated with Thermafil and ProTaper Gutta-percha
Point. However, similar to the present findings, the
groups did not differ after 60 days.
In the present study, lateral condensation was performed with a master cone consisting of a gutta-percha
point with a taper matching that of the preparation. The
procedure was as efficient as lateral condensation using a
standardised 0.02 gutta-percha point as a master cone,
which is in agreement with the results of previous
leakage studies (4,14,24). Hembrough et al. evaluated
obturation quality and efficiency in roots filled with
lateral condensation technique and different master
cones (25). They used 45 single-rooted teeth, which were
instrumented with ProFile 0.06 rotary instruments and
obturated with lateral condensation technique using
either an ISO-standardised (0.02 taper) or a 0.06 tapered
gutta-percha point as master cones. Obturation quality
was evaluated by observing in horizontal sections the
ability of each technique to obliterate the root canal
space. To evaluate obturation efficiency in each group,
the number of accessory cones utilised was recorded. No
significant difference in obturation quality was observed
between groups. Obturation efficiency was significantly
greater in the group where a 0.06 tapered gutta-percha
point was used as master cone.
The Elements Obturation Unit combines the technology of system B and a motor-driven extruder handpiece
of thermoplasticised gutta-percha. Warm vertical condensation of gutta-percha using system B as a heat source
and thermoplasticised gutta-percha for backfilling has
been compared several times with lateral condensation,
with conflicting results. It has been evaluated superior
(26) or equal (2729) to lateral condensation. In this
study, obturation with the Elements Obturation Unit was
found to be as effective as lateral condensation.
Another finding of the present study was that leakage
overtime was increased in all groups. However, statistically significant differences were found in the LC, P and
P-OE groups.
The results show that in single straight root canals
prepared with ProTaper rotary instruments, obturation
with a single ProTaper Gutta-percha Point is as effective as
lateral condensation, laterally compacted ProTaper Guttapercha Point and a combination of system B and thermoplasticised gutta-percha.

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