Gaur & Grover An in-vitro evaluation of radiopacity of four endodontic sealers using conventional and digital radiography
ORIGINAL ARTICLE
An in-vitro evaluation of radiopacity of four endodontic
sealers using conventional and digital radiography
Tarun K Gaur1, Rohit Grover1
ABSTRACT
Present study compared and evaluate the radiopacity of
four endodontic sealers using conventional and digital
radiography. The sealers tested were AH-plus,
Endomethasone, Sealapex and Roeko Seal Auto. The
sealers were mixed and placed in circular wells measuring
3mm in diameter & 1mm in depth and were allowed to harden
and set. Aluminium step wedge was placed alongside the
specimens and radio-graphed. Conventional films used
were developed from standard x-ray developing solutions.
Digital images were also obtained similarly. The images
obtained from both the technique were analysed for their
gray scale values using VIXWIN Software. All tested
materials showed radiopacity above 3mm of aluminium as
recommended by ANSI/ADA Specification no. 57. Higher
mean radiopacity was observed for AH-plus followed by
Sealapex, Roeko Seal and Endomethasone respectively.
Conventional method showed lower value of radiopacity
compare to digital technique. The mean values of tested
sealers were varying in both the methods. Digital
radiography was better than the conventional radiographic
in evaluating the radiopacity of root canal sealers.
Key Words: Digital Radiography, Radiopacity, Root Canal
Filling Materials.
INTRODUCTION
Endodontic diagnosis and treatment relies heavily on
radiographs without which the success or failure of the
treatment would not be evaluated. The evaluation of the
1
Department of Conservative Denstiry & Endodontics, Saraswati
Dental College & Hospital, Lucknow, India
Address for Correspondence:
Dr. Tarun K. Gaur
Saraswati Dental College & Hospital, 233 Tiwari Ganj,
Faizabad Road, Off Chinhat, Lucknow-227 105 (UP), India
Contact No: +919935588365 Email: drtarungaur@yahoo.com
Date of Submission : 12-01 -2011
Review Completed : 25-01 -2011
Date of Acceptance : 28-01 -2011
Asian Journal of Oral Health & Allied Sciences - Volume 1, Issue 1, Jan-Mar 2011
technical quality of the obturated root canals mainly consists
of assessment of the radiopacity of the filling materials on a
radiograph which is two- dimensional. Among other physical
and chemical properties, the ideal root canal material should
present sufficient radiopacity to allow distinction from the
adjacent structures such as bone and dentine.1,2
In the past, many of the literature mainly emphasized on the
solubility, adhesion and antibacterial activity of different root
canal sealers. But there are a few studies on radiographic
properties of root canal sealers. Hence, an attempt is made to
study the radiopacity of root canal sealers using both
conventional and digital radiographic technique.
Radiopacity of root canal material has been of particular
significance as it regulates the material reflection degree, thus
allowing a proper contrast from the tooth structure for the
assessment of the marginal adaptability of the filling material
to the root canal walls highlighting any possible radiolucent
voids in the obturation.
The ISO and the ANSI/ADA procedures for determining
radiopacity calls for creating a disc of known thickness and
radiographing it next to aluminium step wedge that is used as
a reference. The ISO 6876/2001 recommends that the root
canal filling material should be at least as radiopaque as a
3mm thickness of aluminium.3
The aim of the present study was to compare and evaluate
the radiopacity of four endodontic sealers using conventional
and digital radiography.
MATERIALSAND METHODS
Four root canal sealers were evaluated in this study: AH-
plus, Endomethasone, Sealapex and Roeko Seal Auto.The
sample size for each method is sixteen {n=4}. Four tests were
conducted for each sealer. The sealers were mixed according
to the manufacturers recommendations and then introduced
immediately in circular wells (Diameter 3mm, Depth 1mm).
The application of the sealers was accomplished with the use
of a syringe to avoid the air bubbles. An aluminium step wedge
made of 1100 alloy, with a thickness varying from 1 to 10mm,
in uniform steps of 1mm each was positioned alongside the
specimens.
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An in-vitro evaluation of radiopacity of four endodontic sealers using conventional and digital radiography Gaur & Grover

The gray scale tool was applied to the region of the

radiographs containing the sample. Care was taken to analyze
only those regions, which were free of air bubbles and other
anomalies. A graph of the gray scale value of each pixel 0(black)
to 255(white) in the analyzed segment was recorded. Four
radiographic images were taken for each sealer for both
conventional and digital radiographic method. The mean value
was determined and tabulated for both the methods (Table 2).
Data were submitted to statistical analysis using two-way
analysis of variance.

RESULTS

In both the methods, analysis of variance showed a

Fig 1 Aluminium Step Wedge statistically significant difference between the radiopacity
means of the tested sealers (p<0.001). All tested materials
For the conventional method, the specimens were placed on showed radiopacity above 3mm of aluminium as recommended
the radiographic film (Kodak E speed Carestream, USA). by ANSI/ ADA Specification 57. However, higher mean
Dental X-ray machine operating at 70KVp and 10mA with a radiopacity was observed in AH-Plus followed by Sealapex,
focus to target distance of 30 cm (ANSI/ADA 2000) was used Roeko Seal and Endomethasone respectively. The mean values
to take the radiographic images. The exposure was of tested sealers were varying in both the methods used.
standardized to 0.6 seconds and the films were developed Conventional method showed a lower value of radiopacity
with standard x-ray developing solutions which were compare to digital radiographic technique. The difference
maintained at constant temperature. For digital imaging between them was found to be statistically significant
technique, the images were taken using a CCD sensor. The (p<0.001).
images obtained from both the methods were transferred to a Conventional Radiographic Technique
computer for the evaluation of radiopacity with the VIXWIN
analytical software system (Gendex, Desplaines, 1L). Ah-plus Endomet- Sealapex Roeko seal
hasone
9 mm 3mm 5mm 4mm
Product Composition Manu- 8.5 mm 3.5mm 5mm 4.5mm
facture
9 mm 3mm 5.5mm 4mm
AH-PlusDiepoxide, Calcium tungstate, Dentsply,
9 mm 3mm 5mm 4mm
Zirconium oxide, Aerosil, DeTrey,
Pigment, 1-adamantane amine, Germany Digital Imaging Technique
N, N-dibenzyl-5-oxa-
nonandiamine-1,9, Diamine, Ah-plus Endomethasone Sealapex Roeko seal
Calcium tungstate, Zirconium 10 mm 4mm 6mm 5.5mm
oxide, Aerosil, Silicone oil
10 mm 4mm 6mm 5.5mm
Endomethas Hydrocortisone acetate, Specialities
9.5 mm 4mm 6.5mm 5mm
one Thymol iodide, Barium Septodont,
sulphate, Zinc oxide, France 10mm 4mm 6mm 5.5mm
Magnesium stearate, Eugenol
excipients DIGITAL CONVENTIONAL

Sealapex Calcium oxide, Bismuth Sybron Endo,

trioxide, Zinc oxide, Orange, CA,
Sub-micron silica, Titanium USA
dioxide, Zinc stearate,
Tricalcium phosphate, Blend,
Ethyl toluene sulfonamide,
Poly (methylene methyl
salicylate) resin, Isobutyl
salicylate, pigment.
Roeko Seal Polydimethylsiloxane, Silicone Roeko,
oil, Paraffin, hexachloride Langenau,
Platinum acid, Zirconium Germany
dioxide
Fig. 2: AH PLUS

68 Asian Journal of Oral Health & Allied Sciences - Volume 1, Issue 1, Jan-Mar 2011
Gaur & Grover An in-vitro evaluation of radiopacity of four endodontic sealers using conventional and digital radiography
Fig. 3: ROEKO SEAL AUTO
Fig. 4: ENDOMETHASONE
Fig. 5: SEALAPEX
DISCUSSION
Radiopacity is widely acknowledged as a desirable property
of all intraoral materials, including the endodontic sealers.
Dental diagnosis relies mainly on radiology. In order to identify
and distinguish a root canal filling materials from the
surrounding anatomical structures, the root canal sealers
Asian Journal of Oral Health & Allied Sciences - Volume 1, Issue 1, Jan-Mar 2011
should be sufficiently radiopaque. The sealer should
contribute to the radiopacity of the root filling for visualization
on radiographs and evaluation of obturation.
According to International Organization for Standardization,
the radiopacity of root canal sealers should be more than or
equivalent to 3mm of aluminium.3 In the past, conventional
peri-apical radiography was the most common method used
for the evaluation of radiopacity of root canal sealers. In the
conventional radiographic method, the radiographic images
were obtained by the chemical processing of radiographic
film, using developing and fixation solution which is time
consuming.
However, digital imaging technique is an emerging area of
radiology that offers many potential benefits such as better
contrast, visualization, sharp images and it is a quick
procedure.
Digital imaging technique offers computer based image
processing and analysis for the radiographic evaluation. The
images can be easily stored and retrieved as compared to
conventional method. In this present study, the root canal
sealers were compared and evaluated for radiopacity using
both conventional and digital radiographic technique. When
digital radiographic method was compared with conventional
radiographic method, it does not need any conventional
periodical radiographic film or the radiographic chemical
processing, thus saving time and decreasing the stages that
could interfere with the radiographic quality.
In addition, digital radiographic method gives three
dimensional images compare to conventional method, which
gives only two dimensional images. It also reduces the
operators exposure to radiation and provides detailed
analysis of digital images.
In this study, aluminium step wedge was used to compare the
radiopacity of root canal sealers. It is well established that
the radiopacity of pure (99.5%) aluminium is very close to
that of human dentine.4
Results of the present study showed that all tested materials
showed radiopacity above 3mm of aluminium which is
recommended by ANSI/ ADA Specification 57. Conventional
method showed a lower value of radiopacity compared to
digital radiographic technique for the tested sealers. This
variation may be due to the radiographic chemical processing
which can interfere with the final radiographic quality.
Tagger and Katz5 found that the digital radiographic method
can provide more consistent results in evaluating the
radiopacity of root canal sealers. In the present study, the
highest mean radiopacity was observed in AH-plus followed
by Sealapex, Roeko Seal and Endomethasone respectively.
69
An in-vitro evaluation of radiopacity of four endodontic sealers using conventional and digital radiography Gaur & Grover

The root canal sealers vary in their radiopacity, depending reveals demands for the development of international
primarily on their thickness, molecular structure, density, and standards for electronic imaging.
atomic number and most important in their composition. AH-
plus root canal sealer has newer fillers like zirconium oxide REFERENCES
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Endod 1976; 2:22835.
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aluminium recommended by ANSI/ ADA Specification No. sealing materials. ISO 6786:2001.
57. AH-plus root canal sealer exhibited highest radiopacity 4. Steven Gu, Brain J, Barry Lee Musikant. Radiopacity of dental
materials using digital X-ray system. Dent Mater: 2006; 22:
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70 Asian Journal of Oral Health & Allied Sciences - Volume 1, Issue 1, Jan-Mar 2011