journal of dentistry 38 (2010) 547–552

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journal homepage: www.intl.elsevierhealth.com/journals/jden

Sealing properties of one-step root-filling fibre

post-obturators vs. two-step delayed fibre post-placement

Francesca Monticelli a,*, Raquel Osorio b, Manuel Toledano b, Marco Ferrari c,

David H. Pashley d, Franklin R. Tay d,e
a
Department of Surgery, University of Zaragoza, Huesca, Spain
b
Department of Dental Materials, School of Dentistry, University of Granada, Spain
c
Department of Prosthodontics and Dental Materials, University of Siena, Italy
d
Department of Oral Biology, Medical College of Georgia, Augusta, USA
e
Department of Endodontics, Medical College of Georgia, Augusta, USA

article info abstract

Article history: Objectives: The sealing properties of a one-step obturation post-placement technique con-
Received 11 January 2010 sisting of Resilon-capped fibre post-obturators were compared with a two-step technique
Received in revised form based on initial Resilon root filling following by 24 h-delayed fibre post-placement.
23 March 2010 Methods: Thirty root segments were shaped to size 40, 0.04 taper and filled with: (1)
Accepted 29 March 2010 InnoEndo obturators; (2) Resilon/24 h-delayed FibreKor post-cementation. Obturator, root
filling and post-cementation procedures were performed using InnoEndo bonding agent/
dual-cured root canal sealer. Fluid flow rate through the filled roots was evaluated at 10 psi
Keywords: using a computerised fluid filtration model before root resection and after 3 and 9 mm apical
Fibre posts resections. Fluid flow data were analysed using two-way repeated measures ANOVA and
Filling/post-obturator Tukey test to examine the effects of root-filling post-placement techniques and root
Flodec resection lengths on fluid leakage from the filled canals (a = 0.05).
Fluid filtration Results: A significantly greater amount of fluid leakage was observed with the one-step
Resilon technique when compared with two-step technique. No difference in fluid leakage was
observed among intact canals and canals resected at different lengths for both materials.
Conclusions: The seal of root canals achieved with the one-step obturator is less effective
than separate Resilon root fillings followed by a 24-h delay prior to the fibre post-placement.
Incomplete setting of the sealer and restricted relief of polymerisation shrinkage stresses
may be responsible for the inferior seal of the one-step root-filling/post-restoration tech-
nique.
# 2010 Elsevier Ltd. All rights reserved.

1. Introduction adhesive root-filling materials.1,2 Resilon (Resilon Research

LLC, Madison, CL, USA) is a polymer-based thermoplastic root-
Adhesive endodontics represents a facet of contemporary filling material that is introduced with the intention of
endodontics that aims to establish a long-term seal of the root providing an alternative root-filling material to conventional
canal system via the use of adhesive root canal sealers and/or gutta-percha for obturation of root canals.3–5 As Resilon

* Corresponding author at: Department of Surgery, Faculty of Health and Sport Sciences, Calle Velódromo s/n, University of Zaragoza,
22006 Huesca, Spain. Tel.: +34 974 245436; fax: +34 974 245436.
E-mail address: fmontice@unizar.es (F. Monticelli).
0300-5712/$ – see front matter # 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jdent.2010.03.014
548 journal of dentistry 38 (2010) 547–552
contains a small amount of dimethacrylate, it has been
claimed to be bondable to methacrylate resin-based root canal
sealers,6 which, in turn, creates a ‘‘monoblock’’ via bonding of
the adhesive sealer to intraradicular dentine.7 Despite its
potential bondability, gaps generated from the polymerisation
shrinkage of methacrylate resin-based adhesive sealers that
accompanied the use of Resilon have been reported along the
canal walls.8–10
Contamination of orthograde root fillings via leakage of oral
fluids and bacteria may be attributed to the lack of adequate
marginal adaptation of the root canal sealer and the lack of a
coronal seal.11 Immediate fibre post-cementation and adhe-
sive core build-up may be helpful in achieving a better seal of
badly broken down endodontically treated teeth. Although
recent studies reported higher interfacial strengths with
delayed fibre post-luting,12 the exact time interval required
between endodontic treatment and fibre post-restoration does
not seem to be a determinant factor in order to achieve an
optimal seal.13
Filling of instrumented root canals that require coronal
restorations may be completed in one-step instead of the
conventional two-step technique of waiting for long setting
root fillings to completely mature prior to post-core build-ups.
A one-step root-filling post-placement filling technique con-
sisting of the use of Resilon-capped fibre post-obturators has
been introduced with the purpose of filling the instrumented
canal space with a material that is compatible with immediate
coronal restoration. This one-step technique is claimed by the
manufacturer to bridge the gap between endodontics and
restorative dentistry. However, little information is available
from non-manufacturer-sponsored studies on the seal
achieved with the one-step technique.14 Although clinical
trials remain the ultimate test for root-filling restoration
effectiveness, the introduction of new dental materials often
demands the demonstration of acceptable laboratory research
results prior to the initiation of more labour intensive and
expensive clinical studies. A computerised fluid filtration
system provides reasonably accurate quantitative assessment
on the sealing properties of filled root canals.15–19 Thus, the
objective of the present study was to compare the sealing
ability of two different strategies of root canal filling and
coronal restoration with fibre posts using the fluid leakage
evaluation protocol. The null hypothesis tested was that there
are no differences between the one-step and the two-step
root-filling fibre post-restoration techniques in the seal
achieved by the two techniques at different root canal levels.
2. Materials and methods
Thirty extracted human teeth, each with a single straight root
canal and closed apex, were collected with patient’s consent
under a protocol approved by the Human Assurance Com-
mittee of the Medical College of Georgia. The teeth were stored
at 4 8C in 0.9% NaCl solution supplemented with 0.02% sodium
azide to prevent bacteria growth until use. Each tooth was
decoronated using a low-speed Isomet diamond saw (Buehler
Ltd., Lake Bluff, NY, USA) under water cooling to create 17 mm
long root segments. Working length was established at 1 mm
short of the anatomical apex. Canal patency was achieved
with a size 10 stainless steel K-file (Dentsply Tulsa Dental
Specialties, Tulsa, OK, USA). The root apex was covered with
hot, flexible glue that was allowed to solidify before the root
was inserted into a polyvinylsiloxane impression material-
filled Plexiglas tube. This setup permitted recapitulation of
canal patency but prevented fluid extrusion from the apical
foramen during canal preparation. The setup created a closed
canal system that simulated the presence of vapour lock that
prevented idealized canal irrigation from the apical third of
the canal walls during in vivo cleaning and shaping proce-
dures.20,21
Canal instrumentation was performed with a crown down
technique using K-files and EndoSequence 0.04 taper nickel
titanium rotary instruments (Brasseler USA, Savannah, GA,
USA) to size 40. Root canals were rinsed with 10 mL of 5.25%
sodium hypochlorite (The Clorox Company, Oakland, CA,
USA) as the initial irrigant in between instrumentation and
5 mL of 17% ethylenediamine tetraacetic acid (EDTA; Sigma–
Aldrich, St. Louis, MO, USA) as the active final irrigant for
1 min. The irrigants were delivered to the canal space via 30-G
Max-i-Probe needles (Dentsply-Rinn, Elgin, IL, USA) placed to
1 mm short of working length. After irrigating with 17% EDTA,
each canal was flushed with an additional 5 mL of sterile
distilled water as the passive final rinse via the use of a Max-i-
Probe needle. The instrumented roots were randomly divided
into two experimental groups (N = 12) and two control groups
(N = 3).
2.1. Group I. one-step canal obturation and fibre
post-placement
Each canal was fitted with a size 40 Resilon-capped fibre post-
obturator (Heraeus Kulzer Inc., Armonk, NY, USA). The
InnoEndo obturator has a 7 mm Resilon terminus with a
0.02 taper segment for the subsequent 12 mm turning to a
parallel glass fibre post for the remaining 11 mm. The dowel
space was prepared using a proprietary bur. The depth of the
dowel space preparation was determined by subtracting the
length of the Resilon tip of the obturator from the overall
working length of the canal.
The InnoEndo Bonding Agents A and B were mixed in a 1:1
ratio and applied to the canal and over the obturator following
the manufacturer’s instructions. The InnoEndo dual-cured
root canal sealer was introduced apically into the canal space
with a lentulo spiral and dispensed through the auto-mixing
syringe for back-filling of the canal. The obturator was slowly
inserted into the canal to its working length, allowing the
excess of material to extrude coronally. The sealer was light-
cured through the post for 40 s using a quartz-tungsten-
halogen light-curing unit (VIP, Bisco Inc., Schaumburg, IL USA)
with an output intensity of 600 mW/cm2. A layer of InnoEndo
dual-cured core material was placed on top of the post to
create a coronal seal.
2.2. Group II. two-step initial canal obturation followed by
delayed fibre post-placement
Each canal was fitted with a size 40, 0.04 tapered Resilon cone
that was bonded to the intraradicular dentine using the same
procedures as described in Group I. The filled root segments
 journal of dentistry 38 (2010) 547–552
were stored at 37 8C and 100% relative humidity for 24 h before
luting of the fibre post. With the purpose of simulating the
same clinical situation of Group 1, the filling material was
removed with a Largo drill, leaving 7 mm of apical root-filling
material.22 The dowel space was prepared with the proprietary
drill. A parallel glass fibre post (FibreKor post, Pentron Clinical
Technologies, Wallingford, CT, USA) was fitted to the dowel
space and luted using the same materials and procedures as
described in Group I.
2.3. Positive and negative controls
Three root segments that were filled each with a size 40, 0.04
taper Resilon cone without a sealer were used as positive
controls to determine the maximum fluid flow of the fluid
filtration system through the root canals. Three root segments
filled as in Group I and dipped in molten sticky wax and further
covered with nail varnish were used as the negative controls.
2.4. Fluid filtration
The restored specimens were stored for at 37 8C and 100%
relative humidity 24 h prior to the evaluation of fluid leakage.
A 2 mm deep cavity was created from the coronal end of each
root segment by removing the composite restoration. The root
was attached to a Plexiglas platform with cyanoacrylate glue.
Each mounted root was connected via an 18-gauge stainless
steel tubing at the base of the Plexiglas platform to a Flodec
device (De Marco Engineering, Geneva, Switzerland) that
measured water movement through the obturated root
(mL min 1) under a constant pressure of 69 kPa. Data collection
was performed every 1.04 s. The system was allowed to run
until the fluid flow became stable, as visualised by the graphic
display in the Flodec software prior to commencement of the
recording for a 10 min period. The mean fluid flow from each
measurement was expressed as the mean of water movement
from all the 1.04 s intervals during that 10 min period.
After determining the fluid leakage through the entire root
canal, each specimen was sectioned at 3 and 9 mm from the
root apex with the Isomet saw under copious water irrigation.
Fluid filtration was re-measured after each resection. The
mean fluid flow was similarly recorded for each resection
length. Resections were not performed for the positive and
negative controls.
The intrinsic permeability of the fluid filtration system was
assessed with multiple fluid flow measurements (10 min each)
that were repeated with the exit connection clamped with a
haemostat. The recorded value (expressed in mL min 1) was
Table 1 – Fluid leakage recorded in each experimental group at different canal levels from root apex.
Group (N = 12)
One-step root-filling/post-cementation technique
Two-step root-filling/fibre post-cementation technique
Letters in each column and numbers in each row indicate significant differences ( p < 0.05).
a
Values are means (standard deviations), expressed in units of mL min 1 cmH2O 1.
549
subtracted from the mean fluid flow obtained for the intact
root filling and from each resection length of the respective
root-filling technique to generate the mean ‘‘adjusted’’ fluid
flow.
For the positive control group, a pre-weighed beaker was
placed over the apex of the root segment to collect the water
that was expressed through the apex for 1 min at 69 kPa
pressure. The weight of the collected water was converted into
volume, from which the fluid flow in mL min 1 was deduced.
The mean ‘‘adjusted’’ fluid flow, generated at 69 kPa,
were normalised and expressed as hydraulic conductance
(mL min 1 cmH2O 1). As the normality (Kolmogorow–Smirnoff
test) and homoscedasticity (Levene test) assumptions of the
data appeared to be violated, log10-transformations of the data
derived from the intact canals and the resected canals were
performed before statistical evaluation. The transformed data
were analysed using a two-factor repeated measures analysis
of variance to examine the effects of restoration technique (i.e.
one-step vs. two-step) and the repeated factor ‘‘resection
length’’ (i.e. intact root, 3 and 9 mm resections) and the
interaction of those factors on fluid leakage. Post hoc multiple
comparisons were performed using the Tukey test. Statistical
significance was set at a = 0.05.
After assessment of fluid leakage, the 3–9 mm resected
section of each specimen was examined from both ends using
a digital camera attached to a stereomicroscope at 200
magnification (Olympus SZ-CTV, Olympus, Tokyo, Japan).
3. Results
The adjusted hydraulic conductance values for the six
subgroups are reported in Table 1. The intrinsic permeability
of the fluid filtration system varied between zero and
5.7  10 6 mL min 1 cmH2O 1. The mean hydraulic conduc-
tance of the positive control group was 1.6  10 2  0.38 
10 2 mL min 1 cmH2O 1 and the varnish-coated negative con-
trol group approximated null permeability after adjustment
for intrinsic system permeability. The one-step InnoEndo
obturator technique exhibited significantly more fluid leakage
than the two-step Resilon-FiberKor post-technique ( p = 0.001).
No significant difference in the hydraulic conductance was
recorded among the different resection lengths for both the
tested materials ( p = 0.475). The interaction of these two
factors was not statistically significant ( p = 0.318).
When the resected root sections were observed under light
microscopy, voids within the sealer and interfacial defects
were detected mainly in the one-step group (Fig. 1A). When
1
Hydraulic conductance (mL min cmH2O 1)a
0 mm 3 mm 9 mm
0.19 (0.11) B,1 0.26 (0.15) B,1 0.25 (0.15) B,1
0.13 (0.09) A,1 0.12 (0.08) A,1 0.15 (0.08) A,1
550 journal of dentistry 38 (2010) 547–552
Fig. 1 – Light microscopy images of root surfaces filled with
the tested materials sectioned at 3 mm from the root
apices after fluid filtration assessment (200T). (A) In the
one-step group, the sealer used for simultaneous bonding
of the root-filling material and fibre post-separated from
the canal wall, producing gaps (arrow) between the sealer
(S) and the intraradicular dentine (D). F: the Resilon part of
the obturator (B) Less interfacial defects could be seen in
the two-step group when a separate fibre post was placed
24 h after setting of the root canal sealer (S). F: Resilon root
filling; D: intraradicular dentine.
fibre post-placement was performed 24 h after the root canal
filling (two-step group), less interfacial defects were observed
between the sealer and dentine (Fig. 1B).
4. Discussion
The findings of the present study require rejection of the null
hypothesis since there were significant differences in the seal
between the two obturation/restoration techniques. Durable
post-endodontic restorations must ensure the creation of an
impervious seal of the root canal system to prevent fluid and
bacterial leakage.23 The literature is ambiguous in terms of the
optimal sequence and timing for preparation of a dowel space
for retention of coronal restorations after root canal treat-
ments. An early study by Bourgeois and Lemon found no
difference in apical leakage between immediate and delayed
post-space preparation.24 Fox and Gutteridge opined that
immediate restoration of a root-treated tooth with a pre-
fabricated post and composite core produced a better seal than
a temporary post-crown and a subsequently luted cast post
and core.25 Both Wu et al.26 and Metzger et al.27 found that
post-prepared canals have inferior seal than intact root-filled
canals and that a post and core should be immediately placed
after root canal treatment. Theoretically, the use of a
combined root-filling fibre post-obturator in conjunction with
an adhesive root canal sealer can minimise the risk of apical
and coronal leakage. The possibility of filling root canals that
require a coronal restoration in a single visit is also very
attractive for general practitioners. However, the ability of this
simpler and time-saving technique to create a seal that is
comparable with conventional two-step techniques is a
matter of concern.
The fluid leakage model employed in the present study
highlighted the presence of porosities at the interface between
the InnoEndo filling material and intraradicular dentine. The
limitation of the model lies in its inability to determine the
exact locations of leakage within the filled canal space.28 The
adjunctive use of light microscopy examination indicated that
these defects were predominantly present in the middle third
of the root canal.
The one-step InnoEndo procedure somewhat resembles the
single-cone root-filling technique2,29 in that more than half of
the canal space is filled by the sealer. It has been reported that
low root-filling material/sealer ratios may not guarantee a long-
term hermetic seal of the root canals, since many sealers tend to
dissolve over time.29–31 InnoEndo obturators used as single-
cone fillings may result in wider gaps and larger voids than
alternative obturation techniques.31 These structural defects,
most likely originated from air entrapped in the sealer during
passive obturator insertion, may have weakened the root filling,
thereby providing pathways for leakage (Fig. 1A).32,33 Moreover,
generation of polymerisation shrinkage stresses along the canal
walls during light curing of the sealer from the canal orifice
together with the increase in sealer volume34,35 may also have
contributed to the inferior results achieved with the one-step
technique. These findings could have been different if the sealer
was left to polymerise without light curing, allowing better relief
of polymerisation shrinkage stresses via resin flow11 or placing
auxiliary cones, reducing the amount of sealer and therefore the
polymerisation shrinkage.
Under the conditions of the present ex vivo study, the
combination of Resilon and 24 h-delayed fibre post-placement
resulted in a more predictable restoration technique that
produced less fluid leakage. This approach may have mini-
mised the adverse effects derived from poor sealer setting and
excessive polymerisation shrinkage. When compared to the
previously reported conventional one-step root-filling dowel
space preparation techniques,25–27 a 24 h delay in dowel space
preparation may also have reduced the risk of disrupting the
maturing bond at the sealer-dentine interface by rotational
forces generated by the dowel preparation drill.12,36 Fibre post-
cementation using the same methacrylate resin-based sealer
may also explain the lower fluid flow recorded in the two-step
group, thereby ensuring a better coronal seal. This approach is
 journal of dentistry 38 (2010) 547–552
closer to the theoretical concept of a ‘‘secondary mono-
block’’.37
5. Conclusions
Within the limitation of this study, it may be concluded that
the overall seal achieved with the use of an InnoEndo Resilon-
capped obturator is less effective than initial root filling with
Resilon followed by a 24 h delay prior to fibre post-cementa-
tion. These data may not be directly correlated with the
clinical performance of the new filling material and further
research is needed for evaluating the long-term efficacy of the
one-step root-filling post-placement technique. Nevertheless,
emphasis must be focused on the importance of prompt
completion of the coronal restoration for ensuring success in
root canal therapy.
Acknowledgements
Dr. Francesca Monticelli’s visit to the Medical College of
Georgia was supported by a research fellowship from the
University of Siena, Italy. This investigation was also
supported by Grants: CICYT/FEDER #MAT 2008-02347/MAT,
JA P07-CTS-2568, JA P08-CTS-3944.
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