Apically Extruded Sealers: Fate and Influence on Treatment Outcome

By Ricucci D, Rôças IN, Alves FR, Loghin S, Siqueira Jr JF.

Date: 01/2018
Journal: JOE


•Purpose: to evaluate cases of unintentional overfillings after using different sealers and to see the fate of the extruded material and its influence on endodontic treatment outcome. 

N= 105


•Teeth treated by a single operator and exhibiting overfillings in the postobturation radiograph (n = 105), with follow-up examinations ranging from 1 year to up to 30 years, were selected.

•75 had PA lesions at time of treatment and 30 were normal.

•All endodontic treatments were performed using a strict aseptic technique

•Different sealers were randomly used and included the zinc oxide eugenol-materials Pulp Canal Sealer, PCS Extended Working Time (EWT), Tubli-Seal, and Endomethasone; the resin-based sealer AH Plus and the calcium hydroxide–based sealer Apexit.

•Two examiners blinded to the sealer used, compared the baseline and recall radiographs for the fate of the extruded sealer and treatment outcome (Strindberg’s criteria).

Most highlighted Results: 

•At the 1 year Recall: the only statistically significant differences at this period were observed when comparing Tubli-Seal with AH Plus, Apexit, and Endomethasone.

•At the 2-year recall: The frequency of removal of AH Plus and Apexit was significantly lower when compared with all the other sealers.

•At the >4-year evaluation, significant differences were observed between AH Plus and Apexit when compared with the other sealers. Tubli-Seal was the only sealer that showed 100% disappearance.

•All the 30 teeth with no apical periodontitis lesion at the time of treatment remained without disease at all follow-up intervals regardless of the type of extruded material.

•Data from the >4-year follow-up revealed that 79% of the cases with apical periodontitis lesions at the time of treatment were categorized as healed in comparison with 100% of the teeth with no apical periodontitis. This difference was highly significant.

•There was no statistically significant difference in the outcome between the tested sealers at all examination periods. 

•Clinical significance:

Treatment outcome is not significantly affected by the type of extruded sealer as long as the root canals are adequately treated. This does not mean that overfillings are recommended because gross extrusion of filling materials has been reported to cause severe postoperative complications.