TOPICS OF INTEREST

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The Prosthodontic Management
of Endodontically Treated Teeth:
A Literature Review.
Part 11. Maintaining the Apical Seal
Charles J. Goodame, DDS, MSD, * and Kenneth J. Spolnik, DDS, MSDT
Part II of t he three-part l i terature revi ew series addresses factors rel ated t o prosthodontic
J Prosthod 1995;4:57-53. Copyright D 7995 by the American College of Prosthodontists.
INDEX WORDS: endodontically treated teeth, posts and cores, apical seal
t reat ment t hat can affect the apical seal and endodontic success.
ART I OF THIS literature review series pre-
P sented success and failure data and studies re-
lated to the treatment concepts used in the prosth-
odontic management of endodontically treated teeth.
Part I1 discusses how prosthodontic procedures per-
formed on endodontically treated teeth can affect
the apical seal.
Can Gutta percha Be Removed
Immediately After Endodontic
Treatment and a Post Space
Prepared?
Multiple have shown that there is no
difference in the leakage of the root canal filling
material when the post space is prepared immcdi-
ately after completing endodontic therapy. Bour-
geois and Lemon1 found no difference in the "Ca
penetration between immediate preparation of a
post space and preparation I week later when 4 mm
of gutta percha ~7as retained. Zmener2 found no
difference in dye penetration between gutta percha
removal after 5 minutes and 48 hours. Four millime-
ters of gutta percha was retained apically, and two
sealers were tested. When lateral condensation of
gutta percha was used, Madison and Zakariasenj
found no difference in the dye penetration between
*h$ssorandDean, Loma Linda UnicwsiQ School ojDenfirtp, Loma
jAsociate Pr4essor .f Endodontirs, Indiana l/niuersi@ School o j
Correspondme to: Charles J. Guudacre, DDS, MSD: Lomn I.inda
CopNt ht 0 1995 Ly the American Collpge ufProsthodontists
Linda, CA.
Denh@y, Indianapolis, IX
University School ojDentistv, IAma Linda, CA 92350.
I05~-Y4IXI951 0401-00~~$5.00lO
immediate removal and 48-hour removal. Using the
chlorpercha filling technique, Schnel14 compared the
immediate removal of gutta percha with no removal
of gutta pcrcha and found no difference in the
leakage.
Dickey et a15 reported contrasting results because
they found significantly greater leakage with irnmedi-
ate gutta percha removal. Portell et a16found that
delayed gutta percha removal (after 2 weeks) caused
significantly Inore leakage than immediate removal
when only 3 mm of gutta percha was retained api-
cally.
Summary
Adequately condensed gutta pcrcha can be safely
removed immediately after endodontic treatment.
What Instruments Can Be Used
to Remove Gutta Percha Without
Disturbing the Apical Seal?
Multiple have shown that there is no
difference in the leakage between removing gutta
piarcha with hot instruments and removing it with
rotary instruments. Suchina and Ludington' and
Mattison et aI8 found no difference between Gates-
Glidden burs and hot instruments. Camp and Toddg
found no difference between hot, Peeso, and Gates-
Glidden instruments.
Summary
Both rotary and hand instruments can safely be used
tci remove adequately condensed gutta percha.
Journal OfProsthodontics, Val 4, No I (March). 1995:pp 5l dS 51
52 Endodontically Treated Teeth Goodacre and Sbolnik
How Much Gutta Percha Should
Be Retained Apically to Preserve
the Apical Seal?
It is frequently recommended that 3 to 5 mm of
gutta percha be preserved apically (Fig l), but a
detailed look at apical leakage studies gives a more
specific picture.
One study' determined that when 4 mm of gutta
percha was retained only 1 of 89 qpecimens showed
leakage, whereas 32 of 88 specimens leaked when 2
mm of gutta percha was retained. Madison and
Zakariasen3 and Neagley"' found no leakage at 4
mm. Zmener2 found that one of eight specimens
leaked at 4 mm. Portell et alG determined that most
of the specimens with only 3 mm of apical gutta
percha had some leakage. In a comparison of leakage
at 3, 5, and 7 mm of gutta percha, Mattison ct a18
found significant leakage differences between each of
the dimensions, and they concluded that at least 5
mm of gutta percha is necessary for an adequate
apical seal. Endodontic indicate that a
minimum of 5 mm of ptta percha be retained
apically to ensure a good seal.
Summary
Four to 5 mm of gutta percha should he retained
apically to ensure an adcquatc apical seal. When only
3 mm or less is present, there is a greater incidence of
leakage. Although studies indicate that 4 mm pro-
ducts an adequate scal, it is difficult to stop at
precisely 4 mm, and additional removal can cause
leakage. A cansenrative, safe approach is to maintain
5 mm of gutta pcrchawhencvcr possible.
Figure 1. Five millimeters of gutta percha has been
retained apically to assure a good seal of the gutta percha.
Can a Silver Point Maintain
its Apical Seal When a Portion
Will Be Removed During Post
Preparation?
Zmener2 found leakage in all the specimens when 1
mm of a 5-mm long silver point was removed uith a
round bur. Neagley'* found that removal of the zinc
oxide and eugenol filling material coronal to the
silver point with aPeeso reamer causcd no leakage as
long as the siher point u'as riot contacted. However,
when all the zinc oxide and eugenol was removed and
1 mm of the sectional silver point removed, complete
dye penetration occurred in eight of the nine speci-
mens.
Summary
The removal of a portion of a silver point during post
preparation causes apical leakage.
Is it Important to Place
the Definitive Prosthesis as Soon
as Possible After Endodontic
Treatment?
hfagura et all3 performed endodontic treatment on
160 human maxillary anterior teeth using lateral
condensation of gutta percha. I Rq provisional resto-
rations (L.D. Caulk Company, Milford, DE), approxi-
mately 3-mm thick, were then placed over the
obturated canals, and the teeth were immersed in
human saliva for 2,7, 14,28, and 90 days. They found
that significant lcakage of the IRM provisional resto-
rations had occurred by 3 months, adversely affecting
the root canal seal. It was not possible to determine
the precise time at which the leakage became signifi-
cant, but it was somewhere betwccn the 1- and
3-month test periods. The authors suggest that
endodontically treated teeth that have been provision-
ally restored with a zinc oxide eugenol material for
long time periods be retreated to assure a proper seal
before completing the definitive prosthesis.
Summay
Dcfinitive prosthodontic treatment should be per-
formed on asymptomatic endodontically treated teeth
as soon ac; is practical aftcr completing the endodon-
tic therapy. If a zinc oxide eugenol provisional resto-
ration placed over the obturated canal is exposed to
saliva for long time periods ( = 3 months), leakage
March 1995, Volume 4, Number I 53
will occur that compromises the gutta percha seal,
and such teeth should be endodontically retreated.
References
1. Bourgeois RS, Lemon RR. Dowel space preparation and
apical leakage. J Endodont 198 1;7:66-69
2. Zmener 0: Effect of dowel preparation on the apical sral nf
endodontically treated teeth., J Endodont 1980;6:687-690
3. Madison S, Zakariasen KL: Linear and volumetric analysis of
apical leakage in teeth prepared for posts.J Endodont 1981;lO:
4. Schnell FJ: Effect of immediate dnwrl space preparation on
the apical seal of endodontically filled teeth. Oral Surg
1978;45:470-474
5. Dickey DJ, IIarris GZ, Lemon RK, et al: Effect of post space
preparation on apical seal using solvent techniques and Peeso
reamers. J Endodont 3982;8:351-3.54
422-427
6. Portell FR, Bernier WE, Lortori L, et al: The effect of
immediate versus delayed dowel space preparation on the
intcgrityof the apical scal. J Endndont 1982;8:154-160
7. Suchina J A, Ludington J R: Dowel space preparation and the
apical seal. J Endodont 198.5; I I : 1 1- 17
8. Mattison GD, Delivanis PD, Thacker RW, et al: Effect of post
preparation on the apical scal. J Prosthrt Drnt 1984;51:785-
789
9. Camp LR, Todd MJ: The effect of dowel preparation on the
apical seal of three common obturation techniques. J Prosthet
Dent 1983;50:664-666
10. Neagley RL: The effect of dowel preparation on the apical seal
of endodontically treated teeth. Oral Surg Oral Mcd Oral
Pathol 1969;28:739-715
1 I . Gcrstein H: Techniques in Clinical Endcdontics. Philadelphia,
PA, Saunders, 1983, p 370
12. TngleJ I, TaintorJ F: Endodontics. (ed 3 ) . Philadelphia, PA,Lea
8 Frbiger, 198.5, p 822
13. Magura ME, Kafrawy AH: Brown CE J r, et al: Human saliva
coronal microleakage in ohturated root canals: An in vitro
study.J Endodont 1991;17:324-331