O objetivo deste trabalho foi avaliar a radiopacidade de cimentos endodônticos à base de óxido de zinco e eugenol (Endofill), hidróxido de cálcio (Sealapex), resina (Sealer 26 e AH Plus) e silicone (Roeko Seal). Os corpos de prova foram padronizados com 10 milímetros de diâmetro e 1 milímetro de espessura e radiografados conjuntamente com uma escala de alumínio empregando-se filmes oclusais, de acordo com as Normas ISO 6876/2001. As radiografias foram digitalizadas e as radiopacidades dos cimentos comparadas à escala de alumínio com diferentes espessuras, utilizando o software VIXWIN 2000. Os resultados demonstraram que o AH Plus foi o cimento mais radiopaco e o Sealapex apresentou menor radiopacidade (pThe aim of this study was to evaluate the radiopacity of a zinc oxide and eugenol-based (Endofill), a calcium hydroxide-based (Sealapex), two resin-based (Sealer 26 and AH Plus), and a silicone-based root canal sealer (Roeko Seal). Specimens, measuring 10mm in diameter and 1mm in thickness, were radiographed simultaneously with an aluminum step wedge using occlusal films, according to ISO 6876/2001 standards. Radiographs were digitized, and the radiopacity of sealers was compared to the different thicknesses of the aluminum step wedge, using the VIXWIN 2000 software. Results demonstrated that AH Plus was the most radiopaque sealer, while Sealapex was the least radiopaque (

Cezare, Luciana

Gonçalves, Marcelo

Tanomaru Filho, Mário

Tanomaru, Juliane Maria Guerreiro

English

The aim of this study was to evaluate the radiopacity of a zinc oxide and eugenol-based (Endofill), a calcium hydroxide-based (Sealapex), two resin-based (Sealer 26 and AH Plus), and a silicone-based root canal sealer (Roeko Seal). Specimens, measuring 10mm in diameter and 1mm in thickness, were radiographed simultaneously with an aluminum step wedge using occlusal films, according to ISO 6876/2001 standards. Radiographs were digitized, and the radiopacity of sealers was compared to the different thicknesses of the aluminum step wedge, using the VIXWIN 2000 software. Results demonstrated that AH Plus was the most radiopaque sealer, while Sealapex was the least radiopaque (p<0.05). Roeko Seal, Endofill and Sealer 26 presented intermediate radiopacity values. Sealapex presented less radiopacity than the other types of root canal sealers.O objetivo deste trabalho foi avaliar a radiopacidade de cimentos endodônticos à base de óxido de zinco e eugenol (Endofill), hidróxido de cálcio (Sealapex), resina (Sealer 26 e AH Plus) e silicone (Roeko Seal). Os corpos de prova foram padronizados com 10 milímetros de diâmetro e 1 milímetro de espessura e radiografados conjuntamente com uma escala de alumínio empregando-se filmes oclusais, de acordo com as Normas ISO 6876/2001. As radiografias foram digitalizadas e as radiopacidades dos cimentos comparadas à escala de alumínio com diferentes espessuras, utilizando o software VIXWIN 2000. Os resultados demonstraram que o AH Plus foi o cimento mais radiopaco e o Sealapex apresentou menor radiopacidade (p<0,05), sendo intermediários os resultados para os cimentos Roeko Seal, Endofill e Sealer 26. Sealapex apresenta menor radiopacidade que outros tipos de cimentos endodônticos

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Avaliação da radiopacidade de cimentos endodônticos por meio da digitalização de imagens radiográficas

Cadernos Espinosanos (E-Journal)

TOABSTRACTRESUMOwww.fob.usp.br - www.scielo.brEVALUATION OF THE RADIOPACITY OF ROOT CANALSEALERS BY DIGITIZATION OF RADIOGRAPHIC IMAGESAVALIAÇÃO DA RADIOPACIDADE DE CIMENTOS ENDODÔNTICOSPOR MEIO DA DIGITALIZAÇÃO DE IMAGENS RADIOGRÁFICASJuliane Maria Guerreiro TANOMARU1, Luciana CEZARE2, Marcelo GONÇALVES3, Mário TANOMARU FILHO41- PhD, Graduate Student in Endodontics, Araraquara Dental School, State University of São Paulo, UNESP, Araraquara, SP, Brazil.2- DDS, Graduate Student in Dentistry, Araraquara Dental School, State University of São Paulo, UNESP, Araraquara, SP, Brazil.3- Assistant Professor of Radiology, Araraquara Dental School, State University of São Paulo, UNESP, Araraquara, SP, Brazil.4- Associate Professor, Department of Endodontics, Araraquara Dental School, State University of São Paulo, UNESP, Araraquara, SP, Brazil.Corresponding address: Prof. Dr. Mário Tanomaru Filho -  Rua Humaitá, 1680, Caixa Postal 331, Centro, Cep.: 14801-903 - Araraquara, SP,Brasil - Phone +55-16-3301-6390, Fax. +55-16-3301-6392.  Email: tanomaru@uol.com.brReceived:June 06, 2004 - Returned for modification: August 17, 2004 - Accepted: October 06, 2004 he aim of this study was to evaluate the radiopacity of a zinc oxide and eugenol-based (Endofill), a calcium hydroxide-based (Sealapex), two resin-based (Sealer 26 and AH Plus), and a silicone-based root canal sealer (Roeko Seal). Specimens,measuring 10mm in diameter and 1mm in thickness, were radiographed simultaneously with an aluminum step wedge usingocclusal films, according to ISO 6876/2001 standards. Radiographs were digitized, and the radiopacity of sealers was comparedto the different thicknesses of the aluminum step wedge, using the VIXWIN 2000 software. Results demonstrated that AH Pluswas the most radiopaque sealer, while Sealapex was the least radiopaque (p<0.05). Roeko Seal, Endofill and Sealer 26 presentedintermediate radiopacity values. Sealapex presented less radiopacity than the other types of root canal sealers.Uniterms: Root canal filling materials; Radiopacity.   objetivo deste trabalho foi avaliar a radiopacidade de cimentos endodônticos à base de óxido de zinco e eugenol(Endofill), hidróxido de cálcio (Sealapex), resina (Sealer 26 e AH Plus) e silicone (Roeko Seal). Os corpos de prova forampadronizados com 10 milímetros de diâmetro e 1 milímetro de espessura e radiografados conjuntamente com uma escala dealumínio empregando-se filmes oclusais, de acordo com as Normas ISO 6876/2001. As radiografias foram digitalizadas e asradiopacidades dos cimentos comparadas à escala de alumínio com diferentes espessuras, utilizando o software VIXWIN 2000.Os resultados demonstraram que o AH Plus foi o cimento mais radiopaco e o Sealapex apresentou menor radiopacidade(p<0,05), sendo intermediários os resultados para os cimentos Roeko Seal, Endofill e Sealer 26. Sealapex apresenta menorradiopacidade que outros tipos de cimentos endodônticos.Unitermos: Material obturador de canal radicular; Radiopacidade.INTRODUCTIONThe ideal root canal sealer should present, among otherphysical/chemical properties, enough radiopacity to allowdistinction from the adjacent anatomical structures2,11,14,10,such as bone and tooth13. Higginbotham7 (1967) was thefirst researcher to publish a study comparing the radiopacityof various endodontic sealers and gutta-percha cones usedto fill root canals7. Eliasson and Haasken4 (1979) establisheda comparison standard for radiopacity studies, using opticalradiographic density measurements for impression materialsand an equivalent thickness of aluminum capable ofproducing similar radiographic density.Beyer-Olsen and Orstavik2 (1981) included in their studiesa reproducible comparison standard using an aluminum stepwedge with 2mm-increments to determine the radiopacity ofseveral root canal sealers. Their results showed that mostsealers investigated were more radiopaque than dentin.Tagger and Katz16 using similar methodology evaluated theradiopacity of root-end filling materials.The aim of this study was to evaluate the radiopacity offive root canal sealers in comparison to the radiopacity of355J Appl Oral Sci 2004; 12(4): 355-7an aluminum step wedge, according to the ISO 6876/2001standards9, which recommend that root canal filling materialsshould be at least as radiopaque as a 3 mm-thick aluminumwedge.MATERIALS AND METHODSFive root canal sealers were evaluated in this study:Endofill (Dentsply Ind. e Com. Ltda., Petrópolis, RJ, Brazil),Sealapex (Kerr Corp., Orange, CA, USA), Sealer 26 (DentsplyInd. e Com. Ltda., Petrópolis, RJ, Brazil), RSA Roeko Seal(Roeko, Langenau, Germany), and AH Plus (Dentsply DeTrey Gmbh, Konstanz, Germany). The materials were preparedaccording to manufacturers’ instructions. Five specimens,measuring 10mm in diameter and 1mm in thickness, werefabricated from each material tested. Metallic matrices weremade and impressions were taken using a light-bodiedsilicone-based impression material. Samples of the preparedsealers were then inserted into the impressions and storedin a moist chamber (incubator) at 37ºC, until completely set.Following that, the specimens were placed onto fiveocclusal radiographic films (Insight – Kodak Comp,Rochester, NY, USA) and exposed, along with an aluminumstep wedge with thickness varying from 2 to 16mm in 2 mm-increments (Figure 1). A GE-1000 X-ray machine (GeneralElectric, Milwaukee, WI, USA) operating at 50Kv, 10mA, 18pulses/s, and focus-film distance of 33.5cm, was used.Radiographs were digitized using a desktop scanner(SnapScan 1236 – Agfa, Deutschland), and the digitizedimages were imported into the VIXWIN 2000 software(Gendex, Desplaines, IL, USA), where a tool was applied toidentify equal-density areas in the radiographic images(equal-density tool). This procedure allowed comparisonbetween the densities of different sealers and the radiopacityof different degrees of thickness of the aluminum stepwedge. Using the computer mouse, an area correspondingto the specimen was selected from each radiographic image,in order to verify which thickness of the aluminum stepwedge was detected by the software as being equivalent tothe radiographic density of the sample. This determined theequivalence of radiopacity of the selected material comparedto a particular thickness of aluminum, measured in millimeters.Results were analyzed by calculating the means of fivemeasurements for each sample. Data were submitted tostatistical analysis using ANOVA and Tukey test.RESULTSResults showed that the AH Plus sealer presented thegreatest radiopacity (p<0.05) and was equivalent to 16mmof aluminum (Figure 2). Roeko Seal and Endofill sealerspresented radiopacity equivalent to 6mm of aluminum(Figure 3). The calcium hydroxide-based sealers were theleast radiopaque (p<0.05): Sealer 26 was equivalent to 4mmof aluminum, while Sealapex was equivalent to 2mm ofaluminum (Figure 4).DISCUSSIONIn 1990, Katz, et al.11 (1990) evaluated the radiopacity ofgutta-percha points used in endodontic treatment, verifyingFIGURE 1- Occlusal film, specimens, and aluminum stepwedgeFIGURE 2- Radiograph showing the radiopacity of AH Plussealer and its equivalence to the aluminum step wedgeFIGURE 3- Radiograph showing the radiopacity of Endofilland Roeko Seal and their equivalence to the aluminumstep wedge356EVALUATION OF THE RADIOPACITY OF ROOT CANAL SEALERS BY DIGITIZATION OF RADIOGRAPHIC IMAGESthat the average radiopacity of the points was approximatelythe same as 7.4mm of aluminum. McComb & Smith14 (1976)evaluated, among other physical properties, the radiopacityof nine brands of root canal sealers in comparison to twopolycarboxylate-based experimental endodontic materials.The authors concluded that reduction in the amount ofradiopaque substances in the sealers led to decrease inradiopacity.Several other studies have evaluated the radiopacity ofcomposite resin materials using an aluminum step wedge ascomparison standard3,5,6.The radiopacity of root-end filling materials wasevaluated by Shah, et al.15 (1996) and Laghios, et al.13 (2000).These authors reported that most of these materialspresented radiopacity equivalent to at least 2 millimeters ofaluminum, with the exception of glass ionomer-basedmaterials, which did not meet the minimum requirements foruse as root-end filling material.The ISO 6876/20019 establishes that root canal sealersshould be at least as radiopaque as 3mm of aluminumthickness11. According to the ANSI/ADA1 specification #57,endodontic filling materials should present a difference inradiopacity equivalent to at least 2mm of aluminum incomparison to bone or dentin1. Therefore, all sealersevaluated presented the minimum radiopacity required bythese standards, except for Sealapex.AH Plus sealer contains zirconium oxide, whichcontributes for its greater radiopacity in relation to the othermaterials tested. On the other hand, Roeko Seal, apolydimethylsiloxane-based material, presented radiopacitysimilar to the zinc oxide and eugenol-based sealer (Endofill).The calcium hydroxide-based materials, Sealer 26 andSealapex, showed lower radiopacity.Sealapex presented radiopacity values slightly belowthose defined by the ISO9. Kuga, et al.12 (1988) suggestedthe addition of iodoform to Sealapex, with the purpose ofincreasing the radiopacity of this material. This addition didnot affect the sealing properties9 or biocompatibility ofmaterials (Holland, et al.8, 1990).FIGURE 4- Radiograph showing the radiopacity of Sealapexand its equivalence to the aluminum step wedgeCONCLUSIONAnalysis of the present results led to the conclusionthat, although the materials tested presented differentradiopacities, AH Plus, Endofill, Roeko Seal and Sealer 26presented radiopacity values above the minimum valuesproposed by the ISO, except for Sealapex, which presentedradiopacity values slightly below those specified by theISO norms.REFERENCES1- American Dental Association. Specification # 57 for endodonticfilling materials. J Am Dent Assoc 1984;108:88.2- Beyer-Olsen EM, Orstavik D. Radiopacity of root canal sealers. OralSurg Oral Med Oral Pathol 1981;51:320-8.3- Curtis Jr. PM, von Fraunhofer JA, Farman AG. The radiographicdensity of composite restorative resins. Oral Surg Oral Med Oral Pathol1990;70:226-30.4- Eliasson ST, Haasken B. Radiopacity of impression materials. OralSurg Oral Med Oral Pathol 1979;47:485-91.5- Gürdal P, Akdeniz BG. Comparison of two methods for radiometricevaluation of resin-based restorative materials. Dentomaxillofac Radiol1998; 27:236-9.6- Hara AT, Serra MC, Rodrigues Jr. AL. Radiopacity of glass-ionomer/composite resin hybrid materials. Braz Dent J 2001;12:85-9.7- Higginbotham TL. A comparative study of physical properties of fivecommonly used root canal sealers. Oral Surg Oral Med Oral Pathol1967;24:89-101.8- Holland R, Mello W, Souza V, Nery MJ, Bernabé, PFE, Otoboni FilhoJA. Comportamento dos tecidos periapicais de dentes de cães apósobturação de canal com Sealapex acrescido ou não de iodofórmio. RevOdontol UNESP 1990;19:97-104.9- International Organization for Standardization ISO 6876 –2001:Dental root sealing materials.10- Imai Y, komabayashi T. Properties of a new injectable type of rootcanal filling resin and adhesiveness to dentin. J Endod 2003;29:20-3.11- Katz A, Kaffe I, Littner M, Tagger M, Tamse A. Densitometricmeasurement of radiopacity of gutta-percha cones and root dentin. JEndod 1990;16:211-3.12- Kuga MC, Moraes IG, Berbert A. Capacidade seladora do cimentoSealapex puro ou acrescido de iodofórmio. Rev Odontol USP;1988;2:139-42.13- Laghios CD, Benson BW, Gutmann JL, Cutler CW. Comparativeradiopacity of tetracalcium phosphate and other root-end filling materials.Int Endod J 2000;33:311-5.14- McComb D, Smith DC. Comparison of physical properties ofpolycarboxylate-based and conventional root canal sealers.         J Endod1976;2:228-35.15- Shah PMM, Chong BS, Sidhu SK, Ford TRP. Radiopacity of potentialroot-end filling materials. Oral Surg Oral Med Oral Pathol 1996;81:476-9.16- Tagger M, Katz A. A standard for radiopacity of root-end (retrograde)filling materials is urgently needed. I Endod J 2004;37:260-4.357TANOMARU J M G, CEZARE L, GONÇALVES M, TANOMARU FILHO M

Evaluation of the radiopacity of root canal sealers by digitization of radiographic images

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Avaliação da radiopacidade de cimentos endodônticos por meio da digitalização de imagens radiográficas

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