Dichtigkeit unterschiedlicher Verschlussarten endodontischer Zugangskavitäten

1 Objective For a good outcome after endodontic treatment a leak proof coronal sealing is essential besides a good root canal filling. Objective of this study was to compare different techniques of adhesive restoration directly after endodontic treatment. 2 Material and methods 50 extracted upper molars with three roots were decapitated to the cementoenamel junction followed by endodontic treatment. The root canals were instrumented up to ISO size 50 and filled using a gutta-percha mastercone and AhPlus sealer. Then the teeth were divided into five groups and different fillings were applied. The negative control group was filled with Ionofil Molar cement, the other four groups received adhesive fillings with Tetric Ceram. In two groups, the entrances to the root canals were covered with Harvard Cement followed by adhesive filling with Syntac Classic dentin bonding agent. In group 5 total etching was used, in group 2 Syntac Classic was applied according to the manufacturer without etching. In groups 3 and 4 the pulp chamber was filled with Tetric Flow before reconstructing the teeth with Tetric Ceram. In group 4 total etching was used before application of Syntac Classic, in group 3 Syntac Classic was applied without etching. Afterwards thermal loading was applied in a thermocycler (1150 cycles, 5- 55°C), and then the samples were stained with fuchsine. The teeth were dissected in two halves with a diamond saw, ink penetration was evaluated by light microscopy. 3 Results Group 5 achieved best results by covering the root canal entrances with Harvard cement followed by total etching and dentin bonding with Syntac Classic. The results were significantly better than groups 1 and 3 (p < 0,001) as well as Group 2 (p = 0,007). Compared to group 4 with total etching and subsequent bonding and filling of the pulp chamber with Tetric Flow there was no significant difference (p = 0,294). The same observations could be made comparing group 2 and 3 without total etching. Sealing the root canal entries with Harvard Cement achieved better results, but the difference was not significant (p = 0,113). 4 Conclusion Results show, that there are considerable differences between the methods of adhesive restauration after endodontic treatment. When using Syntac Classic and Tetric Ceram there is significantly less leakage if total etching is used. Sealing the root canal entries before adhesive treatment seems to be reasonable. All groups show leakage after 1150 cycles of Thermocycling. That indicates that when restoring extensive defects adhesive filling might not be sufficient and should be followed by a stabilising restauration.