September 1, 2012

EndoRez: Endo/Perio Case Study

EndoRez root canal sealer made by Ultradent is my choice for filling root canals.  It is easy to use and is very hydrophilic making it ideal for flowing into tiny cracks, crevices and accessory canals.  Injecting the sealer with a very thin needle within a millimeter of the apex before obturating with gutta percha ensures that the canals are filled completely.  However, in some cases using this technique overfills can happen.  The manufacture insist that the body is able to absorb the excesses over time and I have seen this happen, though slower than the over zealous salesman claimed (years, not months).  This is a case presentation of one such overfilling where EndoRez may have exacerbated an endo/perio lesion.

This 70 year old white male presented with a toothache in tooth #30.  It was noted that the tooth had locally severe periodontal disease, periapical pathosis and a draining endo/perio lesion through the facial furcation probing 10+mm.  The tooth had a previously placed crown with recurrent decay at the D/F margins.  The tooth would have been a good candidate for extraction and implant/crown placement, but the patient wanted to try and save it.  Root canal therapy was completed with EndoRez sealer and gutta percha obturation.  An overfill was noted to have flown out of the tooth’s MF apex and through the parulus into the furcation.

WL FilmPost-op1 year post-opExtractionNaOCl cleaned toothRemoved EndoRez

Although there was a poor prognosis assigned to this tooth before treatment, this case illustrates the problematic overfilling of the EndoRez system for obturating root canal fillings.  I believe if an overfill is accidentally expressed through a parulus that is associated with the PDL of a tooth, it could artificially keep the pathological communication with the oral cavity open long enough for periodontal disease to establish itself.  Whereas, if the overfill had not occurred in this fashion the parulus would have had a better chance of healing and extending the life of the tooth.

Side note: The patient said at the extraction appointment one year post-endo, “He said I should have taken this tooth out a years ago, and now I believe him.  Get’r out!”


1. J Biomed Mater Res B Appl Biomater. 2012 Jul 18. doi: 10.1002/jbm.b.32739.Cytotoxicity of endodontic sealers after one year of aging in vitro. Brackett MGLewis JBKious ARMesser RLLockwood PEBrackett WWWataha JC. Department of Oral Rehabilitation, Georgia Health Sciences University College of Dental Medicine, Augusta, Georgia.

2. Lasers Med Sci. 2012 Jun 19. Effect of chemical and Er:YAG laser treatment on bond strength of root canal resin-based sealers. Akisue EAraki ATMichelotto ALMoura-Netto CGavini G. Department of Endodontics, University of Santa Cecília, São Paulo, Brazil.

3. J Endod. 2012 May;38(5):636-41. Epub 2012 Feb 11.No evidence for DNA double-strand breaks caused by endodontic sealers. Van Landuyt KLGeebelen BShehata MFurche SLDurner JVan Meerbeek BHickel RReichl FX. Walther-Straub-Institute of Pharmacology and Toxicology, Ludwig-Maximilian University of Munich, Munich, Germany.

4. Int Endod J. 2012 Aug;45(8):730-6. doi: 10.1111/j.1365-2591.2012.02026.x. Epub 2012 Mar 28. Comparison of conventional and digital radiography systems with regard to radiopacity of root canal filling materials. Akcay IIlhan BDundar N. Departments of Endodontics Oral and Maxillofacial Radiology, School of Dentistry Ege University, Bornova, Izmir, Turkey.

5. J Conserv Dent. 2012 Jan;15(1):18-21. An in vitro comparative evaluation of depth of tubular penetration of three resin-based root canal sealers. Chadha RTaneja SKumar MGupta S. Department of Conservative Dentistry and Endodontics, I.T.S. Centre for Dental Studies and Research, Muradnagar, Ghaziabad, Uttar Pradesh, India.

6. J Appl Oral Sci. 2011 Nov-Dec;19(6):644-7. Bond strength of different endodontic sealers to dentin: push-out test. Barbizam JVTrope MTanomaru-Filho MTeixeira ECTeixeira FB. University of Passo Fundo, Passo Fundo, RS, Brazil.

7. J Endod. 2011 Sep;37(9):1247-52. Epub 2011 Jul 20. Bacterial and Candida albicans adhesion on different root canal filling materials and sealers. Senges CWrbas KTAltenburger MFollo MSpitzmüller BWittmer AHellwig EAl-Ahmad A. Department of Operative Dentistry and Periodontology, Albert-Ludwigs-University, Freiburg, Germany.

8. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Oct;112(4):544-7. Epub 2011 Jul 20. Effect of different root canal sealers on fracture strength of simulated immature roots. Ulusoy ÖİNayır YDarendeliler-Yaman S. Faculty of Dentistry, Department of Restorative Dentistry and Endodontics, Gazi University, Ankara, Turkey.

9. J Conserv Dent. 2011 Jan;14(1):16-20. Comparative evaluation of the apical sealing ability and adaptation to dentine of three resin-based sealers: An in vitro study. Kumar SAShivanna VNaian MTShivamurthy G. Department of Conservative Dentistry and Endodontics, College of Dental Sciences, Davangere, Karnataka, India.

10. Braz Dent J. 2011;22(1):41-4. Effectiveness of three solvents and two associations of solvents on gutta-percha and resilon. Faria-Júnior NBLoiola LEGuerreiro-Tanomaru JMBerbert FLTanomaru-Filho M. Department of Restorative Dentistry, Araraquara Dental School, Univ. Estadual Paulista, SP, Brazil.

11. Int Endod J. 2011 Sep;44(9):817-26. doi: 10.1111/j.1365-2591.2011.01885.x. Epub 2011 Apr 20. Monoblocks in root canals: a finite elemental stress analysis study. Belli SEraslan OEskitascioglu GKarbhari V. Department of Endodontics, Faculty of Dentistry, Selçuk University, Konya, Turkey

12. Int Endod J. 2011 Jul;44(7):626-34. doi: 10.1111/j.1365-2591.2011.01863.x. Epub 2011 Feb 10. Cytotoxicity of 5 endodontic sealers on L929 cell line and human dental pulp cells. Karapınar-Kazandağ MBayrak OFYalvaç MEErsev HTanalp JSahin FBayırlı G. Department of Endodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey.