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Endo tips    Better Endo    Endo abstracts    Endo discussions

Bonded Obturation: Time for New Shoes  By: Richard Mounce, DDS
Resilon and Epiphany RealSeal SEM gap between with gutta percha obturation Smear layer removal with SmearClear
RealSeal obturation of the canal The Elements Obturation Unit RealSeal and K3 rotary nickel titanium files

FIGURE 1--Resilon and Epiphany (RE) (Pentron, Wallingford, CT)
FIGURE 2--RealSeal (RS) (SybronEndo, Orange, CA)
FIGURE 3--SEM gap between with gutta percha obturation.
FIGURE 4--Smear layer removal with SmearClear (SybronEndo, Orange, CA). 
          Dr. Jeeraphat Jantarat.
FIGURE 5--RealSeal obturation of the canal without gaps.
FIGURE 6--The Elements Obturation Unit (SybronEndo, Orange, CA, USA)
FIGURE 7--Clinical Case treated with RealSeal and K3 rotary nickel titanium files 
         (SybronEndo, Orange, CA, USA)

In the July, 2004 issue of Oral Health in an article called 
"Bonded Obturation, A Quantum Leap Forward for Endodontics" 
Dr. Gary Glassman and I stated, "The surgical operating 
microscope and the advent of rotary nickel titanium 
instrumentation have both provided a quantum leap forward 
towards a higher standard of endodontics. Adhesion
has done much the same for restorative dentistry. Blending 
the best of adhesion into endodontic obturation has now
become reality. In the authors' opinion, adhesion in canal 
obturation represents another quantum leap forward for the
specialty." We went on to conclude in the same article that 
"...over the next decade, as studies in all probability
will continue to validate this material, it is very possible 
that gutta percha will become obsolete until another
material can be found which will give greater clinical 
benefit with less patient risk such as RealSeal. In the
authors' opinion, this material truly is a quantum leap 
forward in the modern era of endodontics and worthy of
consideration for use as an obturating material in place 
of gutta percha."

Three years on, has our opinion been validated? I believe 
it has. At present, there have been at least 98 references
to Resilon and RealSeal (Resilon Research LLC, (Madison, 
CT and SybronEndo, Orange, CA, USA respectively) in PubMed
and ResilonResearch. com in the form of abstracts, research 
papers, trade publication articles, etc. In summary, the
significant majority of the articles published on this 
material have been positive or shown that the material is no
worse than gutta percha with the detailed exceptions. 
A comprehensive list of references derived from Pubmed and
ResilonResearch.com is given in the bibliography 1-98.
The reader is also directed to http://scholar. google.com/ for
additional references. It is noteworthy that seven of the nine 
papers that are negative about the material have two
authors in common.17,62,66,90-92,98 Never in the memory 
of the author has a single endodontic product generated so
much interest, controversy or debate. This paper was written 
to update the reader in general terms on the existing
research, discuss its clinical usage and provide a comparison 
to gutta percha that frames its significance.

Incontrovertible facts about gutta percha:

1) Gutta percha has no inherent ability to seal canals, except 
   perhaps by a physical one with the flow into lateral
   canals via warm vertical techniques.

2) Gutta percha does not bond to canal walls.

3) Gutta percha does not bond to any sealers.

4) For all intents and purposes, gutta percha is a filler that 
has no other significant function. It has been chosen
because of its lack of toxicity, ability to be thermosoftened 
and compacted, ability to be retreated and its lack of
an alternative (up to the present time) more than any other 
single set of factors.

5) Gutta percha is almost wholly dependent on a coronal seal 
to prevent the apical migration of bacteria if it's challenged 
by coronal leakage. The endodontic literature is absolutely 
clear that excellent coronal seal is correlated with clinical 
success irrespective of the presence of gutta percha.99-104

6) Only resin-based sealers have the potential to bond to canal 
walls when the smear layer has been cleared with a
liquid EDTA solution.

7) Gutta percha shrinks upon cooling approximately 5-7%.

8) Gutta percha has changed very little since it was introduced 
into dentistry at the beginning of this century.

The clinical ramifications of these facts are myriad. One very 
significant clinical issue occurs daily in endodontic
specialist practices across the world. It is a common scenario 
for the endodontist to treat the tooth under a rubber
dam and often a surgical operating microscope (SOM) and then 
place a cotton pellet and temporary filling because the
referring doctor wishes to seal the access permanently. 
Far more often than it should (which is never), this results
in a cotton pellet that is left in the access by accident 
during the second access procedure by the general dentist
during build up placement. Coronal microleakage and subsequent 
clinical failure are predictable with a cotton pellet
left in this manner.

The mechanism of failure is clear. Many times, the build up 
is placed without either a rubber dam or SOM visualization 
risking salivary contamination and subsequent iatrogenic 
events. Without a rubber dam or SOM visualization, the 
clinician lacks ideal visual control and operative command 
over the access cavity. Having a clinician who did not do 
the root canal can also easily lead to perforation of a root 
wall in post space preparation. In addition, even with 
loupes and a light source, there can be challenges 
visualizing all ramifications of the cavity
reparation especially in a tooth with limited physical access.

Coronal microleakage during and after build up placement 
(with and without posts) is a real risk and represents the
"weak link" in the present customary set of practices. 
Empirically, it is my observation that most general dentists
want to do their own build ups. When queried as to why, 
it is often stated that they need the production in their
practices or that they feel that they can do a better job 
in the build up placement. Which is the more technically
challenging procedure, the root canal or the build up? 
And if the patient were the referring doctor's mother, would
they rather have the build up and post placed under a 
rubber dam and SOM or without? Which of these scenarios 
is more consistent with empirical experience and the 
literature with an eye toward providing clinical success?

All of the above alone underscore the vital importance of 
utilizing all means of reducing and eliminating coronal
microleakage, one of these being the use of a bonded 
obturation material. A bonded obturation can and does help
achieve these objectives.

TECHNICAL AND HISTORICAL BACKGROUND

In 2003, Resilon Research introduced Resilon obturating 
oints and Epiphany sealer into the commercial marketplace.
SybronEndo licensed the material as RealSeal. I utilize 
the material as RealSeal and it will be referenced as such.
The material is used clinically exactly like gutta percha 
in that it can be applied with warm or cold obturation
techniques. The points look, feel; handle clinically, 
almost identically to gutta percha. The material can be
retreated with gutta percha solvents. Chemically, the 
material is "...a thermoplastic synthetic resin material 
based on the polymers of polyester and contains a 
difunctional methacrylate resin, bioactive glass and 
radio opaque fillers. RealSeal sealer contains UDMA, 
PEGDMA, EBPADMA and BisGMA resins, silane treated barium 
borosilicate glasses, barium sulfate, silica, 
calcium hydroxide, bismuth oxychloride with amines, 
peroxide, photo initiator, stabilizers and pigment. 
RealSeal Primer is an acidic monomer solution in water. 
RealSeal is non-toxic, FDA approved and non mutagenic. 
With its radio opaque fillers, RealSeal is a highly 
radio opaque material. The sealer is
resorbable." (Oral Health, July 2004, Glassman, Mounce)

The reduction of coronal microleakage occurs as a function 
of RealSeal's ability to be bonded to the canal wall
through the creation of a hybrid layer. In essence, 
the core material is bonded to the chemically similar 
sealer and self-etching primer. Said differently, once 
the smear layer is cleared with a liquid EDTA solution 
like SmearClear (SybronEndo, Orange, CA, USA) the open 
tubules and dentin wall are covered with the self-etching 
primer. A hybrid layer is created on top of this with the 
placement of the sealer. This bonding diminishes in a 
statistically significant manner the amount of bacteria 
that might otherwise be able to migrate in a coronal to 
apical direction. The advance that this represents for 
endodontics and dentistry is hard to overstate given the 
issues of gutta percha detailed above.

From January 2004 to the present, I have exclusively used 
RealSeal clinically. I cannot envision ever returning to
gutta percha. Clinically, using RealSeal is simple. 
As mentioned, the material can be compacted with cold lateral
condensation, a single cone technique, warm compaction 
and is available in the form of SimpliFil R (Discus Dental,
Culver City, CA, USA), Resinate (Obtura Spartan, Fenton,
MO, USA), Enfuse (Hu-Friedy, (Chicago, IL, USA) as well as
RealSeal. I employ the material with the SystemB obturation 
technique observed through the SOM. The source of both
the heat for the downpack and backfill is the Elements 
Obturation Unit (SybronEndo, Orange, CA, USA). The cartridges
used in the backfill are single use, economical, disposable 
and prevent cross contamination. This method has proven
reliable, reproducible, and economical and can be easily 
mastered with practice, especially if practiced initially in
extracted teeth. For a comprehensive discussion of System B 
obturation technique, the reader is directed to the above
referenced Mounce-Glassman paper in Oral Health from July 2004.

THE DISSENT: THE COMFORTABLE OLD SHOE

Recently, in the article "...Seal after Obturation Techniques..." 
Brackett, et al JOE. Dec 2006, vol 31, #12, 1188-1190 stated as 
the final sentence of their article that "...lowest leakage 
values were obtained in the AH Plus/gutta percha control group. 
This remains the gold standard against which all new sealers 
and bondable root filling materials must be measured." How can 
a material with known weaknesses like gutta percha be a 
"gold standard?"

Reasons for not adapting bonded obturation material can be 
summarized in two words, apathy and inertia. In a sentence, 
why change when we know gutta percha works, but only sort of?

As mentioned, seven of nine negative papers have two common 
co-authors. It is interesting to note that virtually
everything in these papers is unfavorable to RealSeal. 
It would take a significant review to discuss these seven
papers. However, suffice it say that Dr. Karl Leinfelder 
Adjunct Professor, University of North Carolina, reviewed
five of the seven and stated that they "have bypassed 
standard scientific practices and their results are therefore
called into question."1

Typical of some of these papers is the fact that RealSeal 
is challenged with chemicals and scenarios that are not
biologically relevant. For example, to quote Dr. Leinfedler 
speaking about the study referenced in the bibliography
as #90: "In this study, highly caustic sodium ethoxide 
(20%) was used to demonstrate that the plasticizer
(polycaprolactone) in Resilon is degradable... 
(sodium ethoxide) is typically used as deplasticizer for
polycaprolactone agents. The selection of this material to 
test the solubility or biodegradation of Resilon
components is not only clinically insignificant but 
specifically demonstrates a known mode of failure for a 
single component of Resilon and not the Resilon material
itself. It has been documented that polycaprolactone is
biodegradable in vivo and that is also highly biocompatible. 
Due to the potential for biodegradation, polycaprolactone 
is compounded with bioactive glass during Resilon synthesis 
for the purpose of generating mineralization should
degradation occur." This speaks for itself.

Some studies lack controls or are purely observational 
and yet the authors at times draw absolute conclusions.

In addition, it is challenging to understand how gutta 
percha can seal better in any of the studies that claim so.
Gutta percha cannot bond to sealer or canal walls. RealSeal 
can bond to both through a cleared smear layer using of a
self-etching primer and sealer. With a chemical bond between 
the filling material and the sealer, one of the major
avenues of leakage has been diminished relative to gutta percha. 
Empirically, this finding leads me to question the
methodology employed to derive a finding where gutta percha
now seals better than a product designed specifically for
this purpose. In short, this research does not match the 
clinical experience I have with the material in FT
endoodntic practice. After three years of daily use, 
not a single obturation has shown any degradation upon recall.
In fact, in every single case that has had apical surplus of 
core filling material at the time of obturation, the
surplus is still there at the recall evaluation while 
as expected in some cases some amount of sealer may have
resorbed, a desirable finding.

Never before that I am aware of has a material at its 
introduction received such a public greeting at its launch.
Dentsply Tulsa Dental (Tulsa OK, USA) sent a letter in 2004 
to numerous opinion leaders around the world and alleged
that obturation based on Resilon technology might be degradable, 
lack the ability to seal, not bond to dentin and
have unfavorable solubility characteristics in water.

In addition, it has also been rumored that RealSeal is 
degradable in canals possibly arising from the article cited
above. There is absolutely not a shred of published proof 
to back this assertion aside from the studies mentioned. An
individual making this claim recently sent me a series of 
radiographs. To preserve confidentiality upon request, I
cannot publish those films, but I can say that what was 
purported to be degradation of the material was a sealer puff
that had been eliminated, a desirable event. The core material 
in the material was unchanged, as expected.

In November 2004, the presidents of Pentron and SybronEndo 
published a public letter that responded to Dentsply's.
They countered, "we do not agree with Dentsply's insinuation 
that the Resilon material "might" or "possibly" could
degrade through some method of action they do not disclose. 
If this were to occur when some of the material was
expressed into the peri-radicular tissues, it would be 
considered a positive property."

In addition, they went on to say:

"Resilon's effectiveness is demonstrated in peer-reviewed 
research. Peer reviewed studies show Resilon to be a
responsible choice for endodontics. We do not agree that 
Dentsply's product evaluation was "intensive", as it
virtually ignores the peer reviewed, published research 
on the Resilon material. The "independent" studies alluded to
in the letter were not peer reviewed or independently 
published. A portion of that research -- specifically the
adhesion study -- was done in house without disclosure 
of the methodologies.

Resilon has excellent leakage studies supporting it. 
We dispute Dentsply's leakage report. The report, which Dentsply
has not released, used an esoteric protocol that was used in 
only three of approximately 750 published leakage
studies. In contrast, the Resilon Material has been evaluated 
independently by some of the best researchers in the field.

Dentsply's water sorption study was simply wrong. The results 
of their water sorption study with the sealer are
specious. No absolute values are stated, only relative ones. 
Dentsply refers to ADA specification 27 and ISO
specification 6876 in their letter. ADA specification 27
does not apply to endodontic materials. Our testing has
shown that we clearly meet the specifications of both ADA 
specification 57 (the appropriate specification for
endodontics) and ISO specification 6876.

We stand behind this exciting new technology. Our decision 
to market this technology was based on reliable, peer
reviewed, scientific research. As we are certain our 
research will stand the test of scrutiny..."

It is interesting that the negative studies that were 
published after these letters were traded were the ones written
with the two co-authors in common and are those with the 
limitations addressed in a review of five of these papers by
Dr. Leinfelder.

At present, Pentron estimates that over 11 million RealSeal 
points have been sold. If the Dentsply claims were true,
would we not have a different set of experiences clinically 
than we actually now have over the past 3 plus years? In
addition, what of the very positive research that has been 
published in the intervening period, is this not without
merit or validity?

Even taking into account these negative papers, the 
overwhelming majority of the remaining studies are either
positive with regard to some measured parameter or show 
that RealSeal is no worse gutta percha. In other words, the
material has the potential to be better.

IN SUMMARY

With the progression and trends in dentistry from alloy to 
adhesion, less gold to more porcelain, from the naked eye
to surgical microscopes, from empiricism to evidence based 
treatment and the rise of minimally invasive dentistry, it
is hard to see a present or future in which gutta percha is 
the gold standard of anything. Adhering to gutta percha
as a holy grail and its use as a sacrament is misplaced 
loyalty in a place within dentistry that is long since
overdue for change. To argue otherwise is to place ones 
head in the proverbial sand out of apathy or indifference 
and deny our patients the best material we have available 
for obturating root canals at this time. Gutta percha is old
and tired shoe, its time for a new pair.

Dr. Mounce lectures globally and is widely published. He is 
in private practice in Endodontics in Vancouver, WA, USA.
Amongst other appointments, he is the endodontic consultant 
for the Belau National Hospital Dental Clinic in the
Republic of Palau. Korror, Palau (Micronesia). He can be 
reached at RichardMounce@ MounceEndo.com.

Dr. Mounce would like to thank Dr. Lele Ambu for the images 
in Fig. 3 & 5. Dr. Mounce has no commercial interest in
any of the products or companies mentioned. Dr. Mounce 
occasionally receives honourarium when he lectures at the
request of SybronEndo.

REFERENCES

1. "A Critical Analysis of Recent Research on Resilon® 
   Obturation Material". Karl Leinfelder, CE Digest, 4th Edition,
   (a peer reviewed publication of the Academy of Dental 
   Therapeutics and Stomatology).

2. "An In Vitro Comparison of the Intraradicular Dentin Bond 
    Strength of Resilon and Gutta-Percha." Skidmore, Berzins
    and Bahcall. Marquette University. JOE, Vol. 32, No. 10,
	October 2006: pp 963-6.

3. "Assessment of the Sealing Ability of a New Root Canal 
   Obturation Material". Umut Tunga, PhD, DDS* and Emre
   Bodrumlu, Phd, DDS. JOE Vol. 32, No. 9, September 2006; 
   pp: 876-878.

4. "An In Vitro Assessment of the Sealing Ability of 
   Resilon/Epiphany Using Fluid Filtration." Biggs et al. Creighton
   University. JOE, Vol. 32, No. 8, August 2006: pp 759-61.

5. "A Fluid Filtration Comparison of Gutta-Percha versus Resilon, 
    a New Soft Resin Endodontic Obturation System."
    Stratton, Apicella and Mines. U.S. Army, Ft. Bragg Endodontic 
	Residency, Ft. Bragg, North Carolina. JOE, Vol. 32, No. 7, 
	July 2006; pp: 642-645.

6. "A Comparison of Thermal Properties Between Gutta-Percha and 
    a Synthetic Polymer Based Root Canal Filling Material
   (Resilon™)." Miner, Berzins and Bahcall. Marquette University, 
   School of Dentistry, Milwaukee, Wisconsin. JOE, Vol.
   32, No. 7, July 2006; pp: 683-686.

7. "A Comparative Study of Physiochemical Properties of AH Plus 
    and Epiphany Root Canal Sealants." Sousa-Neto et al.
    Universidade de Ribeirao Preto, Brazil. IEJ, Vol. 39, No. 6, 
	June 2006: pp464-71.

8. "A Comparison of Resilon and Gutta-Percha Dissolving Qualities 
   in Endodontic Solvents." Kunath et al., U.S. Army
   Dental Facility, Ft. Bragg, NC and Medical College of Georgia, 
   Augusta, GA. Abstract: #PR17, JOE, Vol. 32(3), March 2006.

9. "A Comparison of Coronal Leakage Using RealSeal Sealer and a 
   Dentin Bonding Agent." Fulsaas et al., Keesler A.F.B., Biloxi, 
   MS, and Louisiana State University, New Orleans, LA. Abstract: 
   #OR53, JOE, Vol. 32(3), March 2006.

10. "A Comparison of Root Canals Filled with Gutta-Percha and 
    Resilon in a Coronal Leakage Model." Suhler et al.
    Wilford Hall U.S.A.F. Medical Center, San Antonio, TX. 
	Abstract: #OR13, JOE, Vol. 32(3), March 2006

11. "Antimicrobial Efficacy of medicated Root Canal Filling 
    Materials." Belanger et al., JOE, Vol. 32(2), February
    2006. J Endod. 2006 Feb;32(2):148-51

12. "Apical Adaptation of Root Fillings Completed Using a 
    Soft Resin Canal Filling System." Ungor et al., Baskent
    University, Ankara, Turkey. Abstract: #R42, IEJ, 
	Vol. 38(12), December 2005.

13. "Apical Leakage of a New Obturation Technique," 
    Abstract #42, 31(3), March 2005. Study by Gambarini, 
	et al. Aust Endod J. 2006 Apr;32(1):31-4.

14. "Antimicrobial Potential of Epiphany RCS System" 
    ABSTRACT: 2005 IADR/AADR/CADR 83 rd General Session & Exhibition
    Y. Li, W. Zhang, O. Onyago, W. Jia, and S. Gagliardi, 
	Loma Linda University, Ca, Pentron Corporation, Wallingford ,CT

15. "An in vitro evaluation of the apical sealing ability of a new 
    resin-based root canal obturation system." Onay
    EO, Ungor M, Orucoglu H. J Endod. 2006 Oct;32(10): 976-8.

16. "Apical leakage of Resilon obturation material." Bodrumlu E, 
    Tunga U. J Contemp Dent Pract. 2006 Sep 1;7(4):45-52.

17. "A comparison of cohesive strength and stiffness of Resilon 
    and gutta-percha." Williams C, Loushine RJ, Weller
    RN, Pashley DH, Tay FR. J Endod. 2006 Jun;32(6):553-5.

18. "Adhesive Endodontics: Combining Technologies for Enhanced 
    Success" Dentaltown, Vol. 5, Issue 8, August 2004

19. "Adhesion: on its way to the apex!" Degrange M. J Adhes Dent. 
    2005 Summer;7(2):91.

20. "Biocompatibility of Activ GP and Resilon Cones on L929 
    Cells In Vitro." Zhu et al., University of Connecticut,
    Farmington, CT. Abstract: #OR57, JOE, Vol. 32(3), March 2006.

21. "Bondability of Resilon to Methacrylate-Based Root Canal Sealer.
    " Haraishi et al., JOE, Vol. 32(2), February 2006. J Endod. 2006 
	Feb;32(2):133-7.

22. "Biologic perspectives to support clinical choices in root 
    canal treatment." J.L. Gutmann. Aust. Endod. J., Vol.
    31(1), April, 2005.

23. "Bonding of Self-Etching Primer/Polycaprolacton-Based 
    Root-filling Material to Intaradicular Dentin," ABSTRACT:
    2005 IADR/AADR/CADR 83 rd General Session & Exhibition, 
	F.R. Tay, R.J. Loushine, R.N. Weller, W.F. Kimbrough, D.H.
    Pashley, Y.E. Mak, C.N.S. Lai, R. Raina, and M.C. Williams, 
	University of Hong Kong, China, Medical College of
    Georgia, Augusta, USA.

24. "Bondability of Resilon to a Root Canal Sealant" ABSTRACT: 
    2005 IADR/AADR/CADR 83 rd General Session & Exhibition
    W. Jia, S. Gagliardi, and S. Jin, Pentron Corporation, 
	Wallingford , CT USA

25. "Bonded Endodontic Obturation: Another Quantum Leap Forward 
    for Endodontics," Oral Health, July 2004 (available
    online @ www.oralhealthjournal.com

26. "Coronal Leakage of Teeth Root-Filled With Gutta-Percha or 
    Resilon Root Canal Filling Material". Etienne Pitout,
    BChD,* Theunis Gerhardus Oberholzer, BSc, BCbD MSc, PhD* 
	Elaine Blignaut, BSc, MSc, BChD, PhD,* and Julitha Molepo,
    BSc, BSc(Hons), MSc2*. JOE Vol. 32 No. 9, September 2006: pp 879-881.

27. "Cytotoxicity of a New Root Canal Filling Material on Human 
    Gingival Fibroblasts." Key, Rahemtulla and Eleazer.
    University of Alabama at Birmingham. JOE, Vol. 32, No.8, August 2006: 
	pp 756-8.

28. "Comparison of the Intraosseous Biocompatibility of AH Plus, 
    EndoREZ, and Epiphany(r) Root Canal Sealers". Sousa
    et al. Universidade Federal de Uberlandia, Campus Umuarama, 
	Brazil. JOE, Vol. 32, No. 7, July 2006; pp: 656-662.

29. "Completeness of Root Canal Obturations: Epiphany Techniques 
    versus Gutta-Percha Techniques." Eppley Et Al.
    University of Medicine and Dentistry of New Jersey. JOE, 
	Vol. 32, No. 6, June 2006: pp541-4.

30. "Comparison between Gutta-Percha and Resilon Removal Using 
    Two Different Techniques in Endodontic Retreatment."
    Teixeira Et Al. University of North Carolina. JOE, Vol. 32, 
	No. 4 April 2006: pp362-4.

31. "Comparative analysis of microleakage and seal for 2 
    obturation materials: Resilon/Epiphany and gutta-percha".
    Aptekar A, Ginnan K., J Can Dent Assoc. 2006 Apr;72(3):245

32. "Comparison of the sealing of Resilon, ProRoot MTA and 
    Super-EBA as Root End Filling Materials: A Bacterial
    Leakage Study." Glickman et al., JOE, Vol. 32(4), April 2006. P: 324-7

33. "Comparison of 5.25% Sodium Hypochlorite, MTAD and 2% Chlorhexidine 
    in the Rapid Disinfection of Polycaprolactone-Based Root Canal Filling 
	Material." Royal et al., University of Iowa, Iowa City, IA. J Endod. 2007
    Jan;33(1):42-4.

34. "Clinical Performance of Resilon at 12 Months." Marcos-Arenal et al., 
    University of North Carolina, Chapel Hill, NC. Abstract: #PR20, JOE, 
	Vol. 32(3), March 2006.

35. "Comparison of the Obturation Density of Resilon Using Cold Lateral 
    Condensation and Varying Continuous Wave of Condensation Techniques.
	" Southern and Jackson. West Virginia University, Morgantown, WV. 
	Abstract: #OR27., JOE, Vol. 32(3), March 2006.

36. "Comparative Study of Sealing Ability of a New Resin-Based Root 
    Canal Sealer." Kokorikos et al., Aristotle University of Thessaloniki, 
	Thessaloniki, Greece. Abstract: #R29, IEJ, Vol. 38(12), December 2005.

37. "Cohesive Strength of Resilon and Other Dental Polymers." Williams 
    et al, Medical College of Georgia, Augusta, GA. Abstract: #OR 21, 
	JOE, Vol. 31(3), March 2005.

38. "Clinical Performance of Resilon and Gutta-Percha at 3 and 6 Months.
    " Heffernan et al., University of North Carolina, Chapel Hill, NC. 
	Abstract: #PR11, JOE, Vol. 31(3), March 2005.

39. "Comparison of Lateral and Vertical Condensation techniques Using
     Resilon: A Scanning Electron Microscopy Study." Liu and Williamson, 
	 University of Iowa, Iowa City, IA. Abstract: #PR16, JOE, Vol. 31(3),
	 March 2005.

40. "Comparison of Microleakage of Two Obturation Materials." R. Raina 
    et al., Medical College of Georgia, Augusta,
    GA. Abstract: #OR18, JOE, Vol. 31(3), March 2005

41. "Characterization of Tubule Penetration Using Resilon: A Soft-Resin 
    Obturation System,"ABSTRACT: 2005 IADR/AADR/CADR 83 rd General Session 
	& Exhibition L.P. Benzley, J.C.-H. Liu, and A.E. Williamson, 
	University of Iowa , Iowa City, USA

42. "Comparison of Apical Leakage between Canals Filled with Gutta-Percha
    /AH-Plus and the Resilon/Epiphany System, When Submitted to Two Filling 
	Techniques." Verissimo DM, Sampaio do Vale M, Monteiro AJ. J Endod. 2007
    Mar;33(3):291-4.

43. "Cytotoxicity of Epiphany and Resilon with a root model." Susini G, 
    About I, Tran-Hung L, Camps J. Int Endod J. 2006 Dec;39(12):940-4.

44. "Clinical application of an adhesively bonded fiber post and Resilon.
    " Shipper G, Lopez L. Pract Proced Aesthet Dent. 2006 Apr;18(3):S12-7.

45. "Comparison of the sealing of Resilon, Pro Root MTA, and Super-EBA 
    as root-end filling materials: a bacterial leakage study." J Endod. 
	2006 Apr; 32 (4): 324-7.

46. "Detectability of Residual Epiphany and Gutta-Percha after Root Canal 
    Treatment using a Dental Operating Microscope and Radiographs -- 
	An Ex Vivo Study." Schirrmeister et al. Albert-Ludwigs University, 
	Germany. IEJ, Vol. 39, No. 7, July 2006: pp558-65.

47. "Dentinal bonding reaches the root canal system." Teixeira et al., 
    J. Esthet. Restor. Dent., Vol. 16(6), November 2004.

48. "Disinfection of artificially contaminated Resilon cones with 
     chlorhexidine and sodium hypochlorite at different time exposures.
	 " Dumani A, Yoldas O, Isci AS, Koksal F, Kayar B, Polat E. Oral Surg 
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49. "Effects of Sodium Hypochlorite and Chlorhexedine Solutions on 
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50. "Effect of Intracanal Medicament on the Sealing Ability of Root 
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51. "Efficacy of Retreatment Techniques for a Resin-Based Root Canal 
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	JOE, Vol. 32, No.4, April 2006:pp341-4.

52. "Effect of Calcium Hydroxide-Based Medicaments on Epiphany's 
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53. "Effect of Lipase on the Yield Strength of Thermoplastic 
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54. "Effect of Various Endodontic Irrigants on the Shear Bond 
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55. "Effectiveness of Hand and Rotary Instrumentation for 
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56. "Epiphany - Influence of Sealer Placement and Cone taper on 
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57. "Enterococcus faecalis type strain leakage through root canals 
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58. "Evaluation of microleakage of roots filled with different 
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59. "Fluid Filtration Comparison of Gutta-Percha Versus Resilon: 
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60. "Fracture resistance of simulated immature teeth filled with resilon, 
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61. "Fracture resistance of roots endodontically treated with a new 
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62. "Geometric factors affecting dentin bonding in root canals: a 
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63. "Initial In Vitro Biological Response to Contemporary Endodontic 
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64. "Interfaces in Soft Resin Obturated Root Canals" ABSTRACT: 2005 
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65. "Ideal obturation using synthetic root-filling systems: coronal sealing 
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66. "Interfacial strength of Resilon and gutta-percha to intraradicular 
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67. "Long Term Evaluation of Coronal Leakage of Root Filled Teeth Using 
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68. "Leakage Analysis of Three Modern Root Filling Materials after 
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69. "Leakage along apical root fillings with and without smear layer 
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70. "One-Year Radiographic Evaluation of Teeth Treated Endodontically 
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71. "Physical Properties of Newly Developed Root Canal Sealers." 
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72. "Predictable Endodontic Success: Part II - 
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74. "Push-out bond strengths: the Epiphany-Resilon endodontic 
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75. "Periapical inflammation after coronal microbial 
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76. "Resilon-based sealing of root canals in endodontic therapy".
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77. "Regional Bond Strength of Epiphany/Resilon to Intraradicular 
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78. "Resilon Obturation in a Split-Tooth Model." Anderson et al., 
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79. "Retreatment Efficacy of Epiphany and Resilon." A. Hassanloo, 
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80. "Retreatment of Root Canals Filled with Resilon: A Scanning 
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81. "RealSeal - the real deal." J.D. Maggio. Compend. Contin. 
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82. Resistance to fracture of roots filled with three different 
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83. "Reinforcement of immature roots with a new resin filling
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84. "Resilon will biodegrade from lipases released by bacteria 
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86. "Resilon: A Novel Material to Replace Gutta Percha," Frederic 
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87. Short-term cytotoxicity assessment of components of the 
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88. "Spreader Penetration during Lateral Compaction of Resilon 
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89. "Setting times of Resilon and other sealers in aerobic and 
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