Basic Research—Technology
Comparison of Push-out Bond Strengths of Resilon with
Three Different Sealers
Danielle Stiegemeier, DDS,* J. Craig Baumgartner, DDS, PhD,* and Jack Ferracane, PhD†
Abstract
Introduction: The purpose of this study was to evaluate
the push-out bond strengths of different obturating
materials. Methods: Forty single-rooted human ex-
tracted teeth were used in this study. The teeth were in-
strumented and irrigated by using 5.25% NaOCl, 15%
ethylenediaminetetraacetic acid, and sterile water. The
teeth were then filled with Resilon/RealSeal, Resilon/
RealSeal SE, Resilon/MetaSeal , or gutta-percha/Kerr
EWT sealer. The roots were then sectioned into 1-mm-
thick slices and subjected to vertical loading to displace
the obturating material toward the coronal side of the
slice. The bond strength was then calculated and sub-
jected to statistical analysis. Slices were examined by
using a stereomicroscope at 30 to determine the
mode of failure. Results: The mean push-out bond
strengths were as follows: Resilon/RealSeal, 1.45 
0.99 MPa; RealSeal SE, 0.88  0.49 MPa; Resilon/Meta-
Seal, 2.41  1.7 MPa; and gutta-percha/Kerr EWT
sealer, 2.32  0.74 MPa. Conclusions: The push-out
bond strengths of Resilon/MetaSeal and gutta-percha/
Kerr EWT were significantly (P < .05) higher than either
Resilon/RealSeal or Resilon/RealSeal SE. Resilon/Meta-
Seal and gutta-percha/Kerr EWT did not differ signifi-
cantly. (J Endod 2010;36:318–321)
Key Words
Bond strength, MetaSeal, push-out test, RealSeal
From the *Department of Endodontology and †Department
of Biomaterials and Biomechanics, Oregon Health and Science
University, Portland Oregon.
Dr Stiegemeier is currently in practice in Beachwood, OH.
Address requests for reprints to Dr J. Craig Baumgartner,
Department of Endodontology, Oregon Health Sciences Univer-
sity School of Dentistry, 611 SW Campus Dr, Room 130B, Port-
land, OR 97201. E-mail address: baumgarc@ohsu.edu.
0099-2399/$0 - see front matter
Copyright ª 2010 American Association of Endodontists.
doi:10.1016/j.joen.2009.10.026
318 Stiegemeier et al.
T he main objectives of root canal therapy are to thoroughly clean and shape the root
canal system and to fully obturate the canal system in 3 dimensions, thus sealing off
the root canal from the periapical tissues (1). Gutta-percha has been the traditional
endodontic obturating material, used in combination with zinc oxide–eugenol, calcium
hydroxide, or epoxy resin. In recent years obturating materials and sealers have been
developed on the basis of dentin adhesion technologies borrowed from restorative
dentistry in an attempt to seal the root canal more effectively (2).
Recent research into bonding of root filling materials to dentin has shown that
dentin adhesives significantly reduce apical leakage (3–6) and increase fracture resis-
tance of root-filled teeth (7, 8). Because epoxy resin sealers do not copolymerize with
methacrylate resin–based adhesives, a methacrylate resin sealer was developed with
a self-etching primer that resulted in improvements of apical seal (9) and adhesion
to root dentin (10).
Resilon (Resilon Research LLC, Madison, CT) is advertised as an alternative to
gutta-percha. Resilon is a thermoplastic synthetic polymer-based (polyester) root canal
core material that contains bioactive glass, bismuth oxychloride, and barium sulfate.
The RealSeal sealer is a dual-curing, resin-based composite sealer. The resin matrix
is composed of bisphenol A glycidyl methacrylate (BisGMA), ethoxylated BisGMA,
urethane dimethacrylate (UDMA), and hydrophilic difunctional methacrylate. The
sealer with the aid of a primer adheres to the core material and dentin (11).
An addition to the Resilon system is a new sealer, RealSeal SE (SybronEndo,
Orange, CA), that eliminates the primer from the series. This sealer is applied in the
manner of traditional sealers and is used to bond dentin to Resilon.
Another sealer has been introduced with claims that it bonds both Resilon and
gutta-percha as well as dentin. MetaSeal (Parkell Inc, Farmington, NY) is a 4-methacry-
loyloxyethyl trimellitate anhydride (4-META) containing polymethylmethacrylate-based
(PMMA) endodontic sealer. It is dual-cured and self-adhesive, thereby eliminating the
priming step. The manufacturer claims that MetaSeal bonds to gutta-percha by creating
a hybrid layer similar to that produced with dentin.
Only 2 studies to date have looked at the bond strength of MetaSeal, and 1 has
looked at RealSeal SE; thus the purpose of this study was to compare the push-out
bond strength of Resilon/RealSeal, Resilon/RealSeal SE, Resilon/MetaSeal, and gutta-
percha/Kerr EWT.
Materials and Methods
The Institutional Review Board at Oregon Health & Science University approved
this study. Forty single-rooted extracted human teeth were used for this study. Each
tooth was radiographed buccolingually and mesiodistally to verify presence of a single
canal. Before use each tooth was placed in NaOCl for 2 hours for surface disinfection
and periodontal ligament removal followed by storage in distilled water until use. Each
tooth was inspected under an operating microscope for presence of any cracks. An
access preparation was made with a high speed #4 round bur, pulp tissue was removed
with a barbed broach, and apical patency was confirmed with a #10 K-file. To provide
a definite apical stop, the working length (WL) was established by subtracting 1 mm
from where the file was just visible at the foramen.
Each canal was instrumented by using a high torque DTC motor (Tulsa Dental,
Tulsa, OK) at 300 rpm with 0.04 Profile Series 29 nickel-titanium rotary files. The files
were used in a crown-down manner to WL and enlarged to a #7 Series 29 0.04 file.
JOE — Volume 36, Number 2, February 2010
 Basic Research—Technology
NaOCl (5.25%) was used as the irrigant between files for a total of 5 mL. TABLE 1. Mean Bond Strength (MPa), SD, and Number of Samples per Group
The canals were then irrigated with 5 mL of 15% ethylenediaminetetra-
Mean bond
acetic acid, 5 mL 5.25% NaOCl, and a final irrigation of 5 mL sterile Group strength (MPa) SD (MPa) N
saline. A standardized method of irrigation was performed on all teeth
by using a 27-gauge Monoject endodontic needle (Sherwood Medical, Real Seal 1.447  0.99 10
Real Seal SE 0.8782  0.49 10
St Louis, MO), with the needle placed as far into the canal as possible MetaSeal 2.411  1.74 10
without binding. The canals were dried with paper points, and the teeth Gutta-percha/Kerr EWT 2.321  0.74 10
were divided into 4 groups, with even distribution of tooth type in each
group: Resilon/RealSeal group, obturated with Resilon/RealSeal primer
and sealer; Resilon/RealSeal SE group, obturated with Resilon/RealSeal The plungers were connected to the load cell of a universal testing
Self Etch sealer; Resilon/MetaSeal group, obturated with Resilon/Meta- machine (Instron Corp, Norwood, MA). A vertical load was applied
Seal; and gutta-percha/Kerr EWT group, obturated with gutta-percha/ in an apical to coronal direction at a rate of 1.0 mm/min on the root
Kerr EWT pulp canal sealer. canal filling. Failure was determined when the graph showed a reduction
In Resilon/RealSeal group (n = 10), continuous wave of conden- in load. The bond strength at failure was then calculated and expressed
sation with Resilon/RealSeal Sealer was used according to manufac- in MPa by dividing the load in newtons by the area of the bonded inter-
turer’s instructions. After instrumentation, a size 40 Resilon master face. The area of the bonded interface was calculated with the formula
cone was fit with tug-back to within 1 mm of WL. RealSeal self-etching Area = 2pr  h, where p = 3.14 and r and h are the measured radius
primer was introduced into the canal by insertion of a saturated paper and height, respectively, in millimeters of the filling material pushed out.
point and left in the canal for 30 seconds. Excess primer, if any, was After measurement of bond strength, both sides of the failed bond
removed with a dry paper point. The sealer was then expressed by using were evaluated with 30 magnification to determine the mode of
the auto-mix syringe tip. The master cone was coated with sealer, placed failure. Each sample was evaluated and placed into 1 of 3 failure modes:
into the canal, and pumped up and down to ensure coating of walls with type 1, adhesive failure at sealer/dentin interface; type 2, cohesive failure
sealer. Down-pack was completed with the System B unit (Analytic, Red- at sealer to Resilon/gutta-percha interface; or type 3, mixed cohesive
mond, WA) set at 160 C, with the .06 FM tip to within 4 mm of WL. Back- and adhesive failure. The data were subjected to one-way analysis of
filling was done with the Obtura II (Obtura Spartan, Fenton, MO) set at variance and the post hoc Tukey test, with significance set at a = 0.05.
150 C. The Resilon was placed in small increments and condensed with
Buchanan pluggers (Sybron Endo, Orange, CA) until the cementoena-
mel junction (CEJ) was reached. Results
In Resilon/RealSeal SE sealer group (n = 10), continuous wave of The mean push-out bond strengths were as follows: Resilon/Real-
condensation with Resilon/RealSeal SE sealer was used. Obturation for Seal group, 1.45  0.99 MPa; Resilon/RealSeal SE group, 0.89  0.49
this group was identical to Resilon/RealSeal group; however, with the MPa; Resilon/MetaSeal group, 2.41  1.7 MPa; and gutta-percha/Kerr
new sealer there is no primer. EWT group, 2.32  0.74 MPa (Table 1). Resilon/MetaSeal group and
In Resilon/MetaSeal group (n = 10), a size 40 Resilon cone was fit gutta-percha/Kerr EWT group both showed significantly higher bond
to within 1 mm of WL with tug-back. MetaSeal was mixed according to strength than either Resilon/RealSeal group or Resilon/RealSeal SE
manufacturer’s instructions. The master cone was then coated with the group. There was no difference in bond strength when comparing Re-
sealer and placed into the canal. The gutta-percha cone was seared off silon/MetaSeal group with gutta-percha/Kerr EWT group.
with System B just below CEJ. Modes of failure are listed in Table 2. Microscopic examination
In gutta-percha/Kerr EWT group (n = 10), continuous wave of revealed adhesive failure as the most common mode in all groups
condensation with gutta-percha/Kerr EWT sealer was used. After instru- except Resilon/MetaSeal group, in which failures were more cohesive
mentation of the canal, a size 40 gutta-percha cone was fit with tug-back or mixed.
to within 1 mm of WL. Kerr EWT pulp canal sealer was mixed to manu-
facturer’s instructions. The master cone was coated with sealer, inserted Discussion
into the canal, and pumped up and down. Down-pack and backfilling The results of this study showed that gutta-percha/Kerr EWT and
were the same as for Resilon/RealSeal group except that the heat was set MetaSeal/Resilon have significantly higher bond strengths to root canal
at 200 C for both System B and Obtura. dentin than Resilon/RealSeal or Resilon/RealSeal SE. There was no
All access cavities were sealed with Cavit. The teeth were stored at difference; however, in the bond strengths of Resilon/MetaSeal as
37 C with 100% humidity for 1 week to allow sealers to fully set. compared with gutta-percha/Kerr EWT. The results are in disagreement
with Lawson et al (12), who showed significantly higher push-out bond
strength of MetaSeal/gutta-percha compared with gutta-percha/AH
Push-out Bond Test
The teeth were sectioned perpendicular to the long axis into
1-mm-thick disks by using an Isomet saw (Buehler Ltd, Lake Bluff, TABLE 2. Modes of Failure
IL) under water lubrication. This yielded 5 samples from each tooth, Failure Real Real Gutta-percha/
giving a total of 50 samples for each group. If the sample consisted mode Seal Seal SE MetaSeal Kerr EWT
of noncircular shape filling material, they were discarded because of
Type 1, 49 45 2 50
the fact that there would be nonuniform stress distributions during adhesive
testing, and the stress value calculations would be inaccurate because Type 2, 0 0 20 0
they are based on circular cavities. The exact thickness of each disk cohesive
was measured with a digital caliper to within 0.1 mm. The samples Type 3, 1 5 28 0
were placed on top of a metallic jig with a hole to allow the filling mate- mixed
Total 50 50 50 50
rial to fall through after failure of the bond. Three different-sized samples
plungers were used to closely match the size of the filling material.

JOE — Volume 36, Number 2, February 2010 Push-out Bond Strengths of Different Obturating Materials 319
Basic Research—Technology
Plus. In this study we used Resilon/MetaSeal instead of gutta-percha.
MetaSeal might have a stronger bond with Resilon than with gutta-per-
cha, which increased the bond strength to a level comparable with
gutta-percha/Kerr EWT. Because we used Kerr EWT versus AH Plus,
it is possible that this produced the difference in results, although
because Kerr EWT does not have any bonding properties to dentin,
one would think it would have a lower bond strength than a sealer
with adhesive characteristics. Lawson et al also used different obturat-
ing methods to include single cone technique for both groups as well
as warm vertical for both groups. To follow manufacturer’s recom-
mendations, we used warm vertical compaction for all groups except
for MetaSeal.
A recent study conducted by Babb et al (13) compared the bond
strength of MetaSeal with the bond strength of EndoRez and RealSeal SE.
They found that MetaSeal had higher push-out bond strength than Real-
Seal SE or EndoRez. The authors did not use any core obturating mate-
rial and explained their rationale by stating that a compressive load over
a thermoplastic material can lead to erroneous results. Our study is in
agreement with their findings that MetaSeal has higher bond strength
compared with RealSeal SE, even with a core material.
ProRoot Endo Sealer is a recently developed calcium silicate–
based root canal sealer. Huffman et al (14) found that ProRoot Sealer
had higher push-out bond strengths than either AH Plus or Pulp Canal
Sealer. That study did not include core obturating material, and the
effect of the bulk of sealer used might have affected the bond strength
results. When using either gutta-percha or Resilon, the amount of sealer
is thinned out, and this could reduce the bond strength.
Our study is in agreement with a number of other studies
comparing Resilon/Epiphany with gutta-percha and a variety of sealers.
For the most part, these studies have shown gutta-percha/AH Plus to
have significantly greater push-out bond strength than Resilon/
Epiphany (15–18). Skidmore et al (19) compared gutta-percha/Kerr
EWT and Resilon/Epiphany and found Resilon/Epiphany to have signif-
icantly higher bond strength than gutta-percha/Kerr EWT. Their
protocol was similar to the current study except the sealer was allowed
to set for only 24 hours, whereas we let the sealer set for 1 week. Allow-
ing the sealer to set for 24 hours might have provided for a higher bond
strength than allowing it to set for 1 week, because it has been shown
that Resilon and its sealer have the propensity to degrade over time
(20, 21).
Another difference in the various studies is their use of different
obturating methods with different materials (22). The manufacturer
of MetaSeal (Parkell) recommends using a single cone technique
with their material because they state that heat will cause the sealer to
set up too quickly and cause polymerization shrinkage. We used a single
cone technique for the MetaSeal group but a warm vertical technique for
the other 3 groups.
The MetaSeal group had a very high standard deviation (SD)
compared with the other 3 groups. This high SD might be attributed
to the appearance of voids in the sealer that could be seen on sectioning
the tooth into the 1.0-mm-thick slices. Numerous voids were seen in the
sealer around the core material, and this might have reduced the bond
strength in these particular slices, whereas when there were no voids,
the bond strength was increased. An attempt was made when placing
the sealer and master cone to avoid producing voids in the sealer by
ensuring that the master cone was well-coated with sealer and seated
slowly into the canal, thus avoiding the entrapment of air. This is
a concern in clinical practice, because these voids might provide a reser-
voir for fluid or persistent bacteria and thus compromise the obturation
and bacteriometric seal. It was noted through this push-out bond test
that MetaSeal did appear to bond to the dentin. Most of the failures
occurred when the core material was pushed out, but the MetaSeal
320 Stiegemeier et al.
was still intact on the dental walls. In the other 3 groups, the failures
were mostly of an adhesive nature such that the bond between the dentin
and sealer was broken. This bonding of MetaSeal to root canal dentin
seems to be a desirable attribute. More research is needed to further
understand the properties of MetaSeal. A recent study by De-Deus
et al (23) found that AH Plus/gutta-percha had significantly higher
push-out strength than both Resilon/Epiphany and Resilon/Epiphany
SE.
Creating an effective bond in the root canal is very challenging. A
review article by Schwartz (2) pointed out the difficulties associated
with dentin bonding in the root canal space. These challenges include
polymerization shrinkage, C-factor (ratio of the bonded/nonbonded
surface area) of the root canal space, lack of evaporation of the alcohol
carrier for the sealer in the apical one third of the root canal, an oxida-
tive layer left by irrigating solutions on the dentin, and calcium
hydroxide remnant neutralization of the acid primer, thus reducing
the bond strength. A study by De-Deus et al (24) found that pretreatment
of dentin with 1-hydroxyethylidene-1-bisphosphonate (HEPB) opti-
mized the bond quality compared with ethylenediaminetetraacetic
acid or Biopure MTAD (Dentsply/Tulsa, Tulsa, OK). The lowest bond
strengths were with those treated with NaOCl (24).
Conclusions
Both MetaSeal and gutta-percha/Kerr EWT had statistically higher
push-out bond strengths than either RealSeal group. However, the ques-
tion of whether true dentin bonding occurs with these cements needs to
be addressed.
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Basic Research—Technology
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Push-out Bond Strengths of Different Obturating Materials 321