SEALABILITY OF THE TRIFECTA(TM) TECHNIQUE IN THE PRESENCE OR ABSENCE OF A SMEAR LAYER

The aim of this in vitro study was to assess the sealability of a recently introduced thermoplasticized gutta-percha technique (Trifecta, Hygenic Corp., OH, USA) in the presence or absence of a smear layer. A total of 100 teeth with single straight root canals were included in the study. The teeth were decoronated and the canals prepared with a modified double-flared technique under constant irrigation with 2.5% sodium hypochlorite solution. The apical matrix was prepared to size 40 and apical patency subsequently confirmed with a size 10 file. Four teeth were discarded for technical reasons and the remaining 96 allocated randomly into two groups of 44 teeth and a group of eight teeth which acted as controls, Canals in group 1 were obturated randomly with either cold lateral condensation of gutta-percha or with the Trifecta technique, Canals in Group 2 were rinsed with 17% REDTA to remove the smear layer and then obturated with lateral condensation or the Trifecta technique. All teeth were suspended in India ink for 9 days, demineralized, and rendered transparent prior to the assessment of apical linear dye penetration. Apical extrusion of sealer and gutta-percha occurred commonly but there was no significant difference between the four obturation groups. However, overall, there was significantly more extrusion of sealer with the Trifecta technique compared with lateral condensation (P < 0.05). The majority of canals (79 out of 88) had no evidence of apical leakage and there was no significant difference between the groups. The prevalence of sealer and gutta-percha penetration into the dentinal tubules was significantly different between the four obturation techniques (P < 0.01) and significantly more common in the absence of the smear layer (P < 0.001). Under the conditions of this study, the Trifecta technique proved a satisfactory alternative to lateral condensation. Removal of the smear layer did not enhance sealability despite increasing the proportion of specimens with dentinal penetration of sealer and gutta-percha.