JJOD-1982; No.

of Pages 4

journal of dentistry xxx (2012) xxx–xxx

Available online at www.sciencedirect.com

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Effect of endodontic sealers on tooth colour

Débora Könzgen Meincke a, Maı́ra Prado b,*, Brenda Paula Figueiredo Gomes b,
Alvaro Della Bona c, Ezilmara Leonor Rolim Sousa d
a
Federal University of Pelotas, Pelotas, RS, Brazil
b
Department of Restorative Dentistry, Endodontic Division, State University of Campinas, UNICAMP, Piracicaba, SP, Brazil
c
Chair of Post-graduate Dental Program, Dental School, University of Passo Fundo, UPF, Passo Fundo, RS, Brazil
d
Department of Semiology and Clinical, Endodontic Division, Federal University of Pelotas, UFPEL, Pelotas, RS, Brazil

article info abstract

Article history: Objectives: One of the goals of endodontic treatment is the adequate filling of the root canal,
Received 30 July 2012 which is often done using gutta-percha and sealer. It has been reported that sealer remnants
Received in revised form in the coronary pulp chamber cause tooth colour changes. Therefore, this study was
18 October 2012 designed to examine the effect of endodontic sealer remnants on tooth colour, testing
Accepted 23 October 2012 the hypothesis that sealers cause coronal colour changes.
Methods: Forty single-rooted human teeth were endodontically treated leaving excess sealer
material in the coronary pulp chamber. The specimens were divided into four groups (n = 10)
Keywords: according to the endodontic sealer used (AH, AH Plus; EF, Endofill; EN, endométhasone N;
Endodontic sealers and S26, Sealer 26). Teeth were stored at 37 8C moist environment. Colour coordinates
Root canal filling (L*a*b*) were measured with a spectrophotometer before endodontic treatment (baseline-
Tooth colour control), 24 h and 6 months after treatment. L*a*b* values were used to calculate colour
Spectrophotometer changes (DE). Data were statistically analyzed using Kruskal–Wallis and Mann–Whitney-U
CIELab tests.
Results: Colour changes were observed for all groups with S26 and EN producing the greatest
mean DE values after 6 months.
Conclusion: Endodontic sealer remnants affect tooth colour confirming the experimental
hypothesis.
Clinical significance: This study examined the effect of endodontic sealer remnants on tooth
colour, and observed that after 6 months, the sealers produced unacceptable colour
changes.
# 2012 Elsevier Ltd. All rights reserved.

most severe discolouration to result from N2 pastes and

1. Introduction
Many of the materials placed in contact with dentine have the
potential to cause discolouration, including amalgam, Cavit,
and IRM.1,2 A major cause of tooth discolouration may be
endodontic sealer remnants in the pulp chamber.3–5 Gutierrez
and Guzman6 evaluated endodontic materials and found the
polyantibiotic pastes, but did not identify which ingredients
were responsible for the discolouration. Sealers have also been
evaluated as to their discolouration potential. A study used
extracted premolars to evaluate the staining capacity of eight
sealers introduced into the pulp chambers. Results showed
significant coronal colour changes within several weeks, with
some sealers producing greater changes than others.4

* Corresponding author at: Department of Restorative Dentistry, Piracicaba Dental School State University of Campinas, Avenida Limeira,
901, Piracicaba, 13414 018 SP, Brazil. Tel.: +55 21 8885 5883; fax: +55 19 2106 5218.
E-mail address: mairapr@hotmail.com (M. Prado).
0300-5712/$ – see front matter # 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jdent.2012.10.011

Please cite this article in press as: Meincke DK, et al. Effect of endodontic sealers on tooth colour. Journal of Dentistry (2012), http://dx.doi.org/
10.1016/j.jdent.2012.10.011
JJOD-1982; No. of Pages 4
2 journal of dentistry xxx (2012) xxx–xxx
Table 1 – Description of the endodontic sealers used in the present study.
Group Commercial name Manufacturer
S26 Sealer 26 Dentsply, Petrópolis, Brazil
EF Endofill Dentsply, Buenos Aires,
Argentina
EN Endométhasone N Septodont, Saint-Maur des
Fossés, France
AH AH Plus Dentsply, Konstanz, Germany
The literature is lacking reports on the use of spectro-
photometers to evaluate the discolouration capacity of
endodontic sealers. The use of such instrumentation mini-
mises the subjectivity of colour determination resulting from
the complexity of factors interfering with individual colour
perception, and visual shade determination.7–9 Furthermore,
the interobserver congruence in the visual analyses is
frequently far from optimum.10
Spectrophotometers, such as the Vita Easyshade, are
commonly used in dental studies to quantify tooth discoloura-
tion (staining or bleaching effects)11,12 and colour changes in
dental materials such as ceramics,9,13,14 but they have not
been used to evaluate the coronal colour changes possibly
caused by endodontic sealers. The objective of the present
study was to examine the effect of endodontic sealer
remnants on tooth colour, testing the hypothesis that sealers
produce coronal colour changes.
2. Materials and methods
This study was approved by the local Ethics in Research
Committee. Forty extracted human maxillary and mandib-
ular single rooted incisors and canines free of caries,
restorations, cervical lesions and coronal discolouration
were selected from a tooth bank and used in the present
study. The teeth were cleaned to remove debris and extrinsic
stain, and then stored at 37 8C sterile saline solution (Basa,
Industria Farmacêutica Basa Ltda, Caxias do Sul, RS, Brazil).
The saline solution was changed every 7-day throughout the
experiment. Teeth were divided into 4 groups (n = 10) and
colour coordinates were recorded at baseline (A1, control).
Teeth were accessed and the pulp tissues were extirpated.
The root canals from all teeth were prepared with K-files
using the step-back technique with 2.5% sodium hypochlo-
rite and 17% EDTA for 3 min. After, the root canal was
irrigated with saline solution and dried, lateral condensation
technique was employed for root canal filling using gutta-
percha and a different sealer for each group (Table 1). The
sealers were placed into the root canal and purposefully left
in the coronal pulp chamber. No attempt was made to
remove sealer from the pulp chamber. All teeth were sealed
using composite resin (Filtek Z250TM, 3 M ESPE, St. Paul, MN,
EUA).
A second colour evaluation (A2) was done 24 h after
endodontic treatment followed by a third evaluation (A3) 6
months later. For standardisation purposes, the same operator
performed all colour evaluations.
Please cite this article in press as: Meincke DK, et al. Effect of endodontic sealers on tooth colour. Journal of Dentistry (2012), http://dx.doi.org/
10.1016/j.jdent.2012.10.011
Material composition
Powder: bismuth trioxide, calcium hydroxide, hexamethylene
tetramine, titanium dioxide. Resin: epoxy bisphenol
Powder: zinc oxide, hydrogenated resin, bismuth subcarbonate,
barium sulfate, sodium boroato. Liquid: eugenol and sweet
almond oil
Powder: zinc oxide hydrocortisone acetate, thymol iodide,
barium sulfate, magnesium stearate. Liquid: eugenol
Epoxy resin, zirconium oxide, iron oxide, calcium tungstate,
and silicone oil
A spectrophotometer (EasyShade Advance, Vita Zahnfab-
rik, Bad Säckingen, Germany) was used in ‘‘tooth single’’ mode
for all evaluations (A1, A2, and A3) of the colour coordinates
(L*a*b*). The active point of the spectrophotometer was placed
on the middle third of the coronal facial surface of each tooth
measuring it for three times, which were averaged. The
CIEL*a*b* colour coordinates were used to allow the determi-
nation of colour in the three-dimensional space.9,15 The L*a*b*
values were used to calculate the colour changes (DE), as
follows:
DE ¼ ½ðDLÞ2 þ ðDaÞ2 þ ðDbÞ2 
0:5
where L* is the colour value (lightness), a* and b* denote
chromaticity, in which red is a, green is a, yellow is +b,
and blue is b. The DE values were calculated as follows: DE1,
the colour difference between the baseline evaluation (A1,
control) and the evaluation done 24 h after endodontical treat-
ment (A2); DE2, the colour difference between A2 and A3
evaluations; and DE3, the colour difference between A1 and
A3 evaluations.
Data were statistically analyzed using Kruskal–Wallis and
Mann–Whitney-U tests (a = 0.05).
3. Results
The mean and standard deviation values of DE between
different experimental times for the evaluated sealers are
shown in Table 2. The apparently high coefficient of variation
values are similar to previous reports8,11,16,19 and may be
related to different teeth, mainly the tooth age, used in the
present study.
Considering the endodontic sealers after 6 months, the
tooth colour changes were as follows: S26 = EN > AH = EF.
These data can be clearly observed in Fig. 1.
Table 2 – Mean and standard deviation (SD) values of DE
for different experimental times and statistical group-
ings for the sealers evaluated.
DE1 Mean  SD DE2 Mean  SD DE3 Mean  SD
A A
S26 4.9  3.6 5.6  3.4 6.3  2.1 A
EF 4.3  4.5 A 2.7  1.6 B 3.4  3.1 B
EN 3.7  1.3 A 3.6  2.7 AB 5.6  2.3 A
AH 2.4  1.4 B 3.5  1.8 AB 3.8  2.2 B
Different letters within each column represent statistical group-
ings ( p < 0.05).
JJOD-1982; No. of Pages 4
journal of dentistry xxx (2012) xxx–xxx
Fig. 1 – Mean values of DE for different sealers evaluated.
Considering DE  3.317 or DE  3.518 as clinically acceptable,
only AH produced clinically acceptable colour changes 24 h
after the endodontic treatment. Considering the classic
study,17 all sealers examined produced clinically unacceptable
colour changes after 6 months.
4. Discussion
Tooth colour is determined by a combination of the different
optical properties of the dental structure.19,20 Colour can be
described using different colour systems. The CIELab is a three
dimensional uniform colour space with equal distances
corresponding to equal perceived colour differences. This
system has three axes or coordinates, L*, a* and b*. The L* axis
represent lightness and goes from 0 (black) to 100 (white). Both
a* and b* represent the redness – greenness and yellowness –
blueness axes, respectively. When a* and b* coordinates
approach zero, the colour become neutral. They also (a*and
b* values) can be used to derive metric chroma and hue angle.
A colour difference (DE) between two objects can be calculated
within the CIELab colour system.17,21
Spectrophotometers measure one wavelength at a time
from the reflectance or transmittance of an object and have
been used to measure the visible spectra of extracted and vital
teeth.9,17,22,23
As hypothesised the endodontic sealers examined in the
present study produced progressive colour changes through 6
months, which is agreement with previous study.3 Another
similar study4 found measurable and, in some cases, marked
discolouration within 7 weeks. Differences in the reported
time and intensity of colour changes are probably due to
differences in the study methodology. Most traditional
studies2,4,6 examined the colour changes using the visual
method. The present study used a clinically applicable
method, an intra-oral spectrophotometer, to quantify the
colour changes. This method seems to be more sensitive in
detecting colour changes.7–10
The application of the endodontic sealer into the pulp
chambers was similar to two previous studies.3,4 Sealer was
intentionally placed in the pulp chambers without removal of
the excess. Clinically, all sealer remnants should be removed
from the pulp chamber during the endodontic treatment,
however this does not always occur and sealer remnants can
result in colour changes.3,4 Yet, it is unknown how much time
Please cite this article in press as: Meincke DK, et al. Effect of endodontic sealers on tooth colour. Journal of Dentistry (2012), http://dx.doi.org/
10.1016/j.jdent.2012.10.011
3
lapses until the onset of perceptible colour changes and,
consequently, the initial of aesthetic procedures to repair the
damage.
Although the sealers evaluated in the present study do not
contain silver, or any heavy metal, they obviously contain
substances that stain dentine. It is also apparent that these
substances are changing chemically with time.24 The results
showed that S26 and EN produced greater colour changes than
EF and AH. This may be explained by the presence of calcium
hydroxide in S2625,26 and iodine in the EN compositions (Table
1). In addition, it has been reported that eugenol forms a bond
with zinc oxide and changes chemically (oxidises) with time.3
These components are present in EN and EF composition.
5. Conclusions
Within the experimental conditions of this study and
considering DE  3.317 as a clinically acceptable parameter
for colour change, the endodontic sealers examined produced
clinically unacceptable colour changes after 6 months. Further
in vivo studies should be done to confirm the results of the
present study.
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10.1016/j.jdent.2012.10.011
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