Cavity configuration factor (C-factor) is the ratio of the bonded surface area in a cavity to the unbonded surface area. In a box-like class I cavity, there may be five times more bonded surface area than the unbonded surface area. During polymerization, the volume of monomers is reduced, which creates sufficient shrinkage stresses to debond the material from dentin, thereby decreasing retention and increasing leakage. The important variables influencing bonding adhesive root-filling materials to canals was examined using a truncated inverted cone model. C-factors in bonded root canals exhibit a negative correlation with sealer thickness. For a 20 mm-long canal prepared with a size 25 file, calculated C-factors ranged from 46 to 23,461 with decreasing sealer thickness (500-1 microm), compared to a C-factor of 32 when the canal was filled only with sealer. As the thickness of the adhesive is reduced, the volummetric shrinkage is reduced, which results in a reduction in shrinkage stress (S-factor). C-factors above 954 calculated with sealer thickness smaller than 25 microm are partially compensated by increases in bonding area and decreases in shrinkage volume. However, the interaction of these two geometrically related factors (C- and S-factors) predicts that bonding of adhesive root-filling materials to root canals is highly unfavorable when compared with indirect intracoronal restorations with a similar resin film thickness.

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Introduction Thorough cleaning and shaping of root canals are essential for periapical healing. Restoration of endodontically-treated teeth is also required for them to function and prevent coronal leakage. This study compared the impact of the quality of root canal treatment versus the quality of coronal restoration in treatment outcomes. Methods Literature search was conducted using the search terms “coronal restoration”, “root canal”, “periapical status” and “quality”. Articles that evaluated the effect of the quality of root filling and coronal restoration or both on the success of root canal treatment were selected. Nine articles were identified and were reviewed by three investigators. Data were collected based on pre-determined criteria. Percentages of teeth without apical periodontitis were recorded for each category: Adequate Root Canal Treatment (AE), Inadequate Root Canal Treatment (IE), Adequate Restoration (AR), Inadequate Restoration (IR). Data were analyzed using meta-analysis for odds ratios (ORs). Results After adjusting for significant covariates to reduce heterogeneity, the results were combined to obtain pooled estimates of the common OR for the comparison of AR/AE vs AR/IE (OR 2.734; 95% CI 2.61–2.88; p<0.001) and AR/AE vs IR/AE (OR 2.808; 95% CI 2.64–2.97; p<0.001). Conclusion On the basis of the current best available evidence, the odds for healing of apical periodontitis increase with both adequate root canal treatment and adequate restorative treatment. Although poorer clinical outcomes may be expected with adequate root filling-inadequate coronal restoration and inadequate root filling-adequate coronal restoration, there is no significant difference in the odds of healing between these two combinations.

This in vitro study compared the ultrastructural quality of the apical seal achieved with Resilon/Epiphany and gutta-percha/AH Plus. Single-rooted extracted human teeth were prepared using a crown-down technique, debrided with NaOCl and EDTA, and obturated with either Resilon/Epiphany or gutta-percha/AH Plus. They were examined for gaps along canal walls using SEM, and for apical leakage using a transmission electron microscopy (TEM). SEM revealed both gap-free regions, and gap-containing regions in canals filled with both materials. TEM revealed the presence of silver deposits along the sealer-hybrid layer interface in Resilon/Epiphany, and between the sealer and gutta-percha in the controls. It is concluded that a complete hermetic apical seal cannot be achieved with either root filling materials.