J Dent Mater Tech 2024; 13 (2): 91-95 J Dent Mater Tech

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https://doi.org/ 10.22038/jdmt.2024.79133.1615

Original Article Open Access

Comparison of apical sealing between the Tagger hybrid technique

and lateral condensation technique with different sealers

Belu Ccori Peña1, Luis Adrian Mejía Gonzáles1, Luis Alexander Orrego-Ferreyros1*

Abstract
Objective: This study aimed to compare the effectiveness of the Tagger technique and the lateral condensation
technique with different obturation cements in achieving optimal apical sealing in endodontic treatments.
Methods: An in vitro study was conducted on 68 extracted human upper or lower first premolars. Teeth were
randomly divided into four experimental groups (n=17) based on two obturation techniques and endodontic sealers
employed, as follows: Group 1, Tagger technique with the zinc oxide-eugenol sealer; Group 2, Tagger technique with
the resin-based sealer; Group 3, lateral condensation technique with zinc oxide-eugenol sealer, and Group 4, lateral
condensation technique with resin-based sealer. Homogeneity of the gutta-percha mass and apical obliteration were
evaluated under a digital stereomicroscope. Data were analyzed using the chi-square test, and a P-value<0.05 was
considered statistically significant.
Results: Most group specimens exhibited non-homogeneous gutta-percha, whereas apical obliteration was achieved
in a significant proportion of samples across all groups. No significant difference was found between the study groups
either in the homogeneity of the gutta-percha mass (P=0.978) or in the optimal apical obliteration (P=0.782).
Conclusions: The study found no significant difference in the effectiveness of the Tagger hybrid and lateral
condensation techniques using different sealers in achieving optimal apical sealing and gutta-percha homogeneity.
This highlights the critical role of the clinician's expertise in ensuring successful endodontic outcomes.

Keywords: Endodontics, Gutta-percha, Root canal filling materials; Root canal obturation, Root canal preparation,
Root canal sealer

Introduction the strategies for diagnosing, preventing, and treating

Long-term survival of endodontically treated teeth various pathologic conditions (2, 3).
relies on achieving a well-sealed apical area, an optimal A Critical stage in root canal treatment is obturation,
coronal restoration, and adhering to fundamental which aims to prevent the penetration of
endodontic principles. Due to the morphological microorganisms and fluids from the oral cavity into the
complexities of the root canal system, optimal root canal periapical tissues. This procedure also seeks to entrap
filling can sometimes be challenging, especially in teeth any bacteria that survived after root canal cleaning and
with lateral or accessory canals (1). Successful irrigation and prevent periradicular exudates from
endodontic treatment requires a comprehensive entering the root canal system (4, 5). Up to 58% of
understanding of the biology of the dental pulp and endodontic treatment failures are due to insufficient
periradicular tissues, the causes of related diseases, and canal obturation (6).
Various materials, such as root canal filling materials
1Universidad César Vallejo, Facultad de Ciencias de la Salud,
and root canal sealers, are used in the obturation
Escuela de Estomatología, Piura, Perú
procedure. Gutta-percha is the most commonly used
*Corresponding Author: Luis Alexander Orrego-Ferreyros root canal filling material, but it does not adhere to the
Email: [email protected]
dentinal walls of the canal. Root canal sealers must
Accepted: 28 May 2024. Submitted: 4 April 2024. possess specific physical, biological, and handling

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92 Apical sealing of tagger and lateral condensation techniques

properties (7, 8). They should create a bond between

the filling material and the root canal dentin walls and Sample collection and preparation
fill the canal areas that solid materials cannot reach, This study included 68 extracted human upper or
preventing fluid and bacterial leakage (9). There is a lower first permanent premolars following radiographic
great variety of commercially available endodontic confirmation. The inclusion criteria included single
sealers, which are classified according to their canals with fully formed apices. The exclusion criteria
composition: zinc oxide eugenol (ZOE) based, calcium involved teeth that were cracked, fractured, or had
hydroxide based, glass ionomer based, epoxy resin- morphological alterations. Furthermore, teeth with root
based, and the most recently introduced bioceramics (7, canal calcification or root curvature greater than 30°
10-13). were excluded.
Lateral condensation is the most widely used A simple random sampling method was employed,
technique in endodontics due to its simplicity and low assigning each sample a random number generated by
cost. Despite its advantages, canals obturated using the Microsoft Excel®. The samples were then randomly
cold lateral condensation technique often lack adequate divided into four experimental groups based on the
gutta-percha homogeneity and have a higher void obturation techniques and endodontic sealers, with 17
percentage than other obturation techniques (13, 14). samples allocated to each group. The study groups were
To address these limitations, new techniques using as follows:
warm gutta-percha have been introduced (15, 16). Group 1: The Tagger technique with zinc oxide-
Tagger's hybrid technique is the modification of the eugenol sealer (Pulp Canal Seale; Kerr Co, Lake Bluff, Il,
technique proposed by McSpadden. In the original USA).
McSpadden technique, McSpadden's compactors are Group 2: The Tagger technique with resin-based sealer
used at 20,000 rpm to produce friction between the (AH26; Dentsply, Konstanz, Germany).
gutta-percha and the internal walls of the root canal, Group 3: The lateral condensation technique with zinc
thus resulting in the thermoplasticization of gutta- oxide-eugenol sealer.
percha (17). However, that technique has some Group 4: The lateral condensation technique with
disadvantages, such as the high incidence of overfilling. resin-based sealer.
To address this issue, Tagger (16) proposed a hybrid The canal was prepared using conventional K-files
obturation technique in which the cold lateral (Mani, Japan) and a Reciproc R40 (40/0.06) instrument
compaction of gutta-percha is conducted in the apical (VDW GmbH, Munich, Germany), according to the
third. In contrast, thermo-mechanical compaction is manufacturer’s instructions. During instrumentation,
performed in the middle and coronal thirds of the canal. canals were irrigated with 2.5% sodium hypochlorite
It is assumed that heating gutta-percha improves its (NaOCl; Marvaban, Iran), and 5 ml of 17%
adaptation to the root canal's internal anatomy (18, 19). ethylenediamide tetraacetic acid (EDTA) was used to
Several studies have compared different obturation remove the smear layer. The final irrigation was
techniques regarding apical sealing capacity as performed with 2.5% NaOCl for 30 seconds. The canals
measured by dye infiltration and the homogeneity of were then dried with paper points.
obturation radiopacity. Some studies have Subsequently, the specimens in groups 1 and 2 were
demonstrated the superiority of one technique over the obturated with Tagger’s hybrid technique using gutta-
other (20, 21), but the results are inconclusive. This percha and the zinc oxide-eugenol or resin-based sealer,
study aimed to evaluate the sealing ability of two respectively. This technique has been explained
different obturation techniques (lateral condensation elsewhere (16, 17). One clinician, guided by an
and Tagger techniques) and two different endodontic experienced endodontist, practiced the Tagger hybrid
sealers (zinc-oxide eugenol and resin-based sealers) technique on pilot samples using single-rooted teeth.
through digital stereomicroscope analyses. The teeth in groups 3 and 4 were filled with a
conventional lateral condensation technique, using
Materials and methods gutta-percha and zinc oxide-eugenol or resin-based
Study design sealers, respectively.
The research ethics committee (CIEI) of César Vallejo
University reviewed and provided the approval opinion Homogeneity and apical obliteration evaluation
for the execution of this in vitro research (0120-2024- Apical sealing was assessed by dye penetration
/UCV/P). according to a previous study performed by Kuba et al.

J Dent Mater Tech, Vol 13, No 2, June 2024

Apical sealing of tagger and lateral condensation techniques 93

Table 1. Evaluation of apical obliteration quality according to the applied obturation technique and sealer type

Groups Definition partially completely

obliterated obliterated

Group 1 (Tagger technique + zinc oxide-eugenol sealer) 3 (17.6) 14 (82.3)

Group 2 (Tagger technique + resin-based sealer) 3 (17.6) 14 (82.3)
Group 3 (Lateral condensation technique + zinc oxide-eugenol sealer) 3 (17.6) 14 (82.3)
Group 4 (Lateral condensation + resin-based sealer) 5 (29.4) 12 (70.6)
P-value 0.782

(22). The teeth were sectioned along the long axis of the Results
tooth and examined under a digital stereomicroscope Table 1 presents the frequency and percentage of
(Leica EZ4W, Germany) at ×10 magnification and teeth with partial or complete apical obliteration in the
photographed. study groups. Most specimens exhibited complete
Apical sealing was assessed by dye penetration obliteration of the apical area, regardless of the
technique, using 2% rhodamine B for 24 hours, An technique or sealer used. The chi-square test revealed
experienced blinded examiner assessed the extension of no significant difference between the experimental
dye penetration along the apical interfaces. In this study, groups considering apical obliteration (P=0.782; Table
teeth with less than 1 mm dye penetration were 1).
considered completely obliterated, and those with Table 2 presents the distribution of gutta-percha mass
higher penetration than 1 mm were considered partially homogeneity in the study groups. Most samples
obliterated . displayed non-homogeneous gutta-percha, irrespective
The homogeneity of the gutta-percha mass was of the technique or sealer utilized. The chi-square test
assessed according to a method proposed by Vyavahare showed no significant difference between the groups
et al. (23) at the junction of the apical and middle thirds. regarding gutta-percha homogeneity (P=0.978; Table 2).
The photographs were taken at x20 magnifications, and
the area of voids (%) was measured using AutoCAD Discussion
software. In this study, teeth with less than 2% voids
In this study, the sealing effectiveness of the Tagger
were considered homogenous, and those with ≥2%
hybrid technique and lateral condensation technique
voids were recorded as non-homogenous.
was assessed, using both zinc oxide-eugenol and resin-
based sealers. Two variables were compared among
Statistical analysis groups including gutta-percha homogeneity and apical
STATA software (version 18, StataCorp, Texas, US) was obliteration. The results were presented as scores for
used for statistical analysis. Pearson's chi-square test more simplicity in data interpretation.
was employed to determine the differences between In the present study, 71-82% of samples in different
the groups. The significance level was set at p<0.05. groups showed optimal apical obliteration. Considering
gutta-percha mass homogeneity, about 29%-35% of

Table 2. Distribution of gutta-percha mass homogeneity according to the applied obturation technique and sealer type

Groups Definition Non-Homogeneous Homogeneous

Group 1 (Tagger technique + zinc oxide-eugenol sealer) 11 (64.7) 6 (35.3)

Group 2 (Tagger technique + resin-based sealer) 11 (64.7) 6 (35.3)
Group 3 (Lateral condensation technique + zinc oxide-eugenol sealer) 12 (70.6) 5 (29.4)
Group 4 (Lateral condensation + resin-based sealer) 11 (64.7) 6 (35.3)
P-value 0.978
The difference between groups is statistically significant at p<0.05 according to Pearson's chi-square test.

J Dent Mater Tech, Vol 13, No 2, June 2024

94 Apical sealing of tagger and lateral condensation techniques

samples in different groups displayed homogeneous Conflict of interest

gutta-percha. The study groups showed no significant The authors declare no conflict of interest.
differences regarding apical obliteration or gutta-percha
homogeneity. Therefore, the Tagger hybrid technique Authors’ contributions
was not more effective than the lateral condensation
BC and LM were responsible for conceptualization,
technique in achieving apical seal and gutta-percha
investigation, resources, and writing the original draft
homogeneity.
preparation. LO handled data curation, formal analysis,
The results of this study are consistent with those
methodology, supervision, software, and writing,
presented by Olczak and Pawlicka (24) and Ho et al. (25),
including review and editing. All authors read and
who indicated comparable root canal sealing outcomes
approved the final manuscript.
irrespective of the obturation method used, in contrast
to the outcomes of this study. El Sayed (26) evaluated
Ethical approval
and compared the penetration depths of three different
The research ethics committee (CIEI) of César Vallejo
endodontic sealers (AH-Plus, BioRoot RCS, and
University reviewed and provided the approval opinion
GuttaFlow 2) after obturation with the lateral
for the execution of this in vitro research (0120-2024-
condensation technique. They found that the type of
/UCV/P).
root canal sealer significantly influences the filling of the
lateral canals. Libonati et al. (27) evaluated the gutta-
percha-filled area after root canal obturation with Funding
different techniques and with or without using The present study was supported by César Vallejo
endodontic sealers. They reported that using University research committee.
endodontic sealers could compromise the progression
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