This article presents an evidence-based comparison between gutta-percha obturation and adhesive endodontic filling systems, focusing on sealing ability, long-term stability, biocompatibility, and clinical performance in modern endodontics.
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Root canal obturation has traditionally relied on gutta-percha, a material that continues to be the global standard. However, the introduction of adhesive endodontic filling systems has generated interest due to their potential for monoblock creation, enhanced sealing, and better biomechanical integration. Understanding the scientific evidence supporting each approach is crucial for selecting the most predictable and biologically sound treatment.
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1. Mechanism of Action
➤ Gutta-Percha
Gutta-percha functions as an inert core material, requiring a sealer to adhere to canal walls. Its success depends on the quality of shaping, cleaning, and the sealer’s properties.
➤ Adhesive Endodontic Fillings
These systems use resin-based or bioceramic bonding mechanisms to integrate the filling with dentin. The goal is to create a bonded internal monoblock, improving resistance against reinfection and microleakage.
2. Sealing Ability
➤ Gutta-percha with traditional sealers shows long-term stability but may present interfacial gaps due to shrinkage of sealers.
➤ Adhesive systems, especially those based on bioceramics, provide hydrophilic bonding, dimensional stability, and a reduction in apical microleakage, according to recent in vitro and in vivo studies.
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➤ Gutta-percha is not reinforcing and does not strengthen weakened endodontically treated teeth.
➤ Adhesive fillings, particularly resin-based ones, show potential reinforcement, though clinical outcomes remain controversial and vary with moisture control and polymerization dynamics.
4. Clinical Predictability
➤ Gutta-percha remains highly predictable due to decades of controlled clinical outcomes.
➤ Adhesive systems show promise but require strict technique sensitivity, including moisture management and adequate dentin conditioning.
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➤ Gutta-percha is biocompatible and stable, with minimal cytotoxicity.
➤ Adhesive systems vary: bioceramic adhesives are highly biocompatible, while certain resin-based systems may release monomers if not properly polymerized.
💬 Discussion
Both materials offer well-documented benefits. Gutta-percha remains the gold standard due to its stability, ease of removal, and abundant clinical data. However, adhesive obturation systems represent an important evolution, especially for clinicians seeking better sealing and dentin integration.
The major challenge for adhesive systems lies in technique sensitivity and the variability of long-term clinical outcomes. More robust, multi-center randomized trials are needed to confirm their superiority—or complementarity—over gutta-percha.
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Gutta-percha continues to be the most reliable obturation material in modern endodontics, supported by strong clinical evidence. Adhesive endodontic fillings offer promising advantages in terms of sealing and potential reinforcement, but they currently require more long-term data to fully replace traditional methods. The best choice depends on operator skill, case complexity, and the selected sealer system.
🔎 Recommendations
▪️ Use gutta-percha for most routine cases due to its predictable behavior.
▪️ Consider adhesive filling systems for cases with high risk of microleakage or where reinforcement may be beneficial.
▪️ Avoid resin-based adhesive techniques if moisture control is compromised.
▪️ Continue following updates in bioceramic bonding technology, which shows the greatest clinical potential.
📚 References
✔ Chu, F. C., Leung, W. K., & Tsang, C. S. (2022). Sealing ability of bioceramic-based sealers versus epoxy-resin sealers: A systematic review and meta-analysis. Journal of Endodontics, 48(3), 345–356. https://doi.org/10.1016/j.joen.2021.12.003
✔ Kim, Y., Kim, B. S., & Kim, W. (2020). Comparison of resin-based and bioceramic sealers in obturated root canals: A microleakage study. International Endodontic Journal, 53(7), 940–948. https://doi.org/10.1111/iej.13289
✔ Santos, J. M., Coelho, C. M., Sequeira, D. B., Messias, A., & Palma, P. J. (2020). Biocompatibility of a bioceramic sealer compared with gutta-percha and epoxy resin-based sealer. Clinical Oral Investigations, 24, 1225–1235. https://doi.org/10.1007/s00784-019-03061-5
✔ Tay, F. R., & Pashley, D. H. (2007). Monoblocks in root canals: A hypothetical or tangible goal. Journal of Endodontics, 33(4), 391–398. https://doi.org/10.1016/j.joen.2006.10.009
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