Cusp deflection, infraction and fracture in endodontically treated teeth filled with three temporary filling materials (in vitro)


1 Associate professor, Department of Restorative Dentistry, Faculty of Dentistry, Kerman University of Medical Sciences, Kerman, Iran

2 Associate professor, Department of Oral Pathology, Faculty of Dentistry, Kerman University of Medical Sciences, Kerman, Iran

3 Professor, Department of Endodontics, Faculty of Dentistry, Kerman University of Medical Sciences, Kerman, Iran

4 Assistant professor, Department of Oral Pathology, Faculty of Dentistry, Kerman University of Medical Sciences, Kerman, Iran


Aim: the aim of this study was to compare cusp deflection, infraction and fracture in teeth filled with three temporary filling materials. Materials & method: Forty five extracted human premolar teeth were chosen. After root canal therapy and mesio-occluso-distal cavity preparation, samples were randomly divided into three groups , each contained 15 teeth and filled with three temporary filling materials: Cavisol (Golchai-Iran), Coltosol F (Coltene,Swiss) and Coltene (Ariadent,Iran). Teeth were kept in normal saline at room temperature and every day the intercuspal distance was measured under stereomicroscope for 20 days. Infractions as well as fractures were also noted. Data were analyzed in SPSS 17 using Repeated measurement ANOVA test to evaluate the intercuspal distance and expansion of each sample every day. Results: Intercuspal distance increased in all three groups but was significantly more in Coltosol F group. On the days 10 and 16 two teeth filled with Coltosol F had cusp fracture. Conclusion: Temporary filling materials have hygroscopic expansion and cause cusp deflection which may lead to cusp fracture, so it is recommended to use them in short period of time.


Main Subjects


Success in root canal therapy depends on complete bacterial debridement, pulp tissue elimination and fine cleaning-shaping of root canal. In some cases the endodontic therapy procedure is not completed in one visit, so a temporary filling material is necessary (1). Lack of proper temporary filling is the second pain remaining factor after treatment (2). Temporary filling material must provide adequate canal seal against bacterial, organic material and oral fluids, preserve tooth remaining structure, have acceptable aesthetic and easy handling (3). Among temporary filling materials, reinforced zinc oxide eugenol and calcium sulfate based materials are more common. Coltosol, Cavit and Kalzinol are common temporary filling brands (4). In 2005 Laustsen et al. claimed that Coltosol F causes cusp deflection, infraction and fracture, if used as a temporary filling material in endodontically treated teeth (5). Lubbers- Coltene chief- disapproved Laustsen results about Coltosol F because of inappropriate method in their study (6). The aim of this study was the evaluation of cusp deflection, infraction and fracture in endodontically treated teeth that were filled with three filling material: Cavisol (golchai, iran), Coltosol F (coltene, swiss) and Coltene (aria dent, iran).


Materials and Methods

Forty five human premolars (thirty maxillary and fifteen mandibular second premolars) extracted for orthodontic treatment with the same size were chosen. Teeth were evaluated under stereomicroscope to be free of caries and cracks. Access cavity prepared for root canal therapy.  Canal shaping was done in passive step back method with K files (Mani, Tochigi, Japan). The master apical file was number 30 and working length was one millimeter to the apex. Master cone was number 30 gutta-percha (Aria dent,Tehran,Iran) and lateral condensation method used for canal ubturation. Gutta-percha were cut from orifice. Then MOD cavity prepared in teeth with 4 millimeter Bucco-lingual width, 6 millimeter depth and 1 millimeter above CEJ line and tried to keep pulpal and gingival floor at the same level.

Then teeth divided into three groups of fifteen teeth (ten maxillary and five mandibular premolars). One group filled with Coltosol F, the other with Coltene and last group with Cavisol.

Reference points marked on buccal and lingual cusp tips by needle bars. Samples were kept in normal saline solution at room temperature except for measurement procedure. Thermocycling was done for 700 cycles.

Teeth were observed under stereomicroscope (Zeiss,Jena, Germany) with 20X magnification lens. Two plates and putty used to fix the distance between cusp tips and microscope lens the same for all samples. The photo of each tooth saved in PC and then observed in Photoshop software. The measurement procedure was done every day by two observers for 20 days. Every day, they measured intercuspal distance and if their findings were different from the, the mean number was noted as the right distance. At the end of the 20th day, teeth were transferred to methylene blue 1% for 48 hours, washed then thoroughly and existence of cracks was determined for each tooth which now colored in blue. 

Repeated-measures ANOVA test used to evaluate the percent of expansion for each temporary filling material. . Mann-Whitney U and Chi-square tests used for comparison of expansion between each two groups and existence of cracks in respect.




    1. Sjogren U, Figdor D, Persson S, Sundquist G. Influence of infection at the time of root filling on the outcome of endodontic treatment of teeth with apical periodontitis. International Endodontic Journal 1997; 30:297-306.
    2. Abbott PV. Factors associated with continuing pain in endodontics. Australian Dental Journal 1994; 39:157-61.
    3. Wolanek GA, Loushine RJ, Weller RN, Kimbrough WF, Volkmann KR. Bacterial penetration of endodontically treated teeth coronally sealed with a dentin bonding agent. Journal of Endodontics 2001; 27:354-7.
    4. Widerman FH, Eames EB, Serene TP. The physical and biological properties of cavit. Journal of the American Dental Association 1997; 82:378-82.
    5. Laustsen MH, Munksgaard EC, Reit C, Bjorndal L. A temporary filling material may cause cusp deflection, infractions and fractures in endodontically treated teeth. International Endodontics Journal 2005; 38:653-7.
    6. Lubbers D. Letter to the editor. International Endodontics Journal 2006; 39:330-1.this article have been used at first.
    7. Hannig C, Westphal C, Becker K, Atttin T. Fracture resistance of endodontically treated maxillary premolars restored with CAD/CAM ceramic inlays. J Prosth den 2005; 94:342-9.