Basic ResearchTechnology

Temperature Changes on External Root Surfaces

with the Use of Several Thermoplastic Filling
Techniques
Daniele Zafalon Beraldo, DDS, MSc,* Key Fabiano Souza Pereira, DDS, MSc, PhD,*
Franciely Mariani Silva Yoshinari, DDS, MSc,* Jo~
ao Onofre Pereira Pinto, PhD,

Tiago Henrique de Abreu Mateus, MSc, and Edilson Jose Zafalon, DDS, MSc, PhD*
Abstract
Introduction: The purpose of this study was to measure the temperature rise on the external root surface of filled root canals using Touchn Heat
(Analytic Endodontics, Orange, CA), the TC System
(TC; Tanaka de Castro & Minatel Ltda, Cascavel,
PR, Brazil), and the Tagger technique. Methods:
Forty-five single-canal mandibular premolar human
teeth were used in the 3 experimental groups. The
root canals were enlarged to accommodate up to
an R40 Reciproc file (VDW, Munich, Germany).
Next, the specimens were filled according to the
technique evaluated. The measurement of the temperature was performed by K chromium-aluminum
thermocouples attached to the coronal, middle, and
apical root levels. Results: There was a significant
difference among the 3 techniques (P < .001) in relation to the temperature variation between the highest temperature and the initial temperature. The
highest temperature change was found with the Tagger technique at the middle third root level (11.8C),
and the lowest variation was in TC at the cervical
third (2.05C). Conclusions: There was a rise of
temperature on the external root surface for all of
the techniques evaluated. TC showed the lowest
temperature rise. (J Endod 2016;42:11311134)

Key Words
Tagger technique, TC system, temperature rise, Touchn
heat

he main therapeutic
Signicance
strategy to eliminate
Thermoplasticized gutta-percha techniques have
microorganisms in root
been used in most endodontic treatments percanal systems is chemoformed all over the world. This work highlights the
mechanical debridement.
increase in temperature on the external root surHowever, because of the
face of lled root canals using 3 techniques: TC
known anatomic comSystem, Touch'n Heat, and Tagger technique.
plexity of the root canal,
There was a rise in temperature on the external
microorganisms are left
root surface for all of the techniques evaluated.
inside its space after
TC System showed the lowest temperature rise.
biomechanical preparation. Thus, the obturation
must seal the periradicular tissues from the residual microorganisms (1).
The materials commonly used in the obturation phase are gutta-percha and a
sealer. Cold lateral condensation (CLC) is a very popular obturation technique;
however, it has been stated that CLC does not effectively fill the root canal system
and frequently leaves empty spaces and an irregular distribution of the sealer
(2, 3). Thermoplasticized gutta-percha techniques have been used in most of the
endodontic treatments performed all over the world because they present advantages, such as a shorter time required to perform the obturation and a better filling,
compared with CLC (46).
Much research has shown that an excellent filling results from thermoplasticized
gutta-percha (2, 69). Nevertheless, studies have also shown that the heat used to
plasticize the gutta-percha promotes a rise of temperature at the external root surface
(1012). An increase of up to 10 C, continuing for 1 minute, is not harmful, which is
compatible with normal bone repair, but higher temperatures or longer application
times can cause damage to the periodontal ligament and can cause bone necrosis (13, 14).
There are various systems that are used to plasticize the gutta-percha. The main
advantage of Touchn Heat (TH; Analytic Endodontics, Orange, CA) is the simplicity
of the technique, in which the downpack of gutta-percha can be achieved in 1 continuous motion with 1 heated plugger (15). The Tagger technique (TT) uses thermoplasty
with gutta condensers on the gutta-percha cones inside the root canal (16). There is a
hypothesis that the friction produced between the gutta condenser, the gutta-percha,
and the wall of the root canal can cause a temperature rise, which can be transferred
to the external surface. The TC System (TC; Tanaka de Castro & Minatel Ltda, Cascavel,

From the *Faculty of Dentistry and Faculty of Engineering, Architecture and Urban Planning and Geography, Federal University of Mato Grosso do Sul, Campo
Grande, Mato Grosso do Sul, Brazil.
Address requests for reprints to Dr Key Fabiano Souza Pereira, Senador Filinto Muller Avenue, Faculty of Dentistry, Federal University of Mato Grosso do Sul, Cidade
Universitaria, s/n, Zip Code: 79070-900, Campo Grande, MS, Brazil. E-mail address: keyendo@hotmail.com
0099-2399/$ - see front matter
Copyright 2016 American Association of Endodontists.
http://dx.doi.org/10.1016/j.joen.2016.04.011

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External Root Surfaces and Thermoplastic Filling Techniques

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Basic ResearchTechnology
PR, Brazil) consists of filling the root canal with gutta-percha that has
previously been plasticized in a specific device (17).
Considering the importance of the use of thermoplasty and
whether its use can cause injury to periodontal tissues, the aim of
this study was to measure the temperature rise on the external root surface of filled root canals by TH, TC, and TT.

laterally condensed. Next, a set of gutta-percha and sealer was plasticized

by a #50 stainless steel gutta condenser with a 2% taper (Dentsply Maillefer), which was activated with a micromotor at 10,000 rpm. The depth
of the gutta condenser was 3 mm before the working length, and the
duration of thermoplasty was between 5 and 10 seconds. Thereafter, a
cold hand plugger (Dentsply Maillefer) was used to vertically condense
the plasticized gutta-percha mass.

Materials and Methods

Approval for this study was granted by the Ethics Committee of the
Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
(CAAE 36405614.4.0000.0021). Forty-five mandibular premolars
with complete root formation, which were extracted for orthodontic
or periodontal reasons, were selected for this study. Soft tissues and
the calculus were removed from the teeth. Next, all of the crowns
were removed, and the root lengths were standardized at 12 mm.
The working length was determined to be 1 mm shorter from the apical
foramen.
The biomechanical preparation was performed using the Reciproc
System (VDW, Munich, Germany) powered by an electric motor (VDW)
in reciprocal movement. The root canals were enlarged up to the R40
file size. The irrigant used was 5% sodium hypochlorite of approximately 20 mL per root canal. Before the obturation, passive ultrasonic
irrigation was applied with an Irrisonic tip (Helse Dental Technology,
S~ao Paulo, SP, Brazil), which was activated by an ultrasonic EMS device
(Hu-Friedy, Chicago, IL). Then, the root canals were dried with absorbent paper points, and AH Plus sealer (Dentsply, York, PA) was manipulated according to the manufacturers instructions. In sequence, the
samples were divided into 3 groups (n = 15) in accordance with the
obturation techniques: TC, TH, and TT.

Description of the Obturation Techniques

All of the devices analyzed were handled according to the manufacturers instructions.
TC. First, the wall of the canal was coated with a thin layer of endodontic
sealer as far as the working length with a paper point. Next, the guttapercha alfa skirts were placed inside the electrical heater in which
they had been plasticized by heat induction. The next step was to fill a
small #25 or #40 gutta condenser (Dentsply Maillefer, Ballaigues,
Switzerland) with the plasticized gutta-percha, and the set was introduced
up to 1 mm before the working length. A micromotor was activated in the
sequence at its fastest speed and was withdrawn to the exterior of the root
canal with slow pistonlike movements. After the conclusion of the filling,
a smooth vertical condensation was performed with a cold hand plugger
to take up any shrinkage that might have occurred upon cooling.
TH. Before obturation, the plugger (0.08) was fitted, and the apical
binding point was determined to be 5 mm shorter than the working
length. A master cone #40 of medium size (Odous, de Deus, Brazil)
was fitted to the working length, coated with AH Plus sealer, and placed
in the canal. Each gutta-percha cone was seared at the orifice. TH was set
to 10 potency, and the tip of the plugger was placed into the canal orifice
beside the master cone and was heat activated. The plugger was advanced
through the gutta-percha until it reached the apical binding point. Then,
the heat of the plugger was inactivated, and apical pressure was maintained on the plugger in this position for 5 seconds to avoid any shrinkage
because of the cooling gutta-percha. After 5 seconds, heat was activated
for 1 second, and the plugger was quickly removed from the canal.
TT. A master cone #40 of fine-medium size (Odous) was fitted to the
working length, coated with a minimal amount of root canal sealer
(AH Plus), and placed in the canal. Subsequently, a size 25 fine finger
spreader was selected and introduced within 2 mm of the working length.
Fine accessory XF cones (Dentsply Maillefer) coated with the sealer were
1132

Beraldo et al.

Analysis of Heat Changes on the External Root Surface

The study was performed at room temperature. The temperature
at the mesial aspect of the external root surface was recorded every
5 seconds during the heating and cooling phases using a K
chromium-aluminum thermocouple (Omega Engineering Inc, Stamford, CT) attached to the coronal, middle, and apical root levels with
wax (New Wax; Technew, Rio de Janeiro, RJ, Brazil), and then this
set was fitted to a clamp to perform the obturation technique.
With the recorded temperatures, the evaluation of the effect of the
technique, the temperature level, and both the technique and the temperature in relation to the change of the initial and highest temperatures
reached were analyzed by 2-way analysis of variance, and Tukey posttests were used to perform multiple comparison tests. The statistical
software used was SigmaPlot, version 12.5 (Systat Software Inc, San
Jose, CA), at a significance level of 5%.

Results
The values of the initial and highest temperature recorded in each
third of the evaluated root surface are shown in Table 1. The results of
the temperature difference between the highest temperature and the
initial temperature in each third of the root surface for the techniques
used are shown in Table 2 and Figure 1. In relation to the temperature
difference between the highest temperature and the initial temperature,
there was a significant difference between the performed techniques
(P < .001) of the evaluated thirds or the root surface (P < .001) as
well as an interaction between these 2 factors (P < .001). In the multiple
comparisons (Tukey post-test) at the cervical third, the temperature
rise of the TC technique was observed to have statistically significant differences related to the other 2 evaluated techniques (P < .05). At the
middle third, the temperature rise was different among all of the assessed techniques. TC was the lowest followed by TH and TT
(P < .05). On the other hand, for the apical third, there was no difference among the 3 evaluated techniques (P > .05).
In the comparison of the root surface thirds, the temperature rise
of the TH technique at the cervical and middle thirds was significantly
higher than that recorded for the apical third (Tukey post-test,
P < .05). TT showed a temperature rise that was higher than that of
TABLE 1. Mean (standard deviation) of the Initial and Highest Temperature
Recorded for Each Technique on the Cervical, Middle, and Apical Thirds
Third
Techniques
Touchn Heat
Initial temperature
Highest
temperature
Tagger
Initial temperature
Highest
temperature
TC
Initial temperature
Highest
temperature

Cervical

Middle

Apical

27.91  0.38 28.06  0.42 27.98  0.42

37.15  0.45 35.76  0.60 30.69  0.38
26.12  0.14 26.16  0.17 26.22  0.17
33.82  0.68 37.96  1.29 29.82  0.39
27.53  0.53 27.74  0.58 27.74  0.60
29.58  0.69 29.93  0.70 29.93  0.69

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Basic ResearchTechnology
TABLE 2. Mean (standard deviation) of the Results Regarding the Difference
between the Highest and Initial Temperature for Each Technique on the
Cervical, Middle, and Apical Thirds
Third
Techniques

Cervical

Middle

Apical

Touchn Heat 9.25  0.40Aa 7.70  0.80Ba 2.71  0.23Ab

Tagger
7.69  0.68Ab 11.80  1.28Aa 3.60  0.38Ac
TC
2.05  0.51Ba
2.19  0.56Ca 2.19  0.54Aa
The different capital letters in the columns represent statistically significant differences among the
techniques used in each third as analyzed by the Tukey post-test (P < .05). The different small letters
in each line represent statistically significant differences among the root surface thirds in the evaluated techniques as analyzed by the Tukey post-test (P < .05).

the cervical and apical thirds (P < .05). Moreover, the increase
observed at the cervical third was higher than the apical third in TT
(P < .05). Finally, in the TC technique, there was no observed difference
among the other evaluated thirds (P > .05).

Discussion
The thermoplasty for the gutta-percha techniques results in a
temperature rise inside the root canal that is dissipated to the external
root surface. It was reported that the temperature rise can potentially
cause damage to the surrounding tissues (18). This heating varies according to the technique used, and if the heat rises above 10 C in the
human body, blood flux will be stopped and bone necrosis will occur.
Therefore, a 10 C rise is the limit for preserving surrounding dental
tissues (14, 19).
K chromium-aluminum thermocouples were used in this study
to measure the heat generated inside the root canal and transmitted
to the external root surface. The thermocouples can measure temperatures between 200 C and 1200 C both inside the root canal and at
the external root surface (10, 11, 20). The use of thermocouples
allows the temperature to be monitored at specific points, thus
facilitating the comparison among different root thirds (10). On the
other hand, the thermocouples do not measure all the external root
surface, and there is not a way to customize the sample in relation
to the dentin thickness, which is inversely proportional to the temperature rise in the outer root surface (21). However, facing the surveyed
14
Temperature's difference (degrees
Celsius)

12

TH

TT

TC

10
8
6
4
2
0
Cervical

Middle
Third

Apical

Figure 1. The differences between the highest and initial temperatures for
each technique on the cervical, middle, and apical thirds. The columns
show the mean, and the bars show the standard deviation. The different capital
letters represent statistically significant differences among the techniques in
each third analyzed by the Tukey post-test (P < .05). The different small letters
in a line represent statistically significant differences among the thirds in each
technique as evaluated by the Tukey post-test (P < .05).

JOE Volume 42, Number 7, July 2016

methodologies, the thermocouples seem to be the most appropriate

resource for this kind of experiment.
Infrared cameras are also used to measure the temperature
changes on the external root surface (2224). However, the camera
calibration for emissivity of the root tissue, distance from the root to
the camera, and ambient temperature are difficult variables to
control (25). Hence, thermocouples were applied because they are
easy to handle and are able to very accurately measure temperature
changes on the external root surface (25, 26).
The results showed that there was a temperature variation (27). In
the present study, the root surface of the specimens was left totally
exposed at room temperature. The initial tooth temperature was not
equal to the body temperature (37 C). In an in vitro investigation,
the interval of the recorded temperature is a linear process. Thus,
the difference in degrees Celsius could be compared as if the initial temperature was 37 C (28).
The mechanical thermoplasticizing TT showed the highest temperature change (11.8 C). In this technique, the temperature increase is
related to the rise in the speed of the gutta condenser (29). Although
the velocity of the gutta condenser was standardized at 10,000 rpm, in
this study, this technique exceeded the 10 C limit. These data are worrisome because the mechanical thermoplasticizing technique depends on
a high velocity and a minimum time of approximately 5 to 10 seconds for
its execution; otherwise, thermoplasticization cannot occur.
The TH technique did not exceed the temperature limit. On the other
hand, it was found to have a temperature variation of more than 10 C
when TH was evaluated on mandibular incisors, which have a thinner layer
of dentin than the mandibular premolars used in this study (11). This also
supported and confirmed that the dentin thickness is inversely proportional to the temperature rise in the outer root surface (21).
To date, there has not been any research performed with the TC
technique in relation to root heating and its consequences. TC is a Brazilian system that is similar to the Microseal System (SybronEndo, Orange, CA), with the difference being that the TC system does not use a
master cone and only uses a thermoplasticized gutta-percha. This technique presented the lowest temperature changes, and a hypothesis is
that these results occurred because the gutta-percha had been previously plasticized. In this way, the friction produced and time spent inside the root canal by the gutta condenser were shortened, and, thus, it
dissipated less heat to the outer root surface (17).
The temperature change at the cervical third for TH and TT was
higher than for TC. These data show that the devices applied to plasticize
the gutta-percha inside the root canal could lead to a large temperature
rise. At the middle third, TT presented the highest temperature variation
because of the time of use of the gutta condenser and the large volume of
the gutta-percha that was plasticized (1, 30). The variation of
temperature at the apical third was the lowest and was similar among
the techniques. One explantation for this observation may be that the
devices used to plasticize the gutta-percha do not reach that region in
the TH technique and TT (10, 15). In the case of the TC technique,
the gutta condenser reached that point but did not account for the
temperature rise that was previously described.
The measurement of the temperature rise at the root surface
in vitro is necessary to suggest if it can produce an irreversible thermal
damage to the supporting periodontal structures when the techniques
evaluated are applied in vivo. The present work was performed
in vitro; because of this, there are some limitations inherent to this
type of study, but the data obtained guide the use of safer obturation techniques in relation to the temperature rise. This kind of in vitro study is
very important to suggest that heating on the external root surface can
occur in vivo. This research may promote further exploration from other
investigators to develop new methodologies in vivo or the evaluation of a
External Root Surfaces and Thermoplastic Filling Techniques

1133

Basic ResearchTechnology
series of cases in which obturation thermoplastic techniques were used
and their relation to pathologies like root resorption and chronic postoperative pain in teeth endodontically treated are studied.
The results obtained in this in vitro study suggest that more investigations should be performed, mainly in teeth with large-diameter canals and thin dentinal walls that are obturated with heated tips or by
instruments that cause friction inside the root canal.

13.
14.
15.
16.

Conclusions
According to these results, there was a temperature rise on the
external root surface for all 3 techniques. TC showed the lowest temperature rise.

Acknowledgments

17.
18.
19.

The authors deny any conflicts of interest related to this study.

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