The fate of root canals obturated with Thermafil: 10-year data for patients treated in a master’s program

  • Pirani ChiaraEmail author
  • Zamparini Fausto
  • Ove A. Peters
  • Iacono Francesco
  • Gatto Maria Rosaria
  • Generali Luigi
  • Gandolfi Maria Giovanna
  • Prati Carlo
Original Article



Retrospective description of the 10-year success rate of endodontic treatments with Thermafil (TF).

Materials and methods

Patients treated by postgraduate students in an Endodontics Master’s Program (2006–2008) were enrolled. All treated root canals were filled with TF and AH Plus. Teeth satisfying the inclusion criteria (206 teeth in 89 patients) were reexamined clinically and radiographically to estimate a 10-year survival and periapical health. Demographic and medical data were registered; collected information included pre-, intra-, and postoperative variables. Teeth were classified as “healthy” (PAI ≤ 2 in absence of signs/symptoms), “endodontically diseased” (presenting at least one of the following: PAI ≥ 3, signs/symptoms, retreated in the course of the follow-up, or extracted for endodontic reasons), or “non-endodontically diseased” (extracted for non-restorable fractures or periodontal disease). For teeth lost during the 10-year follow-up, details and reason of extraction were analyzed. Two PAI-calibrated examiners assessed outcomes blinded to preoperative status. Bivariate and multilevel analyses were performed (α level set at 0.05).


At 10 years, 179 (87%) teeth survived and 27 were extracted: 20 for non-endodontic reasons (excluded from success analysis) and 7 for endodontic reasons (considered “endodontically diseased”). Multilevel analysis revealed that the probability of extraction was increased by the presence of preoperative pain (odds ratio = 6.720; 95% confidence interval, 1.483–30.448) and by maxillary location (odds ratio = 2.950; 95% confidence interval, 1.043–8.347). Concerning periapical status, 159/186 teeth (85%) were assessed as “healthy.” Multilevel analysis confirmed that maxillary location (odds ratio = 3.908; 95% confidence interval, 1.370–11.146), presence of flare up (odds ratio = 9.914; 95% confidence interval, 2.388–41.163), and fracture occurrence (odds ratio = 35.412; 95% confidence interval, 3.366–372.555) decreased the odds of healing, respectively.


After 10 years, teeth filled with Thermafil in a specialist master’s program presented a survival and a periapical health comparable to cohorts where root canals were filled with other obturation techniques.

Clinical relevance

Carrier-based techniques provide time savings for clinicians while satisfying clinical quality criteria for the root filling and consequently the clinical outcome.


Carrier-based system Clinical outcome Long term Retrospective study Survival 



The work was supported by the Master of Clinical Endodontology, School of Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.

Compliance with ethical standards

Conflict of interest

Chiara Pirani declares that she has no conflict of interest. Fausto Zamparini declares that he has no conflict of interest. Ove Peters serves as a consultant to Dentsply Sirona. Francesco Iacono declares that he has no conflict of interest. Maria Rosaria Gatto declares that she has no conflict of interest. Luigi Generali declares that he has no conflict of interest. Maria Giovanna Gandolfi declares that she has no conflict of interest. Carlo Prati declares that he has no conflict of interest.

Ethical approval

All procedures performed in the present study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


Although a variety of Dentsply products have been provided to the University of Bologna as part of Dentsply’s global “School Grant Program,” Dentsply was neither aware of this study nor informed of the results prior to publication. Dr. Ove Peters serves as a consultant to Dentsply Sirona.


  1. 1.
    European Society of Endodontology (2006) Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J 39:921–930CrossRefGoogle Scholar
  2. 2.
    Johnson WB (1978) A new gutta-percha technique. J Endod 4:184–188CrossRefPubMedGoogle Scholar
  3. 3.
    Mirfendereski M, Roth K, Bing F, Dubrowski A, Carnahan H, Azarpazhooh A, Basrani B, Torneck CD, Friedman S (2009) Technique acquisition in the use of two thermoplasticized root filling methods by inexperienced dental students: a micro-CT analysis. J Endod 35:1512–1517CrossRefPubMedGoogle Scholar
  4. 4.
    Lipski M (2000) Comparative study on the efficacy of root canal filling with gutta-percha by lateral condensation and Thermafil obturators. Ann Acad Med Stetin 46:317–330PubMedGoogle Scholar
  5. 5.
    Gagliani MA, Cerutti A, Bondesan A, Colombo M, Godio E, Giacomelli G (2004) A 24-month survey on root canal treatment performed by NiTi engine driven files and warm gutta-percha filling associated system. Minerva Stomatol 53:543–554PubMedGoogle Scholar
  6. 6.
    Chu CH, Lo ECM, Cheung GSP (2005) Outcome of root canal treatment using Thermafil and cold lateral condensation filling techniques. Int Endod J 38:179–185CrossRefPubMedGoogle Scholar
  7. 7.
    Özer SY, Aktener BO (2009) Outcome of root canal treatment using soft-core and cold lateral compaction filling techniques: a randomized clinical trial. J Contemp Dent Pract 10:74–81PubMedGoogle Scholar
  8. 8.
    Hale R, Gatti R, Glickman GN, Opperman LA (2012) Comparative analysis of carrier-based obturation and lateral compaction: a retrospective clinical outcomes study. Int J Dent. CrossRefGoogle Scholar
  9. 9.
    Qureshi B, Munir B, Akbar I (2012) A comparison of Thermafil and lateral condensation techniques in obturation of root canal system. Pak Oral Dental J 32:531–534Google Scholar
  10. 10.
    Demirci GK, Çalişkan MK (2016) A prospective randomized comparative study of cold lateral condensation versus core/gutta-percha in teeth with periapical lesions. J Endod 42:206–210CrossRefGoogle Scholar
  11. 11.
    Pirani C, Friedman S, Gatto MR, Iacono F, Tinarelli V, Gandolfi MG, Prati C (2017) Survival and periapical health after root canal treatment with carrier-based root fillings: five-year retrospective assessment. Int Endod J 51:e178–e188. CrossRefPubMedGoogle Scholar
  12. 12.
    Brothman P (1980) A comparative study of vertical and lateral compaction of gutta-percha. J Endod 7:27–30CrossRefGoogle Scholar
  13. 13.
    Venturi M, Di Lenarda R, Prati C, Breschi L (2005) An in vitro model to investigate filling of lateral canals. J Endod 31:877–881CrossRefPubMedGoogle Scholar
  14. 14.
    Clinton K, Van Himel T (2001) Comparison of a warm gutta-percha obturation technique and lateral condensation. J Endod 27:692–695CrossRefPubMedGoogle Scholar
  15. 15.
    Collins J, Walker MP, Kulild J, Lee C (2006) A comparison of three gutta-percha obturation techniques to replicate canal irregularities. J Endod 32:762–765CrossRefPubMedGoogle Scholar
  16. 16.
    Farzaneh M, Abitbol S, Friedman S (2004) Treatment outcome in endodontics: the Toronto study. Phase I and II: orthograde retreatment. J Endod 30:627–633CrossRefPubMedGoogle Scholar
  17. 17.
    Ricucci D, Russo J, Rutberg M, Burleson JA, Spångberg LS (2011) A prospective cohort study of endodontic treatments of 1369 root canals: results after 5 years. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112:825–842CrossRefPubMedGoogle Scholar
  18. 18.
    Fransson H, Dawson VS, Frisk F, Bjørndal L, Kvist T (2016) Survival of root-filled teeth in the Swedish adult population. J Endod 42:216–220CrossRefPubMedGoogle Scholar
  19. 19.
    Lumley PJ, Lucarotti PSK, Burke FJT (2008) Ten-year outcome of root fillings in the general dental service in England and Wales. Int Endod J 41:577–585CrossRefPubMedGoogle Scholar
  20. 20.
    World Medical Association Declaration of Helsinki (2000) Ethical principles for medical research involving human subjects. JAMA 284:3043–3045CrossRefGoogle Scholar
  21. 21.
    Löe H (1967) The gingival index, the plaque index and the retention index systems. J Periodontol 38(Suppl):610–616CrossRefGoogle Scholar
  22. 22.
    Ørstavik D, Kerekes K, Eriksen HM (1986) The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol 2:20–34CrossRefPubMedGoogle Scholar
  23. 23.
    Kirkevang LL, Væth M, Hörsted-Bindslev P, Bahrami G, Wenzel A (2007) Risk factors for developing apical periodontitis in a general population. Int Endod J 40:290–299CrossRefPubMedGoogle Scholar
  24. 24.
    Bergenholtz G, Kvist T (2013) Call for improved research efforts on clinical procedures in endodontics. Int Endod J 46:697–699CrossRefPubMedGoogle Scholar
  25. 25.
    Hussein FE, Liew AKC, Ramlee RA, Abdullah D, Chong BS (2016) Factors associated with apical periodontitis: a multilevel analysis. J Endod 42(10):1441–1445CrossRefPubMedGoogle Scholar
  26. 26.
    Prati C, Pirani C, Zamparini F, Gatto MR, Gandolfi MG (2018) A 20-year historical prospective cohort study of root canal treatments. A Multilevel analysis. Int Endod J 51:955–968. CrossRefPubMedGoogle Scholar
  27. 27.
    Bergenholtz G (2016) Assessment of treatment failure in endodontic therapy. J Oral Rehabil 43:753–758CrossRefPubMedGoogle Scholar
  28. 28.
    Aqrabawi JA (2006) Outcome of endodontic treatment of teeth filled using lateral condensation versus vertical compaction (Schilder’s technique). J Contemp Dent Pract 7:17–24PubMedGoogle Scholar
  29. 29.
    Tang W, Wu Y, Smales RJ (2010) Identifying and reducing risks for potential fractures in endodontically treated teeth. J Endod 36:609–617CrossRefPubMedGoogle Scholar
  30. 30.
    Caplan DJ, Kolker J, Rivera EM, Walton RE (2002) Relationship between number of proximal contacts and survival of root canal treated teeth. Int Endod J 35:193–199CrossRefPubMedGoogle Scholar
  31. 31.
    Stoll R, Betke K, Stachniss V (2005) The influence of different factors on the survival of root canal fillings: a 10-year retrospective study. J Endod 31:783–790CrossRefPubMedGoogle Scholar
  32. 32.
    Ng YL, Mann V, Gulabivala K (2010) Tooth survival following non-surgical root canal treatment: a systematic review of the literature. Int Endod J 43:171–189CrossRefPubMedGoogle Scholar
  33. 33.
    Dammaschke T, Steven D, Kaup M, Reiner KH (2003) Long-term survival of root-canal-treated teeth: a retrospective study over 10 years. J Endod 29:638–643CrossRefPubMedGoogle Scholar
  34. 34.
    Mindiola MJ, Mickel AK, Sami C, Jones JJ, Lalumandier JA, Nelson SS (2006) Endodontic treatment in an American Indian population: a 10-year retrospective study. J Endod 32:828–832CrossRefPubMedGoogle Scholar
  35. 35.
    Fonzar F, Fonzar A, Buttolo P, Worthington HW, Esposito M (2009) The prognosis of root canal therapy: a 10-year retrospective cohort study on 411 patients with 1175 endodontically treated teeth. Eur J Oral Implantol 2:201–208PubMedGoogle Scholar
  36. 36.
    Burry JC, Stover S, Eichmiller F, Bhagavatula P (2016) Outcomes of primary endodontic therapy provided by endodontic specialists compared with other providers. J Endod 42:702–705CrossRefPubMedGoogle Scholar
  37. 37.
    Landys Borén D, Jonasson P, Kvist T (2015) Long-term survival of endodontically treated teeth at a public dental specialist clinic. J Endod 41:176–181CrossRefPubMedGoogle Scholar
  38. 38.
    Pratt I, Aminoshariae A, Montagnese TA, Williams KA, Khalighinejad N, Mickel A (2016) Eight-year retrospective study of the critical time lapse between root canal completion and crown placement: its influence on the survival of endodontically treated teeth. J Endod 42:1598–1603CrossRefPubMedGoogle Scholar
  39. 39.
    Pirani C, Iacono F, Gatto MR, Fitzgibbon RM, Chersoni S, Shemesh H, Prati C (2017) Outcome of secondary root canal treatment filled with Thermafil: a 5-year follow-up of retrospective cohort study. Clin Oral Invest 22:1363–1373. CrossRefGoogle Scholar
  40. 40.
    Vire DE (1991) Failure of endodontically treated teeth: classification and evaluation. J Endod 17:338–342CrossRefPubMedGoogle Scholar
  41. 41.
    Salehrabi R, Rotstein I (2004) Endodontic treatment outcomes in a large patient population in the USA: an epidemiological study. J Endod 30:846–850CrossRefPubMedGoogle Scholar
  42. 42.
    Yan W, Montoya C, Øilo M, Ossa A, Paranjpe A, Zhang H, Arola D (2017) Reduction in fracture resistance of the root with aging. J Endod 43:1494–1498CrossRefPubMedGoogle Scholar
  43. 43.
    Ng YL, Mann V, Gulabivala K (2011) A prospective study of the factors affecting outcomes of nonsurgical root canal treatment: part 2: tooth survival. Int Endod J 44:610–625CrossRefPubMedGoogle Scholar
  44. 44.
    Peters OA, Barbakow F, Peters CI (2004) An analysis of endodontic treatment with three nickel-titanium rotary root canal preparation techniques. Int Endod J 37:849–859CrossRefPubMedGoogle Scholar
  45. 45.
    Pirani C, Chersoni S, Montebugnoli L, Prati C (2015) Long-term outcome of non-surgical root canal treatment: a retrospective analysis. Odontology 103:185–193CrossRefPubMedGoogle Scholar
  46. 46.
    Gandolfi MG, Parrilli AP, Fini M, Prati C, Dummer PM (2013) 3D micro-CT analysis of the interface voids associated with Thermafil root fillings used with AH Plus or a flowable MTA sealer. Int Endod J 46:253–263CrossRefPubMedGoogle Scholar
  47. 47.
    Liang YH, Li G, Wesselink PR, Wu MK (2011) Endodontic outcome predictors identified with periapical radiographs and cone-beam computed tomography scans. J Endod 37:326–331CrossRefPubMedGoogle Scholar
  48. 48.
    Tourè B, Faye B, Kane AW, Lo CM, Niang B, Boucher Y (2011) Analysis of reasons for extraction of endodontically treated teeth: a prospective study. J Endod 37:1512–1515CrossRefPubMedGoogle Scholar
  49. 49.
    Lupi-Pegurier L, Bertrand MF, Muller-Bolla M, Rocca JP, Bolla M (2002) Periapical status, prevalence and quality of endodontic treatment in an adult French population. Int Endod J 35:690–697CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Pirani Chiara
    • 1
    Email author
  • Zamparini Fausto
    • 1
  • Ove A. Peters
    • 2
  • Iacono Francesco
    • 1
  • Gatto Maria Rosaria
    • 1
  • Generali Luigi
    • 3
  • Gandolfi Maria Giovanna
    • 1
  • Prati Carlo
    • 1
  1. 1.Endodontic Clinical Section, School of Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM)Alma Mater Studiorum University of BolognaBolognaItaly
  2. 2.Arthur A. Dugoni School of DentistryUniversity of the PacificSan FranciscoUSA
  3. 3.Department of Surgery, Medicine, Dentistry and Morphological Sciences with Transplant Surgery, Oncology and Regenerative Medicine Relevance, School of Dentistry, Endodontic SectionUniversity of Modena and Reggio EmiliaModenaItaly

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