Microleakage of endodontically treated teeth with different dowel systems

Comparison of the Effect for Fracture Resistance of Different Coronally Extended Post Length with Two Different Post Materials

Aims and Objectives:

To compare the effect for fracture resistance of different coronally extended post length with two different post materials.

Materials and Methods:

One hundred and sixty endodontically treated maxillary central incisors embedded in acrylic resin with decoronated root portion were taken for the study. The postspaces were prepared according to standard protocol. The samples were divided into two groups according to the post material: glass-fiber post and Quartz fiber post. These groups were further subdivided on the basis of coronal extension of 4 and 6 mm for glass fiber and Quartz fiber posts, respectively. The posts were then luted with dual-polymerizing resin cement followed by core buildup. Samples were subjected to increasing compressive oblique load until fracture occurred in a universal testing machine. Data were analyzed with one-way ANOVA and independent Student's t-test. Analysis was done using SPSS version 15 (SPSS Inc., Chicago, IL, USA) Windows software program.

Results:

Glass fiber post with coronal extension of 4 mm (182.8 N) showed better results than with 6-mm length (124.1 N). Similarly, in quartz fiber posts group, 4-mm postlength (314 N) was better when compared with 6 mm (160 N). The 4-mm coronal extension of quartz fiber post displayed superior fracture resistance.

Conclusions:

Glass fiber posts showed better fracture resistance than Quartz fiber posts. 4-mm coronal length showed more fracture resistance than 6 mm.

Direct Composite Resin Veneers in Nonvital Teeth: A Still Viable Alternative to Mask Dark Substrates

Direct composite resin veneers are a practical esthetic restorative treatment for reestablishing the shape and color of affected anterior teeth. The present clinical case reports aim to describe restorative treatment techniques for nonvital anterior teeth presenting color alteration. The direct composite resin layering technique has proven to be an efficient method for recovering the esthetics of darkened teeth. The direct vs indirect restorative treatments are debated as well. Clinical follow-ups of the presented case reports demonstrate that direct composite resin restorations are not affected by the darkened tooth substrate over time.

Coronal Microleakage of Teeth Restored with Cast Posts and Cores Cemented with Four Different Luting Agents after Thermocycling

PURPOSE

The apical seal provided by a root canal filling may be breached via coronal leakage. This study aimed to compare the teeth restored with custom-made cast metal posts and cores cemented with different luting agents in terms of coronal microleakage after thermocycling.

MATERIALS AND METHODS

This in vitro study was conducted on 32 extracted single-canal teeth. Root canals were prepared by step-back technique and filled with gutta percha and sealer. The coronal 7 mm of gutta percha was removed, and post space was prepared using peeso reamers #2 and #3 consecutively. After fabricating the acrylic resin patterns of the posts and cores, they were cast using Ni-Cr metal alloy. The specimens were divided into 4 groups in which the castings were cemented using one of the following luting agents: zinc phosphate (ZP), glass ionomer (GI), Panavia F 2.0, and Speed CEM. After cementation, the teeth were immersed in distilled water and incubated for 7 days. Then, the teeth were subjected to thermocycling, immersed in silver nitrate for 6 hours, and finally sectioned. The degree of dye penetration into the coronal part of the specimens was measured using a stereomicroscope. Data were analyzed using Kruskal-Wallis and Mann-Whitey U tests with significance level of 0.05.

RESULTS

The median microleakage in ZP, Speed CEM, GI, and Panavia were 171.89, 114.76, 26.51, and 20.02 μm, respectively. Pairwise comparisons among GI and ZP, GI, and Speed CEM, ZP and Panavia, ZP and Speed CEM, and Panavia and Speed CEM groups yielded significant differences (p < 0.05).

CONCLUSION

Complete coronal seal was not achieved with any of the luting agents. The highest and the lowest degree of microleakage was yielded by ZP and Panavia luting agents, respectively.

All about Dowels - A Review Part I. Considerations before Cementation

The optimal way of restoring a non vital tooth with dowel-core technique has long been a controversial matter. The purpose of this review was to assess the factors that may influence the successful restoration of root filled teeth with root canal dowels. The first part of the review discusses indications and physical parameters of dowel. Searches were performed in PubMed/Medline database using single or combined key words to obtain the most relevant list of references. Articles selected in the search process were obtained from the journals and reviewed with every aspect of dowel system for reconstruction of endodontically treated teeth. Medline search showed 228 articles for dowels but after applying exclusion criteria, only 51 articles remained to be included in Part I of this review. Out of which, 49 were in vitro studies and two were clinical studies. Reviewing the literature revealed that clinical data is still missing. Literature emphasizes that dowels should only be used for the retention of core material and not in view of reinforcing the remaining tooth structure. The dowel length is limited by the apical seal of four mm to six mm. Dowel width should be as small as possible. Canal configuration determines the selection between prefabricated and custom cast dowel. Fiber based dowel may be clinically appropriate for restoration of endodontically treated anterior tooth, although clinical studies are lacking.

Influence of fiber post cementation length on coronal microleakage values in vitro and finite element analysis

AIM

This study aims to evaluate, the Influence of different fiber posts cementation lengths by finite element analysis (FEA) and coronal microleakage.

MATERIALS AND METHODS

Fifty anterior bovine teeth were sectioned to obtain roots with 16 mm length. The coronal length of the post was 6 mm for all groups, while the radicular length were varied 6, 8, 10 or 12 mm. The fiber posts surfaces were cleaned with alcohol and silanized. Then the posts were cemented using a two steps total etch-and-rinse adhesive system + conventional resin cement. Forty teeth were submitted to mechanical cycling (45°; 2.000.000 cycles; 90N; 4Hz; 37°C) and ten teeth with radicular length of 12 mm was not submitted, ser ving as c ontrol. So, the experimental design was composed by different ratios of post coronal length/post radicular length and mechanical cycling (MC): Gr1- 1/1 + MC; Gr2- 3/4 + MC; Gr3- 3/5 + MC; Gr4- 1/2 + MC. All groups were immersed in a 1% toluidine blue solution. After 24 hours, the teeth were longitudinally sectioned and the microleakage scores was given by a blind operator. Data were submitted to Kruskal-Wallis test (p = 0.05). The experimental variables were simulated in two-dimensional finite element analysis (2D-FEA). The maximum principal stress distributions were compared.

RESULTS

No difference was observed in microleakage values between the cycled groups, whilst the control groups showed the lowest values. FEA analysis showed similar maximum principal stress distribution between the groups.

CONCLUSION

Mechanical cycling affected the values of coronal microleakage and different cementation length generated similar values of coronal microleakage and stress distribution.

CLINICAL SIGNIFICANCE

These results showed that from the microleakage point of view, more conservative cementation lengths have the same effect as longer cementation lengths.

Microleakage of teeth restored with different adhesive dowel systems: an in vitro study

PURPOSE

Commercial fiber-reinforced dowel systems are marketed as having better adhesion and sealing ability than conventional metallic dowel systems. The aim of this in vitro study was to evaluate the microleakage of teeth restored with nine dowel systems.

MATERIALS AND METHODS

Ninety mandibular second premolar teeth were decoronated, and nine homogenous groups were composed of ten teeth each. Root canal and dowel space preparations were made, and eight fiber-reinforced composite dowel systems and one stainless steel dowel system were used to fabricate dowel restorations. Microleakage measurements of the restored teeth were made with a modified fluid filtration method, and data were collected. One sample Kolmogorov-Smirnov, one-way ANOVA, and Tukey-HSD tests were performed on the relative microleakage data of the groups.

RESULTS

Microleakage values were reported relative to those for teeth with unfilled canals. The highest and lowest relative microleakage values were recorded for the metallic Parapost (7.06 × 10(-4) %) and fiber-reinforced Everstick (3.55 × 10(-4) %) groups, respectively. Significant differences in relative microleakage between the fiber-reinforced dowels and stainless steel dowels were observed. Significant differences among the fiber-reinforced dowel groups were observed as well.

CONCLUSIONS

The sealing ability of all fiber-reinforced composite dowels is not better than that of stainless steel dowels, and there are significant differences among different fiber-reinforced dowel systems as well. Differences among commercial dowel systems must be taken into consideration when making a selection.

Effects of different luting cements and light curing units on the sealing ability and bond strength of fiber posts

This study evaluated the sealing ability and push-out bond strength of two luting cements cured with two different types of light curing units (LCU): light-emitting diode (LED) versus quartz tungsten halogen (QTH). Forty teeth were divided into four groups(n=10/group). Quartz fiber posts (D. T. Light-Post) were luted to coronal or apical section of root canals using two types of resin cements (Panavia F or RelyX) cured with either LED LCU (Elipar FreeLight II) or QTH LCU (Optilux 501). Highest push-out bond strength was exhibited by QTH-cured RelyX, which was not significantly different from LED-cured RelyX but was higher than QTH-cured Panavia F. The push-out bond strength of Panavia F did not differ with LCU type (p>0.05), but exhibited lower values than both QTH- and LED-cured RelyX. Fluid filtration test revealed that sealing ability was not influenced by luting cement type, but was significantly influenced by LCU type in favor of QTH light source: QTH-cured specimens displayed better seal than LED-cured ones (p<0.05).

Microleakage of endodontically treated teeth restored with 3 different adhesive systems and 4 different fiber-reinforced posts

STATEMENT OF PROBLEM

Despite recent advances in adhesive dentistry, fiber-reinforced post/resin cement/dentin adhesive combinations are not able to prevent microleakage. While studies have examined microleakage in endodontically treated teeth restored with posts and cores, microleakage among post and adhesive systems remains a concern.

PURPOSE

This study compared the sealing properties of 4 adhesively luted post systems: glass fiber, quartz-glass fiber, zirconia-glass fiber and polyethylene fiber posts.

MATERIAL AND METHODS

Forty-eight permanent maxillary central incisors were divided into 4 groups (n=12). Post space was prepared and each post was adhesively luted with 1 of 3 systems: a 1-stage self-etch, a 2-stage total-etch, and a 3-stage total-etch adhesive. The specimens were separately immersed in freshly prepared 2% methylene blue solution for 1 week. The cleaned specimens were then embedded in autopolymerizing acrylic resin. The teeth were horizontally sectioned into apical, middle, and coronal portions. An occlusal view of each section was digitally photographed with a stereomicroscope. The methylene blue-infiltrated surface for each specimen was measured and data were collected with software. Dye penetration was estimated as the ratio of the methylene blue-infiltrated surface to the total dentin surface. Nonparametric data were analyzed with the Kruskal-Wallis test (α=.05). The Mann-Whitney U-test was used to compute multiple pairwise comparisons that identified differences among groups. Dentin-luting agent and post interfaces were evaluated with a scanning electron microscope.

RESULTS

Significant differences in adhesive and post systems were observed in all sectioned regions (P<.05). There were significant differences between the apical and coronal sections of each post type, and between the following pairs: middle versus coronal sections of zirconia-glass fiber and glass fiber posts and apical versus middle sections of quartz-glass fiber and polyethylene fiber posts (P<.05). No significant differences were found among post types. The variables of middle section and 3-stage adhesive produced significant differences in microleakage between the following post pairs: zirconia-glass fiber versus quartz-glass fiber, zirconia-glass fiber versus polyethylene fiber, and quartz-glass fiber versus polyethylene fiber (P<.05).

CONCLUSIONS

The 3-stage adhesive and zirconia-glass fiber posts demonstrated the least microleakage.

Clinical evaluation of carbon fiber reinforced carbon endodontic post, glass fiber reinforced post with cast post and core: A one year comparative clinical study

Aim:

Restoring endodontically treated teeth is one of the major treatments provided by the dental practitioner. Selection and proper use of restorative materials continues to be a source of frustration for many clinicians. There is controversy surrounding the most suitable choice of restorative material and the placement method that will result in the highest probability of successful treatment. This clinical study compares two different varieties of fiber posts and one cast post and core in terms of mobility of crown margin under finger pressure, recurrent caries detected at the crown margin, fracture of the restoration, fracture of the root and periapical and periodontal pathology requiring crown removal over the period of 12months as evaluated by clinical and radiographical examination.

Materials and Methods:

30 root canal treated, single rooted maxillary anterior teeth of 25 patients in the age range of 18–60 years where a post retained crown was indicated were selected for the study between January 2007 and August 2007; and prepared in a standard clinical manner. It was divided into 3 groups of 10 teeth in each group. After post space preparation, the Carbon fiber and Glass fiber reinforced posts were cemented with Scotch bond multipurpose plus bonding agent and RelyX adhesive resin cement in the first and second groups respectively. The Cast post and cores were cemented with Zinc Phosphate cement in the third group. Following post- cementation, the preparation was further refined and a rubber base impression was taken for metal-ceramic crowns which was cemented with Zinc Phosphate cement. A baseline periapical radiograph was taken once each crown was cemented. All patients were evaluated after one week (baseline), 3 months, 6 months and one year for following characteristics mobility of crown margin under finger pressure, recurrent caries detected at the crown margin, fracture of the restoration, fracture of the root and periapical and periodontal pathology.

Results:

Results after 12 months showed that none of the restorations among groups of cast post and core, carbon fiber reinforced post and glass fiber reinforced post with composite core restorations failed in terms of recurrent caries detected at the crown margin, fracture of the restoration, fracture of the root and periapical and periodontal pathology. One case of cast post and core and one case of carbon fiber reinforced post with composite core restorations showed slight mobility of crown margin under finger pressure at 12^th month recall but all the cases of glass fiber post with composite core restorations did not show any signs of mobility of crown margin under finger pressure at all the recall periods on clinical and radiographical examination.

Conclusion:

From this 12 months clinical evaluation of all the cases in the 3 groups comprising of cast post and core; carbon fiber reinforced post with composite core and glass fiber reinforced post with composite core restored with porcelain fused to metal crowns, it is concluded that glass fiber reinforced post with composite core when used in single rooted upper anterior teeth are associated with a higher success rate in restoration of endodontically treated teeth.

Restoration of endodontically treated teeth review and treatment recommendations

Coronal restorations and posts can positively influence the long-term prognosis of teeth following root canal therapy. Final sealing the canal by placing an appropriate post and core will minimize leakage of oral fluids and bacteria into the periradicular area and is recommended as soon as possible after completion of root canal filling. Glass ionomer or MTA placed over the residual root canal filling after post space preparation may be effective to prevent bacterial leakage. A ferrule of 1-2 mm of tooth tissue coronal to the finish line of the crown significantly improves the fracture resistance of the tooth and is more important than the type of the material the core and post are made of.

Bonding effectiveness and sealing ability of fiber-post bonding

OBJECTIVES

To evaluate the push-out bond strength and the sealing ability of five adhesive cements routinely used for fiber-post bonding.

METHODS

Fifty extracted single-rooted teeth were randomly divided in five groups and restored using Parapost FiberLux and the following luting agents: Panavia 21 (PAN), Clearfil Esthetic Cement (CLF), Variolink II (VAR), RelyX Unicem (UNI) and experimental GC self-adhesive cement (EGC). After 1 week of water storage at 37 degrees C, three sections (coronal, middle and apical) of 2mm thickness were prepared from each specimen. Sealing ability was quantified with a fluid-filtration system (Flodec) during 10 min, after which the push-out bond strength was immediately measured. Data were analyzed with ANOVA (push-out) and Kruskal-Wallis (sealing ability).

RESULTS

The push-out bond strength and sealing ability were not significantly different among the coronal, middle and apical sections for each luting agent. The highest push-out bond strength was measured for CLF (14.60+/-3.63 MPa), which was not significantly different from PAN (12.57+/-2.45 MPa), but significantly higher than VAR (11.09+/-4.09 MPa), UNI (11.29+/-4.31 MPa) and EGC (7.65+/-4.79 MPa). When evaluating the sealing ability, significant differences were not found among PAN, CLF and VAR, and between UNI and EGC. The latter luting agents scored significantly lower than the former ones. The push-out bond strength was correlated to the sealing ability (p<0.001).

SIGNIFICANCE

The self-etching MDP-based cements presented the highest push-out bond strength. Although the bonding effectiveness of self-adhesive cements appears promising, their interaction with root dentin might be too weak to minimize microleakage at the post-cement-dentin interface.

Microleakage in Overflared Root Canals Restored with Different Fiber Reinforced Dowels

Based on the in vitro results of this study, restoration of a tooth with an overflared root canal, using individually shaped polyethylene reinforced dowels, may help to reduce microleakage.

Microleakage and fracture patterns of teeth restored with different posts under dynamic loading

STATEMENT OF PROBLEM

Many studies concerned with the microleakage of endodontically treated teeth restored with posts and cores and subjected to loading can be found in the literature. However, no studies have investigated microleakage under dynamic loading with simultaneous dye penetration, which is more relevant to clinical situations.

PURPOSE

The purpose of this study was to compare microleakage and to classify fracture patterns of endodontically treated teeth restored with various post systems under dynamic loading.

MATERIAL AND METHODS

The crown portions of 40 human mandibular incisors were sectioned at the cementoenamel junction, and the teeth were endodontically treated. Teeth were divided into 4 groups (n=10): teeth restored with a cast post and core, prefabricated metal post (ParaPost), fiber-reinforced composite resin post (FRC Postec), and ceramic post (Cosmopost). After preparing the post space, each post was cemented with dual-polymerized resin cement (DuoLink). With the exception of the cast post-and-core group, the cores were formed directly using a light-polymerized composite resin (Light-Core). An intermittent load of 98 N at 1 Hz was applied for 50,000 cycles at an angle of 135 degrees to the long axis of the restored teeth, which were immersed in a 0.5% basic fuchsin solution. The ratio of the dyed surface area to the total area of the sectioned root surface was determined using an image analysis program. The data were analyzed by a 1-way ANOVA and Duncan's multiple range test (alpha =.05). The fracture patterns of the teeth were classified according to their fracture propagation lines.

RESULTS

The cast post group showed a significantly higher level of microleakage compared to the other groups (P=.001). Regarding the failure mode, the FRC Postec and Cosmopost groups showed fracture patterns that would favor retreatment. The number of cycles of repeated loading was not significantly different among the groups (P=.161).

CONCLUSIONS

Both FRC Postec and Cosmopost groups showed less microleakage under dynamic loading and fracture patterns favoring a retreatment of fractured specimens.

Evaluation of the apical seal after intraradicular retainer removal with ultrasound or carbide bur

There are situations in which intraradicular retainers have to be removed and replaced. The objective of this research was to evaluate the apical seal after the removal of a custom cast post and core with a carbide bur or with an ultrasound apparatus. Twenty five roots of extracted human incisors were used. They were endodontically treated and prepared to receive the posts. The posts and cores were cast with 2 types of dental alloys, CuAlZn and PdAg, and were cemented with zinc phosphate cement. After 24 hours, they were removed using the two above mentioned techniques. Then, the roots had their external surface made impermeable by two layers of cyanoacrylate adhesive, leaving only the cervical area for dye penetration. The teeth were immersed in rhodamine for 24 hours. They were then cut and observed under an optical microscope and analyzed with appropriate software (Imagelab). The results were submitted to ANOVA, and they evidenced that, regarding the alloy factor, PdAg posts presented a larger mean infiltration value (2.23 ± 0.48 mm) as compared to the posts made of CuAlZn (1.39 ± 0.48 mm) (p = 0.025). Regarding the technique factor, there was no significant difference (p = 0.9) between the removal of the intraradicular retainer using ultrasound (1.99 ± 0.62 mm) or using a rotating cutting instrument (1.62 ± 0.62 mm). Under these experimental conditions, it was possible to conclude that the degree of apical leakage was directly related to the alloy type, and it was present in both techniques used.

Sealing properties of two contemporary single-cone obturation systems

AIM

To compare the sealing of root canals filled with two single-cone obturation systems and a warm vertical compaction technique.

METHODOLOGY

Forty-two single-rooted teeth were decoronated to obtain 17-mm-long root segments. The root canals were cleaned and shaped to size 40, 0.06 taper and filled with: (i) warm vertical compaction with AH Plus (control); (ii) ActiV GP and (iii) GuttaFlow with single master cones. Leakage was evaluated by fluid filtration at 10 psi before root resection, and after 3, 6, 9 and 12 mm apical resections. Repeated measures anovas on ranks and Dunn's multiple comparison tests were performed to examine differences in fluid flow rates amongst different resection lengths for each filling technique. The surface and interior aspects of glass-ionomer filler-coated ActiV GP gutta-percha cones was evaluated with SEM.

RESULTS

No statistical difference amongst the filling techniques was seen at 0 and 3 mm root resections. ActiV GP and GuttaFlow exhibited more leakage than AH Plus at 6, 9 and 12 mm resections. AH Plus recorded the best overall results. A nonhomogeneous coating of glass-ionomer fillers on the surface of ActiV GP cones was detected.

CONCLUSIONS

The two single-cone techniques examined are as effective in sealing the apex as AH Plus when the latter was used with warm vertical compaction. It is further hypothesized that the inferior coronal seal of these single-cone techniques may be improved with the placement of accessory cones to reduce sealer thickness or an immediate coronal adhesive restoration.

Bond strength between root dentin and three glass-fiber post systems

STATEMENT OF PROBLEM

Glass-fiber posts were introduced for use after endodontic therapy instead of metal alloy and ceramic posts. There are several new types of glass-fiber post systems available, but little is known about how well these posts bond to the root surface.

PURPOSE

The purpose of this in vitro study was to compare the bond strengths of 3 different types of glass-fiber post systems-opaque, translucent, and electrical glass-in 3 different locations of prepared post spaces.

MATERIAL AND METHODS

Sixty human intact single-rooted extracted teeth were used. The root canals were prepared using a step-back technique and obturated with gutta-percha using lateral condensation. The roots were divided into 3 experimental groups and further divided into 2 subgroups according to testing time (n=10). Roots were restored with 1 of the following post systems according to the manufacturer's instructions: opaque glass-fiber posts (Snowpost), translucent glass-fiber posts (FiberMaster), and electrical glass-fiber posts (Everstick). A self-etching primer (Clearfil Liner Bond) was applied to the walls of the post spaces, allowed to etch for 30 seconds, and gently air dried. A dual-polymerized bonding agent (Clearfil Liner Bond, Bond A and B) was then applied to the same walls. A dual-polymerizing resin luting agent (Panavia F) was mixed for 20 seconds and then placed in the post spaces using a lentulo spiral instrument. The roots were placed in light-protected cylinders; then the light source was placed directly on the flat cervical tooth surfaces and the cement was polymerized. Specimens were stored in light-proof boxes for 24 hours or 1 week after the polymerization procedure. Each root was cut horizontally, and six 1-mm-thick root segments (2 apical, 2 middle, and 2 cervical) were prepared. Using a push-out test, the bond strength between post and dentin was measured after 24 hours or 1 week using a universal testing machine. Statistical analysis was performed with 3-way ANOVA followed by independent t tests (alpha=.05) to detect differences between groups defined by the specific interacting variables. The different combinations of posts and luting material from the cervical segments were analyzed with SEM.

RESULTS

The 3-way ANOVA indicated that push-out test values varied significantly according to the post system used (opaque, electrical, and translucent) (P<.01); the root segments (cervical, middle, and apical) (P<.01), however, did not vary statistically according to the time of testing (24 hours and 1 week). Opaque and electrical glass-fiber posts showed higher bond strength values than translucent posts (P<.01). Push-out bond strength values of cervical segments were significantly higher than the middle and apical segments in translucent and electrical glass-fiber post groups (P<.01). In the opaque glass-fiber post group, there were no significant differences between cervical and middle segments. In SEM analysis, a distinct hybrid zone with long, numerous resin tags located between luting material and dentin was exhibited in all post systems.

CONCLUSION

The opaque and electrical glass-fiber posts exhibited similar bond strengths, and translucent posts exhibited the lowest bond strength. The highest bond strength was observed in the cervical third of the post spaces for translucent and electrical glass-fiber post groups.

Sealing properties of different resin-based root canal sealers

In this study, a comparison of the sealing properties of three different resin-based sealers, AH26, Diaket, and EndoREZ with those of the root canal sealer zinc oxide-eugenol-based U/P Root Canal Sealer was performed. Eighty extracted single-rooted human mandibular first premolar teeth were used. The coronal part of each tooth was removed at the apical 17-mm of roots. The root canals were prepared to a size 7 with ProFile 0.06 taper Series 29 rotary instruments in a crown-down manner before lateral condensation of gutta-percha with the tested sealers (n = 20). A fluid filtration method was used for quantitative evaluation of apical leakage. Statistical analysis revealed that there were no significant differences between the resin-based sealers groups (AH26, Diaket, and EndoREZ) (p > 0.05). U/P Root Canal Sealer, zinc oxide-eugenol-based sealer, leaked significantly more than other tested groups (p < 0.05). Under the limitations of this study, resin-based root canal sealers were found more effective in sealing root canals than the zinc oxide-eugenol-based sealer.