Push-out stress for fibre posts luted using different adhesive strategies

The effect of carbodiimide on push-out bond strength of fiber posts and endogenous enzymatic activity

BACKGROUND

To investigate the effect of 0.3 M 1-ethyl-3(3-dimethylaminopropyl) carbodiimide (EDC) aqueous solution pretreatment on push-out bond strength (PBS) and matrix-metalloproteinases (MMPs) activity within radicular dentin when different post cementation strategies were employed.

METHODS

One hundred and twenty monoradicular human teeth were endodontically treated and randomly divided into six groups, depending on the cementation strategy and root dentin pretreatment (n = 20): EAR: cementation with an etch-and-rinse adhesive (LuxaBond Total Etch, DMG) and resin cement (LuxaCore Z Dual, DMG); EAR/EDC: 1 min EDC pretreatment after etching + EAR; SE: cementation with a self-etch primer (Multilink Primer, Ivoclar Vivadent) and corresponding cement (Multilink Automix, Ivoclar Vivadent); SE/EDC: self-etch primer + EDC pretreatment + SE; SA: cementation with a universal self-adhesive cement (RelyX Universal, 3 M); SA/EDC: EDC pretreatment + SA. Slices were submitted to PBS test and interfacial nanoleakage evaluation 24 h after cementation or after thermocycling (40.000 cycles, 5-55 °C). To investigate the effect of EDC on MMPs activity, 4 additional first maxillary premolars per group were processed for in situ zymography analysis. Multivariate ANOVA and post hoc Tukey tests were used to analyze PBS values. The data from in situ zymography were analyzed with Kruskal-Wallis test and Dunn's pairwise multiple comparison procedures (α = 0.05).

RESULTS

The variables "EDC pretreatment", "root region" and "thermocycling" significantly influenced PBS (p < 0.05), while the variable "cementation strategy" had no influence (p > 0.05). Thermocycling significantly reduced PBS in SE and SA groups (p < 0.05). EDC was effective in preserving PBS after artificial aging. EDC pretreatment significantly reduced enzymatic activity at baseline in EAR and SE groups, and in SA group after thermocycling (p < 0.05).

CONCLUSIONS

The use of EDC prevents the reduction of bond-strength values after artificial aging and silences endogenous enzymatic activity within radicular dentin when different cementation strategies were employed.

Dental Fiber-Post Systems: An In-Depth Review of Their Evolution, Current Practice and Future Directions

The field of dental medicine is constantly evolving and advancing toward minimally invasive techniques. Several studies have demonstrated that bonding to the tooth structure, particularly enamel, yields the most predictable results. In some instances, however, significant tooth loss, pulpal necrosis, or irreversible pulpitis may limit the options available to the restorative dentist. In these cases, placement of a post and core followed by a crown is the preferred treatment option, provided all requirements are met. This literature review provides an overview of the historical development of dental FRC post systems as well as a comprehensive examination of the currently available posts and their bonding requirements. In addition, it offers valuable insights for dental professionals seeking to understand the current state of the field and the prospects of dental FRC post systems.

Effect of sodium/calcium hypochlorite on adhesion and adaptation of fiber posts luted with a dual resin cement

This study aimed to evaluate the effect of different concentrations of sodium hypochlorite (NaOCl) and calcium hypochlorite [Ca(OCl)2] on the bond strength and adaptation of glass fiber posts luted with a dual-curing resin cement. Fifty decoronated premolars were sectioned 14 mm from the apex and endodontically treated. The root canal filling was partially removed. The specimens were divided into 5 groups (n=10) according to the irrigant for post space irrigation: 0.9% sodium chloride (NaCl), (control); 2.5% NaOCl; 5.25% NaOCl; 2.5% Ca(OCl)2; and 5.25% Ca(OCl)2. For each group, irrigation was performed with 5 ml of solution. Afterward, the posts were luted with a dual-curing resin cement. One slice from each third was obtained and submitted to the push-out test and failure modes analysis. An additional slice from the middle third was submitted to confocal images for analysis of adaptation failures (gaps). Two-way ANOVA, Tukey's post-hoc, Kruskal-Wallis with Bonferroni adjusted, and chi-square tests, analyzed data. The group treated with 5.25% NaOCl showed lower bond strength values and generated more cohesive failures compared to the control (p < 0.05). Bond strength decreased from coronal to apical in the post space (p < 0.001). The groups treated with NaOCl had the highest percentages of gaps compared to the control (p < 0.05). Regardless of concentration, Ca(OCl)2 did not influence the bond strength and the occurrence of gaps (P > 0.05). Ca(OCl)2 is a good option for irrigating the post space before luting a fiber post with a dual-curing resin cement.

Effect of dentin moisture on the adhesive properties of luting fiber posts using adhesive strategies

The purpose of this study was to evaluate the effect of dentin moisture (moist and dry) on the bonding of fiber posts to root dentin with different adhesive strategies (etch-and-rinse, self-etch, and self-adhesive). Seventy-two extracted single-rooted human teeth were endodontically treated and divided into six groups (n = 12) according to the moisture of dentin surface and adhesive systems as follows: a) etch-and-rinse/moist, b) etch-and-rinse/dry, c) self-etch/moist, d) self-etch/dry, e) self-adhesive/moist, and 6) self-adhesive/dry. The specimens were sectioned into six slices for push-out bond strength (BS), nanoleakage (NL) by SEM, and Vickers microhardness (VHN) of the resin cement. A universal testing machine (AG-I, Shimadzu Autograph) was used at a crosshead speed of 0.5 mm/min until post extrusion, with a load cell of 50 kg for evaluation of the push-out strength. Data on BS, NL, and VHN were evaluated by two-way ANOVA and Tukey's test (α = 0.05). Dentin moisture as the main factor was not significantly different for the push-out test. However, higher BS values can be observed for the etch-and-rinse group. A lower percentage of NL was found in the dry dentin groups. The moisture pattern was not significant in the hardness values for the pre-etching groups. Additional moisture did not increase the evaluated properties.

Influence of Conventional Polymer, Hybrid Polymer and Zinc Phosphate Luting Agents on the Bond Strength of Customized Zirconia Post in Premolars-An In-Vitro Evaluation

The aim was to identify the influence of conventional polymeric resin based cement (RC), hybrid polymer modified glass ionomer (RMGIC) and Zinc phosphate cement (ZPC) on the pull out strength of the customized zirconia post in premolars. Access cavity and root canals were performed in sixty premolar teeth with the standardized crown down technique (ProTaper Universal, Dentsply). Post space impressions were scanned, and the pre-sintered Zenostar Zr Translucent blanks (Weiland Dental, Pforzheim) were milled with the Opera-system to form the post. All prepared specimens were divided equally in three groups based on the cement type employed for luting as follows: group A: ZPC; group B (GC Fuji PLUS Capsule): RMGIC; group C (and RC (3M RelyX ARC). Ten specimens in each group were thermocycled (TC) at 5 and 55 °C in distilled water baths (40,000 cycles). Pull out bond strength was assessed using a universal testing machine at 0.5 mm/min. The means and standard deviations were compared using ANOVA and Tukey Kramer multiple comparisons tests. A significant difference among the cement groups as well as between TC and non-thermocycled (NTC) groups (p < 0.05) was observed. The highest tensile stress was demonstrated among group C (Resin, 69.89 ± 4.81 (NTC), 64.06 ± 4.36 (TC)) with the least in group A, (zinc phosphate, 43.66 ± 5.02 (NTC), 37.70 ± 5.10 (TC)) for both groups. Group A presented with 100% adhesive bond failures, followed by 80% in group C and 70% in group B, respectively. A similar outcome was observed in the TC group for the cement; however, unlike the NTC group, the TC group showed more cohesive failures compared to the NTC mixed failure. Dual cure polymer based cement demonstrated higher bond strength and efficient adhesive bonding of the customized Zr post with root dentine compared to zinc phosphate (non-polymeric) and RMGIC (hybrid polymer). Thermocycling compromised Zr post adhesive bonding to root dentin.

Influence of glass fiber post design and luting cements on ease of post removal and fracture strength of endodontically retreated teeth: An in vitro study

Aims and Objectives:

The aim of this study was to evaluate the time needed to remove two types of glass fiber posts cemented with two different cements and removed with two different techniques and to evaluate the fracture strength of teeth after post removal.

Materials and Methods:

Root canal treatment was completed in 80 extracted single-rooted premolars and the teeth were decoronated. Following canal preparation, the roots were coated with polysiloxane impression material and embedded in acrylic resin cubes. The specimens were randomly divided into eight experimental groups (n = 10) based on the type of fiber post inserted: Reforpost (R) or Contec Blanco (C); luting cement: Multilink-N/self-etch (M) or G-Cem/self-adhesive (G); technique of removal: Peeso reamer (P); or ultrasonic (U). The posts were removed with respective technique under magnification and the time (in seconds) of post removal was determined. Following post removal, the fracture strength of the specimens was determined using a universal testing machine. The mode of failure was also determined. Data were analyzed by three-way analysis of variance (ANOVA), one-way ANOVA, Tukey’s post hoc test, t test, and correlation. Chi-square analysis was performed to compare the failure mode. Statistical significance was set at P < 0.05.

Results:

The post and cement types had an influence in post removal time (P < 0.05). There was no role of post or cement types on the fracture strength of teeth after post removal with either technique (P > 0.05). A weak negative correlation was found between the post removal time and fracture resistance for both Peeso reamer (r = –0.373) and ultrasonic (r = –0.177) techniques. Both techniques of post removal produced a majority of favorable failures (P > 0.05).

Conclusion:

The type of post and luting cement plays a significant role in ease of post removal by Peeso reamer or ultrasonic technique. Post-removal technique had no effect on the fracture strength of teeth. Parallel serrated fiber post luted with self-etch resin cements was difficult to remove as compared with parallel smooth surface post luted with self-etch or self-adhesive resin cement.

Push-Out Bond Strength Evaluation of Fiber-Reinforced Composite Resin Post Cemented with Self-Adhesive Resin Cement Using Different Adhesive Bonding Systems

The purpose of this in vitro study was to evaluate the push-out bond strength of fiber-reinforced resin posts using self-adhesive cements with different adhesive systems. A total of 50 single-rooted human maxillary premolars with fully developed apices and 15–16 mm straight root canals were selected. The teeth were divided into 10 groups with coronal and apical parts according to the adhesive bonding system and luting material used: one universal adhesive with MDP-containing self-adhesive resin cement; another universal adhesive with MDP-containing self-adhesive resin cement; universal primer with MDP-containing self-adhesive resin cement; universal primer with dual-cure resin cement; MDP-containing self-adhesive resin cement only (Control). Each specimen was subjected to a fatigue load of 600,000 cycles using a chewing simulator with sliding movement and cut horizontally for push-out bond strength testing. Statistical evaluation consisted of a one-way ANOVA test using SPSS v23.0. The highest bond strength (7.05 MPa) was obtained in the coronal part of the Single Bond universal group treated with MDP-containing self-adhesive resin cement and the lowest strength (4.77 MPa) was observed in apical part of MDP-containing self-adhesive resin cement group (Control). However, the one-way ANOVA results showed no significant difference between all 10 groups (p > 0.05). The self-adhesive cement without adhesive bonding showed no statistically different value compared to self-adhesive cements with adhesive bonding.

Effects of Surface Treatments of Glass Fiber-Reinforced Post on Bond Strength to Root Dentine: A Systematic Review

The objective of this systematic review was to determine the influence of surface treatment of glass fiber posts on bond strength to dentine. Laboratory studies were searched in MEDLINE, PubMed, Embase, PubMed Central, Scopus, and Web of Science search engine. All authors interdependently screened all identified articles for eligibility. The included studies were assessed for bias. Because of the considerable heterogeneity of the studies, a meta-analysis was not possible. Twelve articles were found eligible and included in the review. An assessment of the risk of bias in the included studies provided a result that classified the studies as low, medium, and high risk of bias. The available evidence indicated that the coronal region of the root canal bonded better to the glass fiber post than apical regions. Phosphoric acid, hydrogen peroxide, and silane application enhance post’s retentiveness. In light of the current evidence, surface treatment strategies increase the bond strength of glass fiber post to dentine. However, recommendations for standardized testing methods and reporting of future clinical studies are required to maintain clinically relevant information and to understand the effects of various surface treatment of glass fiber post and their bond strength with dentine walls of the root canal.

Adhesive Durability Inside the Root Canal Using Self-adhesive Resin Cements for Luting Fiber Posts

OBJECTIVES

The aim of the study was to investigate the effects of various self-adhesive resin cements on the push-out bond strengths and nanoleakage expression at the luting interfaces of fiber posts immediately and after one year of aging.

METHODS AND MATERIALS

One hundred forty-four extracted human anterior teeth were endodontically treated. After post space preparation, fiber posts were luted using five commercially available self-adhesive resin (SAR) cements and a core build-up material applied with a self-etch adhesive (BF: Bifix SE/Rebilda Post, VOCO; CSA: Clearfil SA Cement/Rely X Fiber Post, 3M ESPE; RX: RelyX Unicem 2/Rely X Fiber Post, 3M ESPE; SPC: Speed Cem/FRC Postec, Ivoclar Vivadent; SMC: Smart Cem/X Post, Dentsply; RB: Rebilda DC-Futurabond/Rebilda Post; n=22). For each group, half of the specimens were subjected to thermocycling (TC) (5°C-55°C, 10,000 cycles) and stored humid for one year at 37°C. Push-out bond strength data of six slices (thickness 1 mm) per root and nanoleakage expression of representative specimens were evaluated after 24 hours (baseline) and after TC and storage for one year (aging), respectively.

RESULTS

Bond strength differed significantly among resin cements (p<0.0005) and the location inside the root canal (p<0.0005), but not by aging (p=0.390; repeated-measures analysis of variance). SMC (14.6±5.8 MPa) and RX (14.1±6.8 MPa) revealed significantly higher bond strength compared to BF (10.6±5.4 MPa) and RB (10.0±4.6 MPa) but differed not significantly from SPC (12.8±4.8) MPa; CSA (6.1±4.6 MPa) revealed significantly lower bond strength compared to all other investigated materials (p<0.05; Tukey Honestly Significantly Different). Qualitative nanoleakage analysis revealed more silver deposits at the interface in all groups after aging. For CSA, a large amount of silver deposits inside the cement was also observed at baseline and after aging.

CONCLUSIONS

Fiber post luting using SAR cements demonstrated reliable bond strengths. Product-specific differences and initial degradation effects could be demonstrated.

Hydrogen bonds of a novel resin cement contribute to high adhesion strength to human dentin

OBJECTIVE

The detachment of fiber posts from root canals is primarily caused by the loss of adhesion between dentin and cement; therefore, the purpose of this study was to formulate a novel resin cement that improves the bond strength of fiber posts to the dentin-cement interface.

METHODS

Three concentrations (30, 35, and 40wt.%) of bis[2-(methacryloyloxy)-ethyl] phosphate (2MP) were prepared as dentin bonding agent components. Isobornyl acrylate (IBOA) and ethylhexylacrylate (EHA) were used as key components to fabricate the resin cement (named IE cement). The adhesive strengths of IE cement to coronal and root canal dentin were tested after placement of specimens in a water bath at 100% humidity and 37°C for either 24h or 5 months. The microtensile bond test, the push-out bond test, and the fracture toughness test were performed. Four commercially available resin cements (Nexus(®) third generation (NX3), Variolink II, RelyX Unicem, and Panavia F 2.0) were used for comparisons. X-ray photoelectron spectroscopy (XPS) was used to analyze the interaction of collagen extracted from human dentin and 2MP as well as the fracture surfaces of the specimens submitted to the microtensile bond test.

RESULTS

The 35% concentration of 2MP, in combination with IBOA and EHA, was the most effective for improving the IE cement's bond strength to dentin. The XPS results revealed that the phosphate groups of 2MP formed hydrogen bonds with the collagen and that such bonds prominently decreased in number in the specimens that were stored for 5 months.

SIGNIFICANCE

The combination of 2MP, IBOA, and EHA can effectively increase the adhesive strength of IE cement to dentin via hydrogen bond formation.

Influence of periodontal ligament simulation on bond strength and fracture resistance of roots restored with fiber posts

Objective

Considering that periodontal ligament simulation may influence the stress distribution over teeth restored with intraradicular retainers, this study aimed to assess the combined effect of mechanical cycling and periodontal ligament simulation on both the bond strength between fiber posts and root dentin and the fracture resistance of teeth restored using glass fiber posts.

Material and Methods

Ninety roots were randomly distributed into 3 groups (n=10) (C-MC: control; P-MC: polyether; AS-MC: addition silicone) to test bond strength and 6 groups (n=10) (C: control; P: polyether; AS: addition silicone, without mechanical cycling, and C-MC, P-MC and AS-MC with mechanical cycling) to test fracture strength, according to the material used to simulate the periodontal ligament. For the bond strength test, fiber posts were cemented, cores were built, mechanical cycling was applied (2×106 cycles, 88 N, 2.2 Hz, and 45º incline), and the teeth cut into 3 slices (2 mm), which were then subjected to the push-out test at 1 mm/min. For the fracture strength test, fiber posts were cemented, cores were built, and half of the groups received mechanical cycling, followed by the compressive strength (45° to the long axis and 1 mm/min) performed on all groups.

Results

Periodontal ligament simulation did not affect the bond strength (p=0.244) between post and dentin. Simulation of periodontal ligament (p=0.153) and application of mechanical cycling (p=0.97) did not affect fracture resistance.

Conclusions

The materials used to simulate the periodontal ligament did not affect fracture or bond strength, therefore periodontal ligament simulation using the tested materials could be considered optional in the conditions of the study.

Combined Characterization of the Time Response of Impression Materials via Traditional and FTIR Measurements

We investigated the temporal response of four dental impression materials, namely three siloxanes (Imprint 4, Flexitime, Aquasil) and one polyether (Impregum). The null hypothesis was that the nominal working times are confirmed by instrumental laboratory tests. We also aimed to identify alternative techniques with strong physical-chemical background for the assessment of temporal response. Traditional characterization was carried out by shark fin test device and durometer at both ambient and body temperature. Additionally, Fourier-transform infrared spectroscopy was performed at room temperature. From shark fin height and Shore hardness versus time the working time and the setting time of the materials were evaluated, respectively. These were in reasonable agreement with the nominal values, except for Impregum, which showed longer working time. Spectroscopy confirmed the different character of the two types of materials, and provided for Imprint 4 and Aquasil an independent evaluation of both evolution times, consistent with the results of the other techniques. Shark fin test and durometer measurements showed deviations in setting time, low sensitivity to temperature for Flexitime, and longer working time at higher temperature for Impregum. Deviations of working time appear in operating conditions from what specified by the manufacturers. Fourier-transform infrared spectroscopy can provide insight in the correlation between material properties and their composition and structure.

Effect of adhesive system on retention in posts comprising fiber post and core resin

The purpose of this study was to compare the retention of fiber-reinforced composite (FRC) posts luted with either conventional or self-adhesive resin cement. The FRC posts and core resin were built up in bovine teeth. The posts were luted with standard etch-andrinse cement, self-etch cement, or one of two self-adhesive cements. The samples were stored in water for 1 or 14 days or subjected to thermal cycling (TC). Retention value was measured with the pull-out test using a universal testing machine. Conventional adhesive resin cement yielded significantly greater retention than self-adhesive resin cement at 1 day. No significant difference was observed in retention among the adhesive systems tested at 14 days or after TC. During the early luting stage, self-adhesive resin cement yielded lower retention value than conventional resin cement. After 14 days storage or TC, retention was comparable to that with conventional resin cement.

Influence of luting agent translucency on fiber post retention

The aim was to assess the influence of cement translucency on the retentive strength of luted fiber posts. Twenty extracted human premolars were randomly divided into four equal groups, based on the combinations of materials to be tested. Two post types of the same size, shape, and chemical composition, but different light-transmission properties [Translucent post (TP) and Opaque post (OP)] were selected. The two post types were luted using the etch-and-rinse, light-curing adhesive in combination with two shades of the same resin cement of markedly different light-transmitting ability [Transparent shade (TS) and Opaque shade (OS)]. Early post retention was assessed using the thin-slice push-out test. Post type did not significantly influence post retention; however, cement translucency emerged as a relevant factor in intraradicular cementation, with the TS achieving higher push-out strengths. The between-factor interaction was also statistically significant; specifically, OP-OS yielded significantly lower retentive strengths than all the other groups. Post translucency did not influence post retention, provided that a highly translucent cement was utilized for luting.

Influence of cement type and thickness on polyfiber post adhesion

Introduction:

To evaluate the effect of two different post space diameters and related resin cement film thicknesses on the bond strength of a polyfiber post.

Materials and Methods:

A total of 48 premolars were randomly divided into two according to the post space diameter: 1.1 mm and 1.5 mm. Then each group was divided into three sub-groups according to luting cement used: RelyX U100, Panavia F2.0/ED primer, Clearfil SA cement. Spirapost was then luted into the canal using luting cements. Two slices were obtained from each root specimen. Push-out tests were performed. Data was analyzed with Kruskal-Wallis and Connover post-hoc and Mann-Whitney U-test (P < 0.05).

Results:

Push-out bond strength was found to vary significantly according to type of adhesive system and post space diameter size (P < 0.05). The self-adhesive resin cement RelyX U100 had significantly higher bond strengths compared with the other adhesive system (P < 0.05). The self-etch adhesive system (Panavia F2.0) showed significantly lower bond strengths compared with the other systems (P < 0.05). There was a significant interaction between the luting systems and post space diameter (P < 0.05).

Conclusion:

The increases in post space diameter significantly reduced the bond strength of Spirapost to root dentine for both groups.

Analysis of resin-dentin interface morphology and bond strength evaluation of core materials for one stage post-endodontic restorations

Purpose

Restoration of endodontically treated teeth using fiber posts in a one-stage procedure gains more popularity and aims to create a secondary monoblock. Data of detailed analyses of so called “post-and-core-systems” with respect to morphological characteristics of the resin-dentin interface in combination with bond strength measurements of fiber posts luted with these materials are scarce. The present study aimed to analyze four different post-and-core-systems with two different adhesive approaches (self-etch and etch-and-rinse).

Materials and Methods

Human anterior teeth (n = 80) were endodontically treated and post space preparations and post placement were performed using the following systems: Rebilda Post/Rebilda DC/Futurabond DC (Voco) (RB), Luxapost/Luxacore Z/Luxabond Prebond and Luxabond A+B (DMG) (LC), X Post/Core X Flow/XP Bond and Self Cure Activator (Dentsply DeTrey) (CX), FRC Postec/MultiCore Flow/AdheSE DC (Ivoclar Vivadent) (MC). Adhesive systems and core materials of 10 specimens per group were labeled using fluorescent dyes and resin-dentin interfaces were analyzed using Confocal Laser Scanning Microscopy (CLSM). Bond strengths were evaluated using a push-out test. Data were analyzed using repeated measurement ANOVA and following post-hoc test.

Results

CLSM analyses revealed significant differences between groups with respect to the factors hybrid layer thickness (p<0.0005) and number of resin tags (p = 0.02; ANOVA). Bond strength was significantly affected by core material (p = 0.001), location inside the root canal (p<0.0005) and incorporation of fluorescent dyes (p = 0.036; ANOVA). CX [7.7 (4.4) MPa] demonstrated significantly lower bond strength compared to LC [14.2 (8.7) MPa] and RB [13.3 (3.7) MPa] (p<0.05; Tukey HSD) but did not differ significantly from MC [11.5 (3.5) MPa].

Conclusion

It can be concluded that bond strengths inside the root canal were not affected by the adhesive approach of the post-and-core-system. All systems demonstrated homogenous hybrid layer formation and penetration into the dentinal tubules in spite of the complicating conditions for adhesion inside the root canal.

Effect of chlorhexidine and ethanol-wet bonding with a hydrophobic adhesive to intraradicular dentine

PURPOSE

To evaluate the effect of adjunctive application of ethanol-wet bonding and chlorhexidine (CHX) with a hydrophobic adhesive on bond durability of fibre posts to intraradicular dentine.

METHODS

Ninety-six extracted human teeth with a single root and root canal were prepared for post placement after endodontic treatment. The teeth were randomly divided into four groups (n=24) after etching and rinsing for rewetting: Group 1: water-wet bonding, Group 2: water-wet bonding with CHX, Group 3: ethanol-wet bonding and Group 4: ethanol-wet bonding with CHX. Teeth in Groups 1 and 2 were treated with either distilled water or distilled water with 2% CHX for 60 s; while teeth in Groups 3 and 4 were treated with either 100% ethanol or 100% ethanol with 2% CHX. Two coats of primer, followed by neat resin were applied and light-cured for 40 s. Fibre posts were luted to bonded root dentine using dual-cure resin cement. Bonded roots were subjected to push-out bond strength testing and interfacial nanoleakage evaluation after 24 h, 6 and 12 months of storage. Data were analyzed using 3-way ANOVA (rewetting solutions, time and post space regions) and SNK tests.

RESULTS

Groups 3 and 4 showed significantly (p<0.05) higher bond strengths and lower nanoleakage than Groups 1 and 2 after 12 months of ageing. Addition of 2% chlorhexidine to ethanol-wet bonding with a hydrophobic adhesive did not further improve the bonding of a fibre post to intraradicular dentine, when compared to ethanol-wet bonding alone after 12 months of ageing.

CLINICAL SIGNIFICANCE

Ethanol-wet bonding with a hydrophobic adhesive alone could improve the bond durability of fibre post to intraradicular dentine and therefore would increase the success rate of post and core restorations of endodontically treated teeth.

Fiber-post bond strength in canals obturated with a cross-linked gutta-percha core obturator

The aim of this in-vitro study was to evaluate the bond strength of fiber posts cemented in a root canal filled using various root-canal obturation techniques. A total of 33 monoradicular samples, treated endodontically, were randomly assigned to three groups according to the root-canal obturation technique: group 1, continuous-wave technique; group 2, plastic-obturator-core technique; and group 3, cross-linked gutta-percha obturator-core technique. Fiber posts were luted in each sample and each was sectioned perpendicular to the post axis. The push-out test was performed using a universal machine and the maximum failure load was recorded in MPa mm(-2) . Several samples were randomly chosen for scanning electron microscopy evaluation. The mean debris and dentinal tubule-opening scores were calculated separately in the coronal and apical portions. Bond strength was significantly higher in group 1 than in groups 2 and 3. Debris scores were significantly higher in the apical portion of groups 2 and 3 than in group 1. Within the limitations of this study it can be affirmed that thermoplasticized alpha gutta-percha seemed to worsen the cleaning of post-space walls and hence reduced fiber-post bond strength.

Effect of Operator Experience on the Outcome of Fiber Post Cementation With Different Resin Cements

Objectives

To evaluate the influence of operator experience (dentist vs student) and cementation system (Adper Scotchbond Multi-Purpose [SBMP] + RelyX ARC [1]; Adper Single Bond 2 [SB] + RelyX ARC [2] and RelyX U100 [3]) on the push-out bond strength (BS) of fiber post to radicular dentin.

Materials and Methods

The roots of 48 extracted human maxillary central incisors were prepared and divided into six groups (n=8), according to combination of the above factors. Glass fiber posts were cemented in accordance with the instructions of the manufacturer of each cementation system. After water storage at 37°C for one week, the roots were cross-sectioned into six 1-mm thick slices and the push-out test was performed (0.5 mm/min). Data were statistically analyzed by two-way analysis of variance and Tukey tests (α=0.05). The BS results obtained by dentist and student for each cementation system were compared using the Student t-test (α=0.05).

Results

Higher BS means were observed for the expert operators, irrespective of the cementation system used (p=0.006). RelyX U100 showed the highest bond strength, but it did not differ from SBMP + RelyX ARC. The Student t-test revealed that only RelyX U100 was not affected by the operator's experience.

Conclusion

Within the limitations of this in vitro study, it can be concluded that the self-adhesive cement RelyX U100 showed the highest bond strength to the root canal in the student's group, and its performance was not affected by the operator's experience.

Preliminary analysis of physiological changes of nursing students during training

Long-term exposure to stress has been associated with chronic diseases, depression, and immune disorders. The precise detection and assessment of stress depends on personalized physiological monitoring and assessment of influence of personal and workplace factors We monitored nursing students during training on a high fidelity simulator in the Real-time Physiological Monitoring Lab at the University of Alabama in Huntsville. In this paper we present the preliminary results of this pilot study. A total of 14 participants were recorded: 12 female and 2 male subjects, 23-46 years old with an average age of 32.8 years. We analyzed heart rate, Heart Rate Variability (HRV), respiration, and physical activity. The results indicate significant strain on subjects during simulation: heart rate increased 16.7%, from 82.8 to 96.6 bpm (p&#60;0.001), falling to a slightly increased level after the training session (84.9 bpm); Root Mean Square of Successive RR Differences (RMSSD) decreased from 38.9 ms to 37.7 ms; the breathing rate increased during the simulation from 16.9 to 17.7 breaths/min. Distractions also significantly influenced physiological parameters: the first telephone call increased heart rate on average 9 bpm (p&#60;0.001), while the second call increased heart rate 8.6 bpm (p&#60;0.001). The simulated patient-related events created even more prominent response; the average heart rate increased 17.4 bpm (p&#60;0.001) at the onset of "patient in crisis" event. Real-time wearable monitoring may provide assessment of occupational stress.

Can the Cure Time of Endodontic Sealers Affect Bond Strength to Root Dentin?

The cure time of endodontic sealers may influence the bond strength of fiber posts to root dentin. Forty teeth were selected and endodontically filled using calcium hydroxide cement and then divided into 2 groups according to the time elapsed between endodontic filling and post luting (n = 20): Immediately - glass fiber post luting immediately after endodontic filling; and Delayed - post luting performed 7 days after endodontic filling. The roots were also subdivided according to resin cement used for post luting (RelyX ARC and RelyX Unicem). The specimens were stored at 37°C for 24 h and sectioned in six 1-mm-thick slices from cervical, middle and apical thirds. The slice specimens were submitted to a push-out test at a crosshead speed of 0.5 mm/min, and the bond strength values obtained (MPa) were submitted to two-way ANOVA in a split-plot arrangement and Tukey's test (α=0.05). For both RelyX ARC and Unicem, the bond strength was significantly higher when the posts were cemented 7 days after the endodontic treatment. RelyX Unicem showed significantly higher bond strength values than RelyX ARC for both cementation periods. It was concluded that post luting should be made after the complete setting of the root canal sealer. Self-adhesive resin cement should be preferred for fiber post luting.

Various irrigation protocols for final rinse to improve bond strengths of fiber posts inside the root canal

Irrigation after post space preparation and its effects on the bond strength of different adhesive strategies are still an issue of interest. The aim of the present study was to investigate the effects of various irrigation protocols (IPs) on the push-out bond strengths of fiber posts. One-hundred and fifty extracted human anterior teeth were divided into three groups (n = 50 each) and endodontically treated. The post space was irrigated before post placement using the following five IPs in each group: IP1 (control): 5 ml of distilled water; IP2: 5.25% sodium hypochlorite (NaOCl) applied with passive ultrasonic irrigation (PUI); IP3: 1% NaOCl applied with PUI; IP4: 18% ethylenediaminetetracetic acid (EDTA) followed by 5.25% NaOCl; and IP5: 2% chlorhexidine (CHX). Fiber posts placement in each group was performed using three different adhesive strategies. A self-etch adhesive system revealed higher bond strength (16.2 ± 6.9 MPa) compared with an etch-and-rinse adhesive (8.5 ± 4.2 MPa) and a self-adhesive resin cement (9.2 ± 4.7 MPa). The use of 18% EDTA/5.25% NaOCl increased the bond strength of the self-adhesive resin cement. Conversely, this IP decreased the bond strength for the etch-and-rinse adhesive system, whilst 1% NaOCl enhanced the bond strength for the same system. Consequently, each adhesive strategy may need to be adapted to a specific IP.

The effect of luting cement thicknesses on the push-out bond strength of the fiber posts

OBJECTIVE

The aim of this study was to evaluate the effect of luting cement thicknesses on the push-out bond strength of the fiber posts.

MATERIALS AND METHODS

Sixty human maxillary canine teeth were endodontically treated. Post spaces were prepared and root specimens randomly divided into three groups: Group 1: etch-and-rinse (Variolink II/Exite DSC), Group 2: self-etch (Panavia F2.0/ED primer) and Group 3: self-adhesive (Clearfil SA Cement). Then each group was divided into four sub-groups according to the cement thickness, as follows: Sub-group 1: 0.35 mm, Sub-group 2: 0.25 mm, Sub-group 3: 0.15 mm, and Sub-group 4: 0.05 mm. Three slices of 1 mm thickness were obtained from each root specimen (n = 15). Push-out tests were performed and data was analyzed with two-way ANOVA and Tukey tests.

RESULTS

The etch-and-rinse system (Variolink II) had a significantly higher bond strength compared with the other systems (p < 0.05). The thickest cement group (0.35 mm) had a significantly lower bond strength compared with the 0.15 and 0.05 mm groups in the etch-and-rinse and self-adhesive groups (p < 0.05). In the self-etch group, the cement thicknesses did not significantly affect the bond strength (p > 0.05).

CONCLUSIONS

The etch-and-rinse system offered better bonding to root dentine than the self-adhesive and self-etch systems. The increases in cement thickness significantly reduced the bond strength of fiber posts to root dentine for both the etch-and-rinse and self-adhesive systems.

Influence of cement thickness on the bond strength of tooth-colored posts to root dentin after thermal cycling

OBJECTIVE

The purpose of this study was to evaluate the effect of different resin cement thickness on the push-out bond strength of different posts (CAD/CAM zirconia post (ZR post)) and an individually formed glass fiber reinforced composite post (IPN post) prior to and after thermal cycling (TC).

METHODS

Post spaces with a height of 9 mm and a diameter of 1.5 mm were drilled in 80 mandibular premolar teeth. Two groups (n = 40) were formed according to the posts used (IPN posts or ZR posts). Then the specimens were randomly assigned into two sub-groups according to the post diameter: (1) 1.5 mm in diameter and (2) 1.2 mm in diameter (n = 20/per group). All posts were luted with a self-adhesive luting agent according to the manufacturer's instructions by using endo tips. Half of the samples (n = 10) were submitted to thermal cycling (5000 cycles, 5-55 °C). Thereafter, four 2-mm thick horizontal sections were obtained and subjected to push-out test. Failure modes were assessed quantitatively and morphologically. The data were statistically analyzed with a three-way analysis of variance (ANOVA) (p < 0.05). Statistical differences in failure modes were investigated by chi-square tests at a significance level of p < 0.05.

RESULT

Push-out bond strengths were significantly influenced both by the post diameter and thermal cycling. Larger (1.5 mm) diameter post results were statistically higher than 1.2 mm results (p < 0.05). Moreover, TC significantly increased the bond strength results (p < 0.05). There was no significant difference between ZR and IPN posts (p = 0.219).

CONCLUSION

The bond strengths of ZR and IPN posts were significantly decreased when the resin cement layer was thick. In addition, thermal cycling drastically influenced bond strengths of the tested post materials.

CLINICAL SIGNIFICANCE

The fit between tooth-colored endodontic posts and post spaces should be as tight as possible.

Effects of different surface pre-treatments on the bond strength of adhesive resin cement to quartz fiber post

OBJECTIVE

The purpose of this study was to evaluate the effect of mechanical and chemical surface treatment methods on the bond strength of resin cement to fiber post.

MATERIALS AND METHODS

The roots of 36 maxillary central incisor teeth were mounted in auto polymerized acrylic resin blocks (10 × 15 mm) and the root canals were enlarged with the drills of post system (2.1 mm width, 12 mm length). Thirty-six fiber posts were randomly assigned to one of the following surface conditioning methods: silane coupling agent, methylene chloride etching, 24% hydrogen peroxide etching, air abrasion with 50 µm Al(2)O(3), 1-3 µm synthetic diamond particles and silica coating with 30 µm SiO(x). Fiber posts were cemented to the root canals with adhesive resin cement (Panavia F 2.0). Three slices of 1.5 mm thick were obtained from each root. Push-out tests were performed with a universal testing machine. The data were analyzed with one-way analysis of variance (ANOVA) and Tukey HSD tests (α = 0.05). The effect of the surface treatments were examined under a scanning electron microscope (SEM) and surface roughness were evaluated with a profilometer.

RESULTS

Surface pre-treatment methods affected the bond strength (p < 0.05). The highest bond strengths were obtained by air abrasion with synthetic diamond particles, the lowest bond strength were obtained by etching with methylene chloride (p < 0.05).

CONCLUSION

Mechanical surface pre-treatment methods showed higher bond strength values than chemical methods. Synthetic diamond particles may be an alternative method to increase resin cement bonding on the quartz fiber post surfaces.

Push-out bond strength of an experimental self-adhesive resin cement

The adhesion of fiber posts luted with simplified adhesive systems has been a matter of great interest over the past years. The aim of this study was to assess the post retentive potential of experimental self-adhesive resin cement (EXP) when used alone and in combination with a self-etch adhesive. Fiber posts were placed in endodontically treated teeth and divided into four groups (n = 6) according the luting material, as follows: group 1 (EXP alone); group 2 (EXP used with self-etch adhesive); group 3 (marketed dual-cured cement used with self-etch adhesive); and group 4 (marketed self-adhesive cement). The push-out test was used to assess the retentive strength of fiber posts (expressed in MPa), and specimens were analyzed under a stereomicroscope to determine failure mode. The adhesive interface between the cement and root canal dentin for each group was evaluated using scanning electron microscopy. The post retentive potential of group 1 (EXP) (7.48 ± 4.35 MPa) was comparable with that of marketed cements from group 4 (6.79 ± 3.68 MPa) and group 3 (8.77 ± 4.58 MPa). When EXP was used in combination with self-etch adhesive (group 2), significantly higher push-out bond-strength values were measured (15.87 ± 4.68 MPa) compared with the other groups.

Real-time monitoring of occupational stress of nurses

Prolonged exposure to stress has been associated with chronic diseases, depression, and immune disorders. Stress perception is highly subjective. Assessment of occupational stress requires personalized physiological monitoring and timely collection of individual characterization of sources of stress. We implemented a wearable system for monitoring of occupational stress of nurses--UAHealth. Personal monitors are implemented on iPhone smartphones with Ant+ wireless interface. Interbeat intervals are collected from a chest belt, and step count and cadence from foot pod sensor. All data are processed in real-time on the phone to assess stress index. A 30-minute personalized maximum over predefined threshold initiates a questionnaire to collect assessment of sources of stress. In this paper we present system organization and preliminary results.

Effect of cleaning method, luting agent and preparation procedure on the retention of fibre posts

AIM

To investigate the effects of various cleaning methods, luting agents and preparation procedures on fibre post retention.

METHODOLOGY

In total, 156 human canines were allocated to twelve groups. Teeth were decoronated, instrumented and root filled using warm vertical gutta-percha compaction. Post space preparation was performed in 78 roots using the dedicated preparation drills of the DT Light Post SL system [group post drill (PD)]. Gutta-percha was removed from the other 78 roots using a round bur (RB) (group RB). Within each of these two groups, 26 root canals were rinsed with 1% NaOCl (control), 26 were cleaned using rotating brushes and pumice powder, and 26 were sandblasted with Al(2) O (3) (50 μm) using an intraoral device. Cleanliness of each root canal was investigated using an operating microscope (n = 24) and scanning electron microscope (n = 2). Fibre posts were inserted using self-adhesive resin cement (SmartCem2) or core build-up material (CoreX Flow/XP Bond). Pull-out force was measured using a universal testing machine. Statistical analyses were performed using three-way anova and Tukey's HSD post hoc tests.

RESULTS

Root canal cleanliness was not affected by the cleaning method (P = 0.618, chi-squared test). Pull-out force for fibre posts was significantly affected by the cleaning method (P = 0.008), the luting agent (P < 0.0005) and the preparation procedure (P < 0.0005, three-way anova). RB group demonstrated significantly higher pull-out forces [399 (88) N] compared with PD group [287 (105) N]. Posts that were inserted using CoreX Flow/XP Bond exhibited significantly higher pull-out forces [370 (62) N] compared with posts inserted using SmartCem2 [315 (141) N].

CONCLUSION

The different cleaning methods did not lead to significant differences in root canal cleanliness and did not enhance fibre post retention inside the root canal. However, post space preparation using a RB might be beneficial for improving retention, especially when self-adhesive cements are used. The use of the core build-up material CoreX Flow/XP Bond instead of the self-adhesive resin cement, SmartCem 2, resulted in significantly higher pull-out force.

One year effect of chlorhexidine on bonding of fibre-reinforced composite root canal post to dentine

OBJECTIVES

Chlorhexidine preserves the long-term bonding between composite restorations and coronal dentine. Our aim was to evaluate the long-term effect of chlorhexidine on attachment of fibre-reinforced composite (FRC) root canal posts to root canals. We hypothesized that chlorhexidine would not negatively affect the bond strength in aged specimens.

METHODS

Root canals of 40 human extracted third molars were prepared for post cementation with each post systems' own burs. Four commercially available FRC posts (Glassix, D.T. Light-Post, Unicore, everStickPOST) were cemented with three different cements (Duo-link, PermaFlo DC, RelyX Unicem). After etching, except with self-adhesive RelyX Unicem, the post spaces were irrigated either with 2% chlorhexidine (Consepsis) or physiological saline for 60s. The roots (n=5 per group) were cut into 2mm thick dentine discs. The discs were stored in artificial saliva for one year. The bond strength was measured with the push-out method, and the failure mode was evaluated with a stereomicroscope.

RESULTS

Unicore with PermaFlo DC and everStickPOST with RelyX Unicem demonstrated significantly higher bond strength values both with and without chlorhexidine. After one year of storage chlorhexidine application improved the bond strength with D.T. Light-Post/Duo-link. With other posts and cements chlorhexidine application did not affect the bond strength.

CONCLUSION

2% chlorhexidine did not negatively affect the long-term bond strength of any material tested.

CLINICAL SIGNIFICANCE

Irrigation of root canals with chlorhexidine, as indicated to prevent root canal infection during post placement, does not interfere with post bond strength when FRC posts are used.

Reliability of fiber post bonding to root canal dentin after simulated clinical function in vitro

The aim of this study was to investigate the effect of thermomechanical loading (TML) on the bond strength of fiber posts luted with three different resin cements. Sixty-six extracted human anterior teeth were endodontically treated and restored with fiber posts (RelyX Fiber Posts, 3M ESPE) using three commercially available resin cements and three corresponding core build-up materials (n=22 each): Panavia F 2.0/Clearfil DC Core Automix (Kuraray), Variolink II/Multicore Flow (Ivoclar Vivadent), and RelyX Unicem/Filtek Z250 (3M ESPE). Twelve specimens of each group received all-ceramic crowns and were subjected to TML. The other 10 specimens were stored in saline solution for 24 hours. The roots were sectioned and bond strength was measured using a push-out test. Adhesive interfaces of two specimens of each group subjected to TML were analyzed using field emission scanning electron microscopy (FESEM). Bond strengths of fiber posts were significantly affected by the type of resin cement (p<0.0005) and TML (p<0.0005; two-way analysis of variance). TML significantly reduced bond strengths for all materials ((6.0 (6.2) MPa)) compared with initial bond strengths ((14.9 (10.4) MPa)). RelyX Unicem resulted in significantly higher bond strengths before ((18.3 (10.3) MPa)) and after TML ((9.8 (7.5) MPa)) compared with the other materials (p<0.0005; Tukey HSD). Using FESEM, Variolink II and Panavia F demonstrated a hybrid layer partly detached from the underlying resin cement, whereas no hybrid layer was observed for RelyX Unicem. The decrease in bond strength after TML suggests that retention of fiber posts may be reduced after clinical function. Therefore, endodontically treated teeth that are restored using fiber posts may benefit from additional reinforcement via coronal restorations using adequate ferrules and/or adhesive techniques.

Current perspectives on post systems: a literature review

This literature review summarizes the most recent and reliable evidence on post systems. A search was limited to review articles published over the last 10 years in dental journals with an impact factor. Papers cited in the initially retrieved review articles were also included if significant. Preservation of tooth tissue, presence of a ferrule effect, and adhesion are regarded as the most effective conditions for long-term success of post-endodontic restorations. Adhesively luted fibre-reinforced composite post restorations have demonstrated satisfactory survival rates over relatively long follow-up periods. The clinical effectiveness of such restorations has been mainly ascribed to the more biomimetic behaviour of fibre-reinforced composite posts that reduces the risk of vertical root fractures. The most common type of failure when using fibre posts is post debonding and it is generally agreed that achieving stable adhesion to intraradicular dentine is more challenging than to coronal dentine. Several factors related to endodontic treatment, root canal shape, post space preparation, post translucency, adhesive cement handling and curing may have an influence on the outcome of the luting procedure. The most reliable results in fibre post cementation are obtained by etch-and-rinse adhesives in combination with dual-cure resin cements. The use of self-adhesive resin cements has also been proposed. Simplification is an obvious advantage of these new materials. However, the durability of their bond still needs to be verified with long-term clinical studies. Several techniques for pre-treating the fibre-reinforced composite post surface have been tested with the aim of improving the bond strength at the post-core and post-cement interfaces. Silicoating followed by silanization currently appears to be the most effective and convenient method for this purpose. In conclusion, the available evidence validates the use of fibre posts as an alternative to metal posts and preferably to other tooth-coloured posts, such as zirconia dowels, in the restoration of endodontically treated teeth. Longer term clinical trials are expected to further strengthen this evidence.

Ultra short term analysis of heart rate variability for monitoring mental stress in mobile settings

Heart rate variability (HRV) analysis is commonly used as a quantitative marker depicting the activity of autonomous nervous system (ANS) that may be related to mental stress. For mobile applications, short term ECG measurement may be used for HRV analysis since the conventional five minute long recordings might be inadequately long. Short term analysis of HRV features has been investigated mostly in ECG data from normal and cardiac patients. Thus, short term HRV features may not have any relevance on the assessment of acute mental stress. In this study, we obtained ultra short term HRV features from 24 subjects during baseline stage and Stroop color word test. We validated these HRV features by showing significant differences in HRV features existed between the two stages. Our results indicated that ultra short term analysis of heart rate and RR intervals within 10 s, RMSSD and PNN50 within 30 s, HF within 40 s, LF/HF, normalized LF, and normalized HF within 50 s could be reliably performed for monitoring mental stress in mobile settings.