In vivo Fluid Movement through Dentin Adhesives in Endodontically Treated Teeth

Ultrasonic activation of adhesive systems increases bond strength and intratubular penetration of resin cement in root dentin subjected to radiation therapy

OBJECTIVE

This study aimed to evaluate the effect of ultrasonic activation of etch-and-rinse and self-etch adhesive systems on the bond strength of resin cement to irradiated root dentin.

MATERIALS AND METHODS

Eighty human maxillary anterior teeth were distributed into 8 groups (n = 10), according to the type of adhesive system used (etch-and-rinse and self-etch), the ultrasonic activation of the adhesive systems, and the dentin condition (irradiated or non-irradiated - 70 Gy). Endodontic treatment was performed followed by fiberglass post-space preparation. After fiberglass posts' luting, the roots were transversely sectioned on dentin discs and submitted to the push-out bond strength test (0.5 mm/min). The fractured specimens were analyzed under a stereomicroscope and Scanning Electron Microscope (SEM) for failure mode classification. One of the dentin discs was analyzed under SEM to evaluate the characteristics of the adhesive interface.

RESULTS

Irradiated specimens had lower bond strength than non-irradiated specimens (P < 0.0001). Ultrasonic activation of both adhesive systems increased the bond strength of the resin cement to irradiated dentin (P < 0.0001). Radiotherapy significantly affected the failure mode in the middle (P = 0.024) and apical thirds (P = 0.032) (adhesive failure).

CONCLUSION

Non-irradiated specimens had a more homogeneous adhesive interface. When ultrasonically activated, both adhesive systems showed a greater number of resinous tags, regardless of the dentin condition.

CLINICAL RELEVANCE

Ultrasonic activation of adhesive systems is a feasible strategy to enhance fiberglass posts retention in oncological patients.

The Effect of Different Condition of Pulpal Pressure on Microtensile Bond Strength of Several Dentin Bonding Agents on Deep and Superficial Dentin

The objective of this study was to examine the effect of different conditions of simulated hydrostatic pulpal pressure on the μTBS of HEMA-based and HEMA-free dentin bonding agents (DBAs). The influence of dentin location (deep and superficial) on μTBS was also evaluated. Flat coronal dentin surfaces of extracted human molars were prepared. Three groups of resin-bonded specimens were exposed to different pulpal pressures. Pulpal pressure was maintained for 20 min for each group. A flowable resin composite was used for coronal build-up. The bonded teeth were sectioned and, after 24 h of water storage, stressed to failure using the microtensile tester (μTBS). Failed samples were analyzed by SEM inspection. HEMA-based DBAs were much more sensitive to pulpal pressure conditions than non-HEMA-containing DBAs. Pulpal pressure had a greater influence in deep dentin. The HEMA-free DBA was insensitive to the presence or absence of pulpal pressure condition. SEM inspection confirmed a relationship between the presence of voids inside the HEMA-based DBAs layer and the lower μTBS results. HEMA-based DBAs are more sensitive to pulpal pressure conditions than HEMA-free DBAs. Interestingly, HEMA-free DBA showed a greater number of water droplets at resin–dentin interface in all tested conditions.

Effect of Silver Antibacterial Agents on Bond Strength of Fiber Posts to Root Dentin

This study was conducted to evaluate whether antibacterial pretreatment irrigation with silver nanoparticles (SNPs) and silver diamine fluoride (SDF) has any effect on bond strength of fiber posts cemented with three types of resin cements in root canal space. Fifty-four endodontically treated maxillary central incisor roots were prepared for fiber post (FRC Postec Plus NO.3, Ivoclar Vivadent) cementation and divided into nine groups in terms of three cement types and two pretreatments with silver antibacterial agents. The cements were as follows: an etch-and-rinse cement (ER, Excite DSC/Variolink N), a self-etch cement (SE, ED Primer/Panavia F2.0), and a self-adhesive cement (SA, Panavia SA Luting Plus). For each cement, the control group was with no treatment and two experimental groups were with SNPs and SDF treatments that were used after acid-etching for ER cement and after EDTA treatment for SE and SA cements. After fiber post cementation, each bonded root was horizontally sectioned into 1-mm thickness microslices to create two slices for each root region (apical, middle and coronal) and underwent push-out bond strength (PBS) test. Data in MPa were analyzed with two-way ANOVA and Tukey test (p=0.05). The interaction of the pretreatment type and cement type was significant (p<0.001). SNPs and SDF significantly increased PBS with ER cement (p≤0.04). This positive effect was also marginally significant for SDF with SE cement (p=0.049). For SA cement, SNPs showed a significant positive effect, but SDF had a significant adverse effect on PBS (p<0.001). The effect of pretreatment with silver antibacterial agents prior to adhesive cementation of fiber posts depends on the resin cement used. Contrary to SNPs with beneficial or no significant effect on bonding for all cements, SDF exhibited a deleterious effect with self-adhesive cement.

The Effect of Viscosity and Application Mode of Phosphoric Acid on Bond Strength of GlassFiber Post

Background

When a phosphoric acid is used, before applying an adhesive system, it is known that obtaining an effective adhesion to the root canal walls is a challenge. The aim of the present study was to evaluate the influence of phosphoric acid viscosity and application mode on the push-out bond strength (BS) values of fiberglass post to root dentin. The conditioning pattern on the root dentin was also evaluated.

Materials and Methods

The roots of 44 endodontically treated premolars were divided into 4 groups, of eleven teeth each, according to the combination of the main factors: phosphoric acid viscosity (liquid or gel) and application mode (passive or sonic). After application of the two-step etch-and-rinse adhesive system, the fiberglass posts were cemented with a dual-cure resin-cement. Roots were sectioned transversely into six 1-mm slices for push-out BS test at 0.5 mm/min. Some roots of each group were selected for evaluation of the conditioning pattern by scanning electron microscopy. BS results (three-way ANOVA and Tukey’s test) and the conditioning pattern (Kruskal–Wallis test and Mann–Whitney test) were statistically evaluated (α= 0.05).

Results

The highest BS value was observed with a liquid phosphoric acid under sonic application mode (p < 0.05), being all other groups similar to one another (p < 0.05). Also, the highest BS value was observed in the cervical third, followed by the medium and the apical thirds (p < 0.05). The sonic application produced better smear layer removal and opening of dentinal tubules for both viscosities (p = 0.015).

Conclusion

A better bonding of fiberglass posts to root canals can be achieved when the post spaces are conditioned with a liquid phosphoric acid under sonic application.

Effect of antibacterial/adhesive approaches on bonding durability of fiber posts cemented with self-etch resin cement

BACKGROUND

Longevity of post-retained restoration is highly depended on bonding stability of fiber post (FP) to root dentin. This study evaluated the effect of different antibacterial/adhesive approaches on bonding durability of FPs luted into root canal with a self-etch cement.

MATERIAL AND METHODS

Seventy-two human maxillary central incisor roots were divided into six groups after endodontic treatment, based on the antibacterial/adhesive treatments as follows: 1)ED primer II (ED, control); 2) Clearfil Protect Bond (PB); 3) 2% chlorhexidine (CH) pretreatment + ED primer II (CH+ED); 4) CH-incorporated into ED primer II (CH in ED); 5) CH pretreatment + Clearfil SE Bond (CH+SE); and 6)CH-incorporated into SE primer (CH in SE). The FPs were then cemented using PanaviaF2.0. After micro-slicing the bonded root dentin, a push-out bond strength (PBS) test was performed immediately or after two years of water storage. Data were analyzed using ANOVA and post hoc Tukey tests (α=0.05).

RESULTS

The effects of antibacterial/adhesive approach, time and interaction between the main factors were significant (p=0.01). There was no significant difference between the immediate groups, except between the CH+ED group (the lowest PBS) and PB and CH in SE groups (the highest PBS) (p≤0.03). After aging, the same difference was observed (p≤0.02); the control group exhibited a significantly lower PBS compared to the other groups (p≤0.01), except for CH+ED. Aging significantly decreased PBS of all the groups (p≤0.01); the control group exhibited the highest reduction.

CONCLUSIONS

CH incorporated into self-etch primers or in pretreatment step prior to two-step self-etch adhesive and antibacterial adhesive could improve bond stability of self-etch cemented fiber post. However, none of these was capable of inhibiting bond degradation over time. Key words:Push-out bond strength, Fiber post, Chlorhexidine.

Does MTA affect fiber post retention in repaired cervical root canal perforations?

This study evaluated the effect of mineral trioxide aggregate (MTA) on the retention of fiber posts in repaired root canal perforations. Ten-millimeter post spaces were prepared in 60 endodontically treated bovine incisors. Root perforations were created in half of the root canals in the cervical area prior to being filled with white MTA-Angelus. Fiber posts were luted into the root canals with two self-adhesive (RelyX Unicem or Set) or self-etching (Panavia F) resin cements. The posts were submitted to a pull-out test, and the data were submitted to two-way ANOVA and Tukey's post hoc tests (α = 0.05). The fiber posts exhibited reduced retention in MTA-repaired root canal perforations, regardless of the type of resin cement that was used (p < 0.001). Self-adhesive resin cements provided higher bond strength values than Panavia F, while no difference was observed between RelyX Unicem and Set (p > 0.05). The presence of MTA in repaired root perforations negatively affected post retention. In addition, self-adhesive cements seemed to be the best option to lute fiber posts within a root canal in these cases.

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.

A Comparative Evaluation of the Retention of Tooth Coloured and Stainless Steel Endodontic Posts: An In-vitro Study

AIMS

This in vitro study evaluated: a) the retention of stainless steel posts of 1.5 mm diameter which were cemented with Zinc Phosphate cement versus Glass fiber posts with 1.1 mm, 1.3 mm and 1.5 mm diameters which were cemented with resin cement and b) the effect of change in diameter on the retention of Glass fiber posts with 1.1 mm, 1.3 mm and 1.5 mm diameters.

MATERIALS AND METHODS

Sixty extracted mandibular premolar teeth were endodontically treated and randomly assigned to four groups of fifteen teeth each. In Groups I, II and III glass fibre posts with diameters 1.1 mm, 1.3 mm and 1.5 mm were cemented by using resin cement. In Group IV, stainless steel posts with diameter 1.5 mm were cemented by using zinc phosphate cement. The specimens were tested for tensile loading at a cross head speed of 2.0 mm/min, on a universal testing machine.

STATISTICAL ANALYSIS USED

One way analysis of variance and Tukey's (post-hoc) test.

RESULTS

Mean tensile strength from highest to lowest was in the order of Group IV, Group II, Group III, Group I. Statistically significant differences were observed between the mean tensile strengths between Groups I and II, Groups I and III, Groups I and IV, Groups II and IV, Groups III and IV, while non significant differences were observed between Groups II and III.

CONCLUSION

Stainless steel posts were more retentive than glass fibre posts. Glass fibre posts with 1.3 mm or 1.5 mm diameters provided significantly greater retention as compared to 1.1 mm diameter posts.

Fracture resistance and stress distribution of simulated immature teeth after apexification with mineral trioxide aggregate

AIM

To evaluate the effect of adhesive restorations on fracture resistance and stress distribution in teeth with simulated immature apices and apical plugs of mineral trioxide aggregate (MTA).

METHODOLOGY

Sixty bovine incisors were sectioned 8 mm above and 12 mm below the cemento-enamel junction (CEJ). The root canal was enlarged using a diamond bur, resulting in remaining root canal walls with 0.1-0.2 mm of thickness. A 5-mm apical plug of MTA was placed and the teeth were restored according to the following groups: GP--the root canal was filled with gutta-percha and endodontic sealer; CR--the root canal was filled with light-cured composite resin inserted incrementally; FP--a fibre post was cemented into the root canal; and RFP--the fibre post was relined with composite resin prior to the cementation into the root canal. A load was applied on the crown of all teeth at 135° to their long axis until fracture. Data was analysed by one-way anova and SNK tests (α = 0.05), whilst the fracture pattern was evaluated according to the position of the fracture. Stress distributions in the restored teeth were verified by finite element analysis.

RESULTS

Teeth restored with fibre posts and relined fibre posts were associated with the highest fracture resistance, whilst the GP group had the lowest values. GP and RC groups had similar fracture resistance values (P = 0.109). All fractures types involved the cervical and middle thirds of roots. The GP model had high levels of stress concentration in the cervical and middle thirds of roots. No difference was found amongst the stress concentration in the RC, FP and RFP models.

CONCLUSION

Restorative protocols alter the fracture resistance and stress distribution of immature teeth after placement of MTA apical plugs.

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.

Overview of Clinical Alternatives to Minimize the Degradation of the Resin-dentin Bonds

The incorporation of hydrophilic and acidic resin monomers substantially improved the initial bonding of contemporary etch-and-rinse (ER) and self-etch (SE) adhesives to intrinsically wet dental substrates, providing quite favorable immediate results, regardless of the bonding approach used. However, in the long term, the bonding effectiveness of most simplified ER and SE adhesives drop dramatically. This review examines the fundamental processes that are responsible for the aging mechanisms involved in the degradation of the resin-bonded interfaces and some possible clinical approaches that have been effective in minimizing or even preventing the degradation of the adhesive interfaces produced with simplified adhesives. The incorporation of some of the feasible approaches - described in this review - may improve the quality of the adhesive restorations performed in clinical practice, while manufacturers develop bonding materials that are less susceptible to the aging mechanisms present in the oral environment.

Effect of 2% chlorhexidine digluconate on bond strength of a glass-fibre post to root dentine

AIM

To assess the immediate influence of dentine bonding systems (DBS) associated with 2% chlorhexidine digluconate (CHX) on glass-fibre post-bond strength to root dentine, in terms of coronal, middle and apical thirds.

METHODOLOGY

Sixty bovine roots were root filled and randomly assigned to 1 of 6 groups (n = 10): SBMP (3-step etch-and-rinse system, Scotchbond Multi-Purpose), SB (2-step etch-and-rinse system, Single Bond 2), SE (2-step self-etching system, Clearfil SE Bond) and SBMP-CHX, SB-CHX and SE-CHX, respectively, associated with CHX. For all groups, a glass-fibre post was luted with a dual-cure resin cement, RelyX ARC. After 7-day storage, specimens were subjected to the push-out test. Failure modes were analysed under optical microscopy (40x). Bond strength values were statistically analysed by two-way anova and Bonferroni tests (P < 0.05).

RESULTS

The effect of DBS was significant (P < 0.05), and SE reached higher bond strength in comparison with the other DBS tested. CHX association did not show improvement with any DBS (P > 0.05); rather, it negatively affected SE, which was detected for all thirds. There was no difference between thirds (P > 0.05), except for the SE-CHX, which presented lower values for the apical third (P < 0.05). Adhesive cement/dentine adhesive failure was predominant for all groups. CHX did not influence the failure mode for any DBS (P > 0.05).

CONCLUSIONS

The performance of the dentine bonding systems was material dependent. CHX did not improve immediate bond strength; however, CHX negatively affected the bond strength of the self-etching system, especially in the third apical.

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.

Ultrastructural evaluation of the hybrid layer after cementation of fiber posts using adhesive systems with different curing modes

This in vitro study evaluated the adhesive interface of intraradicular fiber glass posts and root dentin using scanning electron microscopy (SEM). Forty-eight single-rooted premolars were randomly divided into 6 groups consisting of chemical, dual, or light cured adhesive systems combined with either chemical or dual cure resin cements. Scanning electron microscopic analysis showed the best results for continuity, density and morphology of the hybrid layer and resin tags for the combination of a self-cure adhesive with self-cure cement resin, followed by a dual-cure adhesive with self-cure cement resin, and finally a light-cure adhesive with self-cure cement. For the dual-cure resin cement, the same relation may be observed. The apical third was the most critical region for evaluated the criteria for all combinations of materials (Kruskal-Wallis and Friedman tests; p<0.001). Generally, the simplification of steps in the adhesive system and the polymerization reaction of resin adhesives and cements produced a direct effect on the quality of the adhesive post/dentin substrate interface.

Effect of airborne-particle abrasion and aqueous storage on flexural properties of fiber-reinforced dowels

PURPOSE

A great range of clinical failures have been observed with fiber-reinforced dowels, often attributed to fracture or bending of the dowels. This study investigated flexural properties of fiber-reinforced dowels, with and without airborne-particle abrasion, after storage in aqueous environments over time. Scanning electron microscopy (SEM) was used to analyze the mode of failure of dowels.

MATERIALS AND METHODS

Two dowel systems (ParaPost Fiber Lux and FibreKor) were evaluated. Ten dowels of each system were randomly assigned to one of six experimental groups: 1--control, dry condition; 2--dowels airborne-particle abraded and then stored dry; 3--dowels stored for 24 hours in aqueous solution at 37°C; 4--dowels airborne-particle abraded followed by 24-hour aqueous storage at 37°C; 5--dowels stored for 30 days in aqueous solution at 37°C; 6--dowels airborne-particle abraded followed by 30-day aqueous storage at 37°C. Flexural strength and flexural modulus were tested for all groups according to American Society of Testing and Materials (ASTM) standard D4476. One failed dowel from each group was randomly selected to be evaluated with SEM equipped with energy dispersive spectroscopy (EDS) to characterize the failure pattern. One intact dowel of each system was also analyzed with SEM and EDS for baseline information.

RESULTS

Mean flexural modulus and strength of ParaPost Fiber Lux dowels across all conditions were 29.59 ± 2.89 GPa and 789.11 ± 89.88 MPa, respectively. Mean flexural modulus and strength of FibreKor dowels across all conditions were 25.58 ± 1.48 GPa and 742.68 ± 89.81 MPa, respectively. One-way ANOVA and a post hoc Dunnett's t-test showed a statistically significant decrease in flexural strength as compared to the dry control group for all experimental groups stored in water, for both dowel systems (p < 0.05). Flexural modulus for both dowel systems showed a statistically significant decrease only for dowels stored in aqueous solutions for 30 days (p < 0.05). Airborne-particle abrasion did not have an effect on flexural properties for either dowel system (p > 0.05). SEM and EDS analyses revealed differences in composition and failure mode of the two dowel systems. Failed dowels of each system revealed similar failure patterns, irrespective of the experimental group.

CONCLUSIONS

Aqueous storage had a negative effect on flexural properties of fiber-reinforced dowels, and this negative effect appeared to increase with longer storage times. The fiber/resin matrix interface was the weak structure for the dowel systems tested.

Effect of cement type and water storage time on the push-out bond strength of a glass fiber post

This study investigated the effects of the cement type and the water storage time on the push-out bond strength of a glass fiber post. Glass fiber posts (Fibrekor, Jeneric Pentron) were luted to post spaces using a self-cured resin cement (C&B Cement [CB]), a glass ionomer cement (Ketac Cem [KC]) or a resin-modified glass ionomer cement (GC FujiCEM [FC]) according to the manufacturers' instructions. For each luting agent, the specimens were exposed to one of the following water storage times (n=5): 1 day (T1), 7 days (T7), 90 days (T90) and 180 days (T180). Push-out tests were performed after the storage times. Control specimens were not exposed to water storage, but subjected to the push-out test 10 min after post cementation. Data (in MPa) were analyzed by Kruskal-Wallis and Dunn`s test (α=0.05). Cement type and water storage time had a significant effect (p<0.05) on the push-out bond strength. CB showed significantly higher values of retention (p<0.05) than KC and FC, irrespective of the water storage time. Water storage increased significantly the push-out bond strength in T7 and T90, regardless of the cement type (p<0.05). The results showed that fiber posts luted to post spaces with the self-cured resin cement exhibited the best bonding performance throughout the 180-day water storage period. All cements exhibited a tendency to increase the bond strength after 7 and 90 days of water storage, decreasing thereafter.

Bond strengths, degree of conversion of the cement and molecular structure of the adhesive-dentine joint in fibre post restorations

OBJECTIVES

Because fibre post restorations are influenced by multiple factors such as the types of bonding materials, the dentine region and the time under moist exposure, this study sought to determine the bond strength of endodontic restorations and its relation to the degree of conversion of the cement layer and the molecular structure of the dentine-bonded joints.

METHODS

The performance of 2 etch-and-rinse (All-Bond 2 and One-Step Plus) and 2 self-etch (Clearfil SE Bond and Xeno III) adhesives at post spaces regions, after 7 d or 4 m, was evaluated. FRC Postec Plus posts were cemented to the root canal with a dual-cure resin cement (Duo-Link). Transverse sections of the tooth were subjected to push-out testing, to degree-of-conversion measurements and to hybrid layer evaluation through μ-Raman spectroscopy.

RESULTS

Coronal bonding was higher than cervical and middle bonding. The hybrid layer was thicker for the etch-and-rinse systems, with thicknesses decreasing towards the middle region. The degree of conversion measured for the 3-step etch-and-rinse group after 4 m was significantly higher than that for the self-etching groups.

CONCLUSIONS

Although not totally stable at the adhesive-dentine interface, the 3-step etch-and-rinse adhesive in the coronal dentine provided the best bond strength, degree of conversion of the cement and hybrid layer thickness in post restorations, in both short- and long-term analyses.

The Influence of Time and Cement Type on Push-Out Bond Strength of Fiber Posts to Root Dentin

A self-adhesive resin cement can provide a significantly stronger bond than a three-step etch-and-rinse adhesive and resin cement when used to lute fiber posts.

Conventional dual-cure versus self-adhesive resin cements in dentin bond integrity

During post preparation, the root canal is exposed to the oral cavity, and endodontic treatment may fail because of coronal leakage, bacterial infection and sealing inability of the luting cement.

OBJECTIVE

this study quantified the interfacial continuity produced with conventional dual-cure and self-adhesive resin cements in the cervical (C), medium (M) and apical (A) thirds of the root.

MATERIAL AND METHODS

Forty single-rooted human teeth were restored using Reforpost # 01 conical glass-fiber posts and different materials (N=10 per group): group AC=Adper™ ScotchBond™ Multi-purpose Plus + AllCem; group ARC=Adper™ ScotchBond™ Multi-purpose Plus + RelyX ARC; group U100=RelyX U100; and group MXC=Maxcem Elite. After being kept in 100% humidity at 37°C for 72 hours, the samples were sectioned parallel to their longitudinal axis and positive epoxy resin replicas were made. The scanning electron micrographs of each third section of the teeth were combined using Image Analyst software and measured with AutoCAD-2002. We obtained percentage values of the interfacial continuity.

RESULTS

Interfacial continuity was similar in the apical, medium and cervical thirds of the roots within the groups (Friedman test, p>0.05). Comparison of the different cements in a same root third showed that interfacial continuity was lower in MXC (C=45.5%; M=48.5%; A=47.3%) than in AC (C=85.9%, M=81.8% and A=76.0%), ARC (C=83.8%, M=82.4% and A=75.0%) and U100 (C=84.1%, M=82.4% and A=77.3%) (Kruskal-Wallis test, p<0.05).

CONCLUSIONS

Allcem, Rely X ARC and U100 provide the best cementation; cementation was similar among root portions; in practical terms, U100 is the best resin because it combines good cementation and easy application and none of the cements provides complete interfacial continuity.

The adhesive system and root canal region do not influence the degree of conversion of dual resin cement

OBJECTIVES

The aim of this study was to evaluate the influence of two adhesive systems and the post space region on the degree of conversion of dual resin cement and its bond strength to root dentin.

MATERIAL AND METHODS

One three-step etch-and-rinse (All-bond 2, Bisco) and another one-step self-etch (Xeno III, Dentsply) adhesive systems were applied on 20 (n=10) crownless bovine incisors, at 12-mm-deep post space preparation, and a fiber post (DT Light Post, Bisco) was cemented using a dual cure resin cement (Duo-Link, Bisco). Three transverse sections (3 mm) were obtained, being one from each study region (cervical, middle and apical). The degree of conversion of the dual cure resin cement was determined by a micro-Raman spectrometer. The data (%) were submitted to repeated-measures analysis of variance and Tukey's test (p<0.05).

RESULTS

For both groups, the degree of conversion means (%) (All bond 2cervical = 69.3; All bond 2middle = 55.1; All bond 2apical= 56; Xeno IIIcervical = 68.7; Xeno IIImiddle = 68.8; Xeno IIIapical = 54.3) were not significantly different along the post space regions (p<0.05).

CONCLUSION

Neither the adhesive nor the post space region influenced the degree of conversion of the cement layer.

Effect of relining on fiber post retention to root canal

One of the clinically relevant problems dentists face when restoring endodontically treated teeth is the mismatch between fiber post and post space diameters, which results in an excessively thick resin cement layer. Fiber post relining appears as a solution for this problem.

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

The influence of thermocycling on the bond strength of fibre posts cemented with different luting approaches was investigated. A total of 84 human incisors were selected for the study. Sixty teeth were assigned to one of the following adhesive/cement combinations for push-out bond-strength evaluation: group 1, XP Bond/CoreXFlow + DT Light-Post; group 2, Panavia F 2.0 + Tech 21; or group 3, RelyX Unicem + RelyX. Bonded specimens were cut into 1-mm-thick slabs and either thermocycled (40,000 cycles) or stored in artificial saliva (control specimens) before push-out bond-strength testing. Additional specimens were processed for quantitative interfacial nanoleakage analysis. Thermocycling decreased the bond strength in specimens of groups 2 and 3, but did not affect the specimens from group 1. No difference was observed among luting approaches in control specimens. Thermocycling resulted in increased silver nitrate deposition (i.e. interfacial nanoleakage) in all groups. Within the limitations of the study, the use of an etch-and-rinse adhesive in combination with a dual-cure cement to lute fiber posts is the most stable luting procedure if compared with a self-etch resin-based cement or a self-adhesive cement, as assayed by thermocycling of the bonded specimens.

Effect of an additional hydrophilic versus hydrophobic coat on the quality of dentinal sealing provided by two-step etch-and-rinse adhesives

Objective:

To test the hypothesis that the quality of the dentinal sealing provided by two-step etch-and-rinse adhesives cannot be altered by the addition of an extra layer of the respective adhesive or the application of a more hydrophobic, non-solvated resin.

Material and Methods:

full-crown preparations were acid-etched with phosphoric acid for 15 s and bonded with Adper Single Bond (3M ESPE), Excite DSC (Ivoclar/Vivadent) or Prime & Bond NT (Dentsply). The adhesives were used according to the manufacturers' instructions (control groups) or after application to dentin they were a) covered with an extra coat of each respective system or b) coated with a non-solvated bonding agent (Adper Scotchbond Multi-Purpose Adhesive, 3M ESPE). Fluid flow rate was measured before and after dentin surfaces were acid-etched and bonded with adhesives.

Results:

None of the adhesives or experimental treatments was capable to block completely the fluid transudation across the treated dentin. Application of an extra coat of the adhesive did not reduce the fluid flow rate of adhesive-bonded dentin (p>0.05). Conversely, the application of a more hydrophobic non-solvated resin resulted in significant reductions in the fluid flow rate (p<0.05) for all tested adhesives.

Conclusions:

The quality of the dentinal sealing provided by etch-and-rinse adhesives can be significantly improved by the application of a more hydrophobic, non-solvated bonding agent.

Effect of ethanol application on post-luting to intraradicular dentine

AIM

To examine the effect of the application of an ethanol rinse before luting fibre posts to intraradicular dentine with etch-and-rinse adhesive systems by means of push-out bond strength evaluation and scanning electron microscopic (SEM) analysis.

METHODOLOGY

Fibre posts were luted to single-canal premolars using Dual Link as a luting agent in combination with a three-step (All Bond 2) or a two-step (One Step Plus) etch-and-rinse adhesive system, which were applied as per manufacturers' instructions (control) or with the additional rinse of ethanol on acid-etched dentine prior to the bonding procedures (experimental). Bonded specimens were sectioned into 1-mm-thick slabs and subjected to push-out bond strength testing. In addition, specimens from each group were processed for SEM analysis. Data were analysed by Kruskal-Wallis followed by Dunn's post hoc test at P = 0.05.

RESULTS

Push-out bond strength of All Bond 2 was significantly increased if the adhesive was applied on ethanol-saturated dentine (P < 0.05), whilst no significant difference (P > 0.05) was detected amongst experimental and control groups for One Step Plus. Irrespective of the adhesive, the SEM analysis revealed good impregnation patterns when both bonding techniques were employed.

CONCLUSIONS

The use of the additional ethanol rinse on acid-etched dentine revealed higher bond strength of All Bond 2 when compared with the control application procedure, used in combination with a resin-based cement to lute fibre posts into the dowel space. However, no bond strength improvements were detected using One Step Plus. Further investigations are needed to develop a clinically applicable ethanol/bonding/luting technique.

In vitro assessment of solvent evaporation from commercial adhesive systems compared to experimental systems

Solvents should be properly evaporated after application to dental substrates. The aim of this study was to assess the evaporation of commercial, experimental and neat solvents. The tested null hypotheses were that there are no differences in solvent evaporation regardless of its formulation and over time. Evaporation from commercial adhesive systems (Scotchbond Multipurpose Primer, Scotchbond Multipurpose Adhesive, Prime & Bond NT, Multi Bond, Excite, Single Bond 2, Adhese Primer, Adhese Bond, Xeno III A and Xeno III B) and experimental primers (35% HEMA plus 65% acetone or ethanol or water v/v) were compared to neat solvents (acetone, ethanol and water). Samples (10 µL) of these products were dripped into glass containers placed on a digital precision balance. Evaporation was assessed at 0, 5, 10, 15, 30, 60, 120, 300 and 600 s times to calculate mass loss. Data were analyzed statistically by ANOVA and Bonferroni's correction (a=0.05). Acetone-based products exhibited a remarkable capacity to evaporate spontaneously over time. Neat acetone evaporated significantly more than the HEMA-mixtures and the commercial formulations (p<0.05). The incorporation of monomers and other ingredients in the commercial formulations seem to reduce the evaporation capacity. Solvent evaporation was time and material-dependent.

Vertical root fracture in upper premolars with endodontic posts: finite element analysis

Upper premolars restored with endodontic posts present a high incidence of vertical root fracture (VRF). Two hypotheses were tested: (1) the smaller mesiodistal diameter favors stress concentration in the root and (2) the lack of an effective bonding between root and post increases the risk of VRF. Using finite element analysis, maximum principal stress was analyzed in 3-dimensional intact upper second premolar models. From the intact models, new models were built including endodontic posts of different elastic modulus (E = 37 or E = 200 GPa) with circular or oval cross-section, either bonded or nonbonded to circular or oval cross-section root canals. The first hypothesis was partially confirmed because the conditions involving nonbonded, low-modulus posts showed lower tensile stress for oval canals compared to circular canals. Tensile stress peaks for the nonbonded models were approximately three times higher than for the bonded or intact models, therefore confirming the second hypothesis.

SEM observation of the bond integrity of fiber-reinforced composite posts cemented into root canals

OBJECTIVES

To test the null hypothesis that continuity of resin cement/dentin interfaces is not affected by location along the root canal walls or water storage for 3 months when bonding fiber posts into root canals.

METHODS

Fiber posts were luted to bovine incisors using four resinous luting systems: Multilink, Variolink II, Enforce Dual and Enforce PV. After cementation, roots were longitudinally sectioned and epoxy resin replicas were prepared for SEM analysis (baseline). The original halves were immersed in solvent, replicated and evaluated. After 3 months water storage and a second solvent immersion, a new set of replicas were made and analyzed. The ratio (%) between the length (mm) of available bonding interface and the actual extension of bonded cement/dentin interface was calculated.

RESULTS

Significant lower percent values of bond integrity were found for Multilink (8.25%) and Variolink II (10.08%) when compared to Enforce Dual (25.11%) and Enforce PV (27.0%) at baseline analysis. The same trend was observed after immersion in solvent, with no significant changes. However, bond integrity was significantly reduced after 3 months water storage and a second solvent immersion to values below 5% (Multilink=3.31%, Variolink=1.87%, Enforce Dual=1.20%, and Enforce PV=0.75%). The majority of gaps were depicted at the apical and middle thirds at baseline and after immersion in solvent. After 3 months, gaps were also detected at the cervical third.

SIGNIFICANCE

Bond integrity at the cement/dentin interface was surprisingly low after cementation of fiber posts to root canals with all resin cements. That was not significantly altered after immersion in solvent, but was further compromised after 3 months water storage. Gaps were mainly seen at middle and apical thirds throughout the experiment and extended to the cervical third after water storage for 3 months. Bond integrity of fiber posts luted to root canals was affected both by location and water storage.

Morphological study of fiber-reinforced post-bonding system-root dentin interface by evaluation of two bonding systems

Morphological study of fiber post/bonding system/root dentin interface by evaluation of two bonding systems.

OBJECTIVES

The aim of the study was to analyze the interfaces, and thus the seal, between root dentin and bonded fiber-reinforced posts. The interfaces were obtained by applying two enamel-dentin adhesive systems, a one-bottle system used after application of phosphoric acid and a self-etch system, both used with an adhesive cement. The interface was evaluated by SEM observation of the continuity of the hybrid layer and the morphology of the resin tags, in terms of length, density and presence of side branches, at the interface between the fiber-reinforced post, the bonding system and the root dentin.

METHODS

Twenty-six anterior single-rooted teeth extracted for periodontal reasons were treated endodontically and then randomly separated into two groups of 13 teeth each: group 1: Excite DSC (Ivoclar Vivadent, Liechtenstein); group 2: AdheSE DC (Ivoclar Vivadent, Schaan, Liechtenstein). After preparation of the root canal and application of the adhesive, each specimen received a Postec translucent FRC post (Ivoclar Vivadent, Schaan, Liechtenstein) that was cemented in with Variolink II dual-curing luting composite (Ivoclar Vivadent, Schaan, Liechtenstein). The specimens were then prepared for SEM observation of the continuity of the hybrid layer and scoring of the morphology of the resin tags in each third of the root (at 1, 4.5 and 8mm from the coronal surface).

RESULTS

There was no significant difference (at p<0.05) between the two groups in terms of continuity of the hybrid layer or morphology of the resin tags. The hybrid layer was present, unbroken and uniform in both the group where adhesive was used with a phosphoric acid total etch and the self-etch system group. Whatever the bonding system, the resin tags had side branches, and greater length and density in the cervical third than in the middle or apical thirds. Bubbles were found in the cement layer in most of the specimens.

CONCLUSIONS

The one-bottle and self-etch bonding systems gave similar results in terms of interface morphology when a translucent fiber-reinforced post was cemented into the endodontically prepared roots.

Surface Treatments for Improving Bond Strength to Prefabricated Fiber Posts: A Literature Review

Several surface treatments have been proposed for improving the bonding of resin cements or core materials to FRC (fiber-reinforced composite) posts. The possibility of combining chemical and micromechanical retention on post surface provides the most promising adhesion mechanism.

Accelerated aging of adhesive-mediated fiber post-resin composite bonds: A modeling approach

OBJECTIVES

Although fiber posts luted in root canals are not directly exposed to oral fluids, water storage is considered as in vitro accelerated aging test for bonded interfaces. The aim of the study was to evaluate the influence of accelerated water aging on fiber post-resin composite adhesion.

METHODS

Forty fiber posts (DT Light Post, RTD) were randomly divided into two main groups, according to the surface treatment performed. Group I: XPBond adhesive (Dentsply Caulk); Group II: sandblasting (Rocatec-Pre, 3M ESPE) and XPBond. Dual-cured resin cement (Calibra, Dentsply Caulk) and flowable composite (X-Flow, Dentsply Caulk) were applied on the posts to produce cylindrical specimens. The bond strength at the interface between post and cement/composite was measured with the microtensile test according to the non-trimming technique. Half of the sticks were tested immediately for bond strength, while in the other half testing was performed after 1 month of water storage at 37 degrees C. Post-cement/composite interfaces were evaluated under SEM prior and after water aging. Statistical analysis was performed using the Kruskal-Wallis ANOVA followed by Dunn's multiple range test (p<0.05).

RESULTS

Immediate bond strength was higher on sandblasted posts. After water aging the two post surface treatments resulted comparable in bond strength. Resin cement achieved higher bond strength to fiber posts than flowable composite. Water aging significantly reduced bond strength.

CONCLUSIONS

Sandblasting followed by adhesive coating may improve immediate post-resin bond strength in comparison to adhesive alone. However, fiber post-resin bond strength mediated by hydrophilic adhesive tends to decrease after water aging.

Apical sealing ability of Resilon/Epiphany versus gutta-percha/AH Plus: immediate and 16-months leakage

AIM

To compare the long-term apical sealing ability of gutta-percha/AH Plus and Resilon/Epiphany.

METHODOLOGY

The root canals of 90 single-rooted human mandibular premolars with single narrow root canals were prepared with ProFile 0.4 taper instruments to apical size 40. After each instrument, the canals were irrigated with 1% sodium hypochlorite. Subsequently, the teeth were randomly divided into four groups containing 20 teeth each. Additionally, 10 prepared premolars served as positive and 10 counterparts with intact crowns as negative controls. The root canals were filled with gutta-percha/AH Plus or Resilon/Epiphany using lateral or vertical compaction. Specimens were allowed to set for 7 days at 37 degrees C and 100% humidity. Subsequently, the root fillings were removed down to the apical 4 mm. Fluid movement was then assessed using a fluid transportation model and re-evaluated after 16 months of water storage. Leakage within and between groups was compared using nonparametric tests.

RESULTS

Negative controls revealed no fluid movement and positive controls displayed gross fluid movement at both times of observation. At the immediate measurement, there were no significant differences between the experimental groups (Kruskal-Wallis, P > 0.05). Gutta-percha/AH Plus fillings retained their seal after 16-months storage (Wilcoxon, P > 0.05), whilst the Resilon/Epiphany groups lost their sealing capacity (Wilcoxon, P < 0.001). In these groups, 29 of the 40 specimens exhibited gross leakage similar to positive controls.

CONCLUSION

Initially, Resilon/Epiphany root fillings prevented fluid movement to the same degree as gutta-percha/AH Plus counterparts, but showed more fluid movement when tested at 16 months.

Monoblocks in root canals: a hypothetical or a tangible goal

The term monoblock has become familiar in the endodontic literature with recent interest in the application of dentin adhesive technology to endodontics. Endodontic monoblocks have generated controversial discussions among academicians and clinicians as to whether they are able to improve the quality of seal in root fillings and to strengthen roots. This review attempts to provide a broader meaning to the term monoblock and to see how this definition may be applied to the materials that have been used in the past and present for rehabilitation of the root canal space. The potential of currently available bondable materials to achieve mechanically homogeneous units with root dentin is then discussed in relation to the classical concept in which the term monoblock was first employed in restorative dentistry and subsequently in endodontics.

The effect of application sustained seating pressure on adhesive luting procedure

OBJECTIVES

To evaluate the effect of short versus long application seating pressure on the bond strength of resin blocks, luted with a dual-cured resin cement (Panavia F) to pre-coated or non pre-coated dentin with an hydrophobic light-cured adhesive (Clearfil Protect Bond).

METHODS

Sixteen non-carious human third molars were randomly divided into six Groups (four teeth each). Cylindrical composite blocks were luted with Panavia F (Group Ia) and with Clearfil Protect Bond with Panavia F (Group IIa) and seating pressure was applied for 5s. In Groups Ib and IIb, the two bonding procedures were respectively repeated, but the resin cylinder was maintained under constant pressure during the entire 3min polymerization period for the resin cement. After storing in distilled water for 24h, 0.9mmx0.9mm sticks were produced from these luted specimens for microtensile bond testing and SEM examination.

RESULTS

The use of Clearfil Protect Bond with Panavia F produced higher bond strengths than the use of Panavia F (p<0.05). Extending the time of pressure application up to 3min increased the bond strength (p<0.001) and improved the integrity of the interfacial quality.

SIGNIFICANCE

The application of sustained seating pressure during luting procedures and the additional use of a hydrophobic light-cured adhesive both improve the final bond strength of the resin cement.

Improving the Performance of EndoREZ Root Canal Sealer With a Dual-cured Two-Step Self-etch Adhesive. II. Apical and Coronal Seal

This study tested the hypothesis that the seal of EndoREZ may be improved with an adhesive-modified technique. Instrumented single-rooted teeth were filled with: (a) Warm vertical compaction with AH Plus (control); (b). EndoREZ with master cones and passive application of accessory cones; (c) Application of Clearfil Liner Bond 2V before EndoREZ and gutta-percha condensation. Leakage was assessed by fluid filtration at 10 psi before root resection and after 3 to 12 mm apical resections. Statistical analyses revealed significant differences in filling technique and resection lengths. EndoREZ exhibited significantly higher overall leakage, while no difference was found between AH Plus and the adhesive-modified EndoRez technique. Apical resection of EndoREZ to 12 mm exhibited more leakage than all other interactions, but was not significantly different from the same material resected to 9 mm. Although EndoREZ exhibited an acceptable apical seal, its coronal seal may be improved with the use of a dual-cured self-etch adhesive.

Improving the Performance of EndoRez Root Canal Sealer With a Dual-cured Two-Step Self-etch Adhesive. I. Adhesive Strength to Dentin

This study examined the hypotheses that the use of a self-etching-adhesive improves the adhesion of EndoRez to dentin, and that both techniques are unaffected by the prolonged use of NaOCl when EDTA is used as the final rinse. A tensile bond testing design was employed with composite cylinders bonded to dentin using: (a) 17% EDTA-2 min/EndoRez; (b) 6.15% NaOCl-1 h/EDTA-2min/EndoRez; (c) EDTA-2 min/Clearfil Liner Bond 2V/EndoRez; and (d) NaOCl-1 h/EDTA-2min/Clearfil Liner Bond 2V/EndoRez. Fractographic analyses of debonded specimens were performed using SEM. Two-way ANOVA and Tukey test revealed higher tensile bond strengths with the self-etching-adhesive-modified EndoRez technique (p < 0.001). Sealer tags pulled away from dentinal tubules when EndoRez was used alone, whereas mixed failures occurred within sealer tags, hybrid layers, adhesive, and sealer in the self-etching-adhesive-modified EndoRez technique. Both techniques were unaffected by the prolonged use of NaOCl (p > 0.05) when EDTA was employed as the final rinse.

Effect of Hygroscopic Expansion on the Push-Out Resistance of Glass Ionomer-Based Cements Used for the Luting of Glass Fiber Posts

This study examined the contribution of hygroscopic expansion of glass-ionomer (GIC) and resin modified glass-ionomer (RMGIC) luting cements to the push-out resistance of fiber posts. Glass fiber posts were luted to post spaces using different cements. Experimental specimens were stored in water, while control specimens were desiccated and stored in mineral oil to eliminate water from intraradicular dentinal tubules and/or the external environment that could have contributed to hygroscopic expansion of the cements. Thin slice push-out tests revealed no difference in retention strengths of resin composite cements that were stored in water or oil. Conversely, GIC and RMGIC cements exhibited increased retention strengths after water sorption. As unfavorable cavity geometry is taxing to dentin bond integrity in root canals, a strategy that relies on increasing the frictional resistance to post dislodgement via delayed hygroscopic expansion of glass-ionomer based materials may be a more pragmatic approach to fiber post retention.