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Abstract
Bitter K, Eirich W, Neumann K, Weiger R, Krastl G.
Effect of cleaning method, luting agent and preparation procedure
on the retention of fibre posts. International Endodontic
Journal, 45, 1116–1126, 2012.
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 Al2O3 (50 lm) 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 buildup
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.
Judul Asli
Effect of cleaning method, luting agent and preparation procedure on the retention of fibre posts
Abstract
Bitter K, Eirich W, Neumann K, Weiger R, Krastl G.
Effect of cleaning method, luting agent and preparation procedure
on the retention of fibre posts. International Endodontic
Journal, 45, 1116–1126, 2012.
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 Al2O3 (50 lm) 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 buildup
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.
Abstract
Bitter K, Eirich W, Neumann K, Weiger R, Krastl G.
Effect of cleaning method, luting agent and preparation procedure
on the retention of fibre posts. International Endodontic
Journal, 45, 1116–1126, 2012.
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 Al2O3 (50 lm) 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 buildup
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.
preparation procedure on the retention of bre posts
K. Bitter 1 , W. Eirich 1 , K. Neumann 2 , R. Weiger 3 & G. Krastl 3 1 Department of Operative Dentistry and Periodontology, University School of Dental Medicine, ChariteCentrum 3, Charite Universitatsmedizin Berlin, Berlin; 2 Institute for Biometry and Clinical Epidemiology, ChariteCentrum 4, Charite Universitatsmedizin Berlin, Berlin, Germany; and 3 Department of Periodontology, Endodontology and Cariology, School of Dental Medicine, University of Basel, Basel, Switzerland Abstract Bitter K, Eirich W, Neumann K, Weiger R, Krastl G. Effect of cleaning method, luting agent and preparation proce- dure on the retention of bre posts. International Endodontic Journal, 45, 11161126, 2012. Aim To investigate the effects of various cleaning methods, luting agents and preparation procedures on bre post retention. Methodology In total, 156 human canines were allocated to twelve groups. Teeth were decoronated, instrumented and root lled 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 lm) using an intraoral device. Cleanli- ness of each root canal was investigated using an oper- ating 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 Tukeys 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 bre posts was signicantly 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 sig- nicantly higher pull-out forces [399 (88) N] compared with PD group [287 (105) N]. Posts that were inserted using CoreX Flow/XP Bond exhibited signicantly 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 signicant differences in root canal cleanliness and did not enhance bre post retention inside the root canal. However, post space preparation using a RB might be benecial 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 signicantly higher pull-out force. Keywords: adhesive luting, bre post, post space preparation, root canal cleanliness. Received 10 May 2011; accepted 3 May 2012 Introduction Adhesively luted bre-reinforced composite (FRC) posts are used frequently to restore root lled teeth. Clinical studies have demonstrated favourable results regarding the use of FRC posts in the medium term (Cagidiaco et al. 2008, Bitter et al. 2009a). However, Correspondence: Kerstin Bitter, Department of Operative Den- tistry and Periodontology, University School of Dental Medi- cine, Charite Centrum 3, Charite Universitatsmedizin Berlin, Amannshauser Strae 4-6, D-14197 Berlin, Germany (Tel.: +49 30 450 562 011; fax: +49 30 450 562 932; e-mail: kerstin.bitter@charite.de). 2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 doi:10.1111/j.1365-2591.2012.02081.x 1116 ensuring sufcient bonding to root canal dentine remains a challenge because of the limited access and visibility and because of the deposition of cementum inside the canal and secondary dentine (Mjor et al. 2001). Moreover, bonding inside of the root canal can be compromised by the presence of sealer and gutta-percha remnants and by decient dentine hybridization (Perdigao et al. 2007). Mechanical cleaning methods, such as sandblasting with alumin- ium oxide particles, or rotary instrumentation using brushes and pumice, have been suggested for cleaning the contaminated tooth surface and for eliminating remnants of temporary cement following the removal of temporary crowns (Chaiyabutr & Kois 2008). Moreover, Chaiyabutr & Kois (2008) demonstrated a signicant improvement in bond strength to dentine of a self-adhesive luting cement after sandblasting with aluminium oxide particles compared with clean- ing the tooth surface using a hand instrument. Inside root canals, dentine debridement may be impeded because of the limited access especially in deep areas. Although several laboratory studies have investigated the effectiveness of mechanical cleaning methods (Coniglio et al. 2008a,b), little is known regarding their effects on the bond strength of bre posts. Post space preparation signicantly increased the deformability of anterior maxillary teeth compared to access preparation and manual enlargement; more- over, cylindrical post space preparations demonstrated signicantly higher deformability compared to conical post space preparations. On the basis of these results, it was concluded that both substance loss and modi- cation of the natural root canal geometry play impor- tant roles in tooth rigidity (Lang et al. 2006). A previous study using computational, experimental and fractographic analyses demonstrated the impact of the inner dentine located adjacent to the root canal on tooth fracture resistance and highlighted the importance of preserving structurally sound inner dentine (Kishen et al. 2004). Maximum adaptation of the post to canal walls is essential to improve retention and fracture resistance when nonadhesive post cementation is performed with zinc phosphate cement (Sorensen & Engelman 1990). However, when bre posts are luted with com- posite cement, the post t does not signicantly affect the push-out bond strength (Perdigao et al. 2007) or the fracture resistance (Buettel et al. 2009). Thus, it has been suggested that perfectly tting posts are not necessarily required (Krastl et al. 2011). On the other hand, the resistance to occlusal loading is higher if a post with a greater diameter is used. To avoid inva- sive post preparations especially in noncircular canals, it was suggested that only gutta-percha and sealer should be removed and then multiple smaller bre posts for intracanal anchorage should be used as an alternative (Porciani et al. 2008). A large variety of products on the market for luting bre posts, along with the intrinsic difculties of bond- ing inside the root canal, complicate the selection of a luting strategy. Self-adhesive resin cements are easy to handle and can save time because no etching or bond- ing steps are required. An alternative approach is to use a separate self-etching or etch-and-rinse adhesive prior to the insertion of the resin cement inside the root canal. It has been hypothesized that using phosphoric acid inside the root canal might be advantageous with respect to dissolving the thick smear layer (Bitter et al. 2004). However, the universal occurrence of interfacial gaps inside the root canal along the hybrid layer sur- face of etch-and-rinse adhesives has been observed using a scanning electron microscope (SEM) (Pirani et al. 2005). Self-etch adhesives did not show a discrep- ancy between the etching depth and the resulting resin inltration depth (Watanabe et al. 1994). However, one-step self-etching adhesive systems might lead to water sorption by hydrophilic resin monomers within the resindentine interface, which could contribute to their degradation over time and affect the bond durabil- ity (Hashimoto et al. 2000). Moreover, a previous study indicated that the self-etch approach results in less favourable adhesion compared with the etch-and-rinse or the self-adhesive approaches (Radovic et al. 2008a). The aim of this study was to investigate the effects of various cleaning methods, luting agents and canal preparation procedures on bre post retention with respect to the observed failure modes and root canal cleanliness. The null hypotheses were (i) that bre post retention would not be affected by the cleaning method, the luting agent or the preparation procedure; (ii) that the different cleaning methods would not affect the cleanliness of the root canal; and (iii) that the failure modes would not be affected by the different luting agents or preparation procedures. Materials and methods Specimen preparation For this study, 156 sound human single-rooted canines extracted for periodontal reasons with a root length of 15.516 mm that had no visible fracture Bitter et al. Retention of bre posts 2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1117 lines along the root were selected to obtain specimens with oval-shaped root canals. After soft tissue removal, the teeth were stored in 0.5% chloramine solution (Pharmacy of Charite, University Hospital, Berlin, Germany) until use. Tooth crowns were removed at the proximal cemento-enamel junction using a diamond blade under constant water cooling. Root canal preparations were performed at a working length of 1 mm from the apical foramen using a single-length technique with MTwo rotary instru- ments (sequence: size 10, .04 taper; size 15, .05 taper; size 20, .06 taper; size 25, .06 taper; size 30, .05 taper; size 35, .04 taper; size 40, .04 taper) (VDW, Munich, Germany). Apical enlargement was performed to a size of 60, .02 taper using FlexMaster rotary les (VDW). The teeth were lled with warm, vertically condensed BeeFill
2in1 gutta-percha (VDW)
and AH Plus sealer (Dentsply DeTrey, Konstanz, Germany); the teeth were then stored in water for 24 h. Each root was embedded into enlarged front teeth alveoli of maxillary models of phantom heads using silicon impression material (Silaplast FUTUR; Detax Dental, Ettlingen, Germany) to simulate clinical condi- tions during post space preparation. Post space prepa- rations to a depth of 8 mm for 78 teeth were performed using DT Light Post SL Size 3 drills (VDW) [group post drill (PD)]. In the other 78 roots, gutta-percha was removed up to the same depth of 8 mm using a round bur (RB) (H1SEM 205.010; Komet/Brassler, Lemgo, Germany) (group RB). Magni- fying glasses (magnication 2.59) were used to con- trol the removal of gutta-percha. Specimens from each of these two main groups (PD and RB) were fur- ther divided into subgroups according to the cleaning methods and the luting procedures employed for post insertion (Fig. 1). To ensure equal distribution, the specimens were randomly assigned to the different groups and subgroups, respectively. Cleaning methods following post space preparation In one-third of all specimens, the prepared post space was rinsed using 10 mL of 1% NaOCl (cleaning control group). In the second third, cleaning was per- formed using a rotating interdental brush (Curaprox CRA 12, Curaden AG, Kriens, Switzerland) and pum- ice powder for 15 s with a slow-rotating contra-angle hand piece at 10 000 rpm (brush group). Afterwards, the root canals were thoroughly rinsed with 5 mL of distilled H 2 O. The remaining specimens were sand- blasted with 50 lm of Al 2 O 3 particles (Korox; BEGO, Figure 1 Experimental design overview of groups and subgroups. Retention of bre posts Bitter et al. 2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1118 Bremen, Germany) using an intraoral sandblasting device at 3 bar for 10 s with slight movements to reach all regions of the post space preparation (sand- blasting group). Afterwards, the root canals were thoroughly rinsed with 5 mL of H 2 O. Evaluation of root canal cleanliness Root canal cleanliness was investigated under the operating microscope (magnication 239, OPMI pico; Zeiss, Jena, Germany) by one pre-calibrated observer who did not perform or witness the cleaning of the root canals. The following scoring system was applied to quantify root canal cleanli- ness: (i) completely clean, (ii) small remnants of sealer, (iii) large remnants of sealer and (iv) rem- nants of sealer and gutta-percha (Fig. 2ad). Two representative specimens from each group were sectioned parallel to the long axis of the tooth, and the root canal surfaces were evaluated using SEM (Cam Scan Maxim 2040; Cam Scan Maxim Electron Optics, Cambridge, UK). Fibre post insertion and pull-out testing In all subgroups, bre posts (DT Light Post SL Size 3; VDW) were inserted using either self-adhesive resin cement (SmartCem2; Dentsply DeTrey) or core build- up material (CoreX Flow/XP Bond; Dentsply DeTrey) (Fig. 1). After drying the root canal with paper points, SmartCem2 was applied to the root canal with the aid of a mixing tip provided by the manufacturer. Prior to the use of CoreX Flow/XP Bond, the cavity walls were etched for 15 s with phosphoric acid (DeT- rey Conditioner 36; Dentsply DeTrey). After rinsing for 15 s, the water was removed using paper points and a gentle air blast, avoiding complete desiccation of the cavity. An equal ratio of XP Bond and Self-cure activator was mixed for 5 s and applied using root canal applicator tips provided by the manufacturer for 20 s. Excess adhesive was removed with paper points, and the cavity was gently air-dried for 5 s. CoreX Flow was applied to the root canal using a mixing tip provided by the manufacturer. The posts were inserted into the canal using slight nger pressure, excess CoreX Flow was removed, and light curing was performed using an LED-curing unit set at 1200 mW cm 2 (Elipar Freelight 2, 3M ESPE, Seefeld, Germany) according to the manufacturers instruc- tions. The light intensity of the light-curing unit was checked prior to the use of a Demetron LED Radiome- ter (Kerr, Orange, CA, USA). Subsequently, the speci- mens were stored in 100% humidity for at least 24 h to allow for complete polymerization. Ten specimens from each group were then subjected to pull-out test- ing. For this test, roots were embedded into Technovit 4071 acrylic resin (Heraeus Kulzer, Hanau, Germany) parallel to the long axis of the root. Specimens were then placed into the jig of a universal testing machine (Zwick, Roell, Ulm, Germany), and tensile force at a cross-head speed of 0.5 mm min 1 was applied to the posts until they debonded from the root canals. After (a) (b) (c) (d) Figure 2 (ad) Root canal cleanliness was assessed using an operating microscope. Specimens were categorized into the following four categories: (a) completely clean, (b) small remnants of sealer, (c) large remnants of sealer and (d) remnants of sealer and gutta-percha. Bitter et al. Retention of bre posts 2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1119 the pull-out test, the roots from each specimen were cut longitudinally into two pieces using a band saw (Exakt Apparatebau, Norderstedt, Germany); the root halves and the posts were then observed using a ste- reomicroscope (DV 4; Zeiss) at 40 9 magnication to determine the failure mode. The specimens were divided into the following three groups according to their failure modes: (i) adhesive failures between dentine and cement, (ii) adhesive failures between post and cement and (iii) mixed failures (Fig. 3ac). Confocal laser scanning microscope analysis Confocal laser scanning microscope (CLSM) analysis was applied to two specimens from each group to evaluate the adhesive interface. For CLSM experi- ments, SmartCem2 and CoreX Flow were labelled with 1% rhodamine-isothiocyanate (RITC) (Sigma Aldrich, St Louis, MO, USA) prior to being applied to the root canal. The XP Bond adhesive was labelled with 1% sodium uorescein (FNa) (Sigma Aldrich). Each root was cut perpendicular to its long axis into three 2-mm-thick slices using a band saw (Exakt Apparatebau). Further specimen preparation for CLSM analysis was performed as described previously (Bitter et al. 2009b). CLSM (Leica TCS NT; Leica, Heidelberg, Germany) analysis of the adhesive interface of each slice was performed in dual uorescence mode using a 409 objective and a 29 electronic zoom (Bitter et al. 2009b). Statistical analysis Statistical analysis was performed using SPSS version 16.0 software (SPSS, Chicago, IL, USA). The a (Type I) error level was set to 0.05. The effects of the clean- ing method, luting agent and preparation procedure on the pull-out force of the bre posts were analysed using three-way ANOVA and Tukeys HSD post hoc test. The effects of the cleaning method on root canal cleanliness and the effects of the luting agent and preparation procedure on failure modes were investi- gated using Pearsons chi-squared test. Results Fibre post retention was signicantly affected by the cleaning procedure (P = 0.008), luting agent (P < 0.0005) and preparation technique (P < 0.0005, 3- way ANOVA). A signicant interaction was observed between the luting agent and the preparation proce- dure (P < 0.0005). With regard to the cleaning method, the control group exhibited signicantly higher post retention [mean (SD)] [370 (104) N] com- pared with the brush group [315 (124) N] (P = 0.005, Tukeys HSD); however, the control group did not differ signicantly from the sandblast- ing group [344 (102) N] (P = 0.28; Tukeys HSD). Signicantly higher post retention was observed following the use of CoreX Flow/XP Bond luting agent [370 (62) N] compared with SmartCem2 [315 (141) (a1) (a2) (b1) (b2) (c1) (c2) Figure 3 (ac) Representative images of the three observed failure modes: adhesive failures between the dentin and cement (a1 + 2), adhesive failures between the post and cement (b1 + 2) and mixed failures (c1 + 2). Retention of bre posts Bitter et al. 2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1120 N] (P < 0.0005). The PD preparation method resulted in signicantly lower post retention [287 (105) N] compared with the RB method [399 (88) N] (P < 0.0005). However, this effect was primarily observed with the SmartCem2 luting agent, which showed signicantly higher post retention when the RB [423 (112) N] procedure was utilized compared with the PD preparation technique [207 (58) N] (P < 0.0005) (Table 1). As shown in Table 2, root canal cleanliness was not affected by the investigated cleaning methods (P = 0.618, chi-square test). The failure modes were signicantly affected by the luting agent and prepara- tion procedure (P < 0.0005, chi-squared test); these results are displayed according to the groups in Table 3. Scanning electron microscope evaluation of the pre- pared root canals revealed that the RB created distinct grooves and undercuts (Fig. 4a), whereas the PD created minimal grooves (Fig. 4b). Although sand- blasting had an effect on sealer removal (Fig. 4d), sea- ler remnants were detected in all groups regardless of the cleaning method (Fig. 4c). Analyses of the inter- face using CLSM demonstrated for the material CoreX Flow and the adhesive System XP Bond/Self-cure acti- vator a distinct hybrid layer and numerous resin tags lled with adhesive and resin cement (Fig. 5a). In contrast, no hybrid layer formation was detected, and penetration into the dentinal tubules occurred only sporadically for the self-adhesive resin cement Smart- Cem 2 (Fig. 5b). No effects of the investigated clean- ing methods on the adhesive interface were seen. Discussion The null hypotheses of the present study were par- tially rejected because cleaning method, luting agent and preparation procedure signicantly affected bre post retention inside the root canal; furthermore, the modes of failure were affected by the luting agent and preparation procedure. However, the cleaning meth- ods investigated in the present study did not affect root canal cleanliness. The thin push-out test is considered to be a valid method to analyse the bond strength between bre posts and root canal dentine (Soares et al. 2008). Nevertheless, the exposure of bre posts to dislodging forces during the push-out test cannot be compared with the functional forces incurred during clinical service (Radovic et al. 2008a). Additionally, the sec- tioning process may induce artefacts that could inu- ence the test results. However, as the pull-out test design offers the advantage of testing the entire root canal and post length, it is considered to be more effective in detecting the effects of post surface and root canal dentine pre-treatments of the post as well as of the root canal dentine on bond strength (Schmage et al. 2009a,b). As a result, the pull-out Table 1 Mean (SD) post retention with respect to preparation procedure, luting agent and cleaning method Preparation procedure Luting agent Adhesive Cleaning method Post Retention in N Mean SD Post drill SmartCem2 (LOT 090331, 091218, 091206) None Control 229 67 Brush 182 61 Sandblasting 211 40 CoreX Flow (LOT 090930, 091021, 0809111) DeTrey Conditioner 36 (LOT 0807002999) XP Bond (LOT 0811001247) Self-cure activator (LOT 080624) Control 390 59 Brush 340 102 Sandblasting 369 63 Round bur SmartCem2 (LOT 090331, 091218, 091206) None Control 451 78 Brush 383 151 Sandblasting 436 95 CoreX Flow (LOT 090930, 091021, 0809111) DeTrey Conditioner 36 (LOT 0807002999) XP Bond (LOT 0811001247) Self-cure activator (LOT 080624) Control 409 32 Brush 355 45 Sandblasting 358 30 Bitter et al. Retention of bre posts 2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1121 test method was selected to investigate the effects of root canal cleaning methods on bre post retention. It is well documented that contamination of dentine with temporary cements (Paul & Scharer 1997) or root canal sealers containing eugenol (Menezes et al. 2008) considerably decreases dentine adhesion capacity. Recently, the impact of resin-based sealers, such as AH Plus, on the push-out bond strength of luted bre posts has been investigated. Although Demiryurek et al. (2010) demonstrated a signicant reduction in bond strength, no inuence was found in another study that utilized a comparable methodology (Cecchin et al. 2011). The differences in results could potentially be attributed to differences in the materials used for post cementation or the degree of the cleanli- ness of the canal walls. Following post space prepara- tion of root lled teeth, large areas of dentine covered with gutta-percha and sealer remnants were detected (Serano et al. 2004). The cleaning methods investi- gated in the present study were not effective with respect to root canal cleanliness. The limited accessi- bility of the root canal for the intraoral sandblasting device may have been responsible for the lack of an effect of air abrasion on root canal cleanliness. Moreover, the results suggest that the pressure and rotation frequency of the rotating brushes used with pumice powder were not sufcient to clean the root canal walls. Because sonically activated canal brushes have been shown to effectively remove the smear layer inside root canals when used in combination with 17% EDTA (Salman et al. 2010), further studies should be performed to evaluate their effects on root canal cleanliness. The lack of an effect of air abrasion on bond strength reported here is corroborated by previous studies that failed to show an effect of aluminium air abrasion on dentine surfaces when one- and two-step self-etching adhesive systems (Franca et al. 2007) or etch-and-rinse adhesive systems (Abo-Hamar et al. 2005) were employed. In contrast to these studies, other authors have demonstrated benecial effects of sandblasting on dentine adhesion (Mujdeci & Gokay 2004, Motisuki et al. 2006). Specically, the contaminated coronal dentine bond strength values of self-adhesive cement were shown to be signicantly improved after sandblasting (Chaiyabutr & Kois 2008). Regardless of the cleaning method employed, sealer or gutta-percha remnants were not completely removed in the present study. Interestingly, both phosphoric acid etching and ultrasonic agitation in combination with EDTA/sodium hypochlorite have been shown to be effective in completely cleaning the post space and improving the push-out bond strength compared with manual irrigation with water or EDTA followed by NaOCl (Zhang et al. 2008). In contrast, two previous studies have demonstrated that phos- phoric acid is unable to clean dentine effectively in prepared post spaces (Serano et al. 2004, Coniglio et al. 2008b). Additionally, ultrasonic cleaning devices may require EDTA for efcient canal wall debridement (Coniglio et al. 2008b). Table 2 No signicant effects of the investigated cleaning methods on root canal cleanliness were detected (P = 0.618, chi-squared test) Cleaning method Cleanliness of the root canals in% I II III IV Clean Small remnants of sealer Large remnants of sealer Remnants of sealer and gutta-percha Control 27.4 45 12.5 15 Brush 22.5 37.5 27.5 12.5 Sandblasting 32.5 30 25 12.5 Table 3 Analyses of the failure modes with respect to luting agent and preparation procedure. A P value of <0.05 indicates signicant effects of the luting agent or preparation procedure on the failure modes (Pearson) Luting agent Preparation procedure Failure mode in % I II III P value Adhesive cement dentin Adhesive post cement Mixed SmartCem2 PD 83.3 0 16.7 <0.0005 RB 10 40 50 CoreX Flow PD 23.3 56.7 20 0.006 RB 0 93.4 6.6 PD, post drill; RB, round bur. Retention of bre posts Bitter et al. 2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1122 The lowest post retention values observed in this study occurred after intraradicular cleaning with a rotating brush and pumice paste. For the SmartCem2 self-adhesive material, this might be attributed to the presence of a thick smear layer, which can remain even after pumicing the dentine surface (Bloxham et al. 1990) and impair adhesion (Senawongse et al. 2010). Although it has been reported previously that sodium hypochlorite can reduce bond strength to endodontic surfaces (Morris et al. 2001), the control specimens in which only hypochlorite was used for cleaning the post space exhibited similar pull-out values. In the present study, the etch-and-rinse approach using CoreX Flow/XP Bond resulted in signicantly higher bond strength compared to the self-adhesive resin cement SmartCem2. A previous study using a push-out design revealed similar bond strength values inside the root canal when either CoreX Flow/XP Bond or the self-adhesive resin cement RelyX Unicem was used (Mazzoni et al. 2009). However, the bond strengths of self-adhesive resin cements can differ between materials because of their varied composi- tions (Monticelli et al. 2008, Radovic et al. 2008b). It is likely that the low bond strengths recorded for the self-adhesive cement SmartCem2 are related to its limited ability to demineralize and inltrate the dentine substrate, as previously shown for a compara- ble self-adhesive resin cement, RelyX Unicem (De Munck et al. 2004, Goracci et al. 2005b, Monticelli et al. 2008, Bitter et al. 2009b). These ndings are consistent with the CLSM analysis in the present investigation that revealed that no hybrid layer formation occurred when SmartCem2 was utilized (a) (b) (c) (d) Figure 4 (ad) Scanning electron microscope evaluation of post space preparations revealed distinct grooves and undercuts produced by the round bur (a), whilst the post drill produced marginal grooves (b). Remnants of sealer could be detected in all groups regardless of the cleaning method employed (c). Marginal grooves resulting from sandblasting were observed (d). (a) (b) Figure 5 (a, b) Confocal laser scanning microscope demon- strated a distinct hybrid layer and numerous resin tags lled with adhesive and resin cement for CoreX Flow/XP Bond/ Self-cure activator (a). For SmartCem2, no hybrid layer for- mation was detected, and penetration into the dentinal tubules occurred only sporadically (b). Bitter et al. Retention of bre posts 2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1123 (Fig. 5b). The initial low pH and signicantly increased viscosity of the self-adhesive cement com- pared with self-etching primers may explain why no true hybrid layer is formed when the self-adhesive cement is applied to the root canal. In contrast to the self-adhesive cement SmartCem2, CLSM analysis of the XP Bond etch-and-rinse adhe- sive system with the Self-cure activator and CoreX Flow material revealed a distinctive hybrid layer and numerous resin tags. These results are consistent with a previous study that demonstrated the formation of a homogenous hybrid layer for etch-and-rinse adhe- sive systems inside root canals (Bitter et al. 2009b). The preparation procedure signicantly affected the pull-out bond strength of bre posts in the present investigation. In addition, a signicant interaction between the luting agent and the preparation proce- dure was observed. SEM analysis revealed the crea- tion of distinct undercuts when the RB was used compared with minimal grooves when the PD was used. These undercuts may have contributed to the increased pull-out force observed in the RB group. In the PD group, the CoreX Flow/XP Bond etch-and- rinse adhesive system showed a signicantly higher pull-out force compared with the self-adhesive resin cement SmartCem2. However, when the post space preparation was performed with a RB, which resulted in distinct undercuts on the dentine surface, differ- ences in pull-out force between the two luting agents were negligible. These ndings suggest that increased friction can partially compensate for poor adhesive performance in the root canal; furthermore, consis- tent with previous reports, these results highlight the contribution of frictional retention on the pull-out force of bre posts (Goracci et al. 2005a,. Pirani et al. 2005). The failure modes were signicantly affected by both the luting agent and the preparation procedure used. In the RB group, signicantly fewer failures occurred between the dentine and cement, indicating that the micromechanical retentions enhanced the cement-to-dentine bond strength. When the CoreX Flow/XP Bond material was utilized, signicantly more adhesive failures between the post and cement were observed in the RB group, indicating that the weak part of this interface was between the post and the cement. However, the pull-out bond strength did not increase after using the RB for this material. In contrast, bond strength was signicantly increased for the SmartCem2 material when the RB was employed for post space preparation; moreover, the failure modes changed from being predominantly adhesive between the dentine and the cement to being predominantly mixed or between the post and the cement. Conclusion Within the limitations of the present study, it can be concluded that the investigated cleaning methods after post space preparation were not effective in improving the cleanliness of the canal and did not enhance bre post retention inside the root canal. However, post space preparation using a RB increased the pull-out force of bre posts, suggesting that this approach might be benecial for improving retention, especially when self-adhesive cements are used. Fur- ther studies using microcomputed tomography are clearly warranted to analyse the removal of tooth structure when using a PD or a RB to determine which method is less invasive. References Abo-Hamar SE, Federlin M, Hiller KA, Friedl KH, Schmalz G (2005) Effect of temporary cements on the bond strength of ceramic luted to dentin. Dental Materials 21, 794803. Bitter K, Paris S, Martus P, Schartner R, Kielbassa AM (2004) A Confocal Laser Scanning Microscope investiga- tion of different dental adhesives bonded to root canal den- tine. International Endodontic Journal 37, 8408. Bitter K, Noetzel J, Stamm O et al. (2009a) Randomized clini- cal trial comparing the effects of post placement on failure rate of postendodontic restorations: preliminary results of a mean period of 32 months. Journal of Endodontics 35, 147782. Bitter K, Paris S, Pfuertner C, Neumann K, Kielbassa AM (2009b) Morphological and bond strength evaluation of different resin cements to root dentin. European Journal of Oral Sciences 117, 32633. Bloxham GP, Dennison JD, Charbeneau GT (1990) A clinical scanning electron microscope study of tooth surface prepa- ration and bonding. Australian Dental Journal 35, 34551. Buettel L, Krastl G, Lorch H, Naumann M, Zitzmann NU, Weiger R (2009) Inuence of post t and post length on fracture resistance. International Endodontic Journal 42, 4753. Cagidiaco MC, Goracci C, Garcia-Godoy F, Ferrari M (2008) Clinical studies of ber posts: a literature review. Interna- tional Journal of Prosthodontics 21, 32836. Cecchin D, Farina AP, Souza MA, Carlini-Junior B, Ferraz CC (2011) Effect of root canal sealers on bond strength of breglass posts cemented with self-adhesive resin cements. International Endodontic Journal 44, 31420. Retention of bre posts Bitter et al. 2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1124 Chaiyabutr Y, Kois JC (2008) The effects of tooth prepara- tion cleansing protocols on the bond strength of self-adhe- sive resin luting cement to contaminated dentin. Operative Dentistry 33, 55663. Coniglio I, Carvalho CA, Magni E, Cantoro A, Ferrari M (2008a) Post space debridement in oval-shaped canals: the use of a new ultrasonic tip with oval section. Journal of Endodontics 34, 7525. Coniglio I, Magni E, Goracci C et al. (2008b) Post space cleaning using a new nickel titanium endodontic drill combined with different cleaning regimens. Journal of Endodontics 34, 836. De Munck J, Vargas M, Van Landuyt K, Hikita K, Lambrechts P, Van Meerbeek B (2004) Bonding of an auto-adhesive luting material to enamel and dentin. Dental Materials 20, 96371. Demiryurek EO, Kulunk S, Yuksel G, Sarac D, Bulucu B (2010) Effects of three canal sealers on bond strength of a ber post. Journal of Endodontics 36, 497501. Franca FM, dos Santos AJ, Lovadino JR (2007) Inuence of air abrasion and long-term storage on the bond strength of self-etching adhesives to dentin. Operative Dentistry 32, 21724. Goracci C, Fabianelli A, Sadek FT, Papacchini F, Tay FR, Ferrari M (2005a) The contribution of friction to the dis- location resistance of bonded ber posts. Journal of End- odontics 31, 60812. Goracci C, Sadek FT, Fabianelli A, Tay FR, Ferrari M (2005b) Evaluation of the adhesion of ber posts to intra- radicular dentin. Operative Dentistry 30, 62735. Hashimoto M, Ohno H, Kaga M, Endo K, Sano H, Oguchi H (2000) In vivo degradation of resin-dentin bonds in humans over 1 to 3 years. Journal of Dental Research 79, 138591. Kishen A, Kumar GV, Chen NN (2004) Stress-strain response in human dentine: rethinking fracture predilec- tion in postcore restored teeth. Dental Traumatology 20, 90 100. Krastl G, Gugger J, Deyhle H, Zitzmann NU, Weiger R, Muller B (2011) Impact of adhesive surface and volume of luting resin on fracture resistance of root lled teeth. International Endodontic Journal 44, 4329. Lang H, Korkmaz Y, Schneider K, Raab WH (2006) Impact of endodontic treatments on the rigidity of the root. Journal of Dental Research 85, 3648. Mazzoni A, Marchesi G, Cadenaro M et al. (2009) Push-out stress for bre posts luted using different adhesive strategies. European Journal of Oral Sciences 117, 44753. Menezes MS, Queiroz EC, Campos RE, Martins LR, Soares CJ (2008) Inuence of endodontic sealer cement on breglass post bond strength to root dentine. International Endodontic Journal 41, 47684. Mjor IA, Smith MR, Ferrari M, Mannocci F (2001) The structure of dentine in the apical region of human teeth. International Endodontic Journal 34, 34653. Monticelli F, Osorio R, Mazzitelli C, Ferrari M, Toledano M (2008) Limited decalcication/diffusion of self-adhesive cements into dentin. Journal of Dental Research 87, 9749. Morris MD, Lee KW, Agee KA, Bouillaguet S, Pashley DH (2001) Effects of sodium hypochlorite and RC-prep on bond strengths of resin cement to endodontic surfaces. Journal of Endodontics 27, 7537. Motisuki C, Monti Lima L, Emi Sanabe M, Jacques P, San- tos-Pinto L (2006) Evaluation of the microtensile bond strength of composite resin restoration in dentin pre- pared with different sizes of aluminum oxide particles, using the air abrasion system. Minerva Stomatologica 55, 6118. Mujdeci A, Gokay O (2004) The effect of airborne-particle abrasion on the shear bond strength of four restorative materials to enamel and dentin. The Journal of Prosthetic Dentistry 92, 2459. Paul SJ, Scharer P (1997) The dual bonding technique: a modied method to improve adhesive luting procedures. International Journal of Periodontics and Restorative Dentistry 17, 53645. Perdigao J, Gomes G, Augusto V (2007) The effect of dowel space on the bond strengths of ber posts. Journal of Pros- thodontics 16, 15464. Pirani C, Chersoni S, Foschi F et al. (2005) Does hybridiza- tion of intraradicular dentin really improve ber post retention in endodontically treated teeth? Journal of End- odontics 31, 8914. Porciani PF, Vano M, Radovic I et al. (2008) Fracture resis- tance of ber posts: combinations of several small posts vs. standardized single post. American Journal of Dentistry 21, 3736. Radovic I, Mazzitelli C, Chief N, Ferrari M (2008a) Evalua- tion of the adhesion of ber posts cemented using different adhesive approaches. European Journal of Oral Sciences 116, 55763. Radovic I, Monticelli F, Goracci C, Vulicevic ZR, Ferrari M (2008b) Self-adhesive resin cements: a literature review. Journal of Adhesive Dentistry 10, 2518. Salman MI, Baumann MA, Hellmich M, Roggendorf MJ, Termaat S (2010) SEM evaluation of root canal debride- ment with Sonicare CanalBrush irrigation. International Endodontic Journal 43, 3639. Schmage P, Cakir FY, Nergiz I, Pfeiffer P (2009a) Effect of surface conditioning on the retentive bond strengths of berreinforced composite posts. Journal of Prosthetic Den- tistry 102, 36877. Schmage P, Pfeiffer P, Pinto E, Platzer U, Nergiz I (2009b) Inuence of oversized dowel space preparation on the bond strengths of FRC posts. Operative Dentistry 34, 93101. Senawongse P, Srihanon A, Muangmingsuk A, Harnirattisai C (2010) Effect of dentine smear layer on the performance of self-etching adhesive systems: a micro-tensile bond Bitter et al. Retention of bre posts 2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1125 strength study. Journal of Biomedical Materials Research. Part B, Applied Biomaterials 94, 21221. Serano C, Gallina G, Cumbo E, Ferrari M (2004) Surface debris of canal walls after post space preparation in endodontically treated teeth: a scanning electron microscopic study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics 97, 3817. Soares CJ, Santana FR, Castro CG et al. (2008) Finite element analysis and bond strength of a glass post to intraradicular dentin: comparison between microtensile and push-out tests. Dental Materials 24, 140511. Sorensen JA, Engelman MJ (1990) Effect of post adaptation on fracture resistance of endodontically treated teeth. The Journal of Prosthetic Dentistry 64, 41924. Watanabe I, Nakabayashi N, Pashley DH (1994) Bonding to ground dentin by a phenyl-P self-etching primer. Journal of Dental Research 73, 121220. Zhang L, Huang L, Xiong Y, Fang M, Chen JH, Ferrari M (2008) Effect of post-space treatment on retention of ber posts in different root regions using two self-etching systems. European Journal of Oral Sciences 116, 2806. Retention of bre posts Bitter et al. 2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1126
[International Endodontic Journal 2011-jan 10 vol. 44 iss. 4] D. Cecchin_ A. P. Farina_ M. A. Souza_ B. Carlini-Júnior_ C. C. - Effect of root canal sealers on bond strength of fibreglass posts cemented wi (1)
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