In vitro evaluation of push-out bond strengths of various luting agents to tooth-colored posts

Kerstin Bitter, DDS,a Karsten Priehn, DDS,b Peter Martus, PhD,c and Andrej M. Kielbassa, DDS, PhDd Department of Operative Dentistry and Periodontology, University School of Dental Medicine, Charite - Universitatsmedizin Berlin, Berlin, Germany Statement of problem. Different compositions of tooth-colored posts may inuence the bonding capacity of
various luting agents to these posts. An appropriate understanding of these interactions is presently unavailable.

Purpose. This study initially evaluated the effects of various pretreatment procedures on bond strengths to zirconium-oxide posts using a phosphate-methacrylate resin luting agent. Following that investigation, the bond strengths of various luting agents to tribochemically coated glass-berreinforced composite (FRC) resin and zirconium-oxide posts were investigated. Material and methods. Two hundred zirconium-oxide posts (CosmoPost) divided into 10 groups (n=20) were luted into articial post spaces prepared with drills provided by the manufacturer. In 4 groups the posts were luted with phosphate-methacrylate resin agent (Panavia F) after receiving one of the following pretreatment procedures: no treatment (control); airborne-particle abrasion; silica coating and silanization with an intraoral airborne-particleabrasion device (CoJet); or silica coating and silanization with a laboratory airborne-particle abrasion device in combination with airborne-particle abrasion (Rocatec). The other zirconium-oxide posts in the 6 remaining groups were silica coated (CoJet), silanated, and luted with 1 of 6 different luting agents (Multilink, Variolink, PermaFlo DC, RelyX Unicem, Clearl Core, and Ketac Cem). Additionally, 60 FRC posts (FRC Postec) were silica coated (CoJet), silanated, and luted with 1 of the 6 resin luting agents (Panavia F, Multilink, Variolink, PermaFlo DC, RelyX, and Clearl Core). Push-out tests were performed to evaluate the bond strengths between luting agents and posts. Qualitative scanning electron microscopy (SEM) analyses were performed to evaluate the effects of the pretreatment procedures on the surface of the zirconium-oxide posts. Data were analyzed using analysis of variance (ANOVA) followed by the post hoc Tukey B test (a=.05). Results. Bond strengths to the posts were signicantly affected by the type of luting agent and the type of post (P,.001; 2-way ANOVA). Bond strengths of all luting agents to the FRC posts were signicantly higher than to the zirconium-oxide posts (P,.01), except for Multilink and PermaFlo DC, which demonstrated higher bond strength values to the zirconium-oxide posts (P,.001). Pretreatment procedures signicantly increased the bond strength of Panavia F to the zirconium-oxide posts (P,.05). SEM analyses revealed distinctive irregularities on the surface of the pretreated zirconium-oxide posts compared to the untreated posts. Conclusion. Bond strengths of luting agents to tooth-colored posts are signicantly affected by the type of luting agent and the type of post. All investigated pretreatment procedures of zirconium-oxide posts signicantly increased the bond strength of Panavia F. (J Prosthet Dent 2006;95:302-10.)

CLINICAL IMPLICATIONS
Fiber-reinforced composite posts showed signicantly higher in vitro bond strength values to resin luting agents than zirconium-oxide posts, depending on the luting agent used. Therefore, FRC posts may be more suitable to resist loss of retention of endodontic posts.

ndodontic posts have been shown to improve the retention of a foundation core restoration in situations in which endodontically treated teeth have a signicant

Presented at the 3rd annual meeting of the German Endodontic Society, Munich, Germany, October, 2004. a Lecturer, Department of Operative Dentistry and Periodontology. b Lecturer, Department of Restorative Dentistry, University School of Dental Medicine. c Professor, Department of Medical Informatics, Biometry, and Epidemiology. d Professor and Lecturer, Department of Operative Dentistry and Periodontology.

loss of coronal tooth structure, but it has also been demonstrated that these posts do not strengthen a root.1 Most clinical failures involving endodontically treated teeth reconstructed with posts are due to cementation failure of posts, whereas root fractures are the most serious type of failure.2-4 In situations in which all-ceramic restorations are used for restoring maxillary anterior teeth, metal posts may result in unfavorable esthetic results, such as a gray discoloration of translucent allceramic crowns and the surrounding gingiva.5 Moreover, corrosive reactions with prefabricated posts made from certain metal alloys can cause complications involving the surrounding tissues and oral environment,
VOLUME 95 NUMBER 4

302 THE JOURNAL OF PROSTHETIC DENTISTRY

BITTER ET AL

THE JOURNAL OF PROSTHETIC DENTISTRY

including a metallic taste, oral burning, sensitization, oral pain, and other reactions.6,7 Various tooth-colored posts such as translucent berreinforced composite (FRC) and yttrium-stabilized zirconium-oxide posts are available and provide some advantages when restoring endodontically treated teeth.8,9 Since 1990, studies have described favorable physical properties for FRC posts.10,11 One study revealed that long-term water storage weakened the exural strengths of FRC posts, but when inserted into bovine teeth and stored for 1 year in oral uids, no reduced exural strength values of the posts could be observed.12 Partially yttrium-stabilized zirconium-oxide post systems were introduced in the mid 1990s by various investigators.5,13 Pure zirconia material shows a polymorphic phase transformation from a cubic, to a tetragonal, to a monoclinic phase, accompanied by a high volume change when cooling down after sintering, which makes the sintered body unstable. Therefore, dental zirconia material contains 3 to 6 wt% Y203 as an additive to stabilize the ceramic in the tetragonal phase that is usually not stable at room temperature.14 Zirconium-oxide posts demonstrate high fracture resistance due to high exural strengths, which is comparable to that of cast gold posts and cores or titanium posts.9,15,16 Fractures of teeth restored with zirconium-oxide posts are often unrestorable, whereas in vitro studies on fracture strengths of FRC posts showed less catastrophic failures due to a modulus of elasticity that is closer to that of dentin.17 Different resin luting agents and corresponding bonding systems have been proposed for cementing tooth-colored posts and can be generally divided into conventional bis-GMAbased resin luting agents and so-called adhesive resin luting agents containing functional monomers such as 10-Methacryloyloxydecyl hydrogen phosphate (10-MDP) or 4-methacryloxyethyl trimellitate anhydride (4-META).18 Several in vitro studies reported controversial results regarding bond strengths of different luting agents to endodontic posts and root canal dentin.18-27 Bonding to zirconium-oxide ceramics requires different pretreatment procedures compared to glass ceramics.28 High-strength zirconium-oxide ceramics are not silica based; therefore, chemical silica-silane bonds cannot be established.29 Moreover, the application of acidic agents such as phosphoric or hydrouoric acid to zirconium-oxide ceramic will not create a sufciently roughened surface for enhanced micromechanical retention.28,30 Thus, various pretreatment procedures have been recommended. Airborne-particle abrasion with alumina particles changes the structure of the surface by plastic deformation and roughening, resulting in an increased surface area and a volume loss of material.31 The use of aluminum-trioxide particles modied with silica for airborne-particle abrasion was introduced in
APRIL 2006

the late 1980s.32 Investigators have described that the blasting pressure results in the embedding of the silicacoated alumina particles on the zirconia surface. Consequently, this surface is chemically more reactive to resin after the application of silane coupling agents. This procedure has been found to be effective for conditioning high-strength ceramics.33 One system to accomplish this procedure is the Rocatec system (3M ESPE, Seefeld, Germany). It is performed in 3 steps. First the surface is blasted with aluminum-oxide particles to obtain a clean and activated surface. This is followed by a tribochemical coating with a blasting procedure using silica-modied aluminum-oxide particles. This results in a surface partially coated with silicon-dioxide, and after silanization, a chemical bond to an organic resin can be established.34 The CoJet system (3M ESPE) is a chairside system with an intraoral airborne-particleabrasion device (DentoPrep; Ronvig, Daugaard, Denmark); the system includes a tribochemical coating of the surface with silica-modied aluminum-oxide particles (CoJet Sand; 3M ESPE) followed by silanization (ESPE Sil; 3M ESPE). Compared to the Rocatec system, no prior cleaning of the surface with aluminum-oxide particles is performed. The effect of airborne-particle abrasion and silica coating on the strength of high-strength ceramics has been controversial. An analysis of radial cracking on various ceramic layers after the application of critical loads found that airborne-particle abrasion or grinding may result in the development of aws inside the microstructure of the ceramic.35 Findings by others investigating the effect of airborne-particle abrasion and surface grinding on the exural strength of zirconium-oxide ceramics indicated that airborne-particle abrasion may have a strengthening effect.36,37 Airborne-particle abrasion with Al2O3 particles in combination with an MDP-containing resin luting agent has been shown to be effective for zirconium-oxide ceramic, even after long-term water storage and thermal cycling.38,39 In contrast to this, another study found no inuence of different pretreatment procedures on bond strengths to zirconia-oxide posts luted with Panavia F.22 Due to these conicting results, the present investigation initially evaluated the effects of 3 different pretreatment procedures for zirconium-oxide posts on bond strengths using a phosphate-methacrylate resin luting agent. In the second part of this investigation, a comparison of the bond strengths of various luting agents between tribochemically coated zirconium-oxide and FRC posts was performed. It was hypothesized that the bond strength was affected by the surface treatment, the type of the post, and the type of luting agent used.

MATERIAL AND METHODS

All luting agents and corresponding adhesive systems used in this study are presented in Table I. They
303

THE JOURNAL OF PROSTHETIC DENTISTRY

BITTER ET AL

Table I. Luting agents and corresponding adhesive systems used in this investigation
Luting agent Bonding agent Manufacturer Classication of adhesive system Composition of composite resins Composition of primers

10-MDP, bis-GMA, HEMA, hydrophobic dimethacrylate, benzoyl peroxide, N,N9 diethanol p-toluidine, sodium benzene sulnate, ethyl alcohol Water, phosphoric acid acrylate, Dimethacrylate, HEMA, Multilink Multilink Primer Ivoclar Vivadent, Self-etch HEMA, polyacrylic acidmodied barium glass, ytterbium A&B Schaan, methacrylate resin triuoride, silica Liechtenstein Panavia F Ed Primer Kuraray Co Ltd Self-etch Barium glass powder, sodium 10-MDP, HEMA, N-methacryl uoride, dimethacrylate, MDP, 5-aminosalicylic, sodium silica, benzoyl peroxide, amine, benzene sulnate, sodium aromatic sulnate N,N9 diethanol p-toluidine, water PermaFlo PermaFlo DC Ultradent, Salt 3-step Bis-GMA, benzoyl Data not known DC Primers A&B Lake City, Utah etch-and-rinse peroxide, tertiary amine HEMA, bis-GMA, glycerine Variolink II Excite DSC Ivoclar Vivadent 2-step Bis-GMA, urethane dimethacrylate, phosphoric acid etch-and-rinse dimethacrylate, triethylene acrylate, highly dispersed silica, glycol dimethacylate, ethanol ytterbium triuoride barium glass, silica RelyX 3M ESPE, Seefeld, Self-adhesive Silica, glass, calcium No primer available Germany resin cement hydroxide, methacrylated phosphoric ester, dimethacrylate, acetate No primer available Ketac Cem 3M ESPE Conventional Glass powder, pigments, Aplicap luting agent polycarboxylic acid, tartaric acid, water, conservation acid Clearl Core New Bond Kuraray Co Ltd, Osaka, Japan 2-step Bis-GMA, TEGDMA, silica, etch-and-rinse silanated glass powder, benzoyl peroxide, amine
Information provided by manufacturers. TEGDMA, tri-ethylene-glycol dimethacrylate; HEMA, 2-hydroxymethyl methacrylate; MDP, 10-methacryloyloxydecyl hydrogen phosphate.

represent different adhesive systems, including selfetching-systems, 2- and 3-step etch-and-rinse-systems, a self-adhesive resin luting agent, and a conventional luting cement. All specimens were prepared by 1 investigator to ensure standardization. To evaluate the effect of different surface treatments on bond strengths, 80 zirconium-oxide posts (CosmoPost; Ivoclar Vivadent, Schaan, Liechtenstein) (coronal diameter 1.7 mm) were divided into 4 groups of 20 posts each and received different surface treatments. Methyl methacrylate cylinders (Technovit 4071; Heraeus Kulzer, Hanau, Germany) were fabricated for this study and received 18-mm-deep standardized drill holes with a diameter of 3.5 mm. The holes were lled with composite resin (Tetric Ceram; Ivoclar Vivadent) placed in 2-mm increments and polymerized with a halogen lamp for 40 seconds (Pulse Program, 150-1200 mW/cm2; Astralis 10; Ivoclar Vivadent) with the tip-to-specimen distance held constant at 2 mm. Subsequently, post space preparations with a length of 17 mm were prepared with dedicated drills provided by the post manufacturer (CosmoPost Reamer 1.7 mm # 572712; Ivoclar Vivadent). The posts were luted into these articial post spaces using a phosphate-methacrylate resin luting agent (Panavia F;
304

Kuraray Co Ltd, Osaka, Japan). The posts were cleaned with alcohol (2-Propanol; Merck, Darmstadt, Germany) and the different surface treatments were applied. For the control group specimens (CNTR), the surface of the post was wetted with bonding primer (ED Primer; Kuraray Co Ltd). For the airborne-particleabrasion (AIRB) group, the posts were abraded with aluminum-oxide particles (Rocatec-Pre; 3M ESPE) (110-mm diameter/3-bar pressure) for 16 seconds prior to bonding. The distance between the blasting unit and the post was 1 cm. In the CJET group, the posts were tribochemically coated (CoJet; 3M ESPE). Silica-coated alumina particles (30-mm diameter) were blasted onto the post surface for 32 seconds at 2.8-bar pressure, followed by silanization (ESPE Sil; 3M ESPE) and application of the bonding material (ED Primer; Kuraray Co Ltd). The distance between the intraoral airborne-particleabrasion device of the CoJet system and the post was 4 mm. In the group receiving both airborne-particle abrasion and tribochemical coating (ROCA), the posts were abraded with aluminum-oxide particles (110-mm diameter) (Rocatec-Pre; 3M ESPE), creating a clean and activated surface and a microretentive roughness.
VOLUME 95 NUMBER 4

BITTER ET AL

THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 1. Flowchart representing sample size of zirconium-oxide and FRC posts, performed pretreatment procedures, and luting agents used.

This was followed by coating with silica-modied aluminum-oxide particles (Rocatec-Soft Bonding Material; 3M ESPE). The particles (30-mm diameter) coated with a thin layer of silicon dioxide were blasted (3-bar pressure/4-mm distance) for 32 seconds onto the surface of the post prior to the silanization (ESPE Sil). To determine the effect of various luting agents on bond strengths to zirconium-oxide posts, 120 additional CosmoPosts (Ivoclar Vivadent) were divided into 6 groups of 20 posts each and treated with the CoJet System (3M ESPE). Due to its ease of handling in a dental ofce, the chairside CoJet system was used for this procedure in the present investigation. In each group the posts were luted with 1 of 6 different luting agents, according to the manufacturers recommended procedures as described previously (Fig. 1). Moreover, 60 glass-berreinforced composite posts (FRC Postec; Ivoclar Vivadent) (coronal diameter 2.0 mm; size 3) were divided into 6 groups of 10 posts each. The study initially focused on the effect of various pretreatment procedures on bond strengths to zirconium-oxide posts. After investigating a sample size of 10, the sample size
APRIL 2006

was doubled to 20 to verify the method used to determine the bond strengths. In comparing sample sizes of 10 and 20, it was found that the results did not signicantly change by doubling the sample size. Therefore, the bond strengths to the FRC posts were evaluated using a sample size of 10. The FRC posts are purported by the manufacturer to contain unidirectional silane-coated glass bers (61.5% weight), which are embedded in a polymer matrix of triethylene-glycol-dimethacrylates (TEGMA) and urethane-dimethacrylates (UDMA) in combination with highly dispersed silicon dioxide. After pretreatment with the CoJet system, the posts were inserted with 6 luting agents (Fig. 1) as described previously, except using different drills (FRC Postec Reamer Size 3, #572800AN; Ivoclar, Vivadent). In all situations the luting agent was applied into the prepared post space with a lentulo spiral (VDW, Munich, Germany), as well as onto the post surface using a spatula. Subsequently, the posts were inserted into the drill hole and excess material was gently removed. To obtain a standardized insertion depth and a central
305

THE JOURNAL OF PROSTHETIC DENTISTRY

BITTER ET AL

Fig. 2. Experimental design and preparation of specimens: top of post was xed into exact-tting hole in acrylic glass (left); standardized insertion depths and central position of post in prepared post space are illustrated. Microtome saw was used to prepare 4 sections through luted post specimen, each 2 mm thick (center). Push-out bond strength testing was performed using universal testing machine (right).

position of the post, the top of the post was xed into an exact-tting hole in an acrylic glass plate, 3.5 mm thick, and subsequently inserted into the drill hole. The acrylic glass plate was fabricated for this purpose (Technical Department; ChariteUniversitatsmedizin Berlin; Germany) and mounted perpendicular to the long axis of the methyl methacrylate cylinder, which was placed in a plastic mold. Thus, the depth of insertion of the zirconium-oxide posts into the drill hole was standardized at 17 mm (total length 20.5 mm). Due to the different lengths of the posts, the insertion depth of the FRC posts (total length 18 mm) was 14.5 mm. After the polymerization of the luting agent, the specimens were stored for 24 hours in distilled water. The methyl methacrylate cylinders were placed on a slide perpendicular to the long axis of the posts and then sectioned transversally with a microtome saw (Exakt Apparatebau, Norderstedt, Germany). The top 4.5 mm of the posts were sectioned with the microtome saw, resulting in 4 specimens, each 2 mm thick. The push-out tests were performed at a crosshead speed of 0.5 mm/min using a universal testing machine (Zwick, Ulm, Germany) (Fig. 2). To push out the smallest diameter of the tapered section of the posts, the top of the post was indicated on each specimen during the sectioning process. All fractured specimens were analyzed using a stereomicroscope (403; Stereomicroscope Stemi DV 4; Carl Zeiss AG, Jena, Germany) to determine whether the failure mode was adhesive between post and cement, or cohesive within the cement. Specimens that failed between the embedding composite resin and the luting cement were excluded. The maximum failure load was recorded in newtons (N) and converted into megapascals (MPa). The maximum stress was calculated from the recorded peak load divided by the computed surface. To calculate the exact bonding surface, the tapered design of the
306

posts with regard to the respective part of the post was considered. Therefore, each specimen was measured with a micrometer screw (Mitutoyo Messgerate GmbH, Neuss, Germany; accuracy: 0.001 mm), and the bonding surface was calculated using the formula of a conical frustrum (Fig. 3)24:
pR 1 1 R 2 OR 1 2R 2 2 1 h2

One-way analysis of variance (ANOVA) was performed for the comparison of the pretreatment procedures to the zirconium-oxide posts using the luting agent Panavia F (ANOVA model 1) and for the comparison of the luting agents separately for the zirconium-oxide posts and the FRC posts (ANOVA models 3 and 4). Two-way ANOVA was performed for the comparison of luting agents and type of post (ANOVA model 2). For comparison of cell mean values, model 2 was reanalyzed as a 1-way ANOVA with 12 factor levels (2 types of post combined with 6 luting agents). Post hoc comparisons (Tukey B test) were applied. The a-level of significance was .05 (2-sided) for all testing. All analyses were performed using statistical software (SPSS for Windows 12.0; SPSS GmbH, Munich, Germany). A post hoc power analysis revealed that differences of 1.30 SDs between materials were detectable for zirconium-oxide post and pretreatment CJET, differences of 1.16 SDs between pretreatments for material Panavia F, and differences of 1.60 SDs between both types of posts for 6 materials were detectable with a power of 80% and Bonferroni correction within single experiments. Representative specimens of the zirconium-oxide posts prepared with the different pretreatment proceduresairborne-particle abrasion, and tribochemical coating with either an intraoral (CoJet; 3M ESPE) or a laboratory airborne-particleabrasion device (Rocatec; 3M ESPE)in comparison to an untreated post were evaluated using scanning electron microscopy (SEM)
VOLUME 95 NUMBER 4

BITTER ET AL

THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 3. Bonding area of post/cement interface was measured using formula of conical frustrum: top (R1) and bottom radius (R2) of post along with height of specimen: A pR 1 1 R 2 OR 1 2R 2 2 1 h2 . Table II. ANOVA models
Model number Source of variation Sum of squares df Mean square F P

Pretreatment Error Total Type of post Luting agent Type of post 3 Luting agent Error Total Luting agent Error Total Luting agent Error Total

1058 651 1709 766 1257 939 1986 4779 3957 1291 5248 1266 713 1979

3 76 79 1 5 5

353 8.6 766 251 188

41.2

,.001

64.8 21.3 15.9

,.001 ,.001 ,.001

Fig. 4. Plot showing bond strength values of zirconium-oxide posts using different pretreatment groups and a phosphatemethacrylate resin agent (Panavia F). Different letters indicate signicant differences between groups (P,.05). Upper and lower limitations of boxes indicate rst (25%) and third (75%) quartile of the observations (q0.25 and q0.75). Box length is thus dened as d=q0.75 2 q0.25. Upper limitations terminate at maximum of observations within range q0.75 1 1.5 d. Lower limitations are dened analogously. All observations smaller than q0.25 2 1.5 d or larger than q0.75 1 1.5 d are indicated as circles. Table III. Mean bond strength values (SDs) of investigated post types to different luting agents
Luting agent Bond strength CosmoPost (MPa) Bond strength FRC post (MPa) P value

168 12 179 6 659 133 9.7 139 5 253 54 13.1 59

67.9

,.001

19.2

,.001

Model 1, 1-way-ANOVA, comparison of pretreatment procedures to zirconium-oxide posts; Model 2, 2-way-ANOVA, comparison of luting agents (Ketac Cem excluded) and types of posts; Model 3, 1-way-ANOVA, comparison of luting agents to zirconium-oxide posts; Model 4, 1-wayANOVA, comparison of luting agents to FRC posts.

Panavia F Multilink Variolink PermaFlo DC RelyX Clearl Core Ketac Cem

16.6 14.7 11.0 18.9 16.7 15.9 2.1

(3.1) (2.9)B (2.3)C (3.3)A (3.4)AB (4.1)B (1.0)D

AB

22.7 (3.3) 15.9 (1.4)B 16.2 (4)B 14.9 (2)B 24.1 (4.6)A 26.9 (4.4)A Not investigated

P,.001 P ..97 P,.01 P,.001 P,.001 P,.001

Same superscript letters indicate that mean values are not signicantly different (P..05). Signicant differences between 2 post systems are given with P values.

(Cam Scan Maxim 2040; Cam Scan Maxim Electron Optics Ltd, Cambridge, UK). The investigation was performed in the low vacuum mode.

RESULTS
The ANOVA model 1 revealed that bond strengths (SDs) of the phosphate-methacrylate resin agent (Panavia F) to the zirconium-oxide posts were signicantly affected by the investigated pretreatment procedures (Table II). The CNTR posts showed
APRIL 2006

signicantly lower bond strength values (11.8 (2.7) MPa) than all pretreated posts (P,.05). The bond strengths of the AIRB posts (20.3 (2.3) MPa) and the ROCA posts (21.4 (3.2) MPa) showed no signicant differences, but both were signicantly higher compared to the CJET posts alone (16.6 (3.1) MPa) (P,.05) (Fig. 4). In the ANOVA model 2, the mean bond strengths were signicantly affected by the type of luting agent and the type of post. The interaction between luting agent and post type was also statistically signicant (Table II). PermaFlo showed signicantly higher bond
307

THE JOURNAL OF PROSTHETIC DENTISTRY

BITTER ET AL

Fig. 5. Representative surface of untreated zirconium-oxide post revealing smooth grooves. (Original magnication 3300.)

Fig. 6. Representative airborne-particleabraded surface indicating micromechanical retentive areas after treatment with aluminum-oxide particles (110-mm diameter). (Original magnication 3300.)

Fig. 7. CoJet-treated surface revealing smaller microretentive areas compared to airborne-particleabraded surface. (Original magnication 3300.)

Fig. 8. Representative surface after pretreatment with Rocatec System. Surface appears smoother compared to airborneparticle abrasion alone. (Original magnication 3300.)

strength values to the zirconium-oxide posts than to the FRC posts. For the material Multilink, no signicant differences between the 2 types of posts were observed. Each of the other materials showed signicantly higher bond strength values to the FRC posts (Table III). The ANOVA model 3 revealed that the bond strengths to the CJET pretreated zirconium-oxide posts were signicantly affected by the type of luting agent (Table II). Ketac Cem showed signicantly lower bond strength values to the zirconium-oxide posts than all other tested materials (P,.001). Variolink showed lower bond strength values to the zirconium-oxide posts than all the other investigated luting agents except
308

for Ketac Cem (P,.05). ANOVA model 4 revealed that the bond strengths to the CJET pretreated FRC posts were signicantly affected by the type of luting agent (Table II). The luting agents Clearl Core, Panavia F, and RelyX had signicantly higher bond strength values to the FRC posts than the other investigated luting agents (P,.05). Figures 5 through 8 show representative specimens of the investigated pretreatment procedures. The untreated zirconium-oxide posts (Fig. 5) exhibit smooth grooves on the surface, whereas the surfaces of the pretreated posts showed distinctive irregularities, creating a microretentive roughness (Figs. 6 through 8).
VOLUME 95 NUMBER 4

BITTER ET AL

THE JOURNAL OF PROSTHETIC DENTISTRY

DISCUSSION
The hypothesis of the present study was conrmed; the bond strengths to the posts were signicantly affected by the investigated surface treatments, the type of post, and the luting agent used. In the present investigation, bond strengths of various luting agents to tooth-colored posts were evaluated using a push-out design. A previous study showed reproducible bond strength measurements using a conical version of the push-out design compared to a microtensile technique.19 Therefore, this design was chosen for the present study. Preliminary testing focused on the pretreatment of the zirconium-oxide posts. Nontreated posts served as a control, and all investigated pretreatment procedures signicantly increased bond strengths of a phosphate-methacrylate resin agent (Panavia F) to the posts. The CoJet system enables a clinician to perform a tribochemical coating with an intraoral airborne-particle abrasion device in a dental ofce. Thus, the CoJet system was used as a pretreatment procedure for the subsequent evaluation, although airborne-particle abrasion or tribochemical coating in combination with airborne-particle abrasion (Rocatec) showed higher bond strength values. The results of the present study showed that bond strength values to zirconium-oxide posts were signicantly affected by the type of luting agent. This is in agreement with the ndings of other investigators,18,22,23 and may be explained by differences in surface energy characteristics of the post and luting agent.25 Ketac Cem showed signicantly lower bond strength values than all other investigated resin luting agents and is not recommended for luting zirconium-oxide posts, which again is in agreement with other studies.26,27 Previous studies showed a strong and durable bond for the combination of Panavia F and an airborne-particleabraded surface of zirconium-oxide ceramic, even after long-term water storage.39 However, tribochemical coating with the Rocatec system and a conventional bis-GMA-based luting agent resulted in a signicant increase in initial bond strengths compared to untreated or airborne-particleabraded zirconium-oxide surfaces. After thermal cycling, the initial bond strength values to Rocatec-treated surfaces decreased for the bisGMA-based luting agents.28,38,39 The results of the different pretreatment procedures in the present study are in contrast to another study that evaluated the bond strengths of 2 different resin luting agents to zirconium-oxide posts after various surface treatments.22 A phosphate-methacrylatebased resin agent (Panavia F; Kuraray Co Ltd) exhibited a comparable effect on bond strength values for airborne-particle abrasion and CoJet treatment.22 Using another testing mode, Panavia F and a conventional bis-GMA-based resin luting agent showed signicantly higher bond strength values for
APRIL 2006

CoJet-treated posts when compared to airborne-particle abrasion and the untreated control.18 In both studies, airborne-particle abrasion was performed with alumina particles of 50 mm, whereas particles of 110 mm were used in the present investigation; this might have created increased microretention, resulting in higher bond strength values. This is supported by the SEM observations of the present investigation, which revealed more micromechanical retention after airborne-particle abrasion compared to the CoJet treatment (Figs. 6 and 7). Another study investigated zirconium-oxide posts that were luted into extracted teeth after various surface treatments with a phosphate-methacrylate resin agent (Panavia F; Kuraray Co Ltd) and a conventional bisGMA-based resin luting agent (ParaPost Cement; ` Coltene Whaledent). After luting the posts with Panavia F, none of the surface treatments signicantly inuenced the retention of the posts compared to the untreated posts. This was explained by an increased adherence between the post and Panavia F, so that bonding to dentin was regarded as the main determining factor.23 It can be concluded that bond strength to zirconium-oxide ceramics is affected by the surface treatment and the resin luting agent used. The aim of the present investigation was to evaluate the bond strengths between posts and luting agents and the effects of different surface treatments of the posts on bond strengths. Therefore, the posts were inserted into methyl methacrylate cylinders with an articially created post space. If posts are luted into extracted teeth, bonding to dentin might inuence the bond strength values. Even if the bond strengths to dentin seem to be more clinically relevant, this investigation was focused on bond strengths between posts and luting agents. In the present study, differences in bond strengths between the investigated post types might be explained by different compositions and surface structures of zirconium-oxide and FRC posts, which resulted in completely different requirements for bonding. These ndings are supported by other studies that also revealed higher bond strengths to FRC than to zirconium-oxide posts.20,21 A recently published study evaluated the bond strengths of FRC and zirconium-oxide posts luted with various resin luting agents into post spaces of extracted teeth.24 The zirconium-oxide posts showed lower bond strength values when compared to the FRC posts,24 which is in agreement with the results of the present study. Considering that loss of retention is a frequent type of failure with restorations of various post-and-core systems, the bond strength between post and luting agent should be considered an important factor. The results of the present investigation revealed signicantly higher initial bond strength values to FRC compared to zirconium-oxide posts. Therefore, adhesively luted FRC posts appear to be more likely to prevent loss of
309

THE JOURNAL OF PROSTHETIC DENTISTRY

BITTER ET AL

retention. Nevertheless, further in vitro studies focusing on the effect of thermo-mechanical cyclic loading on bond strength should be initiated; moreover, longterm clinical studies should be conducted to evaluate the survival rate of FRC posts under clinical conditions.

CONCLUSIONS
Within the limitations of this study, the following conclusions were drawn: 1. Pretreatment of zirconium-oxide signicantly increased bond strength to composite resin when Panavia F was used (P,.05). 2. Bond strength was also signicantly affected by the types of luting agent post used (P,.001). 3. FRC posts demonstrated signicantly higher bond strength values compared to the zirconium-oxide posts, depending on the luting agent used (P,.01).
REFERENCES
1. Sorensen JA, Engelman MJ. Effect of post adaptation on fracture resistance of endodontically treated teeth. J Prosthet Dent 1990;64:419-24. 2. Axelsson P, Lindhe J, Nystrom B. On the prevention of caries and periodontal disease. Results of a 15-year longitudinal study in adults. J Clin Periodontol 1991;18:182-9. 3. Testori T, Badino M, Castagnola M. Vertical root fractures in endodontically treated teeth: a clinical survey of 36 cases. J Endod 1993;19:87-91. 4. Bergman B, Lundquist P, Sjogren U, Sundquist G. Restorative and endodontic results after treatment with cast posts and cores. J Prosthet Dent 1989;61:10-5. 5. Meyenberg KH, Luthy H, Schaerer P. Zirconia posts: a new all-ceramic concept for nonvital abutment teeth. J Esthet Dent 1995;7:73-80. 6. Hayashi Y, Nakamura S. Clinical application of energy dispersive x-ray microanalysis for nondestructively conrming dental metal allergens. Oral Surg Oral Med Oral Pathol 1994;77:623-6. 7. Kedici SP, Aksut AA, Kilicarslan MA, Bayramoglu G, Gokdemir K. Corrosion behaviour of dental metals and alloys in different media. J Oral Rehabil 1998;25:800-8. 8. Bateman G, Ricketts DN, Saunders WP. Fibre-based post systems: a review. Br Dent J 2003;195:43-8. 9. Heydecke G, Butz F, Hussein A, Strub JR. Fracture strength after dynamic loading of endodontically treated teeth restored with different postand-core systems. J Prosthet Dent 2002;87:438-45. 10. Asmussen E, Peutzfeldt A, Heitmann T. Stiffness, elastic limit, and strength of newer types of endodontic posts. J Dent 1999;27:275-8. 11. King PA, Setchell DJ. An in vitro evaluation of a prototype CFRC prefabricated post developed for the restoration of pulpless teeth. J Oral Rehabil 1990;17:599-609. 12. Mannocci F, Sherriff M, Watson TF. Three-point bending test of ber posts. J Endod 2001;27:758-61. 13. Dietschi D, Romelli M, Goretti A. Adaptation of adhesive posts and cores to dentin after fatigue testing. Int J Prosthodont 1997;10:498-507. 14. Piconi C, Maccauro G. Zirconia as a ceramic biomaterial. Biomaterials 1999;20:1-25. 15. Pontius O, Hutter JW. Survival rate and fracture strength of incisors restored with different post and core systems and endodontically treated incisors without coronoradicular reinforcement. J Endod 2002;28:710-5. 16. Heydecke G, Butz F, Strub JR. Fracture strength and survival rate of endodontically treated maxillary incisors with approximal cavities after restoration with different post and core systems: an in-vitro study. J Dent 2001;29:427-33. 17. Akkayan B, Gulmez T. Resistance to fracture of endodontically treated teeth restored with different post systems. J Prosthet Dent 2002;87:431-7. 18. Saha A, Peutzfeld A, Asmussen E, Gotfredsen K. Effect of surface treatment of prefabricated posts on bonding of resin cement. Oper Dent 2004;29:60-8.

19. Goracci C, Tavares AU, Monticelli F, Raffaelli O, Cardoso PC, Tay F, et al. The adhesion between ber posts and root canal walls: comparison between microtensile and push-out bond strengths measurements. Eur J Oral Sci 2004;112:353-61. 20. Hedlund SO, Johansson NG, Sjogren G. Retention of prefabricated and individually cast root canal posts in vitro. Br Dent J 2003;195:155-8. 21. OKeefe KL, Miller BH, Powers JM. In vitro tensile bond strength of adhesive cements to new post materials. Int J Prosthodont 2000;13: 47-51. 22. Saha A, Peutzfeldt A, Asmussen E, Gotfredsen K. Bond strength of resin cement to dentin and to surface-treated posts of titanium alloy, glass ber, and zirconia. J Adhes Dent 2003;5:153-62. 23. Saha A, Peutzfeldt A, Asmussen E, Gotfredsen K. Retention and failure morphology of prefabricated posts. Int J Prosthodont 2004;17:307-12. 24. Perdigao J, Geraldeli S, Lee IK. Push-out bond strengths of toothcolored posts bonded with different adhesive systems. Am J Dent 2004; 17:422-6. 25. Asmussen E, Attal JP, Degrange M. Factors affecting the adherence energy of experimental resin cements bonded to a nickel-chromium alloy. J Dent Res 1995;74:715-20. 26. Caputo AA, Standlee JP. Endodontic dowel retention with resinous cements. J Prosthet Dent 1992;68:913-7. 27. Mendoza DB, Eakle WS. Retention of posts cemented with various dentinal bonding cements. J Prosthet Dent 1994;72:591-4. 28. Ozcan M, Vallittu PK. Effect of surface conditioning methods on the bond strength of luting cements to ceramic. Dent Mater 2003;19:725-31. 29. Blatz MB, Sadan A, Kern M. Resin-ceramic bonding: a review of the literature. J Prosthet Dent 2003;89:268-74. 30. Awliya W, Oden A, Yaman P, Dennison JB, Razzoog ME. Shear bond strength of a resin cement to densely sintered high-purity alumina with various surface conditions. Acta Odontol Scand 1998;56:9-13. 31. Kern M, Thompson VP. Effects of sandblasting and silica-coating procedures on pure titanium. J Dent 1994;22:300-6. 32. Peutzfeldt A, Asmussen E. Silicoating: evaluation of a new method of bonding composite resin to metal. Scand J Dent Res 1988;96:171-6. 33. Ozcan M, Pfeiffer P, Nergiz I. A brief history and current status of metal-and ceramic surface-conditioning concepts for resin bonding in dentistry. Quintessence Int 1998;29:713-24. 34. Matinlinna JP, Lassila LV, Ozcan M, Yli-Urpo A, Vallittu PK. An introduction to silanes and their clinical applications in dentistry. Int J Prosthodont 2004;17:155-64. 35. Lawn BR, Deng Y, Lloyd IK, Janal MN, Rekow ED, Thompson VP. Materials design of ceramic-based layer structures for crowns. J Dent Res 2002;81:433-8. 36. Kosmac T, Oblak C, Jevnikar P, Funduk N, Marion L. The effect of surface grinding and sandblasting on exural strength and reliability of Y-TZP zirconia ceramic. Dent Mater 1999;15:426-33. 37. Kosmac T, Oblak C, Jevnikar P, Funduk N, Marion L. Strength and reliability of surface treated Y-TZP dental ceramics. J Biomed Mater Res 2000;53: 304-13. 38. Kern M, Wegner SM. Bonding to zirconia ceramic: adhesion methods and their durability. Dent Mater 1998;14:64-71. 39. Wegner SM, Kern M. Long-term resin bond strength to zirconia ceramic. J Adhes Dent 2000;2:139-47. Reprint requests to: DR KERSTIN BITTER DEPARTMENT OF OPERATIVE DENTISTRY AND PERIODONTOLOGY UNIVERSITY SCHOOL OF DENTAL MEDICINE CAMPUS BENJAMIN FRANKLIN CHARITE, UNIVERSITATSMEDIZIN BERLIN AMANNSHAUSERSTR. 4-6 14197 BERLIN, GERMANY FAX: 49-030-8445-6204 E-MAIL: kerstin.bitter@charite.de 0022-3913/$32.00 Copyright 2006 by The Editorial Council of The Journal of Prosthetic Dentistry.

doi:10.1016/j.prosdent.2006.02.012

310

VOLUME 95 NUMBER 4