Meta-analysis of the influence of bonding parameters on the clinical outcome of tooth-colored cervical restorations

PURPOSE: To meta-analyze the literature on the clinical performance of Class V restorations to assess the factors that influence retention, marginal integrity, and marginal discoloration of cervical lesions restored with composite resins, glass-ionomer-cement-based materials [glass-ionomer cement (GIC) and resin-modified glass ionomers (RMGICs)], and polyacid-modified resin composites (PMRC). MATERIALS AND METHODS: The English literature was searched (MEDLINE and SCOPUS) for prospective clinical trials on cervical restorations with an observation period of at least 18 months. The studies had to report about retention, marginal discoloration, marginal integrity, and marginal caries and include a description of the operative technique (beveling of enamel, roughening of dentin, type of isolation). Eighty-one studies involving 185 experiments for 47 adhesives matched the inclusion criteria. The statistical analysis was carried out by using the following linear mixed model: log (-log (Y /100)) = β + α log(T ) + error with β = log(λ), where β is a summary measure of the non-linear deterioration occurring in each experiment, including a random study effect. RESULTS: On average, 12.3% of the cervical restorations were lost, 27.9% exhibited marginal discoloration, and 34.6% exhibited deterioration of marginal integrity after 5 years. The calculation of the clinical index was 17.4% of failures after 5 years and 32.3% after 8 years. A higher variability was found for retention loss and marginal discoloration. Hardly any secondary caries lesions were detected, even in the experiments with a follow-up time longer than 8 years. Restorations placed using rubber-dam in teeth whose dentin was roughened showed a statistically significantly higher retention rate than those placed in teeth with unprepared dentin or without rubber-dam (p < 0.05). However, enamel beveling had no influence on any of the examined variables. Significant differences were found between pairs of adhesive systems and also between pairs of classes of adhesive systems. One-step self-etching had a significantly worse clinically index than two-step self-etching and three-step etch-and-rinse (p = 0.026 and p = 0.002, respectively). CONCLUSION: The clinical performance is significantly influenced by the type of adhesive system and/or the adhesive class to which the system belongs. Whether the dentin/enamel is roughened or not and whether rubberdam isolation is used or not also significantly influenced the clinical performance. Composite resin restorations placed with two-step self-etching and three-step etch-and-rinse adhesive systems should be preferred over onestep self-etching adhesive systems, GIC-based materials, and PMRCs.

Measuring Bond Strength Between Fiber Post and Root Dentin: A Comparison of Different Tests

Purpose The aim of this study was to evaluate the ability of bond strength tests to accurately measure the bond strength of fiber posts luted into root canals Materials and Methods The test methods studied were hourglass microtensile (HM), push-out (PS), modified push out (MP) and pull out (PL) The evaluated parameters were bond strength values, reliability (using Weibull analysis), failure mode (using confocal microscopy), and stress distribution (using finite element analysis) Forty human intact single rooted and endodontically treated teeth were divided into four groups Each group was assigned one of the test methods The samples in the HM and PS groups were 1 0 +/- 0 1 mm thick, the HM samples were hourglass shaped and the PS samples were disk shaped For the PL and MP groups, each 1 mm dentin slice was luted with a fiber post piece Three dimensional models of each group were made and stress was analyzed based on Von Mises criteria Results PL provided the highest values of bond strength followed by MP both of which also had greater amounts of adhesive failures PS showed the highest frequency of cohesive failures MP showed a more homogeneous stress distribution and a higher Weibull modulus Conclusion The specimen design directly influences the biomechanical behavior of bond strength tests

Influence of NaHCO(3) Powder on Translucency of Microfilled Composite Resin Immersed in Different Mouthrinses

The regular use of mouthrinses, particularly when combined with the use of air-powder polishing, could affect the appearance of tooth-colored restorations. The current study sought to evaluate the effect of NaHCO(3) powder on translucency of a microfilled composite resin immersed in different mouthrinses, at distinct evaluation periods. Eighty disk-shaped specimens of composite resin (Durafill VS, Heraeus Kulzer GmbH & Co. KG, Hanau, Germany) were prepared. The composite specimens were then randomly allocated into two groups according to the surface treatment: exposure to NaHCO(3) powder (10 seconds) or nonexposure, and they were randomly assigned into four subgroups, according to the mouthrinses employed (N = 10): Periogard (Colgate/Palmolive, Sao Bernardo do Campo, SP, Brazil), Cepacol (Aventis Pharma, Sao Paulo, SP, Brazil), Plax (Colgate/Palmolive), and distilled water (control group). The samples were immersed for 2 minutes daily, 5 days per week, over a 4-month test period. Translucency was measured with a transmission densitometer at seven evaluation periods. Statistical analyses (analysis of variance and Tukey`s test) revealed that: distilled water presented higher translucency values (86.72%); Periogard demonstrated the lowest translucency values (72.70%); and Plax (74.05%) and Cepacol (73.32%) showed intermediate translucency values, which were statistically similar between them (p > 0.01). NaHCO(3) air-powder polishing increased the changes in translucency associated with the mouthrinses. Air-powder polishing alone had no effect on material translucency. Translucency percent was gradually decreased from 1 week of immersion up to 4 months. It may be concluded that the NaHCO(3) powder and the tested mouthrinses have affected the translucency of microfilled composite resin, according to the tested time. CLINICAL SIGNIFICANCE During the last decade, the demand for composite resin restorations has grown considerably, however, controversy persists regarding the effect of surface roughness on color stability.

IN VITRO FRACTURE RESISTANCE OF GLASS-FIBER AND CAST METAL POSTS WITH DIFFERENT LENGTHS

Statement of problem. Dental fractures can occur in endodontically treated teeth restored with posts. Purpose. The purpose of this study was to evaluate the in vitro fracture resistance of roots with glass-fiber and metal posts of different lengths. Material and methods. Sixty endodontically treated maxillary canines were embedded in acrylic resin, except for 4 mm of the cervical area, after removing the clinical crowns. The post spaces were opened with a cylindrical bur at low speed attached to a surveyor, resulting in preparations with lengths of 6 mm (group 6 mm), 8 mm (group 8 mm), or 10 mm (group 10 mm). Each group was divided into 2 subgroups according to the post material: cast post and core or glass-fiber post (n=30). The posts were luted with dual-polymerizing resin cement (Panavia F). Cast posts and cores of Co-Cr (Resilient Plus) crowns were made and cemented with zinc phosphate. Specimens were subjected to increasing compressive load (N) until fracture. Data were analyzed with 2-way ANOVA and the Tukey-Kramer test (alpha=.05). Results. The ANOVA analysis indicated significant differences (P<.05) among the groups, and the Tukey test revealed no significant difference among the metal posts of 6-mm length (26.5 N +/- 13.4), 8-mm length (25.2 N +/- 13.9), and 10-mm length (17.1 N +/- 5.2). Also, in the glass-fiber post group, there was no significant difference when posts of 8-mm length (13.4 N +/- 11.0) were compared with the 6-mm (6.9 N +/- 4.6) and 10-mm (31.7 N +/- 13.1) groups. The 10-mm-long post displayed superior fracture resistance, and the 6-mm-long post showed significantly lower mean values (P<.001). Conclusions. Within the limitations of this study, it was concluded that the glass-fiber post represents a viable alternative to the cast metal post, increasing the resistance to fracture of endodontically treated canines. (J Prosthet Dent 2009;101:183-188)

Influence of customized composite resin fibreglass posts on the mechanics of restored treated teeth

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Fracture strength of flared bovine roots restored with different intraradicular posts

Objective: The aim of this study was to evaluate the fracture strength and failure mode of flared bovine roots restored with different intraradicular posts. Material and Methods: Fifty bovine incisors with similar dimensions were selected and their roots were flared until 1.0 mm of dentin wall remained. Next, the roots were allocated into five groups (n=10): GI-cast metal post-and-core; GII-fiber posts plus accessory fiber posts; GIII-direct anatomic post; GIV-indirect anatomic post and GV-control (specimens without intraradicular post). A polyether impression material was used to simulate the periodontal ligament. After periodontal ligament simulation, the specimens were subjected to a compressive load at a crosshead speed of 0.5 mm/min in a servo-hydraulic testing machine (MTS 810) applied at 135 to the long axis of the tooth until failure. The data (N) were subjected to ANOVA and Tukey's post-hoc test (alpha=0.05). Results: GI and GIV presented higher fracture strength (p<0.05) than GII. GIII presented intermediate values without statistically significant differences (p>0.05) from GI, GII and GIV. Control specimens (GV) produced the lowest fracture strength mean values (p<0.05). Despite obtaining the highest mean value, GI presented 100% of unfavorable failures. GII presented 20% of unfavorable failures. GIII, GIV and GV presented only favorable failures. Conclusions: Although further in vitro and in vivo studies are necessary, the results of this study showed that the use of direct and indirect anatomic posts in flared roots could be an alternative to cast metal post-and-core.

Effects of mechanical cycling on the bonding of zirconia and fiber posts to human root dentin

Purpose: To evaluate the effect of cyclical mechanical loading on the bond strength of a fiber and a zirconia post bonded to root dentin.Materials and Methods: Forty single-rooted human teeth (maxillary incisors and canines) were sectioned, and the root canals were prepared at 12 mm. Twenty randomly seleced specimens received a quartz fiber post (FRC) (D.T. Light-Post) and 20 others received a zirconia post (ZR) (Cosmopost). The posts were resin luted (All Bond 2 + resin cement Duo-link) and each specimen was embedded in epoxy resin inside a PVC cylinder. Ten specimens with FRC post and 10 specimens with ZR post were submitted to fatigue testing (2,000,000 cycles; load: 50 N; angle of 45 degrees; frequency: 8 Hz), while the other 20 specimens were not fatigued. Thus, 4 groups were formed: G1: FRC+O cycles; G2: FRC+2,000,000 cycles; G3: ZR+O cycles; G4: ZR+2,000,000 cycles. Later, the specimens were cut perpendicular to their long axis to form 2-mm-thick disk-shaped samples (4 sections/specimen), which were submitted to the push-out test (1 mm/min). The mean bond strength values (MPa) were calculated for each tooth (n = 10) and data were submitted to statistical analysis (alpha = 0.05).Results: Two-way ANOVA revealed that the bond strength was significantly affected by mechanical cycling (p = 0.0014) and root post (p = 0.0325). The interaction was also statistically significant (p = 0.0010). Tukey's test showed that the mechanical cycling did not affect the bonding of FRC to root dentin, while fatigue impaired the bonding of zirconium to root dentin.Conclusion: (1) the bond strength of the FRC post to root dentin was not reduced after fatigue testing, whereas the bonding of the zirconia post was significantly affected by the fatigue. (2) Cyclical mechanical loading appears to damage the bond strength of the rigid post only.

Effect of adhesive system type and tooth region on the bond strength to dentin

Purpose: This study evaluated the bond strength of two etch-and-rinse adhesive systems (two- and three-step) and a self-etching system to Coronal and root canal dentin.Materials and Methods: The root canals of 30 human incisors and canines were instrumented and prepared with burs. The posts used for luting were duplicated with dual resin cement (Duo-link) inside Aestheti Plus #2 molds. Thus, three groups were formed (n = 10) according to the adhesive system employed: All-Bond 2 (TE3) + resin cement post (rcp) + Duo-link (DI); One-Step Plus (TE2) + rcp + DI; Tyrian/One-Step Plus (SE) + rcp + DI. Afterwards, 8 transverse sections (1.5 mm) were cut from 4 mm above the CEJ up to 4 mm short of the root canal apex, comprising coronal and root canal dentin. The sections were submitted to push-out testing in a universal testing machine EMIC (1 mm/min). Bond strength data were analyzed with two-way repeated measures ANOVA and Tukey's test (p < 0.05).Results: The relationship between the adhesives was not the same in the different regions (p < 0.05). Comparison of the means achieved with the adhesives in each region (Tukey; p < 0.05) revealed that TE3 (mean standard deviation: 5.22 +/- 1.70) was higher than TE2 (2.60 +/- 1.74) and SE (1.68 +/- 1.85).Conclusion: Under the experimental conditions, better bonding to dentin was achieved using the three-step etch-and-rinse system, especially in the coronal region. Therefore, the traditional etch-and-rinse three-step adhesive system seems to be the best choice for teeth needing adhesive endodontic restorations.

Stress analysis of an upper central incisor restored with different posts

The effect of different anatomic shapes and materials of posts in the stress distribution on an endodontically treated incisor was evaluated in this work. This study compared three post shapes (tapered, cylindrical and two-stage cylindrical) made of three different materials (stainless steel, titanium and carbon fibre on Bisphenol A-Glycidyl Methacrylate (Bis-GMA) matrix). Two-dimensional stress analysis was performed using the Finite Element Method. A static load of 100N was applied at 45degrees inclination with respect to the incisor's edge. The stress concentrations did not significantly affect the region adjacent to the alveolar bone crest at the palatine portion of the tooth, regardless of the post shape or material. However, stress concentrations on the post/dentin interface on the palatine side of the tooth root presented significant variations for different post shapes and materials. Post shapes had relatively small impact on the stress concentrations while post materials introduced higher variations on them. Stainless steel posts presented the highest level of stress concentration, followed by titanium and carbon/Bis-GMA posts.

Aesthetic posts and cores for metal-free restoration of endodontically treated teeth.

Utilization of contemporary post and core systems has facilitated the aesthetic restoration of endodontically treated teeth. Light transmission and biocompatibility have been enhanced by the introduction of metal-free post systems. The periodontal and endodontic status, root length, and histological structure of the devitalized teeth must be considered in order to achieve successful restoration following endodontic treatment. This article presents various restorative criteria for the aesthetic placement and buildup of post and core materials, as well as the preservation of maximum coronal and root structure.

The influence of ultrasound on the retention of cast posts cemented with different agents

Aim: The aim of this study was to evaluate the influence of ultrasound during the removal of posts cemented with either zinc phosphate cement, glass ionomer cement or resin cement. Methodology: Eighty-four single-rooted teeth were prepared and after cementation of cast posts, they were randomly divided into six groups of 14. Groups 1, 2 and 3 did not receive ultrasonic vibration, whilst groups 4, 5 and 6 received ultrasonic vibration for 10 min. The force necessary for post removal was determined using a universal testing machine. Results were statistically analysed using ANOVA and Tukey tests (5%). Results: The application of ultrasonic vibration reduced the retention provided by zinc phosphate and glass ionomer cements by 39% and 33%, respectively. Conclusions: A statistically significant reduction in the force necessary to remove posts cemented with zinc phosphate and glass ionomer cements occurred following application of ultrasound. The application of ultrasonic vibration did not influence the retention of cast posts cemented with resin cement.

Effect of silica coating on flexural strength of fiber posts

Purpose: Fiber-reinforced composite (FRC) posts can be air-abraded to obtain good attachment to the resin cement. This study tested the effect of silica coating on the flexural strength of carbon, opaque, and translucent quartz FRC posts. Materials and Methods: Six experimental groups of FRC posts (n = 10 per group) were tested, either as received from the manufacturer or after chairside silica coating (30-μm CoJet-Sand). Results: There was no significant difference in the flexural strength of nonconditioned (504 to 525 MPa) and silica-coated (514 to 565 MPa) specimens (P > .05) (analysis of variance). The type of post did have a significant effect on flexural strength (P < .05). Conclusion: Chairside silica coating did not affect the flexural strength of both carbon and quartz FRC posts.

Fatigue resistance of bovine teeth restored with resin-bonded fiber posts: Effect of post surface conditioning

This study evaluated the effect of post surface conditioning on the fatigue resistance of bovine teeth restored with resin-bonded fiber-reinforced composite (FRC). Root canals of 20 single-rooted bovine teeth (16 mm long) were prepared to 12 mm using a preparation drill of a double-tapered fiber post system. Using acrylic resin, each specimen was embedded (up to 3.0 mm from the cervical part of the specimen) in a PVC cylinder and allocated into one of two groups (n = 10) based on the post surface conditioning method: acid etching plus silanization or tribochemical silica coating (30 μm SiOx + silanization). The root canal dentin was etched (H2PO3 for 30 seconds), rinsed, and dried. A multi-step adhesive system was applied to the root dentin and the fiber posts were cemented with resin cement. The specimens were submitted to one million fatigue cycles. After fatigue testing, a score was given based on the number of fatigue cycles until fracture. All of the specimens were resistant to fatigue. No fracture of the root or the post and no loss of retention of the post were observed. The methodology and the results of this study indicate that tribochemical silica coating and acid etching performed equally well when dynamic mechanical loading was used.

Adhesive cementation of zirconia posts to root dentin: Evaluation of the mechanical cycling effect

This study evaluated the effect of mechanical cycling on the bond strength of zirconia posts to root dentin. Thirty single-rooted human teeth were transversally sectioned to a length of 16 mm. The canal preparation was performed with zirconia post system drills (CosmoPost, Ivoclar) to a depth of 12 mm. For post cementation, the canals were treated with total-etch, 3-steps All-Bond 2 (Bisco), and the posts were cemented with Duolink dual resin cement (Bisco). Three groups were formed (n = 10): G1 - control, no mechanical cycling; G2 - 20,000 mechanical cycles; G3 - 2,000,000 mechanical cycles. A 1.6-mm-thick punch induced loads of 50 N, at a 45° angle to the long axis of the specimens and at a frequency of 8 Hz directly on the posts. To evaluate the bond strengths, the specimens were sectioned perpendicular to the long axis of the teeth, generating 2-mm-thick slices, approximately (5 sections per teeth), which were subjected to the push-out test in a universal testing machine at a 1 mm/min crosshead speed. The push-out bond strength was affected by the mechanical cycling (1-way ANOVA, p = .0001). The results of the control group (7.7 ± 1.3 MPa) were statistically higher than those of G2 (3.9 ± 2.2 MPa) and G3 (3.3 ± 2.3 MPa). It was concluded that the mechanical cycling damaged the bond strength of zirconia posts to root dentin.