Effect of material types on the fracture resistance of maxillary central incisors restored with CAD/CAM post and cores.

AIM: To evaluate the fracture resistance and failure pattern of endodontically treated teeth with post and cores made of different CAD/CAM materials in comparison with cast post and cores. MATERIALS AND METHODS: A total of 40 maxillary central incisors were divided into four groups. Post and cores were fabricated using the following materials: fiber-reinforced composite, high-density polymer, polymer-infiltrated ceramic network, and nonprecious metal alloy as a control group. Specimens were covered with lithium disilicate crowns and subjected to thermomechanical cyclic loading followed by fracture resistance testing until failure. One-way ANOVA followed by Bonferroni multiple comparison tests were used to determine significant differences between the four groups. The significance level was set at 0.05. 3D finite element analysis was then performed, and results were analyzed based on the von Mises stress distribution criteria and the maximum principal stress for the possible failure areas. RESULTS: No statistically significant differences were found in the fracture resistance between the four groups. In terms of unrestorable failures, no significant differences were found among the tested groups. CONCLUSION: The tested post and cores have comparable fracture resistance to that of metallic cast post and cores in the anterior region. CLINICAL SIGNIFICANCE: Post and cores made of CAD/CAM materials offer an acceptable alternative for the restoration of anterior teeth.

Treatment after inadequate immediate replantation of accidentally extracted immature mandibular premolar during primary molar extraction.

During extraction of the primary mandibular right second molar in an 11-year-old girl, the unerupted second premolar was accidentally extracted. Clinical and radiographic examination showed that the immediately replanted immature premolar was not oriented and positioned correctly. Four hours later, treatment consisted of manual extrusion of the permanent tooth bud, rotation, and gentle repositioning into its original position. Adequate replantation was confirmed by a post-operative radiograph. After 2 years and 4 months, clinical examination revealed normal, healthy appearance of the replanted tooth, no sensitivity to percussion, no tenderness to palpation, and a slight response to a cold pulp sensibility test. A radiograph showed completely developed root with closed apical foramen, slightly irregular root morphology and shorter root length, complete obliteration of the pulp, and no signs of periapical pathosis.

Fracture Resistance and Failure Pattern of Endodontically Treated Teeth Restored with Computer-aided Design/ Computer-aided Manufacturing Post and Cores: A Pilot Study.

AIM: To evaluate the fracture resistance and failure pattern of custom made computer-aided design & computer-aided manufacturing (CAD/CAM) post and cores using a fiber reinforced composite material (FRC) and a high-density-polymer. MATERIALS AND METHODS: Thirty extracted mandibular second premolars were selected, endodontically treated and prepared to receive the posts. The specimens were randomly divided into three groups (n = 10) according to each material: group 1 (RXP) : fiber posts (Rely X, 3M-ESPE) with composite core build-up (Filtek Bulk Fill Posterior, 3M-ESPE) as a control group; group 2 (BLC): one-piece milled post and core from fiber reinforced composite blocks (Trilor, Bioloren); and group 3 (AMC): one-piece milled post and core from hybrid ceramic disks (Ambarino, Creamed). All the posts were cemented using a self-adhesive resin cement (Rely X U200, 3M ESPE). Fracture resistance was tested using a universal testing machine, failure patterns were then observed visually and radiographically then evaluated under SEM. Data was analyzed using One-way analysis of variance (ANOVA) followed by Tamhane post-hoc test in order to determine significant differences among groups (α = 0.05). RESULTS: The mean fracture resistance values were: 426.08 ± 128.26 N for group 1 (R X P), 367.06 ± 72.34N for group 2 (BLC), and 620.02 ± 54.29N for group 3 (AMC). Statistical analysis revealed that group 3 (AMC) had the highest mean load to fracture in comparison to the other groups (p = 0.000). failures were cohesive in group 2 and 3 and mixed in group 1 with no catastrophic failures reported in all groups. CONCLUSION: All systems evaluated presented sufficient mean load-to-failure values for endodontically treated teeth restorations. CAD/CAM post and cores made from high-density-polymer showed a better performance than prefabricated fiber posts.

Performance of CAD/CAM fabricated fiber posts in oval-shaped root canals: An in vitro study.

PURPOSE: To assess the push-out strength, the cement layer thickness and the interfacial nanoleakage of prefabricated fiber posts, CAD/CAM fiber posts and metal cast posts cemented into oval-shaped root canals. METHODS: Oval-shaped post spaces were prepared in 30 single-rooted premolars. Roots were randomly assigned to three groups (n=10), according to the post type to be inserted: Group 1: Prefabricated fiber post (D.T. Light-Post X-RO Illusion); Group 2: Cast metal post; Group 3: CAD/CAM-fabricated fiber post (experimental fiber blocks). In Group 3, post spaces were sprayed with scan powder (VITA), scanned with an inEos 4.2 scanner, and fiber posts were milled using an inLab MC XL CAD/CAM milling unit. All posts were cemented using Gradia Core dual-cure resin cement in combination with Gradia core self-etching bond (GC). After 24 hours, the specimens were sectioned perpendicular to the long axis into six 1 mm-thick sections, which were differentiated by the root level. Sections from six roots per group were used to measure the cement thickness and subsequently for the thin-slice push-out test, whereas the sections from the remaining four teeth were assigned to interfacial nanoleakage test. The cement thickness around the posts was measured in micrometers (µm) on the digital images acquired with a digital microscope using the Digimizer software. Thin-slice push-out test was conducted using a universal testing machine at the crosshead speed of 0.5 mm/minute and the bond strength was expressed in megaPascals (MPa). The interfacial nanoleakage was observed under light microscope and quantified by scoring the depth of silver nitrate penetration along the post-cement-dentin interfaces. The obtained results were statistically analyzed by Kruskal-Wallis ANOVA, followed by the Dunn's Multiple Range test for post hoc comparisons. The level of significance was set at P< 0.05. RESULTS: Statistically significant differences were found among the groups in push-out bond strength, cement thickness and interfacial nanoleakage (P< 0.05). CAD/CAM-fabricated fiber posts achieved retention that was comparable to that of cast metal posts and significantly higher than that of prefabricated fiber posts. The cement layer thickness around CAD/CAM-fabricated fiber posts was significantly lower than around prefabricated fiber posts, but higher than that around cast metal posts. Root level was not a significant factor for push-out strength in any of the groups, whereas it significantly affected cement layer thickness only in the prefabricated fiber post group. No differences were observed in interfacial nanoleakage between CAD/CAM fabricated and prefabricated fiber posts, while nanoleakage recorded in cast metal posts was significantly lower. CLINICAL SIGNIFICANCE: CAD/CAM fabricated fiber posts could represent a valid alternative to traditionally used posts in the restoration of endodontically-treated teeth with oval or wide root canals, offering the advantages of better esthetics, retention, and cement thickness values that are comparable to cast post and cores.

Influence of luting agent translucency on fiber post retention.

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

Micro-computerized tomographic analysis of premolars restored with oval and circular posts.

OBJECTIVES: The purpose of the study was to evaluate by micro-computerized tomography (microCT) areas and volumes of post, cement, and voids/bubbles in the post space of oval-shaped premolars restored either with oval or circular posts. MATERIALS AND METHODS: Twelve extracted premolars were divided into two groups according to the drill-fiber post system used: (1) GC Fiber Post Drill + circular post GC Fiber Post; (2) Ellipson tip(TM) + oval post Ellipson post(TM). Each tooth was scanned using microCT, and areas and volumes of canal, post space, post, cement, and voids at coronal, medium, and apical level were calculated by using a three-dimensional visualization software. Two-way analyses of variance and Tukey tests were used for statistical analysis (p < 0.05). RESULTS: The area of voids was significantly greater at apical level of oval posts, but no difference was found between the levels among the groups. Regardless of post shape, the volume of voids and of cement was significantly higher at the coronal level. With oval posts, the total volume of cement was twice as much as with circular posts, and the difference was statistically significant. CONCLUSIONS: Our results indicate that the volume of voids does not depend on post shape. Moreover, the microCT analysis demonstrated that the volume of cement was greater with oval posts compared to circular posts. CLINICAL RELEVANCE: The microCT analysis provided interesting information on voids distribution and on the ratio between post shape and cement thickness. These results might address the clinician in the reconstruction of teeth with fiber posts.

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

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

Shear bond strength to enamel and flexural strength of different fiber-reinforced composites.

PURPOSE: To assess the shear bond strength to unground human enamel (ESBS) and flexural strength (FS) of different reinforcing fibers used in combination with a flowable composite resin. MATERIALS AND METHODS: For ESBS testing, 90 human molars were selected and randomly divided into 9 groups (n = 10) according to the reinforcing fiber to be tested: 1. RTD Quartz Splint additionally impregnated at chairside with Quartz Splint Resin (RTD); 2. RTD Quartz Splint without additional impregnation; 3. Ribbond-THM (Ribbond) impregnated with OptiBond FL Adhesive; 4: Ribbond Triaxial (Ribbond) impregnated with OptiBond FL Adhesive; 5. Connect (Kerr) impregnated with OptiBond FL Adhesive; 6. Construct (Kerr) impregnated with Opti- Bond FL Adhesive; 7. everStick PERIO (Stick Tech); 8. everStick C&B (Stick Tech); 9. nonreinforced composite Premise flowable (Kerr). Cylinders of flowable composite reinforced with the fibers were bonded to the intact buccal surface of the teeth. After 24 h of storage, shear loading was performed until failure occurred. FS was assessed performing three-point bending test according to ISO Standard 4049/2000. ESBS and FS data were analyzed using one-way ANOVA, followed by Tukey's HSD test for post-hoc comparisons (p < 0.05). RESULTS: For each group, the ESBS and FS, respectively, in MPa were: 1. 17.07 ± 4.52 and 472.69 ± 30.49; 2. 14.98 ± 3.92 and 441.77 ± 61.43; 3. 18.59 ± 5.67 and 186.89 ± 43.89; 4. 16.74 ± 6.27 and 314.41 ± 148.52; 5. 14.38 ± 4.14 and 223.80 ± 77.35; 6. 16.00 ± 5.55 and 287.62 ± 85.91; 7. 16.42 ± 3.67 and 285.35 ± 39.68; 8. 23.24 ± 5.81 and 370.46 ± 29.26; 9. 12.58 ± 4.76 and 87.75 ± 22.87. For most fibers, no significant difference in ESBS was found compared to the control group, except for everStick C&B, which yielded higher ESBS. Nonreinforced composite exhibited the lowest FS, while all fibers positively affected the FS. CONCLUSIONS: Fiber reinforcement of flowable composite does not affect its ESBS. The flexural strength of FRCs is significantly influenced by fiber composition and pattern.

Influence of selective enamel etching on the bonding effectiveness of a new "all-in-one" adhesive.

PURPOSE: To evaluate in vitro the all-in-one adhesive G-Bond Plus/G-aenial Bond (GBP), used according to the selective enamel etching (SEE) technique, compared to Optibond FL, an etch-and-rinse adhesive tested as control (C). METHODS: 133 molars provided specimens for enamel and dentin shear bond strength (SBS) testing, microleakage measurements in class 5 restorations, and scanning electron microscope observations of demineralization patterns produced by GBP and 37% phosphoric acid (PA). RESULTS: On enamel: C displayed the highest SBS. PA etching significantly increased enamel SBS of GBP. No statistically significant difference in SBS was noted among the bonding procedures on dentin. On both substrates, C revealed the most satisfactory seal. PA pre-etching did not significantly affect the sealing ability of GBP on either substrate.

Microleakage of Class II restorations and microtensile bond strength to dentin of low-shrinkage composites.

PURPOSE: To evaluate the microleakage of Class II cavities restored with experimental low-shrinking resin composites proposed for bulk filling and to measure their microtensile bond strength (microTBS) to dentin and compare to those of previously marketed low-shrinkage composites. METHODS: Class II cavities (7 mm occluso-gingival height, 2 mm mesio-distal depth of the box, 4 mm occlusal depth, 4 mm bucco-lingual width) were prepared in 50 molars and randomly divided into five groups (n = 10), according to the material: SureFil SDR flow (SDR), Filtek Silorane (FS) and experimental materials (G-aenial Flo bulk fill, GF; G-aenial Universal Flo bulk fill, GUF; GC Kalore bulk fill, GK). Microleakage was separately assessed at enamel and dentin margins by scoring the depth of silver-nitrate penetration. Twenty teeth divided into five groups (n = 4) were selected for microTBS testing. The same materials as for microleakage assessment were placed in bulk to mid-coronal dentin. Microtensile beams were loaded in tension, and microTBS at failure was calculated in MPa. Microleakage and microTBS data were analyzed by ANOVA on ranks, followed Dunn's post hoc test (P< 0.05). RESULTS: Microleakage was not observed at the enamel interface in any of the groups. At the dentin interface, SDR recorded significantly higher microleakage than the other materials. microTBS of GF, GUF and GK did not differ among each other (33 +/- 12 MPa, 31 +/- 11 MPa, 30 +/- 9 MPa, respectively), while SDR (63 +/- 17 MPa) and FS (55 +/- 17MPa) achieved significantly higher microTBS values. No direct association between the sealing properties and the bond strength values was observed.

Post-retentive ability of new flowable resin composites.

PURPOSE: To investigate the applicability of flowable composites as post luting agents by assessing the push-out strength of posts. METHODS: 36 intact single rooted human premolars were selected. The endodontic treatment was performed and half of the specimens were restored with light transmitting posts (DT Light Post Illusion) and the other half with opaque posts (Tech 21 X-OP). In both groups the following combinations of adhesive/cement were tested: OptiBond Solo Plus/Nexus Third Generation (NX3), XP Bond/SureFil SDR Flow (SDR), and Vertise Flow (VF). Push-out test was used to assess the retentive strength of fiber posts, which was expressed in megapascals (MPa). Specimens were analyzed under a stereomicroscope to determine failure mode (adhesive between luting agent and post, adhesive between luting agent and dentin or mixed failure). Push-out data and failure mode distribution were analyzed by two-way ANOVA and Chi-square test, respectively (P< 0.05). RESULTS: The statistical analysis revealed that only the type of luting material significantly influenced push-out bond strength of the post (P< 0.001). SDR (9.00 +/- 2.17 MPa) performed similarly to the control group NX3 (7.15 +/- 1.74 MPa), while VF (4.81 +/- 1.51 MPa) should significantly lower bond strength. Failure modes differed significantly among groups.

Clinically Relevant Properties of 3D Printable Materials for Intraoral Use in Orthodontics: A Critical Review of the Literature.

The review aimed at analyzing the evidence available on 3D printable materials and techniques used for the fabrication of orthodontic appliances, focusing on materials properties that are clinically relevant. MEDLINE/PubMed, Scopus, and Cochrane Library databases were searched. Starting from an initial retrieval of 669 citations, 47 articles were finally included in the qualitative review. Several articles presented proof-of-concept clinical cases describing the digital workflow to manufacture a variety of appliances. Clinical studies other than these case reports are not available. The fabrication of aligners is the most investigated application of 3D printing in orthodontics, and, among materials, Dental LT Clear Resin (Formlabs) has been tested in several studies, although Tera Harz TC-85 (Graphy) is currently the only material specifically marketed for direct printing of aligners. Tests of the mechanical properties of aligners materials lacked homogeneity in the protocols, while biocompatibility tests failed to assess the influence of intraoral conditions on eluents release. The aesthetic properties of 3D-printed appliances are largely unexplored. The evidence on 3D-printed metallic appliances is also limited. The scientific evidence on 3D printable orthodontic materials and techniques should be strengthened by defining international standards for laboratory testing and by starting the necessary clinical trials.

Microtensile bond strength evaluation of self-adhesive resin cement to zirconia ceramic after different pre-treatments.

PURPOSE: To evaluate the influence of different surface treatments and metal primer application on bond strength of zirconia ceramic to a self-adhesive resin cement. METHODS: 40 cylinder-shaped (Ø 12 x 5.25 mm high) of zirconia ceramic (Aadva Zirconia) were randomly divided into four groups (n= 10), based on the surface treatment to be performed: (1) Sandblasting with 125 microm Al2O3 particles (S) (positive control); (2) Selective infiltration etching (SIE); (3) Experimental heated etching solution applied for 30 minutes (ST); (4) No treatment (C). Half of the zirconia specimens of each group received the application of Metal Primer II. Eight disks for each group were luted using a self-adhesive resin cement (G-Cem Automix) to composite overlays (Paradigm MZ100). After 24-hour storage (37 degrees C, 100% RH) bonded specimens were cut into microtensile sticks and loaded in tension until failure. Data were analyzed with two-way ANOVA and Games-Howell (P < 0.05). Failure mode distribution was recorded and scanning electron microscopy (SEM) was used to examine the fractured microbars. The remaining cylinders of each group (n = 2) were used for SEM surface analysis. RESULTS: Both surface treatments and Metal Primer II application improved bond strength values (P < 0.05). When Metal Primer II was not applied ST treatment achieved highest bond strength values (22.17 +/- 10.37 MPa). Sandblasting in combination with Metal Primer II enhanced bond strength values compared to the other groups (23.46 +/- 11.19 MPa).

Enamel and dentin bond strength of new simplified adhesive materials with and without preliminary phosphoric acid-etching.

PURPOSE: To assess the influence of preliminary phosphoric acid-etching on shear bond strength (SBS) to enamel and dentin of a self-adhering restorative composite and of a new self-etch adhesive used in combination with the proprietary flowable composite. METHODS: 100 human molars were selected. SBS was assessed on flat buccal enamel surfaces and mid-coronal dentin. Teeth from each group were divided into five subgroups (n=10): (1) FL: etch-and-rinse adhesive OptiBond FL/Premise flowable; (2) XTR: 2-step self-etch adhesive OptiBond XTR/Premise flowable; (3) eXTR: OptiBond XTR on etched substrates/Premise flowable; (4) VF: self-adhering flowable composite Vertise Flow; (5) eVF: Vertise Flow on etched substrates. Specimens were stressed in shear until failure. Failure modes were evaluated under a stereomicroscope. Data were analyzed by two-way ANOVA and Fisher's exact test (P< 0.05). RESULTS: Dental substrate, material and between-factor interaction significantly influenced SBS (MPa). In FL group (16.83 +/- 2.93) significantly higher SBS to enamel than in the other groups (XTR 8.59 +/- 4.39; eXTR 7.04 +/- 3.63; VF 6.61 +/- 2,41; eVF 9.87 +/- 4.24) was measured. On dentin FL (8.15 +/- 3.88) performed similarly to XTR (10.60 +/- 5.0), eXTR (9.60 +/- 4.91) and eVF (5.48 +/- 4.94); VF recorded significantly lower SBS (2.94 +/- 2.79 MPa). Failure modes differed significantly among groups.

Bracket Bonding to All-Ceramic Materials with Universal Adhesives.

The need for bracket bonding to ceramic restorations is increasing. The aim of this study was to evaluate the effect of universal adhesives on bracket adhesion to polished or glazed lithium disilicate (LDS) and monolithic zirconia (MZ) surfaces. One hundred and twenty brackets (N = 10) were bonded to either polished or glazed LDS (e.max CAD B32, Ivoclar Vivadent, Schaan, Liechtenstein) and MZ (In-Ceram® YZ, VITA, Bad Sackingen, Germany) blocks using three different adhesives combined with Transbond™ XT Paste (3M Unitek, Monrovia, CA, USA). Tested universal adhesives were Scotchbond™ Universal Adhesive (SU, 3M St. Paul, MN, USA) and Assure Plus (AP, Reliance, Itasca, IL, USA). Transbond™ XT Primer (XTP, 3M Unitek, Monrovia, CA, USA) served as a control adhesive. Bracket bond strength was measured in shear mode (SBS). Failure type was determined by the Modified Adhesive Remnant Index (ARI). Data were statistically analyzed. On polished LDS, SU yielded bracket SBS significantly superior to those of AP and XTP. On polished MZ, the use of SU and AP significantly enhanced bracket retention as compared with XTP. Low SBS values, below the threshold of clinical acceptability, were reached by all tested adhesives on glazed LDS and MZ specimens. SBS measurements corresponded with failure type observations. Universal adhesives SU and AP could be considered for use on polished LDS and MZ surfaces.

Deep proximal margin rebuilding with direct esthetic restorations: a systematic review of marginal adaptation and bond strength.

This review aimed to characterize the effect of direct restorative material types and adhesive protocols on marginal adaptation and the bond strength of the interface between the material and the proximal dentin/cementum. An electronic search of 3 databases (the National Library of Medicine [MEDLINE/PubMed], Scopus, and ScienceDirect) was conducted. Studies were included if they evaluated marginal adaptation or bond strength tests for proximal restorations under the cementoenamel junction. Only 16 studies met the inclusion criteria and were included in this review. These studies presented a high degree of heterogeneity in terms of the materials used and the methodologies and evaluation criteria of each test; therefore, only a descriptive analysis could be conducted. The included studies were individually evaluated for the risk of bias following predetermined criteria. To summarize the results of the included studies, the type of restorative material affected the test results, whereas the use of different adhesive protocols had an insignificant effect on the results. It could be concluded that various categories of resin-based composites could be a suitable choice for clinicians to elevate proximal dentin/cementum margins, rather than the open sandwich technique with resin-modified glass ionomers. Despite challenges in bonding to proximal dentin/cementum margins, different adhesive protocols provided comparable outcomes.

No correlation between two methodological approaches applied to evaluate cervical margin relocation.

The study evaluated the quality of gingival margins created by cervical margin relocation (CMR) technique using different materials and assessed the consistency of the results obtained by two in vitro methods: microleakage test and scanning electron microscopy (SEM). Mesio-occlusal-distal cavities with subgingival proximal margins were prepared. Mesial margins were elevated supragingivally with total-etch adhesive and flowable composite (Group 1) or with universal adhesive and bulk-fill flowable composite (Group 2). Distal margins were not elevated. Teeth were restored with CAD/CAM overlays. Marginal quality was evaluated by microleakage test and SEM observation of epoxy resin replicas. Statistical analyses showed no significant correlations between microleakage scores and percentage of marginal integrity observed under SEM at CMR margins, lower microleakage scores at margins without CMR compared to CMR margins, lower microleakage scores in Group 2 than in Group 1 and no difference in SEM integrity between groups at CMR margins.

Can Fiber-post Placement Reinforce Structurally Compromised Roots?

PURPOSE: Immature teeth are characterized by short roots, thin root canal walls, and open apices, which makes them prone to fracture. The aim was to investigate whether fiber-post placement had an influence on the fracture resistance of endodontically treated immature teeth. MATERIALS AND METHODS: To simulate immature teeth, the apical third of 20 intact mandibular premolars was resected. After the access cavity was prepared, root canals and apices were enlarged. A 4-mm apical barrier was placed using calcium-silicate based material (Biodentine, Septodont). The teeth were then randomly assigned to two groups (n = 10). Root canals in group 1 were sealed using Acroseal (Septodont, France) and gutta-percha, followed by composite resin for the coronal restoration (Evetric, Ivoclar Vivadent). In group 2, fiber posts (FRC Postec Plus, Ivoclar Vivadent) were luted using self-adhesive composite cement (SpeedCEM Plus, Ivoclar Vivadent), followed by the same coronal restoration. The teeth were then subjected to fatigue and static load testing. RESULTS: The average loads (± SD) that led to tooth fracture were: 401.40 ± 296.83 N in group 1 and 636.20 ± 204.95 N in group 2. Unfavorable fractures were noted in 9 specimens from group 1 and in 7 specimens in group 2. No statistically significant difference in fracture resistance or fracture mode was found between the groups. CONCLUSION: Fiber-post placement had no significant influence on the fracture resistance of endodontically treated immature teeth.

Cervical margin relocation in indirect adhesive restorations: A literature review.

PURPOSE: The aim of this review was to summarize the existing scientific literature investigating on cervical margin relocation technique (CMR) performed prior to the adhesive cementation of the indirect restorations. STUDY SELECTION: An electronic search with no date restriction was conducted in the MEDLINE database, accessed through PubMed. The following main keywords were used: "cervical margin relocation", "coronal margin relocation", "deep margin elevation" and "proximal box elevation". RESULTS: Seven in vitro studies and 5 clinical reports investigating on CMR are taken into consideration for the present review. The most frequently investigated parameter in almost all of the in vitro studies was the marginal adaptation of the indirect restorations. One study additionally assessed the influence of CMR on the fracture behavior of the restored teeth and one study assessed the bond strength of the indirect composite restoration to the proximal box floor. Clinical reports provided documentation with a detailed description of the treatment protocol. In the current literature no randomized controlled clinical trials or prospective or retrospective clinical studies on CMR technique could be found. CONCLUSIONS: On the basis of the reviewed literature, it can be concluded that currently there is no strong scientific evidence that could either support or discourage the use of CMR technique prior to restoration of deep subgingival defects with indirect adhesive restorations. Randomized controlled clinical trials are necessary to provide the reliable evidence on the influence of CMR technique on the clinical performance, especially on the longevity of the restorations and the periodontal health.

Marginal sealing of relocated cervical margins of mesio-occluso-distal overlays.

We investigated the effect of cervical marginal relocation (CMR) on marginal sealing with two different viscosity resin composites, before adhesive cementation of composite computer-aided design/computer-assisted manufacture mesio-occluso-distal (MOD) overlays. Standardized MOD cavities prepared in 39 human molars were randomly assigned to three groups. The proximal margins on the mesial side were located 1 mm below the cementoenamel junction. On the distal side of the tooth, the margins were located 1 mm above the cementoenamel junction. In Groups 1 and 2, mesial proximal boxes were elevated with a hybrid composite (GC Essentia MD) and a flowable composite (GC G-ænial Universal Flo), respectively. CMR was not performed in Group 3. The overlays were adhesively cemented, and interfacial leakage was quantified by scoring the depth of silver nitrate penetration along the adhesive interfaces. Leakage score at the dentin-CMR composite interface did not significantly differ between the two tested composites but was significantly lower for Group 3. In all groups, scores were significantly higher at the dentin interface than at the enamel interface. These results indicate that the performance of flowable and microhybrid resin composites, as indicated by marginal sealing ability, is comparable for CMR.