Development of criteria for investigation of periapical tissue from root-filled teeth.

OBJECTIVE: To develop and assess a set of criteria to grade inflammation including relative area of inflammation in periapical lesions in endodontically treated teeth. MATERIAL AND METHODS: A set of criteria was developed, encompassing data on: Lymphocytes, denoting chronic inflammation, were graded 0 (occasional) to 4 (heavy/dense inflammation). Polymorphonuclear cells, denoting acute inflammation, were graded 0 (none) to 2 (many). The third parameter, area of inflammation, that is, the relative area of the specimen that was inflamed, was graded 0 (none) to 4 (76-100%). The criteria were tested on 199 consecutive biopsies from 180 patients (aged 31-75 years). Information about symptoms was retrieved from the referrals. Mann-Whitney's U-test was used to calculate possible differences in average values for the histopathological variables in the two groups of patients: symptomatic or asymptomatic. RESULTS: Using the criteria, varying grades of inflammation were seen in the biopsies. The majority showed few or no PMN cells. There was a correlation between symptoms and the extent of infiltration of lymphocytes and plasma cells (p = .001), PMN cells (p < .001) and the area of inflammation (p = .002): biopsies from the asymptomatic patients exhibited less pronounced and relatively smaller areas of inflammation. CONCLUSIONS: Using the criteria on a specific selection of root-filled teeth with persisting apical periodontitis, periapical inflammation was common, but varied in extent and severity. The inflammation was less pronounced and affected a relatively smaller area in asymptomatic teeth, although outliers in both directions were identified.

Comparative evaluation of the vertical fracture resistance of endodontically treated roots filled with Gutta-percha and Resilon: a meta-analysis of in vitro studies.

BACKGROUND: Teeth treated endodontically are more susceptible to vertical root fracture (VRF). Some studies have suggested that obturating the root canals with Gutta-percha or Resilon can reinforce endodontically treated teeth, but a few others have presented conflicting results. These inconsistent results cannot guide clinicians in determining clinical approaches. The objective of this meta-analysis is to evaluate and compare the vertical fracture resistance of endodontically treated root canals obturated with Gutta-percha/AH plus and the Resilon system. METHODS: Comprehensive literature searches were performed in the PubMed, Cochrane Library, ScienceDirect, Web of Science and Embase databases. The titles and abstracts of all of the retrieved articles were independently assessed by two authors according to predefined selection criteria. Data in the included articles were independently extracted. Statistical analyses were conducted using Review Manager 5.3 and Stata 12.0 software. The pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated for the outcome indicators. The level of statistical significance was set at p < 0.05. The Cochran Q test (I2 test) was used to test for heterogeneity among studies. RESULTS: Fourteen randomized controlled in vitro trials were included in the meta-analysis. The results demonstrated that the vertical root fracture resistance of unprepared and unfilled roots was significantly higher than that of roots obturated with Gutta-percha/AH plus (SMD = - 0.69, 95% CI = - 1.34 to - 0.04, p = 0.04) or the Resilon system (SMD = - 0.54, 95% CI = - 1.07 to - 0.00, p = 0.05). The differences in fracture resistance between the roots filled with Gutta-percha/AH plus and the prepared unfilled root canals was not significant (SMD = 0.59, 95% CI = - 0.02 to 1.21, p = 0.06). Roots obturated with Resilon had higher fracture resistance than instrumented unfilled roots (SMD = 0.83, 95% CI = 0.44 to 1.22, p < 0.0001) or roots filled with Gutta-percha/AH plus (SMD = 0.62, 95% CI = 0.01 to 1.23, p = 0.05). CONCLUSIONS: The present study suggests that filling with Gutta-percha/AH plus dose not reinforce endodontically treated roots, whereas obturating with the Resilon system can increase vertical root fracture resistance of prepared roots. As this meta-analysis was based on in vitro studies, it should be careful to extrapolate its conclusion to the clinical context.

Characterization of the apical bridge barrier formed following amelogenin apexification.

BACKGROUND: Recombinant amelogenin protein (RAP) is reported to induce complete root apex formation in dog model when used as apexification therapy. It also induces pulp regeneration in 85% of the treated group. Thus, the aim of this study was to investigate the nature of the remaining regenerated calcified tissues of the RAP group that showed no pulp regeneration compared to the calcium hydroxide treated group (CH). METHODS: A total of 240 dogs' open apex root canals were used, after establishment of canals contamination. Canals were cleaned, irrigated, and filled with RAP as an apexification material and compared with CH. Treated teeth were assessed by H&E, trichrome staining, and/or immunohistochemistry technique, at 1, 3, and 6 months. RESULTS: A time-dependent increase in the calcified tissue barrier was observed in the apex of the RAP-treated group compared to the CH-treated group. The newly formed dentin in this RAP group was mainly tubular dentin and was functionally attached to the bone by periodontal ligament, while the CH group showed dentin-associated mineralized tissue (DAMT) associated with the newly formed apical barrier. CONCLUSIONS: Out results suggest that RAP can be used as novel apexification material, resulting in a thickening and strengthening of the canal walls, and achieving apical closure.

Assessment of Fracture Resistance Capacity of Different Core Materials with Porcelain Fused to Metal Crown: An in vitro Study.

Aim: The aim of the study was to evaluate the capacity to resist fracture in different core buildup materials with porcelain fused to metal (PFM) crown. Materials and methods: Totally, 45 mandibular single rooted first premolars were collected, which were sound along with similar shape and size. The teeth were sectioned at 15 mm above the root apex sparing the sound tooth structure. The teeth were endodontically treated with the crown-down technique using nickel-titanium (NiTi) instrumentation. The specimens were randomized into three groups as per the core materials used and were labeled accordingly. Group I consisted of dual-cured composite resin, group II consisted of glass ionomer reinforced with resin, and group III consisted of Miracle mix. Universal loading machine is used for measuring the compres-sive load applied to fracture the tooth. Results: The mean value of compressive strength was maximum in the dual cured composite resin (598.42 ± 22.64) followed by glass ionomer reinforced with resin (478.88 ± 26.74) and Miracle mix (442.16 ± 30.10). The results showed a significant difference statistically within the core materials used with p < 0.05. The results from the Tukey's post hoc test of multiple comparisons between dual-cured composite resin vs glass ionomer reinforced with resin, dual-cured composite resin vs Miracle mix, and glass ionomer reinforced with resin vs Miracle mix showed a highly statistical difference with p < 0.05, which is significant. Conclusion: This in vitro study showed that the dual-cured composite resin had maximum resistance to fracture compared with other core buildup materials on teeth which were endodonti-cally treated. Clinical significance: Restoration of a tooth which is structurally compromised is a tricky job for all the dentists. Restoring it with a proper core buildup material with adequate fracture resistance makes the tooth structure stable. The core material should be able to resist all types of occlusal forces and to distribute it equally within the tooth structure. Keywords: Core buildup, Crowns, Endodontically treated teeth, Fracture resistance.

Evaluation of root maturation after revitalization in immature permanent teeth with nonvital pulps by cone beam computed tomography and conventional radiographs.

AIM: To investigate the response of immature permanent teeth with nonvital pulps after revitalization procedures using cone beam computed tomography imaging and conventional radiograph. METHODOLOGY: Clinical records of patients who had undergone revitalization between 1997 and 2014 were collected. Seventeen patients attended the follow-up examination. Clinical examination and radiographic examination by means of CBCT imaging and conventional radiographs were conducted to evaluate treatment outcomes, especially the dimensional changes of the root and the pattern of root maturation. Statistical analysis was conducted using Fisher's exact test and Monte Carlo test to investigate the effect of potential outcome predictors. RESULTS: For the follow-up period as far as 96 months, thirteen teeth (76%) were classified as a 'success'. Conventional radiographs showed various degrees of dimensional changes in the immature roots ranging from 0% to 73% changes. The mean percentage changes of root length and root wall thickness were 14.38 ± 20.92% and 13.82 ± 11.17%, respectively. CBCT images illustrated various patterns of root maturation including incomplete root development with wide-open apices and fully formed roots with various apical shapes. Root canal contents varied radiographically from empty canals to many degrees of unpredictable patterning of radiopaque deposits. CONCLUSION: Revitalization in immature teeth with nonvital pulps resulted in unpredictable responses in terms of continued root development. Various types of root maturation and root canal contents were observed radiographically, which were different from typical root development.

In vivo study of the effectiveness of quantitative percussion diagnostics as an indicator of the level of structural pathology of teeth after restoration.

STATEMENT OF PROBLEM: Conventional diagnostic aids based upon imagery and patient symptoms do not indicate whether restorative treatments have eliminated structural pathology. PURPOSE: The purpose of this clinical study was to evaluate quantitative percussion diagnostics (QPD), a mechanics-based methodology that tests the structural integrity of teeth noninvasively. The study hypothesis was that QPD would provide knowledge of the structural instability of teeth after restorative work. MATERIAL AND METHODS: Eight participants with 60 sites needing restoration were enrolled in an IRB-approved clinical study. Each participant was examined comprehensively, including QPD testing. Each site was disassembled and microscopically video documented, and the results were recorded on a defect assessment sheet. A predictive model was developed for the pathology rating based on normalized fit error (NFE) values using data from the before treatment phase of the study published previously. Each restored site was then tested using QPD. The mean change in NFE values after restoration was evaluated by the pathology rating before treatment. The model was then used to predictively classify the rating after restoration based on the NFE values after treatment. The diagnostic potential of the rating was explored as a marker for risk of pathology after restoration. RESULTS: After restoration, 51 of the 60 sites fell below an NFE of 0.04, representing a greatly stabilized tooth site sample group. Several sites remained in the high-risk category and some increased in pathologic micromovement. Two models were used to determine severity with indicative cutoff points to group sites with similar values. CONCLUSIONS: The data support the hypothesis that QPD can indicate a revised level of structural instability of teeth after restoration.

Surgical management of damaged inferior alveolar nerve caused by endodontic overfilling of calcium hydroxide paste.

AIM: To evaluate the neurosensory outcome of management of damaged inferior alveolar nerves caused by endodontic overfilling and to assess the efficacy of delayed surgical intervention. METHODOLOGY: Nine patients who underwent surgical removal of extruded endodontic material were included. All patients were evaluated for neurosensory function using a set of standardized tests. The outcome of surgical intervention was evaluated through patient interview and quantitative statistical analysis. RESULTS: Surgical procedures included foreign body removal, microsurgical external/internal decompression, excision of neuroma followed by nerve repair, and excision of damaged nerve segment with interpositional nerve graft. Seven of the nine patients had significant improvement according to the follow-up neurosensory assessment. Four patients reported significant improvement, three patients reported mild improvement and two patients reported no appreciable improvement in the Visual Analog Scale (VAS). Two patients who reported no appreciable improvement in VAS also did not achieve FSR. In these patients, calcium hydroxide was spread widely along the IAN and a surgical approach was obtained via sagittal spit osteotomy. The mean time to reach FSR was 222.7 (±41.8) days with a range of 106-397 days. In the early repair group who received surgery within 60 days, three out of five patients achieved FSR in a mean time of 198.0 (±76.2) days. The mean time to FSR in all four subjects who received surgical attention over 60 days after injury was 241.3 (±139.8) days with a range of 106-397 days. As all four cases in the late repair group with limited amount of nerve injury achieved FSR, only 3 of 5 early repair cases with wide-spread injury achieved a similar outcome. CONCLUSION: The results of this case series confirmed the notion that surgical management of the inferior alveolar nerve is effective in the treatment of nerve injuries caused by endodontic extrusion of calcium hydroxide paste. Delayed surgical repair of the inferior alveolar nerve can be indicated and helpful for the neurosensory recovery of damaged IAN, however, the surgical management was less effective in case of widespread nerve injuries.

Effects of Dentin Moisture on Cementation of Fiber Posts to Root Canals.

PURPOSE: Achieving optimal moisture inside the root canal is a challenge during bonding of fiberglass posts. This study evaluated the effect of different moisture patterns on the push-out bond strength (PBS) and nanoleakage (NL) of fiber posts bonded to the root canal of two simplified etch-and-rinse adhesives. MATERIALS AND METHODS: The roots of 72 human premolars were endodontically prepared and divided into 6 groups according to the combination of the main factors: adhesive (Ambar and Adper Single Bond 2) and moisture (dry, wet, and overwet). The posts were cemented and after 1 week, the roots were cross sectioned into 6 disks. Two disks each were obtained from the cervical, middle, and apical thirds, and the PBS test was carried out (0.5 mm/min; n = 8). The NL was evaluated by scanning electron microscopy after the immersion of specimens in 50% silver nitrate (n = 4). The failure pattern was examined on all debonded specimens. Data were analyzed by three-way repeated measures ANOVA and Tukey's test (5%). RESULTS: For both adhesives, higher PBS values and lower NL were observed in the wet groups, and lower PBS and higher NL in the dry group. In general, the overwet condition showed intermediate results. CONCLUSIONS: The root dentin walls should be left slightly moist before performing fiber post cementation procedures.

Influence of insertion techniques for resin cement and mechanical cycling on the bond strength between fiber posts and root dentin.

PURPOSE: To evaluate the effect of the insertion technique for resin cement and mechanical cycling on the bond strength between fiber posts and root dentin. MATERIALS AND METHODS: Sixty-four single-rooted bovine teeth were endodontically prepared to receive glass-fiber posts. The insertion of cement into the root canal was performed using one of the following techniques: POS, insertion with the post; LEN, the use of a lentulo-type drill; EXP, insertion with a straight-tip explorer; or CEN, the use of a Centrix syringe. Half of the specimens were mechanically cycled. All specimens were sectioned into slices of 1.8 mm for the push-out test and 0.5 mm for analysis of the cement layer quality. RESULTS: The insertion technique affected the interaction between factors (bond strength and mechanical cycling; p < 0.0001). Insertion of the Centrix syringe after mechanical cycling showed the highest bond values (13.6 ± 3.2 MPa). Group-to-group comparisons for baseline and cycled conditions indicated that mechanical cycling significantly influenced the bond strength (p < 0.0001) of the POS and CEN groups. The quality of the cement layer did not differ between the techniques when evaluated in the middle (p = 0.0612) and cervical (p = 0.1119) regions, but did differ in the apical region (p = 0.0097), where the CEN group had better layer quality for the two conditions tested (baseline and cycled). CONCLUSION: The use of the Centrix syringe improved the homogeneity of the cement layer, reducing the defects in the layer and increasing adhesive strength values to dentin, even after mechanical cycling.

Considerations for Altering Preparation Designs of Porcelain Inlay/Onlay Restorations for Nonvital Teeth.

PURPOSE: The aim of this study was to compare all ceramic inlay/onlay survival rates in vital and nonvital teeth having the same cavity design. Filling the pulp chamber with ceramic materials or not was also discussed. MATERIALS AND METHODS: Ceramic class II inlays/onlays were made on 11 premolars and 30 molars: 14 vital, 27 endodontically treated. The same tooth preparation design was performed on vital and nonvital teeth: In nonvital teeth the pulp chambers were covered by a glass ionomer cement until the pulpal floor depths were between 2 and 2.5 mm, more likely similar to the vital teeth preparations. In vital teeth, glass ionomer was used as a liner to achieve pulpal floor depths between 2 and 2.5 mm when needed. The restorations were assessed (at baseline, 6 months, 1 and 2 years) according to three criteria: marginal discoloration, marginal integrity, and fracture of teeth/restorations, consistent with United States Public Health Service (USPHS) criteria. RESULTS: Eight teeth (19%) showed minor marginal discolorations, while three molars (7%) had loss of marginal integrity. These margins were adjusted using rubber polishing cups and were then judged clinically acceptable. From these three molars, one was vital and two were endodontically treated. No fracture of teeth or restorations was observed. Chi square and exact probability tests were used. There was no statistical difference between vital and nonvital teeth (p = 0.719 chi-squared and Fisher) or between premolars and molars (p = 0.564 chi-squared; 1.000, Fisher). CONCLUSION: Within the limitations of this study there was no difference for the same inlay/onlay cavity design between vital and nonvital teeth. In nonvital teeth, it seems that filling the pulp chamber with a ceramic core material is not important. Long-term observation periods are needed to reinforce the clinical behavior outcome.

Nonsurgical endodontic treatment of permanent maxillary incisors with immature apex and a large periapical lesion: a case report.

Immature teeth with necrotic pulp and large periapical lesions are difficult to treat via conventional endodontic therapy. However, they can be treated with calcium hydroxide and mineral trioxide aggregate (MTA). This article reports the case of a nonvital tooth with a periapical lesion and an open apex that was treated with a single-visit MTA apical plug. A radiographic evaluation taken 6 months post-treatment showed a decrease in the periapical lesion; at 1 year, complete healing was visible.

The Effect of Self-adhesive and Self-etching Resin Cements on the Bond Strength of Nonmetallic Posts in Different Root Thirds.

PURPOSE: The purpose of this study was to evaluate the effect of self-adhesive and self-etching resin cements on the bond strength of nonmetallic posts in different root regions. MATERIALS AND METHODS: Sixty single-rooted human teeth were decoronated, endodontically treated, post-space prepared, and divided into six groups. Glass-fiber (GF) posts (Exacto, Angelus) and fiber-reinforced composite (FRC) posts (EverStick, StickTeck) were cemented with self-adhesive resin cement (Breeze) (SA) (Pentral Clinical) and self-etching resin cement (Panavia-F) (SE) (Kuraray). Six 1-mm-thick rods were obtained from the cervical (C), middle (M), and apical (A) regions of the roots. The specimens were then subjected to microtensile testing in a special machine (BISCO; Schaumburg, IL, USA) at a crosshead speed of 0.5 mm/min. Microtensile bond strength data were analyzed with two-way ANOVA and Tukey's tests. RESULTS: Means (and SD) of the MPa were: GF/SA/C: 14.32 (2.84), GF/SA/M: 10.69 (2.72), GF/SA/A: 6.77 (2.17), GF/SE/C: 11.56 (4.13), GF/SE/M: 6.49 (2.54), GF/SE/A: 3.60 (1.29), FRC/SA/C: 16.89 (2.66), FRC/SA/M: 13.18 (2.19), FRC/SA/A: 8.45 (1.77), FRC/SE/C: 13.69 (3.26), FRC/SE/M: 9.58 (2.23), FRC/SE/A: 5.62 (2.12). The difference among the regions was statistically significant for all groups (p < 0.05). The self-adhesive resin cement showed better results than the self-etching resin cement when compared to each post (p < 0.05). No statistically significant differences in bond strengths of the resin cements when comparable to each post (p > 0.05). CONCLUSION: The bond strength values were significantly affected by the resin cement and the highest values were found for self-adhesive resin cement.

Effect on push-out bond strength of glass-fiber posts functionalized with polydopamine using different adhesives.

PURPOSE: To evaluate the push-out bond strengths of prefabricated glass-fiber posts (Beijing Oya Biomaterials) with polydopamine functionalized to root dentin using two different resin cements (Paracore and RelyX Unicem) in different root regions (cervical, middle, and apical). MATERIALS AND METHODS: Forty extracted human, single-rooted teeth were endodontically treated and a 9-mm post space was prepared in each tooth with post drills provided by the manufacturer. Specimens were then randomly assigned into four groups (n = 10 per group), depending on the adhesive system and post surface treatment used: group IA (Paracore + polydopamine); group IB (Paracore + control); group IIA (RelyX Unicem + polydopamine); group IIB (RelyX Unicem + control). Following post cementation, the specimens were stored in distilled water at 37°C for 7 days. The push-out test was performed using a universal testing machine (0.5 mm/ min), and the failure modes were examined with a stereomicroscope. Data were statistically analyzed using twoway ANOVA (p = 0.05). RESULTS: Bond strengths (mean ± SD) were: 7.909 ± 3.166 MPa (group IA), 4.675 ± 2.170 MPa (group IB), 8.186 ± 2.766 MPa (group IIA), 4.723 ± 2.084 MPa (group IIB). The bond strength of polydopamine groups was significantly higher than one of the control groups (p < 0.0001). No significant difference was found in the micro push-out bond strengths between the two resin cement groups or the root regions (p > 0.05). Stereomicroscopic analysis showed a higher percentage of adhesive than cohesive failures in all groups. CONCLUSION: Surface polydopamine functionalization was confirmed to be a reliable method for improving the bond strength of resin luting agents to fiber posts. The bond strength of Paracore to fiber posts was not significantly different from that of RelyX Unicem, and considering its convenient application, Paracore can be recommended.

Influence of occlusal contact and cusp inclination on the biomechanical character of a maxillary premolar: a finite element analysis.

STATEMENT OF PROBLEM: Restoring teeth with large amounts of dentin loss is challenging, especially for posterior teeth with high cusps. However, strategies for reducing the lateral forces are based on clinical experience instead of than scientific evidence. PURPOSE: The purpose of this study was to analyze the biomechanical characteristics of maxillary premolars with different ferrule configurations and to investigate the influence of occlusal contact and cusp inclination on stress distribution with the finite element method. MATERIAL AND METHODS: Five numerical casts of a maxillary premolar were generated; each adopted 1 of the 5 coronal dentin configurations: i (access cavity with 4-mm dentin height) and ii to v (2-mm complete ferrule, 2-mm facial ferrule, 2-mm palatal ferrule, 2-mm proximal ferrule, and restored with a post and core, respectively). Both gold-alloy and glass-fiber posts were modeled. An oblique load of 200 N was applied to the top, middle, and bottom of the 45-degree facial cusps. The cusp inclination was remodeled to 60 degrees, followed by the application of a 200-N load to the top. The values of the maximum principal stress and von Mises stress were calculated to assess overload risk. RESULTS: When the top of 45-degree facial cusps was loaded, the maximum local stress concentration on dentin was found in teeth with a facial ferrule and restored with a gold-alloy post. When the middle of 45-degree facial cusps were loaded, the principal stresses of teeth with a complete ferrule, palatal ferrule, and proximal ferrule were similar to those of the access cavity teeth. In contrast, the principal stress of a tooth with a facial ferrule was close to that of the access cavity tooth after remodeling the facial inclination to 60 degrees. CONCLUSIONS: Maxillary premolars with only facial dentin remaining show higher local stress on root dentin. Altering the loading position and reducing the facial cusp inclination can reduce local stresses.

Effect of chlorhexidine on bond strength between glass-fiber post and root canal dentine after six month of water storage.

Aim of this study was to assess the influence of chlorhexidine digluconate (CHX) application on bond strength of glass fibre reinforced composite (FRC) posts to root dentine using adhesive luting systems. Forty extracted human mandibular premolars were endodontically treated and root canals were prepared. Teeth were divided into 2 groups according to luting system as SuperBond C&B (etch-and-rinse/chemical cure) and FuturaBond DC (self-etch/ dual cure). Each group was further divided in 2 subgroups (n=10) according to whether CHX was applied or not. Group Futura/CHX: FuturaBond DC + CHX; group Futura: FuturaBond DC; group Super/CHX: Super Bond C&B + CHX; group Super: SuperBond C&B + CHX. Mean and standard deviation (in parenthesis) values of bond strength in MPa were: group Futura/CHX: 8.86 (1.96), group Futura: 7.65 (1.01), group Super/CHX: 17.47(2.93), group Super: 12.41 (3.83). Bond strength values were affected by the type of luting agent and CHX irrigation (p=0.001, two-way ANOVA). There were statistically significant differences among the groups according to one-way ANOVA (p<0.001). Significant differences were observed in bond strength between groups Super/CHX and Super (p=0.023), between groups Futura/CHX and Super/CHX (p<0.001). Application of CHX before luting procedure with etch-and-rinse/chemical cure luting agent of glass FRC post improved long-term bond strength between glass FRC and root dentine.

The influence of elastic modulus mismatch between tooth and post and core restorations on root fracture.

AIM: To investigate the influence of elastic modulus mismatch between tooth and post and core restorations on mechanisms of root fracture. METHODOLOGY: Three-dimensional mathematical models of a root filled maxillary premolar tooth with supporting periodontium were constructed. The tooth was restored with a cast Ni-Cr alloy or fibre-reinforced composite post and core that was bonded or nonbonded to dentine. In the nonbonded simulation, a nonlinear contact analysis was executed to simulate a friction and a potential sliding phenomenon in the interface between tooth and post and core. Risks of root fracture and debonding at the bonded interface were estimated based on the principal stress of the root and the shear stress on the interface, respectively. RESULTS: The fracture risk of the bonded cast post and core was lower than that of the composite post and core, although the cast restoration exhibited eight times greater stress than the composite. The risk of root fracture based on the tensile stress of the tooth structures was higher with the bonded composite post and core than that with the cast post and core. These stresses doubled when the restorations were not bonded to the tooth structures. The risk of debonding of the cast post and core based on the shear stress was approximately twice that of the composite post and core. CONCLUSIONS: The elastic modulus mismatch appears to be a factor responsible for the debonding of post and cores from root canals, with the potential to increase the risk of root fracture indirectly.

Effects of silane application on luting fiber posts using self-adhesive resin cement.

PURPOSE: To evaluate the effects of different glass-fiber post surface treatments on the bond strength to root dentin. MATERIALS AND METHODS: Fifty bovine incisors were used in this study. After removing the crowns, the teeth were endodontically treated. The roots were randomly divided into five groups according to post surface treatment. The groups were as follows: CO (Control) - no treatment; G1 - RelyX Ceramic Primer (silane) only; G2 - silane and Solobond M; G3 - silane and Scotchbond Adhesive; G4 - silane and Excite. For post cementation, RelyX Unicem was used according to the manufacturer's recommendation and the roots were stored in a light-proof container with 100% relative humidity for 24 h. The specimens were transversally sectioned. Subsequently, the cervical, middle, and apical regions of the root were positioned in a push-out device and tested at 0.5 mm/min using a universal testing machine (Instron). The data were statistically analyzed with two-way ANOVA and Tukey's post-hoc test. The fractured specimens were then observed under a stereoscopic loupe at 60X magnification. RESULTS: No significant difference in bond strength was found among the groups that received a silane or silane plus an adhesive system (p > 0.05). However, the CO (no silane) showed the lowest bond strength. Regarding G1, G2, G3, and G4, the cervical region of the root canal attained better bond strengths than did the middle or apical regions. The most frequent failure mode occurred at the cement/dentin interface. CONCLUSION: Silane application may be necessary to improve the adhesion of fiber posts luted with the self-adhesive resin cement evaluated here. The application of an adhesive layer between the fiber post and resin cement did not have any influence on the bond strength when the silane coupling was previously used.

Influence of adhesive techniques on fracture resistance of endodontically treated premolars with various residual wall thicknesses.

STATEMENT OF PROBLEM: The choice of restorative method is commonly based on the cavity configuration and the residual number of cavity walls. However, the residual wall thickness could be a valuable clinical parameter in the choice of restoration for endodontically treated teeth. PURPOSE: The fracture resistance of endodontically treated premolars was compared with different wall thicknesses restored with direct composite resin with and without cuspal coverage and with and without fiber post insertion. MATERIAL AND METHODS: This study included 104 intact human maxillary premolars extracted for periodontal or orthodontic reasons. Standardized mesio-occluso-distal cavities were prepared with different palatal wall thicknesses (1.5, 2, and 2.5 mm) and a buccal wall thickness of 2 mm. Teeth were restored with or without a fiber post and with or without cuspal coverage. Specimens were subjected to thermocycling (3000 cycles, 5 to 55°C) and embedded in polymerized acrylic resin. Teeth were submitted to cyclic fatigue followed by a static fatigue test with a universal testing machine; a compressive force was applied 30 degrees to the long axis of the teeth until fracture. The results were statistically analyzed by 3-way ANOVA (α=.05). RESULTS: Residual wall thickness (P=.004), the type of adhesive restoration (P<.001), and fiber post insertion (P<.001) significantly influenced the fracture resistance of endodontically treated premolars. CONCLUSIONS: In specimens with a cavity wall thickness >2 mm, direct intracuspal composite resin restorations supported by a fiber post achieved comparable fracture resistance. With a residual wall thickness <2 mm, only cuspal coverage with or without a fiber post provided satisfactory fracture resistance.

Histometric study of resorption on replanted teeth with enamel matrix-derived protein.

BACKGROUND: Enamel matrix-derived proteins (Emdogain) stimulate the proliferation of periodontal ligament cells, contributing to their regeneration. AIM: This study was to perform histometric assessment of root surface resorption in replanted teeth with the use of Emdogain®. MATERIALS AND METHODS: Male Wistar rats (Rattus norvegicus), weighing 180 to 200 gm, were anesthetized, subjected to extraction of the upper right incisor tooth, which was then replanted into the alveoli with the following treatment: (a) control group--tooth with root canal filled with calcium hydroxide paste and (b) treated group--tooth with root canal filled with enamel matrix-derived protein. The animals were sacrificed 25 days after tooth replantation. The maxilla was processed to obtain thin sections (6 µ) and stained with hematoxylin and eosin. The resorption volume percentage of each dental element was calculated from the cementoenamel junction to the apex. RESULTS: Quantification of resorption revealed that Emdogaintreated teeth showed a lower percentage of resorption (31.58%) compared to controls (80.48%) (statistically significant values--t-test p-value=0.0431). CONCLUSION: It was concluded that Emdogain used as root canal filling has properties capable of showing a lower percentage of resorption in replanted teeth.

Extent of cement polymerization along dowel space as a function of the interaction between adhesive and cement in fiber post cementation.

PURPOSE: To assess whether the polymerization extent of cement is influenced by curing mode of the adhesive and/or by photoactivation of the cement. MATERIALS AND METHODS: One hundred five root segments were prepared from endodontically treated teeth. After post space preparation, the root segments were randomly divided into 7 groups, based on the cementation procedure to lute RelyX Fiber Posts (3M ESPE): 1. Variolink II (V, Ivoclar Vivadent); 2. V light-cured (LC); 3. Excite LC (ELC, Ivoclar Vivadent)/V; 4. ELC/V LC; 5. ELC-V LC (One Shot); 6. Excite DSC (EDSC)/V; 7. EDSC-V LC (One Shot). Each root segment was submitted to the acetone shake test to remove the unpolymerized resin and then cut longitudinally. On each half, the extent of cure of the cement was measured with image analysis software. RESULTS: The deepest and basically complete polymerization was obtained with EDSC (groups 6 and 7), regardless of whether light curing was performed. The extent of polymerization was most limited when adhesive was not applied (groups 1 and 2), or when ELC was only light cured, while V was allowed to auto-cure (group 3). With the one-shot polymerization of ELC and V (group 5), the extent of polymerization was similar to the procedure involving separate irradiation of adhesive and cement (group 4). The one-shot technique was significantly more effective if EDSC was used (group 6). CONCLUSION: The use of a self-activating dual-curing adhesive system in combination with a dual-curing cement enables effective luting of FRC posts regardless of the amount of light transmitted through the post.