Fracture strength of flared root canals reinforced using different post and core materials.

PURPOSE: To examine the fracture strength and fracture mode of flared root canals reinforced with different post and core materials. MATERIALS AND METHODS: Forty endodontically treated bovine teeth structured to mimic human mandibular premolars with flared root canals were reinforced with resin composite and glass fiber post (FRC), composite resin (RC), ceramic core (LD), and ceramic core with resin composite reinforcement (RLD), and restored with single zirconia crowns (n = 10 in each group). The fracture strength and mode of the root canals restored with zirconia crown were assessed. The fracture strength was compared with a one-way analysis of variance (ANOVA) following Tukey HSD tests. A multiple regression analysis was conducted to test the effect of the post/core materials on the fracture loads. Fisher's exact test was used in the failure mode analysis. RESULTS: The mean fracture strength of RLD was significantly higher than RC, FRC, and LD (p < 0.05), while no significant differences were found among RC, FRC, and LD (p < 0.05). The regression analysis found that the fracture strength using the lithium disilicate was significantly lower for the post and higher for the core than that using the resin composite (p < 0.05), and there were no significant difference in the fracture strengths between the resin composite and glass fiber used for the post (p > 0.05). Most of the specimens exhibited root fractures, and no significant differences were observed among the groups (p < 0.05). CONCLUSIONS: The results of this study suggest that reinforcement of flared root canals using a combination of resin composite for the core and lithium disilicate ceramic for the post is superior to resin composite and glass fiber in mechanical properties when restoring a single crown.

Dentin Bonding Durability of Two-step Self-etch Adhesives with Improved of Degree of Conversion of Adhesive Resins.

PURPOSE: To evaluate (1) the initial and long-term microtensile bond strengths of two-step self-etch adhesives with different degrees of conversion (DC); (2) the elastic modulus of the respective adhesive resins; (3) the water sorption of the respective adhesive resins. MATERIALS AND METHODS: Two two-step self-etch adhesives, Clearfil SE Bond (CSE) and Clearfil SE Bond 2 (CSE2) were used in this study. The DC was determined using ATR/FT-IR with a time-based spectrum analysis. Midcoronal flat dentin surfaces of 24 human molars were prepared with 600-grit SiC paper for microtensile bond strength (µTBS) testing. CSE and CSE2 were applied to the dentin surfaces according to the manufacturer's instructions, followed by composite buildups. The µTBS was measured after water storage for 24 h, 6 months, and 1 year. The elastic modulus (before and after 1 month of water immersion) was determined by the three-point flexural bending test and water sorption values by the water sorption test. RESULTS: CSE2 showed significantly higher DC than CSE. The µTBS of CSE2 was significantly higher than that of CSE in all water storage periods. One-year water storage decreased the µTBS of CSE; however, it did not decrease that of CSE2. Regarding the polymerized adhesive resins, the elastic modulus of CSE2 was significantly higher than that of CSE before and after water immersion (p < 0.001), and the water sorption of CSE was higher than that of CSE2. CONCLUSIONS: The higher DC of adhesive resins of two-step self-etch adhesives resists water aging and improves the initial bond strengths and durability of the resin-dentin bond.

Surface strain at the cervical area and fracture strength of flared root canals reinforced using a zirconia tube and glass-fiber post.

Background/purpose: Recently, an effective core build-up system for teeth with flared root canals is needed. This research aimed to evaluate the effect of foundation restorations using a composite resin core with a fiber post reinforced with a zirconia tube for the surface strain at the cervical area and the fracture load of teeth with flared root canals. Materials and methods: Bovine teeth were shaped to mimic human premolars with flared root canals and restored using three types of composite resin foundation restorations with each materials described below: a fiber post (FC), a zirconia tube (ZC), a fiber post and zirconia tube (ZFC). Each specimen was restored with a zirconia crown. The surface strains of the specimens at the cervical area and fracture loads were analyzed using a one-way analysis of variance (ANOVA), followed by Tukey's honest significant difference test. Results: The surface strains of Groups ZFC and ZC were significantly lower than that of Group FC in the buccal root. The fracture strengths of Groups ZFC and ZC were significantly higher than that of Group FC. The strength of Group ZFC was significantly higher than that of Group ZC. Conclusion: The use of a composite resin core with a zirconia tube for the simulated premolar with flared root canals reduced surface strain at the cervical area and provided higher fracture strength compared to using a composite resin core with a fiber post. And the zirconia tubes provided even higher fracture strength when used with a fiber post.

Effects of immersion in 4-methacryloyloxyethyl trimellitate anhydride/methyl methacrylate-tri-n-butyl borane resin-activated liquid on microtensile bond strength of root canal dentin.

Background/purpose: 4-methacryloyloxyethyl trimellitate anhydride/methyl methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin is used for indirect restorations. We aimed to evaluate effects of immersion in 4-META/MMA-TBB-activated liquid on the bond strength of root canal dentin. Materials and methods: We used freshly extracted single-rooted human teeth. After decoronation, each root was vertically sectioned into halves; their dentin walls were polished and flattened. The control group underwent dentin treatment with Green Activator. The immersion group was treated with Green Activator and Teeth Primer and immersed in 4-META/MMA-TBB-activated liquid. After bonding the resin blocks with Super-Bond, microtensile bond strength (µTBS) tests were performed (n = 6), and fracture surfaces were analyzed. Before surface treatment, dentin was immersed in a sodium fluorescein solution for 3 h, and resin blocks were bonded with Super-Bond with rhodamine B as in the bond strength test. The bonded cross section was observed using confocal laser scanning microscopy (CLSM). Results: µTBS was significantly higher in the immersion group than in the control group (61.5 [51.3-66.7] vs. 33.0 [20.4-57.8] MPa; P < 0.05). Fracture mode analysis showed that, compared with the control group, the immersion group had a significantly lower rate of adhesive failure at the dentin interface and a significantly higher rate of cohesive failure in Super-Bond (P < 0.01). CLSM showed a water droplet-like accumulation of fluorescein dye above the hybrid layer in the control group, not in the immersion group. Conclusion: Immersion in a 4-META/MMA-TBB-activated liquid inhibited water exudation from the root canal dentin and improved the bond strength.

Marginal fit and retention force of zirconia resin-bonded fixed dental prostheses in the posterior region with different designs.

Background/purpose: Retainer debonding of resin-bonded fixed dental prostheses (RBFDPs) is one of the major reasons for their lower survival rates than fixed dental prostheses (FDPs) with full-coverage crowns. Recent advances in milling technology have enabled the fabrication of RBFDPs with complex retainers (D-shaped designs). This study aimed to assess the marginal fit and retention force of zirconia RBFDPs with inlay-, L-, and D-shaped designs to clarify their clinical applications. Materials and methods: Three abutment teeth models without maxillary second premolars were created using inlay-, L-, and D-shaped retainer designs. The zirconia RBFDPs were designed and fabricated according to the manufacturer's instructions (n = 10). The marginal gap was measured using the silicone replica technique. Zirconia frameworks were bonded to the abutment teeth using resin cement. Tensile test was conducted after thermal cycling and dynamic loading tests. The loads during debonding or fracture were recorded. The failure pattern was analyzed by observing the fracture surface using a scanning electron microscope. Results: D-shaped RBFDPs showed a significantly larger marginal gap than inlay- and L-shaped RBFDPs (P < 0.05). However, the mean marginal values were clinically acceptable (<120 µm). The D-shaped model exhibited the highest tensile strength in the tensile tests. The inlay-shaped and most of the D-shaped RBFDPs experienced debonding with cohesive failure, whereas the L-shaped RBFDPs showed fractures near the connector. Conclusion: The D-shaped retainer design was superior to the inlay- and L-shaped designs with respect to the inhibition of retainer debonding. However, the marginal fitness needs to be improved.

A composite resin core with a new zirconia tube reduces the surface strain at the cervical area of a mandibular molar: A model tooth study.

PURPOSE: This study aimed to evaluate the surface strain at the cervical area of endodontically treated molars with a large pulp chamber restored using a composite resin core with three different types of core build-up systems. METHODS: Reproduction models of human mandibular molars with prepared post spaces were used in this study. Roots duplicated with a composite resin were used as the experimental teeth. Three types of core build-up systems were used: composite resin core(RC), composite resin core with fiber posts (FC), and composite resin core with a prefabricated zirconia tube (ZC). Each group comprised eight specimens. Crowns made of yttria partially stabilized zirconia were cemented with dual-cure resin cement. Four strain gauges were attached to the surfaces of each specimen: the cervical area of the root and crown, on the buccal and lingual sides. The surface strain at each cervical area was measured using a static loading test and statistically analyzed. RESULTS: In the case of static loading to the buccal cusp inner slope, ZC showed a significantly lower strain than RC in the crown on the buccal side and in the root and FC in the root. In the central fossa, ZC showed a significantly lower strain than FC in the root on the lingual side. CONCLUSIONS: The prefabricated zirconia tube reduced the surface strain at the cervical area of the buccal/lingual root in molars; however, the effect was small in the cervical area of the crown.

Fostering globally competent dental students through virtual team-working, problem-solving and person-centred multi-disciplinary care planning.

Background/purpose: : Development and acquisition of communication, logical thinking, team-building, critical appraisal, critical thinking and person-centred multi-disciplinary care planning must be considered as skill sets and global core competencies for a dental professional. Therefore, an international online study course to foster undergraduate dental students' skill sets in these areas was established and this study aimed to report the perceptions of participants. Materials and methods: An international online course consisting of three levels pertaining to the school year was delivered to dental undergraduates of Japan and Thailand from September to December in 2021. An online questionnaire survey was conducted to obtain feedback from the participants and assess the implementation of the course. Results: In total, 64 responses were obtained from students who participated in all the assigned online sessions and completed the questionnaire (a response rate of 88%). More than 95% of students from each level felt that the programme increased their motivation to study clinical dentistry, and was beneficial for their future and made them appreciate the importance of participating in international exchange. The ratio of favourable respondents was more than 90% with a 95% confidence interval. Conclusion: Fostering globally competent dental students is important and the acquisition of necessary skill sets could be enhanced through international virtual team-working, problem-solving and person-centred multi-disciplinary care planning activities. These are beneficial for undergraduate dental student training so that they graduate with a broader global perspective and an appreciation of the importance of delivering person-centred culturally sensitive dental care.

Effect of Method of Removing Caries-Affected Dentin on the Bond Strength of Composite Resin to Root Canal Dentin.

The adhesion of composite resin to caries-affected dentin differs from the adhesion of resin to sound dentin. We evaluated the bond strengths of dual-cure resin composites applied to caries-affected root canal dentin under various clinical conditions and using several caries removal indicators. In the dye stain 1 group, caries were removed to a pale pink stain level using a caries detector. In the dye stain 2 group, caries were removed to a stain-free level using a caries detector. In the probing group, caries were removed to the level of hardness based on probing with a sharp explorer. Additionally, a sound dentin group was used as a control. We compared the resin composite microtensile bond strengths and failure mode distribution among the groups. The bond strengths (MPa) of the probing (64.6 ± 11.9) and the sound dentin (68.7 ± 11.1) groups were significantly higher than those of the dye stain 1 (46.9 ± 7.9) and 2 (47.5 ± 8.4) groups (p < 0.05). The removal of caries-affected dentin using a dentin-hardness-based technique showed higher tensile strength than that using a dye stain technique involving removal to any color level. Thus, the caries removal technique used on root canal dentin affects the bond strength of the resin composite.

Novel flapless esthetic procedure for the elimination of extended gingival metal tattoos adjacent to prosthetic teeth: Er:YAG laser micro-keyhole surgery.

PURPOSE: This article describes a novel, minimally invasive procedure called Er:YAG laser micro-keyhole surgery (EL-MIKS) that removes metal or amalgam tattoos in the gingiva adjacent to prosthetic teeth without gingival deformity and recession. We aimed to evaluate the clinical efficacy of EL-MIKS for removing metal tattoos and present its long-term treatment outcomes. METHODS: The EL-MIKS procedure consists of several steps that are all performed under a microscope. First, a micro-keyhole (1-2 mm diameter) was prepared using an Er:YAG laser in the center of the metal pigmentation. The connective tissue was evaporated in the deep layer, where metal debris was deposited. Second, within the accessible range, the irradiation angle was changed in various directions to ablate the metal pieces and discolored connective tissue without enlarging the keyhole. Finally, after blood filled the space created by the tissue evaporation, the surface of the blood clot at the entrance of the micro-keyhole was thermally coagulated with defocus laser irradiation. Pigmentation that could not be successfully removed from a single micro-keyhole was treated by forming new micro-keyholes at a distance of 3 mm or more from each previously created hole. Depigmentation over an extended area was completed over a few sessions every 4 weeks without gingival recession after surgery. CONCLUSION: EL-MIKS, a novel depigmentation technique, was able to successfully remove an extended area of metal tattoos in the gingiva using a simpler, easier, and less invasive procedure than conventional periodontal plastic surgery. Esthetic restoration was successfully achieved without postoperative alteration of the gingival contour.

Investigation of stress distribution within an endodontically treated tooth restored with different restorations.

Background/purpose: Recently, metal-free restoration has become the standard in prosthetic treatment. However, it is still unclear which combination is most effective in preventing root fracture and secondary caries. The purpose of this study was to evaluate the influence of different post systems, crown materials, crown thickness and luting agents on the stress distribution around the crown margins, cervical dentin and the tip of the post. Materials and methods: Ninety-six mandibular first premolar models were developed and analyzed using finite element analysis (FEA). Two designs of crowns, six kinds of crown materials, four types of post and core systems and two kinds of luting agents were included and evaluated for the stress distribution within the abutment teeth. The Von Mises stress magnitudes were compared among all models. Results: The stress at the tip of the post decreased as the young's modulus of luting agent decreased; The stress concentrated more at the cervical area (dentin and crown), as the physical properties of the crown material increased. Conclusion: Crowns fabricated using polyetheretherketone (PEEK) can reduce the stress concentration at the cervical area, so it may be possible to reduce the amount of tooth reduction during abutment tooth preparation. The stress distribution around the post tip is affected by the post and core systems and luting agent, regardless of crown materials and thickness. When inserting a post of the higher Young's modulus such as zirconia post, methyl methacrylate luting cement can reduce the stress concentration at the tip of the post.

The investigation of the stress distribution in abutment teeth for connected crowns.

BACKGROUND/PURPOSE: With the advancement of an over aging society, the average number of remaining teeth has increased. However, these remaining teeth do not always have sufficient alveolar bone support, and sometimes fabricated connected crowns are applied. This study evaluated the influence of crown material, crown thickness, and alveolar bone resorption on the stress distribution within the abutment teeth of connected crowns. MATERIALS AND METHODS: Using structural analysis software, a premolar crown model was fabricated. Three kinds of crown materials, two types of crown thickness, two types of post and core systems, and two levels of alveolar bone were assumed and evaluated for the stress distribution within the abutment teeth. RESULTS: The higher material properties crown was, the more stress was concentrated at the marginal area. The composite resin core showed larger stress values around the marginal area, and the metal core showed larger stress values at the tip of the post. Alveolar bone resorption progressed, the marginal area stress value increased. CONCLUSION: The low elastic modulus crown material polyetheretherketone (PEEK) prevented stress concentrations at the marginal area of the crown and dentine, even with alveolar bone resorption. However, the amount of bone resorption has a great influence on the stress distribution around the tip of the post compared to the type of crown material.

Effect of bonded area and/or fiber post placement on the fracture strengths of resin-core reconstructions for pulpless teeth.

PURPOSE: To compare the fracture strengths of pulpless teeth restored using resin cores with and without fiber posts, and with and without bonding adhesive in the post cavity. METHODS: Human extracted roots were prepared with post cavities and divided into four experimental groups: Groups 1 and 2--after application of adhesive to both the top surface of the root and the inner surface of the post cavity, DC core Automix was injected into the post space with or without fiber-post placement; Groups 3 and 4--adhesive was applied to the top surface of the root only, with or without post placement. Resin-cores were then built-up. Teeth prepared for full crowns served as controls. After water storage at 37 degrees C for 24 hours, the all specimens were embedded in acrylic resin at 2 mm below CEJ, and loaded at 45 degrees to the long axis of the tooth using a universal testing machine until fracture. The data were analyzed by one-way ANOVA (alpha = 0.05). RESULTS: The fracture loads were, Group 1: 1832 +/- 240 N, Group 2: 1815 +/- 347 N, Group 3: 1626 +/- 396 N, Group 4: 1810 +/- 332 N, Control Group: 1622 +/- 274 N. There were no significant differences among all the groups (P > 0.05).

Evaluation of composite resin core with prefabricated polyetheretherketone post on fracture resistance in the case of flared root canals.

The aim of this study was to use polyetheretherketone (PEEK) for the post material and evaluate the fracture load of six restoration patterns in teeth with flared root canals; composite resin core alone (Group R); glass fiber sleeve (Group S); PEEK post (Group P); glass fiber post (Group F); PEEK post in glass fiber sleeve (Group PS); glass fiber post in glass fiber sleeve (Group FS). In this study, cylindroid specimens were prepared and underwent three-point-bending test in a steady condition and after water immersion. In the loading test, the materials in clinical conditions using bovine teeth were evaluated. In the bending test, groups using glass fiber posts and sleeves decreased in strength after water immersion. In the loading test, Groups F, FS and PS showed higher fracture load than other groups. This study showed PEEK posts and glass fiber sleeves are recommended in the case of flared root canals.

Photoelastic stress analysis of different post and core restoration methods.

The aim of this study was to compare three types of post and core systems by analyzing the stress magnitude within the root. To this end, two-dimensional photoelastic simulation models of endodontically treated maxillary central incisors were fabricated. Three different types of post and core systems were selected for this study: composite resin post and core, composite resin core in combination with a glass fiber post, and conventional cast metal post and core. The fabricated models were observed in a transmission polariscope with the same loading force (400 N) on 45 degrees palatal direction and the fringe orders registered were thereby analyzed. Results obtained in this study suggested that abutment build-up using composite resin core in combination with a glass fiber post model produced the lowest stress concentration and is hence effective in preventing stress concentration in the case of restored endodontically treated teeth.

Effect of reinforcement with resin composite on fracture strength of structurally compromised roots.

This study was aimed at evaluating the fracture resistance of structurally compromised roots restored with four different post and core systems. Thirty-two bovine roots were uniformly shaped to simulate human mandibular premolar roots. The roots were divided into four groups based on the type of restoration: cemented cast post and core (Group MC), resin composite build-up (Group CR), resin composite and prefabricated glass fiber post build-up (Group FRC), and thick-layer dual-cured resin composite-reinforced small-diameter tapered cast post and core (Group CRM). After a static loading test, the failure mode and fracture resistance were recorded. Group CRM (719.38+/-196.73 N) exhibited a significantly high fracture resistance compared with the other groups (Group MC: 429.56+/-82.43 N; Group CR: 349.56+/-66.21 N; Group FRC: 398.94+/-112.71 N; p<0.05). In conclusion, Group CRM exhibited better mechanical properties for structurally compromised roots with no ferrules, although all types of restorations showed non-restorable fracture modes.

Investigation of distortions around the cervical area of teeth restored with two kinds of crown materials.

The purpose of this study was to identify crown materials to decrease the stress concentrated at the cervical area of endodontically treated teeth. To this end, 14 extracted human mandibular premolars were divided into two groups for this study: complete cast crowns versus polymer-based crown and bridge material crowns. Both complete cast crowns (MC) and polymer-based crown and bridge material crowns (HC) were cemented with a glycidyl methacrylate-based resin cement (RC) to composite resin cores with glass fiber posts. Static loading was applied and distortion was measured with four pieces of strain gages attached to the marginal area. Findings showed that there was a large difference in distortion between crown and root in MC. On the other hand, distortions at the cervical area of crown and root were similar in HC.

Investigation of stress distribution in roots restored with different crown materials and luting agents.

The purpose of this study was to identify crown materials and luting agents that would decrease the stress concentrated at the roots of endodontically treated teeth. To this end, natural tooth model (NT), full cast crown model (gold-silver-palladium alloy; MC), polymer-based restorative material crown model (HCC), and all-ceramic crown model (ACC) were constructed. In each model, methyl methacrylate-based resin cement (MMA) and composite cement (CC) were used as luting agents. The magnitudes of von Mises stress of the roots during function were compared. When the luting agent was changed from MMA to CC, von Mises stress in the cervical area decreased by 37.8% for MC, 27.1% for HCC, and 37.0% for ACC. Within the limitations of this study, the combination of HCC and CC gave rise to the lowest stress concentration at the cervical area.

Stress distribution in roots restored with different types of post systems with composite resin.

Although composite resin core is used with various types of prefabricated posts, it remains unclear which kind of material is most suitable for the post. The aim of this study was to evaluate the influence of prefabricated posts on the stress distribution within the root by finite element analysis. Posts and cores were built up with composite resin and four types of prefabricated posts: two types of glass fiber posts (GFP1, GFP2) with low and high Young's moduli, a titanium post (TIP), and a stainless steel post (SSP). In all models, stress distribution during function was calculated. There were differences in stress concentration at the root around the end of posts. The magnitudes of stress for GFP1, GFP2, TIP, and STP were 8.7, 9.3, 11.7, and 13.9 MPa respectively. Given the results obtained, GFP1 was the most suitable material for post fabrication since this model showed a lower stress value. It would therefore mean a lower possibility of root fracture.

The effect of glass fiber posts and ribbons on the fracture strength of teeth with flared root canals restored using composite resin post and cores.

PURPOSE: This study evaluated the fracture strength and mode of failure of structurally compromised teeth with flared root canals restored using composite resin with four different systems. METHODS: Sixty endodontically treated bovine teeth were uniformly shaped to simulate human mandibular premolars with flared root canals. The roots were divided into four groups of 15 specimens each based on the type of restoration: composite resin core only (control), glass fiber post, cylindroid glass fiber ribbons, and glass fiber post and ribbons. All specimens were loaded until fracture occurred using a universal testing machine. Average fracture loads were compared with a one-way ANOVA and Tukey HSD test (α=.05). The modes of failure were observed and the Fisher exact test and Bonferroni correction were used for statistical analysis. RESULTS: The fiber post and ribbon group (1035.70N) and the fiber ribbon group (881.77N) showed significantly higher fracture strength than the controls (567.97N) (p<.05). The fiber post and ribbon group also showed significantly higher fracture strength than the fiber post group (769.40N). Almost all specimens showed unrestorable root fractures (p<.008). The control group had a significantly higher ratio of core sectional fractures (p<.017). CONCLUSIONS: Cylindroid glass fiber ribbons significantly increased the fracture strength of the composite resin post and cores in the case of the dentin within the thin root canal wall. Based on the results, this study recommends the combined use of glass fiber post and ribbons.

The effects of post and core material combination on the surface strain of the 4-unit zirconia fixed partial denture margins.

The suitability of various post and core materials for the 4-unit zirconia fixed partial denture abutment teeth was investigated to lower stress concentration. Artificial mandibular teeth (44 and 47) were used as the abutment teeth. There were two types of posts and cores: resin composite with glass fiber posts (RC), and cast platinum gold alloy (MC). Two experimental groups were analyzed. For Group RM, the premolars were restored with RC and the molars were restored with MC. For Group MR, the premolars were restored with MC and the molars were restored with RC. Static loading was applied to the occlusal surfaces, and the surface strain of the frameworks and roots was measured with a strain gauge. Group RM had a greater number of statistical differences between premolars and molars compared to Group MR. This result suggests that the Group MR post and core material combination reduces stress concentration.