Factors influencing the clinical performance of the restoration of endodontically treated teeth: An assessment of systematic reviews of clinical studies.

STATEMENT OF PROBLEM: How best to restore endodontically treated teeth is still unclear because many types of material and techniques are involved. PURPOSE: The purpose of this overview of systematic reviews of clinical studies was to assess the available evidence-based literature on the influence of associated clinical factors on the clinical performance (survival, failure rate, or success) of restored endodontically treated teeth. MATERIAL AND METHODS: PubMed, Scopus, and Web of Science were searched from inception until September 27, 2021, to identify systematic reviews. Two reviewers independently screened titles, abstracts, and full-text articles, and each reviewer extracted the data of half of the included studies. A single reviewer with an independent verifier completed the quality appraisal. A descriptive analysis of the collected data was made. RESULTS: A total of 36 systematic reviews fulfilled the inclusion criteria. The factors most assessed were the type of coronal restorative technique (n=22) and type of post (n=22). The results indicated that metal and fiber posts seem to present similar clinical performance, endocrowns could be a suitable restorative option, there is no evidence to confirm whether single crowns are better or worse than direct restoration, the maintenance of the coronal structure is a fundamental factor, and the ferrule effect is still a controversial topic. Most of the studies (n=30, 81%) presented a final Grading of Recommendations, Assessment, Development and Evaluations (GRADE) rating of "critically low." CONCLUSIONS: The post type does not appear to influence the clinical performance of restored endodontically treated teeth. However, conclusive evidence to suggest how different materials or techniques for restoring coronal tooth structure affect the clinical performance of such restorations, as well as the impact of the ferrule effect, is still lacking.

Light transmission and bond strength of glass fiber posts submitted to different surface treatments.

STATEMENT OF PROBLEM: Light transmitted deep into the root canal is an important parameter to increase bonding of the cement to the post and dentin. Glass fiber posts seem to be an option to increase transmitted light, but literature on the light transmittance profile and power transmission to deep canal regions is lacking. PURPOSE: The purpose of this in vitro study was to evaluate light delivered by 2 types of fiberglass posts submitted to different surface treatments and to evaluate the bond strength. MATERIAL AND METHODS: Whiteposts and Superposts were allocated to 4 groups: no surface treatment, surface treatment with 24% hydrogen peroxide, surface treatment with silane, and surface treatment with 24% hydrogen peroxide plus silane. The total light transmitted by the posts was measured by using an integrating sphere to collect the diffuse light. The light profile that was laterally delivered to the post was measured with a power detector equipped with an optical fiber probe. The bond strength was measured with the push-out test. Scanning electron microscopy was used to evaluate the surface treatments. The light transmission data were analyzed by using a generalized linear model and the Bonferroni test and the bond strength values were evaluated by using ANOVA and the Tukey test (α=.05). RESULTS: The cervical third presented the highest transmission (74.1% for Whiteposts and 74.6% for Superposts), followed by the middle (20.9% for Whiteposts and 20.4% for Superposts) and apical (5.0% for both Whiteposts and Superposts) thirds. Superposts led to higher bond strength than Whiteposts (9.73 ±5.89 and 8.48 ±4.99 MPa, respectively). Surface treatment with silane and hydrogen peroxide plus silane afforded similar bond strength (11.4 ±6.4 and 10.7 ±5.6 MPa, respectively), which was higher as compared with the bond strength obtained after surface treatment with hydrogen peroxide. For both post types, the bond strength decreased from the cervical (12.2 ±6.0 MPa) to the middle (9.7 ±5.0 MPa) and apical (6.5 ±3.6 MPa) thirds. CONCLUSIONS: Light transmission and bond strength decreased from the cervical to the apical third. Surface treatment impacted bond strength; light transmission through Whiteposts was slightly higher than light transmission through Superposts.

Evaluation of Passive Ultrasonic Irrigation and GentleWave System as Adjuvants in Endodontic Retreatment.

INTRODUCTION: Nonsurgical endodontic retreatment continues to be a challenge in endodontics, particularly when dealing with a complex tooth anatomy. This study evaluated the efficacy of passive ultrasonic irrigation (PUI) and the GentleWave system as supplementary techniques to remove remaining filling materials from oval-shaped root canals. METHODS: Twenty distal roots of human mandibular molars with single and oval-shaped canals were shaped with R40 (40.06) instrument and filled with gutta-percha and AH Plus sealer using warm vertical obturation. Initial filling material removal was performed with R50 (50.05) instrument, followed by the use of PUI (n = 10) or GentleWave system (n = 10). Micro-computed tomographic images were obtained after obturation, initial material removal, and after the use of PUI and GentleWave. The volume of remaining filling material was calculated for the entire canal as well as for the coronal, middle, and apical thirds. Statistical analyses were performed by using analysis of variance, Kruskal-Wallis and Mann-Whitney tests. P ≤ .05 was considered significant. RESULTS: The use of PUI and GentleWave as supplementary techniques significantly reduced the volume of remaining filling material after initial instrumentation (P < .05). However, none of these techniques was able to render canals free from filling materials. PUI showed better performance by removing 18% of the remaining filling material, whereas the GentleWave system was able to remove approximately 10% (P = .02). CONCLUSIONS: The use of supplementary techniques optimized filling material removal after initial instrumentation. PUI enhanced the overall cleaning of the root canal system during endodontic retreatment in oval-shaped canals.

Solubility of Epiphany endodontic sealer prepared with resinous solvent.

PURPOSE: To evaluate in vitro the solubility of the Epiphany endodontic filling material Epiphany (Pentron Clinical Technologies, Wallingford, CT) prepared with its resinous solvent. METHODS: The specimens were prepared in the following experimental conditions: (1) GI, epiphany without photoactivation; (2) GII, Epiphany prepared with resinous solvent without photoactivation; (3) GIII, Epiphany followed by photoactivation; and (4) GIV, Epiphany prepared with resinous solvent followed by photoactivation. Ten specimens of each group were obtained from Teflon molds with 80% reduction in volume of the specimen's dimensions based on American National Standard Institute/American Dental Association (ANSI/ADA) Specification No. 57. The samples were weighted and immersed in distilled water for 7 days. After this period, they were removed, dried, and weighed again. Solubility was calculated by using samples weight loss (%). The immersion liquid was evaluated through atomic absorption spectrometry. RESULTS: The sealers without photoactivation were statistically similar (p > 0.05) between themselves (GI = 6.93% and GII = 6.39%) and different from the uncured sealers, which were statistically different between themselves (p < 0.05) (GIII = 3.56% and GIV = 0.47%). Only the Epiphany sealer prepared with resinous solvent followed by photoactivation presented solubility values within ANSI/ADA requirements, liberating the following amounts of ions: 114.43 microg of Ca(2+)/mL, 2.4 microg of Mg(2+)/mL, 0.33 microg of Fe(2+)/mL, 0.11 microg of Zn(2+)/mL, 1.31 microg of Ni(2+)/mL, and 7.1 microg of Na(+)/mL. CONCLUSION: The association of resinous solvent to the Epiphany sealer followed by photoactivation resulted in a filling material with low solubility and expressive liberation of calcium ions.

Temperature changes in the deciduous pulp chamber during cavity preparation with the Er:YAG laser.

PURPOSE: The purpose of this in vitro study was to evaluate the temperature changes in the pulp chambers of deciduous molars during cavity preparation with an Er:YAG (erbium substituted: yttrium aluminium garnet) laser. METHODS: Two cavities were prepared in 14 maxillary deciduous molars: one with the Er:YAG laser and other with a diamond bur using a high-speed handpiece (control), providing 4 groups with 7 cavities each. The laser treatment was applied for 30 seconds (group 1) and 60 seconds (group 3). The internal pulp temperature was recorded during preparation procedures with a thermocouple, and temperature changes were calculated by the difference between the maximum and initial temperature. RESULTS: There were significant differences (P<.01) between Er:YAG laser irradiation for 60 seconds and 30 seconds and the 2 high-speed drilling groups, which were similar. The Er:YAG laser used for 60 seconds provided the highest temperature alteration (4.01 degrees C). CONCLUSION: Er:YAG laser irradiation increased the temperature of the deciduous teeth compared to the high-speed drilling treatment. The temperature increments, however, remained below the critical value (5.5 degrees C).