Influence of sonic vibration and cement type on the bond strength of fiberglass posts after aging / Influencia de la vibración sónica y el tipo de cemento en la fuerza de unión de los postes de fibra de vidrio después del envejecimiento

Introduction: This study evaluated the influence of sonic vibration and thermocycling on the bond strength of fiberglass posts using conventional dual-cured and self-adhesive resin cements. Material and Methods: Ninety-six single-rooted endodontically treated teeth were divided randomly into eight groups according to the cement used (dual-cured or self-adhesive resin cement), use of sonic vibration during post accommodation, and aging conditions (24h in distilled water or 5,000 thermal cycles). The fiberglass posts (White Post DC1, FGM) were cleaned with alcohol, treated with silane and cemented with dual-cured (Allcem Core, FGM) or with self-adhesive resin cement (seT, SDI). For groups in which sonic vibration was used, the posts were accommodated, and sonic vibration was applied for 10 s using a special tip placed on top of the post (Sonic Smart Device, FGM). Pull-out tests were performed after storage in distilled water for 24h at 37°C or after thermocycling (5000 cycles, at 5°C and 55°C). The results were evaluated using three-way ANOVA and Tukey's test (α=0.05). Results: Significant differences were not observed between the bond strengths of dual-cured (87.93±41.81 N) and self-adhesive cement (82.53±41.43 N). Bond strength for the sonic vibration groups (100.36±42.35 N) was significantly higher than for groups without sonic vibration (70.13±34.90 N). There were significant differences between specimens subjected to thermocycling (98.33±39.42 N) and those stored for 24h in distilled water (72.16±39.67 N). Conclusion: It can be concluded that both sonic vibration and thermocycling significantly improved bond strength of fiberglass posts with the two evaluated resin cements.

Introducción: Este estudio evaluó la influencia de la vibración sónica y el termociclado en la fuerza de unión de los postes de fibra de vidrio utilizando cementos de resina autoadhesivos y de curado dual convencionales Material y Métodos: Se dividieron aleatoriamente noventa y seis dientes tratados endodónticamente de raíz única en ocho grupos según el cemento utilizado (cemento de resina de curado dual o autoadhesivo), el uso de vibración sónica durante la acomodación posterior y las condiciones de envejecimiento (24 horas agua destilada o 5.000 ciclos térmicos). Los postes de fibra de vidrio (White Post DC1, FGM) se limpiaron con alcohol, se trataron con silano y se cementaron con cemento de curado dual (Allcem Core, FGM) o con cemento de resina autoadhesivo (seT, SDI). Para los grupos en los que se utilizó vibración sónica, se acomodaron los postes y se aplicó la vibración sónica durante 10 s utilizando una punta especial colocada en la parte superior del poste (Sonic Smart Device, FGM). Las pruebas de extracción se realizaron después del almacenamiento en agua destilada durante 24 horas a 37ºC o después del termociclado (5000 ciclos, a 5ºC y 55ºC). Los resultados se evaluaron mediante ANOVA de tres vías y la prueba de Tukey (α = 0.05). Resultados: No se observaron diferencias significativas entre las resistencias de adhesión del cemento de curado dual (87,93 ± 41,81 N) y el cemento autoadhesivo (82,53 ± 41,43 N). La fuerza de unión para los grupos de vibración sónica (100,36 ± 42,35 N) fue significativamente mayor que para los grupos sin vibración sónica (70,13 ± 34,90 N). Hubo diferencias significativas entre los especímenes sometidos a termociclado (98,33 ± 39,42 N) y los almacenados durante 24 h en agua destilada (72,16 ± 39,67 N). Conclusión: Se puede concluir que tanto la vibración sónica como el termociclado mejoraron significativamente la fuerza de unión de los postes de fibra de vidrio con los dos cementos de resina evaluados.

Stress analysis of maxillary central incisors endodontically -treated with varying ferrule heights and three different post dowel materials - a finite element analysis / Análisis de tensión de los incisivos centrales superiores tratados endodónticamente con diferentes alturas de férula y tres materiales diferentes de clavija posterior: un análisis de elementos finitos

Statement of problem : fracture of endodontically treated teeth is reduced by the use of a post with ferrule, but the effect of different ferrule configurations and dowel materials is not clear. Purpose: to evaluate the effect of ferrules with different configurations and heights on the stress of endodontically treated teeth restored with three different post and dowel materials. Materials and Methods: fifteen models of maxillary central incisors restored with porcelain fused to metal crowns were obtained using pro engineer software. the models were divided into three groups, each consisting of five models with ferrule heights of 0mm, 2mm, 4mm, 2mm with oblique fracture, 4mm with oblique fracture, the models under group GFR were restored with fiberglass reinforced post (GFR) and composite core build-up, group NiCr with a custom cast post metal alloy (NiCr), and group Zr with zirconia post (Zr) and composite core build-up. an oblique load of 100N and 150N at an angle of 135 degrees was applied to the palatal surface of the tooth, a vertical load of 100N and 150N at an angle of 90 degrees was applied to the incisal tip of the tooth. The maximum principal stress and the von mises stress was calculated for the remaining tooth structure and post apex using the finite element analysis (FEA) software. Results: the maximum von misses stress was observed in the apex of the post (p<0.05). Group Zr showed the highest mean stress (6.39Mpa) followed by group NiCr (5.65Mpa). There was a significant difference between post and between NiCr and Zr post for 2mm and 4mm ferrule height, while for 0mm ferrule there was a significant difference between the GFR and NiCr groups (p<0.05). Under oblique load, the maximum mean stress was observed in remaining tooth structures while for vertical load, it was observed at the apex of the post. Regarding ferrule heights, there were significant differences between 0mm-2mm, and 0mm-4mm uniform ferrule in post apex in the case of NiCr posts (p<0.05). Absence of ferrule resulted in higher stress for the NiCr group. Conclusion: higher loads that led to fracture were observed only at the apex of the post. Zirconia posts (group Zr) had higher fracture loads, whereas absence of ferrule resulted in higher fracture load with custom cast posts (group NiCr). Fracture thresholds were high on the remaining tooth structure for all the dowel systems especially for composite core build up irrespective of ferrule height and configuration. Clinical implications: appropriate selection of post and dowel materials in different configurations of ferrule heights ensures clinical success.

Indicación del problema: la fractura de los dientes tratados endodónticamente se reduce mediante el uso de un poste con férula, pero el efecto de diferentes configuraciones de férula y materiales de clavija no está claro. Propósito: evaluar el efecto de los casquillos con diferentes configuraciones y alturas sobre el estrés de los dientes tratados endodónticamente restaurados con tres materiales diferentes de postes y tacos. materiales y métodos: quince modelos de incisivos centrales superiores restaurados con porcelana fundida a coronas de metal se obtuvieron con el software Pro Engineer. Los modelos se dividieron en tres grupos, cada uno de los cuales consta de cinco modelos con alturas de casquillo de 0mm, 2mm, 4mm, 2mm con fractura oblicua, 4mm con fractura oblicua. los modelos del grupo GFR fueron restaurados con poste reforzado con fibra de vidrio (GFR) y acumulación de núcleo compuesto, grupo nicr con una aleación de metal de poste fundido personalizado (NiCr) y grupo Zr con poste de zirconia (Zr) y acumulación de núcleo compuesto. se aplicó una carga oblicua de 100N y 150N en un ángulo de 135º a la superficie palatina del diente. se aplicó una carga vertical de 100N y 150N en un ángulo de 90º a la punta incisal del diente. la tensión principal máxima y la tensión de von mises se calcularon para la estructura dental restante y después del vértice utilizando el software de análisis de elementos finitos (FEA). Resultados: el estrés máximo de von falta se observó en el vértice de la publicación (p<0.05). El grupo Zr mostró el mayor estrés medio (6.39Mpa) seguido del grupo NiCr (5.65Mpa). Hubo una diferencia significativa entre la publicación NiCr y Zr para la altura de la férula de 2mm y 4mm, mientras que para la férula de 0mm hubo una diferencia significativa entre los grupos GFR y NiCr (p<0,05), bajo la carga oblicua, la tensión media máxima en las estructuras dentales restantes, mientras que para la carga vertical, se observó en el vértice del poste. En cuanto a las alturas de la férula, hubo diferencias significativas entre la férula uniforme de 0mm-2mm y de 0mm-4mm en el post-apex en el caso de los postes de NiCr (p<0.05), la ausencia de férula dio como resultado un mayor estrés para el grupo NiCr. Conclusión: las cargas más altas que llevaron a la fractura se observaron solo en el vértice del poste; Los postes de zirconia (grupo Zr) tuvieron mayores cargas de fractura, mientras que la ausencia de férula dio como resultado una mayor carga de fractura con postes moldeados personalizados (NiCr de grupo). Los umbrales de fractura fueron altos en la estructura dental restante para todos los sistemas de clavijas, especialmente para la acumulación de núcleos compuestos independientemente de la altura y configuración de la férula. Implicaciones clínicas: la selección adecuada de materiales de postes y tacos en diferentes configuraciones de alturas de férulas asegura el éxito clínico.

Evaluation of fiber posts vs metal posts for restoring severely damaged endodontically treated teeth: a systematic review and meta-analysis.

OBJECTIVES: This review was undertaken to answer a controversial clinical question with high-quality evidence: When severely damaged teeth are restored, which type of post (metal or fiber) demonstrates superior clinical performance? DATA SOURCES: The meta-analysis was conducted according to the guidelines in the Cochrane handbook. Electronic databases (MEDLINE, EMBASE, CENTRAL) and gray literatures were screened up to January 2018. Only randomized controlled trials (RCTs) with follow-up of at least 3 years were included. The quality of included studies was assessed by the Cochrane Collaboration's tool. Meta-analysis compared survival, success, post debonding, and root fracture incidence of teeth restored with fiber and metal posts. The GRADE system (Grading of Recommendations, Assessment, Development and Evaluations) was used to assess the strength of the evidence. Of 1,511 records, 14 full texts were obtained. Only four RCTs with follow-up times of 3 to 7 years met the selection criteria. The methodologic quality of included RCTs was low risk of bias. Fiber posts presented significantly higher survival rates than did metal posts (RR 0.57, 95% CI: 0.33 to 0.97, P = .04), while no difference was observed in success rates, post debonding rates, or root fracture rates. The GRADE assessment indicated a high quality of evidence for survival rates and a moderate quality for success rates. CONCLUSION: It was concluded that fiber posts displayed higher medium-term (3 to 7 years) overall survival rates than did metal posts when used in the restoration of endodontically treated teeth with no more than two coronal walls remaining.

Evaluation of Intra Root Canal Er,Cr:YSGG Laser Irradiation on Prosthetic Post Adherence.

PURPOSE: In clinical prosthetics procedures, including endodontics and post fixation, the presence of a smear layer can reduce the post bond strength. An Er,Cr:YSGG laser, which emits at 2780 nm, can promote a smear-layer-free surface due to the ablation process. Considering these aspects, the purpose of this work was to evaluate the influence of Er,Cr:YSGG laser irradiation using either a radial or an axial fiber tip on the bond strength of three resin cements to the fiber-reinforced composite posts. MATERIALS AND METHODS: Ninety recently extracted single rooted human teeth had their root canal instrumented and were randomly distributed into nine experimental groups, in which three resin cements (total-etching Variolink II, self-etching Panavia F, and self-adhesive RelyX Unicem Aplicap) and three root canal treatments (no treatment, laser irradiation using the radial fiber tip, laser irradiation using the axial fiber tip) were used. Specimens were then sectioned into three sections (cervical, middle, and apical thirds) with two slices on each section. A push-out test was performed on each slice, and the values were recorded as MPa. The push-out data were analyzed by a Ryan-Joiner normality test followed by a two-way ANOVA test and Tukey pairwise comparison. The statistical analysis was performed on each third section separately, with a 5% significance level. RESULTS: Laser irradiation with axial fiber tip significantly increased the post bond strength of RelyX Unicem Aplicap on middle third of specimens (p < 0.001) when compared to other root canal treatments (unlased or irradiated with radial tip). Considering the Panavia resin cement, laser irradiation with either axial or radial tips promoted a significant increase on the post bond strength of middle third when compared to unlased specimens (p < 0.001); however, laser irradiation did not influence the post bond strength of Variolink resin cement. CONCLUSIONS: The use of the Er,Cr:YSGG laser for clinical prosthetics procedures enhances the post bond strength of Panavia and RelyX Unicem Aplicap resin cements, mainly at middle third of roots, and does not interfere with the bond strength of Variolink resin cement. For the RelyX Unicem Aplicap system, the use of axial tip is most advantageous and can be recommended for future clinical application.

The Influence of Post System Design and Material on the Biomechanical Behavior of Teeth with Little Remaining Coronal Structure.

PURPOSE: To evaluate the influence of different post systems on the biomechanical behavior of teeth with a severe loss of remaining coronal structure. MATERIALS AND METHODS: Fifty standardized bovine teeth (n = 10 per group) were restored with: cast post-and-core (CPC), prefabricated metallic post (PFM), parallel glass-fiber post (P-FP), conical glass-fiber post (C-FP), or composite core (no post, CC). The survival rate during thermomechanical challenging (TC), the fracture strength (FS), and failure patterns (FP) were evaluated. Finite element models evaluated the stress distribution after the application of 100 N. RESULTS: All specimens survived TC. Similar FS was observed among post-containing groups. Groups P-FP and CC presented 100% repairable fractures. The von Mises analysis showed the maximum stresses into the root canal in groups restored with metallic posts. Glass-fiber posts and CC presented the maximum stresses at the load contact point. Glass-fiber groups showed lower stresses in the analysis of maximal contact pressure; CPC led to the highest values of contact pressure. The modified von Mises (mvM) stress in dentin did not show differences among groups. Moreover, mvM values did not reach the dentin fracture limit for any group. CONCLUSIONS: The type of intracanal post had a relevant influence on the biomechanical behavior of teeth with little remaining coronal structure.

Influence of glass fibre post cementation depth on dental root fracture.

INTRODUCTION: Glass fibre posts that are newer and have better properties are gaining more popularity than metal posts. However, there is no consensus about the optimal cementation depth of glass fibre posts. In our study, we have attempted to assess fracture resistance of roots restored with glass fibre posts cemented at different root depths. MATERIALS AND METHODS: Specimens were formed with peeso reamers and a special reamer adapted for the cementation of glass fiber posts at different depths. Glass fibre posts were cemented using self-etching cement: in group 1 - at the depth of 2/3 of the working length of the root canal (11 mm), in group 2 - at the depth of 1/2 of the working length of the root canal (7.5 mm) and in group 3 - at the depth of 1/3 of the working length of the root canal (5 mm). Dental roots were standardized by preparing their walls to equal measurements with a mill. Specimens were embedded on a metal plate at a 45° angle and were vertically pressed with a hydraulic press in buccolingual direction. Fracture force was recorded in Newton (N) to the breaking point. RESULTS: After data analyses with ANOVA and T-test software, the null hypothesis was confirmed: there was no statistically significant difference among the results of all 3 groups (P >0.05). CONCLUSION: The cementation depth of the glass fibre posts that we studied has no influence on root fracture resistance.

[Clinical observation of the restoration of computer aided designed and manufactured one-piece zirconia posts and cores: a 5-year prospective follow-up study].

OBJECTIVE: To evaluate the effect of computer aided design and computer aided manufacture (CAD/CAM) one-piece zirconia posts and cores for the restoration of defective teeth. METHODS: In the study, 72 defective teeth of 47 patients who had proper root canal therapy were restored with CAD/CAM one-piece zirconia posts and cores. All the ceramic crowns were finally used to restore contour and function of the teeth. The defective teeth were divided into two groups on the basis of the teeth defect degree. Group A: 39 defective teeth presented with three or four coronal residual walls, and group B: 33 defective teeth presented with less than two coronal residual walls. During the clinical observation period, the stability, dislocation of posts and the occurrence of fractures in either teeth or posts and cores were assessed and analyzed with a paired t test(α=0.05). Meanwhile shade matching was conducted between the restored teeth and normal reference teeth, the marginal fitness of the restored teeth were recorded according to the standard of United States Public Health Service (USPHS) and analyzed with descriptive statistics. RESULTS: The average follow up was (65.0±4.8) months. During the observation period, the restorations were examined both clinically and with periapical radiograph. No incidence of teeth fracture or posts and cores complications were observed in both groups, and all CAD/CAM one-piece zirconia posts and cores remained intact with restored teeth. There were no post and core dislodgement or fracture. There was no difference between group A and group B (P>0.05). The restorative effect of CAD/CAM one-piece zirconia posts and cores with all the ceramic crowns were assessed according to the standard of USPHS, and the number of the restored tooth shade matching with level A was 67, and 5 with level B. The rate of shade matching was 93.06%. As the marginal fitness, 64 restored teeth were level A, and 8 with level B. The rate of restorative teeth marginal fitness was 88.89%. CONCLUSION: CAD/CAM one-piece zirconia posts and cores were successfully used to restore defective teeth and received excellent clinical effect. So, it can be a good choice for defective teeth which need post-cores and crowns restoration.

In vitro retention of prefabricated and individually formed posts: A pilot study.

STATEMENT OF PROBLEM: Data on the retention of individually formed fiber-reinforced composite posts (everStick) cemented with self-adhesive cement are lacking. PURPOSE: The purpose of this in vitro study was to investigate the pull-out strength of 2 different fiber-reinforced composite posts (prefabricated and individually formed) cemented into extracted teeth with self-adhesive resin cement. MATERIAL AND METHODS: Thirty extracted single-rooted human teeth were decoronated, endodontically treated, and prepared with post spaces of equal length. Prepared specimens were divided into 2 groups (n=15 each) based on the type of post: commercially prefabricated fiber posts (GC) and individually formed resin posts (using GC reinforcing fibers). Self-adhesive resin cement (G-CEM LinkAce; GC) was used to cement all posts. Each post was held with moderate pressure, and root surfaces were light polymerized for 20 seconds (650 mW/cm2). After cementation, the specimens were stored in saline solution for 30 days. Treated teeth were kept in water for 24 hours before pull-out testing parallel to the longitudinal axis of the posts. Data were analyzed using the Student t test (α=.05) and the coefficient of variance as the ratio of the standard deviation to the mean. RESULTS: The mean pull-out retention strength was 185.7 ±61.2 N for the prefabricated fiber posts and 98.9 ±56.5 N for the individually formed fiber posts (P=.026). CONCLUSIONS: The prefabricated fiber posts exhibited significantly higher retention forces than the individually formed posts.

Direct or indirect post crowns to restore compromised teeth: a review of the literature.

Post crowns are restorations which utilise the root canal space to improve the retention and resistance form of teeth which lack coronal tooth structure. In recent years there have been significant developments in the materials, systems and evidence-base surrounding the provision of post crowns. This review aims to refresh the general dental practitioner's (GDPs) knowledge of the different factors that must be considered when placing a post crown, and how these factors can help guide the dentist in their decision to provide either a direct or indirect post and core.

Clinical follow-up evaluation of Dalbo®-Rotex® retention elements in the private practice

The aim of this retrospective study was to investigate the clinical outcome of Dalbo®-Rotex® retention elements in a private practice. The majority of the retention elements was fixed with self-adhesive composite cement, and in almost 40% the exposed root surface was additionally covered with composite. The success rate of 96.3% after 24 months in a total of 50 included patients (response rate 48.5%) demonstrated that a simple and cost-effective fixation of removable dentures using prefabricated, chair-side inserted retention elements is feasible. Maintenance care comprised single or repeated replacement and activation of the female part in 12.3% and 39.4% of the cases, respectively. Fractures were rare, occurring in 3.4% of the cases and more likely in patients with parafunctional habits. Frequent oral hygiene correlated with probing depths up to 3 mm at the maxi- mum, while the risk of greater probing depths associated with less frequent oral hygiene increased by a factor of 2.4. Patients' assessment of the parameters handling and wearing comfort, chewing ability and prosthesis retention was predominantly positive. Based on the findings of the study, covering of exposed dentin areas with composite resin and regular recall comprising professional cleaning, fluoride application and oral hygiene instruction are recommended.

Effect of Chlorhexidine Treatment Prior to Fiber Post Cementation on Long-Term Resin Cement Bond Strength.

The purpose of this study was to evaluate the push-out bond strength of two different adhesive cements (total etch and self-adhesive) for glass fiber post (GFP) cementation in simulated, long-term service (thermocycling) when the root canal is treated with chlorhexidine before cementation. One hundred twenty premolar specimens with a single root canal were selected, endodontically treated, and shaped for GFP cementation (n=120). The specimens were randomly placed into one of 12 groups (10 specimens each) according to cement (T = total-etch RelyX ARC or S = self-adhesive RelyX Unicem), treatment with chlorhexidine (N or Y: without or with), and number of thermal cycles (00, 20, or 40: 0, or 20,000 or 40,000 cycles): 1. TN00, 2. TN20, 3. TN40, 4. TY00, 5. TY20, 6. TY40, 7. SN00, 8. SN20, 9. SN40, 10. SY00, 11. SY20, 12. SY40. The root of each specimen was cut perpendicular to the vertical axis, yielding six 1.0 mm-thick sections. A push-out bond strength test was performed followed by statistical analysis using a factorial analysis of variance. Pairwise comparisons of significant factor interactions were adjusted using the Tukey test. Significant differences of push-out bond strengths were found in the four main effects (resin cement [ p<0.0001], treatment with chlorhexidine [ p<0.0001], number of cycles [ p<0.0001], and root third [ p<0.0001]) and all interactions ( p<0.05 for all). Both resin cements produced higher bond strength in the cervical third followed by the middle third, and lower values were detected in the apical third. Additionally, the results suggest that the use of an additional disinfection treatment with chlorhexidine before the cement application produced the highest push-out bond strength regardless of root third. Further, the thermocycling simulation decreased the bond strength for both resin cements long-term when the chlorhexidine was not applied before cementation. However, when the root canal was treated with chlorhexidine and the fiber post was cemented with self-adhesive cement, the bond strength increased after 0, 20,000 and 40,000 cycles.

Influence of light transmission through fiber posts: Quantitative analysis, microhardness, and on bond strength of a resin cement.

CONTEXT: Light transmission (LT) into deeper areas of the dentin root is limited. AIM: The aim of this study is to perform a quantitative investigation of the radial transmission of light (LT) through different fiber posts and its influence on the Knoop hardness number (KHN) and bond strength (BS) of a dual-cure self-adhesive resin cement at 3 different depths. MATERIALS AND METHODS: Four types of fiber posts (2 translucent and 2 conventional) were used. LT and KHN analyses were performed in a specially designed matrix, which allowed measurements at 3 different depths. LT was measured using a volt-ampere meter while KHN tests were performed in a microhardness tester. For BS analysis, endodontically treated bovine roots were divided into 4 groups, each group receiving one type of post. After cementation, cross sections of the root were tested for resistance to displacement using a universal testing machine. STATISTICAL ANALYSIS USED:: Statistical analysis was performed by using this ANOVA and Tukey's test. RESULTS: For LT, translucent posts showed significantly higher values at all depths compared to the conventional ones. For all posts, LT decreased at the deeper depths. The KHN results showed no statistical differences among the different posts, regardless of depth. For BS, a translucent post showed the highest values, and comparative analyses between the different depths of posts also showed statistically significant differences while comparisons among the different depths of the same post showed no differences. CONCLUSIONS: LT depended on the type of post and on depth. The type of post did not significantly influence the cement KHN. A translucent post showed higher BS in pooled data.

Comparing Fracture Resistance and the Time Required for Two Different Fiber Post Removal Systems.

PURPOSE: To compare two fiber post removal techniques in terms of fracture resistance and time required for post removal. MATERIALS AND METHODS: Post space was prepared to a 9-mm depth in each root canal. The roots were randomly divided into three groups of 15 specimens each. D.T. Light-Posts were cemented in all groups. In group 1, fiber posts were removed using the D.T. Light-Post-removal kit; in group 2, Start-X stainless-steel ultrasonic tips were used. In group 3, fiber posts were left without removal (the control group). For all groups, fracture resistance (N) value was measured and recorded using a universal testing machine. Times required for fiber post removal were also recorded for the two study groups. RESULTS: There was no significant difference between the control and removal kit groups for fracture resistance values (p = 0.233). The fracture resistance value of the ultrasonic group was found to be significantly lower than that of the control group (p = 0.001) as well as that of the removal kit group (p = 0.032). The fiber post removal time for the ultrasonic group was significantly longer than that for the removal kit group (p < 0.001). CONCLUSION: Compared to the removal kit, removal of the fiber posts with an ultrasonic tip decreases the fracture resistance of the roots, although significantly more time is required.

Clinical observation of the restoration of computer aided designed and manufactured one-piece zirconia posts and cores: a 5-year prospective follow-up study / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the effect of computer aided design and computer aided manufacture (CAD/CAM) one-piece zirconia posts and cores for the restoration of defective teeth.@*METHODS@#In the study, 72 defective teeth of 47 patients who had proper root canal therapy were restored with CAD/CAM one-piece zirconia posts and cores. All the ceramic crowns were finally used to restore contour and function of the teeth. The defective teeth were divided into two groups on the basis of the teeth defect degree. Group A: 39 defective teeth presented with three or four coronal residual walls, and group B: 33 defective teeth presented with less than two coronal residual walls. During the clinical observation period, the stability, dislocation of posts and the occurrence of fractures in either teeth or posts and cores were assessed and analyzed with a paired t test(α=0.05). Meanwhile shade matching was conducted between the restored teeth and normal reference teeth, the marginal fitness of the restored teeth were recorded according to the standard of United States Public Health Service (USPHS) and analyzed with descriptive statistics.@*RESULTS@#The average follow up was (65.0±4.8) months. During the observation period, the restorations were examined both clinically and with periapical radiograph. No incidence of teeth fracture or posts and cores complications were observed in both groups, and all CAD/CAM one-piece zirconia posts and cores remained intact with restored teeth. There were no post and core dislodgement or fracture. There was no difference between group A and group B (P>0.05). The restorative effect of CAD/CAM one-piece zirconia posts and cores with all the ceramic crowns were assessed according to the standard of USPHS, and the number of the restored tooth shade matching with level A was 67, and 5 with level B. The rate of shade matching was 93.06%. As the marginal fitness, 64 restored teeth were level A, and 8 with level B. The rate of restorative teeth marginal fitness was 88.89%.@*CONCLUSION@#CAD/CAM one-piece zirconia posts and cores were successfully used to restore defective teeth and received excellent clinical effect. So, it can be a good choice for defective teeth which need post-cores and crowns restoration.

Effect of CAD/CAM glass fiber post-core on cement micromorphology and fracture resistance of endodontically treated roots.

PURPOSE: To investigate the fracture resistance of weakened roots restored with prefabricated or CAD/CAM-customized posts and cores as well as the thickness of the cement film and the presence of voids in the cement. METHODS: The roots of 40 human premolars were weakened by removing internal dentin with a diamond bur (2.5 mm in the coronal third and 1.5 mm in the apical third) and restored with prefabricated posts (PPs) or customized posts (CPs) with or without a zirconia crown (n= 10). Posts and crowns were cemented with resin cement. Microtomography was used to determine the thickness of the cement film and whether voids were present. After fatigue testing (1 million cycles, 50 N, 5 Hz, 36.5°C), the specimens underwent compression testing with an oblique load (30°, 1 mm/minute) and fracture strengths were recorded (N). Fracture strength and film thickness were analyzed with ANOVA and the Games-Howell test; the variable presence of voids was analyzed with the Mann-Whitney test (α= 5%). RESULTS: Mean fracture strengths varied between 640.4 and 792.9 N and did not differ significantly between groups. The CP group had a thinner cement film and fewer voids than the PP group. There was a positive, statistically significant correlation (Spearman, R=0.488, P= 0.029) between these variables. CLINICAL SIGNIFICANCE: CAD/CAM-manufactured glass-fiber posts and cores do not affect the fracture strength of flared root canals or cause catastrophic failure of the root when used with zirconia crowns.

Dentin-like versus Rigid Endodontic Post: 11-year Randomized Controlled Pilot Trial on No-wall to 2-wall Defects.

INTRODUCTION: This is the first long-term randomized controlled trial to evaluate dentin-like glass fiber posts (GFPs) compared with rather rigid titanium posts (TPs) for post-endodontic restoration of severely damaged endodontically treated teeth with 2 or fewer remaining cavity walls. METHODS: Ninety-one subjects in need of post-endodontic restorations were randomly assigned to receive either a tapered GFP (n = 45) or TP (n = 46). Posts were adhesively luted by using self-adhesive resin cement, followed by composite core build-up and preparation of 2-mm ferrule design. Primary end point was loss of restoration for any reason. Kaplan-Meier curves were constructed, and log-rank test was calculated (P < .05). RESULTS: After a follow-up of 132 months, 17 GFP and 20 TP restorations survived, and 19 failed (12 GFP, 7 TP). Failure modes for GFP were root fracture (n = 4), core fracture (n = 1), secondary caries (n = 1), endodontic failure (n = 2), extraction because of tooth mobility grade III associated with insufficient design of removable partial denture (n = 1), tooth fracture (n = 1), and changes in treatment plan (n = 2); failure modes for TP were endodontic failure (n = 5), root fracture (n = 1), and 1 extraction for other reasons. Cumulative survival probability was 58.7% for GFP and 74.2% for TP. CONCLUSIONS: When using self-adhesively luted prefabricated posts, resin composite core build-up, and 2-mm ferrule to reconstruct severely damaged endodontically treated teeth, tooth survival is not influenced by post rigidity. Survival decreased rapidly after 8 years of observation in both groups.

Comparison of Different Post Systems for Fracture Resistance: An in vitro Study.

INTRODUCTION: Endodontic restoration becomes a challenging task for the clinician because of severe loss of coronal tooth structure owing to trauma, caries, restorative, and endodontic procedures. The restoration of these teeth requires the use of a post and core as individual units or as abutment supports for fixed or removable restorations in a predictable long-term manner. AIM: To compare and assess the compressive bond strength of glass, quartz, and carbon fiber posts restored with porcelain-fused-to-metal (PFM) crown. MATERIALS AND METHODS: A total of 45 upper central incisor teeth having straight root canals, similar anatomically root segments, and fully developed apices were selected. Teeth were divided into three groups of 15 teeth after endodontic treatment. Group I: Teeth inserted with the prefabricated glass fiber post. Group II: Teeth inserted with the quartz fiber post. Group III: Teeth inserted with carbon fiber post. The posts were placed and core was fabricated using composite restoration followed by PFM crown cementation using adhesive resin. Compressive load required to fracture the tooth was measured using a universal loading machine. The difference between the variables was assessed by one-way analysis of variance, followed by Tukey's post hoc test. RESULTS: The compressive strength exhibited by carbon fiber posts was highest with a mean of 668.33 ± 26.397, followed by quartz fiber post (635.80 ± 30.390). Least compressive strength was exhibited by glass fiber post (567.53 ± 26.632). An analysis of variance shows statistically highly significant difference (p < 0.005) among the posts used. CONCLUSION: This study concluded that the carbon fiber posts had higher compressive strength than other quartz, glass fiber posts. CLINICAL SIGNIFICANCE: Endodontic treatment results in loss of a significant part of the tooth structure. Posts restore these teeth and provide retention.

Radiopacity of Esthetic Post Materials: Evaluation with Digital Analysis Technique.

PURPOSE: To evaluate the radiopacity of five post materials using a digital image analysis method. MATERIALS AND METHODS: Twelve specimens from each post type (two zirconia and three fiber based) of 2 mm in thickness were obtained using a diamond blade mounted on a cutting machine, and digital radiographs were taken along with aluminum step-wedge and dentin discs under standard exposure conditions. The mean gray-values of specimens were measured using a computer graphics program. Data were analyzed using one-way ANOVA followed by Holm-Sidak multicomparison test (p = 0.05). RESULTS: The highest radiopacity was observed in custom zirconia (5.842 millimeters of equivalent Al [mmAl]), and the lowest value was detected with FRC-Postec (Ivoclar Vivadent) (1.716 mmAl). Significant differences were revealed between the radiopacity values among all groups (p < 0.05), except the Zr post materials (p = 0.56). CONCLUSIONS: All tested post materials had higher radiopacity than dentin. Further studies will be required to clarify optimum radiopacity properties of the post materials to provide a precise clinical observation.

Evaluation of in vitro push-out bond strengths of different post-luting systems after artificial aging.

BACKGROUND: The purpose of this study was to evaluate the push-out bond strengths of four commercially available adhesive luting systems (two self-adhesive and two etch-and-rinse systems) after mechanical aging. METHODS: Forty single-rooted anterior teeth were divided into four groups according to the luting cement system used: Cement-One (Group 1); One-Q-adhesive Bond + Axia Core Dual (Group 2); SmartCem® 2 (Group 3); and XP Bond® + Core-X™ Flow (Group 4). Anatomical Post was cemented in groups 1 and 2, and D.T. Light-Post Illusion was cemented in groups 3 and 4. All samples were subjected to masticatory stress simulation consisting of 300,000 cycles applied with a computer-controlled chewing simulator. Push-out bond strength values (MPa) were calculated at cervical, middle, and apical each level, and the total bond strengths were calculated as the averages of the three levels. Statistical analysis was performed with data analysis software and significance was set at P<0.05. RESULTS: Statistically significant differences in total bond strength were detected between the cements (Group 4: 3.28 MPa, Group 1: 2.77 MPa, Group 2: 2.36 MPa, Group 3: 1.13 MPa; P<0.05). Specifically, Group 1 exhibited a lower bond strength in the apical zone, Group 3 exhibited a higher strength in this zone, and groups 2 and 4 exhibited more homogeneous bonding strengths across the different anatomical zones. CONCLUSIONS: After artificial aging, etch-and-rinse luting systems exhibited more homogeneous bond strengths; nevertheless, Cement-One exhibited a total bond strength second only to Core-X Flow.

Light-transmitting fiber optic posts: An in vitro evaluation.

STATEMENT OF PROBLEM: The clinical challenge of adhering cement to intracanal dentin is transmitting light to the most apical parts of root canals to allow more efficient polymerization of the cement. PURPOSE: The purpose of this in vitro study was to compare the cement-polymerizing ability, microstructure, and radiopacity of a new fiber optic post (iLumi fiber optic Post) with a clinically successful fiber post (DT Light Post). MATERIAL AND METHODS: Polymerizing ability was compared using a modified depth-of-polymerization protocol. A split aluminum mold with a 12-mm cylindrical hole (diameter=4.7 mm) was filled with light-polymerized resin cement (Variolink Esthetic LC). Each fiber post (n=12) was positioned and light-polymerized on the coronal end for 60 seconds with a light-emitting diode polymerization light. Unpolymerized resin was dissolved with an organic solvent, and the weight and length of the polymerized resin cement were measured. Scanning electron microscopy was used to examine vertical and horizontal cross-sections. The radiopacity values of both the posts and 5 additional reference posts were evaluated using an aluminum step wedge. RESULTS: The weight and length of the polymerized resin cement were significantly greater (P<.05) with the fiber optic post, which scanning electron microscopy showed to have a higher density of parallel fibers. The iLumi post demonstrated greater radiopacity among the tested fiber posts and a titanium alloy post. CONCLUSIONS: The iLumi fiber optic posts have a unique structural fiber composition and excellent radiopacity and light-transmitting ability that produce more complete polymerization of the resin cement than the DT Light posts.