A Multicenter Randomized Double-blind Controlled Clinical Trial of Fiber Post Cementation Strategies.

OBJECTIVES: The aim of this prospective randomized multicenter clinical trial was to evaluate the survival rate of glass fiber-reinforced posts cemented with self-adhesive or regular resin cements. METHODS: The sample was comprised of 152 teeth randomized within two centers and in accordance with the adhesive strategies for RelyX U100/U200 (3M ESPE) or Single Bond and RelyX ARC (3M ESPE). The cementation procedures were standardized and performed by previously trained operators. The primary outcome evaluated was post debonding. A trained evaluator, one for each center, assessed all subjects at intervals of 12 months for up to 6 years. Statistical analysis was performed using the Kaplan-Meier method. RESULTS: There was no statistically significant difference in survival rates between the two strategies assessed ( p=0.991), with a 92.7% survival rate for the self-adhesive cement and 93.8% for the regular cement. CONCLUSION: Both the self-adhesive and the regular resin cements are good alternatives for glass fiber post cementation.

Fractographical Analysis and Biomechanical Considerations of a Tooth Restored With Intracanal Fiber Post: Report of the Fracture and Importance of the Fiber Arrangements.

OBJECTIVE: This article aims to present a fractographic analysis of an anterior tooth restored with a glass fiber post with parallel fiber arrangement, taking into account force vectors, finite element analysis, and scanning electron microscopy (SEM). METHODS: A patient presented at the Faculty of Dentistry (Federal University of Santa Maria, Brazil) with an endodontically treated tooth (ETT), a lateral incisor that had a restorable fracture. The treatment was performed, and the fractured piece was analyzed using stereomicroscopy, SEM, and finite element analysis. RESULTS: The absence of remaining coronal tooth structure might have been the main factor for the clinical failure. We observed different stresses actuating in an ETT restored with a fiber post as well as their relationship with the ultimate fracture. Tensile, compression, and shear stresses presented at different levels inside the restored tooth. Tensile and compressive stresses acted together and were at a maximum in the outer portions and a minimum in the inner portions. In contrast, shear stresses acted concomitantly with tensile and compressive stresses. Shear was higher in the inner portions (center of the post), and lower in the outer portions. This was confirmed by finite element analysis. The SEM analysis showed tensile and compression areas in the fiber post (exposed fibers=tensile areas=lingual surface; nonexposed fibers=compression areas=buccal surface) and shear areas inside the post (scallops and hackle lines). Stereomicroscopic analysis showed brown stains in the crown/root interface, indicating the presence of microleakage (tensile area=lingual surface). CONCLUSION: We concluded that glass fiber posts with parallel fibers (0°), when restoring anterior teeth, present a greater fracture potential by shear stress because parallel fibers are not mechanically resistant to support oblique occlusal loads. Factors such as the presence of remaining coronal tooth structure and occlusal stability assist in the biomechanical equilibrium of stresses that act upon anterior teeth.

Effect of Adhesive Cementation Strategies on the Bonding of Y-TZP to Human Dentin.

This study evaluated the effects of different adhesive strategies on the adhesion of zirconia to dentin using conventional and self-adhesive cements and their corresponding adhesive resins. The occlusal parts of human molars (N=80) were sectioned, exposing the dentin. The teeth and zirconia cylinders (N=80) (diameter=3.4 mm; height=4 mm) were randomly divided into eight groups according to the factors "surface conditioning" and "cement type" (n=10 per group). One conventional cement (CC: RelyX ARC, 3M ESPE) and one self-adhesive cement (SA: RelyX U200, 3M ESPE) and their corresponding adhesive resin (for CC, Adper Single Bond Plus; for SA, Scotchbond Universal Adhesive-SU) were applied on dentin. Zirconia specimens were conditioned either using chairside (CJ: CoJet, 30 µm, 2.5 bar, four seconds), laboratory silica coating (RC: Rocatec, 110 µm, 2.5 bar, four seconds), or universal primer (Single Bond Universal-UP). Nonconditioned groups for both cements acted as the control (C). Specimens were stored in water (37°C, 30 days) and subjected to shear bond strength (SBS) testing (1 mm/min). Data (MPa) were analyzed using two-way analysis of variance and a Tukey test (α=0.05). While surface conditioning significantly affected the SBS values (p=0.0001) (C

Effect of ceramic etching protocols on resin bond strength to a feldspar ceramic.

This study sought to evaluate the resin microtensile bond strength (MTBS) stability of a leucite-reinforced ceramic after different ceramic etching protocols. The microtensile test had 40 ceramic blocks (5×5×6 mm) assigned to five groups (n=8), in accordance with the following surface etching protocols: NE nonetched (control); 9HF: hydrofluoric (HF) acid etching (9%HF)+wash/dry; 4HF: 4%HF+wash/dry; 5HF: 5%HF+wash/dry; and 5HF+N: 5%HF+neutralizer+wash/dry+ultrasonic-cleaning. Etched ceramic surfaces were treated with a silane agent. Next, resin cement blocks were built on the prepared ceramic surface and stored for 24 hours in distilled water at 37°C. The specimens were then sectioned to obtain microtensile beams (32/block), which were randomly assigned to the following conditions, nonaged (immediate test) and aged (water storage for 150 days plus 12,000 thermal cycles), before the microtensile test. Bond strength data were submitted to one-way analysis of variance and Tukey test (α=0.05). Additional ceramic samples were subjected to the different ceramic etching protocols and evaluated using a scanning electron microscope (n=2) and atomic force microscopy (n=2). Aging led to a statistically significant decrease in the MTBS for all groups, except the untreated one (NE). Among the groups submitted to the same aging conditions, the untreated (NE) revealed inferior MTBS values compared to the 9HF and 4HF groups. The 5HF and 5HF+N groups had intermediate mean values, being statistically similar to the higher values presented by the 9HF and 4HF groups and to the lower value associated with the NE group. The neutralization procedure did not enhance the ceramic/resin cement bond strength. HF acid etching is a crucial step in resin/ceramic bonding.

Preliminary results of the survival and fracture load of roots restored with intracanal posts: weakened vs nonweakened roots.

PURPOSE: To evaluate the fracture load and survival rate of weakened and non-weakened roots restored with different intracanal posts. METHODS: Eighty teeth (16 mm) were prepared to a length of 10 mm with a custom drill. Fifty roots were weakened with a tapered diamond drill, and 30 roots were not. The specimens were embedded with acrylic resin up to 3 mm from the coronal aspect, and the periodontal ligament was simulated. The 50 weakened roots were restored with (n=10) CPC-gold (cast post and core made of gold alloy), CPC-Ni (cast post and core made of Ni-Cr alloy), FP (glass fiber posts), FP-W (glass fiber posts with a wider coronal diameter), and FP-CR (fiber posts relined with composite resin). The 30 nonweakened roots were restored with (n=10) CPC-gold, CPC-Ni, and FP. All of the posts were adhesively cemented. All of the specimens were mechanically cycled (37°C, 45°, 130 N, 2.2 Hz, and 1.5 million pulses) and evaluated after every 5 × 10(4) cycles to evaluate the presence of cracks as a primary outcome (event). The specimens that survived cycling were subjected to a fracture load test (load application on the palatal aspect at a 45° inclination). Failure mode was classified as favorable (above the simulated bone level) and catastrophic (below the simulated bone level). Survival rates were estimated using the Kaplan-Meier method. Fracture load data were analyzed using the Kruskal-Wallis test (α=0.05) for weakened roots, one-way analysis of variance, and Tukey test (p<0.05) for non-weakened roots, and Student t-test (p<0.05) compared nonweakened vs weakened roots for the same post system. RESULTS: For the preliminary survival results, FP-W showed a higher survival rate when compared with CPC (gold/Ni). For the fracture load (N), the statistical analysis (p<0.0001) presented differences among the weakened groups: CPC-gold (541.4) = CPC-Ni (642.6) > FP (282.2) = FP-W (274.1) = FP-RC (216.6). No differences were observed for the groups that were nonweakened (majority of favorable failures): CPC-gold (459.3) = CPC-Ni (422.0) = FP (347.9). Weakened roots restored with CPC-gold promoted high values of load fracture and unfavorable failure rates. CONCLUSION: Cast post and cores or fiber posts can be used for restoring nonweakened roots. However, for weakened roots, a fiber post with a wider cervical emerging diameter appears to be a better alternative when compared with cast post and cores.

Survival rate, load to fracture, and finite element analysis of incisors and canines restored with ceramic veneers having varied preparation design.

PURPOSE: To evaluate the survival rate, success rate, load to fracture, and finite element analysis (FEA) of maxillary central incisors and canines restored using ceramic veneers and varying preparation designs. METHODS AND MATERIALS: Thirty human maxillary central incisors and 30 canines were allocated to the following four groups (n=15) based on the preparation design and type of tooth: Gr1 = central incisor with a conservative preparation; Gr2 = central incisor with a conventional preparation with palatal chamfer; Gr3 = canine with a conservative preparation; Gr4 = canine with a conventional preparation with palatal chamfer. Ceramic veneers (lithium disilicate) were fabricated and adhesively cemented (Variolink Veneer). The specimens were subjected to 4 × 10(6) mechanical cycles and evaluated at every 500,000 cycles to detect failures. Specimens that survived were subjected to a load to fracture test. Bidimensional models were modeled (Rhinoceros 4.0) and evaluated (MSC.Patrans 2005r2 and MSC.Marc 2005r2) on the basis of their maximum principal stress (MPS) values. Survival rate values were analyzed using the Kaplan-Meier test (α = 0.05) and load to fracture values were analyzed using the Student t-test (α = 0.05). RESULTS: All groups showed 100% survival rates. The Student t-test did not show any difference between the groups for load to fracture. FEA showed higher MPS values in the specimens restored using veneers with conventional preparation design with palatal chamfer. CONCLUSION: Preparation design did not affect the fracture load of canines and central incisors, but the veneers with conventional preparation design with palatal chamfer exhibited a tendency to generate higher MPS values.