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Endodontic Sealers- Their Properties Endodontic Sealers- Their Properties and Effects on Fiber Post Retentionand Effects on Fiber Post Retention
To obtain fiber post retention To obtain fiber post retention with 2 endodontic sealers and with 2 endodontic sealers and 2 cements2 cements
PurposePurpose
11stst part of the study- part of the study- Post Indications Post Indications
The primary purpose of post The primary purpose of post is to retain the core build up is to retain the core build up material or to reinforce the material or to reinforce the remaining tooth structure to remaining tooth structure to provide retention for the provide retention for the final restoration.final restoration.
Rosenstiel of fixed prosthodontics.9Rosenstiel of fixed prosthodontics.9thth Ed. Ed.
Post Classification
Custom Prefabricated
Can be cast from:-Direct pattern in pt mouth
- In direct pattern in laboratory
•Noble alloy•Carbon fiber posts•Composite fiber posts•Ceramic (zirconia) posts
– ceramic composite
•William C. A review of the management of endodontically treated teeth: post and core and the final William C. A review of the management of endodontically treated teeth: post and core and the final restoration.2005; J Am Dent Assoc.restoration.2005; J Am Dent Assoc.
Evolution of the Fiber PostEvolution of the Fiber Post1995: C-POST
1997: AESTHETI-POST
1998: U.M. AESTHETI-PLUS
1999: AESTHETI-PLUS
1999:LIGHT-POST
2001
D. T. (double-taper)LIGHT-POST®
Advantages of Composite Advantages of Composite Fiber PostFiber Post Can bonded to the tooth with resin Can bonded to the tooth with resin
cementcement Modulus of elasticity similar to dentinModulus of elasticity similar to dentin Ease of removal for retreatmentEase of removal for retreatment Excellent estheticsExcellent esthetics Non corrosiveNon corrosive
• Richard S.S.Post placement and restoration of edodontically terated teeth.2004; J EndodRichard S.S.Post placement and restoration of edodontically terated teeth.2004; J Endod
Fiber posts absorb stress as a result have different root fracture location
Twin luscent. Light transmitting esthetic posts for endodontically treated teeth
Fracture with metal postsFracture with metal posts
FracturedFracturedrootroot
Vector Vector of of
ForceForce
FracturedFracturedrootroot
Vector Vector of of
ForceForce
Fracture location with Fracture location with fiber postsfiber posts
DisadvantagesDisadvantages
Their retention is based on the bond Their retention is based on the bond strength – technique sensitive.strength – technique sensitive.
Many fiber posts are not radiopaqueMany fiber posts are not radiopaque
• Richard S.S.Post placement and restoration of edodontically terated teeth.2004; J EndodRichard S.S.Post placement and restoration of edodontically terated teeth.2004; J Endod
Types of luting cementTypes of luting cement
Etch-and-rinse adhesiveEtch-and-rinse adhesive Self-etch adhesiveSelf-etch adhesive Self-adhesiveSelf-adhesive Glass-ionomer adhesiveGlass-ionomer adhesive
Factors affecting post Factors affecting post retentionretention Post lengthPost length
--Increased Increased Length = More Length = More RetentionRetention
-Longer -Longer Length = More Length = More PerforationPerforation
Post diameterPost diameter Post designPost design Luting cementLuting cement Canal shape Canal shape
William C. A review of the management of endodontically treated teeth: post and core and the final restoration.2005; J Am William C. A review of the management of endodontically treated teeth: post and core and the final restoration.2005; J Am Dent AssocDent Assoc
Literature reviews- post Literature reviews- post retention (push out tests)retention (push out tests)
Francesca Z et al.(2008), 50 extracted teeth Francesca Z et al.(2008), 50 extracted teeth Panavia F, Clearfil, Panavia F, Clearfil, Variolink II, Rely X Unicem, Experimental GCVariolink II, Rely X Unicem, Experimental GC. . No significant No significant difference among coronal, middle, apical sections for post retention difference among coronal, middle, apical sections for post retention or sealor seal. Clearfil (14.6± 4) and Panavia (12.6 ±2) significantly higher . Clearfil (14.6± 4) and Panavia (12.6 ±2) significantly higher than the othersthan the others
Vivian JJW. Ya-ming C et al.(2008), measured post retention for Vivian JJW. Ya-ming C et al.(2008), measured post retention for two fiber reinforced post types two fiber reinforced post types ( carbon fiber post – quartz fiber ( carbon fiber post – quartz fiber reinforced posts)reinforced posts) cemented with (total etch resin cement cemented with (total etch resin cement/C&B and a /C&B and a self-adhesive resin cement Rely X Unicemself-adhesive resin cement Rely X Unicem), ), The total etch The total etch adhesive had significantly better post retention the self adhesive adhesive had significantly better post retention the self adhesive cement. BScement. BS coronal→ apical coronal→ apical
Ayse D et al.(2007), Compared retention produced by a total etch Ayse D et al.(2007), Compared retention produced by a total etch resin cement (Variolink II) and a self adhesive cement (Unicem) for resin cement (Variolink II) and a self adhesive cement (Unicem) for 4 reinforced posts using a push-out test. 4 reinforced posts using a push-out test. Fiber composite posts with Fiber composite posts with Variolink II had the greatest bond strength.Variolink II had the greatest bond strength.
22ndnd part- Microleakage part- Microleakage
Passage of fluid and bacteria Passage of fluid and bacteria between the sealer and the dentin.between the sealer and the dentin.
Coronal leakageCoronal leakage Apical leakage Apical leakage
AM Yung.AM Yung.Direct Aesthetic Dental Restoratives: Microleakage and adhesionDirect Aesthetic Dental Restoratives: Microleakage and adhesion
Coronal microleakage leads toCoronal microleakage leads to: : DiscolorationDiscoloration Recurrent cariesRecurrent caries Apical microleakage leads to:Apical microleakage leads to: Apical infection Apical infection
AM Yung.AM Yung.Direct Aesthetic Dental Restoratives: Microleakage and adhesionDirect Aesthetic Dental Restoratives: Microleakage and adhesion
Microleakage (cont’d)
Causes of MicroleakageCauses of Microleakage
Polymerization shrinkage of the sealerPolymerization shrinkage of the sealer Sealer porositySealer porosity Poor adhesion of the sealerPoor adhesion of the sealer
AM Yung.AM Yung.Direct Aesthetic Dental Restoratives: Microleakage and adhesionDirect Aesthetic Dental Restoratives: Microleakage and adhesion
Types of SealersTypes of Sealers
Eugenol based sealers:Eugenol based sealers: – Zinc – oxide eugenolZinc – oxide eugenol
Non- Eugenol based sealers:Non- Eugenol based sealers: Calcium – hydroxide cementCalcium – hydroxide cementResin based cementResin based cementGlass ionomer cementsGlass ionomer cements
Ingle J.Endodontics.4Ingle J.Endodontics.4thth Ed Ed
Good adhesion to root dentinGood adhesion to root dentin Produce a hermitic seal Produce a hermitic seal RadiopaqueRadiopaque Have low shrinkageHave low shrinkage Slow set Slow set BacteriostaticBacteriostatic Insoluble in tissue fluidInsoluble in tissue fluid Non-irritatingNon-irritating Soluble in common solventSoluble in common solvent Non stainingNon staining Ingle J.Endodontics.4Ingle J.Endodontics.4thth Ed Ed..
Ideal root canal sealersIdeal root canal sealers
Microleakage measuredMicroleakage measured
Dye penetrationDye penetration
*Dyes used:*Dyes used: -India Ink-India Ink -Methylene Blue-Methylene Blue -Silver Nitrate -Silver Nitrate
Cristina BX. Ruben W. Root end filling materials: apical microleakage and marginal Cristina BX. Ruben W. Root end filling materials: apical microleakage and marginal adaptation.2005adaptation.2005
Dye penetrationDye penetration
Factors affecting dye penetration techniques:Factors affecting dye penetration techniques:
Air bubbles in the canalAir bubbles in the canal pH of the dyepH of the dye Molecular weight of the dyeMolecular weight of the dye Immediate immersion / delayed immersion in the dyeImmediate immersion / delayed immersion in the dye Tooth anatomyTooth anatomy Skill of the operatorSkill of the operator Type of sealerType of sealer
A.Tamse .A. Katz F. Kablan.Comparison of apical leakage shown A.Tamse .A. Katz F. Kablan.Comparison of apical leakage shown by four different dyes with two evaluating methods.1998by four different dyes with two evaluating methods.1998
--Streptococcus mutans Streptococcus mutans mostly usedmostly used
--Viability of the freshly Viability of the freshly inoculated bacteria is inoculated bacteria is requiredrequired
Francesca M. efficacy of two contemporary single- cone filling techniques in Francesca M. efficacy of two contemporary single- cone filling techniques in preventing bacterial leakage.2006preventing bacterial leakage.2006
Bacterial filtrationBacterial filtration
Fluid Filtration TechniqueFluid Filtration Technique
Hasan O, et al. Apical Leakage of Resin Based Root Canal Sealers with a New Computerized Fluid Filtration Meter JOE 2005
Microleakage Literature ReviewMicroleakage Literature Review
F.Kont Cobenkara et al. (2002) Measured F.Kont Cobenkara et al. (2002) Measured microleakage of endodontic fillings using 4 root microleakage of endodontic fillings using 4 root canal sealers (AH Plus, Roeko seal, Ketac-Endo, canal sealers (AH Plus, Roeko seal, Ketac-Endo, Sultan) by aSultan) by a fluid filtration method, fluid filtration method, Roeko Seal and Roeko Seal and AH Plus had better seal than Ketac-Endo or Sultan.AH Plus had better seal than Ketac-Endo or Sultan.
Fernando G et al.(1995), compared the sealing Fernando G et al.(1995), compared the sealing ability of Ketac-Endo and Tubli Seal. Teeth using ability of Ketac-Endo and Tubli Seal. Teeth using India ink 7 day immersion and cleared. Stain India ink 7 day immersion and cleared. Stain measured at X50.measured at X50.No significant difference between No significant difference between groups.groups.
33rdrd Part -Effects of Eugenol Part -Effects of Eugenol on Post Retentionon Post Retention
Most sealers contain zinc oxide eugenol (ZOE)Most sealers contain zinc oxide eugenol (ZOE)
Adversely affects composite resins…Adversely affects composite resins…
Reduced transverse or bending strength Reduced transverse or bending strength (Reisbick 1971)(Reisbick 1971)
Decreased surface hardness Decreased surface hardness (Rosenstiel & Gegauff 1988)(Rosenstiel & Gegauff 1988)
Interfere with dentinal bonding of resins Interfere with dentinal bonding of resins (Hansen& Asmussen 1987)(Hansen& Asmussen 1987)
Literature ReviewLiterature Review
No significant difference in post retention in teeth No significant difference in post retention in teeth containing eugenolcontaining eugenol and non-eugenol root canal and non-eugenol root canal sealers. S.T Davis et al.(2007)sealers. S.T Davis et al.(2007)
The group filled with GP and The group filled with GP and ZOE sealerZOE sealer had had lower lower bond strength than the one without sealerbond strength than the one without sealer. Edson A . Edson A et al.(2006) et al.(2006)
No significant influence on the mean retention of No significant influence on the mean retention of endodontic post luted with composite resin endodontic post luted with composite resin cementcement .Teeth were obturated with GP and different .Teeth were obturated with GP and different root canal sealers (ZOE, AH 26,CaOH). Hagge et al.root canal sealers (ZOE, AH 26,CaOH). Hagge et al.(2002),(2002),
No difference in post retention with ZOE or CAOHNo difference in post retention with ZOE or CAOH when prefabricated posts luted with resin cement. when prefabricated posts luted with resin cement. David R B et al.(2000) David R B et al.(2000)
Specific AimsSpecific Aims
In endodontically treated teethIn endodontically treated teeth To measure and compare the leakage of To measure and compare the leakage of
glass ionomer and zinc oxide eugenol glass ionomer and zinc oxide eugenol sealers.sealers.
To evaluate the retention of 40 fiber post To evaluate the retention of 40 fiber post using 2 cements-a self-etching and a self- using 2 cements-a self-etching and a self- adhesive.adhesive.
HypothesesHypotheses
There will be no significant difference in leakage There will be no significant difference in leakage when using glass ionomer (Activ-GP) or zinc oxide when using glass ionomer (Activ-GP) or zinc oxide eugenol (Roth’s) eugenol (Roth’s)
There will be no significant difference in post There will be no significant difference in post retention when the posts are cemented with a self-retention when the posts are cemented with a self-adhesive (Rely X Unicem) or dual-cure (Panavia F adhesive (Rely X Unicem) or dual-cure (Panavia F 2.0) cement.2.0) cement.
There will be no effect on post retention of either There will be no effect on post retention of either cement by the zinc oxide eugenol or glass ionomer cement by the zinc oxide eugenol or glass ionomer
sealerssealers
Study DesignStudy Design
40 mandibular
premolars
10 teeth +ZOE+ fiber post+
Rely X Unicem
10 teeth+ ZOE + fiber post+
Panavia F 2.0
10 teeth + GICs+ fiber post
+Rely X Unicem
10 teeth+ GICs+fiber post
+Panavia F2.0
Gutta-perchaGutta-percha
Paper pointPaper point
SealersSealers
FilesFiles
Finger spreaderFinger spreader
MaterialsMaterials
Fiber Post -3M Fiber Post -3M ESPEESPE
RelyX UnicemRelyX Unicem
Panavia F 2.0Panavia F 2.0
Materials (con’t)Materials (con’t)
Extracted single canal premolars Extracted single canal premolars were selected and calculus and were selected and calculus and soft tissues removedsoft tissues removed
Two radiographs made- 1 from Two radiographs made- 1 from mesiodistally & 1 from mesiodistally & 1 from buccolingualbuccolingual
Each tooth was sectioned with Each tooth was sectioned with diamond disc under water spray diamond disc under water spray 1mm coronal to CEJ1mm coronal to CEJ
MethodsMethods
Specimens were instrumented to # 45 file and filled with GP using lateral condensation
Sodium hypochlorite solution (5%) was used to irrigate canal throughout instrumentation
The canals were dried with paper points and obturated with MC 45, sealer using finger spreader and lateral condensation method
Coronal orifice was sealed and stored in incubator at 37° C for 7 days before proceeding
Methods (cont’d)Methods (cont’d)
F. Zicari.E.Couthino. Jan DM. Bonding and sealing ability of fiber post bonding.2008F. Zicari.E.Couthino. Jan DM. Bonding and sealing ability of fiber post bonding.2008
Post PreparationPost Preparation
Control length withPeeso Reamer
Post space prepared With Drill
Injecting self etchingprimer
Injecting self etchingprimer
Injecting mixed Panavia F2
Post placement
Light curing 20 sec
Self- adhesive SystemSelf- adhesive System
Mixing Unicem Coating post with Unicem
Unicem cemented post Cured for 20 sec
Universal Testing Machine (Instron) Universal Testing Machine (Instron) Push-out TestPush-out Test
MicroleakageMicroleakage
Apical sections were coated with two layers of nail Apical sections were coated with two layers of nail polish leaving the apical 1 mm exposedpolish leaving the apical 1 mm exposed
The teeth immersed into a 50% wt silver nitrate dye The teeth immersed into a 50% wt silver nitrate dye for one hour then washed by distilled water for 1 for one hour then washed by distilled water for 1 minuteminute
Inserted in photo developing solution and exposed Inserted in photo developing solution and exposed them to light for 12 hthem to light for 12 h
Washed with running water and the nail polish Washed with running water and the nail polish cleanedcleaned
All specimens were cleared using the 5%nitric acid, All specimens were cleared using the 5%nitric acid, followed by washing for 2 h and dehydrated in followed by washing for 2 h and dehydrated in ascending concentration of alcohol (80%, 90%, and ascending concentration of alcohol (80%, 90%, and 100%)100%)
The roots were subsequently cleared using methyl The roots were subsequently cleared using methyl salicylatesalicylate
The cleared specimen examined under a 3D The cleared specimen examined under a 3D microscope (100X)microscope (100X)
Suspended apical section
Suspended apical sectionCoated with nail polish
Keyence Microscope (3D)Keyence Microscope (3D)
Measuring dye penetration
Cleared specimens
Gutta -perchaGutta -perchaDye Dye
SEM EvaluationSEM Evaluation
The Three Way Analysis The Three Way Analysis (ANOVA) of Post Bond Strength(ANOVA) of Post Bond Strength
Source Source MeanMean
SquareSquare
P-valueP-value
Third SectionThird Section 12.19212.192 0.060120.06012
SealerSealer 1.0801.080 0.83180.8318
Cement Cement 76.98676.986 0.07520.0752
Sealer*Cement Sealer*Cement 11.52911.529 0.48840.4884
Bond Strength (MPa) -Mean Bond Strength (MPa) -Mean and Std of four groupand Std of four group
SealerSealer CementCement MeanMean±SD±SD
Glass Glass Ionomer Ionomer
Panavia F Panavia F 2.02.0
7.77.7± 2.6± 2.6
Glass Glass IonomerIonomer
Rely X Rely X UnicemUnicem
10.310.3± 1.3± 1.3
Zinc Oxide Zinc Oxide Eugenol Eugenol
Panavia F Panavia F 2.02.0
88±1.2±1.2
Zinc Oxide Zinc Oxide EugenolEugenol
Rely X Rely X UnicemUnicem
1212±2.5±2.5
Interaction between Post Interaction between Post Retention, Sealer Type and Retention, Sealer Type and CementCement
0
2
4
6
8
10
12
14
16
Panavia F 2.0 Rely X Panavia F 2.0 Rely X
GICs GICs ZOE ZOE
Bon
d S
tren
gth(
MP
a)
Failure MechanismFailure Mechanism
Resin cement adhered to the post surface.Resin cement adhered to the post surface.
100X
SEM EvaluationSEM Evaluation
PanaviaF2- Root Canal PanaviaF2- Root Canal DentinDentin
Mean Mean ±SD±SD for Microleakage (mm) for Microleakage (mm)
SealerSealerGlass Glass
IonomerIonomerZinc OxideZinc Oxide
EugenolEugenol
Mean Mean ±SD±SD 1.5 1.5 ± 0.3± 0.3 2.1 2.1 ± 0.4± 0.4
0
0.5
1
1.5
2
2.5
3
Glass Ionomer Zinc Oxide Eugenol
Mic
role
akag
e (m
m)
Mean Mean ±SD±SD for Microleakage for Microleakage
Results were Results were higherhigher for both for both cements compared to Goracci et cements compared to Goracci et al who used a “thin slice’’ push- al who used a “thin slice’’ push- out test and transmission electron out test and transmission electron microscopy. The microscopy. The tested adhesive tested adhesive cements were VariolinkII (10cements were VariolinkII (10±3 ±3 MPa) Rely X Unicem(5.05± 3) MPa) Rely X Unicem(5.05± 3) Panavia (5.04±3)Panavia (5.04±3)
This study showed no difference in bond strength This study showed no difference in bond strength between the coronal, middle, apical third between the coronal, middle, apical third with both with both cements in contrast to Carlos 2007 thesis.cements in contrast to Carlos 2007 thesis.
This study agrees with Zicari F et al, who reported This study agrees with Zicari F et al, who reported not significantly difference among the coronal. not significantly difference among the coronal. middle and apical sectionsmiddle and apical sections for each luting cements for each luting cements
BS was measured for Panavia 21(12.6BS was measured for Panavia 21(12.6±3) ±3) Unicem(11± 4) VariolinkII(11±4Unicem(11± 4) VariolinkII(11±4))
A 20 gauge Endo-Eze tip that reached the A 20 gauge Endo-Eze tip that reached the apical root canal area ensured the delivery of apical root canal area ensured the delivery of the conditioner to the deepest part portion of the conditioner to the deepest part portion of the canalthe canal
The type of sealer used has no effect on The type of sealer used has no effect on values of bond strength which agrees with S.T values of bond strength which agrees with S.T Davis et al, Davis et al, no significant difference with non eugenol no significant difference with non eugenol (190(190±55) and eugenol (183± 56)±55) and eugenol (183± 56)
Teeth were irrigated with water for cleaning Teeth were irrigated with water for cleaning purpose before cementation. purpose before cementation. No sodium No sodium hypochlorite were used. Which might effect hypochlorite were used. Which might effect retention. retention. A study by Hale A et al.(2003) showed A study by Hale A et al.(2003) showed that 5% NaOCL reduce the bond strength to that 5% NaOCL reduce the bond strength to dentin of Panavia F,C&B Metabond, ViriolinkIIdentin of Panavia F,C&B Metabond, ViriolinkII
Dye penetration technique was subjectiveDye penetration technique was subjective
Sealing the root canal coronal and apical Sealing the root canal coronal and apical parts of the root canal is equally important parts of the root canal is equally important for the success of treatmentfor the success of treatment
The results agreed with the null hypothesis The results agreed with the null hypothesis in both experimentsin both experiments
Within the limitation of the study, it can be Within the limitation of the study, it can be concluded that the use of self- adhesive or concluded that the use of self- adhesive or self-etch luting system had the same action self-etch luting system had the same action on retentionon retention
The eugenol containing and Glass Ionomer The eugenol containing and Glass Ionomer containing sealer have no effect on values containing sealer have no effect on values of bond strength of bond strength
ZOE and Glass Ionomer did not show ideal ZOE and Glass Ionomer did not show ideal sealing, and both groups had leakagesealing, and both groups had leakage
Future Studies Future Studies
Further research on other aged teeth with Further research on other aged teeth with eugenol, does fresh eugenol have a greater eugenol, does fresh eugenol have a greater effect?effect?
Comparing total etch with different delivery Comparing total etch with different delivery systems to self adhesive cements all three systems to self adhesive cements all three with the same delivery system. with the same delivery system.
More studies should be conducted using resin More studies should be conducted using resin materials to improve the bond strength to materials to improve the bond strength to dentin with the endodontic treated teeth. dentin with the endodontic treated teeth.