endodontic sealers- their properties and effects on fiber post retention

1. Endodontic Sealers- Their Properties and Effects on Fiber Post Retention Farrah Najib Prosthodontic Department\Biomaterials 2008

3. 1st part of the study- Post Indications The primary purpose of post is to retain the core build up material or to reinforce the remaining tooth structure to provide retention for the final restoration. Rosenstiel of fixed prosthodontics.9th Ed.

4. William C. A review of the management of endodontically treated teeth: post and core and the final restoration.2005; J Am Dent Assoc.

5. Evolution of the Fiber Post RTD / Bisco have introduced improvements as they developed the technology to improve working qualities WITHOUT compromising their ideal, proven mechanical properties.RTD / Bisco have introduced improvements as they developed the technology to improve working qualities WITHOUT compromising their ideal, proven mechanical properties.

6. Advantages of Composite Fiber Post Can bonded to the tooth with resin cement Modulus of elasticity similar to dentin Ease of removal for retreatment Excellent esthetics Non corrosive Richard S.S.Post placement and restoration of edodontically terated teeth.2004; J Endod

7. Fiber posts absorb stress as a result have different root fracture location Twin luscent. Light transmitting esthetic posts for endodontically treated teeth

8. Disadvantages Their retention is based on the bond strength – technique sensitive. Many fiber posts are not radiopaque Richard S.S.Post placement and restoration of edodontically terated teeth.2004; J Endod

9. Types of luting cement Etch-and-rinse adhesive Self-etch adhesive Self-adhesive Glass-ionomer adhesive

10. Factors affecting post retention Post length -Increased Length = More Retention -Longer Length = More Perforation

11. Post diameter Post design Luting cement Canal shape William C. A review of the management of endodontically treated teeth: post and core and the final restoration.2005; J Am Dent Assoc

12. Literature reviews- post retention (push out tests) Francesca Z et al.(2008), 50 extracted teeth Panavia F, Clearfil, Variolink II, Rely X Unicem, Experimental GC. No significant difference among coronal, middle, apical sections for post retention or seal. Clearfil (14.6± 4) and Panavia (12.6 ±2) significantly higher than the others Vivian JJW. Ya-ming C et al.(2008), measured post retention for two fiber reinforced post types ( carbon fiber post – quartz fiber reinforced posts) cemented with (total etch resin cement/C&B and a self-adhesive resin cement Rely X Unicem), The total etch adhesive had significantly better post retention the self adhesive cement. BS? coronal? apical Ayse D et al.(2007), Compared retention produced by a total etch resin cement (Variolink II) and a self adhesive cement (Unicem) for 4 reinforced posts using a push-out test. Fiber composite posts with Variolink II had the greatest bond strength.

13. 2nd part- Microleakage Passage of fluid and bacteria between the sealer and the dentin. Coronal leakage Apical leakage AM Yung.Direct Aesthetic Dental Restoratives: Microleakage and adhesion

14. Coronal microleakage leads to: Discoloration Recurrent caries Apical microleakage leads to: Apical infection AM Yung.Direct Aesthetic Dental Restoratives: Microleakage and adhesion

15. Causes of Microleakage Polymerization shrinkage of the sealer Sealer porosity Poor adhesion of the sealer AM Yung.Direct Aesthetic Dental Restoratives: Microleakage and adhesion

16. Types of Sealers Eugenol based sealers: Zinc – oxide eugenol Non- Eugenol based sealers: Calcium – hydroxide cement Resin based cement Glass ionomer cements Ingle J.Endodontics.4th Ed

17. Good adhesion to root dentin Produce a hermitic seal Radiopaque Have low shrinkage Slow set Bacteriostatic Insoluble in tissue fluid Non-irritating Soluble in common solvent Non staining Ingle J.Endodontics.4th Ed. Ideal root canal sealers

18. Microleakage measured Dye penetration *Dyes used: -India Ink -Methylene Blue -Silver Nitrate Cristina BX. Ruben W. Root end filling materials: apical microleakage and marginal adaptation.2005

19. Dye penetration Factors affecting dye penetration techniques: Air bubbles in the canal pH of the dye Molecular weight of the dye Immediate immersion / delayed immersion in the dye Tooth anatomy Skill of the operator Type of sealer A.Tamse .A. Katz F. Kablan.Comparison of apical leakage shown by four different dyes with two evaluating methods.1998

20. -Streptococcus mutans mostly used -Viability of the freshly inoculated bacteria is required Francesca M. efficacy of two contemporary single- cone filling techniques in preventing bacterial leakage.2006

22. Microleakage Literature Review F.Kont Cobenkara et al. (2002) Measured microleakage of endodontic fillings using 4 root canal sealers (AH Plus, Roeko seal, Ketac-Endo, Sultan) by a fluid filtration method, Roeko Seal and AH Plus had better seal than Ketac-Endo or Sultan. Fernando G et al.(1995), compared the sealing ability of Ketac-Endo and Tubli Seal. Teeth using India ink 7 day immersion and cleared. Stain measured at X50.No significant difference between groups.

23. 3rd Part -Effects of Eugenol on Post Retention

24. Literature Review No significant difference in post retention in teeth containing eugenol and non-eugenol root canal sealers. S.T Davis et al.(2007) The group filled with GP and ZOE sealer had lower bond strength than the one without sealer. Edson A et al.(2006) No significant influence on the mean retention of endodontic post luted with composite resin cement .Teeth were obturated with GP and different root canal sealers (ZOE, AH 26,CaOH). Hagge et al.(2002), No difference in post retention with ZOE or CAOH when prefabricated posts luted with resin cement. David R B et al.(2000)

25. Specific Aims In endodontically treated teeth To measure and compare the leakage of glass ionomer and zinc oxide eugenol sealers. To evaluate the retention of 40 fiber post using 2 cements-a self-etching and a self- adhesive.

26. Hypotheses There will be no significant difference in leakage when using glass ionomer (Activ-GP) or zinc oxide eugenol (Roth’s) There will be no significant difference in post retention when the posts are cemented with a self-adhesive (Rely X Unicem) or dual-cure (Panavia F 2.0) cement. There will be no effect on post retention of either cement by the zinc oxide eugenol or glass ionomer sealers

27. Study Design

28. Gutta-percha

29. Fiber Post -3M ESPE

30. Extracted single canal premolars were selected and calculus and soft tissues removed Two radiographs made- 1 from mesiodistally & 1 from buccolingual Each tooth was sectioned with diamond disc under water spray 1mm coronal to CEJ

31. 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

32.

35. Self- adhesive System

36. Universal Testing Machine (Instron) Push-out Test

37. Microleakage Apical sections were coated with two layers of nail polish leaving the apical 1 mm exposed The teeth immersed into a 50% wt silver nitrate dye for one hour then washed by distilled water for 1 minute Inserted in photo developing solution and exposed them to light for 12 h Washed with running water and the nail polish cleaned All specimens were cleared using the 5%nitric acid, followed by washing for 2 h and dehydrated in ascending concentration of alcohol (80%, 90%, and 100%) The roots were subsequently cleared using methyl salicylate The cleared specimen examined under a 3D microscope (100X)

38. Keyence Microscope (3D)

39. Gutta -percha Dye

40. SEM Evaluation

42. The Three Way Analysis (ANOVA) of Post Bond Strength

43. Bond Strength (MPa) -Mean and Std of four group

44. Interaction between Post Retention, Sealer Type and Cement

45. Failure Mechanism

46. Rely X unicem- Dentin short resin tags were present

47. PanaviaF2- Root Canal Dentin

48. SEM Evaluation- canal dentin Rough surface shows the smear layer was not removed and part of the post matrix was present. (tooth surface)

49. Mean ±SD for Microleakage (mm)

51.

52. Results were higher for both cements compared to Goracci et al who used a “thin slice’’ push- out test and transmission electron microscopy. The tested adhesive cements were VariolinkII (10±3 MPa) Rely X Unicem(5.05± 3) Panavia (5.04±3)

53. This study showed no difference in bond strength between the coronal, middle, apical third with both cements in contrast to Carlos 2007 thesis. This study agrees with Zicari F et al, who reported not significantly difference among the coronal. middle and apical sections for each luting cements BS was measured for Panavia 21(12.6±3) Unicem(11± 4) VariolinkII(11±4) A 20 gauge Endo-Eze tip that reached the apical root canal area ensured the delivery of the conditioner to the deepest part portion of the canal

54. The type of sealer used has no effect on values of bond strength which agrees with S.T Davis et al, no significant difference with non eugenol (190±55) and eugenol (183± 56) Teeth were irrigated with water for cleaning purpose before cementation. No sodium hypochlorite were used. Which might effect retention. A study by Hale A et al.(2003) showed that 5% NaOCL reduce the bond strength to dentin of Panavia F,C&B Metabond, ViriolinkII

55. Dye penetration technique was subjective Sealing the root canal coronal and apical parts of the root canal is equally important for the success of treatment

57. The results agreed with the null hypothesis in both experiments Within the limitation of the study, it can be concluded that the use of self- adhesive or self-etch luting system had the same action on retention The eugenol containing and Glass Ionomer containing sealer have no effect on values of bond strength ZOE and Glass Ionomer did not show ideal sealing, and both groups had leakage

58. Future Studies Further research on other aged teeth with eugenol, does fresh eugenol have a greater effect? Comparing total etch with different delivery systems to self adhesive cements all three with the same delivery system. More studies should be conducted using resin materials to improve the bond strength to dentin with the endodontic treated teeth.

60. Acknowledgments John O Burgess Mark Litaker Firoz Rahemtulla Madelyn Coar Deniz Cakir Preston Beck Ramtin Sadid Zadeh