Cecilia Goracci

Current perspectives on post systems: a literature review

This literature review summarizes the most recent and reliable evidence on post systems. A search was limited to review articles published over the last 10 years in dental journals with an impact factor. Papers cited in the initially retrieved review articles were also included if significant. Preservation of tooth tissue, presence of a ferrule effect, and adhesion are regarded as the most effective conditions for long-term success of post-endodontic restorations. Adhesively luted fibre-reinforced composite post restorations have demonstrated satisfactory survival rates over relatively long follow-up periods. The clinical effectiveness of such restorations has been mainly ascribed to the more biomimetic behaviour of fibre-reinforced composite posts that reduces the risk of vertical root fractures. The most common type of failure when using fibre posts is post debonding and it is generally agreed that achieving stable adhesion to intraradicular dentine is more challenging than to coronal dentine. Several factors related to endodontic treatment, root canal shape, post space preparation, post translucency, adhesive cement handling and curing may have an influence on the outcome of the luting procedure. The most reliable results in fibre post cementation are obtained by etch-and-rinse adhesives in combination with dual-cure resin cements. The use of self-adhesive resin cements has also been proposed. Simplification is an obvious advantage of these new materials. However, the durability of their bond still needs to be verified with long-term clinical studies. Several techniques for pre-treating the fibre-reinforced composite post surface have been tested with the aim of improving the bond strength at the post-core and post-cement interfaces. Silicoating followed by silanization currently appears to be the most effective and convenient method for this purpose. In conclusion, the available evidence validates the use of fibre posts as an alternative to metal posts and preferably to other tooth-coloured posts, such as zirconia dowels, in the restoration of endodontically treated teeth. Longer term clinical trials are expected to further strengthen this evidence.

Influence of phosphoric acid etching on microleakage of a self-etch adhesive and a self-adhering composite.

BACKGROUND The aim of this study was to evaluate the influence of preliminary phosphoric acid etching on the microleakage of a self-adhering flowable composite and a self-etch adhesive used in combination with the proprietary flowable composite. METHODS Standard Class V cavities were prepared on the buccal side of 20 extracted sound human molars. Specimens were randomly divided into five groups: (1) Gel Etchant/Optibond FL/Premise Flowable; (2) Vertise Flow; (3) Optibond XTR/Premise Flowable; (4) Gel Etchant/Vertise Flow; and (5) Gel Etchant/Optibond XTR/Premise Flowable (Kerr). The interfacial sealing ability of the materials was evaluated by scoring the depth of silver nitrate penetration and through scanning electron microscopy observations. Differences in leakage at either the enamel or the dentine interface were evaluated for statistical significance (Kruskal-Wallis ANOVA, Mann-Whitney U test, p < 0.05). RESULTS At the enamel interface, no significant differences were found among the materials. On dentine, Gel Etchant/Vertise Flow had the highest leakage scores and the difference was statistically significant (p < 0.05). CONCLUSIONS The early sealing ability of the self-adhering flowable composite and the self-etch adhesive in Class V restorations did not significantly benefit from selective enamel etching. Preliminary phosphoric acid etching of dentine negatively affected the quality of the seal when using the adhesive-free flowable composite.

Post retentive ability of a new resin composite with low stress behaviour

OBJECTIVES To assess by means of push-out test the post retentive potential of a new flowable resin composite with low polymerization stress. METHODS SureFil(®) SDR™ (Dentsply, S) was compared with the resin cement Calibra (Dentsply, C). S and C were used in combination with the adhesive XP Bond (Dentsply, XPB). In C group the Self-Cure Activator was mixed with XPB. The following types of fibre posts were luted into 30 extracted premolars: Radix Fiber Post (Dentsply, R), DT Light Post (RTD, LP), ER Dentin Post (Komet, ER), DT Light SL (VDW, SL), FibreKleer (Jeneric Pentron, F). Six posted roots per group were tested. Each root provided three to five 1mm-thick slices. Measured push-out strengths were differentiated by post space level and statistically analysed (p<0.05). The failure mode of each debonded specimen was assessed. RESULTS Cement type did not have a significant effect on post retention (p=0.54). Post type was a significant factor for push-out strength (p<0.001). LP exhibited significantly higher retentive strength than SL and F; push-out strengths of ER and R were significantly higher than those of F. Post retention was significantly influenced by post space level (p<0.001). Significantly higher push-out strengths were recorded at the coronal third than at the middle and apical levels. The post-cement interaction was significant (p=0.002). Posts luted with S most often failed at the cement-post interface. CONCLUSIONS When the new flowable low-stress composite was used to lute fibre posts, similar retentive strengths to those of a marketed cement from the same manufacturer were achieved. CLINICAL SIGNIFICANCE SureFil(®) SDR™, a flowable composite originally proposed for bulk filling of posterior restorations, exhibited post retentive strengths similar to those of a cement by the same manufacturer. With a relatively high filler load, yet a low curing stress, SureFil(®) SDR™ may be adequate for both post cementation and core build-up.