You are on page 1of 7

SEM Evaluation of the Cement Layer Thickness After

Luting Two Different Posts


Simone Grandinia/Cecilia Goraccib/Francesca Monticellic/Andrea Borracchinid/Marco Ferrarie

Purpose: To verify with SEM the cement layer thickness and uniformity of resin-relined translucent fiber posts
(anatomic posts) and standard translucent fiber posts.

Materials and Methods: On 20 extracted maxillary anterior teeth, the roots were endodontically treated and
prepared for the insertion of a fiber post. Translucent fiber posts (DT) were luted with a dual-curing resin cement
(Duo-Link) in 10 specimens (group 1) after the canal walls had been treated with the One-Step bonding system. In
the other 10 specimens (group 2), experimental anatomic posts (Anatomic Postn Core) were tested. To these
posts, a layer of light-curing resin is added to allow for a pre-cementation relining of the post, aimed at improving
its fit into the endodontic space. For luting, the same adhesive-resin cement combination of group 1 was used. All
the roots were sectioned and prepared for SEM observations. At the 1-mm, 4.5-mm, and 8-mm level of each root,
cement thickness was measured, and the presence of gaps or voids within the luting material or at its interfaces
was evaluated. A statistical analysis was performed to test the significance of differences in the cement layer
thickness around the two types of post and at different levels of the same type of post.

Results: In the presence of anatomic posts, the cement layer was significantly thinner and more uniform at the
coronal and middle level of the root. In both groups, voids and bubbles were detected within the luting material,
within the abutment material, and between fiber post and cement. Gaps were also visible between post and relining
material.

Conclusions: The resin cement thickness was significantly lower in the anatomic post group than in the control
group (standardized posts), except at the apical third of the canal, where there was no statistically significant
difference. A good adaptation of anatomic posts was evident in all of the specimens.

Keywords: fiber posts, dental bonding, endodontically treated teeth.

J Adhes Dent 2005; 7: 235240. Submitted for publication: 06.08.03; accepted for publication: 02.12.04.

he increasing popularity and widespread use of fiber hesive/resin cement/fiber post8,12 due to its good reten-
T posts is inevitably changing the procedure of recon-
structing endodontically treated teeth. Since the introduc-
tion values1,6 and behavior under mechanical stress.20
The evolution of fiber posts has accelerated since
tion of fiber posts in 1990,7 many investigations have carbon and quartz fiber posts have been replaced by
confirmed the good clinical performance of the system ad- glass fiber posts, which are translucent and often radio-
paque. The shape of these posts has also changed: from
a double cylinder designed for retention purposes, to
cylindrical (Endopost) and conical profiles (DT posts),
a Professor, Chair of Endodontics, University of Siena, Italy. based on the good performances of the new bonding pro-
b Chair of Dental Materials, University of Siena, Italy. cedures.15
c Clinical Professor, Department of Dental Materials and Restorative Dentistry, The property of translucency proves favorable for luting
University of Siena, Italy.
purposes, as the transmission of light through the post
d Chair and Professor of Prosthetic Dentistry, University of Siena, Italy.
allows the clinician to also use dual-curing cements.13,24
e Professor of Dental Materials and Restorative Dentistry, University of Siena,
Italy.
Moreover, the wider choice of available shapes makes it
possible to limit the amount of residual dentin that must
Reprint requests: Dr. Marco Ferrari, Piazza Attias 19, Livorno, 57120, Italy. be removed in order to achieve satisfactory post adapta-
Tel: +39-0586-892283, Fax: +39-0586-898305. e-mail: ferrarimar@unisi.it tion.

Vol 7, No 3, 2005 235


Grandini et al

Furthermore, the translucent fiber post has a modulus MATERIALS AND METHODS
of elasticity similar to that of dentin and the other posts,
and there is evidence it possesses adequate mechanical Twenty maxillary anterior teeth, extracted for periodontal
properties.6 The use of one-bottle adhesive systems has reasons, were selected for this study. The teeth were
greatly simplified the procedure of bonding in root canals endodontically instrumented at a working length of 1 mm
as well, and has proved to be clinically adequate,10,28 from the apex to a #35 master apical file. A step-back
especially when a microbrush (instead of a regular brush) technique was used with stainless-steel K-files (Union
is employed to carry the adhesive and resin cement Broach, New York, NY, USA) and Gates Glidden drills #2
inside the root canal.11 to #4 (Union Broach). 2.5% sodium hypochlorite was used
Clinical studies12,16,25 have revealed that when using for irrigation. The prepared teeth were obturated with ther-
fiber posts, the most common cause of failure is not root moplasticized, injectable gutta-percha (Obtura, Texceed,
fracture, as it happens with metallic or cast posts, but Costa Mesa, CA, USA) and a resin sealer (AH-26, DeTrey,
debonding. Endodontic failure is also an important Zurich, Switzerland).
issue27 and a reliable predictor of the success rate of The root canal walls of each specimen were enlarged
many kinds of restorations, although it is easier to with low-speed rotating instruments provided by the man-
remove a fiber post than any kind of metallic post,21 thus ufacturer (RTD, St Egrve, France). The depth of the post
offering the clinician a chance of retreatment. Debonding space preparation was 9 mm from the cementoenamel
is more likely to occur in the absence of the desirable junction. The sample was randomly divided into two
ferrule effect, or in the presence of an excessively thick groups of 10 specimens each.
layer of cement.8 In particular, if the post does not fit well,
especially at the coronal level, the cement layer ends up Group 1 (Control)
being too thick, and bubbles are likely to be present with- The first 10 specimens were treated with the One Step
in it, all of which predisposes to debonding. bonding system (Bisco, Schaumburg, IL, USA) following
Clinically, when debonding occurs, the post is often manufacturers instructions. The root canal walls were
coated by cement still adhering to it. In this case, it is etched with 32% phosphoric acid (Bisco) for 15 s,
possible to lute this anatomically shaped, cement-re- washed with a water syringe, and then gently air dried.
lined post again. This individual post, shaped to the root Excess water was removed from the post space using pa-
canal space, has a better fit than any other prefabricated per points. Four to five coats of primer-adhesive material
post.8 were applied into the root canals with a microbrush pro-
The opportunity presented by such relining is partic- vided by the manufacturer. Excess primer-adhesive solu-
ularly appreciated when dealing with root canals which tion was removed with a paper point, the remaining mate-
have an elliptic shape, such as canines, mandibular pre- rial was gently air dried, and then light cured for 20 s.
molars, etc. In these cases, the clinician is otherwise Duo-Link (Bisco), a new dual-curing resin cement, was
forced to adapt the residual root structure to the post used. The catalyst and base components of the material
shape by removing more dentin. In contrast, it would be were mixed according to the manufacturers instructions.
desirable for the post to adapt to the root canal anatomy The resin cement was applied into the root canal space
as produced by endodontic treatment. This is the ratio- with a lentulo drill, and the fiber post was seated. The
nale for the creation of an anatomic post.3,4 excess resin was removed and the remaining material
Since 2001, attempts have been made to create light cured for 20 s through the post.
anatomic posts by relining a quartz post with self-curing The DT translucent fiber posts (RTD, St Egrve, France)
resin and a translucent post with light-curing resin.3,9,14 were used. They were available in three different sizes
In this manner, the authors were able to achieve a better (DT1, 120 m tip diameter, 10% conicity; DT2, 100 m
adaptation of the post to the residual root canal anatomy. tip diameter, 8% conicity; DT3, 90 m tip diameter, 6%
Recently, the Anatomic Postn Core (RTD, St Egrve, conicity). The choice between them was dictated by the
France) has been introduced.9 This new post consists of size and the shape of the roots, the objective being the
a DT post No. 1a which is covered by a light-curing resin achievement of a good fit of the post in the apical portion
(Lumiglass, RTD, St Egrve, France). of the canal. The length of each post was checked, and
The aim of this study was to evaluate the resin cement the post was properly cut before luting.
thickness after luting anatomic posts and standardized
fiber posts into root canal preparations. The null hypothe- Group 2
sis was that similar resin cement thicknesses were The other 10 specimens were used for testing experimen-
present when anatomic or standardized posts were used. tal anatomic posts (RTD), following manufacturers in-
In addition, the luting material and the interface be- structions (Fig 1). After lubricating the canal walls with a
tween the cavity walls and the post were examined for the glycerin gel, the anatomic post was fitted into the root
presence of voids and/or bubbles, and the uniformity and preparation, and irradiated by the curing light for 20 s.
morphological characteristics of the resin-dentin interdif- Then the post was removed and fully light cured for other
fusion zone were analyzed under a scanning electron mi- 20 s. The post was tried in the root canal again in order
croscope, as parameters usually assessed when judging to check for easy insertion without any interference. Copi-
the adhesion quality of the post inside the canal.5,10,17-19 ous rinsing was performed to remove excess lubricant

236 The Journal of Adhesive Dentistry


Grandini et al

Fig 1 Shape of the anatomic post in comparison


with DT posts of different sizes (DT 1, 2, and 3).

Table 1 Means and standard deviations of resin cement


thickness (in m) recorded at 1-, 4.5-, and 8-mm levels

Group 1-mm level 4.5-mm level 8-mm level


(coronal (middle (apical Fig 2 The three levels of observations: apical, middle, and coronal
third) third) third) level (original magnification 13X).

1. Control 610 67d 240 21.6c 130 10.4b


2. Anatomic posts 20 2a 40 3.6a 100 8.2b

Same superscript indicates no significant difference.

gel. Finally, the post was luted following the same tech- The differences in the cement layer thickness sur-
nique already described for group 1 specimens, which rounding the two types of posts at each of the three root
involved phosphoric acid etching of root canals, followed canal levels were tested for statistical significance (t-test,
by the application of the One-Step adhesive system and p = 0.05). In addition, within each group, the differences
Duo-Link resin cement. among the cement layer thicknesses measured at the
The sample teeth were stored in a water solution at three examined levels of the root canal were evaluated
room temperature. A week later, the root specimens were statistically (one-way ANOVA, p = 0.05). Fishers Exact
sectioned parallel to the long axis of the tooth by means test was also applied to check for statistical significance
of a diamond saw (Isomet, Buehler, Lake Bluff, IL, USA). of the differences in frequency of defects between the two
experimental groups (p > 0.05).
Resin Cement Thickness
The sections were gently decalcified (32% phosphoric
acid for 30 s, then washed and gently air dried) and RESULTS
deproteinized (immersion in a 2% sodium hypochlorite
solution for 120 s) in order to clean the surface of any The cement thicknesses measured in the two groups of
debris. Specimens were at this point dehydrated with specimens are given in Table 1.
alcohol, sputter coated with gold (Edwards, London, UK), It can be observed that the resin cement thickness
and observed under a scanning electron microscope (Phil- decreased from the apical to the coronal level in the ana-
ips 515, Philips, Amsterdam, The Netherlands) at differ- tomic samples (group 2), while the opposite occurred in
ent standardized magnifications (250X, 500X, 2300X, group 1 (Figs 3 and 4). In group 2, the greatest thickness
and 4580X for resin tags; 625X and 1310X for resin-den- of cement (ca 100 m) was seen at the margin between
tin interdiffusion zone). the coronal portion of the anatomic post and the resin
Serial SEM photomicrographs of the canal walls were composite abutment (Fig 5).
taken at the 1-, 4.5-, and 8-mm levels (500X magnifica- Statistically significant differences in cement thick-
tion) (Fig 2). The photomicrographs were aligned to form ness were found between the two groups of specimens at
a continuous horizontal examination strip at the three the coronal and the middle level of the canal (p < 0.05).
levels. Irrespective of the number of photomicrographs In addition, within the same group of specimens, cement
needed to form a complete strip, each strip was subdivid- thicknesses at the three different levels of observation
ed into eight assessment units. In each assessment were significantly different (p < 0.05). Only in the pres-
unit, two different operators in double blind evaluated the ence of anatomic posts were similar thicknesses of
resin cement thickness at the three different levels, and cement measured at the coronal and middle third of the
the presence or absence of gaps a) inside the resin canal (Fig 6) (Table 1).
cement, b) between the dentinal walls and resin cement, A good adaptation of the fiber post, relining material,
c) between the resin cement and the post. luting material, and residual dentin was observed (Fig 7).

Vol 7, No 3, 2005 237


Grandini et al

Fig 4 SEM image of group 1 sample. Abundant cement can be


seen around the fiber post (original magnification 21X). FP: fiber
post; D: dentin; LC: luting cement.

Fig 3 SEM image of group 2 sample. Low magnification image


showing the relining provided by the light-activated resin surrounding
the post (13X). Fig 5 SEM image of group 2 sample. A thicker layer (arrows) of
cement (C) is visible at the interface between the abutment and the
coronal dentin (original magnification 170X).

Voids and bubbles were often detected within the resin usually preferable, as it is repeatable. For this reason, the
cement (Table 2), as well as within the abutment in both present study employed a recently proposed quantitative
groups of specimens (Table 3). Voids and bubbles were analysis10 for the evaluation of cement thickness as well
also found between the fiber post and the resin material. as the frequency of structural discontinuities in the adhe-
Occasionally, gaps of different extension were observed sive interface, such as bubbles, voids, or gaps. This eval-
between the resin composite relining material and the uation was performed because formation of both resin
fiber post (Table 2). tags and the resin-dentin interdiffusion zone (RDIZ) con-
The differences in frequency of defects between the tribute to creating a proper mechanical bond to etched
two experimental groups were not statistically significant dentin and consequently to sealing it.19,28 TEM examina-
(p > 0.05). tion and measurement of the bond strength are the best
way to assess the quality of the resin-dentin interdiffusion
zone.23,26 However, even if the SEM evaluation of the
DISCUSSION RDIZ is not the optimal method for assessing the quality
of adhesion, it may provide quantitative information on its
SEM observations allow for a high resolution assessment uniform formation.
of the conditions of adhesion. Using SEM, the morpholog- The clinical steps needed to create the anatomic post
ical characteristics of the adhesive interface can be ana- have been described. The technique is relatively easy
lyzed either qualitatively or quantitatively. The latter is and, by adding only a few more steps to those required to

238 The Journal of Adhesive Dentistry


Grandini et al

Fig 7 Higher magnification SEM image showing the good quality of


the adhesion between relining material (RM), luting material
(between arrows) and root canal dentin (D) (original magnification
356X).

Table 2 Number of samples with presence of gaps/voids/


bubbles within resin cements along the root canal preparation

Within resin Post/resin Dentinal


cement material walls/cement

Group 1 5 0 3
Group 2 1 1 0

Table 3 Number of samples with presence of gaps/voids/


bubbles within the abutment

Within resin material Post/resin material

Group 1 8 3
Group 2 9 2

Fig 6 Voids/bubbles within the resin material


(original magnification 11X).

bond a conventional translucent fiber post, makes it pos- dardized post.14 Of course, these advantages must be
sible to achieve a superior quality of fit, as well as to con- verified by further studies, as no statistically significant
siderably reduce the thickness of the cement layer, within differences were evident between the two groups.
which the development of voids or bubbles is less likely. Compared to metallic posts, the anatomic post offers
The expected advantages of this technique can be the same advantages as all of the other fiber posts,
listed as follows: as a result of relining, the thickness of including the fact that, in case endodontic retreatment is
the cement layer is lower and constant; the formation of needed, a fiber post is more quickly and easily removed
bubbles or voids, representing areas of weakness within than a metallic post.27 In addition, in terms of chairtime
the material, is less likely in a thin and uniform layer of and costs involved in the two procedures for restoring en-
cement; the polymerization stress that develops within a dodontically treated teeth, the balance is tipped in favor
relatively thin film of cement is minimal. Furthermore, if, of fiber posts, because the use of these as opposed to
following endodontic treatment, a root canal is conical or cast posts allows bonding the post and building up the
not perfectly round, relining the anatomic post has a dis- core in only one visit, without any laboratory phase or fee.
tinct advantage: because the post adapts to the canal, Whether a light-curing cement is adequate for luting
there is no need to try to adapt the root canal to the stan- fiber posts or dual-curing materials are preferable is still

Vol 7, No 3, 2005 239


Grandini et al

a matter of debate in the literature, the heart of the issue 2. Boschian L, Galimberti B, Fadini L. A new method to evaluate the conver-
being light transmission through the post. In other words, sion of a composite resin into the root canal: HPLC [abstract 1842]. J Dent
Res 2001;80:757.
according to some authors, the amount of light that pass- 3. Boudrias P, Sakkal S, Petrova Y. Anatomical post design applied to quartz
es through the post and reaches the apical portion of the fiber/epoxy technology: a conservative approach. Oral Health 2001;11:
9-16.
post is not enough to adequately cure a light-activated 4. Boudrias P, Sakkal S, Petrova Y. Anatomical post design meets quartz fiber
resin cement.22 Other authors, however, state that trans- technology: rationale and case report. Compendium 2001;22:337-348.
mission through a translucent post is sufficient to induce 5. Chappel RP, Cobb CM, Spencer P. Dentinal tubule anastomosis: A potential
factor in adhesive bonding? J Prosthet Dent 1994;72:183-188.
polymerization in the apical portion of the post as well.2 6. Drummond JL, Toepke RS, King TJ. Thermal and cycling loading of
As far as the anatomic post is concerned, the issue of endodontic posts. Eur J Oral Sci 1999;107:220-224.
light transmission through its relining resin must still be 7. Duret B, Reynaud M, Duret F. Un nouveau concept de reconstitution
corono-radiculaire: le composiposte (1). Chirurg Dent France 1990;540:
investigated. The question of whether light absorption 131-141.
through the relining resin may negatively affect the poly- 8. Ferrari M, Vichi A, Mannocci F, Mason PN. Retrospective study of clinical
merization process of the cement can in fact be raised. behavior of several types of fiber posts. Am J Dent 2000;13:B15-B18.
9. Ferrari M, Scotti R. Fiber posts: clinical and research aspects. Milano:
Until data have been gathered that will answer the ques- Masson Ed, 2002.
tion, it remains safer and advisable to use a dual-curing 10. Ferrari M, Vichi A, Grandini S, Goracci C. Efficacy of a Self-Curing Adhesive/
resin cement for luting anatomic posts. Resin Cement System on Luting Glass-Fiber Posts into Root Canals: An
SEM Investigation. Int J Prosthod 2001;14:543-549.
Just like all of the resin-based materials, the relining 11. Ferrari M, Vichi A, Grandini S. Influence of adhesive application technique
resin surrounding the anatomic post also shrinks as it on efficacy of bonding to root canal walls: An SEM investigation. Dent Mater
cures. Although this aspect needs further evaluation, it 2001;17:422-429.
12. Fredriksson M, Astback J, Pamenius M, Arvidson K. A retrospective study
seems logical that the shrinkage should favor the extrac- on 236 patients with teeth restored by carbon fiber-reinforced epoxy resin
tion of the anatomic post from the canal after its relining. posts. J Prosthet Dent 1998;80:151-157.
The quality of the adhesion between the post and the 13. Grandini S, Sapio S, Goracci C, Monticelli F, Ferrari M. A one step procedure
for luting glass fibre posts: an SEM evaluation. Int Endod J 2004;37:
relining resin appeared good in all of the SEM images. 679-686.
This may be due to the compatibility between the two 14. Grandini S, Sapio S, Goracci C, Monticelli F, Ferrari M. Use of anatomic
postn core for the reconstruction of an endodontically treated tooth: a
materials, which have the same matrix components, as case report. J Adhes Dent 2003;5:243-247.
well as to the addition of a coupling agent (silane) at the 15. Kurtz JS, Bowles WR, Perdigao J, Geraldeli S, Hodges JS. Push-out bong
interface between the post and the relining resin. strengths of tooth-coloured posts [abstract 0425]. J Dent Res 2002;
81(special issue A):A78.
The literature does not offer an undivided opinion on 16. Malferrari S, Baldissara P, Arcidiacono A. Translucent quartz fiber posts:
the greater thickness of the resin cement layer found with a 20 month in vivo study [abstract 2656]. J Dent Res 2002;81(special
the standardized post. Some clinical studies both pro- issue A):A-333.
17. Mason PN. Bonding to root canal dentin. [Transactions of Academy of
spective and retrospective show that debonding occurs Dental Materials Meeting]. Siena, 2001:65-69.
when a thicker cement layer is present.8,12,16,25 In this 18. Mjr IA, Nordhal I. The density and branching of dentinal tubules in human
sense, it can be assumed that a more precise fit obtained teeth. Arch Oral Biol 1996;41:401-412.
19. Nakabayashi N, Pashley DH. Hybridization of dental hard tissue. Berlin:
with the anatomic post can improve this aspect, but a Quintessence, 1998.
further clinical control study would be needed to confirm 20. Rengo S, Apicella A, Ausiello P, Davidson CL. The distribution of stress in
this. carbon fiber posts restorations: a preliminary study. [Proceedings from the
3rd International Symposium]. S. Margh Ligure, Italy, 1999:60-61.
21. de Rijk WG. Removal of fiber posts from endodontically treated teeth. Am
J Dent 2000;13:19B-21B.
22. Rovatti L, Dallari A. Odontoiatria conservatrice. Milano: Hermes Ed, 2001.
CONCLUSION 23. Sano H, Takatsu T, Ciucchi B, Horner JA, Matthews WG, Pashley DH.
Nanoleakage: leakage within the hybrid layer. Oper Dent 1995;20:18-25.
The null hypothesis tested in the study was not con- 24. Sawada N, Hikage S, Sakaguci K. Shape of composite resins photopoly-
firmed. The resin cement thickness was significantly merized by the translucent post [abstract 2569]. J Dent Res 2002;(special
issue A):A-322.
lower in the anatomic post group than in the control group 25. Scotti S, Malferrari S, Monaco C. Clinical evaluations of quartz fiber posts:
(standardized posts), except in the apical third of the a 30 month result [abstract 2657]. J Dent Res 2002;81(special issue A):
A-333.
canal, where there was no statistically significant differ-
26. Tay FR, Gwinnett AJ, Pang KM, Wei SHY. Micromorphologic relationship of
ence. Although there is no scientific evidence that a thin- the resin-dentin interface following a total-etch technique in vivo using a
ner layer of cement can improve the quality of the luting dentinal bonding system. Quintessence Int 1995;26:63-70.
27. Tronstad L, Asbjornsen K, Doving L, Pedersen I, Eriksen HM. Influence of
procedure, a good adaptation of anatomic posts was coronal restorations on the periapical health of endodontically treated
evident in all of the specimens, allowing the post to main- teeth. Endod Dent Traumatol 2000;16:218-221.
tain its position during the luting procedures. The clinical 28. Vichi A, Grandini S, Davidson CL, Ferrari M. An SEM evaluation of several
adhesive systems used for bonding fiber posts under clinical conditions.
procedure for constructing an anatomic post was effec- Dent Mater 2002a;18:495-502.
tive and easy to perform.

Clinical relevance: Anatomic post and core provides


REFERENCES a better adaptation to the root canal anatomy com-
pared to a prefabricated fiber post.
1. Asmussen E, Peutzfeldt A, Heitmann T. Stiffness, elastic limit, and strength
of newer types of endodontics posts. J Dent 1999;27:275-278.

240 The Journal of Adhesive Dentistry

You might also like