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Bond Strengths of Custom Cast and Prefabricated Posts Luted with Two Cements

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Bond Strengths of Custom Cast and Prefabricated Posts Luted with Two Cements QUINTESSENCE INTERNATIONAL Bond strengths of custom cast and prefabricated posts luted with two cements Khalil Ibrahim Aleisa, BDS, MSc1 Objective: This in vitro study evaluated the bond strength of custom cast and prefab- ricated posts luted with resin or zinc phosphate cements into unobturated canals of extracted teeth. Method and Materials: Forty-eight custom cast and prefabricated posts were placed into extracted single-rooted human teeth. Post-cavity preparation was 1.5 mm in diameter and 10 mm in depth. Specimens were randomly divided into 4 groups of 12 each. Two of the groups were then luted with resin cement, while the other two groups were luted with zinc phosphate cement. A pull-out bond strength evaluation was performed using a universal testing machine. The Kolmogorov-Smirnov test was used to prove normal distribution. Data were statistically analyzed using two-way ANOVA and the Student t test (α = .05). Results: For both luting agents, the prefabricated posts group exhibited significantly less bond strength than the custom cast posts group (P = .0001). There were statistically significant differences in mean bond strength for the prefabricated posts group luted with resin cement vs the group cemented with zinc phosphate cement (P = .002). There was no significant difference between the mean bond strength values of custom cast posts luted with resin cement or zinc phosphate cement. Conclusion: Custom cast posts showed significantly greater bond strength than prefabricated posts when luted with either resin or zinc phosphate cements. The type of cement had less sig- nificance on the retention of custom cast posts. (Quintessence Int 2011;42:e31–e38) Key words: adhesive resin cement, bond strength, cast post, prefabricated Parapost, zinc phosphate cement Posts are often used to retain a core in end- merizing resin that in turn is cast in either odontically treated teeth that have minimal precious or nonprecious metal alloys.14 remaining tooth structure.1 Retention of the Prefabricated posts are either tapered or post in the root is one important consid- cylindrical in shape and made of metallic or eration.1 Length,2–4 diameter,3,5,6 geometric nonmetallic materials.1,14 design, and surface configuration of posts2–4,6; Laboratory studies showed that pas- coronal preparation after cementation7–9; type sive smooth tapered posts are the least of root canal sealers used for obturation10–12; retentive.2–5 However, on the other hand, and type of luting agents used3–13 are some several clinical studies have shown an factors that affect the retention of posts. excellent survival rate of custom cast Generally, posts can be classified as posts and cores.15–17 Gluskin et al16 found custom cast or prefabricated. Custom cast that the traditional custom cast post was posts reproduce the morphology of the less likely to result in a catastrophic root prepared canal by using wax or autopoly- fracture. In addition, cast posts had bet- ter retention than prefabricated posts.16 Moreover, Balkenhol et al17 analyzed 802 1 Assistant Professor, Department of Prosthetic Dental Sciences, custom fabricated cast posts and cores College of Dentistry, King Saud University, Riyadh, Saudi Arabia. using a standardized technique and Correspondence: Dr Khalil Aleisa, PO Box 60169, Riyadh 11545, reported a cumulative failure of 11.2% Saudi Arabia. Email: [email protected], drimplant_ [email protected] over 10 years. VOLUME 42 • NUMBER 2 • FEBRUARY 2011 e31 © 2010 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. QUINTESSENCE INTERNATIONAL Aleisa Even though custom-made metallic METHOD AND MATERIALS posts have several advantages, there are now many concerns in regard to the asso- Tooth preparation ciated inhomogenous stress distribution, Forty-eight single-rooted mandibular sec- biologic adverse effects due to microleak- ond premolars extracted for orthodontic age and corrosion, and the influence of their reasons were selected for this study. Teeth dark color under all-ceramic restorations.4,18 were subjected to radiographic and micro- The introduction of nonmetallic fiber- scopic examination and were stored in a reinforced composite (FRC) posts helped dark container in 0.5% Chloramines T at to improve the stress distribution issue 4°C and used within 6 weeks of extraction. as their elastic modulus is similar to that Teeth were decoronated 2 mm coronal to of dentin.19–22 Although fiber posts proved the most incisal point of the cementoenamel effective in withstanding compressive loads junction (CEJ) using a low-speed diamond in posterior teeth,23,24 they behave differently saw (Isomet 2000, Buehler) under copious in anterior teeth where nonaxial forces pre- water cooling. vail and flexural behavior plays an important Endodontic treatment of the root canals role.25 was performed following the conventional In fixed prosthodontics, the cement procedure of using hand instrumentation functions as a luting and intermediate with K-files (LD Caulk Division, Dentsply) agent, where the stresses are distributed sequentially from size 15 through 50. Each evenly throughout the root surface.26 A file was used five times and then discarded. number of studies have investigated the The root canals were left unobturated. The effects of cement on post retention.3,5,27–34 preparation for post spaces was performed Early studies reported no significant dif- with Peeso reamers (Pulpdent) sequentially ferences in post retention with zinc phos- from no. 1 through 5 to a depth of 10 mm. phate, polycarboxylate, or glass-ionomer A new Peeso reamer was used for every 10 cements.3,5,13 teeth. A standard dimension of post spaces Recently, the use of resin-based lut- was prepared using a no. 6 parallel-sided ing agents has become widely accept- Parapost twist drill (Parapost Black P-42, ed.27–34 Several studies have reported a Whaledent) at low speed. The resultant significant increase in bond strength with post space was 1.5 mm in diameter and resin cements compared to conventional 10 mm in depth. Water irrigation was used luting cements.27–30 Sen et al27 showed that during instrumentation to clean debris from Paraposts (Whaledent) cemented with zinc the canal. Radiographs of the specimens phosphate cement had significantly less were taken mesiodistally and buccolingual- bond strength than those luted with adhe- ly to ensure a minimum of 1 mm of tooth sive resin cements. However, other reports structure thickness around the post space. have not confirmed these findings.6,12,13,31–34 Throughout all root canal therapy and post Turner13 compared the retention of cast space preparations, teeth were held in a posts cemented with different luting agents gauze sponge soaked in saline to maintain and found that posts luted with zinc phos- moistness. phate cement had the highest retention. Leary et al32 found that there was no sig- nificant difference in bond strength between Post preparation zinc phosphate cement and resin cement. After preparation, the teeth were randomly The purposes of this study were (1) to divided into 2 equal groups of 24 each investigate the effect of two types of den- (which were both later split into two groups tal cement materials on the bond strength of 12). In group 1, a no. 6 parallel-sided, of two metal post systems (cast post and vented prefabricated post (Parapost EP one prefabricated Paraposts) and (2) to 44-6-12, Whaledent) was used. All posts compare the bond strength of custom cast were passively fit when completely seated posts with prefabricated Paraposts. in their respective canals before luting. In group 2, Parapost serrated, cylindrical, vented, plastic burnout post patterns (Black 32 VOLUME 42 • NUMBER 2 • FEBRUARY 2011 © 2010 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. QUINTESSENCE INTERNATIONAL Aleisa Table 1 Study materials Material Description Dual-cure adhesive resin Bisphenol-A-diglycidylether dimethacrylate (BisGMA) and triethylene glycol cement (Rely X ARC, 3M ESPE) dimethacrylate (TEGDMA) polymer Zinc phosphate cement Zinc oxide (powder) and buffered solution of phosphoric acid (liquid) (Kleio, Lascod) Prefabricated stainless steel No. 6 parallel-sided, vented stainless steel post; not sandblasted post (Parapost 44-6-12, Whaledent) Plastic post (Parapost Black Serrated, cylindrical, vented, plastic burnout post patterns P-50-6, Whaledent) Base-metal alloy Nickel 63.4%, chromium 21.6%, molybdenum 8.4%, niobium 4.2%, iron (Bellabond, Bego) 2.2%, and aluminum 0.2% P-50-6, Whaledent) were positioned in their Post application respective prepared canals. Posts were Materials tested in this study are summa- sprued, invested using phosphate-bonded rized in Table 1. The specimens in each investment material (Bellavest T, Bego), group were further randomly divided equal- and then cast in fresh base-metal alloy ly into two subgroups of 12 each. The posts (Bellabond, Bego) using an induction cast- in the first group were cemented with zinc ing machine (Fornax 35 EUM, Bego). The phosphate cement (Kleio, Lascod) and in castings were examined under 10× mag- the second group with a dual-cured adhe- nifications to detect casting defects. Each sive resin cement (Rely X ARC, 3M ESPE). casting was placed on the respective tooth The canal surface preparation and mixing to verify its fit and adjusted if needed using and handling of the cements were both a no. ½ round carbide bur with a high-speed accurately performed according to the man- handpiece. Finally, only cast posts were ufacturers’ instructions. Light curing was sandblasted with 50 μm aluminum oxide. carried out using a halogen light-polymer- izing unit (Astralis 10, Ivoclar Vivadent) at Sample preparation 750 mW/cm2.
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