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Abstract:
Objective: To evaluate the effect of 0.2% chitosan conditioning upon the pull out
bond strength of posts bonded with different cements.
Materials and Method: Sixty freshly extracted human permanent canines
with single roots were selected, instrumented with Rotary ProTaper in a
sequential manner till F4 and obturated. The post space was prepared to a
depth of 12 mm using No. 1-3 drills of the glass fibre post system. Samples
were randomly divided into 2 groups (n=30) on the basis of chelators used.
Group A: 5 ml of 17% ethylenediaminetetraacetic acid (EDTA) for 3 minutes.
Group B: 5 ml of 0.2% chitosan for 3 minutes. Each group was randomly
divided into two equal sub-groups on the basis of luting cement. Group A1
and B1: Dual-Cure resin cement: RelyX U200. Group A2 and B2: Dual-Cure
resin cement: SmartCem 2. After the cementation, the pull out bond strength
of posts was tested with universal testing machine at a rate of 0.5mm/min until
the posts separated. The results, in newtons, were analyzed with 1-way
ANOVA and independent t test ( = .01).
Results:
Highest mean pull out bond strength was observed for sub-group A1
Conclusion: The type of chelator used for post space conditioning significantly
affected pull out bond strength of glass fibre posts.
Keywords: Chitosan, EDTA, Fibre glass posts, Pull-Out Bond Strength, Selfadhesive resin cements.
INTRODUCTION
Restoration of endodontically treated teeth is often complicated because of the loss
of tooth structure by caries, restorative procedures, fractures, and endodontic access
preparation. All of these have a negative impact on a large part of the crown
structure, resulting in the need for the use of intra-radicular posts, with the aim of
increasing stability and resistance to the fracture. 1,2
Fibre reinforced resin posts have gained popularity in the last few years to restore
endodontically treated teeth. They consist of epoxy resin matrix with reinforcing glass
or quartz fibre. Important characteristics include modulus of elasticity similar to that
of dentin, ability to be cemented using an adhesive technique, superior distribution of
masticatory forces, biocompatibility, high durability, resistance to corrosion and
esthetically superior as their optical properties provide greater translucency to the
dental core.1,2
Clinical studies3,4 have reported success rates of 95 to 99% for teeth restored with
fibre-reinforced posts. The retention of fibre posts in the root canal depends on the
bond strength between the post material and a luting agent, as well as the bond
strength between the luting agent and post space dentin. 5-8 However, failures have
been reported in the form pull out of the cement and/or post restoration assembly, as
a result of lack of retention of the fibre posts. 9,10
The recent trend for luting fibre posts has been toward resin cements, because they
increase retention, tend to leak less than other cements and provide at least shortterm strengthening of the root.11 However, they are more technique sensitive and
require extra steps such as pretreatment or conditioning of the canal walls with acid
or EDTA and placing a dentin-bonding agent. 11
To overcome these limitations self-adhesive cements were introduced in 2002.
These cements do not require separate steps of etching and bonding and their main
adhesive mechanism is attributed to a chemical reaction between phosphate
methacrylates and hydroxyapatite.12
Retention of adhesive luting agents to the root canal dentin is based on several
factors of which smear layer is one of the factors. Studies have suggested that the
efficacy of the dentin adhesive mostly depends on the removal of the smear layer. 13,14
Chemical irrigation has been recommended as a regular procedure for removal of
smear
layer
in
root
canal
treatments.15
Alternate
irrigation
with
subgroups B1 and B2, the post spaces of the specimens were conditioned by
irrigating with 0.2% Chitosan solution for 3 minutes. The post spaces were then
rinsed copiously with 5 ml of distilled water to remove remnants of chelators. For
cementation of silanized post, the cement was manipulated according to the
manufacturers instructions. The cement was dispensed directly into the prepared
post space beginning apically in the root canal. The post was then covered with a
layer of cement and seated in the root canal immediately. Excess was removed with
a cotton pellet and the entire assembly was light cured for 40 seconds.
Self-cure auto-polymerizing acrylic resin was poured into cylindrical moulds and the
specimens were aligned vertically along their long axis. The pull out bond strength of
posts was tested with the help of a universal testing machine at a rate of
0.5mm/minute until the post separated from the root.
The obtained data was subjected to one way ANOVA test and Independent t test.
RESULTS
The mean force required for debonding the posts and standard deviations obtained
are shown in Table 1. Highest mean value of pull out bond strength was observed for
sub-group A1 (312.20 N).Lowest mean value of pull out bond strength was observed
for sub-group A2 (133.47).
The one way ANOVA test showed that the type of chelator used for post space
conditioning significantly influenced the bond strength of glass fibre posts (p=.000).
In addition, the type of luting cement used also demonstrated a statistically
significant difference in the post retention (p=.000) (Table 2).
No study was found in the literature to validate the effect of 0.2% Chitosan solution
as a post space conditioner on the pull-out bond strength of glass fibre posts. The
chelating effect of chitosan for endodontic applications had not been widely studied;
however adsorption, ionic exchange and chelation are probably the mechanisms
responsible for the formation of complexes between chitosan and metal ions. 26
2. Neto GPA, Pinto WRS, Klautau EB, Alves BP. Pull-out strength of
endodontically treated teeth restored with glass fiber posts of different
diameters. RGO - Rev Gacha Odontol., Porto Alegre 2011;59(4):609614.
3. Mosharraf R, Haerian A. Pull-out bond strength of a fiber post system
with two resin cements. Dent Res J 2011;8(1):S8893.
4. Schwartz RS, Robbins JW. Post placement and restoration of
endodontically
5.
treated
teeth:
literature
review.
Endod
2004;30(5):289-301.
Malferrari S, Monaco C, Scotti R. Clinical evaluation of teeth restored
with quartz fiber-reinforced epoxy resin posts. Int J Prosthodont
2003;16(1):39-44.
6. D'Arcangelo C, Cinelli M, De Angelis F, D'Amario M. The effect of resin
cement film thickness on the pullout strength of a fiber-reinforced post
system. J Prosthet Dent 2007;98(3):193-198.
7. Akgungor G, Akkayan B. Influence of dentin bonding agents and
polymerization modes on the bond strength between translucent fiber
posts and three dentin regions within a post space. J Prosthet Dent
2006;95(5):368-378.
8. Ferrari M, Vichi A, Grandini S, Geppi S. Influence of microbrush on
efficacy of bonding into root canals. Am J Dent 2002;15(4):227-231.
9. Aksornmuang J, Foxton RM, Nakajima M, Tagami J. Microtensile bond
strength of a dual-cure resin core material to glass and quartz fibre
posts. J Dent 2004;32(6):443-450.
10. Monticelli F, Grandini S, Goracci C, Ferrari M. Clinical behavior of
translucent-fiber posts: a 2-year prospective study. Int J Prosthodont
2003;16(6):593-596.
11. Mannocci F, Innocenti M, Ferrari M, Watson TF. Confocal and scanning
electron microscopic study of teeth restored with fiber posts, metal
posts, and composite resins. J Endod 1999;25(12):789-794.
of
Wuhan
University
of
Technology-Mater
Sci
Ed
2013;28(5):984-989.
24. Alkhudhairy F, Yaman P, Dennison J, McDonald N. Effect of Irrigation
Solutions on Bond Strength of Fiber Posts. 2012 (Paper 1219).
25. Takarada K. Stable adhesion to dentin. Combination of EDTA 3-2
(NH4/Fe) pretreatment and 2% 4-META/MMA-TBB resin. Shika Zairyo
Kikai 1990;9:841849.
26. Onsyen E, Skaugrud O. Metal recovery using chitosan. Journal of Chemical
Technology and Biotechnology 1990;49:395404.
27. Slutzky-Goldberg I, Maree M, Liberman R, Heling I. Effect of sodium
hypochlorite on dentin microhardness. J Endod 2004;30, 880882.
28. Silva PV, Guedes DFC, Nakad FV, Pecora JD, Cruz-Filho AM. Chitosan:
a new solution for removal of smear layer after root canal
instrumentation. Int Endod J 2013;46(4):332-338.
29. Evren Ok, Kalkan A, Ertas H, Saygih G. Comparison of bond strength of
three different self-adhesive resin cement to post and root dentin. Rezin
simanlarin balanma dayanimi 2014:62-65.
30. Baldea B, Furtos G, Antal M, Nagy K, Popescu D, Nica L. Push-out
bond strength and SEM analysis of two self-adhesive resin cements: An
in vitro. J Dent Sci 2013;8: 296-305.
31. Hiplitoa VD, Da Cunha Azevedoa L, Pivetaa FB, Vieira-Filhoa WS,
Anauate-Nettoa C, Alonsoa RCB. Effect of dentinal surface preparation
on the bonding of self-adhesive luting cements. Journal of Adhesion
Science and Technology 2014:2-18.
32. SmartCem2. Scientific compendium. Dentsply International 2008.
SUB-GROUPS
A2
A1
MEAN
STANDARD
EDTA
+ B1
B2
CHITOSAN
U200
312.20
36.356
RELYX U200
193.00
46.543
133.47
20.392
+ CHITOSAN
SMARTCEM2
137.80
20.355
DEVIATION
Table
2:
Comparison
Between
Mean
Values
of
Different
Sub-Groups
Pairs of
t - test
p Value
16.607
.000**
7.817
.000**
16.211
.000**
-4.538
.000**
Group
Group
A1 & A2
Group
A1 & B1
Group
A1 & B2
Group
A2 & B1
Group
-0.582
A2 & B2
Group
B1 & B2
** Significant values
0.565
4.208
.000**