Basic Research—Technology
Influence of Chlorhexidine Application Time on the Bond
Strength between Fiber Posts and Dentin
Doglas Cecchin, PhD,* Ana Paula Farina, PhD,* Mateus Giacomin, DDS,*
Cristina de Mattos Pimenta Vidal, PhD,† Bruno Carlini-J

unior, PhD,*
and Caio Cezar Randi Ferraz, PhD‡
Abstract
Introduction: The aim of this study was to investigate
the effects of chlorhexidine (CHX) application time on
the bond strength and durability of the adhesion of fiber
posts relined with resin composite to the root dentin.
Methods: Eighty bovine incisor roots were divided into
4 groups after root preparation: control group (irrigation
with physiological solution) and experimental groups,
CHX for 30 seconds, CHX for 60 seconds, and CHX for
120 seconds. Fiber posts relined with resin composite
were cemented with RelyX ARC. The Scotchbond Multi-
Purpose total-etching adhesive system was used in half
of the samples of each group, and the Clearfil SE Bond
self-etching adhesive system was used in the other half.
The samples were randomly divided into 2 subgroups,
24 hours of storage and 12 months of storage. All roots
were sectioned transversely, and push-out tests were per-
formed. Bond strength means were analyzed by analysis
of variance and Tukey test (a = 0.05). Failure mode was
determined by examining specimen’s surfaces under
scanning electron microscope, and its distribution was
evaluated by using c2 test (a = 0.05). Results: CHX pre-
treatment resulted in homogeneous bond strength
values at 24 hours and 12 months of storage, irrespective
of the CHX application time and adhesive system (P <
.05). A significant bond strength decrease was noticed
after 12 months of storage when irrigation was per-
formed with physiological solution in the control groups
(P > .05). Significant differences were observed for frac-
ture patterns (P < .001). Conclusions: The use of CHX
pretreatment could preserve the bond strength of the
fiber post relined with resin composite to root dentin
for 12 months, irrespective of the CHX application time
and adhesive system used. (J Endod 2014;40:2045–2048)
Key Words
Application time, bond strength, chlorhexidine, dura-
bility, fiber post, root canal
From the *Department of Restorative Dentistry, College of Dentistry, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil; †Department of Restorative
Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois; and ‡Department of Restorative Dentistry, Piracicaba Dental School, State University of
Campinas, Piracicaba, S~ao Paulo, Brazil.
Address requests for reprints to Dr Doglas Cecchin, Universidade de Passo Fundo, Campus I, Faculdade de Odontologia, BR 285, Km 171, Bairro S~ao Jos
e, Caixa
Postal 611, 99052-900, Passo Fundo, Rio Grande do Sul, Brazil. E-mail address: dgscecchin@yahoo.com.br
0099-2399/$ - see front matter
Copyright ª 2014 American Association of Endodontists.
http://dx.doi.org/10.1016/j.joen.2014.08.019
JOE — Volume 40, Number 12, December 2014
F iber-reinforced posts have been widely used for the restoration of endodontically
treated teeth. Because of the similarity in elastic behavior between fiber posts and
the residual root dentin, root fracture rarely occurs in these restorations (1). To
improve the retention of the composite core to post and tooth, prefabricated fiber posts
are cemented with adhesives and composite resin luting cements (2, 3). However,
adhesion between resin and dentin is considered to be a weak point in luting a fiber
post (4).
Current studies have indicated that the loss of integrity of resin-dentin bonds over
time is likely to be due to the degradation of denuded collagen fibrils exposed to incom-
pletely infiltrated hybrid layers (5, 6). This is attributed to an endogenous proteolytic
mechanism involving the activity of matrix metalloproteinases (MMPs) (7) found in the
coronal (8–10) and radicular dentin (11, 12). Furthermore, recent studies revealed
that cysteine cathepsins are also present in dentin, which may also contribute to the
breakdown of the exposed collagen in dentin hybrid layers and caries progression
(13, 14).
Chlorhexidine digluconate (CHX) has been proposed as an irrigant in endodontic
treatment because of its antimicrobial activity (15), substantivity (16), and also because
it does not affect the bond strength of resin composite restorations (17) and root canal
sealers to the dentin (18). According to Moreira et al (19), CHX does not promote
morphologic structure alterations in the dentin organic matrix of root dentin; thus, it
maintains the quality of the dentin substrate for later obturation or restoration of the
tooth with resin-based materials. Moreover, some studies have shown that CHX has
beneficial effects on the preservation of resin-dentin bonds by inhibiting the proteolytic
activity of MMPs in the hybrid layer (2, 3, 20–22) and that CHX can also inhibit the
activity of dentin cysteine cathepsins (23).
Both in vitro and in vivo studies have shown that CHX applied to demineralized
dentin postpones the resin-dentin degradation of adhesive interfaces, when compared
with interfaces to which no CHX is applied (2, 3, 20–22). Despite these advantages,
the use of CHX demands more chair time during the adhesive procedure, and this
contrasts with the clinician’s needs for simplification. Therefore, the aim of this
study was to investigate the effects of CHX application time on the bond strength
and durability of the adhesion of the fiber post relined with resin composite to
the root dentin by using a total-etching and a self-etching adhesive system. The tested
null hypothesis was that irrespective of the application time, CHX could not prevent
the bond strength reduction of fiber posts to root dentin after 12 months of water
storage.
Chlorhexidine Treatment for Adhesive Durability 2045
Basic Research—Technology
Materials and Methods
Specimen Preparation
Eighty freshly extracted bovine incisors with anatomically similar
root segments and fully developed apices were selected. Each tooth
was decoronated below the cementoenamel junction perpendicular
to the longitudinal axis. The roots were cut to a uniform length of 14
mm from the apical end. The apices of the teeth were sealed with a tem-
porary filling material (Cavit W; Premier Dental Produtos, Rio de Ja-
neiro, RJ, Brazil).
Pulp tissue and the predentin were removed, and the root canals
were enlarged by using #6 Largo burs (Maillefer, Ballaigues,
Switzerland) and a #130 file (Maillefer). The apical end (1 mm) was
left unprepared to prevent the apical extrusion of solutions and luting
cement. Roots were rinsed with 5 mL physiological saline solution
(NaCl) to remove remaining debris, and the roots were divided as fol-
lows: control group, no treatment; and experimental groups: the root
canals were completely filled with 2% CHX for 30 seconds, 60 seconds,
or 120 seconds. All roots were dried with paper points, and fiberglass
posts relined with resin composite were cemented as described below.
The Scotchbond Multi-Purpose (SBMP) total-etching adhesive system
was used in half of the samples of each group, and the Clearfil SE
Bond (CB) self-etching adhesive system was used in the other half.
Intracanal Restoration with Composite Resin
The intracanal restoration was done by using fiberglass posts no. 3
(Angelus, Londrina, PR, Brazil) relined with composite resin (B 0.5,
Z250; 3M ESPE, St Paul, MN). Initially, the adhesive systems were
applied into the canals according to manufacturer’s instructions. CHX
was applied after 37% phosphoric acid etching and before primer
application when SBMP was used. In the case of CB, CHX was applied
before primer application. Both adhesive systems were light-cured
for 40 seconds by using a halogen light-curing unit operated at
600 mW/cm2 (Optilux; Demetron Res Corp, Danbury, CT). Then, the
walls were lubricated with a water-soluble gel (Natrosol; Drogal Phar-
macy, Piracicaba, SP, Brazil). The posts were cleaned with 37% phos-
phoric acid for 5 seconds, washed, and dried with an air/water syringe.
Next, they were silanized twice, waiting 60 seconds after each applica-
tion. SBMP or CB adhesives were applied to the post surface and imme-
diately polymerized for 20 seconds on each side. The fiber post was
covered with resin composite and inserted into the canal, and resin
was polymerized for 20 seconds. After removing the post, polymeriza-
tion was completed outside the root canal for more than 40 seconds
(2, 3, 23).
After copious rinsing to remove the lubricant gel from the root
canal, the root canals were dried with absorbent paper points. One
additional drop of the respective adhesive system was applied onto
the root canal surface, and the excess was removed with absorbent pa-
per points before light polymerization for 40 seconds.
The dual-polymerizing resin luting material Rely X ARC (3M ESPE)
was mixed and injected into the prepared root canal with a Centrix
TABLE 1. Bond Strength Means (MPa) and the Respective Standard Deviations Obtained in Each Experimental Condition
SBMP
Groups Immediate
NaCl (control) 5.92  1.79aA
CHX for 30 s 5.89  1.37aA
CHX for 60 s 6.39  1.44aA
CHX for 120 s 6.29  1.42aA
Comparisons are only valid within each adhesive system. Means followed by different uppercase letters in same row and lowercase letters in same column are significantly different at 5% level.
2046 Cecchin et al.
syringe (Shelton, CT) by using an appropriate needle (20-gauge). Sub-
sequently, the fiber post relined with resin composite was covered with
cement and seated inside the root canal and kept under finger pressure
for 20 seconds, with the excess cement removed. The cement was light-
polymerized for 30 seconds on each surface (buccal, palatal, mesial,
and distal), resulting in a 2-minute light polymerization cycle. Speci-
mens of each group were randomly divided into 2 subgroups according
to their storage, 24 hours of water storage and 12 months storage in
water, which was renewed every 15 days.
Push-out Test: Specimen Preparation, Post Dislodgment,
and Failure Pattern Analysis
Each root was cut horizontally with a slow-speed, water-cooled
diamond saw (Isomet 2000; Buehler Ltd, Lake Bluff, IL) to produce
2 slices approximately 1 mm thick. Seven slices were obtained from
each root canal. The first slice was excluded. Thus, 6 slices were consid-
ered from each root canal (n = 30).
The push-out test was performed by applying a load at 0.5 mm/min
to the apex in the direction of the crown until the fiber post relined
segment was dislodged from the root slice. Care was also taken to
ensure that the contact between the punch tip and the fiber post section
occurred over the most extended area possible to avoid notching effect
of the punch tip on the fiber post’s surface.
The bonding area was calculated as previously described (2, 3),
and the bond strength values were expressed in megapascals (MPa).
The fractured specimens were sputter-coated with gold in a Denton Vac-
uum Desk II Sputtering device (Denton Vacuum, Cherry Hill, NJ) and
observed by scanning electron microscopy (JSM–5600LV; JEOL Ltd, To-
kyo, Japan) to classify the failure pattern into 5 types (2, 3): (1) adhe-
sive between the fiber post and resin cement (no cement visible around
the post); (2) mixed, with resin cement covering 0%–50% of the post’s
diameter; (3) mixed, with resin cement covering 50%–100% of the
post’s surface; (4) adhesive between resin cement and root canal
(post enveloped by resin cement); and (5) cohesive in dentin.
Bond strength data were analyzed by using analysis of variance and
Tukey test for post hoc comparisons (a = 0.05). The distribution of
failure patterns was evaluated by c2 test (a = 0.05).
Results
The means and standard deviations are presented in Table 1. The
statistical analysis revealed significant differences among the groups
(P < .05). Immediate groups showed similar bond strength values
with or without CHX pretreatment (P > .05). After 12 months of storage,
a significant decrease in the control group was observed (P < .05),
whereas the use of CHX preserved the bond strength in the groups
stored in water for 12 months (P < .05), irrespective of the CHX appli-
cation time and adhesive system.
A significant difference in predominant failure mode between
groups was revealed by the c2 test (P < .001). The mixed failure types
2, 3, and 4 were the predominant failures in all groups (Fig. 1). When
CB
12 mo of storage Immediate 12 mo of storage
4.38  1.34bB 6.38  0.98aA 4.15  1.15bB
5.76  1.31aA 5.66  0.47aA 5.41  1.16aA
6.02  1.38aA 6.00  1.41aA 5.80  1.53aA
6.06  1.55aA 6.01  1.54aA 5.81  1.09aA
JOE — Volume 40, Number 12, December 2014

Figure 1. Failure mode distribution in the experimental groups.
CHX was applied, a decrease in adhesive failures between resin cement
and root canal was observed after 12 months of storage for CB, with an
increase in mixed failures. For SBMP, CHX application promoted more
homogeneity in failure distribution after 12 months of storage.
Discussion
Coronal restoration quality is an important factor in the success of
endodontically treated teeth (24). Therefore, bonding of the post to the
root dentin should aim to achieve gap-free interfaces, which is indicative
of coronal seal and adequate retention (25). The results of this study
showed that CHX used as pretreatment in the root dentin does not inter-
fere with the immediate bond strength of fiber posts relined with resin
composite in any of the adhesive systems used, which is supported by
previous studies (2, 3). However, there was a significant decrease in
the bond strength values in the control after 12 months of storage, as
indicated by the degradation of the adhesive-dentin bonds over time.
On the other hand, irrespective of the application time, CHX kept the
bond strength in the long-term evaluation, thereby preserving the dura-
bility of adhesive-dentin bonds. Therefore, the null hypothesis was
rejected.
The present study confirms previous findings that resin-dentin in-
terfaces bonded with total-etching or self-etching adhesives can degrade
over time (2, 3, 5, 20–22). These findings suggest that deterioration of
the resin-dentin bonds occurred mainly as a result of intrinsic factors,
possibly because of activation of endogenous proteolytic enzymes such
as MMPs (20–22) and cysteine cathepsins, as recently speculated
(14, 26). However, the higher bond strength observed after 12
months of storage with CHX pretreatment compared with control can
be explained by the CHX-related improvement in the long-term stability
of hybrid layer integrity and bond strength that is based on MMPs’ in-
hibition (2, 3, 20–22). Carrilho et al (21) demonstrated in vivo a pro-
tective effect of CHX application against the degradation of the coronal
adhesive interface that lasted for up to 14 months after the establishment
of resin-dentin bonds. Although the presence of cysteine cathepsins was
recently demonstrated in coronal dentin (14), these enzymes are
thought to have an important role in collagen degradation (14). The
effect of CHX in preserving the bond strength values may be due to in-
hibition of dentinal cysteine cathepsins also (26). In addition, it should
be mentioned that CHX has an antimicrobial effect (15) and could inter-
fere with collagen degradation promoted by proteolytic enzymes pro-
duced by bacteria (27). Moreover, less reduction in bond strength
was observed irrespective of the application time, so one may suggest
that CHX is likely to bind to collagen fibrils at a very fast rate, and
JOE — Volume 40, Number 12, December 2014
Basic Research—Technology
thus even short periods of time such as 30 seconds seem to be sufficient
to guarantee such binding.
The long-term action of CHX can also be explained by its confine-
ment to the adhesive interface because its removal by the dentinal fluid
outflow is likely minimized by the formation of resin tags that obliterate
the tubules. The adhesive monomers that envelop the collagen fibrils
treated with CHX, as well as the presence of an adhesive layer on the
hybrid layer, can also contribute to the preservation of CHX at the
interface and prolong its inhibitory action (20, 21). Substantivity of
CHX, or its ability to be retained in dentin matrices (16), could be
another reason why CHX-treated dentin may form more stable hybrid
layers.
Previous studies investigated the effects of CHX treatment associ-
ated or not with ethanol. The ethanol wet-bonding technique and
CHX in combination or not preserved the bond strength of the self-
etching adhesive system (2); on the other hand, they did not preserve
the bond strength of a total-etch adhesive system (3). Similar results
were reported by Manso et al (28), which showed that the combined
use of ethanol/1% CHX diacetate did not stabilize bond strengths after
15 months by using 2 total-etching adhesive systems. Dentin degrada-
tion caused by endogenous enzymes after 12 months of storage is rein-
forced by these findings.
Regarding the fracture analysis, it should be emphasized that the
predominant types of failure in all groups were adhesive and mixed,
implying homogeneity in failure distribution. The decrease in adhesive
failures indicates superior quality of the bond when CHX was applied
before the use of CB. This suggests that the bond between the resin
cement and root canal dentin was less affected than in the groups
with no pretreatment with CHX.
Conclusion
Despite the limitations of the present study, the use of CHX pre-
treatment could preserve the bond strength of the fiber post relined
with resin composite to root dentin for 12 months, irrespective of
CHX application time (30, 60, or 120 seconds) and of the adhesive sys-
tem used.
Acknowledgments
The authors thank Angelus for donating the fiber post and FA-
PERGS Foundation-Brazil for financial support through grant
2010/00100-7.
The authors deny conflicts of interest related to this study.
Chlorhexidine Treatment for Adhesive Durability 2047
Basic Research—Technology
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