Journal of Dental Medicine

Background and Aim: The structural rehabilitation of a pulpless tooth is critically important to ensure a successful restorative outcome following endodontic treatment. A post and core is often indicated for the retention and reinforcement of the final restoration. But, the clinical situation is significantly challenging if the root exhibits immature development or there is a thin root wall that can compromise the prognosis for a long- term successful treatment. The purpose of this in vitro study was to evaluate different methods of intraradicular reinforcement in structurally compromised roots.

Materials and Methods: In this experimental study, seventy two extracted intact maxillary central incisors with similar size, shape and root anatomy were selected. After root canal therapy in 60 teeth, an acrylic laboratory bur was used to thin the cervical area and simulate the thin dentinal walls of immature teeth. The preparation was performed through the palatal access and extended 5mm apical to CEJ. The remaining 12 teeth remained unprepared to serve as positive control group. Cases were randomly divided into six groups of 12 teeth each and restored as follows. In the 12 cervically unprepared teeth (positive controls) the composite resin with dentin bonding agent (DBA) was placed in access cavity and cured for 120 seconds. This technique was also applied to other groups when the access was restored with composite. In the second group, the access cavity was restored with composite only to the level of CEJ. In the third group the cervically prepared teeth were reinforced with cement resin (Enforce) and a prefabricated post was placed in 5mm apical to the CEJ. In the fourth group, the cervically prepared teeth were reinforced with composite resin and DBA by a clear plastic post. In the fifth group the cervically prepared teeth were reinforced with composite resin and dba and a cast post. In the sixth group the cervically prepared teeth were restored with composite resin and dba with a prefabricated post. All of the specimens were mounted by rubberized technique and tested in the Instron universal testing machine. The fracture loads in samples were analyzed with ANOVA and Duncan tests with p<0.05 as the limit of significance.

Results: Significant differences in fracture resistance were observed between the first and second groups compared with others. The highest fracture resistance values were recorded for first group while the lowest were registered for the second group. Fracture resistance of the third, fourth and fifth groups had no significant statistical differences with others and fracture resistance of sixth group was the highest with significant difference (P<0.05).

Conclusion: From this study, it may be concluded that the use of a dba and a composite resin in thin-walled roots reinforces the immature teeth and facilitates the use of post.

Background and Aim: Microleakage has been always a major concern in restorative dentistry. The curing contraction of composites still presents a problem with controlling microleakage and postoperative sensitivity. The aim of this study was to investigate the effect of flowable and dual-cure resin composite liners on gingival microleakage of packable resin composite restorations.

Materials and Methods: Sixty Class II cavities with cervical margins 1 mm below the CEJ were prepared in 30 extracted human molars. The teeth were randomly divided into five groups of 12 each. In control group, each tooth was restored incrementally with Tetric Ceram composite without applying any liner. In the second and forth groups, flowable materials- Tetric Flow and dual-cure composite resin cement Relay X ARC were placed respectively as a 1-mm thick gingival increment and cured before the resin composite restoration, whereas, in the third and fifth groups liners were cured with the first increment of packable composite.The restored teeth were stored for one week in distilled water at 37⁰C, and thermocycled between 5⁰C and 55⁰C, sealed with nail varnish except the tooth - composite interface in cervical restoration margins and immersed in 2% basic fuchsin for 24 hours. Dye penetration was evaluated using a stereomicroscope with 28x magnification. The data were analyzed by Kruskal-Wallis and Mann-Whitney U-tests with p<0.05 as the level of significance.

Results: The results of this study indicated that there were significant statistical differences between control - cured flowable liner, control-flowable liner without separately curing, control-cured dual cure composite resin cement groups.However there were no significant differences between dual-cure composite resin cement without separately curing-control,cured flowable liner-cured dual cure composite resin cement, flowable liner without separately curing-dual cure composite resin cement without separately curing groups.

Conclusion: The results of this study indicated that none of techniques could thoroughly eliminate microleakage in gingival floor, however the effect of flowable or a dual-cure liner on reducing the gingival microleakage was found to be statistically significant in tested restorative material.

Background and Aim: Fractured anterior teeth can be restored by adhesive bonding of the separated fragment to the remaining tooth structure. This invitro study evaluated the force required for fracture of rebonded fragments which were dried and rewetted for various time intervals prior to bonding.

Materials and Methods: One hundred and eight human mandibular incisors were selected and were divided into 9 groups and then were fractured. The fragments were stored in air at room temperature and ambient humidity. They were air dried for 30 minutes in group 1, 2 and 3,  6 h in group 4 and 5,  24 h in group 6 and 7, and 3 days in groups 8 and 9. The apical parts of the fractured teeth were stored in water.After storage in air, each fragment in group 1 was bonded to the remaining apical tooth structure with a bonding agent and flowable composite.In groups 2, 4, 6 and 8 after air drying the fragments were stored in water for 30min. The time of storage in water in groups 3, 5, 7, 9 was 24 hours. Then each fragment was bonded to the apical part structure. The mean force required for fracture was measured by a mechanical testing machine. One way ANOVA and Tuckey tests were used for analysis.

Results: There were statistically significant differences between different groups (p<0.001).The highest and lowest force required for fracture belonged to groups 3 and 8 respectively. The force required for fracture in group 1 was lower than group 2, 3, 5 and 7 and 9 and more than groups 4,6 and 8 with significant differences.While there were no significant differences among groups 3, 5, 7, 9 and 4, 6, 8 the force required for fracture in groups 2, 3, 5, 7 and 9 was more than 4, 6, 8 with significant differences.

Conclusion: This research revealed that the force required for fracture was affected by air storage of fragments prior to bonding. Also showed that with an increase in duration of drying the force required for fracture decreased and after a period of time it becomes steady. This study showed that in order to increase the fracture strength after air drying the fragment should be immersed in water for at least 24 hours prior to bonding.

Background and Aim: As composite-dentin bond strength is affected by cavity preparation and the bond strength of composite resin to new and used bur prepared dentin has not yet been evaluated, this study evaluated the effects of cutting dentin with different cutting efficacy (new and used) of burs on composite-dentin shear bond strength using self-etching primer bonding system and total etching bonding system.

Materials and Methods: Sixty caries free human 3rd molar were sectioned in occlosal surface to expose dentin, then polished with silicon carbide paper and randomly divided into four groups. Each group was prepared in a depth of 0.5mm of dentin, using new diamond bur, or used diamond bur. To change into a used bur, each new rough diamond bur had to work on bovine enamel for 30 minutes, under a load of 150g. Then, each group was bonded, using a total etch adhesive (single Bond) or a self etch adhesive (clearfil SE Bond) So there were 4 groups : 1-SE Bond, New bur 2-SE Bond , used bur 3-Single Bond , New bur 4-Single Bond, used bur. Similar composite capsules(Filtek Z250) were bonded to dentin surface and cured. specimens were stored in physiologic saline for 48h at 37⁰ c , then put under shearing load to define composite - dentin shear bond strength. Results were interpreted via statistical analysis (T-test & two - way variance).

Results: Shear bond strength of each group was as follows: 1-(27.3Mpa), 2-(33.5Mpa), 3-(16.9Mpa) 4-(19.3Mpa). Statistical analysis proved that shear bond strength of used diamond bur prepared groups (2,4) was more than new diamond bur prepared ones (1,3). This statistical difference, specially, was seen between SE Bond groups (1,2) but not between single Bond groups (3,4). Also, shear bond strength of (SE Bond) bonded groups (1,2) were more significantly than (single Bond) bonded ones (3,4).

Conclusion: This study show that Bur cutting efficiency influences composite - dentin shear bond strength especially when the adhesive is SE Bond (used bur> new bur) Also type of adhesive affects on composite - dentin shear bond strength. (SE Bond > Single Bond).