Introducción A La Rehabilitación Posendodóntica 2 (2018)

REHABILITACIÓN POSENDODÓNTICA (Parte 2)
Anclajes intraradiculares
Dr. Alejandro Bertoldi Hepburn
2018
Cátedra de Endodoncia - FOUBA
Prof. Titular Dr. Pablo Rodríguez
Buenos Aires - Argentina
Los anclajes intra radiculares cumplen Varias funciones
elementales en la rehabilitación posendodóntica:
4
1.Conectar la porción radicular con la restauración coronaria cuando el
remanente coronario no pueda hacerlo por ser escaso o poco resistente
2.Apuntalar la porción coronaria ante fuerzas no axiales (función habitualmente
necesaria en el sector anterior y en dientes pilares PFP u otras estructuras).
3.Sellado hermético del conducto radicular
4.Algunos pernos mejoran el patrón de fractura en algunas piezas anteriores o
posteriores: actúan como disipadores de fuerzas evitando que éstas se
concentren en puntos específicos
Clasificación de anclajes intraradiculares
1.Metálicos colados
2.Preformados • Metálicos
• No metálicos • Cerámicos
• Base o matriz orgánica reforzados con
fibras (PERNOS DE FIBRA - POSTES)
Los pernos metálicos colados
siguen siendo los más
empleados …
!
Estéticos
Mecánicos
Técnicos
…pero presentan varios inconvenientes que pueden afectar el

proceso de rehabilitación
PERNO MUÑONES METÁLICOS -
LIMITACIONES ESTÉTICAS
Inconvenientes estéticos asociados a PMC

R!
TA
AL
NF Preparaciones
DE
dentarias sin
NATURALIDAD:
UE
decoloraciones
P
+
NO
Materiales
semitranslúcidos
RESTAURACIONES SOBRE PERNO COLADOS
METÁLICOS - LIMITACIONES ESTÉTICAS
Una ecuación muy conocida…
Oscuridad + opacidad + decoloración sobre el núcleo ó la raíz =

Resultados no naturales y/o alteraciones ópticas en las restauraciones
PERNO MUÑONES METÁLICOS -
LIMITACIONES ESTÉTICAS
1. Todas las aleaciones metálicas son opacas (bloquean la transmisión de luz)

2. Muchas aleaciones empleadas para su elaboración son oscuras
3. Todas las aleaciones no nobles presentan corrosión y tiñen en grados variables los tejidos que los rodean
Texto
Cuando la corrosión tiñe los tejidos y se presentara

una recesión gingival, es común observar
márgenes oscuros que afectan estéticamente
PERNO COLADOS METÁLICOS -
LIMITACIONES MECÁNICAS
Inconvenientes mecánicos
Una Asociación Criminal…
A. Habitualmente se genera un importante desgaste

de dentina para preparar el lecho para el perno
B. Alto módulo de elasticidad (rigidez: poca o nula
capacidad de flexión) del perno
Solomon CS, Osman YI. In vitro comparison of endodontic posts in structurally compromised roots of maxillary
incisors. SADJ. 2011. 66:220-223
A Preparar un lecho para cualquier tipo de perno
implica remoción de dentina y
debilitamiento estructural de la raíz
Por razones técnicas y mecánicas, con los
pernos metálicos colados los lechos
suelen ser sobreextendidos ocasionando
mayor desgaste de tejidos y
debilitamientoo radicular
A
Pernos metálicos colados - Sobre extensión de los lechos radiculares
Después de terminar la obturación endodóntica, el

conducto no se debería ensanchar adicionalmente
para alojar al perno…
Robbins JW. Restauración de Dientes Tratados Endodónticamente. En: Schwartz R, Summit J y Robbins W, editores. Fundamentos en Odontología
Operatoria. Colombia: D´Vinni Editorial Ltda; 1999. p. 321-36.
A
Pernos metálicos colados - Sobre extensión de los lechos radiculares
Pero no es eso lo
que habitualmente
se hace!
Robbins JW. Restauración de Dientes Tratados Endodónticamente. En: Schwartz R, Summit J y Robbins W, editores. Fundamentos en Odontología
Operatoria. Colombia: D´Vinni Editorial Ltda; 1999. p. 321-36.
Pernos metálicos colados - Por qué se sobre extienden los lechos?
Al ser más grueso, el perno
La toma de metálico mejora
impresiones es más
sencilla
proporcionalmente su
resistencia a la fractura
Se producen
menos
distorsiones al
vaciar el modelo
La elaboración del perno (inclusión en revestimiento,

colado del metal) es más simple y precisa
El módulo de elasticidad de los pernos
A+B=
B
metálicos oscila entre 80 y 200 GPa. El de la
dentina radicular, entre 15 y 18 GPa (hasta 10
veces menor)
Existe una flexión no uniforme entre el

perno y la raíz que lo contiene
Se produce concentración de fuerzas en

áreas puntuales del lecho (variable según la
cantidad de remanente coronario;
normalmente es en el ápice del perno)
Las estructuras metálicas son isotrópicas (conservan su
módulo de elasticidad independientemente del
ángulo de incidencia de la carga). El ME varía de 80

a 200 GPa
B
Los pernos de fibra son estructuras
anisotrópicas, varían su ME
según el ángulo de incidencia
de la fuerza: el ME varía de 13 a
47 GPa comportándose muy
parecido al ME de la dentina
humana
A+B+C
Punto de concentración de fuerzas
(ápice del perno) = fisuras/fracturas
Gentileza Dr. Ricardo Portigliatti
LIMITACIONES TÉCNICAS
Inconvenientes técnicos
La técnica del perno metálico colado demanda 3 sesiones clínicas. 1 correspondiente al TE y 2

para la confección y fijación del perno: mucho tiempo (e incomodidad) / menor ganancia
Permanece gran parte del
conducto desobturado durante
lapsos variables: eventual

contaminación e irritación
periapical (estrecha relación con
la calidad y cantidad del sellado
coronario temporal y de la
obturación endodóntica
remanente).
PROBLEMA ESPECIALMENTE
SERIO EN CASO DE
CONDUCTOS LATERALES
• No son estériles (de hecho, están muy contaminados!)
Enterococo faecalis
Images belong to Dr. Pablo Ensinas (Argentina)

•Normalmente no se emplea el dique de goma cuando se preparara el

lecho para el perno o cuando se lo cementa: riesgo de contaminación
• El riesgo de contaminación al no aislar con GD

es mayor ante la presencia de conductos
laterales y deficientes obturaciones apicales
204 dientes evaluados. En 30 emplearon dique de goma en la
cementación de postes y en 174 no la usaron
Control con un promedio de 2.7 años  
Sin GD 73.6% de Exitos 
Con GD 93.3% de Exitos
Goldfein J et al. J Endod 39:1481,2013
Muy frecuentemente el
perno no ocupa
completamente su lecho,
dejando un espacio donde
pueden existir bacterias y
en algunos casos irritar los
tejidos periapicales.
Además, es posible la
existencia de conductos
laterales lo que dejaría el
conducto en contacto con
los tejidos periapicales
INVESTIGACIÓN - ENDODONCIA
Evaluación del grado de filtración a nivel de los

conductos laterales y su relación con el material

de obturación, luego de la instalación de anclajes •Controlar radiográficamente el adecuado asentamiento del anclaje
intrarradiculares
Evaluation of the degree of leakage in the lateral canals intrarradicular de manera previa al cementado, a fin de evitar la
and its relationship with the filling material after luting
intraradicular posts Presentado: 22 de julio de 2016
Aceptado: 18 de agosto de 2016
presencia de espacios vacíos dentro del conducto radicular.
Marcela Roitman, Gonzalo García, Fernando Goldberg
Cátedras de Endodoncia I y II, Escuela de Odontología, Universidad del Salvador / Asociación Odontológica Argentina • Rehabilitar con un poste preformado en la misma sesión del
Resumen
Objetivo: Evaluar el grado de filtración en conductos la-
terales simulados y su relación con el material de obturación,
luego de la instalación de anclajes intrarradiculares.
Materiales y métodos: Se utilizaron 30 premolares
el material de obturación endodóntico. Se procedió de igual
forma que en el Grupo 1, sólo que el tallado del conducto late-
ral simulado se realizó antes de la obturación endodóntica, de
modo que éste estuviese obturado con alguno de los materiales
tratamiento endodóntico, para evitar así la temporización y el riesgo de
posibles filtraciones.
humanos cuyos conductos radiculares se instrumentaron con de obturación endodóntica empleados. Grupo 3: Conducto late-
ProTaper Universal (Dentsply Maillefer, Ballaigues, Suiza) ral vacío. Se procedió como en el Grupo 1, sólo que el tallado
hasta F3 y se dividieron aleatoriamente en tres grupos. Gru- del conducto lateral simulado se realizó después del cementado
po 1: Conducto lateral obturado con el medio de cementado de los postes de fibra de vidrio, de modo que estuviese vacío.
de resina SmartCem 2 (Dentsply, De Trey, Konstanz, Alema- Se pintaron las superficies radiculares con esmalte para uñas,
nia). Los conductos radiculares fueron obturados con un cono excepto la zona de la salida del conducto lateral simulado, y
• Utilizar siempre aislamiento absoluto al momento de cementar el

de gutapercha F3, conos accesorios y termocompactados con se instalaron verticalmente en un enrejado metálico contenido
Guttacondensor #45 (Dentsply Maillefer, Ballaigues, Suiza). en un recipiente plástico con azul de metileno al 2%, con las
Como sellador se empleó AH26 (Dentsply De Trey, Konstanz, porciones radiculares que incluían el conducto lateral simulado
Alemania). A continuación se realizó la preparación para poste sumergidas en el colorante. En esas condiciones, se mantuvie-
con fresas de Largo (Dentsply Maillefer, Ballaigues, Suiza) #1, ron en estufa a 37 °C y 100% de humedad durante 72 horas.
anclaje intrarradicular, descontaminando o pretratando la dentina

2 y 3 y taladros preparadores del poste por emplear. Se talló Posteriormente, se lavaron los especímenes y se desgastaron
un conducto lateral simulado por mesial de cada muestra, a 6 mm por la cara vestibular con discos de carburundum y de papel
del borde coronario. Se cementaron en cada conducto postes hasta descubrir el conducto lateral simulado, y se observaron
orgánicos de fibra de vidrio cilíndricos Glass Post (Densell/ con una lupa a 2,5X. Para la evaluación se estableció la siguien-
GDK, Buenos Aires, Argentina) con cemento resina SmartCem 2 te categorización ordinal: 0. Sin filtración en el conducto lateral
radicular, según las indicaciones del material de cementado.

(Dentsply De Trey), introducido a la preparación intrarradicu- simulado; 1. Colorante en el interior del conducto lateral simu-
lar con un Lentulo (Dentsply Maillefer, Ballaigues, Suiza) a lado; 2. Colorante en el interior del conducto lateral simulado
baja velocidad. La resina se fotopolimerizó a través del poste y en las paredes del conducto principal. Para el análisis estadís-
durante sesenta segundos con una lámpara halógena Ultralux tico, se realizaron las pruebas de Kruskall-Wallis y de Dunn.
EL (Dabi Atlante, Riberão Preto, San Pablo, Brasil). En estas Resultados: La filtración fue mayor en el Grupo 3
condiciones el conducto lateral simulado quedaba obturado con que en los Grupos 1 y 2, con diferencias estadísticamen-
la resina cementante. Grupo 2: Conducto lateral obturado con te significativas (p<0,001). Entre los Grupos 1 y 2 no se
110 Roitman M, García G, Goldberg F. Evaluación del grado de filtración a nivel de los conductos laterales y su relación
con el material de obturación, luego de la instalación de anclajes intrarradiculares. Rev Asoc Odontol Argent 2016;104:110-115.
Roitman M, García G, Goldberg F. Evaluación del grado de filtración a nivel de los conductos laterales y su relación con el
material de obturación, luego de la instalación de anclajes intrarradiculares. Rev Asoc Odontol Argent 2016;104:110-115.
La remoción del perno para un retratamiento endodóntico es
difícil y muchas veces riesgosa
Pernos metálicos colados - Ventajas
•Técnica conocida y de fácil acceso

•Estructuras individualizadas: logran íntimo contacto con las paredes del lecho
radicular - traba mecánica primaria
•La sección del perno no suele ser redonda: no hay posibilidad de rotación
•Cementación convencional: pocas variables en juego (técnicas más exitosas)
•Alta radiopacidad
•Forman una sola pieza con el núcleo (muñón)
LAS DESVENTAJAS PREVALECEN AL TRABAJAR CON PMC
El dentista que
piensa...
Y entonces?
A
S
R R
V S O
A A
L E PT
P
1
O AL E
O IP C
ID Muchas veces el uso de pernos - y sus

N C N
O
inconvenientes asociados - se evitarán si se

R 3C
IN
emplearan sólo donde están

correctamente indicados (recuerde las
P
indicaciones!)
Goreig AC et al (1983) hacen énfasis en que no todos los dientes tratados

endodónticamente requieren pernos o coronas
Goreig AC, Mueninghoff LA. Management of the endodontically treted tooth. Part I: Concept for restorative designs. Journal of Prosthetic Dentistry 1983;49(3):340-5.
A
S
R R
V S O
A A
L E PT
P
2
O AL E
O IP C
ID
N C N
Si precisara de un perno (recuerde las

O
R 3C
indicaciones!!!), los pernos de fibra

IN
ofrecen ventajas mecánicas,

P
estéticas y técnicas
Pernos de fibra
Generalidades
Una matriz de resina mantiene unidas distintos tipos de fibras

(vidrio y cuarzo son actualmente las más comunes)
Pernos de fibra
Ventajas 1. Perno preformado
2. Perno de resina (base orgánica) reforzado con

fibra (PBORF)
3. Permite un trabajo continuo y coherente con el tratamiento

endodóntico
• TRABAJO EN UNA SESIÓN CLÍNICA: se ahorran tiempo y costos
•NO HAY OBTURACIÓN PROVISORIA: el conducto nunca queda sin sellado. El riesgo de contaminación se
reduce o elimina
• NO HAY IMPRESIONES: no hay necesidad de sobre extender el lecho para facilitarlas. También ayuda a
emplear el dique de goma lo que a su vez mejora el acceso, visibilidad, separa tejidos blandos, permite
el uso de aparatología más compleja para el tratamiento y reduce riesgo de contaminación
• MAYOR CONSERVACIÓN DE TEJIDOS: el protocolo de instrumentación de un perno preformado conlleva
a menor desgaste de tejidos, y así colabora con el mejor rendimiento mecánico del diente
POR SER UN PERNO PREFORMADO

• NO HAY RELACIÓN DIRECTAMENTE PROPORCIONAL ENTRE EL CALIBRE Y LA RESISTENCIA: se remueve menos dentina
radicular porque no se sobrextiende el lecho
• COMPORTAMIENTO ELÁSTICO SIMILAR AL DE LA DENTINA: se deforman en conjunto con el diente; no hay
concentración de estrés sobre puntos específicos de la raíz. Actúan como disipadores de fuerzas mejorando el
pronóstico mecánico en algunas piezas contras restauraciones sin pernos de fibra, o en comparación a pernos
rígidos como los metálicos o cerámicos
• ASPECTO ÓPTICO NATURAL: La mayoría de los pernos de fibra no son oscuros u opacos. Mejor estética sobre el
muñón, raíz y encía
• MENOS PROPENSOS A LA CORROSIÓN (ataque electroquímico del entorno sobre un material): mejoran aspectos
estéticos y previenen inconvenientes mecánicos sobre el perno y la raíz
POR SER UN PERNO DE Resina reforzado con FIBRA (PBORF)

• La instrumentación radicular, en especial cuando es mecanizada, deja al conducto con una
conformación muy cercana a la que precisará el perno (en especial en su porción más apical) lo
que colabora con la posibilidad de su inserción en la misma sesión del tratamiento endodóntico
Trabajo continuo tratamiento endodóntico - inserción

perno de fibra
A
S
R R
V S O
Los pernos de fibra tienen
A A
L E PT
P
O AL E
limitaciones.
3
O IP C
ID En gran medida, esas

N C N
O
limitaciones podrán ser

R 3C
IN
superadas con (A) una

P
correcta selección del perno

acorde a ciertas propiedades y
(B) con el empleo de algunas
técnicas clínicas
Pernos de fibra - Desventajas Fracturas
2
Desprendimientos
Pernos de fibra - Desventajas
Desprendimientos
Después de la preparación del
lecho, los pernos de fibra no
suelen presentar retención
por traba mecánica (no hay
adaptación íntima entre ambas
superficies), y su sección es
redonda.
Estos factores los predispone
al desalojo
EXISTEN 3
MECANISMOS
PARA LA
RETENCIÓN DEL
PERNO
1
La traba mecánica primaria proviene de la fricción
superficial que desarrollen el perno y las paredes del lecho.
Está condicionada por la adaptación del perno a las paredes del
lecho y por su extensión en profundidad.
Es el factor más importante para la retención del perno
2
La traba mecánica secundaria es provista por el material
cementante: líquido que al solidificar aumenta el contacto entre el
perno y las paredes de su lecho.
Está condicionada por la traba mecánica primaria y por las
propiedades físicas y mecánicas del material cementante
3
La adhesión es provista por un cemento resinoso y su
adhesivo: uniones por trabas micromecánicas sobre el perno y la
dentina radicular (capa híbrida y tags de resina).
Por distintas razones, es complejo conseguir adhesión sobre la
dentina del lecho para el perno.
Su importancia es relativa si se cuenta con traba mecánica
primaria y secundaria
Goracci C, Tay F, Ferrari M. The contribution of friction to the dislocation resistance of bonded
Basic Research—Technology
The Contribution of Friction to the Dislocation Resistance

of Bonded Fiber Posts
fiber posts. JOE 2005. Vol 31(8): 608-612
Cecilia Goracci, Andrea Fabianelli,* Fernanda T. Sadek,* Federica Papacchini,*
Franklin R. Tay,† and Marco Ferrari*
Abstract
This study tested the null hypothesis that the use of
dentin adhesives produces no improvement on the
fixation of fiber posts with resin cements in endodon-
I mprovements in dentin adhesive technology in the past decade have fostered attempts
to reduce microleakage (1) and improve retention (2) by bonding to root canals in
the restoration of endodontically treated teeth. Because of the unfavorable cavity con-
tically treated teeth. Post spaces were prepared in 36 figuration factors (3) encountered within post spaces (4, 5), and the high wall-to-wall
single-rooted root-filled teeth. Silanized glass fiber contraction experienced in thin resin films (6), bonding of posts presents challenges in
posts were cemented to the post spaces using a self- relieving shrinkage stresses that are generated along canal walls during the polymer-
etch (ED primer/Panavia 21) and a total etch resin ization of resin cements (5, 7). Recent studies indicated that restorations bonded with
cement (Excite DSC/Variolink II), with or without the fiber posts fail via the dislodging of the posts from root canals (8, 9). These results were
accompanying dentin adhesives. Fixation strengths and supported by frequent observations of premature bond failures when root sections
interfacial ultrastructure were evaluated using a “thin containing fiber posts bonded to root canals were prepared for microtensile bond
slice” push-out test and transmission electron micros- testing (10).
copy. For both resin cements, the fixation strengths To prevent superimposing disruptive stresses (11, 12) during specimen trimming,
obtained from specimens luted with resin cement only the “thin slice” push-out test (13) has been advocated as a more forgiving test for
did not differ significantly from those in which the evaluating the fixation strengths of fiber posts bonded to root canals (10). It is known
intraradicular dentin was first bonded with a dentin that sliding friction derived from interfacial roughness (14) contributes substantially to
adhesive. In the presence of incomplete smear layer the results derived from push-out tests of composite materials (15–17). The discrep-
removal and interfacial gaps, the dislocation resistance ancy in experiences with the microtensile and push-out tests (10) strongly suggests the
of bonded fiber posts was contributed largely by sliding dislocation resistance of bonded fiber posts may be largely derived from sliding friction.
friction. Thus, the objective of this study was to examine, with the use of a push-out test, the
fixation strengths of fiber posts that were cemented with either resin cements only, or in
Key Words conjunction with a self-etch and a total-etch dentin adhesive. The null hypothesis tested
Dislocation resistance, fiber post, adhesive resin ce- was that the use of dentin adhesives produces no additional improvement on the fixation
ment, sliding friction of fiber posts with resin cements in endodontically treated teeth.
From the Department of Dental Materials, University of Materials and Methods

Siena, Policlinico “Le Scotte,” viale Bracci, Siena, Italy; and
Faculty of Dentistry, University of Hong Kong, Prince Philip
Thirty-six single-rooted teeth were mechanically cleaned with a curette to remove
Dental Hospital, Pokfulam, Hong Kong SAR, China. soft tissue remnants from the root surfaces. The crown of each tooth was removed at
Address request for reprints to Dr. Cecilia Goracci, Depart- 2-mm beneath the cementoenamel junction using a high-speed diamond saw (Isomet,
ment of Dental Materials, University of Siena, Policlinico “Le Buehler, Lake Bluff, IL) under water cooling. The working length was established 1-mm
Scotte,” viale Bracci, Siena 53100, Italy. E-mail address: short of the apex. Instrumentation of the root canals was performed with a crown-down
cecilia.goracci@tin.it.
Copyright © 2005 by the American Association of technique, using Profile nickel-titanium rotary instruments (Dentsply TulsaDental,
Endodontists Tulsa, OK). All canals were prepared to ISO size 35, 0.06 taper. Each canal was irrigated
with 17% EDTA and 5% sodium hypochlorite, dried with paper points and obturated
with gutta-percha and AH26 (Dentsply DeTrey, Konstanz, Germany). Downpacking was
performed using the continuous wave warm vertical compaction technique (System B,
SybronEndo, Orange, CA), and backfilling was performed with Obtura II (Spartan,
El uso de adhesivos previo al cemento resinoso en procura de conseguir

Fenton, MO).
After 24 hr, the gutta-percha was removed from the coronal and middle thirds of
each root. At least 5 mm of intact gutta-percha was left behind to preserve the apical seal.
A dowel space was then prepared with increasing sizes of post-hole drills (FRC Postec,
Ivoclar-Vivadent, Schaan, Liechtenstein). A size #3 drill was used as the largest drill,
corresponding to the same size of a tapered FRC Postec glass fiber post (1 mm in
adhesión no produce mejoras significativas en la resistencia a la remoción del

diameter apically). Each post was silanized with Monobond-S (Ivoclar-Vivadent) before
cementation.
The teeth were randomly divided into two experimental groups, depending on the
type of resin cement system (self-etch versus total etch) employed for post cementation.
Each group was further divided into two subgroups (n ! 6), according to whether the
608 Goracci et al. JOE — Volume 31, Number 8, August 2005
poste; la traba mecánica es el factor de retención más importante

Manicardi CA et al. Influence of Filling Materials on the Bonding Interface
Basic Research—Technology
Influence of Filling Materials on the Bonding Interface

of Thin-walled Roots Reinforced with Resin and
of Thin-walled Roots Reinforced with Resin and Quartz Fiber Posts. JOE 2011. Vol 37 (4) 531-37
Quartz Fiber Posts
Cid Alonso Manicardi, PhD, Marco Aur!elio Versiani, MS, Paulo C!esar Saquy, PhD,
Jesus Djalma P!ecora, PhD, and Manoel Dami~ ao de Sousa-Neto, PhD
Abstract
Introduction: A common complication during the resto-
ration of severely destroyed teeth is the loss of coronal
root dentine. The aim of this study was to evaluate the
influence of different sealers on the bonding interface
Key Words
Bond strength, endodontic sealer, fiber post, push-out bond testing
... the dislocation resistance of bonded fiber posts may be largely derived
from sliding friction. As a result, the retentive strength of a bonded post
of weakened roots reinforced with resin and fiber posts.
Methods: Sixty extracted maxillary canines were used.
The crowns were removed, and the thickness of root A common complication encountered during the restoration of severely destroyed
teeth is the loss of coronal root dentine that results in a funnel-shaped canal
with thin walls (1). These teeth very often need to be restored with a post and core
dentine was reduced in the experimental (n = 40) and
positive control (n = 10) groups. The specimens of as a foundation for the final restoration (2, 3). Traditionally, posts were either
experimental group were assigned to four subgroups prefabricated or cast in metal (4). Prefabricated posts are classified according to their
to root canal dentin may depend largely on frictional sliding resistance

(n = 10) according to the filling material: gutta-percha structural composition as metal, ceramic, or resin reinforced with fibers. The introduc-
+ Grossmann’s sealer, gutta-percha + AH Plus (Dentsply tion of fiber posts has further extended the applications of adhesive dentistry in
De Trey Gmbh, Konstanz, Germany), gutta-percha + endodontics and has been advocated because of their advantages of corrosion
Epiphany (Pentron Clinical Technologies, Wallingford, resistance, nonhypersensitivity, aesthetic appeal, easier removal for endodontic retreat-
CT), and Resilon (Resilon Research LLC, Madison, CT) ment, and single-visit office placement (4–8).
Adhesive techniques for luting fiber posts have increased in popularity, and resin
to dislodgement rather than on the relatively low micromechanical and

+ Epiphany. In the negative control group (n = 10),
canals were not filled. After post space preparation, cement materials have been proposed for use in combination with an acid etching
the roots were restored with composite resin light- technique (2, 9–12). It involves the removal of the smear layer, demineralization of
activated through a translucent fiber post. After 24 the dentine, and exposure of a fine network of collagen fibrils. Infiltration of this
hours, specimens were transversally sectioned into 1- network with resin permits the formation of a hybrid layer, resin tags, and adhesive
mm-thick slices. Push-out test and scanning electron lateral branches, thus creating a micromechanical retention of the resin to the
chemical adhesion achieved by resin-based dentin bonding agents.

microscopic (SEM) analyses of different regions were demineralized substrate (4, 13). Despite improvements of the adhesive systems,
performed. Data from push-out test were analyzed by optimal intraradicular bonding must be considered as a real challenge because of
using Tukey post hoc multiple comparison tests. The the anatomic factors linked to the well-known limitations of the current materials
percentage of failure type was calculated. Data from (13). As a consequence, the most frequent cause of adhesive failure is debonding of
SEM analysis were compared by Friedman and Kruskal- post restoration at the resin cement/dentin interface (7, 10, 14–19). Thus, concerns
Wallis tests (a = 0.05). Results: The mean bond have been expressed that residual filling materials could prevent effective bonding in
strength was significantly higher in the negative control some areas (1, 20–23).
group as compared with the other groups (P < .05). In all The effect of eugenol on the retention of resin-cemented posts has been studied
groups, the most frequent type of failure was adhesive. with conflicting results. Its presence on the canal walls appeared to have an adverse
Overall, apical and middle regions presented a lower effect on post retention (20, 23–28). To avoid this problem, resin-based root canal
density of resin tags than the coronal region (P < .05). sealers have been recommended (29). Resilon (Resilon Research LLC, Madison,
CT), a polymer-based thermoplastic root-filling material, has been introduced with
Conclusions:
Conclusions: The push-out bond strength was not
affected by sealer or region. The canal region affected claims to be bondable to a variety of dentin adhesives and resin cement-type sealers
significantly the resin tag morphology and density at such as Epiphany (Pentron Clinical Technologies, Wallingford, CT). The Epiphany
the bonding interface. (J Endod 2011;37:531–537) system contains a self-etching primer and a dual-curable resin composite sealer whose
adjunctive use with Resilon purportedly creates a monoblock between root canal dentin
...nonweakened roots showed the highest retentive strength in all thirds, the most frequent type
and the root-filling material (30–34). AH Plus (Dentsply De Trey Gmbh, Konstanz,
Germany) is an epoxy resin-based sealer that is frequently used as a control material
From the Department of Restorative Dentistry, Faculty of
Dentistry, University of S~ao Paulo, Ribeir~ao Preto, S~ao Paulo, in research because of its physic-chemical properties (31, 32, 34). Despite the fact
Brazil. that Epiphany has shown a penetration into dentinal tubules similar to AH Plus (30),
Address requests for reprints to Dr Manoel Dami~ao de previous studies verified that the adhesion of the former to radicular dentin was not
of failure was adhesive between dentin and cement...

Sousa-Neto, Rua C!elia de Oliveira Meirelles 350, 14024-070 superior when compared with other resinous sealers (32, 33). It has been stated
Ribeir~ao Preto, SP, Brasil. E-mail address: sousanet@forp.usp.br
0099-2399/$ - see front matter
that AH Plus was based on the creation of a covalent bond by an open epoxide ring
Copyright ª 2011 American Association of Endodontists. to exposed amino groups in the collagen network (31). Thus, the removal of the
doi:10.1016/j.joen.2010.12.009 sealer-impregnated dentin from the canal walls during post space preparation seems
JOE — Volume 37, Number 4, April 2011 Adhesion of Fiber Posts to Weakened/Resin-restored Root Dentin 531
¿Qué hacer si el perno no logra
adecuada traba mecánica primaria
después de la PAI?
ESO
1
2
Cortesía Pablo Ensinas y Daniel Martucci (Argentina)

2
DENTINA
CEMENTO DE
COMPOSITE
Cortesía Pablo Ensinas y Daniel Martucci (Argentina)

De la A a la Z…
a.Falta de visión
b.Restos de cemento sellador y gutapercha sobre las paredes del lecho
c.Colágeno con alteración propia de un diente sin vitalidad pulpar
d.Colágeno dañado por el calor de la instrumentación para el lecho
e.Alteración estructural de la dentina luego del tratamiento endodóntico: colágeno dañado por efectos del hipoclorito de sodio que no
permite adecuada hibridización
f. Obstrucción de túbulos dentinarios por sellador endodóntico o barro dentinario secundario
g.Factor de configuración del lecho muy alto: tensiones de contracción de polimerización del cemento de resina que pueden llegar
hasta 20 MPa
h. Influencia de líquidos irrigantes, selladores y otras sustancias sobre la activación o polimerización del MCR
i. Dificultad para lograr adecuada activación física de la polimerización del cemento de resina (no hay acceso para la luz de activación)
De la A a la Z…
j. Polimerización incompleta del cemento de resina cuando activa químicamente: no desarrolla propiedades mecánicas altas y así se
promueve el desalojo (pobre traba mecánica 2a.)
k. Agua puede afectar la polimerización y propiedades del cemento de resina esp. cuando activa químicamente: relación con adhesivos
simplificados (capas adhesivas más ácidas e hidrófilas permiten el pasaje de agua)
l. Bajo pH de algunos adhesivos alteran la activación química del cemento de resina
m. Dificultad y falta de certeza para mojar las superficies con micropinceles
n. Inadecuada inserción del cemento de resina dentro del lecho (mala distribución)
o. Posible polimerización anticipada del cemento de resina por anaerobiosis y/o acción del léntulo: no permite correcta inserción del
perno
p. Espesores importantes de cemento: problemas mecánicos en el cemento (cracks)
q. Espesores imporantes de cemento: presencia de defectos (burbujas)
r. Espesores importantes de cemento resinoso: mayor generación de tensiones
s. Etc....
FRACTURAS
Ante exigencias mecánicas que superen la resistencia
del complejo raíz-anclaje intraradicular, podrían
colapsar:
1. La raíz
2. El perno
3. La raíz y el perno
Fraturas catastróficas
Una fractura es catastrófica o

irrecuperable cuando se produce
apicalmente al tercio cervical de la
raíz dentaria
Fraturas recuperáveis
En cambio, una fractura se considera favorable o recuperable cuando sólo se fractura el perno,
cuando se genera sobre la porción coronaria del diente con nula o mínima invasión del espacio
biológico o bien cuando se produce sobre la ráiz sin superar su tercio cervical
Adaptado de Heydecke (2001)
A ring or cap, typically a metal one, that strengthens the end of a handle, stick, or tube and prevents it from splitting or wearing.
La corona logrará adecuado efecto “ferrule” (zuncho) :

remanente de dentina coronal con 2 mm de altura y 1 mm de
espesor uniforme
76
!
Operative Dentistry, 0000, 00-0, 000-000
Ferrule-Effect Dominates Over Use

of a Fiber Post When Restoring
Endodontically Treated Incisors:
An In Vitro Study
SEGURIDAD: las fuerzas P Magne ! PC Lazari ! MA Carvalho ! T Johnson ! AA Del Bel Cury
Clinical Relevance
serán evacuadas sobre el

The use of a post for the restoration of nonvital incisors with a ferrule is not necessary. The
additional time, materials, and risk involved in the placement of the post do not provide an
increase in mechanical resistance. Post placement can be correlated with unrestorable
fractures.
remanente y de allí a la
ABSTRACT to composite resin core buildups with or with-
Objectives: The aim of this study was to out a fiber post. A no-ferrule group with post
investigate the restoration of broken-down was also included for comparison.
endodontically treated incisors with the fer- Methods and Materials: Thirty decoronated
rule effect using glass ceramic crowns bonded endodontically treated bovine incisors with a
2-mm ferrule were restored with a direct
*Pascal Magne, BSc, MSc, DMD, PhD, The Don & Sybil
Harrington Professor of Esthetic Dentistry, Department of
buildup using a nanohybrid direct composite
resin (Miris 2 and Optibond FL) with or with-
raíz y tejidos de soporte

Restorative Sciences, Herman Ostrow School of Dentistry,
University of Southern California, Los Angeles, CA, USA out a glass-fiber–reinforced post. An additional
Priscilla C Lazari, DDS, MS, Department of Prosthodontics group of 15 teeth without a ferrule were
and Periodontology, Piracicaba Dental School, University of restored with buildup and a fiber post. All
Campinas, São Paulo,Brazil teeth were prepared to receive bonded glass
Marco A Carvalho, DDS, MS, Department of Prosthodontics ceramic crowns (e.max CAD luted with Vari-
and Periodontology, Piracicaba Dental School, University of olink Esthetic DC) and were subjected to
Campinas, São Paulo, Brazil accelerated fatigue testing. Cyclic isometric
Taoheed Johnson, DMD, Advanced Specialty in Endodontics, loading was applied to the incisal edge at an
Taoheed Johnson, DMD, Advanced Specialty in Endodontics, angle of 308 and a frequency of 5 Hz, beginning
Herman Ostrow School of Dentistry, University of Southern with a load of 100 N (35000 cycles). A 100 N load
California, Los Angeles, CA, USA increase was applied each 15,000 cycles. Spec-
Altair A Del Bel Cury, DDS, PhD, professor, Department of imens were loaded until failure or to a maxi-
Prosthodontics and Periodontology, Piracicaba Dental mum of 1000 N (3140,000 cycles). Groups were
School, State University of Campinas, São Paulo, Brazil
compared using the Kaplan Meier survival
*Corresponding author: 925 W 34th St, Los Angeles, CA analysis (log rank test at p=0.05).
In vitro fracture resistance of endodontically treated central incisors

90089, USA; e-mail: magne@usc.edu
Results: None of the tested specimens with-
DOI: 10.2341/16-243-L
stood all 140,000 load cycles. Specimens with
with varying ferrule heights and configurations. Philip LB, Aquilino SA,
Gratton DG, Stanford CM, Chian S, Johnson WT. Journal of Prosthetic
Dentistry. Vol 93 (4). April 2005. 331-336
!
Operative Dentistry, 0000, 00-0, 000-000
Ferrule-Effect Dominates Over Use

of a Fiber Post When Restoring
Endodontically Treated Incisors:
An In Vitro Study
P Magne ! PC Lazari ! MA Carvalho ! T Johnson ! AA Del Bel Cury
Clinical Relevance
The use of a post for the restoration of nonvital incisors with a ferrule is not necessary. The
additional time, materials, and risk involved in the placement of the post do not provide an
increase in mechanical resistance. Post placement can be correlated with unrestorable
RIESGO: las fuerzas se concentran sobre el

fractures.
ABSTRACT to composite resin core buildups with or with-

Objectives: The aim of this study was to out a fiber post. A no-ferrule group with post
investigate the restoration of broken-down was also included for comparison.
perno. El pronóstico de cualquier

endodontically treated incisors with the fer- Methods and Materials: Thirty decoronated
rule effect using glass ceramic crowns bonded endodontically treated bovine incisors with a
2-mm ferrule were restored with a direct
*Pascal Magne, BSc, MSc, DMD, PhD, The Don & Sybil
Harrington Professor of Esthetic Dentistry, Department of
buildup using a nanohybrid direct composite
Restorative Sciences, Herman Ostrow School of Dentistry, resin (Miris 2 and Optibond FL) with or with-
University of Southern California, Los Angeles, CA, USA out a glass-fiber–reinforced post. An additional
Priscilla C Lazari, DDS, MS, Department of Prosthodontics group of 15 teeth without a ferrule were
restored with buildup and a fiber post. All
rehabilitación con AI empeorará…

and Periodontology, Piracicaba Dental School, University of
Campinas, São Paulo,Brazil teeth were prepared to receive bonded glass
Marco A Carvalho, DDS, MS, Department of Prosthodontics ceramic crowns (e.max CAD luted with Vari-
and Periodontology, Piracicaba Dental School, University of olink Esthetic DC) and were subjected to
Campinas, São Paulo, Brazil accelerated fatigue testing. Cyclic isometric
Taoheed Johnson, DMD, Advanced Specialty in Endodontics, loading was applied to the incisal edge at an
Taoheed Johnson, DMD, Advanced Specialty in Endodontics, angle of 308 and a frequency of 5 Hz, beginning
Herman Ostrow School of Dentistry, University of Southern with a load of 100 N (35000 cycles). A 100 N load
California, Los Angeles, CA, USA increase was applied each 15,000 cycles. Spec-
Altair A Del Bel Cury, DDS, PhD, professor, Department of imens were loaded until failure or to a maxi-
Prosthodontics and Periodontology, Piracicaba Dental mum of 1000 N (3140,000 cycles). Groups were
School, State University of Campinas, São Paulo, Brazil
compared using the Kaplan Meier survival
*Corresponding author: 925 W 34th St, Los Angeles, CA analysis (log rank test at p=0.05).
In vitro fracture resistance of endodontically treated central incisors

90089, USA; e-mail: magne@usc.edu
Results: None of the tested specimens with-
DOI: 10.2341/16-243-L
stood all 140,000 load cycles. Specimens with
with varying ferrule heights and configurations. Philip LB, Aquilino SA,
Gratton DG, Stanford CM, Chian S, Johnson WT. Journal of Prosthetic
Dentistry. Vol 93 (4). April 2005. 331-336
Con escaso remanente coronario y poca posibilidad de lograr “efecto ferrule”,
muchos clínicos indican pernos resistentes pero a la vez muy rígidos (por ej.;
metálicos de Ni-Cr colados o preformados) y contraindican el empleo de pernos más
flexibles por su menor resistencia pero...
…la literatura científica dice que

debería ser al revés…!!!
Influence of Crown Ferrule Heights and Dowel Material
Selection on the Mechanical Behavior of Root-Filled Teeth:
A Finite Element Analysis
Mauricio U. Watanabe, DDS, MSc,1 Rodolfo Bruniera Anchieta, DDS, MSc,2
Eduardo Passos Rocha, DDS, MS, PhD,2 Sidney Kina, DDS, MSc,2 Erika Oliveira de Almeida, DDS, MS,2
Amilcar Chagas Freitas Junior, DDS, MS,2 & Roberta Tarkany Basting, DDS, MSc, PhD1
1
Centro de Pesquisas Odontológicas, São Leopoldo Mandic, Brazil
2
Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Araçatuba, Sao Paulo State University – UNESP, Araçatuba, SP, Brazil
En situaciones de pobre “efecto ferrule”,

Keywords Abstract
Crown ferrule; glass fiber dowel; metallic cast;
finite element analysis. Purpose: This study used the 3D finite element (FE) method to evaluate the mechanical
behavior of a maxillary central incisor with three types of dowels with variable heights
Correspondence of the remaining crown structure, namely 0, 1, and 2 mm.
Eduardo Passos Rocha, Departamento de Materials and Methods: Based on computed microtomography, nine models of a
Materiais Odontológicos e Prótese, maxillary central incisor restored with complete ceramic crowns were obtained, with
Faculdade de Odontologia de three ferrule heights (0, 1, and 2 mm) and three types of dowels (glass fiber = GFD;
el riesgo de fractura radicular es mayor

Araçatuba-UNESP, Rua Jose Bonifacio, 1193, nickel-chromium = NiCr; gold alloy = Au), as follows: GFD0 – restored with GFD
Vila Mendonça, 16015-000, Araçatuba-SP, with absence (0 mm) of ferrule; GFD1 – similar, with 1 mm ferrule; GFD2 – glass
Brazil. E-mail: eduardo_rocha@foa.unesp.br fiber with 2 mm ferrule; NiCr0 – restored with NiCr alloy dowel with absence (0 mm)
of ferrule; NiCr1 – similar, with 1 mm ferrule; NiCr2 – similar, with 2 mm ferrule;
This study was supported by the Sao Paulo Au0 – restored with Au alloy dowel with absence (0 mm) of ferrule; Au1 – similar,
Research Foundation (FAPESP – Brazil, with 1 mm ferrule; Au2 – similar, with 2 mm ferrule. A 180 N distributed load was
2008/00209-9) and by the Foundation for the
applied to the lingual aspect of the tooth, at 45◦ to the tooth long axis. The surface of
Coordination of Higher Education and
the periodontal ligament was fixed in the three axes (x = y = z = 0). The maximum
con pernos rígidos...

Graduate Training (CAPES, BEX 2325-05-5).
principal stress (σ max ), minimum principal stress (σ min ), equivalent von Mises (σ vM )
The authors deny any conflicts of interest.
stress, and shear stress (σ shear ) were calculated for the remaining crown dentin, root
dentin, and dowels using the FE software.
Results: The σ max (MPa) in the crown dentin were: GFD0 = 117; NiCr0 = 30; Au0 =
Accepted September 25, 2011 64; GFD1 = 113; NiCr1 = 102; Au1 = 84; GFD2 = 102; NiCr2 = 260; Au2 = 266.
The σ max (MPa) in the root dentin were: GFD0 = 159; NiCr0 = 151; Au0 = 158;
doi: 10.1111/j.1532-849X.2011.00832.x GFD1 = 92; NiCr1 = 60; Au1 = 67; GFD2 = 97; NiCr2 = 87; Au2 = 109.
Conclusion: The maximum stress was found for the NiCr dowel, followed by the
Au dowel and GFD; teeth without ferrule are more susceptible to the occurrence of
fractures in the apical root third.
The recovery of function by direct and/or indirect restora- tooth structure.8 Some authors have shown that the fracture
tions in endodontically treated teeth is still challenging,1 resistance of dentin is directly proportional to the volume of
especially due to the reduced fracture resistance after endodon- remaining tooth structure.5,9,10
tic treatment.2,3 Endodontic treatment changes the tooth’s ar- It is believed that the presence of ferrules protects the restored
chitecture secondary to removal of decayed dental tissue, as teeth, because it reinforces the tooth/prosthesis assembly.11,12
well as endodontic access and root canal instrumentation,4 This portion of dental tissue adjacent to the core increases the
which is associated with the greater induction of stress in these fracture resistance,12 providing a positive effect by reducing the
teeth.5,6 stress concentration on the tooth.13-18
This is especially critical when there is large destruction of The biomechanics of these teeth is also influenced by the
the remaining tooth structure, because the reduced height of placement of dowels.8,19 According to some authors, the use of
this remaining structure7 increases the probability of fracture a metallic dowel with a high modulus of elasticity concentrates
compared to teeth with a greater height of intact remaining the stresses on the apical root third, thereby being associated
304 c 2012 by the American College of Prosthodontists

Journal of Prosthodontics 21 (2012) 304–311 ⃝
Watanabe M et al (2011)
doi:10.1111/j.1365-2591.2010.01807.x
Influence of post system and remaining coronal

tooth tissue on biomechanical behaviour of root
filled molar teeth
F. R. Santana1, C. G. Castro1, P. C. Simamoto-Júnior2, P. V. Soares1, P. S. Quagliatto1,

C. Estrela3 & C. J. Soares1
Teeth with no ferrule and cast Ni–Cr

1
Operative Dentistry and Dental Materials Department, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil;
2
Technical Course in Dental Prosthesis, Technical School of Health, Federal University of Uberlândia, Uberlândia, Brazil; and
3
Endodontic Department, School of Dentistry, Federal University of Goiás, Goiás, Brazil
Abstract Duncan’s test (a = 0.05). The failure mode was eval-

uated using an optical stereomicroscope and classified
Santana FR, Castro CG, Simamoto-Júnior PC, Soares PV,
alloy post and core resulted in

according to the location of the failure.
Quagliatto PS, Estrela C, Soares CJ. Influence of post
Results The absence of ferrule was associated with
system and remaining coronal tooth tissue on biomechanical
lower fracture resistance regardless of the post system.
behaviour of root filled molar teeth. International Endodontic
Groups restored with glass fibre post and cast Ni–Cr
Journal, 44, 386–394, 2011.
alloy post and core had similar fracture resistance and
Aim To investigate ex vivo the influence of post system higher values than groups without posts, regardless of
and amount of remaining coronal tooth tissue on the the remaining coronal tooth tissue. Teeth with no
catastrophic fractures and those

fracture resistance, fracture mode and strain of root ferrule and cast Ni–Cr alloy post and core resulted in
filled molar teeth. catastrophic fractures and those with no ferrule and
Methodology Seventy mandibular human molar glass fibre post or no ferrule and post absence resulted
teeth were divided into seven groups (n = 10), one in restorable failures. Buccal strain was higher in sound
control (sound teeth) and six experimental groups teeth and lower in teeth without posts. Glass fibre post
resulting from the interaction between the two study insertion decreased the buccal strain compared to the
factors: post system (Pa, post absence; Gfp, glass fibre teeth with ferrule and absence of post.
post; Cmp, cast Ni–Cr alloy post and core) and amount Conclusions Two millimetre of ferrule had a signif-
with no ferrule and fibre posts

of remaining coronal tooth tissue (Fe, 2 mm of ferrule; icant influence on cusp strain, fracture resistance and
NFe, no ferrule). Teeth in the experimental groups were failure mode. The glass fibre post was as effective as the
restored with metal crowns. For the strain gauge test, cast Ni–Cr alloy post and core in the restoration of root
two strain gauges per sample were attached on the filled molars regardless of the remaining tooth tissue.
buccal and proximal root surfaces, and the samples of Absence of a post decreased the fracture resistance and
each group (n = 5) were submitted to a load of 0– increased the cusp strain.
100 N. Fracture resistance (N) was assessed in a
resulted in restorable failures

Keywords: cast post and core, fracture resistance,
mechanical testing device (n = 10). Strain gauge and
glass fibre post, root filled molar, strain gauge test.
fracture resistance data were analysed by two-way
anova (3 · 2) followed by the Tukey’s HSD and Received 3 April 2010; accepted 11 September 2010
Correspondence: Prof. Dr. Carlos José Soares, Biomechanical

Introduction
Research Group, Federal University of Uberlândia, School of Root filled teeth are considered to have a higher
Dentistry, Avenida Pará, 1720, Bloco 2B, Sala 24, Campus
Umuarama, Uberlândia, MG, Brazil CEP. 38400-902
prevalence of fracture because of their inherently poor
(Tel.: +55 34 3218 2255; fax: +55 34 3218 2279; structural integrity as a result of pre-existing caries or
e-mail: carlosjsoares@umuarama.ufu.br). tooth preparation (Burke 1992, Assif & Gorfil 1994,
386 International Endodontic Journal, 44, 386–394, 2011 ª 2011 International Endodontic Journal
Santana FR et al (2010)
www.scielo.br/jaos
!"#$#%&'(") %*) (*+,-"##$*') *.) /"&0"'"1) -**%#)

subjected to different root reconstruction protocols
!"#$%&'())$*$&+,-./011, Guilherme de Siqueira Ferreira Anzaloni SAAVEDRA2, Paula Elaine CARDOSO3, Márcia
Carneiro VALERA42&3$4($&567)($&389(6:&;<&5=5>?,4
1- DDS, MSc, PhD, Professor, School of Dentistry, Sagrado Coração University, Bauru, SP, Brazil.
2- DDS, MSc, PhD, Associate Professor, Department of Restorative Dentistry, School of Dentistry of São José dos Campos, Univ. Estadual Paulista - UNESP,
São José dos Campos, SP, Brazil.
3- DDS, MSc, PhD, Department of Restorative Dentistry School of Dentistry of São José dos Campos, Univ. Estadual Paulista - UNESP, São José dos
Campos, SP, Brazil.
4- DDS, MSc, PhD, Associate Professor, Department of Restorative Dentistry School of Dentistry of São José dos Campos, Univ. Estadual Paulista - UNESP,
São José dos Campos, SP, Brazil.
Corresponding address: Lucas Villaça Zogheib - Universidade de Sagrado Coração/Faculdade de Odontologia - Rua Irmã Arminda, 10050 - Bauru, SP -
17011-160 - Brasil - Phone: (14) 8153 0479 - e-mail: lucaszogheib@yahoo.com.br
=<#<(@<;A&?"B<&CD2&EDDF&G&3:;(H#$I(:BA&3$4#J&CK2&EDCD&G&5##<LI<;A&EK&5L4()2&EDCC
ABSTRACT
O bjective: This study evaluated, in vitro, the fracture resistance of human non-vital
%""%2) -"#%*-"1) /$%2) 1$.."-"'%) -"(*'#%-3(%$*') ,-*%*(*4#5) 6&%"-$&4) &'1) +"%2*1#7) 8*-%9)
23+&')&'%"-$*-)-**%#)*.)#$+$4&-)#2&,")&'1)1$+"'#$*'#)/"-")&##$:'"1)%*).*3-):-*3,#);'<=>?@)
&((*-1$':)%*)%2")-**%)-"(*'#%-3(%$*'),-*%*(*47)A-*3,)B);(*'%-*4?7)'*'C/"&0"'"1)-**%#)/$%2)
:4&##)DE"-),*#%F)A-*3,)BB7)-**%#)/$%2)(*+,*#$%")-"#$')E9)$'(-"+"'%&4)%"(2'$G3")&'1):4&##)
DE"-),*#%F)A-*3,)BBB7)-**%#)/$%2)&(("##*-9):4&##)DE"-),*#%#)&'1):4&##)DE"-),*#%F)&'1)A-*3,)
BH7)-**%#)/$%2)&'&%*+$():4&##)DE"-),*#%)%"(2'$G3"5)8*44*/$':),*#%)("+"'%&%$*')&'1)(*-")
-"(*'#%-3(%$*'@)%2")-**%#)/"-")"+E"11"1)$')(2"+$(&449)&(%$I&%"1)&(-94$()-"#$')&'1)#3E+$%%"1)
%*).-&(%3-")-"#$#%&'(")%"#%$':@)/$%2)&)(*+,-"##$I")4*&1)&%)&')&':4")*.)JKL)$')-"4&%$*')%*)%2")
4*':)&M$#)*.)%2")-**%)&%)&)#,""1)*.)>5K)++N+$')3'%$4).-&(%3-"5)O44)1&%&)/"-")#%&%$#%$(&449)
&'&49P"1)/$%2)E$4&%"-&4)Q3''"%%R#)%"#%);!=0.05). Results: Group I presented higher mean
I&43"#)*.).-&(%3-")-"#$#%&'(")/2"')(*+,&-"1)/$%2)%2")%2-"")"M,"-$+"'%&4):-*3,#@)/2$(2@)$')
turn, presented similar resistance to fracture among each other. None of the techniques of
-**%)-"(*'#%-3(%$*')/$%2)$'%-&-&1$(34&-),*#%#)$+,-*I"1)-**%)#%-"':%2@)&'1)%2")$'(-"+"'%&4)
%"(2'$G3")/&#)#3::"#%"1)&#)E"$':)%2")+*#%)-"(*++"'1&E4"@)#$'(")%2")%9,")*.).-&(%3-")%2&%)
*((3--"1)&44*/"1)%2")-"+&$'$':)1"'%&4)#%-3(%3-")%*)E")-",&$-"15)S*'(43#$*'7)T2")-"#34%#)*.)
this in vitro study suggest that the healthy remaining radicular dentin is more important
to increase fracture resistance than the root reconstruction protocol.
Key words: Nonvital tooth. Tooth root. Permanent dental restoration. Post and core
technique. Compressive strength. Tooth fractures.
INTRODUCTION Intraradicular posts are necessary for restoring

%2") (-*/'#) *.) %""%2) (*+,-*+$#"1) E9) "'1*1*'%$()
T2")#3(("##)&(2$"I"1)/$%2)"#%2"%$()-"#%*-&%$I") %-"&%+"'%@) /$%2) /$1"'"1) (&'&4#5) U"I"-&4) &3%2*-#)
treatments has resulted in an increasing demand 2&I")&.D-+"1)%2&%)%2")'""1)%*)3#")$'%-&-&1$(34&-)
by patients for these treatments, especially for ,*#%#) $#) 1"%"-+$'"1) E9) %/*) +&$') .&(%*-#7) %2")
anterior teeth17,22. Consequently, there has been a G3&'%$%9)*.)-"+&$'$':)1"'%$').*-)-"%&$'$':)%2")(-*/'@)
#$:'$D(&'%)$'(-"&#")$')%2")3#")*.)("-&+$()(-*/'#@)&#) and the internal nature of the root structure4,7,24.
/"44)&#)$'%-&-&1$(34&-),*#%#)&'1)(*-")+&%"-$&4#)/$%2) Factors such as, caries and trauma may create a
satisfactory mechanical and esthetic properties4,9. /$1"'"1)-**%)(&'&45)B')(&#"#)*.)1"'%&4)%-&3+&)$')
Prefabricated intraradicular posts are preferred young patients, these frequently interrupt apical
because they are more practical, economic, and in closing and complete root development, leading to
some situations, less invasive than custom-made %2").*-+&%$*')*.)&')/$1"'"1)-**%)(&'&4)%2&%)-"+&$'#)
cast metal cores18,21,23,25. like that10,11. Widened canals are more susceptible
%*) .-&(%3-") E"(&3#") *.) %2") %2$') -"+&$'$':) /&44#@)
J Appl Oral Sci. 648 2011;19(6):648-54
Resistance to compression of weakned roots subjected to different root reconstruction protocols. Zogheib L et al (2011). J Appl Oral Sci;19(6):648-54
J Appl Oral Sci. 2009;17(6):574-8
1. The use of intraradicular posts increased the fracture

www.fob.usp.br/jaos or www.scielo.br/jaos
FRACTURE STRENGTH OF FLARED BOVINE ROOTS

RESTORED WITH DIFFERENT INTRARADICULAR POSTS
Victor Grover Rene CLAVIJO1, José Maurício dos Santos Nunes REIS2, William KABBACH1, André Luis Faria e SILVA3,
Osmir Batista de OLIVEIRA JUNIOR4, Marcelo Ferrarezi de ANDRADE4 strength of the flared roots
2. Direct and indirect anatomic posts could be an
1- DDS, MSc PhD student, Department of Restorative Dentistry, Araraquara Dental School, São Paulo State University, Araraquara, SP, Brazil.
2- DDS, MSc, PhD, Substitute Professor, Department of Dental Materials and Prosthodontics, Araraquara Dental School, São Paulo State University,
Araraquara, SP, Brazil.
3- DDS, MSc, PhD student, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil.
4- DDS, MSc, PhD, Associate Professor, Department of Restorative Dentistry, Araraquara Dental School, São Paulo State University, Araraquara, SP,
alternative to cast metal post-and-core during the

Brazil.
Corresponding address: Prof. José Maurício dos Santos Nunes Reis - Faculdade de Odontologia de Araraquara - UNESP - Departamento de Materiais
Odontológicos e Prótese -Rua Humaitá, nº. 1680 - 14801-903 - Araraquara, SP - Brasil - Phone: +55 016 3301-6408 - Fax: +55 016 3301-6406 - e-mail:
reisunesp@hotmail.com / josemsnreis@foar.unesp.br
treatment of flared roots

Received: August 19, 2008 - Modification: May 18, 2009 - Accepted: July 21, 2009
ABSTRACT
O bjective: The aim of this study was to evaluate the fracture strength and failure mode of flared bovine roots restored with
3.The fracture strength of teeth restored with cast metal

different intraradicular posts. Material and Methods: Fifty bovine incisors with similar dimensions were selected and their roots
were flared until 1.0 mm of dentin wall remained. Next, the roots were allocated into five groups (n=10): GI- cast metal post-and-
core; GII- fiber posts plus accessory fiber posts; GIII- direct anatomic post; GIV- indirect anatomic post and GV- control (specimens
without intraradicular post). A polyether impression material was used to simulate the periodontal ligament. After periodontal
ligament simulation, the specimens were subjected to a compressive load at a crosshead speed of 0.5 mm/min in a servo-hydraulic
post and core and anatomic fiber posts, fabricated by

testing machine (MTS 810) applied at 135º to the long axis of the tooth until failure. The data (N) were subjected to ANOVA and
Tukey’s post-hoc test (α=0.05). Results: GI and GIV presented higher fracture strength (p<0.05) than GII. GIII presented intermediate
values without statistically significant differences (p>0.05) from GI, GII and GIV. Control specimens (GV) produced the lowest
fracture strength mean values (p<0.05). Despite obtaining the highest mean value, GI presented 100% of unfavorable failures. GII
presented 20% of unfavorable failures. GIII, GIV and GV presented only favorable failures. Conclusions: Although further in vitro
both direct and indirect techniques, presented similar

and in vivo studies are necessary, the results of this study showed that the use of direct and indirect anatomic posts in flared roots
could be an alternative to cast metal post-and-core.
Key words: Post and core technique. Compressive strength. Prosthodontics.
INTRODUCTION
Intraradicular posts are commonly used to restore
endodontically treated teeth when their remaining coronal
However, the use of fiber posts in flared root canals is
compromised. In this case, if the post does not fit well,
especially at the coronal level, the resin cement layer would
be excessively thick, and bubbles are likely to form within
values
4. As opposed to the cast metal post-and-core,
tissue can no longer provide adequate support and retention it, predisposing to debonding14.
for the restoration material. However, flared canal restoration One solution to overcome this problem is the use of
continues to be a challenge to clinicians. The flared canal dentin-bonded composite resin. This technique increases the
may result from carious extension, trauma, pulpal pathosis internal thickness of dentin on root walls and reduces the
and iatrogenic misadventure20. resin cement thickness5,15. However, light-activation of
all fractures presented by the anatomic fiber

Endodontically treated teeth have been restored using composite resin in more apical regions of the root canal is
cast metal post-and-core for decades. Instead the high difficult and may compromise this technique. Another
retention and thin cement layer, these conventional posts solution is to reline the fiber post with composite resin. This
present high elastic modulus and can lead to root individual post system increases the adaptation of the post
fracture13,16,19,24,26. Another option is to use fiber posts1,16,26. to root walls and reduces the resin cement thickness5,15.
posts were favorable

The similarity in elastic modulus of the fiber post, resin However, this technique presents another interface (fiber
cement and dentin was perceived to be advantageous for post-composite resin) that may lead to failure. Thus,
improving the performance of restorations 1,15,19,22,23,29. fabricating an individual fiber post-resin composite may
574
Clavijo V et al (2009)
Dental Materials (2006) 22, 477–485
www.intl.elsevierhealth.com/journals/dema
Most of the fractured teeth restored with cast

Fracture resistance of pulpless teeth restored
with post-cores and crowns metallic post-cores were not
reparable.
Mikako Hayashi*, Yutaka Takahashi, Satoshi Imazato, Shigeyuki Ebisu
Department of Restorative Dentistry and Endodontology, Osaka University Graduate School of Dentistry,
1-8 Yamadaoka, Suita, Osaka 565-0871, Japan
Received 14 December 2004; accepted 24 March 2005
KEYWORDS
Root fracture;
Fracture resistance;
Summary Objectives. The present study was designed to test the null hypothesis
that there is no difference in the fracture resistance of pulpless teeth restored with
different types of post-core systems and full coverage crowns.
In contrast, the majority of fractures in the fiber
post group were limited to the
Fracture load; Methods. Extracted human upper premolars were restored with a fiber post,
Pulpless teeth; prefabricated metallic post or cast metallic post-core. Teeth with full crown
Fiber post; preparations without post-core restorations served as a control. All teeth were
Metallic post; restored with full coverage crowns. A 90-degree vertical or 45-degree oblique load
Cast metallic post- was applied to the restored teeth with a crosshead speed of 0.5 mm/min, and the
core fracture loads and mode of fracture were recorded.
cervical portion of the root including

Results. Under the condition of vertical loading, the fracture load of teeth restored
with the cast metallic post-cores was greatest among the groups (two-factor
factorial ANOVA and Scheffe’s F test, P!0.05). All fractures in teeth restored with all
types of post-core systems propagated in the middle portions of roots, including the
apices of the posts. Under the condition of oblique loading, the fracture load of teeth
restored with pre-fabricated metallic posts was significantly smaller than that in
the core-dentin interface, since the stress

other groups. Two-thirds of fractures in the fiber post group propagated within the
cervical area, while most fractures in other groups extended beyond the middle of
the roots.
Significance. From the results of the present investigations, it was concluded that
under the conditions of vertical and oblique loadings, the combination of a fiber post
and composite resin core with a full cast crown is most protective of the remaining
was concentrated in the cervical area and the

tooth structure.
Q 2005 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
outer root surface. This type of fracture is

Introduction
Restorative methods for pulpless teeth with post-

* Corresponding author. Tel.: C81 6 6879 2927; fax: C81 6
core systems have been widely investigated with
6879 2928. the aim of achieving long-term promising prognoses
easier to repair.
E-mail address: mikarin@dent.osaka-u.ac.jp (M. Hayashi). [1,2]. Despite the various attempts that have been
0109-5641/$ - see front matter Q 2005 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.dental.2005.03.017
Hayashi M et al (2005)
En casos de gran pérdida vertical de tejidos (escaso “efecto ferrule”) y socavamiento del lecho, el rendimiento
de cualquier rehabilitación con perno es crítico.
Pero los patrones de fracaso son más favorables cuando se emplean pernos de fibra: fracturas del perno, o bien de la raíz afectando
al tercio cervical
La incidencia de fracturas radiculares es menor al trabajar con
pernos de fibra
Los patrones de fractura suelen ser más favorables con pernos de
fibra que con pernos rígidos (como los metálicos colados) ya
que los pernos de fibra generan una distribución de cargas
uniforme a lo largo de la raíz
A Randomized Controlled Trial of Endodontically Treated and Restored Premolars. Ferrari M, Vichi A, Fadda GM, Cagidiaco MC, Tay FR, Breschi
77
L, Polimeni A, Goracci C
(2012). J Dent Res. Vol 91. Supl 1: 72-78
…ESO ES EXACTAMENTE LO
CONTRARIO DE LO QUE ME
CONTARON POR AÑOS…
El perno debe ofrecer un comportamiento elástico similar a
la dentina, pero al mismo tiempo ser RESISTENTE
Flexión + Resistencia
2
A - Resistencia a la fractura (resistencia flexural): static strength; one single load is applied over the
post until fracture
B - Resistencia a la fatiga: dynamic strength; cyclic loads lead to a slow crack initiation and
propagation till fracture
Variables que condicionan la resistencia la fractura por flexión y
a la fatiga
d e n t a l m a t e r i a l s 2 3 ( 2 0 0 7 ) 265–271
• Diámetro del poste
available at www.sciencedirect.com
• Proporción fibra/matriz: relación porcentual entre el área de fibras y de matriz por mm2 (varían del 35 al 70%)
• Presencia de defectos estructurales en la matriz y/o en la fibra (burburjas, cracks o poros)
journal homepage: www.intl.elsevierhealth.com/journals/dema
Resistance to fracture and structural characteristics of

different fiber reinforced post systems
Frank Seefeld, Hans-Jürgen Wenz ∗ , Klaus Ludwig, Matthias Kern

Department of Prosthodontics, Propaedeutics and Dental Materials, University Hospital Schleswig-Holstein, Campus Kiel, Germany
• Densidad de fibras (número de fibras por mm2)
a r t i c l e
Article history:
i n f o
Received 30 September 2005

Accepted 18 January 2006
a b s t r a c t
Objectives. The aim of this study was to investigate the ultrastructure and resistance to
fracture of eight different types of fiber post, and to verify the existence of a correlation
between structural characteristics and flexural strength.
• Distribución de las fibras (uniforme / no uniforme)
• Mala calidad de la adhesión de la fibra a la resina: agente de enlace
Methods. Eight types of fiber post were selected for this study. Fiber Kor (Jeneric-Pentron),
Para Post Fiber White (Colténe), Luscent Anchor (Dentatus), Twin-Luscent Anchor (Denta-
Keywords: tus), Style Post (Metalor), DT White-Post (VDW), DT Light-Post (VDW) and ER Dentin Post
FRC-post (Brasseler). Ten posts of each experimental group were selected for a three-point bending
Fiber/matrix Ratio test, and one was processed for SEM evaluation. A universal testing machine loading at an
Structural characteristics angle of 90◦ was employed for the three-point bending test. The test was carried out until
• Incorporación de materiales radiopacos en la matriz o en la fibra

Interface fracturing of the post. After fracture testing, the posts with the highest and the lowest val-
SEM-evaluation ues of flexural strength of each system were additionally processed for SEM analysis. SEM
evaluation was performed using a PC-measurement program to assess the fiber/matrix ratio
and fiber dimensions.
Results. The fracture load of the tested systems ranged from 60 to 96 N and the flexural
strength from 565 to 898 MPa. DT White-Post and DT Light-Post (898 and 842 MPa, respec-
• Calidad de la superficie externa

tively) had significantly higher flexural strengths than the other posts. Style Post (565 MPa)
showed a significantly lower flexural strength than all other posts. The differences in fiber
diameter ranged from 8.2 to 21 !m and for the fiber/matrix ratio from 41 to 76%. Of the var-
ious structural characteristics investigated, only the fiber/matrix ratio showed a significant
correlation to the flexural strength (r = 0.922, p = 0.003).
Significance. The FRC-posts investigated displayed significant differences with regard to frac-
• Diámetro de las fibras (de 8 a 20 micrones)

ture load and flexural strength. A strong and significant linear correlation between the
fiber/matrix ratio and the flexural strength was found.
© 2006 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
• Orientación de las fibras

1. Introduction [3–6]. FRC-posts contain a high percentage of continuous rein-
forcing fibers embedded in a polymer matrix. Matrix polymers
For 15 years endodontic posts made out of fiber reinforced are commonly epoxy resins or other polymers with a high
composites (FRC) have been described in the literature [1,2]. degree of conversion and a highly cross-linked structure [7–9].
Glass-, silica- and carbon fiber reinforced materials especially, The elastic moduli of fiber posts are closer to dentin than that
have been marketed and provided the dental profession with of any metal post [10]. The first clinical trials reported promis-
• Proceso de fabricación
the first true alternative to cast or pre-fabricated metal posts ing results [3,4,11,12]. Laboratory studies examined different
∗
Corresponding author at: Arnold-Heller-Strasse 16, 24105 Kiel, Germany. Tel.: +49 431 5972874; fax: +49 431 5972860.
E-mail address: hjwenz@proth.uni-kiel.de (H.-J. Wenz).
0109-5641/$ – see front matter © 2006 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.
• Tipo de fibra (vidrio, carbono, cuarzo, zirconio)

doi:10.1016/j.dental.2006.01.018
• Tipo de matriz (Bis-GMA, UDMA / resinas epóxicas)

Seefeld F, Wenz J, Ludwig K, Kern M. Resistance to fracture and structural characteristics of different fiber reinforced post systems. Dent Mater 2007 Mar; 23(3):265-71
DT Light Post (RTD)
Grupo 1 Grupo 4 Grupo 6
Perno de fibra más estudiado!!!

(PATRÓN)
Grandini S, Goracci C, Monticelli F, Borracchini AF, Ferrari M. An evaluation using a “three-point bending” test of the fatigue resistance of certain fiber posts. II
Dentista Moderno, March 2004:70-75
La resistencia la fractura por flexión y a la fatiga puede ser muy
distinta entre los pernos de fibra
2.000.000 de ciclos equivale a 4 años de actividad en un sistema masticatorio normal…
“It is noteworthy that the fiber posts with the lowest flexural strengths were found to fail the
fatigue test, confirming that internal defects, as much as intrinsic fiber and matrix properties,
contribute to the performances of the posts”.
Cheleux N, Sharrock PJ. Mechanical properties of glass fiber-reinforced endodontic
posts. Acta Biomater. 2009 Oct;5(8):3224-30
“Failure due to fatigue stress is a phenomenon of paramount importance from a clinical standpoint as
failure commences from a small structural defect such as a void or microcrack within the material.
From this area of weakness a crack front can gradually propagate through the material, finally resulting in
catastrophic failure”.
Fatigue resistance and structural characteristics of fiber posts: three-point bending test
and SEM evaluation. Grandini S, Tay F, Ferrari M. Journal of Dental Materials 2004
POSTE 1 POSTE 2 TRABAJO DE INVESTIGACIÓN VOL. 7 - Nº 1 - ENERO-JUNIO -2012. PÁGS. 5 - 14
Dep. LegaL eLéctronico: ppi 201202Me4105 • iSSn eLectronico: 2244-8861 iSnn: 1856-3201/ DepÓSito LegaL : pp200502Me2052
ESTUDIO COMPARATIVO DE LA MICROESTRUCTURA INTERNA DE

DIFERENTES MARCAS DE PERNOS DE FIBRAS DE VIDRIO
Karla D. Mora Barrios1, Angélica M. Sifontes Vivas1, Sonia A. Miranda Montealegre2, Gladys A Rojas
Palaviccini2, Rigoberto Dugarte Lobo2.
1
Odontóloga,.Práctica privada. 2Facultad de Odontología, Departamento de Odontología Restauradora,
Universidad de Los Andes. Mérida 5101. Venezuela. E-mail: karladaniela0484@gmail.com
RESUMEN
Los pernos de fibra de vidrio usados en las reconstrucciones de dientes, se han populariza-
do por poseer un módulo elástico similar a la dentina y color altamente estético, sin embargo han
presentado fracasos clínicos de tipo mecánicos por fatiga del perno, por lo que se sospecha que
un factor relevante es la calidad microestructural. El objetivo fue evaluar la ultraestructura interna
de diferentes marcas de pernos de fibra de vidrio. Se evaluaron en cortes transversales cinco tipos
de postes de fibra de vidrio (FRC Postec Plus Ivoclar Vivadent®, Parapost Fiber White Coltene
Whaledent®, Parapost Fiber Lux Coltene Whaledent®, Glass Fiber Post Superpost® y Reforpost
Rx Angelus®). Al Microscopio Electrónico de Barrido se obtuvieron imágenes a 100µm, 500µm
y 2500µm de aumento. Con Photoshop se realizó la conversión de pixel a micra y se calculó: área
total, área de defecto, homogeneidad en el diámetro de las fibras y relación fibra–matriz. El sistema
más homogéneo, compacto y que no presentó imperfecciones fue el FRC Postec Plus. El Parapost
Fiber White mostró los diámetros de las fibras más homogéneos y menor concentración de fibras.
El Reforpost Rx presentó mayor número de defectos evidentes. Los pernos de fibra de vidrio pre-
sentan diferentes calidades microestructurales, algunos muestran defectos y baja consistencia en
sus fibras. La calidad microestructural es un aspecto importante a tomar en cuenta en el momento
de seleccionar un perno que requiera un desempeño mecánico adecuado en las reconstrucciones
de muñón de dientes anteriores.
Palabras clave: pernos de fibra de vidrio, microestructura interna, matriz, fibra, defectos
internos.
COMPARATIVE STUDY OF THE INTERNAL MICROSTRUCTURE OF

DIFFERENT BRANDS OF POSTS OF FIBERGLASS.
POSTE 3 ABSTRACT
The fiberglass bolts used in reconstruction of teeth, have become popular for having an
elastic modulus similar to dentin and highly aesthetic color, however, have presented clinical fail-
ures of mechanical fatigue of the bolt, so it is suspected that a relevant factor is the microstructural
quality. Our objective was to evaluate the internal ultrastructure of different brands of glass fiber
posts. Cross sections were assessed cinco types of glass fiber posts (FRC Postec Plus Ivoclar Viva-
POSTE 4 POSTE 5 RECIBIDO: 16-09-2011 / ACEPTADO: 26-03-2012 • REVISTA ODONTOLOGICA DE LOS ANDES 5
Dra. Karla Mora (Caracas, Venezuela)

POSTE 1 POSTE 2
POSTE 3
POSTE 4 POSTE 5
Dra. Karla Mora (Caracas, Venezuela)

Pobre adhesión entre matriz de resina y fibras
Áreas desprovistas de fibras

Área ocupada por radiopacificador (sin fibras)
“Lagunas de resina” por mala distribución de las fibras

Dres. Ricardo Portigliatti y Jorge Olmos (Argentina)
Dres. Ricardo Portigliatti y Jorge Olmos (Argentina)
Para el éxito en la técnica de pernos de fibra
Selección de
un perno de
fibra
apropiado
1. Alta resistencia a la fractura por
flexión y a la fatiga
2. Diseño cilíndrico cónico
3. Alto contraste radiográfico
4. Translucidez que permita conducción lumínica
5. Ranuras que mejoren la traba mecánica
secundaria
6. Fresas calibradoras que generen preparaciones
ajustadas a la forma del perno
DT Light-Post (RTD)
Macro-Lock (RTD)
RelyX Fiber Post (3M/Espe)
ParaPost Taper Lux (Coltène Whaledent)
ParaPost Fiber Lux (Coltène Whaledent)
Unicore (Ultradent)
FRC Postec Plus (Ivoclar - Vivadent)
Rebilda Post (VOCO GmbH)
FibreKleer Tapered (Pentron)
Criterio anatómico
DT Light Post (RTD)
Macro Lock (RTD)
ParaPost Taper Lux (Coltène/Whaledent)
Rebilda Post (VOCO GmbH)
El diseño del poste debe asegurar adecuada retención respetando la anatomía radicular para
evitar desgaste innecesario de tejidos: los pernos de fibra cónico - cilíndricos son más adecuados
Craig RG, Farah JW. Stress anlysis and design of single restorations and fixed bridges. Oral Sci Rev 1997; 10:45-74
Radiopacidad
Los pernos de fibra

presentan
contrastes
radiográficos muy
variables
82
Imágenes del Dr. Richard Bohay (Ontario- Canada)
Un alto grado de polimerización es muy importante en una fijación que emplee adhesivos,
cementos resinosos y materiales para muñón de activación dual.
Mejoran así sus propiedades mecánicas.
La activación química es insuficiente, incompleta y afectada por muchos
factores; se requiere de fotoactivación
La luz de activación sólo podría alcanzar el tercio coronario del

lecho radicular…
Conducción lumínica guiada por el perno
La única forma de
fotoactivar adhesivos y
MCR en los tercios
medios y apicales del
lecho es
conduciendo la luz
a través del perno
87
El perno de fibra debe
permitir una eficiente
conducción de la
luz cuando se ejecute
una fijación con
adhesivos y/o cementos
de resina duales
88
Lámpara de fotoactivación LED Quartz Light (RTD) con conos posicionadores
DT Light Post - RTD Rebilda Post - VOCO ParaPost Taper Lux - Coltène
ALTA
La capacidad de conducción de luz en los pernos de fibra

es también muy variable
BAJA / NULA
El flujo radiante que conduce el perno puede
ser registrado por equipamiento especial
Conducción lumínica guiada Basic Research—Technology
por el perno Influence of Fiber-post Translucency on the Degree of

Conversion of a Dual-cured Resin Cement
André Luís Faria e Silva, DDS, MS,* Vanessa Gallego Arias, DDS, PhD,*
Luís Eduardo Silva Soares, DDS, PhD,† Airton Abrahão Martin, Phys, PhD,†
and Luís Roberto Marcondes Martins, DDS, PhD*
Abstract
This study evaluated the degree of conversion of one
dual-cured resin cement when used to lute fiber posts
with different translucencies. To measure the degree of
F iber posts are commonly used to restore endodontically treated teeth when their
remaining coronal tissue can no longer provide adequate support and retention for
the restoration (1, 2). The similarity in elastic module among fiber post, resin cement,
conversion, polyvinylsiloxane molds were prepared to and dentin was judged to be advantageous for improving performance of the restora-
simulate root canals. The posts, Aestheti-Post or Light- tions (3, 4). Recently, however, it was shown that the expectation of creating mono-
Post, were cemented in these molds and, after photo- blocks by dentin bonding in root canals is unrealistic. The performance of the adhesive
activation, were removed to obtain the resin cement technique in root canals is compromised because of poor moisture control, the thick
spectrum by FT-Raman spectroscopy. Spectra were ac- smear layer, accessibility during handling of the materials, difficulty of light-curing the
quired at three depths: superficial, medium, and deep. adhesive system, and the highly unfavorable cavity configuration factor (5, 6). Fiber post
For Light-Post, the resin cement at deep depth showed retention is derived more from sliding friction than from true adhesion to intraradicular
the lowest degree of conversion and no significant dentin (7). Thus, the differences in the mechanical properties of resin cements may
difference in degree of conversion was found between result in an increase in the friction coefficient (8). With respect to resin cements,
the other depths. For Aestheti-Post, the superficial adequate polymerization is necessary to provide optimal mechanical properties (9).
depth presented a higher degree of conversion values Dual-cured cements were developed to provide some benefits offered by self- and
than those in the medium and deep depths, which were light-curing components. The rationale was to have a material with extended working
not significantly different from each other. Light-Post time and capable of reaching a high degree of conversion, in either the presence or the
exhibited a higher degree of conversion than that of absence of light (10). Nevertheless, some dual-cure resin cements are primarily de-
Aestheti-Post only at medium depth. Light-Post effec- pendent on light-activation, so an inadequate degree of conversion is expected when
tiveness regarding the degree of conversion is depen- light from the curing unit is not available (11, 12). During post fixation, exposed
dent on the depth. (J Endod 2007;33:303–305) marginal areas can be largely assisted by both self- and light-curing modes because they
are readily accessible to the curing light. As light is irradiated, a significant reduction in
Key Words intensity occurs as a result of the light scattering within the resin cement and shadowing
Degree of conversion, dual-cure resin cement, fiber produced by both tooth structure and post (13).
post, translucent post The use of a light-transmitting translucent fiber post was reported to increase the
depth of resin cure in studies that used light-cured resin composites (14 –16). No study
has, however, evaluated the ability of translucent fiber posts to increase the degree of
conversion of dual-cured resin cements, which are commonly used for post fixation.
From *Restorative Dentistry Department, Piracicaba Den- The aim of this study was to evaluate the degree of conversion of one dual-cured resin
tal School, University of Campinas, Piracicaba, SP, Brazil; and
†
Laboratory of Biomedical Vibrational Spectroscopy, Research cement at different depths, when used to lute fiber posts with different translucencies.
and Development Institute, Vale do Paraíba University, Sao
Jose dos Campos, SP, Brazil.
This work was supported by FAPESP Grant 05/54802-4. Materials and Methods
Address requests for reprints to André Luís Faria e Silva, The translucent quartz-fiber post Light-Post (Bisco Inc., Schaumburg, IL, USA)
Piracicaba Dental School, Restorative Dentistry, Av. Limeira and the quartz-coated carbon-fiber post Aestheti-Post (Bisco) were used in this study.
901, Vila Areião, 13414-903 Piracicaba, SP, Brazil. E-mail Both fiber posts are cylindrical and present two different diameters: 2.1 mm in the
address: andrelfs@fop.unicamp.br
0099-2399/$0 - see front matter upper and 1.4 mm in the lower part. To enable fiber posts covered with the resin cement
Copyright © 2007 by the American Association of to be removed to measure the degree of conversion (DC), polyvinylsiloxane impression
Endodontists. material (Aquasil, Dentsply DeTrey, Konstanz, Germany) molds were configured to
doi:10.1016/j.joen.2006.11.015 simulate root canals. The long axis of all fiber posts was ground with #600-grit Silicon
Carbide paper to expose a flat surface in the middle of the posts. This was made to create
a flat resin surface, which is better than the circular one for spectrum acquisition. One
ground Light-Post and one ground Aestheti-Post were used to make the impression and
to create the molds. Plastic plates [1.4 ! 12 ! 1 mm (width ! length ! thickness)]
were attached to the ground flat surfaces of these fiber posts using cyanoacrylate cement
to create space for the resin cement. The fiber-post impressions involved the entire
length of the plastic plate, creating 12-mm deep molds. Five molds were prepared for
each fiber post and dry-stored for 24 hours before the post cementation (n " 5).
The base and catalyst pastes of the dual-cured resin cement RelyX ARC (3M ESPE, St.
Paul, MN, USA), translucent and shade A1, were mixed and the cement was inserted in the
JOE — Volume 33, Number 3, March 2007 Factors Influencing Conversion Degree of Dual-cured Resin Cement 303
Pueden existir incrementos significativos en el grado de conversión del cemento

resinoso (espectroscopía FT Raman) de acuerdo a la eficiencia de conducción lumínica del perno
Conducción lumínica guiada
por el perno Dental Materials (2004) 20 , 617–622
En cambio, métodos de
www.intl.elsevierhealth.com/journals/dema
The effect of a translucent post on resin composite

depth of cure
estudio indirectos del

Howard W. Robertsa,*, Daniel L. Leonardb, Kraig S. Vandewallea, Mark
E. Cohenc, David G. Charltonc
a
United States Air Force Dental Investigation Service, Det 1 USAFSAM, 310C B Street, Building 1H, Great
Lakes, IL 60088, USA
grado de polimerización
b
Mission St. Joseph’s Hospital, Asheville, NC, USA
c
Naval Institute for Dental and Biomedical Research, Great Lakes, IL, USA
Received 5 February 2003; received in revised form 10 August 2003; accepted 9 October 2003
KEYWORDS Summary Objective. To evaluate the effect of a light-transmitting post on the depth of
(como el análisis de la
Light transmittal; Depth cure of a resin composite.
of cure; Resin composite; Methods. Acetate resin molds were filled with resin composite in which a light-
Translucent posts transmitting post was inserted into the center and photopolymerized to the
manufacturer’s recommendations. Identical molds without a light-transmitting post
were photopolymerized in a similar matter and served as a control. Molds were
sectioned on a water-cooled, diamond saw at prescribed distances and the depth of
cure was determined using a Knoop Hardness bottom-to-top ratio criterion. Data
within each group were analyzed using 2-way (depth-by-distance) repeated measure
ANOVA. Between-group contrasts (post versus no post) were accessed by a 3-way (2
dureza), pueden llegar a

within-subjects and 1 between-subjects) ANOVA with critical p ¼ 0:05:
Results. The presence of the post did increase ðp , 0:001Þ Knoop Hardness values in
simulated apical regions as compared to a control. However, there was no difference
in the depth of cure between the groups (3-way analysis p ¼ 0:2) and also when
evaluated using an 80% bottom-to-top Knoop Hardness ratio.
Significance. The results suggest that these posts may have a limited utility when
judged against a Knoop Hardness ratio criterion.
Published by Elsevier Ltd on behalf of Academy of Dental Materials.
Introduction
Clinicians frequently encounter situations where

excessive loss of coronal tooth structure and
internal root dentin has resulted from disease
techniques. In these cases, some type of post and
core is often indicated to assist in retention of the
final restoration.1 However, posts and cores used in
situations with minimally remaining root dentin or
thin root walls may have a compromised prognosis.2
resultados opuestos
processes, trauma, or overaggressive endodontic Guidelines have been published for the restora-
tion of endodontically treated teeth3 which serve to
*Corresponding author. Tel.: þ1-847-688-7676; fax: þ1-847- assist the practitioner in the selection of a post and
688-7667. core that affords the best prognosis for the retention
E-mail address: howard.roberts@ndri.med.navy.mil of a coronal restoration. Traditionally, two post and
0109-5641/$ - see front matter Published by Elsevier Ltd on behalf of Academy of Dental Materials.
doi:10.1016/j.dental.2003.10.004
Preparación para el
anclaje
intraradicular (PAI)
racional
PAI RACIONAL
1. Planificación sobre la Rx
2. Secuencia de instrumentación gradual y lógica
3. Conservación de dentina
4. Instrumentación con constante irrigación y baja velocidad: protección
contra la deshidratación / evitar formación de barro dentinario secundario
5. Adecuada limpieza (mecánica y química) del espacio para el perno: uso de
iluminación y magnificación (microscopios!).
PAI RACIONAL
1. Después de la obturación completa del
conducto radicular: el proceso ENDO/AI
demanda normalmente DOS sesiones clínicas.
2. Preparación inicial simultáneamente con la
instrumentación radicular / Obturación parcial
del conducto - tercio apical / Preparación final
empleando únicamente la fresa calibradora
correspondiente al perno: el proceso ENDO/AI
demanda normalmente UNA sesión clínica
PAI RACIONAL
Un sólo perno por diente: en dientes multirradiculares,
palatinos en superiores, distales en inferiores.
Suelen ser los conductos más

rectos y amplios. Los otros
conductos presentan zonas curvas
y a veces muy adelgazadas: riesgos
de perforaciones o fracturas.
Sivers JE, Johnson WT. Restauración de dientes con tratamiento endodóntico. Clínicas Odontológicas de Norteamérica 1992;3:647-65.
Stockton LW. Factors affecting retention of post system: A literature review. Journal of Prosthetic Dentistry 1999;81:380-5.
PAI RACIONAL
La extensión en profundidad debe ser la

mayor posible ya que asegura la traba del
perno pero no deben comprometerse la
obturación apical ni tampoco ingresar en
porciones curvas del conducto.
Mallat Callís E. Manual de restauración del diente tratado endodónticamente. Ed. Ergon. Madrid, España. 2014.
Bergman B, Lundquist P, Sjögren U, Sundquist G. Restorative and endodontic results after treatment with cast post cores. Journal of Prosthetic Dentistry
1989;61(1):10-5.
Mattison GD, Delivanis PD, Thacker RW, Hassell KJ. Effect of post preparation on the apical seal. Journal of Prosthetic Dentistry 1984;51:785-9.
PAI RACIONAL
Para lograr éstos y otros

objetivos se planifica
sobre la RX
preoperatoria
PAI RACIONAL

La preparación radicular es sus distintas etapas debe reducir el desgaste de
tejido: mejorará la resistencia mecánica de la raíz
Pilo R, Tamse A. Residual thickness in mandibular premolars prepared with Gates Glidden and ParaPost drills. Journal of Prosthetic Dentistry 2000;83:617-23.
Conocer la anatomía de los conductos y la acción de los instrumentos

ayudará en este objetivo: sin dudas, el endodoncista está mejor preparado en este aspecto
Abou-Rass M, Iann JM, Jobe D, Tsutsui F. Preparation of space for posting: Effect on thickness of canal walls and incidence of perforation in molars. Journal of
American Dental Association 1982;40:834-7.
Mc Lean A. Criteria for the predictably restorable endodontically treated tooth. Journal of Canadian Dental Association 1998;64:652-6.
El sellado apical no debe ser perturbado: dejar como mínimo de 3 a 5 mm de

obturación.
Hudis SI, Goldstein GR. Restoration of endodontically treated teeth: A review of literature. Journal of Prosthetic Dentistry 1986;55(1):34-3
Kvist T, Rydin E, Reit C. The relative efrecuency of periapical lesions in teeth with root canal-retained post. Journal of Endodontics 1989;15:578-80
PAI RACIONAL
• El promedio de fracturas radiculares se

incrementa proporcionalmente con la
cantidad de dentina radicular removida
• El espesor mínimo de dentina luego de la
PAI debería ser de 1,00 mm
Trabert KC, Caputo AA, Abou-Rass M. Tooth fracture-a comparison of endodontic and restorative treatments. J Endod 1978;4:341-345
Sathorn Ch, Palamara JEA, Palamara D, Messer HH. Effect of root canal size and external root surface morphology on fracture susceptibility
and pattern: a finite element analysis. J Endod 2005;31:288-292
Caputo AA, Standlee JP. Pins and posts-why, when and how. Dent Clin North Am. 1976;20:299-311
PAI RACIONAL
Se han investigado diferentes métodos para remover gutapercha

y comenzar la PAI (mecánicos, con instrumentos calientes o
químicos), así como el efecto que tienen sobre el sellado apical;
los métodos mecánicos y/o con instrumentos
calientes son más seguros y no presentan mayores
ventajas uno sobre otro…
Bergman B, Lundquist P, Sjögren U, Sundquist G. Restorative and endodontic results after treatment with cast post cores. Journal of Prosthetic Dentistry
1989;61(1):10-5.
PAI RACIONAL
Las fresas Peeso (Largo de Maillefer) son las más
empleadas para la remoción mecánica de la gutapercha
(muchos profesionales también usan Gates-Gildden)
Con el primer instrumento se sugiere trabajar con mayor
velocidad para termoplastificar la gutapercha o emplear previamente
un instrumento caliente… y no desgastar dentina durante el
proceso…
Bergman B, Lundquist P, Sjögren U, Sundquist G. Restorative and endodontic results after treatment with cast post cores. Journal of Prosthetic
Dentistry 1989;61(1):10-5.
PAI RACIONAL
Fresas Gates Glidden:
Parte activa de 3 mm
Indicación: ensanchamiento del 1/3 coronario del conducto
Punta inactiva
Largo del vástago: 15 o 19 mm
Poseen 3 filos
Velocidad de rotación: 750 a 1000 rpm
Nº 1 = equivale a una lima Nº 50
PAI RACIONAL
Fresas Peeso (Largo de Maillefer):

Parte activa de 8 mm
Punta inactiva
Largo del vástago: 15 o 19 mm
Poseen 3 filos
Velocidad de rotación: 800 a 1200 rpm
PAI RACIONAL
Para la confección del lecho donde se instalará el AI, los sistemas de pernos tienen su
correspondientes fresas de tallado. En general, la secuencia de instrumentación inicia
con una fresa Largo/Peeso.
La misma presenta como característica una punta guía que facilita la remoción
del material de obturación endodóntico y se continúa con una zona de
paredes paralelas de aproximadamente 8 mm de longitud.
Se comercializan en varios calibres, siendo las más empleadas los números I y II, que se
corresponden con las limas tipo K #70 y #90 respectivamente. Estos significa que en su
porción activa poseen un calibre de 0.70 y 0.90 mm.
Goldberg F et al. Relación entre el diámetro mesiodistal del tercio cervical y medio de 200 incisivos inferiores y el calibre de las fresas de Largo I y II usadas para la preparación del anclaje
intrarradicular. Revista Canal Abierto. 2016. 32: 4-7.
PAI RACIONAL
Una fresa Largo/Peeso #2 puede

presentar un calibre excesivo y así
desgastar gran cantidad de dentina en
conductos de algunas piezas, como por
ejemplo incisivos inferiores…
Goldberg F et al. Relación entre el diámetro mesiodistal del tercio cervical y medio de 200 incisivos inferiores y el calibre de las fresas de Largo I y II usadas para la preparación del anclaje
intrarradicular. Revista Canal Abierto. 2016. 32: 4-7.
PAI RACIONAL
Luego del uso de las fresas Peeso, se

emplearán las fresas que se
corresponden en forma y calibre con
el perno (fresas calibradoras)
PAI RACIONAL
Article published in
AMERICAN JOURNAL OF
DENTISTRY
December 2017 Vol.30 No.6: 295-298
(Portigliatti RP, Tumini JL, Bertoldi Hepburn
AD, Aromando FR, Olmos JL)
PAI RACIONAL
PAI RACIONAL
Existe fricción con los tejidos: trabajar con baja

velocidad (idealmente entre 1000 - 1500 rpm)
Abundante, continua y permanente irrigación en el lecho
para el perno: solución fisiológica o agua
destilada.
Renovación periódica de los instrumentos (12 a 15
usos)
Caputo AA, Standlee JP. Pins and posts-why, when and how. Dent Clin North Am. 1976;20:299-311
PAI RACIONAL
Instrumente siempre en forma secuencial desde la

primera fresa hasta la correspondiente al perno
seleccionado.
Las fresas se introducen hasta la longitud de
trabajo una o (a lo sumo) dos veces por el riesgo
de vibración horizontal que amplíe el lecho
(Caputo AA, Standlee JP. Pins and posts-why, when and how. Dent Clin North Am. 1976;20:299-311)
In vitro evaluation of temperature rise during different post space preparations Hakan Gokturk, Ismail Ozkocak, Mehmet Murat Taskan, Fatma Aytac ,Emine Sirin.
Although water coolant used, the critical temperature rise was observed on the outer root surface in all post drill systems Rebilda 1 (8.08 ± 5.4°C) Rebilda
1aused the lowest temperature rise…
Rebilda Post System
VOCO GmbH
Peeso File #1 (apical diameter Rebilda Post Reamer #1 (apical Rebilda Post Reamer #2 (apical Rebilda Post Reamer #3 (apical
0.70 mm) (cilindrical) diameter 0.50 mm) (tapered) diameter 0.65 mm) (tapered) diameter 0.80 mm) (tapered)
PAI RACIONAL
Si el conducto fue obturado hasta el inicio

de la porción coronaria (situación más frecuente),
luego de la instrumentación rotatoria del
lecho para el perno, habrá que limpiar sus
paredes de restos de gutapercha y/o
cemento…
PAI RACIONAL
RESUMIENDO…
PAI después de la obturación del conducto
PLANIFICACIÓN SOBRE RX

Fresas Peeso (con o sin
desobturación previa con calor) Fresas calibradoras
DESOBTURACIÓN /
PRECONFORMACIÓN CONFORMACIÓN
MAGNIFICACIÓN E ILUMINACIÓN INSTRUMENTACIÓN MECÁNICA + IRRIGACIÓN
LIMPIEZA LIMPIEZA
FINAL
Microscopes (or magnifying Different manual instruments and Different substances (water+detergent,
glasses with light source) irrigant solutions (normally poliacrylic acid in water solution,
physiological solution / distilled water / phosphoric acid, EDTA + sodium
water based disinfectants) hypochlorite, etc.)
LIMPIEZA FINAL
LIMPIEZA: INSTRUMENTACIÓN
LIMPIEZA: MAGNIFICACIÓN E (ACONDICIONAMIENTOS QUE
MECÁNICA + CONTINUA
ILUMINACIÓN BUSCAN MAYOR LIMPIEZA - OTROS
IRRIGACIÓN
ABRIR TÚBULOS)
!
ESTE PROCESO DE LIMPIEZA, DEMANDANTE DE TIEMPO
Y COMPLEJIDAD, PUEDE SER EVITADO SI EL CONDUCTO
SE OBTURARA SÓLO EN SU PORCIÓN MÁS APICAL (o
bien si el espacio para perno se completara
inmediatamente a la obturación radicular)…
PAI RACIONAL
Obviando la desobturación se evitarán el

proceso de limpieza mecánica/química: es
MUY recomendable obturar sólo la porción
apical del conducto… Y continuar en la misma
sesión de trabajo con la preparación para el anclaje
intrarradicular (PAI) y la posterior inserción del perno…
Perno
1. Limpieza con alcohol
2. Aplicación y fotoactivación de resina a base de dimetacrilatos
Diente:
1. Limpieza mecánica (cucharetas, cepillos) con
detergente y agua, enjuague con sol. fisiológica y secar
2. Aplicación de glicerina
FRC strips
El FRC se corta, posiciona en porciones medias y coronarias sobre perno, se lleva al conducto y se fotopolimeriza
CEMENTOS RESINOSOS
AUTOGRABANTES
Fiber post
FRC
Resin cement
PAI RACIONAL
Si la desobturación no es efectuada por el Endodoncista, el
Rehabilitador debe contar con la siguiente información:
1. Radiografías pre (longitud aparente) y postoperatorias del TC
(muestra la obturación final)
2. Longitud de trabajo, indicando la referencia coronaria
3. Número del instrumento final empleado
4. Numeración del cono principal
5. Tipo de cemento empleado
6. Otras (ej.; conicidad lograda en el conducto)
PAI RACIONAL
Lograr continuidad entre el

perno y la gutapercha (evitará
formación de espacios donde
pueden existir irritantes y se sellará
el acceso a conductos laterales):
calibrar adecuadamente cada una de
las fresas al preparar el lecho y
controlar permanentemente la
longitud de trabajo
PAI RACIONAL
PAI RACIONAL
Cátedra de Endodoncia de la Facultad de Odontología de la Universidad de Buenos Aires (UBA)

PAI RACIONAL
La instrumentación
endodóntica mecanizada
ayuda en conseguir una
PAI más apropiada
PAI RACIONAL
La instrumentación
mecanizada puede dejar
el conducto
preconformado para el
perno con mayor rapidez,
facilidad, precisión y
predictibilidad que la
61 instrumentación manual
55
49
43
37
25 31
PAI RACIONAL
Así, la PAI
probablemente
80 se reduzca sólo al
empleo de la
fresa calibradora
correspondiente
61
80
al perno
55
49
43
37
25 31
PAI RACIONAL

PERNOS ACCESORIOS PERNO ANATÓMICO CON FRC
Obtención de la
traba mecánica
(Y muchas veces
también de una
estructura más
gruesa y resistente)
SUPLEMENTO DE LA
DENTINA DEL CONDUCTO
CON IVMR DE ALTA
VISCOSIDAD
POSTE ANATÓMICO
POSTE ANATÓMICO CON FRC
CON COMPOSITE
C1. Sustituto dentinario con IV de
alta viscosidad
Voco Ionofil Molar (VOCO)
“Los pernos de fibra anatómicos
y los pernos de fibra
insertados en raíces
rellenas con ionómero de
vidrio mostraron el
menor nivel de estrés
radicular. Los pernos
metálicos colados, el mayor”
Huertas Mogollón G, Castilla Camacho M. Estrés
radicular en premolares con tratamiento de conducto
con canal ensanchado restaurado con postes
personalizados y convencionales por el método de
elemento finito. Rev Cient Odont 2013;1:14-19
C2. Pernos anatómicos con composite
Polofil NHT (VOCO)
Los composites empleados para esta técnica deben tener

alta carga cerámica; poseen propiedades mecánicas más
altas y mayor resistencia a la fatiga
Mallat Callís E. Manual de restauración del diente tratado endodónticamente. Ed. Ergon. Madrid, España. 2014.
FRC en tiras
Quartz Splint (RTD)
GrandTec (VOCO)
Splint-it (Jeneric Pentron)
Fibrex-Lab Medial (Angelus)
Vectris Pontic (Ivoclar Vivadent)
Fiber-Splint ML (Polydentia)
C3. Pernos anatómicos con FRC

C3. Pernos anatómicos con FRC
C4. Pernos accesorios
The use of accessory glass fibre posts affected
the fracture mode favorably: 90% of fractures
in group AGP were in the coronal third.
doi:10.1111/j.1365-2591.2008.01424.x
Fracture resistance of structurally compromised

root filled bovine teeth restored with accessory
glass fibre posts
H. Martelli Jr, E. P. Pellizzer, B. T. Rosa, M. B. Lopes & A. Gonini Jr

University North of Paraná, Londrina, Paraná, Brazil
Abstract anova were performed to examine differences in

fracture resistance; fracture modes were analysed by
Martelli H Jr, Pellizzer EP, Rosa BT, Lopes MB, Gonini A
Fischer’s exact test.
Jr. Fracture resistance of structurally compromised root filled
Results The mean fracture resistance values (kgf)
bovine teeth restored with accessory glass fibre posts. Interna-
were 61.8 (MP), 63.1 (GP), 55.5 (AGP), 56 (GP-R) and
tional Endodontic Journal, 41, 685–692, 2008.
(53.1) AGP-R. No statistically significant difference was
Aim To evaluate the mechanical behaviour of struc- found between groups. The Fisher’s exact test indicated
turally compromised root filled bovine roots after significant differences (P < 0.05) in the fracture mode
restoration with accessory glass fibre posts. amongst groups MP, GP and AGP, indicating 100%,
Methodology Fifty roots of bovine teeth received 50% and 10% of catastrophic fractures, respectivelly.
conventional post preparations with a cervical diame- Conclusions The use of accessory glass fibre posts
ter of 3.5 mm. The roots were assigned to five groups affected the fracture mode favorably: 90% of fractures
(n = 10): group MP – cast metal post, group GP – glass in group AGP were in the coronal third.
fibre post and group AGP – glass fibre post plus
Keywords: cast metal post, fracture resistance, glass
accessory glass fibre posts. In groups GP-R and AGP-R
fibre post, pre-fabricated post, root fracture.
(similar to groups GP and AGP), 2 mm of coronal tooth
structure were left intact. All groups were subjected to Received 5 October 2007; accepted 6 March 2008
an elastic limit assay and tested in an universal
machine for fracture resistance. Repeated measures
To prevent fractures, factors such as the amount of

Introduction
remaining tooth structure, the mechanical resistance of
The restoration of root filled teeth is a challenge. Loss the post and bonding between the canal walls and
of tooth structure although carious lesions, fractures restoration must be considered (Sornkul & Stannard
and as a result of root canal treatment leads to 1992). Although a cast metal post and core is the
weakening of the remaining tooth tissues (Gutmann traditional approach because of its proven clinical
1992). When the coronal restoration is associated effectiveness (Solomon & Osman 2003), its mechanical
with an intraradicular post, the likelihood of restora- properties may increase the risk of root fracture
tion failure increases, with root fracture one of the (Hornbrook & Hastings 1995).
most unfavourable outcomes (Qualtrough & Mannocci As an alternative to metal, pre-fabricated posts made
2003). of glass fibres in a matrix of epoxy resin were developed
(Duret et al. 1990). They have high mechanical
resistance and their modulus of elasticity is similar to
that of dentine (Fokkinga et al. 2004). Such properties
Correspondence: Alcides Gonini Júnior, Rua Pernambuco, 390
Sala 903, Londrina, Paraná, CEP 86020-913, Brazil (Tel.:
would allow them to form a homogeneous complex
+55 43 3324 7016; fax: +55 43 3329 1197; e-mail: with the root and provide absorption of loads compa-
gonini@sercomtel.com.br). rable with a sound tooth (Duret et al. 1990). In
ª 2008 International Endodontic Journal International Endodontic Journal, 41, 685–692, 2008 685
C5. Pernos ovales
C5. Pernos ovales
POSTES OVALES Y DE
CONICIDAD AUMENTADA
C6. Pernos personalizables
“Specimens restored with fiber dowels, accessory dowels, relined dowels, and ribbon-reinforced resin provided adequate fracture
resistance with increased incidence of repairable fractures”.
Aggarwal V, Singla M et al. Comparative evaluation of fracture resistance of structurally compromised canals restored with different dowel methods. J Prosthodont.
2012 Jun;21(4):312-316. doi: 10.1111/j.1532-849X.2011.00827.x. Epub 2012. Feb 19.
“The use of accessory glass fibre posts affected the fracture mode favorably: 90% of fractures in this group were in the coronal third”.
Martelli H Jr, Pellizzer EP, Rosa BT, Lopes MB, Gonini A Jr. Fracture resistance of structurally compromised root filled bovine teeth restored with accessory glass
fibre posts. Int Endod J. 2008 Aug;41(8):685-92. Epub 2008 Jun 28.
“ Fracture strength values of groups with accessory were statistically higher, irrespective of the post geometry tested, than those of only one
master post. When restoring with posts, especially in wide oval-shaped canals, the use of accessory posts (with quartz fiber master post)
reduces the cement thickness around the posts thus increasing the resistance to fractures, and could be proposed as an efficient treatment
alternative to reinforce endodontically treated teeth”.
Alkumru H et al. Fracture strength of teeth in oval-shaped root canals restored with post systems and accessory post systems. Canadian Journal of Restorative Dentistry &
Prosthodontics. Vol 6. No 1. Spring 2013
“It was observed that flared roots filled with composite resin and/or accessory glass fiber posts presented a lower incidence of catastrophic fractures compared
with cast posts and core groups. These posts, associated with composite resin or accessory glass fiber posts seems to be an effective method to improve the
bio-mechanical behavior of flared roots.”
da Silva GR et al Effect of post type and restorative techniques on the strain and fracture resistance of flared incisor roots. Braz Dent J (2011);22(3):230-7.
“...using multiple (fiber) posts for the restoration, smaller quantities of cement and core resin are used. Accordingly, shrinkage effects are minimized,
proportionately to the polymerization volume reduction, the post pull-out risk is reduced, and a longer restoration durability to cyclic loading... can be expected”.
Maceri F et al. Mechanical behaviour of endodontic restorations with multiple prefabricated posts:A finite element approach. J Biomech. 2007;40(11):2386-98. Epub 2007 Jan 24
“DT Light-Post with accessory posts provided higher fracture strength values compared to other reconstruction options investigated. The volume of fibres was
increased and the cement thickness was minimized. All teeth fractured favourably..... No root fractures were observed in any of the groups”.
Akkayan, B., et al Effect of post geometry on the resistance to fracture of endodontically- treated teeth with oval-shaped root canals. Canadian Journal of Restorative Dentistry and
Prosthodontics. Summer 2010. Pages 20-26.
“The structurally-compromised teeth restored with DT Light-Posts and extra fibers showed the most fracture resistance compared to subgroups; and their
strengths were comparable to to those of normal roots restored with DT Light-Posts. More desirable fracture patterns were observed in teeth restored with fiber
posts (compared to metal or zirconia posts)”.
Mortazavi V, Fathi M et al. Fracture resistance of structurally compromised and normal endodontically treated teeth restored with different post systems. Dent Res J 2012 Mar-Apr; 9(2):185-91
“It may be advisable to use several small accessory posts with a larger one. In this way, it could reduce the thickness of the luting material, increasing fracture
resistance. The use of multiple posts resulted in fracture resistances higher than that of the single post of corresponding size for two of the three diameters
studied”.
Porciani PF et al. Fracture resistance of fiber posts: Combinations of several small posts vs. standardized single post. Am J Dent 2008; 21: 373-376
”Macro-Lock (RTD) post combined with the auxiliary fiber posts increased the fracture resistance of the overflared root.”
Li Q et al Effects of auxiliary fiber posts on endodontically- treated teeth with flared canals. Oper Dent. 2011 Jul-Aug;36(4):380-9. Epub 2011 Aug 11.
C7. Pernos maquinados (MAD-CAM / CAD CAM)
Video Dr. Fernando Salatay

(La Plata, Argentina)
Publicado en Facebook
•Clínicamente simple y rápida
Cementación •Sin variables complejas que puedan
condicionar su resultado
simplificada •No se aplican adhesivos sobre la
dentina radicular (si se lo hace,
adhesivos de uso simplificado)
•Sin tratamientos adhesivos
sobre el perno
•Con materiales cementantes que
aportan eficiente traba mecánica
secundaria
CEMENTACIÓN SIMPLIFICADA
2 Cementos de ionómero
modificado con resina
Cementos de resina autograbantes

Many scientific reports indicate that good retention values can be achieved when working
with simplified cementation procedures (especially with self-adhesive resin cements)
2
‣ Higher hydrophilicity at the beginning of the setting
reaction: better wetting properties (micromechanical locks)
‣ Higher physical properties: two setting reactions (resin
like / glass ionomer cement like)
‣ Less sensitive working technique
‣Chemical bonding
Resin modified glass ionomer cements
Self-adhesive composite resin cements
CEMENTACIÓN SIMPLIFICADA
The mean bond strength of Elite 100® zinc

phosphate cement to Aestheti-Plus™ posts was
7.71 MPa (±2.51). Whereas the mean bond
strength of Calibra resin cement was 5.69 MPa
(±3.23). RelyX ARC exhibited the lowest mean
bond strength, 4.29 MPa (±3.53) and RelyX
Unicem showed the highest bond strength
compared to the other groups, 7.98MPa (±2.61).
Yahya, N.A; Lui, J.L; Chong, K.W.A; Abu Kasim, N.H; Radzi, Z; Lim, C.M.
Effect of luting cement to push-out bond strength of fibre reinforced
post. Annals of Dentistry 15 (1), 11-19.
Laboratory investigations found comparable
retentive strength values between RelyX
Unicem and resin cements that utilized two
or three-steps adhesives
(Bitter K, Priehn K, Martus P, Kielbassa AM. In vitro evaluation of push-out bond strengths
of various luting agents to tooth-colored posts. J Prosthet Dent 2006; 95: 302-310).
Bateman, GJ; Lloyd, CH; Chadwick, RG & Saunders, WP. Retention of quartz-fibre endodontic posts with a
self-adhesive dual cure resin cement. Eur. J. Prosthodont. Restor. Dent.,13:33-37, 2005.
Bitter, K; Meyer-Lueckel, H; Priehn, K; Kanjuparambil, JP & Neumann, K & Kielbassa, AM . Effects of luting
agent and thermocycling on bond strengths to root canal dentin. Int. Endod. J., 39(10): 809-818, 2006.
Huber, L; Cattani-Lorente, M; Shaw, L; Krejci, I; Bouillaguet, S. Push-out bond strengths of endodontic

posts bonded with different resin-based luting cements. Am. J. Dent., 20:167-172, 2007.
Baldissara, P; Monaco, C; Valandro, LF & Scotti, R. Retention of quartz fiber posts using different luting
cements. J. Dent. Res., 88 (Spec. Issue A) Abstract #976 (dentalresearch.org), 2009.
Kahnamouei, MA; Mohammadi, N; Navimipour, EJ & Shakerifar, M. Push-out bond strength of quartz fibre
posts to root canal dentin using total-etch and self-adhesive resin cements. Med. Oral. Patol. Oral Cir.
Bucal, 17(2):337-344, 2012.
Bitter, K; Hambarayan, A; Neuman, K; Blunck,U; Sterzenbach G. Various irrigations protocols for final rinse
to improve bond strengths of fiber posts inside the root canal. Eur. J. Oral Sci., 121:349-54, 2013.
Yahya NA et al Effect of luting cement to push-out bond strength of fibre reinforced post. Annal Dent
Univ Malaya 2008; 15(1): 11-19, 2008.
A higher sealing ability of RelyX
Unicem was found when dispensed
with the elongation tip in
comparison with other multi-step
cements which were inserted into
root canal with a lentulo spiral or
directly applied on post surface.
Simonetti M, Coniglio I, Magni E, Cagidiaco
MC, Ferrari M. Sealing ability and
microscopic aspects of a selfadhesive resin
cement used for fiber post luting into root
canals. Int Dent S Afr 2008; 8: 24-30.
‣ The advantages of RMGIC include less sensitivity to technique and a smaller time commitment, but the system
achieves bond strengths comparable to most of the tested adhesive luting systems...
Dental Traumatology 2012; doi: 10.1111/edt.12013
Restoration of endodontically treated teeth

with major hard tissue loss – bond
strength of conventionally and adhesively
luted fiber-reinforced composite posts ‣ However, the indication for using RMGIC for luting endodontic posts should be
Stefanie Binus1, Andreas Koch1,
Anselm Petschelt1, Christine
Berthold1,2
1
Dental Clinic 1 – Operative Dentistry and
Periodontology, Friedrich-Alexander-University,
Erlangen, Germany; 2Faculty of Dentistry,
Division of Endodontics, University of British
Abstract – Aim: To evaluate the influence of the luting system on the pull-
out bond strength of conventionally and adhesively luted fiber-reinforced
composite posts (FRCPs). Material and methods: One hundred extracted
bovine teeth (Di 3) were endodontically treated and randomly assigned to
nine test groups and one control group (n = 10) according to luting system.
After preparing the post cavities (8 mm), the custom-made FRCPs were
inserted using conventional glass-ionomer cement (Ketac Cem), resin-rein-
critically discussed and needs further evaluation. RMGIC is known for water
sorption and consequent expansion of the material, which could theoretically lead
Columbia, Vancouver, BC, Canada forced glass-ionomer cement (Meron Plus and Fuji Plus), self-adhesive
resin cement (RelyX Unicem and BisCem), self-conditioning adhesive and
resin cement [Multilink Primer + Multilink and AdheSE + DC Activa-
tor + MultiCore Flow, or etch-and-rinse adhesive and resin cement (Seal-
Bond Ultima + CoreCem, and LuxaBond + LuxaCore Z). As a control,
custom-made titanium posts were inserted with Ketac Cem. After water
storage (37°C, 24 h, dark), the pull-out test was performed, followed by
failure mode evaluation. The data were statistically analyzed (a = 0.05)
to vertical root fractures when used in root canals. This consideration can only be
Key words: fiber reinforced posts; bond using analysis of variance and the Dunnett T3 post hoc test. Results: Lut-
strength; pull-out test; root strengthening;
ing system type and identity significantly influenced bond strength
immature traumatized teeth; post-endodontic
restoration (P < 0.001); the bond strengths of all luting systems except Ketac Cem,
MeronPlus, and BisCem were significantly higher than the control
Correspondence to: Dr. Christine Berthold, (4.4 ± 1.1 MPa). RelyX Unicem (12.0 ± 3.0 MPa) and LB + LCZ
Friedrich-Alexander-University Erlangen-
(14.8 ± 2.3 MPa) generated the highest bond strengths. The clinical appli-
Nuremberg, Dental Clinic 1 – Operative
Dentistry and Periodontology, Glueckstr.11, cation was demonstrated by restoring a traumatized tooth with extensive
91054 Erlangen, Germany coronal destruction and thin root canal walls, using a FRCP combined
neglected if absolutely no water can access the luting material around the
e-mail: berthold@dent.uni-erlangen.de, with direct composite build-up. Conclusion: Luting system selection signif-
berthoce@dentistry.ubc.ca icantly influenced the bond strength of conventionally and adhesively luted
Accepted 14 September, 2012 FRCPs to bovine root canal dentin.
As a result of falls, fighting, sports, and bicycle acci- posts is recommended to provide additional retention
dents, approximately 18–25% of the human population for the core build-up. Anterior teeth and premolars are
cemented post.
suffers traumatic dental injuries during childhood and more frequently treated with posts than are molars,
adolescence, usually before finishing school (1, 2). Max- due to the small retention area within the remaining
illary incisors are most commonly affected, and crown dentin and enamel (4, 5).
fractures without pulp exposure are the predominant The dental market offers a wide variety of post sys-
type of injury (58–73%) (3). For more severe injuries tems. Custom-cast gold posts or prefabricated metal
that result in pulp exposure, the treatment should aim posts (stainless steel, palladium alloy, titanium), luted
to retain pulp vitality, especially in immature teeth, to with zinc phosphate or glass-ionomer cements, have
ensure apexogenesis and thickening of the root canal been successfully used in the clinic for decades (6–9).
walls by dentin apposition. In cases of pulp necrosis, However, the disadvantages of metallic post restora-
endodontic treatment must be considered. The individ- tions include the unsatisfying esthetical outcome as well
ual loss of tooth structure influences the treatment as the risk of vertical and horizontal root fractures.
options in terms of restoration; endodontically treated The distinctively higher modulus of elasticity of metal
anterior teeth with a minimal or moderate degree of posts compared to dentin has been suggested to cause
destruction can be restored conservatively with bonded these fractures (10–12). Fiber-reinforced composite
direct composite restorations. For severely destroyed posts (FRCPs), with a modulus of elasticity similar to
teeth (<2 mm of tooth substance remaining), the use of dentin, should solve this problem. FRCPs are believed
© 2012 John Wiley & Sons A/S 1
Binus S, Koch A, Petschelt A, Berthold C (2012). Restoration of endodontically treated teeth with major hard tissue loss – bond strength of conventionally
and adhesively luted fiber-reinforced composite posts. Dental Traumatology 2012; doi: 10.1111/edt.12013
Revista de OpeRatORia dental y biOmateRiales
Estudio de Investigación
PROTOCOLO DE CEMENTADO ALTERNATIVO PARA SITUACIONES
CLÍNICAS ADVERSAS UTILIZANDO POSTES DE FIBRA; ESTUDIO CON
MICROSCOPÍA ELECTRÓNICA DE BARRIDO.
ALTERNATIVE BONDING TECHNIQUE PROTOCOL FOR ADVERSE
CLINICAL CONDITIONS USING FIBER POSTS; A SEM STUDY.
Gustavo Parodi Estellano1, Sergio Pignata Volpe2

1. Profesor de Clínica de Cariología y Prevención, Facultad de Odontología, Universidad Católica del Uruguay
Ex Profesor Adjunto, Cátedra de Operatoria Dental II, Facultad de Odontología, Universidad de la República
Oriental del Uruguay. gustavoparodi@hotmail.com
2. Profesor de Preclínico de Operatoria Dental, Facultad de Odontología, Universidad Católica del Uruguay
Profesor Adjunto, Cátedra de Operatoria Dental II, Facultad de Odontología, Universidad de la
República Oriental del Uruguay.
RESUMEN ABSTRACT
Objetivo: El objetivo de este estudio fue analizar por Microscopía Elec- Objectives: The aim of the study was to analyze by Scanning Electron
trónica de Barrido las interfases resultantes luego de cementar con ion- Microscopy the interphase resulting after cementing fiber posts with hybrid
ómero híbrido, postes de fibra individualizados con resina compuesta. Se ionomer cement, individualized with composite resin. The structure and
evaluó la estructura y continuidad de tres interfases: dentina radicular- continuity of three interphase were evaluated: dentin root-glass ionomer
cemento; cemento-resina compuesta y resina compuesta-poste de fibra. cement; glass ionomer cement-composite resin and composite resin-fiber
Método: Se realizó la endodoncia en veinte dientes uniradiculares extraí- post. Method: Root canal was performed in twenty single-rooted teeth
dos por razones periodontales. Los canales fueron ensanchados en su ter- extracted for periodontal reasons. The canals were flared in their coronal
cio coronario con una fresa de diamante. Luego del tallado del canal para third with a diamond bur. After standardized post-space preparation the
el poste y aplicación del acondicionador dentinario, cada espécimen recibió root dentine was pretreated with a dentin conditioner (10% polyacrylic
un poste de fibra de cuarzo previamente rebasado con resina compuesta. acid), and each specimen received a quartz fiber post relined with compos-
Se utilizó un cemento de ionómero híbrido para la fijación de acuerdo a ite resin. The glass-ionomer hybrid cement was used according manufac-
las indicaciones del fabricante. Luego de ser almacenadas por 48 horas a turer’s instructions for post cementation. After storage at room tempera-
‣
temperatura ambiente en suero fisiológico, 10 raíces fueron seccionadas ture for 48 hours in physiological saline solution, 10 roots were sectioned
La ligera expansión higroscópica que presentan los

transversalmente en 3 partes y 10 longitudinalmente en mitades. Se realizó transversally into 3 pieces and 10 roots longitudinally into halves.The speci-
la preparación de los especímenes para Microscopía Electrónica de Bar- mens were then prepared for Scanning Electron Microscopy (SEM) to ob-
rido (MEB) con el fin de observar las interfases resultantes. Resultados: serve the resulting interphases. Results: The SEM examination revealed
El examen por MEB reveló una interfase perfecta entre el ionómero y la a perfectly sealed interface between glass ionomer and root dentin. The
pared radicular. Por otra parte la interfase cemento-resina compuesta fue ionomer-composite resin interface was good and the post-resin interface
buena y la interfase resina compuesta-poste mostró una integración per- showed a perfect integration. Conclusion: Within the parameters of this
fecta. Conclusiones: Dentro de los parámetros de este estudio, la técnica study, the technique of individualization of posts with composite resin and
IVMR mejora la fricción del perno contra las

de individualización de postes con resina compuesta y su posterior cemen- subsequently cemented hybrid ionomer appears to be a valid alternative in
tado con ionómero híbrido parece ser una alternativa válida en el caso de the cases of elliptical or over-flared root canals.
canales radiculares elípticos o sobre ensanchados.
Keywords: Bonding techniques, fiber posts, resin modified glass iono-
Palabras clave: Técnicas de cementado, postes de fibra, ionómero hí- mers (RMGI), individualized post, anatomic post.
brido, poste individualizado, poste anatómico.
paredes del lecho Volumen IV. Número 2. Mayo - Agosto 2015

http://www.rodyb.com/protocolo-de-cementado-alternativo
44
Parodi G, Pignata S (2015)

‣ Algunos trabajos también describen una mejora en la resistencia a la fractura al trabajar con
pernos de fibra y cementación simplificada (RMGIC)
Fracture resistance of endodontically
treated teeth restored with glass fiber
reinforced posts and cast gold post and
cores cemented with three cements
Carlos Torres-Sánchez, DDS, MS,a Vanessa Montoya-Salazar,
DDS, MS,b Paola Córdoba, DDS, MS,c Claudia Vélez, DDS, MS,d
Andrés Guzmán-Duran, DDS, MS,e José-Luis Gutierrez-Pérez,
DMD, PhD,f and Daniel Torres-Lagares, DDS, PhD g
School of Dentistry, University of Seville, Seville, Spain; School of
Dentistry, University Schools of Colombia, Bogotá, Colombia
Statement of problem. Dental fractures can occur in endodontically treated teeth restored with glass fiber reinforced
posts and cast gold posts.
Purpose. The objective of this study was to record the fracture strength of endodontically treated teeth restored with
glass fiber reinforced or cast gold post and cores cemented with 3 cements.
Material and methods. Forty-two single-rooted premolars with standardized weakened roots were endodontically
treated and allocated to 6 experimental groups (n=7) defined by the 2 factors investigated: post system and cement.
Three groups were restored with glass fiber posts and resin-modified glass ionomer cement, dual-polymerizing resin
cement, or chemically active autopolymerizing resin cement. The other 3 groups were restored with cast gold post and
cores and the same 3 cements. The cores of the glass fiber post groups were fabricated with composite resin core ma-
terial. Metal crowns were cemented on the cores in the 6 groups. The entire system was subjected to continuous com-
pression in a universal testing machine, and fracture limit and location (cervical third, middle third, or apical third)
were noted. Two-way ANOVA and the Scheffé test were used to analyze the data and compare the groups (α=.05).
Results. Two-way ANOVA showed significant differences in the post type (P<.001) and the cements (P<.001). The
interaction between them (P<.001) was statistically significant in the fracture resistance of the endodontically treated
teeth. The greatest interaction between post and cement was the glass fiber post with resin-modified glass ionomer
cement, followed by the cast gold post and core with resin-modified glass ionomer cement.
Conclusions. The use of a glass fiber reinforced post and resin-modified glass ionomer cement increased the fracture
resistance of endodontically treated teeth. (J Prosthet Dent 2013;110:127-133)
Clinical Implications
In situations involving weakened roots, a glass fiber post luted with resin-
modified glass ionomer cement represents a viable alternative for the pros-
thetic restoration of endodontically treated teeth. Post systems with an
elastic modulus similar to that of dentin and core have a biomechanical
advantage because fractures occur more frequently at the cervical third of
the tooth, resulting in a better prognosis. In addition, glass fiber posts can
be removed and replaced easily without the risk of perforating the root.
Torres-Sánchez C et al. Fracture resistance of endodontically treated teeth restored with glass fiber
a
PhD student, Department of Stomatology, Faculty of Dentistry, University of Seville.
b
PhD student, Department of Stomatology, Faculty of Dentistry, University of Seville.
c
Private practice, Bogota, Colombia.
d
Private practice, Bogota, Colombia.
e
Professor and Chief, Department of Prosthodontics, Faculty of Dentistry, University schools of Colombia.
f
Master Chief of Oral Surgery, Faculty of Dentistry, University of Seville.
Master Chief of Oral Surgery, Faculty of Dentistry, University of Seville.
reinforced posts and cast gold post and cores cemented with three cements. J Prost Dent. Vol 110.
g
Torres-Sánchez et al
Issue 2. 127:133
... although the self-adhesive cement RelyX Unicem is capable of adhering to fiber-post surfaces through methacrylated phosphoric
esters, silanization was able to improve the bond of this material to the post. In contrast, a recent study found no difference
regarding silane application for luting fiber posts using RelyX Unicem. (Nota: Perdigao et al tampoco encontraron diferencias en
2006).
Leme AA et al (2012). Effects of Silane Application on Luting Fiber Posts Using Self-adhesive Resin Cement. J Adhes Dent 2013; 15: 269–274.
Adhesivos autograbantes +
composites duales
Adhesivos autograbantes
Universales DUALES
No use la clorexidina
2% al emplear un Dental Research Journal Basic research
International J. of Healthcare & Biomedical Research, Volume: 2, Issue: 1, October 2013, Pages 43-47
adhesivo autograbante
J Dent Sci 2010;5(1):8−13 DOI: 10.5395/JKACD.2010.35.6.486
Original article:
Effect of 2% chlorhexidine application on microtensile bond strength of
Original Article
resin composite to dentin using one-step self-etch adhesives Effect of cavity disinfection with chlorhexidine on microleakage of
ORIGINAL ARTICLE Effect of chlorhexidine on bonding durability of two self-etching composite restorations using total etch and self etch single bottle
adhesives with and without antibacterial agent to dentin Soon-Ham Jang1, Bock Hur1, Hyeon-Cheol Kim1, Yong-Hun Kwon2, Jeong-Kil Park1*
adhesive systems: an in-vitro study
Department of Conservative Dentistry, 2Department of Dental Materials,
1
Annals of Biomedical Engineering, Vol. 38, No. 6, June 2010 (! 2010) pp. 1989–2003
pyrig
Effect of 1% chlorhexidine gel on the bonding Fereshteh Shafiei1, Armaghan Alikhani1,2, Ali Asghar Alavi1 Pusan National University School of Dentistry, Yangsan, Korea
1Dr. Neha Agrawal *, 2Dr. Hemal Agrawal, 3Dr. Pathik Patel
No Co
1
DOI: 10.1007/s10439-010-9969-6 Departments of Operative Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, 2Jundishapour University of Medical
t fo strength to dentin Sciences, Ahwaz, Iran
ht
rP Objectives:
1Senior Lecturer,Dept. of Conservative Dentistry & Endodontics, Karnavati School of Dentistry, Uvarsad, Gandhinagar
by N
ub
Effect of Chlorhexidine Application in a Self-etching lication
Q ui
2Assistant Professor,Dept. of Prosthetic Dentistry, Government Dental College & Hospital, Ahmedabad
ABSTRACT
Adhesive/Dentin Interface: The Weak Link in the Composite Restoration te ot Mehmet Dalli,1* Ertuğrul Ercan,2 Yahya Orçun Zorba,3 Bayram İnce,1 Materials and Methods:
n
Adhesive on the Immediate Resin-Dentin Bond Strength ss e n c e fo r 3PG Student, Dept. of Conservative Dentistry & Endodontics, Karnavati School of Dentistry, Uvarsad, Gandhinagar
Cafer Şahbaz,1 Emrullah Bahşi,1 Hakan Çolak2 Background: Considering the possibility of remaining bacteria in the cavity or invading via
PAULETTE SPENCER,1,2 QIANG YE,2 JONGGU PARK,2 ELIZABETH M. TOPP,3 ANIL MISRA,2,4 ˙ microgaps, the use of antibacterial agents in adhesive restoration may be beneficial. This study *Corresponding author: Dr. Neha Agrawal; Email Id: drhemal79@gmail.com
ORESTES MARANGOS,4 YONG WANG,5 BRENDA S. BOHATY,6 VIRAJ SINGH,1 FABIO SENE,7 JOHN ESLICK,2 Jianfeng Zhoua/Jianguo Tanb/Xu Yangc/Chuoyue Chengd/Xiaoling Wangd/Li Chena evaluated the effect of chlorhexidine on immediate and long-term shear bond strength of adhesives
1
KYLE CAMARDA,8 and J. LAWRENCE KATZ2,9 Department of Operative Dentistry, Dental School, Dicle University, Diyarbakir, Turkey with and without antibacterial agent to dentin.
2 ABSTRACT:
Department of Operative Dentistry, Dental School, Kirikkale University, Kirikkale, Turkey
1
Department of Mechanical Engineering, University of Kansas, 1530 W. 15th St., Lawrence, KS 66045, USA; 2Bioengineering
3 Materials and Methods: In this in vitro study, the occlusal surfaces of 80 intact human premolars
Research Center, University of Kansas, Lawrence, KS, USA; 3Department of Industrial and Physical Pharmacy, Purdue Department of Operative Dentistry, Dental School, Erciyes University, Kayseri, Turkey Introduction: The aim of our study was to evaluate the effect of chlorhexidine cavity disinfectant on microleakage in Class II
University, West Lafayette, IN, USA; 4Department of Civil Engineering, University of Kansas, Lawrence, KS, USA;
were removed to expose the flat midcoronal dentin. The teeth were assigned to four groups. Two
5
Department of Oral Biology, University of Missouri-Kansas City School of Dentistry, Kansas City, MO, USA; 6Department of Purpose: To investigate whether the application of chlorhexidine in a two-step self-etching adhesive has an adverse adhesive systems, Clearfil SE Bond (SE) and Clearfil Protect Bond (PB) were used according to cavities restored with light cured composites using two adhesive systems.
Pediatric Dentistry, University of Missouri-Kansas City School of Dentistry, Kansas City, MO, USA; 7Department of effect on the immediate resin-dentin bond strength. manufacturer’s instructions as the control groups. In the experimental groups, 2% chlorhexidine
Restorative Dentistry, State University of Londrina, School of Dentistry, Londrina, Brazil; 8Department of Chemical Materials and Method: Class II cavities were prepared on mesial and distal surfaces of 40 non-carious mandibular first molars,
Engineering, University of Kansas, Lawrence, KS, USA; and 9School of Engineering, Case Western Reserve University, Materials and Methods: Different amounts of 20 wt% chlorhexidine digluconate were added directly to the Clearfil Received: Oct 13, 2009 Background/purpose: The purpose of this in vitro study was to evaluate the effect was applied prior to acidic primer of two adhesives.Then, resin composite was applied. Half of the resulting in total 80 cavities. All 80 cavities were rinsed with 2% chlorhexidine (Consepsis, Ultradent) cavity disinfectant. 40
SE Bond primer to prepare mixtures of 4 different concentrations of chlorhexidine: 0.05 wt%, 0.1 wt%, 0.5 wt%, and Results:
Cleveland, OH, USA Accepted: Jan 10, 2010 of 1% chlorhexidine (CHX) gel on dentin bond strengths of posterior composite resin specimens in each group were submitted to shear bond test after 24 h without thermocycling, and
1.0 wt%. Sixteen extracted third molars were randomly divided into 4 groups. Each group corresponded to one of the cavities were restored with total etch adhesive system (Adper single bond plus, 3M ESPE) and nanohybrid composite resin
(Received 3 January 2010; accepted 12 February 2010; published online 27 February 2010)
4 chlorhexidine concentrations. Each of the 16 teeth was sectioned into halves. One half was customarily bonded applied with two different adhesive systems. the other half were submitted to water storage for 6 months and thermocycling before testing.The
with Clearfil SE Bond without chlorhexidine, and the other half was bonded with Clearfil SE Bond containing different KEY WORDS: Material and methods: In total, 75 extracted, caries-free human molars were used. data was analyzed using three-way analysis of variance (ANOVA) and t-test (a = 0.05). (Z350, 3M ESPE) while other 40 cavities were restored with self etch single bottle adhesive system (Adper easy one self etch,
Associate Editor Michael S. Detamore oversaw the review of this article. concentrations of chlorhexidine. Microtensile bond strengths were tested immediately after specimen preparation. adhesion; The occlusal surface of each tooth was ground to create a flat dentin surface. Then, Results: Chlorhexidine application significantly decreased the initial bond strength (BS) of the two Conclusions:
The modes of fractures were examined under a stereomicroscope. each tooth was mounted in acrylic. The dentin specimens were randomly assigned 3M ESPE) and nanohybrid composite resin. Microleakage was evaluated at the gingival margin using methylene blue dye
bond strength; Received: October 2012 self-etch adhesives to dentin (P < 0.05). There was a significant reduction in BS of SE and PB after
Results: No significant difference of immediate resin-dentin bond strength was observed between the control groups to five groups of 15 specimens each. In Group 1, Prime & Bond NT (PBNT) was Accepted: December 2012 penetration method.
Abstract—Results from clinical studies suggest that more performance of posterior composite restorations. The cavity disinfection; aging compared to initial bonding (P < 0.05). However, there was no significant difference between
and any of the experimental groups containing chlorhexidine (p > 0.05). applied; in Group 2, a 1% CHX gel + etching for 15 s + PBNT were applied; in Group 3,
than half of the 166 million dental restorations that were
placed in the United States in 2005 were replacements for
chemical composition of dentin adhesives has been chlorhexidine gel;
etching + 1% CHX gel + PBNT were applied; in Group 4, Clearfil S3 Bond was applied; Address for correspondence: BS of the control and chlorhexidine-treated groups for the tested adhesives after aging. PB showed Results & Conclusion: Rinsing off the cavity disinfectant before the bonding procedure does not effect the seal at the resin-tooth
reviewed recently,125 but there has been less attention Conclusion: The addition of chlorhexidine to a two-step self-etching adhesive primer (Clearfil SE Bond primer) has no Key words:
failed restorations. This emphasis on replacement therapy is posterior composite resin
and in Group 5, 1% CHX gel + Clearfil S3 Bond were applied. A dentine bonding sys- Dr. Fereshteh Shafiei, a lower BS than SE in two time periods (P < 0.05). interface. When using either of the adhesive systems, however, chlorhexidine cavity disinfectant produced significantly higher
devoted to a review of the structural and physico- adverse effect on the immediate resin-dentin bond strength when the chlorhexidine concentration in the primer is Department of Operative
expected to grow as dentists use composite as opposed to
chemical factors that impact bond integrity and dura- lower than or equal to 1.0 wt%. tem was applied to dentin surfaces, and composite cylinders were built up using a Conclusion: Chlorhexidine was capable of diminishing the loss of BS of these adhesives over
dental amalgam to restore moderate to large posterior Dentistry, School of microleakage while restoring the cavities using a self etch single bottle adhesive system.
lesions. Composite restorations have higher failure rates, bility at the adhesive/dentin interface. special device and then light-polymerized. Specimens were mounted and sheared Dentistry, Shiraz University
time. However, considering the negative effect of chlorhexidine on the initial BS, the benefits of
Keywords: chlorhexidine, bond degradation, matrix metalloproteinases, self-etching adhesives, microtensile bond
more recurrent caries, and increased frequency of replace-
test.
using an Instron universal testing machine at a cross-head speed of 0.5 mm/min. of Medical Sciences, Shiraz, chlorhexidine associated with these adhesives cannot possibly be used. Keywords: chlorhexidine, microleakage, self etch, total etch
ment as compared to amalgam. Penetration of bacterial Results: The results were recorded in megapascals. The sheared specimens were Iran.
enzymes, oral fluids, and bacteria into the crevices between
the tooth and composite undermines the restoration and CLINICAL PERFORMANCE: COMPOSITE VS. examined under a light microscope, and the type of failure (adhesive, cohesive or E-mail: shafief@sums.ac.ir Key Words: Antibacterial monomer, bond strength, chlorhexidine, self-etch adhesive
J Adhes Dent 2010; 12: 27-31. Submitted for publication: 28.05.08; accepted for publication: 16.10.08.
leads to recurrent decay and premature failure. Under in vivo DENTAL AMALGAM RESTORATIONS doi: 10.3290/j.jad.a17543 mixed) was recorded. Data were compared by one-way analysis of variance and INTRODUCTION presence of a good seal from the oral cavity.6 Other
conditions the bond formed at the adhesive/dentin interface Tukey’s honestly significant difference tests. Means were 16.4 ± 4.1 MPa in Group 1,
can be the first defense against these noxious, damaging In 2005, 166 million dental restorations were placed
substances. The intent of this article is to review structural 16.2 ± 3.9 MPa in Group 2, 13.0 ± 4.5 MPa in Group 3, 11.9 ± 2.7 MPa in Group 4, and Polymerization shrinkage appears to be the most studies have shown that bacteria left in the prepared
in the United States2 and clinical studies suggest that
aspects of the clinical substrate that impact bond formation 11.5 ± 2.7 MPa in Group 5. The use of 1% CHX gel before acid etching was signifi- INTRODUCTION degradation of resin-dentin interface can occur
more than half were replacements for failed restora- significant problem with the composite restorations, cavity could survive for a long time and this problem
at the adhesive/dentin interface; to examine physico-chemical
tions.74 Replacement of failed restorations accounts cantly higher than after etching on the shear bond strength of PBNT (P < 0.05), but rapidly over time.[1] Also, the plaque accumulation
B
factors that affect the integrity and durability of the adhesive/
for nearly 70% of all restorative dentistry74 and the onds created by dentin adhesives are not as durable Dentin matrix contains MMPs, a class of zinc-activated, did not differ significantly from PBNT alone (P > 0.05). as it has the potential to initiate gap formation at the may be magnified by microleakage of composite
dentin interfacial bond; and to explore how these factors act
synergistically with mechanical forces to undermine the as previously conjectured.2,7,12,15 The susceptibility of calcium-dependent endopeptidases, which play strategic Conclusion: Within the limitations of the present in vitro study, it was concluded Despite the significant improvement in adhesive containing microorganisms on the composite surface
emphasis on replacement therapy is expected to
composite restoration. The article will examine the various increase as concern about mercury release from dental contemporary dentin adhesives to water/oral fluid sorp- roles in tooth development5 and dentinal caries.10 MMPs that 1% CHX gel application did not adversely affect the shear bond strengths of systems, they are not capable of preventing the is more than that of the enamel surface and other tooth-composite interface,1 which can lead to resin at margins not ending on enamel.(7-9) Based
avenues that have been pursued to address these problems tion, polymer swelling, and consequent resin leaching has are a group of 23 mammalian enzymes capable of degrad- dentin-bonding agents.
and it will explore how alterations in material chemistry
amalgam forces dentists to select alternative materials.
been proven by many in vitro and in vivo studies.12,18 ing all extracellular matrix components. Human dentin formation of microgaps at the dentinal margins of restorative materials.[2] Hence, microorganisms are microleakage,2 secondary caries,3 and eventually upon these evidences, the use of antibacterial cavity
Resin composite is the most commonly used alterna-
could address the detrimental impact of physico-chemical
tive,99 but moderate to large composite restorations
Apart from these extrinsic factors, intrinsic, host-derived contains at least collagenase (MMP-8), gelatinases (MMP- composite restorations.[1,2] Even when immediate always in contact with cured adhesives via microgaps.
stresses on the bond formed at the adhesive/dentin interface.
matrix metalloproteinases (MMPs) also appear to be in- 2 and MMP-9), and enamelysin (MMP-20).21,22,31,32 It has Additionally, some active microorganisms may be leading to failure of the bond.4 Although various cleanser has been recommended after cavity
have higher failure rates, more recurrent caries and
volved in the breakdown of hybrid layers.19,26 been shown that simplified etch-and-rinse adhesives23 complete marginal sealing was established,
Keywords—Adhesive/dentin interfacial bond, Structure, increased frequency of replacement as compared to
and the less aggressive versions of self-etching ad- Introduction is due primarily to demands for improved esthetics. left in the cavity due to lack of definitive and reliable 1
Jang SH, DDS, MS, Graduate Student; Hur B, DDS, PhD, Professor; Kim HC, DDS, PhD, Associate Professor; Park JK, DDS, PhD, Associate generations of dentin bonding agents have been preparation to eliminate the potential risks due to
Physico-chemical stresses, Bonding durability, Adhesive amalgam.3,11,63,72,74,99,102 For example, after 8 years hesives25,33 are capable of releasing and activating en-
development. the failure rate for posterior composite restorations However, it is generally accepted that resin compos- Access this article online assessment criteria for detection of carious dentin Professor, Department of Conservative Dentistry, Pusan National University School of Dentistry developed to reduce the effects of polymerization bacterial activity. Chlorhexidine has been
dogenous MMPs during dentin bonding, which are thought
was at least 50% greater than the high copper amal- In response to increasing esthetic demands of pa- ites are not yet able to guarantee excellent results and complete elimination of microorganisms in the 2
Kwon YH, PhD, Associate Professor, Department of Dental Materials, Pusan National University School of Dentistry, Yangsan, Korea
to be responsible for the manifestation of thinning and dis-
gam restorations.9 At 5 years, the need for additional
a Postgraduate Student, Department of Prosthodontics, Peking University
tients, the use of composite resin materials for pos- when used for posterior tooth restorations. This is *Correspondence to Jeong-Kil Park, DDS, PhD. shrinkage, microleakage remains a problem of recommended by various authors an effective agent
This review article is focused on the adhesive/dentin School and Hospital of Stomatology, Beijing, P. R. of China. appearance of collagen fibrils from incompletely infiltrated cavity. Particularly, this problem is more serious
interface and the role of this interface in the clinical treatment was 50% greater in children receiving com- b Associate Professor, Department of Prosthodontics, Peking University School hybrid layers in aged, bonded dentin.3,16,26 terior tooth restorations is increasing.1 This increase due to postoperative sensitivity and penetration of by increasing predilection to a minimally invasive Associate Professor, Department of Conservative Dentistry, Pusan National University School of Dentistry, Beomeo-li, Mulgem-up, Yangsan, clinical significance.5 Residual bacteria have been to disinfect dentin.(10,11) It is also effective in reducing
posite restorations as compared to children treated and Hospital of Stomatology, Beijing, P. R. of China. The activity of MMPs can be suppressed by protease in- Website: http//:drj.mui.ac.ir Korea 626-770
Address correspondence to Paulette Spencer, Department of
with dental amalgam.11 Based on the review of dental c Dentist, Department of Prosthodontics, Peking University School and Hospi- hibitors,26 indicating that MMP inhibition may be benefi- tissue-saving dentistry.[3] Subsequently, the adjunctive TEL, +82-55-360-5213; FAX, +82-55-360-5214; E-mail, jeongkil@pusan.ac.kr shown to proliferate from the smear layer even in the the levels of S.mutans found on exposed carious root
records from 3,071 subjects, Simecek and colleagues tal of Stomatology, Beijing, P. R. of China. cial in the preservation of hybrid layers. This has been
Mechanical Engineering, University of Kansas, 1530 W. 15th St., treatment with antibacterial agents during dentin *This work was supported for two years by Pusan National University Research Grant.
reported in 2009 a significantly higher risk of replace- d Dentist, Department of Preventive Dentistry, Peking University School and demonstrated in recent in vivo and in vitro studies in *Corresponding author. Department of Operative Dentistry, Dental School, Dicle University, Diyarbakir 21230, Turkey.
Lawrence, KS 66045, USA. Electronic mail: pspencer@ku.edu,
Hospital of Stomatology, Beijing, P. R. of China. E-mail: mdalli@dicle.edu.tr bonding would be beneficial for preventing the 43
yeq@ku.edu ment for posterior composite restorations as compared which the application of chlorhexidine, known to have a
1989 broad-spectrum MMP-inhibitory effect,14 significantly im-
Correspondence: Dr. Jianguo Tan, Associate Professor, Department of Prostho- proved the integrity of the hybrid layers created by a simpli- ©2010 Association for Dental Sciences of the Republic of China www.ijhbr.com
! 2010 Biomedical Engineering Society dontics, Peking University School and Hospital of Stomatology, 22 Zhongguan- Dental Research Journal / November 2013 / Vol 10 / Issue 6 795
0090-6964/10/0600-1989/0
cun, Nandajie Haidian District, Beijing, 100081, P. R. of China. Tel: +86-10- fied etch-and-rinse adhesive (Single Bond; 3M ESPE; St Jang SH et al. JKACD Volume 35, Number 6, 2010
62173402 Ext.2347, Fax: +86-10-62173402. e-mail: kqtanjg@bjmu.edu.cn Paul, MN, USA).6,8,9,19 However, whether chlorhexidine can
Vol 12. No 1, 2010 27

Journal of Applied Microbiology 2005, 99, 703–715 doi:10.1111/j.1365-2672.2005.02664.x Journal of Dental Research
http://jdr.sagepub.com/
RESEARCH REPORTS
Biomaterials & Bioengineering
A REVIEW Effect of chlorhexidine on the bond J. Hebling1, D.H. Pashley2,

L. Tjäderhane3, and F.R. Tay2,4* Chlorhexidine Arrests
Shear Bond Strength of Composite Resin to Dentin after strength of a self-etch adhesive system
application of Cavity Disinfectants - An In Vitro Study
Cationic antiseptics: diversity of action under a common 1 Department of Orthodontics and Pediatric Dentistry, Subclinical Degradation of Limitations in Bonding to Dentin and Experimental Strategies to Prevent Bond Degradation
epithet to sound and demineralized dentin University of São Paulo State, Araraquara Dental School, Y. Liu, L. Tjäderhane, L. Breschi, A. Mazzoni, N. Li, J. Mao, D.H. Pashley and F.R. Tay
São Paulo, Brazil; 2 Department of Oral Biology &
Maxillofacial Pathology, School of Dentistry, Medical Dentin Hybrid Layers in vivo J DENT RES 2011 90: 953 originally published online 10 January 2011
DOI: 10.1177/0022034510391799
College of Georgia, Augusta, GA, USA; 3 Institute of
Dentistry, University of Helsinki, Finlandm and Department
Mary Anne Sampaio de-Melo(a) Abstract: This study evaluated the effect of a 2% chlorhexidine-based The online version of this article can be found at:
Vivek Sharma,1 Poonam Rampal,2 Sukesh Kumar3 P. Gilbert and L.E. Moore Diego da Costa Goes(a) disinfectant (CHX) on the short-term resin-dentin bond strength of a
of Oral and Maxillofacial Diseases, Helsinki University
Central Hospital (HUCH); and 4Pediatric Dentistry and http://jdr.sagepub.com/content/90/8/953
School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Manchester, UK Maria Denise Rodrigues Orthodontics, University of Hong Kong, Prince Philip
de-Moraes(b) self-etch adhesive system to human dentin with different mineral con- Dental Hospital, 34 Hospital Road, Pokfulam, Hong Kong
2005/0059: received 20 January 2005, revised 14 March 2005 and accepted 15 March 2005
Sérgio Lima Santiago(a) tents. Dentinal mineralization was tested at 4 levels (sound, and after 2, SAR, China; *corresponding author, franklintay@gmail.com INTRODUCTION
Published by:
C
Lidiany Karla Azevedo 4, or 8 days of demineralization-remineralization cycles) and disinfectant
Introduction Rodrigues(a) J Dent Res 84(8):741-746, 2005
onsiderable evidence has accumulated over the past decade, based on
both in vitro and in vivo work, that bonds created in dentin by resin-
at 2 levels [deionized water (DW, negative control) and CHX]. Dentin
Restorative procedures such as cavity preparation are 1. Summary, 703 4.2.1 The bisbiguanides chlorhexidine and based adhesives may not be as durable as was previously conjectured (De http://www.sagepublications.com
demineralization induced by pH-cycling was characterized by cross-
used to remove the infected dentin and make space for 2. Perspectives, 703 alexidine, 709 (a) Munck et al., 2005; Frankenberger et al., 2005). Degradation of these bonds
Faculty of Pharmacy, Dentistry and Nursing, sectional hardness (CSH). Each dentin surface was divided into halves,
the restorative materials. The successes of these 3. Background, 704 4.2.2 Polyhexamethylene biguanides, 710 ABSTRACT occurs via the interaction of the components above and below the adhesive On behalf of:
Univ Federal do Ceará - UFC, Fortaleza,
Aims: To evaluate the effect of different cavity disinfectants on procedures depend on the effective removal of infected 4. Cationic antimicrobial agents, 705 5. Conclusions, 712 CE, Brazil.
one treated with DW and the other with CHX (5 minutes). Each surface The recent paradigm that endogenous collagen- interface. Although the current strategies of incorporating ionic and International and American Associations for Dental Research
dentin bond strengths of composite resin applied with two different dentin, prior to the placement of the restorative 4.1 Quaternary ammonium compounds, 706 6. References, 713 was bonded with a self-etch adhesive system and restored. The specimens olytic and gelatinolytic activities derived from hydrophilic resinous components into total-etch and self-etch adhesives
(b)
adhesive systems. material. School of Dentistry, Faculdade Católica acid-etched dentin result in degradation of hybrid arise from the need to bond to an intrinsically wet substrate, they create
4.2 Biguanides, 708 Rainha do Sertão - FCRS, Quixadá, CE,
were sectioned and subjected to microtensile bond testing. CSH and mi-
Any leftover bacterial remnants during and after the layers requires in vivo validation. This study tested potentially unstable resin matrices that slowly degrade via water sorption
Methods and Material: Two hundred mandibular molars were cavity preparation pose one of the major problem in Brazil. crotensile bond strength (µTBS) data were analyzed by regression analy- (Yiu et al., 2004). This is particularly so when resin-dentin bonds are not
Additional services and information for Journal of Dental Research can be found at:
the null hypothesis that there is no difference
sectioned parallel to the occlusal surface to expose dentin in the restorative dentistry.1 Failure to mechanically remove sis and ANOVA-Tukey tests (α = 5%), respectively. The groups treated between the degradation of dentin bonded with an protected by enamel (De Munck et al., 2003), and when the durability of
midcoronal one third. The dentinal surfaces were polished with Email Alerts: http://jdr.sagepub.com/cgi/alerts
the infected tooth structure and achieve complete with CHX resulted in mean µTBS similar to those found for the groups etch-and-rinse adhesive and that in conjunction these bonds is challenged by the reduction of adhesive interfaces into
waterproof-polishing papers. The specimens were randomly divided sterilization of the cavity preparation can lead not only agents and highlights key differences that render them smaller portions, to expedite aging effects and increase their interactions
1. SUMMARY in which the dentin was exposed to DW (p = 0.821). However, mean with chlorhexidine, an MMP inhibitor, applied Subscriptions: http://jdr.sagepub.com/subscriptions
into 5 groups of 40 teeth each as follows: Group 1(Control) - to microleakage, increased pulp sensitivity and pulpal with water (Shono et al., 1999; Hashimoto et al., 2002; DeMunck et al.,
distinct categories of antibacterial agent. after phosphoric-acid-etching. Contralateral pairs
specimens were not treated with any cavity disinfectants. Groups 2 µTBS were strongly influenced by dentin mineralization (p < 0.05): the
inflammation, but also to secondary caries, Cationic antimicrobials have been in general use within of bonded Class I restorations in primary molars 2003).
to 5 (Experimental Groups) - dentin surfaces were treated with the bond strength found for sound dentin was lower than that found for den- Reprints: http://www.sagepub.com/journalsReprints.nav
necessitating replacement of the restoration.2,3 clinical and domestic settings for over half a century. of clinical subjects were retrieved after a six- A potential bond degradation mechanism that is derived from beneath
following cavity disinfectants, respectively; 2% chlorhexidine 2. PERSPECTIVES
Therefore, after removal of the carious dentin, it is Recently, the use of antiseptics and disinfectants has been tin cycled for 8 days, which was even lower than the bond strengths for month period of intra-oral functioning and the bonded interface is the instability of the demineralized dentin collagen
solution, 0.1% benzalkonium chloride based disinfectant, 1% Permissions: http://www.sagepub.com/journalsPermissions.nav
important to eliminate any remaining bacteria that may questioned in such settings because of the possibility that In recent years there has been some questioning of the dentin cycled for 2 or 4 days. The results suggest that the degree of den- processed for transmission electron microscopy. matrix. This was manifested as the thinning or disappearance of collagen
chlorhexidine gel, and an iodine potassium iodide / copper sulfate be present on the cavity walls, in the smear layer, at the Hybrid layers from the chlorhexidine-treated teeth fibrils from aged, unbonded, or bonded dentin (Hashimoto et al., 2003a,b;
based disinfectant. The specimens were then randomly divided into chronic exposure of the environment to such agents might potential of antiseptic residues, accumulating within high use tin demineralization affects the bond strength of self-etching adhesives,
enamel-dentin junction, or in the dentinal tubules.4 exhibited normal structural integrity of the Ferrari et al., 2004; Yoshida et al., 2004), or the failure of aged hybrid
2 subgroups including twenty teeth each to evaluate the effect of Histological and bacteriologic studies have shown that select for less susceptible strains towards these agents and environments such as clinics and hospitals, to select for but the use of CHX does not modify this effect. collagen network. Conversely, abnormal hybrid layers to take up heavy metal stains (De Munck et al., 2003; Armstrong et
different bonding systems. Dentin bonding systems were applied to towards third party antibiotics. Whilst no supportive evi- bacteria that are altered with respect to their susceptibility not >> Version of Record - Jul 12, 2011
only a small proportion of the teeth are sterile after layers were seen in the control teeth, with al., 2004). The issue of collagen instability has potential consequence in the
the dentin surfaces and the composite buildups were done. After dence has emerged from retrospective field studies of high use only towards other antiseptics but also towards third party
cavity preparation and that bacteria left in the cavity Descriptors: Dentin-Bonding Agents; Chlorhexidine; Tooth progressive disintegration of the fibrillar network, pathogenesis of dentinal caries, with the breakdown of acid-demineralized
the specimens were stored in an incubator for 24 h, the shear bond environments such debate has tempered new applications for agents such as antibiotics. The utility of cationic antibacterials OnlineFirst Version of Record - Jan 10, 2011
preparation could survive for longer than a year.
Demineralization; Dentin. to the extent that it was beyond detection by collagen matrices by host-derived matrix metalloproteinases (MMPs), a
strength was measured at a crosshead speed of 1 mm/min. The Today, the application of disinfectants after cavity these molecules. In the clinic, use of antiseptics, together with to combat cross infection is undeniable, as is the overall collagen staining. Self-destruction of collagen class of zinc- and calcium-dependent endopeptidases (Tjäderhane et al., What is This?
specimens were then statistically analysed. preparation and before tooth restoration is gaining products, such as dressings, catheters and sutures, which are contribution of antisepsis to the reduction of hospital- matrices occurs rapidly in resin-infiltrated dentin 1998; Sulkala et al., 2001; van Strijp et al., 2003).
Statistical analysis used: One way analysis of variance and Tukey-
acceptance as they are considered to eliminate impregnated with biocides has increased. Prominent amongst acquired infection. Indeed, reductions in antibiotic use in vivo and may be arrested with the use of In the context of dentin bonding, residual collagenolytic activity was
HSD tests.
potential risks due to bacterial activity.5,6 For two these biocides are the cationics. Much of the research brought about by such policies can be argued to have had a Declaration of Interests: The authors Introduction chlorhexidine as an MMP inhibitor. observed in mineralized dentin powder produced from extracted teeth that
decades, many chemicals have been tested as cavity certify that they have no commercial or accounted for the disintegration of collagen fibrils from unbonded, aged
pertaining to the mechanisms of action of cationic antibac- positive impact upon antibiotic resistance development. Minimally invasive cavity designs have been proposed, and the ex-
Results: There was no significant difference between chlorhexidine disinfectants, including chlorhexidine digluconate (CHX),
terials was conducted in the 1960s and 1970s and has not been Nevertheless, re-examination of the action and resistance associative interest that represents a conflict KEY WORDS: primary dentin, hybrid layer, acid-etched dentin, in the absence of the contribution from bacterial or
benzalkonium chloride and iodine potassium iodide / cavation of dentin caries may eliminate only the more superficial zone collagenolysis, gelatinolysis, MMPs. salivary MMPs. This low but persistent endogenous collagenolytic activity
gel and control groups regardless of the type of the bonding agent subject to extensive review. Analysis of available publications mechanisms associated with all antibacterial molecules des- of interest in connection with the manuscript.
used (p > 0.05). On the other hand, pretreatment with copper sulphate etc.7,8 of irreversibly damaged dentin,1 facilitating the preservation of tooth was completely inhibited by the use of protease inhibitors, the incorporation
However, there is concern about the use of cavity suggest that monoquaternary ammonium compounds (QAC, tined for use in a clinical and domestic setting is appropriate. of which preserved the structural integrity of the collagen fibrils (Pashley et
benzalkonium chloride based, iodine potassium iodide / copper structure. 2 It has been suggested that the temporary sealing of cavities
disinfectants with dentin bonding agents, since they cetrimide, benzalkonium chloride), biquaternaries and bis- Cationic antimicrobials have been widely deployed in al., 2004). In that study, phosphoric-acid-etching reduced, but did not
sulfate based disinfectants or chlorhexidine solutions had a Corresponding Author: may isolate residual acidogenic bacteria from dietary sources of ferment-
may have an adverse effect on the bond strength of the biguanides (Chlorhexidine, Barquat), and polymeric bigua- antisepsis for well over half a century without any apparent Lidiany Karla Azevedo Rodrigues completely inhibit, the inherent collagenolytic activity of mineralized
negative effect on the shear bond strength of self-etching bonding
composite resins. The objective of this study was to nides (Vantocil, Cosmocil) whilst having similarities in action reduction in their effectiveness. They remain the mainstay of able carbohydrates, making them dormant. 3 However, the restoration of dentin, while the use of chlorhexidine, in even very low concentrations,
systems. E-mail: lidianykarla@yahoo.com
compare the effect of the most commonly used cavity mechanism, differ substantially in the nature of their routine chemical antisepsis and disinfection. Amongst the infected tissues requires careful evaluation, since studies have demon- strongly inhibited such activity. Thus, apart from being a commonly known
Conclusions: The findings of this study suggest that when disinfection materials on shear bond strength of interaction with cell envelopes. This has profound implica- commonly deployed cationic antimicrobials are the quater- strated that microorganisms are capable of surviving even extreme envi- disinfectant, chlorhexidine also functions as a potent MMP inhibitor
benzalkonium chloride based, iodine potassium iodide / copper composite with either a two-step self-etching or an tions in terms of cross-resistance where changes in suscep- nary ammonium compounds (QAC; cetrimide, benzalkonium ronmental conditions.4 Therefore, antibacterial treatment of the dentin (Gendron et al., 1999).
sulfate based disinfectants or chlorhexidine solutions are used as a etch-and-rinse bonding system. tibility towards QAC is not reflected in changes towards other chloride), bisbiguanides (chlorhexidine, hibitane) and poly- Submitted: Sep 05, 2012 These reported results, however, are of clinical significance only if
may suppress the growth of bacteria under existing restorations, thus proteolysis of the resin-infiltrated collagen network can be demonstrated in
cavity disinfectant, an etch-and-rinse bonding system should be cationics. This review examines action mechanisms for these meric biguanides (vantocil). All of these positively charged Accepted for publication: Jan 31, 2013
preferred. Last revision: Feb 13, 2013 minimizing the risk of recurrent caries. The use of 2% chlorhexidine di- vivo . To ascertain that endogenous enzymatic activities are involved, we
molecules bind strongly to the cell walls and membranes of
Subjects and Methods Correspondence to: Peter Gilbert, School of Pharmacy and Pharmaceutical Sciences,
University of Manchester, Manchester M13 9PL, UK bacteria because of their opposite, negative charge. Disrup- gluconate has been recommended for cleaning tooth preparations, due must identify such activities from aged, adhesive-bonded dentin that is
Key-words: bond strength, adhesive, composite resin, cavity Received February 20, 2005; Last revision April 28, 2005; completely surrounded by enamel (De Munck et al., 2003). Such an in vivo
disinfection, CHX gel, CHX solution, Benzalkonium chloride based Two hundred human permanent mandibular molars (e-mail: peter.gilbert@man.ac.uk). tion of the target cell is brought about by perturbation of these Accepted April 28, 2005 study should also demonstrate that such activities can be arrested via the use
disinfectant, iodine potassium iodide / copper sulfate based free of cracks, caries and restorations on visual ª 2005 The Society for Applied Microbiology
disinfectant. inspection, were used for the study. The teeth were Braz Oral Res. 741 Downloaded from jdr.sagepub.com at UNIVERSIDAD FINIS TERRAE on August 20, 2014 For personal use only. No other uses without permission.
scraped of any residual tissue tags, kept in 2.6% sodium © 2011 International & American Associations for Dental Research
1 hypochlorite solution and rinsed under running water

, 2011
© 2011
No todos los adhesivos
autograbantes son compatibles
con cementos de resina de
polimerización química o DUAL
A
B
C
D RESTAURACIONES POSENDODÓNTICAS CON PERNOS DE FIBRA
Cátedra de Endodoncia de la Facultad de Odontología
Universidad de Buenos Aires
Postgrado de Endodoncia - Director Dr. Pablo Alejandro Rodríguez
Gracias totales!
Fotos, textos y edición: Dr. Alejandro Bertoldi Hepburn

Introducción A La Rehabilitación Posendodóntica 2 (2018)

Cargado por

Información del documento

Título original

Derechos de autor

Formatos disponibles

Compartir este documento

Compartir o incrustar documentos

Opciones para compartir

¿Le pareció útil este documento?

¿Este contenido es inapropiado?

Copyright:

Formatos disponibles

Introducción A La Rehabilitación Posendodóntica 2 (2018)

Cargado por

Copyright:

Formatos disponibles

REHABILITACIÓN POSENDODÓNTICA (Parte 2)

…pero presentan varios inconvenientes que pueden afectar el

Inconvenientes estéticos asociados a PMC

Una ecuación muy conocida…

Oscuridad + opacidad + decoloración sobre el núcleo ó la raíz =

1. Todas las aleaciones metálicas son opacas (bloquean la transmisión de luz)

Cuando la corrosión tiñe los tejidos y se presentara

A. Habitualmente se genera un importante desgaste

Después de terminar la obturación endodóntica, el

La elaboración del perno (inclusión en revestimiento,

Existe una flexión no uniforme entre el

Se produce concentración de fuerzas en

ángulo de incidencia de la carga). El ME varía de 80

La técnica del perno metálico colado demanda 3 sesiones clínicas. 1 correspondiente al TE y 2

lapsos variables: eventual

Images belong to Dr. Pablo Ensinas (Argentina)

•Normalmente no se emplea el dique de goma cuando se preparara el

• El riesgo de contaminación al no aislar con GD

Evaluación del grado de filtración a nivel de los

conductos laterales y su relación con el material

• Utilizar siempre aislamiento absoluto al momento de cementar el

anclaje intrarradicular, descontaminando o pretratando la dentina

radicular, según las indicaciones del material de cementado.

•Técnica conocida y de fácil acceso

ID Muchas veces el uso de pernos - y sus

inconvenientes asociados - se evitarán si se

emplearan sólo donde están

Goreig AC et al (1983) hacen énfasis en que no todos los dientes tratados

Si precisara de un perno (recuerde las

indicaciones!!!), los pernos de fibra

ofrecen ventajas mecánicas,

Una matriz de resina mantiene unidas distintos tipos de fibras

2. Perno de resina (base orgánica) reforzado con

3. Permite un trabajo continuo y coherente con el tratamiento

POR SER UN PERNO PREFORMADO

POR SER UN PERNO DE Resina reforzado con FIBRA (PBORF)

Trabajo continuo tratamiento endodóntico - inserción

ID En gran medida, esas

limitaciones podrán ser

superadas con (A) una

correcta selección del perno

The Contribution of Friction to the Dislocation Resistance

From the Department of Dental Materials, University of Materials and Methods

El uso de adhesivos previo al cemento resinoso en procura de conseguir

adhesión no produce mejoras significativas en la resistencia a la remoción del

608 Goracci et al. JOE — Volume 31, Number 8, August 2005

poste; la traba mecánica es el factor de retención más importante

Influence of Filling Materials on the Bonding Interface

to root canal dentin may depend largely on frictional sliding resistance

to dislodgement rather than on the relatively low micromechanical and

chemical adhesion achieved by resin-based dentin bonding agents.

of failure was adhesive between dentin and cement...

Cortesía Pablo Ensinas y Daniel Martucci (Argentina)

Cortesía Pablo Ensinas y Daniel Martucci (Argentina)

Una fractura es catastrófica o

La corona logrará adecuado efecto “ferrule” (zuncho) :

Ferrule-Effect Dominates Over Use

serán evacuadas sobre el

raíz y tejidos de soporte

In vitro fracture resistance of endodontically treated central incisors

Ferrule-Effect Dominates Over Use

RIESGO: las fuerzas se concentran sobre el

ABSTRACT to composite resin core buildups with or with-

!"#$#%&'(") %) (+,-"##$') .) /"&0"'"1) -**%#)