Effect of cleaning method, luting agent and

preparation procedure on the retention of bre posts

K. Bitter
1
, W. Eirich
1
, K. Neumann
2
, R. Weiger
3
& G. Krastl
3
1
Department of Operative Dentistry and Periodontology, University School of Dental Medicine, ChariteCentrum 3,
Charite Universitatsmedizin Berlin, Berlin;
2
Institute for Biometry and Clinical Epidemiology, ChariteCentrum 4, Charite
Universitatsmedizin Berlin, Berlin, Germany; and
3
Department of Periodontology, Endodontology and Cariology, School of
Dental Medicine, University of Basel, Basel, Switzerland
Abstract
Bitter K, Eirich W, Neumann K, Weiger R, Krastl G.
Effect of cleaning method, luting agent and preparation proce-
dure on the retention of bre posts. International Endodontic
Journal, 45, 11161126, 2012.
Aim To investigate the effects of various cleaning
methods, luting agents and preparation procedures on
bre post retention.
Methodology In total, 156 human canines were
allocated to twelve groups. Teeth were decoronated,
instrumented and root lled using warm vertical
gutta-percha compaction. Post space preparation was
performed in 78 roots using the dedicated preparation
drills of the DT Light Post SL system [group post drill
(PD)]. Gutta-percha was removed from the other 78
roots using a round bur (RB) (group RB). Within each
of these two groups, 26 root canals were rinsed with
1% NaOCl (control), 26 were cleaned using rotating
brushes and pumice powder, and 26 were sandblasted
with Al
2
O
3
(50 lm) using an intraoral device. Cleanli-
ness of each root canal was investigated using an oper-
ating microscope (n = 24) and scanning electron
microscope (n = 2). Fibre posts were inserted using
self-adhesive resin cement (SmartCem2) or core build-
up material (CoreX Flow/XP Bond). Pull-out force was
measured using a universal testing machine. Statistical
analyses were performed using three-way ANOVA and
Tukeys HSD post hoc tests.
Results Root canal cleanliness was not affected by
the cleaning method (P = 0.618, chi-squared test).
Pull-out force for bre posts was signicantly affected
by the cleaning method (P = 0.008), the luting agent
(P < 0.0005) and the preparation procedure (P <
0.0005, three-way ANOVA). RB group demonstrated sig-
nicantly higher pull-out forces [399 (88) N] compared
with PD group [287 (105) N]. Posts that were inserted
using CoreX Flow/XP Bond exhibited signicantly
higher pull-out forces [370 (62) N] compared with
posts inserted using SmartCem2 [315 (141) N].
Conclusion The different cleaning methods did not
lead to signicant differences in root canal cleanliness
and did not enhance bre post retention inside the root
canal. However, post space preparation using a RB
might be benecial for improving retention, especially
when self-adhesive cements are used. The use of the
core build-up material CoreX Flow/XP Bond instead of
the self-adhesive resin cement, SmartCem 2, resulted in
signicantly higher pull-out force.
Keywords: adhesive luting, bre post, post space
preparation, root canal cleanliness.
Received 10 May 2011; accepted 3 May 2012
Introduction
Adhesively luted bre-reinforced composite (FRC)
posts are used frequently to restore root lled teeth.
Clinical studies have demonstrated favourable results
regarding the use of FRC posts in the medium term
(Cagidiaco et al. 2008, Bitter et al. 2009a). However,
Correspondence: Kerstin Bitter, Department of Operative Den-
tistry and Periodontology, University School of Dental Medi-
cine, Charite Centrum 3, Charite Universitatsmedizin Berlin,
Amannshauser Strae 4-6, D-14197 Berlin, Germany
(Tel.: +49 30 450 562 011; fax: +49 30 450 562 932;
e-mail: kerstin.bitter@charite.de).
2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012
doi:10.1111/j.1365-2591.2012.02081.x
1116
ensuring sufcient bonding to root canal dentine
remains a challenge because of the limited access and
visibility and because of the deposition of cementum
inside the canal and secondary dentine (Mjor et al.
2001). Moreover, bonding inside of the root canal
can be compromised by the presence of sealer and
gutta-percha remnants and by decient dentine
hybridization (Perdigao et al. 2007). Mechanical
cleaning methods, such as sandblasting with alumin-
ium oxide particles, or rotary instrumentation using
brushes and pumice, have been suggested for cleaning
the contaminated tooth surface and for eliminating
remnants of temporary cement following the removal
of temporary crowns (Chaiyabutr & Kois 2008).
Moreover, Chaiyabutr & Kois (2008) demonstrated a
signicant improvement in bond strength to dentine
of a self-adhesive luting cement after sandblasting
with aluminium oxide particles compared with clean-
ing the tooth surface using a hand instrument. Inside
root canals, dentine debridement may be impeded
because of the limited access especially in deep areas.
Although several laboratory studies have investigated
the effectiveness of mechanical cleaning methods
(Coniglio et al. 2008a,b), little is known regarding
their effects on the bond strength of bre posts.
Post space preparation signicantly increased the
deformability of anterior maxillary teeth compared to
access preparation and manual enlargement; more-
over, cylindrical post space preparations demonstrated
signicantly higher deformability compared to conical
post space preparations. On the basis of these results,
it was concluded that both substance loss and modi-
cation of the natural root canal geometry play impor-
tant roles in tooth rigidity (Lang et al. 2006). A
previous study using computational, experimental
and fractographic analyses demonstrated the impact
of the inner dentine located adjacent to the root canal
on tooth fracture resistance and highlighted the
importance of preserving structurally sound inner
dentine (Kishen et al. 2004).
Maximum adaptation of the post to canal walls is
essential to improve retention and fracture resistance
when nonadhesive post cementation is performed
with zinc phosphate cement (Sorensen & Engelman
1990). However, when bre posts are luted with com-
posite cement, the post t does not signicantly affect
the push-out bond strength (Perdigao et al. 2007) or
the fracture resistance (Buettel et al. 2009). Thus, it
has been suggested that perfectly tting posts are not
necessarily required (Krastl et al. 2011). On the other
hand, the resistance to occlusal loading is higher if a
post with a greater diameter is used. To avoid inva-
sive post preparations especially in noncircular canals,
it was suggested that only gutta-percha and sealer
should be removed and then multiple smaller bre
posts for intracanal anchorage should be used as an
alternative (Porciani et al. 2008).
A large variety of products on the market for luting
bre posts, along with the intrinsic difculties of bond-
ing inside the root canal, complicate the selection of a
luting strategy. Self-adhesive resin cements are easy to
handle and can save time because no etching or bond-
ing steps are required. An alternative approach is to
use a separate self-etching or etch-and-rinse adhesive
prior to the insertion of the resin cement inside the root
canal. It has been hypothesized that using phosphoric
acid inside the root canal might be advantageous with
respect to dissolving the thick smear layer (Bitter et al.
2004). However, the universal occurrence of interfacial
gaps inside the root canal along the hybrid layer sur-
face of etch-and-rinse adhesives has been observed
using a scanning electron microscope (SEM) (Pirani
et al. 2005). Self-etch adhesives did not show a discrep-
ancy between the etching depth and the resulting resin
inltration depth (Watanabe et al. 1994). However,
one-step self-etching adhesive systems might lead to
water sorption by hydrophilic resin monomers within
the resindentine interface, which could contribute to
their degradation over time and affect the bond durabil-
ity (Hashimoto et al. 2000). Moreover, a previous study
indicated that the self-etch approach results in less
favourable adhesion compared with the etch-and-rinse
or the self-adhesive approaches (Radovic et al. 2008a).
The aim of this study was to investigate the effects
of various cleaning methods, luting agents and canal
preparation procedures on bre post retention with
respect to the observed failure modes and root canal
cleanliness. The null hypotheses were (i) that bre
post retention would not be affected by the cleaning
method, the luting agent or the preparation
procedure; (ii) that the different cleaning methods
would not affect the cleanliness of the root canal; and
(iii) that the failure modes would not be affected by
the different luting agents or preparation procedures.
Materials and methods
Specimen preparation
For this study, 156 sound human single-rooted
canines extracted for periodontal reasons with a root
length of 15.516 mm that had no visible fracture
Bitter et al. Retention of bre posts
2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1117
lines along the root were selected to obtain specimens
with oval-shaped root canals. After soft tissue
removal, the teeth were stored in 0.5% chloramine
solution (Pharmacy of Charite, University Hospital,
Berlin, Germany) until use. Tooth crowns were
removed at the proximal cemento-enamel junction
using a diamond blade under constant water cooling.
Root canal preparations were performed at a working
length of 1 mm from the apical foramen using a
single-length technique with MTwo rotary instru-
ments (sequence: size 10, .04 taper; size 15, .05
taper; size 20, .06 taper; size 25, .06 taper; size 30,
.05 taper; size 35, .04 taper; size 40, .04 taper)
(VDW, Munich, Germany). Apical enlargement was
performed to a size of 60, .02 taper using FlexMaster
rotary les (VDW). The teeth were lled with warm,
vertically condensed BeeFill

2in1 gutta-percha (VDW)

and AH Plus sealer (Dentsply DeTrey, Konstanz,
Germany); the teeth were then stored in water for
24 h.
Each root was embedded into enlarged front teeth
alveoli of maxillary models of phantom heads using
silicon impression material (Silaplast FUTUR; Detax
Dental, Ettlingen, Germany) to simulate clinical condi-
tions during post space preparation. Post space prepa-
rations to a depth of 8 mm for 78 teeth were
performed using DT Light Post SL Size 3 drills (VDW)
[group post drill (PD)]. In the other 78 roots,
gutta-percha was removed up to the same depth of
8 mm using a round bur (RB) (H1SEM 205.010;
Komet/Brassler, Lemgo, Germany) (group RB). Magni-
fying glasses (magnication 2.59) were used to con-
trol the removal of gutta-percha. Specimens from
each of these two main groups (PD and RB) were fur-
ther divided into subgroups according to the cleaning
methods and the luting procedures employed for post
insertion (Fig. 1). To ensure equal distribution, the
specimens were randomly assigned to the different
groups and subgroups, respectively.
Cleaning methods following post space preparation
In one-third of all specimens, the prepared post space
was rinsed using 10 mL of 1% NaOCl (cleaning
control group). In the second third, cleaning was per-
formed using a rotating interdental brush (Curaprox
CRA 12, Curaden AG, Kriens, Switzerland) and pum-
ice powder for 15 s with a slow-rotating contra-angle
hand piece at 10 000 rpm (brush group). Afterwards,
the root canals were thoroughly rinsed with 5 mL of
distilled H
2
O. The remaining specimens were sand-
blasted with 50 lm of Al
2
O
3
particles (Korox; BEGO,
Figure 1 Experimental design overview of groups and subgroups.
Retention of bre posts Bitter et al.
2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1118
Bremen, Germany) using an intraoral sandblasting
device at 3 bar for 10 s with slight movements to
reach all regions of the post space preparation (sand-
blasting group). Afterwards, the root canals were
thoroughly rinsed with 5 mL of H
2
O.
Evaluation of root canal cleanliness
Root canal cleanliness was investigated under the
operating microscope (magnication 239, OPMI
pico; Zeiss, Jena, Germany) by one pre-calibrated
observer who did not perform or witness the
cleaning of the root canals. The following scoring
system was applied to quantify root canal cleanli-
ness: (i) completely clean, (ii) small remnants of
sealer, (iii) large remnants of sealer and (iv) rem-
nants of sealer and gutta-percha (Fig. 2ad). Two
representative specimens from each group were
sectioned parallel to the long axis of the tooth, and
the root canal surfaces were evaluated using SEM
(Cam Scan Maxim 2040; Cam Scan Maxim Electron
Optics, Cambridge, UK).
Fibre post insertion and pull-out testing
In all subgroups, bre posts (DT Light Post SL Size 3;
VDW) were inserted using either self-adhesive resin
cement (SmartCem2; Dentsply DeTrey) or core build-
up material (CoreX Flow/XP Bond; Dentsply DeTrey)
(Fig. 1). After drying the root canal with paper points,
SmartCem2 was applied to the root canal with the
aid of a mixing tip provided by the manufacturer.
Prior to the use of CoreX Flow/XP Bond, the cavity
walls were etched for 15 s with phosphoric acid (DeT-
rey Conditioner 36; Dentsply DeTrey). After rinsing
for 15 s, the water was removed using paper points
and a gentle air blast, avoiding complete desiccation
of the cavity. An equal ratio of XP Bond and Self-cure
activator was mixed for 5 s and applied using root
canal applicator tips provided by the manufacturer for
20 s. Excess adhesive was removed with paper points,
and the cavity was gently air-dried for 5 s. CoreX
Flow was applied to the root canal using a mixing tip
provided by the manufacturer. The posts were
inserted into the canal using slight nger pressure,
excess CoreX Flow was removed, and light curing
was performed using an LED-curing unit set at
1200 mW cm
2
(Elipar Freelight 2, 3M ESPE, Seefeld,
Germany) according to the manufacturers instruc-
tions. The light intensity of the light-curing unit was
checked prior to the use of a Demetron LED Radiome-
ter (Kerr, Orange, CA, USA). Subsequently, the speci-
mens were stored in 100% humidity for at least 24 h
to allow for complete polymerization. Ten specimens
from each group were then subjected to pull-out test-
ing. For this test, roots were embedded into Technovit
4071 acrylic resin (Heraeus Kulzer, Hanau, Germany)
parallel to the long axis of the root. Specimens were
then placed into the jig of a universal testing machine
(Zwick, Roell, Ulm, Germany), and tensile force at a
cross-head speed of 0.5 mm min
1
was applied to the
posts until they debonded from the root canals. After
(a) (b)
(c) (d)
Figure 2 (ad) Root canal cleanliness
was assessed using an operating
microscope. Specimens were categorized
into the following four categories: (a)
completely clean, (b) small remnants of
sealer, (c) large remnants of sealer
and (d) remnants of sealer and
gutta-percha.
Bitter et al. Retention of bre posts
2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1119
the pull-out test, the roots from each specimen were
cut longitudinally into two pieces using a band saw
(Exakt Apparatebau, Norderstedt, Germany); the root
halves and the posts were then observed using a ste-
reomicroscope (DV 4; Zeiss) at 40 9 magnication to
determine the failure mode. The specimens were
divided into the following three groups according to
their failure modes: (i) adhesive failures between
dentine and cement, (ii) adhesive failures between
post and cement and (iii) mixed failures (Fig. 3ac).
Confocal laser scanning microscope analysis
Confocal laser scanning microscope (CLSM) analysis
was applied to two specimens from each group to
evaluate the adhesive interface. For CLSM experi-
ments, SmartCem2 and CoreX Flow were labelled
with 1% rhodamine-isothiocyanate (RITC) (Sigma
Aldrich, St Louis, MO, USA) prior to being applied to
the root canal. The XP Bond adhesive was labelled
with 1% sodium uorescein (FNa) (Sigma Aldrich).
Each root was cut perpendicular to its long axis into
three 2-mm-thick slices using a band saw (Exakt
Apparatebau). Further specimen preparation for CLSM
analysis was performed as described previously (Bitter
et al. 2009b). CLSM (Leica TCS NT; Leica, Heidelberg,
Germany) analysis of the adhesive interface of each
slice was performed in dual uorescence mode using
a 409 objective and a 29 electronic zoom (Bitter
et al. 2009b).
Statistical analysis
Statistical analysis was performed using SPSS version
16.0 software (SPSS, Chicago, IL, USA). The a (Type
I) error level was set to 0.05. The effects of the clean-
ing method, luting agent and preparation procedure
on the pull-out force of the bre posts were analysed
using three-way ANOVA and Tukeys HSD post hoc test.
The effects of the cleaning method on root canal
cleanliness and the effects of the luting agent and
preparation procedure on failure modes were investi-
gated using Pearsons chi-squared test.
Results
Fibre post retention was signicantly affected by the
cleaning procedure (P = 0.008), luting agent (P <
0.0005) and preparation technique (P < 0.0005, 3-
way ANOVA). A signicant interaction was observed
between the luting agent and the preparation proce-
dure (P < 0.0005). With regard to the cleaning
method, the control group exhibited signicantly
higher post retention [mean (SD)] [370 (104) N] com-
pared with the brush group [315 (124) N]
(P = 0.005, Tukeys HSD); however, the control
group did not differ signicantly from the sandblast-
ing group [344 (102) N] (P = 0.28; Tukeys HSD).
Signicantly higher post retention was observed
following the use of CoreX Flow/XP Bond luting agent
[370 (62) N] compared with SmartCem2 [315 (141)
(a1) (a2)
(b1) (b2)
(c1) (c2)
Figure 3 (ac) Representative images
of the three observed failure modes:
adhesive failures between the dentin
and cement (a1 + 2), adhesive failures
between the post and cement (b1 + 2)
and mixed failures (c1 + 2).
Retention of bre posts Bitter et al.
2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1120
N] (P < 0.0005). The PD preparation method resulted
in signicantly lower post retention [287 (105) N]
compared with the RB method [399 (88) N]
(P < 0.0005). However, this effect was primarily
observed with the SmartCem2 luting agent, which
showed signicantly higher post retention when the
RB [423 (112) N] procedure was utilized compared
with the PD preparation technique [207 (58) N]
(P < 0.0005) (Table 1).
As shown in Table 2, root canal cleanliness was
not affected by the investigated cleaning methods
(P = 0.618, chi-square test). The failure modes were
signicantly affected by the luting agent and prepara-
tion procedure (P < 0.0005, chi-squared test); these
results are displayed according to the groups in
Table 3.
Scanning electron microscope evaluation of the pre-
pared root canals revealed that the RB created distinct
grooves and undercuts (Fig. 4a), whereas the PD
created minimal grooves (Fig. 4b). Although sand-
blasting had an effect on sealer removal (Fig. 4d), sea-
ler remnants were detected in all groups regardless of
the cleaning method (Fig. 4c). Analyses of the inter-
face using CLSM demonstrated for the material CoreX
Flow and the adhesive System XP Bond/Self-cure acti-
vator a distinct hybrid layer and numerous resin tags
lled with adhesive and resin cement (Fig. 5a). In
contrast, no hybrid layer formation was detected, and
penetration into the dentinal tubules occurred only
sporadically for the self-adhesive resin cement Smart-
Cem 2 (Fig. 5b). No effects of the investigated clean-
ing methods on the adhesive interface were seen.
Discussion
The null hypotheses of the present study were par-
tially rejected because cleaning method, luting agent
and preparation procedure signicantly affected bre
post retention inside the root canal; furthermore, the
modes of failure were affected by the luting agent and
preparation procedure. However, the cleaning meth-
ods investigated in the present study did not affect
root canal cleanliness.
The thin push-out test is considered to be a valid
method to analyse the bond strength between bre
posts and root canal dentine (Soares et al. 2008).
Nevertheless, the exposure of bre posts to dislodging
forces during the push-out test cannot be compared
with the functional forces incurred during clinical
service (Radovic et al. 2008a). Additionally, the sec-
tioning process may induce artefacts that could inu-
ence the test results. However, as the pull-out test
design offers the advantage of testing the entire root
canal and post length, it is considered to be more
effective in detecting the effects of post surface and
root canal dentine pre-treatments of the post as well
as of the root canal dentine on bond strength
(Schmage et al. 2009a,b). As a result, the pull-out
Table 1 Mean (SD) post retention with respect to preparation procedure, luting agent and cleaning method
Preparation
procedure Luting agent Adhesive
Cleaning
method
Post Retention in
N
Mean SD
Post drill SmartCem2
(LOT 090331,
091218, 091206)
None Control 229 67
Brush 182 61
Sandblasting 211 40
CoreX Flow
(LOT 090930,
091021, 0809111)
DeTrey Conditioner
36 (LOT 0807002999)
XP Bond (LOT
0811001247)
Self-cure activator
(LOT 080624)
Control 390 59
Brush 340 102
Sandblasting 369 63
Round bur SmartCem2 (LOT
090331, 091218,
091206)
None Control 451 78
Brush 383 151
Sandblasting 436 95
CoreX Flow (LOT
090930, 091021,
0809111)
DeTrey Conditioner
36 (LOT 0807002999)
XP Bond (LOT 0811001247)
Self-cure activator (LOT
080624)
Control 409 32
Brush 355 45
Sandblasting 358 30
Bitter et al. Retention of bre posts
2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1121
test method was selected to investigate the effects of
root canal cleaning methods on bre post retention.
It is well documented that contamination of dentine
with temporary cements (Paul & Scharer 1997) or
root canal sealers containing eugenol (Menezes et al.
2008) considerably decreases dentine adhesion
capacity. Recently, the impact of resin-based sealers,
such as AH Plus, on the push-out bond strength of
luted bre posts has been investigated. Although
Demiryurek et al. (2010) demonstrated a signicant
reduction in bond strength, no inuence was found in
another study that utilized a comparable methodology
(Cecchin et al. 2011). The differences in results could
potentially be attributed to differences in the materials
used for post cementation or the degree of the cleanli-
ness of the canal walls. Following post space prepara-
tion of root lled teeth, large areas of dentine covered
with gutta-percha and sealer remnants were detected
(Serano et al. 2004). The cleaning methods investi-
gated in the present study were not effective with
respect to root canal cleanliness. The limited accessi-
bility of the root canal for the intraoral sandblasting
device may have been responsible for the lack of an
effect of air abrasion on root canal cleanliness.
Moreover, the results suggest that the pressure and
rotation frequency of the rotating brushes used with
pumice powder were not sufcient to clean the root
canal walls. Because sonically activated canal brushes
have been shown to effectively remove the smear
layer inside root canals when used in combination
with 17% EDTA (Salman et al. 2010), further studies
should be performed to evaluate their effects on root
canal cleanliness.
The lack of an effect of air abrasion on bond strength
reported here is corroborated by previous studies that
failed to show an effect of aluminium air abrasion on
dentine surfaces when one- and two-step self-etching
adhesive systems (Franca et al. 2007) or etch-and-rinse
adhesive systems (Abo-Hamar et al. 2005) were
employed. In contrast to these studies, other authors
have demonstrated benecial effects of sandblasting on
dentine adhesion (Mujdeci & Gokay 2004, Motisuki
et al. 2006). Specically, the contaminated coronal
dentine bond strength values of self-adhesive cement
were shown to be signicantly improved after
sandblasting (Chaiyabutr & Kois 2008).
Regardless of the cleaning method employed, sealer
or gutta-percha remnants were not completely
removed in the present study. Interestingly, both
phosphoric acid etching and ultrasonic agitation in
combination with EDTA/sodium hypochlorite have
been shown to be effective in completely cleaning the
post space and improving the push-out bond strength
compared with manual irrigation with water or EDTA
followed by NaOCl (Zhang et al. 2008). In contrast,
two previous studies have demonstrated that phos-
phoric acid is unable to clean dentine effectively in
prepared post spaces (Serano et al. 2004, Coniglio
et al. 2008b). Additionally, ultrasonic cleaning
devices may require EDTA for efcient canal wall
debridement (Coniglio et al. 2008b).
Table 2 No signicant effects of the investigated cleaning
methods on root canal cleanliness were detected (P = 0.618,
chi-squared test)
Cleaning
method
Cleanliness of the root canals in%
I II III IV
Clean
Small
remnants
of sealer
Large
remnants
of sealer
Remnants of
sealer and
gutta-percha
Control 27.4 45 12.5 15
Brush 22.5 37.5 27.5 12.5
Sandblasting 32.5 30 25 12.5
Table 3 Analyses of the failure modes with respect to luting agent and preparation procedure. A P value of <0.05 indicates
signicant effects of the luting agent or preparation procedure on the failure modes (Pearson)
Luting
agent
Preparation
procedure
Failure mode in %
I II III
P
value
Adhesive
cement
dentin
Adhesive
post
cement Mixed
SmartCem2 PD 83.3 0 16.7 <0.0005
RB 10 40 50
CoreX Flow PD 23.3 56.7 20 0.006
RB 0 93.4 6.6
PD, post drill; RB, round bur.
Retention of bre posts Bitter et al.
2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1122
The lowest post retention values observed in this
study occurred after intraradicular cleaning with a
rotating brush and pumice paste. For the SmartCem2
self-adhesive material, this might be attributed to the
presence of a thick smear layer, which can remain even
after pumicing the dentine surface (Bloxham et al.
1990) and impair adhesion (Senawongse et al. 2010).
Although it has been reported previously that sodium
hypochlorite can reduce bond strength to endodontic
surfaces (Morris et al. 2001), the control specimens in
which only hypochlorite was used for cleaning the post
space exhibited similar pull-out values.
In the present study, the etch-and-rinse approach
using CoreX Flow/XP Bond resulted in signicantly
higher bond strength compared to the self-adhesive
resin cement SmartCem2. A previous study using a
push-out design revealed similar bond strength values
inside the root canal when either CoreX Flow/XP
Bond or the self-adhesive resin cement RelyX Unicem
was used (Mazzoni et al. 2009). However, the bond
strengths of self-adhesive resin cements can differ
between materials because of their varied composi-
tions (Monticelli et al. 2008, Radovic et al. 2008b).
It is likely that the low bond strengths recorded for
the self-adhesive cement SmartCem2 are related to its
limited ability to demineralize and inltrate the
dentine substrate, as previously shown for a compara-
ble self-adhesive resin cement, RelyX Unicem (De
Munck et al. 2004, Goracci et al. 2005b, Monticelli
et al. 2008, Bitter et al. 2009b). These ndings are
consistent with the CLSM analysis in the present
investigation that revealed that no hybrid layer
formation occurred when SmartCem2 was utilized
(a) (b)
(c) (d)
Figure 4 (ad) Scanning electron microscope evaluation of post space preparations revealed distinct grooves and undercuts
produced by the round bur (a), whilst the post drill produced marginal grooves (b). Remnants of sealer could be detected in all
groups regardless of the cleaning method employed (c). Marginal grooves resulting from sandblasting were observed (d).
(a)
(b)
Figure 5 (a, b) Confocal laser scanning microscope demon-
strated a distinct hybrid layer and numerous resin tags lled
with adhesive and resin cement for CoreX Flow/XP Bond/
Self-cure activator (a). For SmartCem2, no hybrid layer for-
mation was detected, and penetration into the dentinal
tubules occurred only sporadically (b).
Bitter et al. Retention of bre posts
2012 International Endodontic Journal International Endodontic Journal, 45, 11161126, 2012 1123
(Fig. 5b). The initial low pH and signicantly
increased viscosity of the self-adhesive cement com-
pared with self-etching primers may explain why no
true hybrid layer is formed when the self-adhesive
cement is applied to the root canal.
In contrast to the self-adhesive cement SmartCem2,
CLSM analysis of the XP Bond etch-and-rinse adhe-
sive system with the Self-cure activator and CoreX
Flow material revealed a distinctive hybrid layer and
numerous resin tags. These results are consistent with
a previous study that demonstrated the formation of
a homogenous hybrid layer for etch-and-rinse adhe-
sive systems inside root canals (Bitter et al. 2009b).
The preparation procedure signicantly affected the
pull-out bond strength of bre posts in the present
investigation. In addition, a signicant interaction
between the luting agent and the preparation proce-
dure was observed. SEM analysis revealed the crea-
tion of distinct undercuts when the RB was used
compared with minimal grooves when the PD was
used. These undercuts may have contributed to the
increased pull-out force observed in the RB group. In
the PD group, the CoreX Flow/XP Bond etch-and-
rinse adhesive system showed a signicantly higher
pull-out force compared with the self-adhesive resin
cement SmartCem2. However, when the post space
preparation was performed with a RB, which resulted
in distinct undercuts on the dentine surface, differ-
ences in pull-out force between the two luting agents
were negligible. These ndings suggest that increased
friction can partially compensate for poor adhesive
performance in the root canal; furthermore, consis-
tent with previous reports, these results highlight the
contribution of frictional retention on the pull-out
force of bre posts (Goracci et al. 2005a,. Pirani et al.
2005).
The failure modes were signicantly affected by
both the luting agent and the preparation procedure
used. In the RB group, signicantly fewer failures
occurred between the dentine and cement, indicating
that the micromechanical retentions enhanced the
cement-to-dentine bond strength. When the CoreX
Flow/XP Bond material was utilized, signicantly
more adhesive failures between the post and cement
were observed in the RB group, indicating that the
weak part of this interface was between the post and
the cement. However, the pull-out bond strength did
not increase after using the RB for this material. In
contrast, bond strength was signicantly increased
for the SmartCem2 material when the RB was
employed for post space preparation; moreover, the
failure modes changed from being predominantly
adhesive between the dentine and the cement to
being predominantly mixed or between the post and
the cement.
Conclusion
Within the limitations of the present study, it can be
concluded that the investigated cleaning methods
after post space preparation were not effective in
improving the cleanliness of the canal and did not
enhance bre post retention inside the root canal.
However, post space preparation using a RB increased
the pull-out force of bre posts, suggesting that this
approach might be benecial for improving retention,
especially when self-adhesive cements are used. Fur-
ther studies using microcomputed tomography are
clearly warranted to analyse the removal of tooth
structure when using a PD or a RB to determine
which method is less invasive.
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