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Microleakage of endodontically treated teeth restored with fiber posts and composite cores after cyclic loading: A confocal microscopic study

Identifieur interne : 002949 ( Istex/Corpus ); précédent : 002948; suivant : 002950

Microleakage of endodontically treated teeth restored with fiber posts and composite cores after cyclic loading: A confocal microscopic study

Auteurs : Francesco Mannocci ; Marco Ferrari ; Timothy F. Watson

Source :

RBID : ISTEX:542ABAFD7E8143BE22B22054F52FC49F11A315D2

English descriptors

Abstract

Abstract: Statement of Problem. The effectiveness of the seal obtained with carbon fiber posts and composite cores is still unclear. Both 3-step dental adhesives and self-etching adhesive primers have been suggested as adhesive systems. Purpose. This confocal microscopic study evaluated the microleakage of teeth endodontically treated and restored with fiber posts and composites with 3 adhesive systems. Material and Methods. A total of 72 human mandibular premolars were endodontically treated and divided into 6 groups of 12 teeth each. The first 3 groups were treated with an endodontic sealer containing zinc oxide-eugenol (ZOE) and restored with temporary filling materials containing ZOE. The last 3 groups were treated with ZOE-free materials. Post spaces were prepared in the root canals. The first group treated with ZOE-based materials was restored with fiber posts cemented with zinc phosphate cement and composite cores without adhesive. The other 2 groups of ZOE-treated teeth were restored with fiber posts cemented with All Bond 2 and Panavia 21 dental adhesives, respectively. The last 3 groups were restored with fiber posts cemented with All Bond 2, Panavia 21, and Panavia Fluoro cement, respectively. The teeth were loaded intermittently at 2 cycles per second in a moist environment and, after 300,000 cycles, immersed in a solution of Rhodamine B dye for 48 hours. A confocal microscope was used to observe the teeth. The ratio between the length of the interfaces observed and the length of the dye penetration was evaluated. Two teeth from each group acted as controls and were not subjected to dynamic loads. Results. All resin cement groups leaked significantly less than the group cemented with zinc phosphate cement. No statistically significant difference was found between the microleakage of teeth treated with ZOE-based and non-ZOE-based materials. Teeth restored with All Bond 2 dental adhesive leaked significantly less than those restored with Panavia cement. Conclusion. The 3-step dental adhesive (All Bond 2) resulted in a better marginal seal than that obtained with the self-etching primers (Panavia 21 and Panavia F). The use of endodontic sealers and temporary filling materials containing ZOE had no detrimental effect on the marginal seal of carbon fiber post/composite resin core restorations. (J Prosthet Dent 2001;85:284-91.)

Url:
DOI: 10.1067/mpr.2001.113706

Links to Exploration step

ISTEX:542ABAFD7E8143BE22B22054F52FC49F11A315D2

Le document en format XML

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<div type="abstract" xml:lang="en">Abstract: Statement of Problem. The effectiveness of the seal obtained with carbon fiber posts and composite cores is still unclear. Both 3-step dental adhesives and self-etching adhesive primers have been suggested as adhesive systems. Purpose. This confocal microscopic study evaluated the microleakage of teeth endodontically treated and restored with fiber posts and composites with 3 adhesive systems. Material and Methods. A total of 72 human mandibular premolars were endodontically treated and divided into 6 groups of 12 teeth each. The first 3 groups were treated with an endodontic sealer containing zinc oxide-eugenol (ZOE) and restored with temporary filling materials containing ZOE. The last 3 groups were treated with ZOE-free materials. Post spaces were prepared in the root canals. The first group treated with ZOE-based materials was restored with fiber posts cemented with zinc phosphate cement and composite cores without adhesive. The other 2 groups of ZOE-treated teeth were restored with fiber posts cemented with All Bond 2 and Panavia 21 dental adhesives, respectively. The last 3 groups were restored with fiber posts cemented with All Bond 2, Panavia 21, and Panavia Fluoro cement, respectively. The teeth were loaded intermittently at 2 cycles per second in a moist environment and, after 300,000 cycles, immersed in a solution of Rhodamine B dye for 48 hours. A confocal microscope was used to observe the teeth. The ratio between the length of the interfaces observed and the length of the dye penetration was evaluated. Two teeth from each group acted as controls and were not subjected to dynamic loads. Results. All resin cement groups leaked significantly less than the group cemented with zinc phosphate cement. No statistically significant difference was found between the microleakage of teeth treated with ZOE-based and non-ZOE-based materials. Teeth restored with All Bond 2 dental adhesive leaked significantly less than those restored with Panavia cement. Conclusion. The 3-step dental adhesive (All Bond 2) resulted in a better marginal seal than that obtained with the self-etching primers (Panavia 21 and Panavia F). The use of endodontic sealers and temporary filling materials containing ZOE had no detrimental effect on the marginal seal of carbon fiber post/composite resin core restorations. (J Prosthet Dent 2001;85:284-91.)</div>
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<note>Reprint requests to: Dr Francesco Mannocci, Via Gemignani 3, 56015 Riglione (Pisa), ITALY, Fax: (390)50-316-3235, E-mail: mannocci@sirius.pisa.it</note>
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<p>Statement of Problem. The effectiveness of the seal obtained with carbon fiber posts and composite cores is still unclear. Both 3-step dental adhesives and self-etching adhesive primers have been suggested as adhesive systems. Purpose. This confocal microscopic study evaluated the microleakage of teeth endodontically treated and restored with fiber posts and composites with 3 adhesive systems. Material and Methods. A total of 72 human mandibular premolars were endodontically treated and divided into 6 groups of 12 teeth each. The first 3 groups were treated with an endodontic sealer containing zinc oxide-eugenol (ZOE) and restored with temporary filling materials containing ZOE. The last 3 groups were treated with ZOE-free materials. Post spaces were prepared in the root canals. The first group treated with ZOE-based materials was restored with fiber posts cemented with zinc phosphate cement and composite cores without adhesive. The other 2 groups of ZOE-treated teeth were restored with fiber posts cemented with All Bond 2 and Panavia 21 dental adhesives, respectively. The last 3 groups were restored with fiber posts cemented with All Bond 2, Panavia 21, and Panavia Fluoro cement, respectively. The teeth were loaded intermittently at 2 cycles per second in a moist environment and, after 300,000 cycles, immersed in a solution of Rhodamine B dye for 48 hours. A confocal microscope was used to observe the teeth. The ratio between the length of the interfaces observed and the length of the dye penetration was evaluated. Two teeth from each group acted as controls and were not subjected to dynamic loads. Results. All resin cement groups leaked significantly less than the group cemented with zinc phosphate cement. No statistically significant difference was found between the microleakage of teeth treated with ZOE-based and non-ZOE-based materials. Teeth restored with All Bond 2 dental adhesive leaked significantly less than those restored with Panavia cement. Conclusion. The 3-step dental adhesive (All Bond 2) resulted in a better marginal seal than that obtained with the self-etching primers (Panavia 21 and Panavia F). The use of endodontic sealers and temporary filling materials containing ZOE had no detrimental effect on the marginal seal of carbon fiber post/composite resin core restorations. (J Prosthet Dent 2001;85:284-91.)</p>
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<ce:sup>a</ce:sup>
Clinical Professor, Department of Restorative Dentistry, University of Siena.</ce:note-para>
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<ce:label>☆☆</ce:label>
<ce:note-para>
<ce:sup>b</ce:sup>
Professor, Department of Dental Materials, University of Siena; and Research Professor, Department of Restorative Dentistry, School of Dental Medicine, Tufts University, Boston, Mass.</ce:note-para>
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<ce:label>★</ce:label>
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<ce:sup>c</ce:sup>
Professor, Department of Conservative Dentistry, Guy's, King's, and St. Thomas' Dental Institute.</ce:note-para>
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<ce:article-footnote>
<ce:label>★★</ce:label>
<ce:note-para>Reprint requests to: Dr Francesco Mannocci, Via Gemignani 3, 56015 Riglione (Pisa), ITALY, Fax: (390)50-316-3235, E-mail: mannocci@sirius.pisa.it</ce:note-para>
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<ce:note-para>J Prosthet Dent 2001;85:284-91</ce:note-para>
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<ce:title>Microleakage of endodontically treated teeth restored with fiber posts and composite cores after cyclic loading: A confocal microscopic study</ce:title>
<ce:author-group>
<ce:author>
<ce:given-name>Francesco</ce:given-name>
<ce:surname>Mannocci</ce:surname>
<ce:degrees>MD, DDS
<ce:sup>a</ce:sup>
</ce:degrees>
</ce:author>
<ce:author>
<ce:given-name>Marco</ce:given-name>
<ce:surname>Ferrari</ce:surname>
<ce:degrees>MD, DDS, PhD
<ce:sup>b</ce:sup>
</ce:degrees>
</ce:author>
<ce:author>
<ce:given-name>Timothy F.</ce:given-name>
<ce:surname>Watson</ce:surname>
<ce:degrees>BSc, BDS, PhD
<ce:sup>c</ce:sup>
</ce:degrees>
</ce:author>
<ce:affiliation>
<ce:textfn>Faculty of Dentistry, University of Siena, Siena, Italy, and Guy's, King's, and St. Thomas' Dental Institute, Guy's Hospital, London, England</ce:textfn>
</ce:affiliation>
</ce:author-group>
<ce:abstract>
<ce:section-title id="st0010">Abstract</ce:section-title>
<ce:abstract-sec>
<ce:simple-para id="sp0040">
<ce:bold>Statement of Problem.</ce:bold>
The effectiveness of the seal obtained with carbon fiber posts and composite cores is still unclear. Both 3-step dental adhesives and self-etching adhesive primers have been suggested as adhesive systems.
<ce:bold>Purpose.</ce:bold>
This confocal microscopic study evaluated the microleakage of teeth endodontically treated and restored with fiber posts and composites with 3 adhesive systems.
<ce:bold>Material and Methods.</ce:bold>
A total of 72 human mandibular premolars were endodontically treated and divided into 6 groups of 12 teeth each. The first 3 groups were treated with an endodontic sealer containing zinc oxide-eugenol (ZOE) and restored with temporary filling materials containing ZOE. The last 3 groups were treated with ZOE-free materials. Post spaces were prepared in the root canals. The first group treated with ZOE-based materials was restored with fiber posts cemented with zinc phosphate cement and composite cores without adhesive. The other 2 groups of ZOE-treated teeth were restored with fiber posts cemented with All Bond 2 and Panavia 21 dental adhesives, respectively. The last 3 groups were restored with fiber posts cemented with All Bond 2, Panavia 21, and Panavia Fluoro cement, respectively. The teeth were loaded intermittently at 2 cycles per second in a moist environment and, after 300,000 cycles, immersed in a solution of Rhodamine B dye for 48 hours. A confocal microscope was used to observe the teeth. The ratio between the length of the interfaces observed and the length of the dye penetration was evaluated. Two teeth from each group acted as controls and were not subjected to dynamic loads.
<ce:bold>Results.</ce:bold>
All resin cement groups leaked significantly less than the group cemented with zinc phosphate cement. No statistically significant difference was found between the microleakage of teeth treated with ZOE-based and non-ZOE-based materials. Teeth restored with All Bond 2 dental adhesive leaked significantly less than those restored with Panavia cement.
<ce:bold>Conclusion.</ce:bold>
The 3-step dental adhesive (All Bond 2) resulted in a better marginal seal than that obtained with the self-etching primers (Panavia 21 and Panavia F). The use of endodontic sealers and temporary filling materials containing ZOE had no detrimental effect on the marginal seal of carbon fiber post/composite resin core restorations. (J Prosthet Dent 2001;85:284-91.)</ce:simple-para>
</ce:abstract-sec>
</ce:abstract>
</head>
<body>
<ce:sections>
<ce:para id="p0010">
<ce:display>
<ce:textbox id="b0010">
<ce:textbox-body>
<ce:sections>
<ce:para id="p0015">In this study, 3-step dental adhesives appeared to perform better than self-etching primers for the composite core reconstruction of endodontically treated teeth.</ce:para>
</ce:sections>
</ce:textbox-body>
</ce:textbox>
</ce:display>
</ce:para>
<ce:para id="p0020">Coronal leakage at the margin of an artificial crown for endodontically treated teeth may result in recurrent caries and failure of both the restoration and the root canal treatment.
<ce:cross-ref refid="bib1">
<ce:sup>1</ce:sup>
</ce:cross-ref>
Several in vitro and in vivo studies have reported that prefabricated posts may offer a better prognosis than cast posts and cores for endodontically treated teeth.
<ce:cross-refs refid="bib2 bib3 bib4">
<ce:sup>2-4</ce:sup>
</ce:cross-refs>
When custom-made cast posts and cores are used, a temporary post-crown must be prepared while the definitive restoration is constructed; in contrast, prefabricated posts allow a core reconstruction immediately after the post space preparation. In a recent dye leakage study, temporary post-crowns cemented with zinc oxide-eugenol (ZOE) cement produced significantly more coronal microleakage than cast or prefabricated post systems.
<ce:cross-ref refid="bib5">
<ce:sup>5</ce:sup>
</ce:cross-ref>
Another study reported that bacteria and endotoxins were able to penetrate the obturating materials in post-prepared root canals.
<ce:cross-ref refid="bib6">
<ce:sup>6</ce:sup>
</ce:cross-ref>
The authors concluded that immediate restoration of the tooth with a prefabricated post and composite core was preferable to placing a temporary post-crown before a final cast post and core. Nevertheless, Fogel
<ce:cross-ref refid="bib7">
<ce:sup>7</ce:sup>
</ce:cross-ref>
evaluated various prefabricated post-core systems with a fluid filtration microleakage test and found that none of the post systems tested were capable of consistently achieving a fluid-tight seal. Similar results were reported by Tjan et al,
<ce:cross-ref refid="bib8">
<ce:sup>8</ce:sup>
</ce:cross-ref>
who used dental adhesives of the second generation and found that all teeth showed leakage.</ce:para>
<ce:para id="p0025">The adhesive strength of composite to tooth structure may be influenced by environmental conditions such as the cleanliness of the tooth surface. In a recent investigation of temporary cement remnants as inhibiting factors to adhesion at the interface between resin cements and bovine dentin, the application of the temporary cement significantly decreased the tensile bond strengths of all adhesive systems studied.
<ce:cross-ref refid="bib9">
<ce:sup>9</ce:sup>
</ce:cross-ref>
Xie et al
<ce:cross-ref refid="bib10">
<ce:sup>10</ce:sup>
</ce:cross-ref>
reported that the contamination of enamel and dentinal surfaces with various agents lowered the bond strengths of composite restorations when combined with different bonding agents. Terata
<ce:cross-ref refid="bib11">
<ce:sup>11</ce:sup>
</ce:cross-ref>
found that both eugenol-containing and eugenol-free temporary cements decreased the tensile bond strength of resin-luting cements to bovine teeth. Woody and Davis
<ce:cross-ref refid="bib12">
<ce:sup>12</ce:sup>
</ce:cross-ref>
reported no difference in leakage of resin-luted inlays when the cavity preparations were treated with either eugenol-containing or eugenol-free temporary cements.</ce:para>
<ce:para id="p0030">Root fractures can be a problem with restored pulpless teeth.
<ce:cross-refs refid="bib13 bib14 bib15">
<ce:sup>13-15</ce:sup>
</ce:cross-refs>
Two studies
<ce:cross-refs refid="bib16 bib17">
<ce:sup>16,17</ce:sup>
</ce:cross-refs>
have reported that carbon fiber posts are less likely than other types of posts to produce root fractures. Other studies indicated that, when fractures occurred in teeth restored with carbon fiber posts, the fractures tended to be less destructive.
<ce:cross-refs refid="bib18 bib19">
<ce:sup>18,19</ce:sup>
</ce:cross-refs>
In a recent investigation of carbon fiber post-core restorations cemented with dentin bonding agents and resin cements, less microleakage was observed compared with posts cemented with glass ionomer and zinc phosphate cements.
<ce:cross-ref refid="bib20">
<ce:sup>20</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para id="p0035">Recently, new carbon fiber posts coated with quartz fibers (Aestheti-Post RTD, St. Egreve, France) have been produced. The purpose of these new posts is to provide better esthetic results by preventing the discoloration of the tooth from the dark carbon fibers.</ce:para>
<ce:para id="p0040">Coronal and apical microleakage has been measured by penetration of bacteria, dyes, and isotopes
<ce:cross-ref refid="bib21">
<ce:sup>21</ce:sup>
</ce:cross-ref>
; however, leakage investigations are not easily comparable or reproducible. The presence of entrapped air along the restorative interface is considered one of the most important reasons for this lack of reproducibility.
<ce:cross-ref refid="bib22">
<ce:sup>22</ce:sup>
</ce:cross-ref>
A fluid filtration system has been developed
<ce:cross-ref refid="bib23">
<ce:sup>23</ce:sup>
</ce:cross-ref>
and used to quantify the apical leakage of post-core restorations.
<ce:cross-ref refid="bib7">
<ce:sup>7</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para id="p0045">The aim of this study was to evaluate the leakage associated with 3 different adhesive systems used for fiber post and composite core restorations of teeth either treated or untreated with endodontic sealers and temporary cements containing ZOE. Confocal microscopy was used to examine the penetration of fluorescent dye.</ce:para>
<ce:section id="s0010">
<ce:section-title id="st0015">Material and methods</ce:section-title>
<ce:para id="p0050">Seventy-two caries-free mandibular premolars, extracted for periodontal reasons, were chosen for the investigation. The teeth were stored in saline solution, and all external debris was removed with an ultrasonic scaler. Buccolingual and mesiodistal radiographs of all teeth were made and examined to evaluate the root integrity and the number of canals present. All teeth involved in the investigation contained 1 canal only. The roots did not display cracks, resorptions, or open apices. After the crowns were amputated at the cemento- enamel junction (CEJ), the roots were divided into 6 groups of 12 teeth each (Table I).
<ce:display>
<ce:table id="t0010" colsep="0" rowsep="0" frame="topbot">
<ce:label>Table I</ce:label>
<ce:caption>
<ce:simple-para id="sp0045">Materials used in this study</ce:simple-para>
</ce:caption>
<tgroup cols="8">
<colspec colname="col1" colsep="0"></colspec>
<colspec colname="col2" colsep="0"></colspec>
<colspec colname="col3" colsep="0"></colspec>
<colspec colname="col4" colsep="0"></colspec>
<colspec colname="col5" colsep="0"></colspec>
<colspec colname="col6" colsep="0"></colspec>
<colspec colname="col7" colsep="0"></colspec>
<colspec colname="col8" colsep="0"></colspec>
<thead>
<row valign="bottom">
<entry>
<ce:bold>Group no.</ce:bold>
</entry>
<entry align="center">
<ce:bold>No. of samples</ce:bold>
</entry>
<entry align="center">
<ce:bold>Endodontic sealer</ce:bold>
</entry>
<entry align="center">
<ce:bold>Temporary filling material</ce:bold>
</entry>
<entry align="center">
<ce:bold>Dental adhesive</ce:bold>
</entry>
<entry align="center">
<ce:bold>Cement</ce:bold>
</entry>
<entry align="center">
<ce:bold>Composite core</ce:bold>
</entry>
<entry align="center">
<ce:bold>Post</ce:bold>
</entry>
</row>
</thead>
<tbody>
<row>
<entry>1</entry>
<entry align="center">10</entry>
<entry align="center">AH 26</entry>
<entry align="center">Z100</entry>
<entry align="center">All Bond 2</entry>
<entry align="center">C&B</entry>
<entry align="center">Z100</entry>
<entry align="center">AP</entry>
</row>
<row>
<entry>2</entry>
<entry align="center">10</entry>
<entry align="center">Pulp canal sealer</entry>
<entry align="center">IRM</entry>
<entry align="center">All Bond 2</entry>
<entry align="center">C&B</entry>
<entry align="center">Z100</entry>
<entry align="center">AP</entry>
</row>
<row>
<entry>3</entry>
<entry align="center">10</entry>
<entry align="center">AH 26</entry>
<entry align="center">Z100</entry>
<entry align="center">Panavia 21</entry>
<entry align="center">Panavia 21</entry>
<entry align="center">CPC</entry>
<entry align="center">T2</entry>
</row>
<row>
<entry>4</entry>
<entry align="center">10</entry>
<entry align="center">Pulp canal sealer</entry>
<entry align="center">IRM</entry>
<entry align="center">Panavia 21</entry>
<entry align="center">Panavia 21</entry>
<entry align="center">CPC</entry>
<entry align="center">T2</entry>
</row>
<row>
<entry>5</entry>
<entry align="center">10</entry>
<entry align="center">AH 26</entry>
<entry align="center">Z100</entry>
<entry align="center">Panavia F</entry>
<entry align="center">Panavia F</entry>
<entry align="center">CPC</entry>
<entry align="center">T2</entry>
</row>
<row>
<entry>6</entry>
<entry align="center">10</entry>
<entry align="center">Pulp canal sealer</entry>
<entry align="center">IRM</entry>
<entry align="center">—</entry>
<entry align="center">SS White</entry>
<entry align="center">CPC</entry>
<entry align="center">AP</entry>
</row>
<row>
<entry namest="col1" nameend="col8"></entry>
</row>
</tbody>
</tgroup>
<ce:legend>
<ce:simple-para id="sp0050">
<ce:italic>Panavia F</ce:italic>
= Panavia Fluoro;
<ce:italic>CPC</ce:italic>
= Clearfil Photo Core;
<ce:italic>AP</ce:italic>
= Aestheti-Post;
<ce:italic>T2</ce:italic>
= Tech 2000.</ce:simple-para>
</ce:legend>
</ce:table>
</ce:display>
One tooth of each group was used as positive control group and 1 as negative control; thus, each experimental group had 10 specimens. The materials that served as variables and that were used to restore teeth are listed in Table II.
<ce:display>
<ce:table id="t0015" colsep="0" rowsep="0" frame="topbot">
<ce:label>Table II</ce:label>
<ce:caption>
<ce:simple-para id="sp0055">Manufacturers and batch numbers of materials used in this study</ce:simple-para>
</ce:caption>
<tgroup cols="3">
<colspec colname="col1" colsep="0"></colspec>
<colspec colname="col2" colsep="0"></colspec>
<colspec colname="col3" colsep="0"></colspec>
<thead>
<row valign="bottom">
<entry>
<ce:bold>Material</ce:bold>
</entry>
<entry align="center">
<ce:bold>Manufacturer</ce:bold>
</entry>
<entry align="center">
<ce:bold>Batch number</ce:bold>
</entry>
</row>
</thead>
<tbody>
<row>
<entry>Aestheti-Post</entry>
<entry align="center">RTD</entry>
<entry align="center">ASH9809A</entry>
</row>
<row>
<entry>Tech 2000</entry>
<entry align="center">Carbotech</entry>
<entry align="center">C108</entry>
</row>
<row>
<entry>All Bond 2 Primer A</entry>
<entry align="center">Bisco</entry>
<entry align="center">970008104</entry>
</row>
<row>
<entry>All Bond 2 Primer B</entry>
<entry align="center">Bisco</entry>
<entry align="center">970008105</entry>
</row>
<row>
<entry>All Bond 2 Pre-Bond</entry>
<entry align="center">Bisco</entry>
<entry align="center">9900007441</entry>
</row>
<row>
<entry>Panavia 21</entry>
<entry align="center">Kuraray Co Ltd</entry>
<entry align="center">41125</entry>
</row>
<row>
<entry>Panavia F</entry>
<entry align="center">Kuraray Co Ltd</entry>
<entry align="center">011113</entry>
</row>
<row>
<entry>Zinc phosphate cement</entry>
<entry align="center">SS White</entry>
<entry align="center">659924</entry>
</row>
<row>
<entry>Z100 composite</entry>
<entry align="center">3M</entry>
<entry align="center">C3021A3</entry>
</row>
<row>
<entry>Pulp canal sealer</entry>
<entry align="center">Kerr</entry>
<entry align="center">5105899</entry>
</row>
<row>
<entry>AH 26 sealer</entry>
<entry align="center">De Trey</entry>
<entry align="center">748535</entry>
</row>
</tbody>
</tgroup>
</ce:table>
</ce:display>
</ce:para>
<ce:para id="p0055">The curvature of the canals was examined with Schneider's method.
<ce:cross-ref refid="bib24">
<ce:sup>24</ce:sup>
</ce:cross-ref>
All roots included in the experiment showed a canal curvature lower than 10 degrees in the coronal 10 mm. The canals of all groups were prepared chemomechanically. All teeth were instrumented to the working length of a size 35 file (Flex R File, Union Broach, New York, N.Y.). The middle and the coronal third were enlarged by using sizes 2, 3, and 4 Gates Glidden drills (Maillefer, Ballaigues, Switzerland). The apical patency was checked by passing a size 10 file (Flex R File, Union Broach) through the apex. Irrigation with 3 mL 2.5% sodium hypoclorite solution was performed after every change in the file size throughout the cleaning and shaping process by using a Luer-Lok syringe (Ultradent Products Inc, South Jordan, Utah) and a 27-gauge endodontic needle (Ultradent). The canals then were flushed with 10 mL deionized water and dried with paper points. Standardized gutta-percha points (PD, Vevey, Switzerland) that fit with “tug-back” at the working lengths were selected as master points.</ce:para>
<ce:para id="p0060">After the root canal preparation, the buccolingual and mesiodistal diameters of the teeth were measured at the CEJ. Teeth were ranked according to size and distributed into groups by using a stratified sampling method. In this way, the experimental groups contained teeth of approximately the same distribution of canal sizes. In groups 1, 3, and 5, the root canal procedures were performed with lateral compaction of gutta-percha and AH 26 eugenol-free sealer (De Trey, Konstanz, Germany). The root canal filling procedures for groups 2, 4, and 6 were performed with a ZOE sealer (Pulp Canal Sealer, Kerr, Romulus, Mich.). The master gutta-percha point was coated with sealer and seated in the canal to the full working length. A finger spreader (Kerr) then was inserted into the canal to a level that was approximately 1 mm short of the working length. Lateral compaction with nonstandardized fine gutta-percha points (De Trey) was performed until the entire canal was obturated.</ce:para>
<ce:para id="p0065">Before the dye leakage test, the teeth in groups 2, 4, and 6 received a temporary filling with a ZOE material (IRM, De Trey). The teeth in the other groups received a composite temporary filling, (Z100, 3M, St. Paul, Minn.) without any adhesive procedure. The temporary fillings were removed with an excavator after a 1-week period of storage in saline solution. Gutta-percha fillings of teeth in all groups were removed to a depth of 9 mm with Peeso drills (Maillefer, Baillagues, Switzerland). The working length of the drills was established with silicone stoppers. In groups 1, 2, and 6, the root canal walls were enlarged with the low-speed burs provided by the manufacturer for the preparation of a size 1 carbon-quartz fiber post (RTD). The depth of the post space preparation was 9 mm. This depth was obtained by using, as a referral point, a line painted on the shank of the burs provided by the manufacturers at a distance of 9 mm from the tip of the burs. The roots of groups 3, 4, and 5 were prepared for the cementation of a size 14 carbon fiber post (Tech 2000) with the low-speed burs provided by the manufacturer. The depth of the post space preparation was 9 mm and verified with a periodontal probe. The diameters of the posts of groups 3, 4, and 5 were 1.4 mm; the posts of groups 1, 2, and 6 were 1.4 mm in diameter in the coronal aspect and 1 mm in the apical 2.5 mm.</ce:para>
<ce:para id="p0070">The root canal walls for groups 1 and 2 were etched with 10% phosphoric acid (All Etch, Bisco, Schaumburg, Ill.) for 30 seconds, washed with water spray, and gently air-dried. All Bond 2 Primer A and B (Bisco) were mixed and applied in the canals. All Bond 2 Pre-Bond Resin (Bisco) was applied in the canal. A layer of All Bond 2 Primer B was applied on the carbon-quartz fiber posts, and then equal volumes of base and catalyst of C&B luting composite (Bisco) were mixed for 10 seconds according to the manufacturer's instructions. The cement was applied on the post surface, and the post was inserted into the canal. The cement was allowed to set, and the core reconstruction was made with Bis Core (Bisco) composite and an Automatrix (De Trey). The composite was injected with a Centrix syringe (Hawe Neos, Gentilino, Switzerland). The height of the core was 4 mm, and the width was the same as the diameter of the tooth at the CEJ. The cylindrical shape of the core was determined by the shape of the matrix.</ce:para>
<ce:para id="p0075">After setting, excess composite was removed with a high-speed diamond stone (Hi-Di Diamond Precisions Tool LTD, London, United Kingdom) under water coolant. The root canal walls in groups 3 and 4 teeth were conditioned with Panavia 21 ED Primer (Kuraray Co Ltd, Osaka, Japan) for 60 seconds. Panavia 21 composite cement (Kuraray) was applied on the post surface, and the post was placed in the root canal. A small amount of Clearfil Photocore composite (Kuraray) was photopolymerized around the canal access to allow the anaerobic setting reaction of the Panavia 21 composite cement. The core was made as described for the previous groups, but with Clearfil Photocore composite instead of Bis Core. The teeth in group 5 were treated as those in group 3, except that the dual-cured Panavia Fuoro cement was photocured for 40 seconds. No dentin conditioning procedure was performed for the roots of group 6. The carbon fiber posts were cemented with zinc phosphate cement (SS White, Rio de Janeiro, Brazil), and 2.60 g powder and 1 mL liquid were mixed for each post. The powder was divided into 6 portions. The first portion was brought into the liquid and mixed with a linear motion for 10 seconds. This action was repeated for the second and third portions. The fourth and fifth portions were mixed for 15 seconds each. The sixth portion was added in small increments for consistency adjustments for 15 seconds. After allowing the zinc phosphate cement to set for 15 minutes, the core was developed with Bis-Core composite without an adhesive technique. The experimental model used for the cyclic loading was similar to that described by Isidor et al,
<ce:cross-ref refid="bib16">
<ce:sup>16</ce:sup>
</ce:cross-ref>
the only differences being the loading machine
<ce:cross-ref refid="bib25">
<ce:sup>25</ce:sup>
</ce:cross-ref>
and the humid environment used for the test.</ce:para>
<ce:para id="p0080">In the experimental protocol, a fatigue test was included with the aim of stressing the interfaces of the post-core restorations prior to the dye leakage test. The load applied was 125 N. Chewing forces are commonly less than 100 N,
<ce:cross-ref refid="bib26">
<ce:sup>26</ce:sup>
</ce:cross-ref>
although peak values occasionally reach 150 N. In cyclic loading tests, most of the failures of post-core restorations for post or core fractures are reported to occur after 10
<ce:cross-ref refid="bib4">
<ce:sup>4</ce:sup>
</ce:cross-ref>
loading cycles
<ce:cross-ref refid="bib27">
<ce:sup>27</ce:sup>
</ce:cross-ref>
; therefore, the loading procedure was interrupted after 300,000 cycles.</ce:para>
<ce:para id="p0085">The roots of all groups were mounted in acrylic resin blocks with 6 mm of the root extending beyond the blocks. A small ball of composite (Z100, 3M) was applied on the root tip, and a thin layer of silicone was applied along the root surface to simulate a periodontal ligament. The specimens were loaded by using a frequency of 2 cycles per second, with a peak load of 125 N. The load was applied with a custom-made machine
<ce:cross-ref refid="bib25">
<ce:sup>25</ce:sup>
</ce:cross-ref>
on the buccal aspect of the premolars, 45 degrees to the long axis of the tooth. The machine was stopped after 300,000 impacts. During the cyclic loading procedure, the teeth were maintained at a relative humidity of 90% ± 2% measured with a digital relative humidity meter (HM 34, Vaisala Sensor Systems, Helsinki, Finland) and at a temperature of 22°C. After loading, the teeth were removed from the resin blocks without damaging the root surfaces.</ce:para>
<ce:para id="p0090">The cementum layer was removed with a No. 5-6 Gracey curette (LM Dental, Turku, Finland) from the coronal 5 mm of the roots. The root-planing procedure was performed as suggested by Waerhaug
<ce:cross-ref refid="bib28">
<ce:sup>28</ce:sup>
</ce:cross-ref>
for complete removal of the cementum for 30 seconds on each surface (mesial, distal, lingual, and buccal) of the root. The teeth then were covered with a double layer of nail varnish (Ellen Betrix 193, Betrix, Frankfurt, Germany) apical to the 5 mm around the core interface and immersed for 48 hours in a solution of Rhodamine B (concentration 2.09 × 10
<ce:sup>−5</ce:sup>
mmol/L
<ce:sup>−1</ce:sup>
in deionized water). One tooth from each group was treated similar to the experimental groups. These teeth served as negative controls to ensure that the nail polish was able to block the penetration of the dye. Another tooth from each group was treated similar to the experimental groups but immersed in the dye without any nail varnish coating. These teeth served as positive controls. After removal from the dye, the teeth were sectioned parallel to their long axes, and the halves were microscopically observed.</ce:para>
<ce:para id="p0095">Confocal microscopy can be used to observe thin optical sections below the surface of the specimens.
<ce:cross-ref refid="bib29">
<ce:sup>29</ce:sup>
</ce:cross-ref>
Moreover, fluorophores can also act as markers for fluid penetration at the interface between the tooth and the restoration.
<ce:cross-refs refid="bib29 bib30 bib31">
<ce:sup>29-31</ce:sup>
</ce:cross-refs>
A confocal microscope of the tandem scanning type (TSM Noran Instruments, Middleton, Wis.) was used and focused below the surfaces damaged by sectioning. Samples were examined by using ×20/0.8 numerical apeture (NA) oil immersion objectives in conjunction with a ×10 eyepiece, with a final magnification of ×200.</ce:para>
<ce:para id="p0100">Dye penetration was measured in tenths of microns from the point of penetration on the external surface of the root to the beginning of the root canal. Both penetration into the resin-dentin interface and penetration into the dentinal tubules were considered. Penetration of the fluorescent dye was recorded with the appropriate fluorescence excitation and barrier filters. For all observed interfaces, the length of the interfaces and the length of the dye penetration were registered, and their ratio was established. The results obtained in the experimental groups were statistically compared with a Kruskal-Wallis and χ
<ce:sup>2</ce:sup>
test. The statistical analysis was processed with SPSS/PC software (SPSS Inc, Chicago, Ill.).</ce:para>
</ce:section>
<ce:section id="s0015">
<ce:section-title id="st0020">Results</ce:section-title>
<ce:para id="p0105">Positive controls revealed extensive dye penetration, whereas no penetration was noted for negative controls. The results obtained in the experimental and control groups are presented in Table III.
<ce:display>
<ce:table id="t0020" colsep="0" rowsep="0" frame="topbot">
<ce:label>Table III</ce:label>
<ce:caption>
<ce:simple-para id="sp0060">Results for experimental and control groups</ce:simple-para>
</ce:caption>
<tgroup cols="4">
<colspec colname="col1" colsep="0"></colspec>
<colspec colname="col2" colsep="0"></colspec>
<colspec colname="col3" colsep="0"></colspec>
<colspec colname="col4" colsep="0"></colspec>
<thead>
<row valign="bottom">
<entry>
<ce:bold>Group</ce:bold>
</entry>
<entry align="center">
<ce:bold>Mean lengths of interface (μ)</ce:bold>
</entry>
<entry align="center">
<ce:bold>Mean lengths of dye infiltrations (μ)</ce:bold>
</entry>
<entry align="center">
<ce:bold>Mean ratios of dye infiltration/interfaces</ce:bold>
</entry>
</row>
</thead>
<tbody>
<row>
<entry>1</entry>
<entry align="center">2580</entry>
<entry align="center">1820</entry>
<entry align="center">0.70 (SD = 0.22)</entry>
</row>
<row>
<entry>2</entry>
<entry align="center">2580</entry>
<entry align="center">1960</entry>
<entry align="center">0.76 (SD = 0.14)</entry>
</row>
<row>
<entry>3</entry>
<entry align="center">2790</entry>
<entry align="center">2140</entry>
<entry align="center">0.86 (SD = 0.70)</entry>
</row>
<row>
<entry>4</entry>
<entry align="center">3070</entry>
<entry align="center">2670</entry>
<entry align="center">0.87 (SD = 0.15)</entry>
</row>
<row>
<entry>5</entry>
<entry align="center">3330</entry>
<entry align="center">2900</entry>
<entry align="center">0.79 (SD = 0.41)</entry>
</row>
<row>
<entry>6</entry>
<entry align="center">3200</entry>
<entry align="center">3150</entry>
<entry align="center">0.98 (SD = 0.21)</entry>
</row>
<row>
<entry>Positive controls</entry>
<entry align="center">3200</entry>
<entry align="center">3200</entry>
<entry align="center">
<ce:hsp sp="1.0"></ce:hsp>
 1.0 (SD = 0)</entry>
</row>
<row>
<entry>Negative controls</entry>
<entry align="center">3150</entry>
<entry align="center">0</entry>
<entry align="center">
<ce:hsp sp="1.0"></ce:hsp>
0.00 (SD = 0)</entry>
</row>
</tbody>
</tgroup>
</ce:table>
</ce:display>
</ce:para>
<ce:para id="p0110">All groups, except the negative controls, showed some degree of infiltration. Groups 1 and 2 (All Bond 2 groups) leaked significantly less (
<ce:italic>P</ce:italic>
≤.02243) (Fig. 1) than groups 3, 4, and 5 (Panavia Groups) (Fig. 2).
<ce:display>
<ce:figure id="f0010">
<ce:label>Fig. 1</ce:label>
<ce:caption>
<ce:simple-para id="sp0065">All Bond 2 specimen. Fluorescence image shows penetration of rhodamine dye (
<ce:italic>arrows</ce:italic>
) into resin composite (
<ce:italic>C</ce:italic>
)-dentin (
<ce:italic>D</ce:italic>
) interface.
<ce:italic>P</ce:italic>
= Post. Obsevation specifications: 546/600 nm, ×20 lens, 0.8 numerical apeture, oil immersion. Field width 250 μm, bar length 50 μm.</ce:simple-para>
</ce:caption>
<ce:link locator="gr1"></ce:link>
</ce:figure>
</ce:display>
<ce:display>
<ce:figure id="f0015">
<ce:label>Fig. 2</ce:label>
<ce:caption>
<ce:simple-para id="sp0070">Panavia specimen. Reflection image shows penetration of rhodamine dye (
<ce:italic>arrows</ce:italic>
) into cement (
<ce:italic>C</ce:italic>
)-dentin (
<ce:italic>D</ce:italic>
) interface and into dentinal tubules.
<ce:italic>P</ce:italic>
= Post. Observation specifications: no pass filter used, ×20 lens, 0.8 numerical aperture, oil immersion. Field width 250 μm, bar length 50 μm.</ce:simple-para>
</ce:caption>
<ce:link locator="gr2"></ce:link>
</ce:figure>
</ce:display>
All resin cement groups leaked significantly less (
<ce:italic>P</ce:italic>
≤.03215) than the group cemented with zinc phosphate cement (Fig. 3).
<ce:display>
<ce:figure id="f0020">
<ce:label>Fig. 3</ce:label>
<ce:caption>
<ce:simple-para id="sp0075">Zinc phosphate specimen. Reflection image shows extensive penetration of rhodamine dye (
<ce:italic>arrows</ce:italic>
) into cement (
<ce:italic>C</ce:italic>
)-dentin (
<ce:italic>D</ce:italic>
) interface, into dentinal tubules, and into cement layer.
<ce:italic>P</ce:italic>
= Post. Observation specifications: no excitation pass filter used, ×20 lens, 0.8 numerical aperture, oil immersion. Field width 250 μm, bar length 50 μm.</ce:simple-para>
</ce:caption>
<ce:link locator="gr3"></ce:link>
</ce:figure>
</ce:display>
</ce:para>
<ce:para id="p0115">No statistically significant difference (
<ce:italic>P</ce:italic>
=.8176 and
<ce:italic>P</ce:italic>
=.9342) was found among groups treated with or without ZOE-based materials. The teeth in group 5 (Panavia Fluoro cement) leaked significantly less (
<ce:italic>P</ce:italic>
≤.04341) than those in groups 3 and 4 (Panavia 21 groups).</ce:para>
</ce:section>
<ce:section id="s0020">
<ce:section-title id="st0025">Discussion</ce:section-title>
<ce:para id="p0120">To obtain the best possible standardization of the dye leakage test, teeth were ranked according to size and distributed into groups by using a stratified sampling method. All the post-space preparations were of the same length (9 mm), shape (cylindrical), and diameter in the coronal portions (1.4 mm). The difference between the diameters of the apical portion of Tech 2000 fiber posts and Aestheti-Post dowels was not relevant to the dye leakage test because dye penetration was measured from the point of penetration on the external surface of the root to the beginning of the root canal. The interface at which the penetration of the dye occurred and was measured was the composite core-root interface (Fig. 4).
<ce:display>
<ce:figure id="f0025">
<ce:label>Fig. 4</ce:label>
<ce:caption>
<ce:simple-para id="sp0080">Specimen before insertion into dye solution.</ce:simple-para>
</ce:caption>
<ce:link locator="gr4"></ce:link>
</ce:figure>
</ce:display>
For this reason, the possible differences between the apical size and shape of the posts and the shape and size of the canals were not relevant to the dye leakage measurement. The ratio between the observed interface and the infiltrated interface was evaluated to avoid misleading results because of possible differences between the length of the interfaces observed in the experimental groups.</ce:para>
<ce:para id="p0125">No difference was found between the microinfiltration values of specimens treated with or without ZOE. The results of this study confirmed those of Woody and Davis,
<ce:cross-ref refid="bib12">
<ce:sup>12</ce:sup>
</ce:cross-ref>
who reported no difference in leakage of resin-luted inlays when the cavity preparations were treated with either eugenol-containing or eugenol-free temporary cements. It might be speculated that the preparation of the root canal walls and acid-etching procedures were able to remove enough of the temporary cement and endodontic sealer remnants to avoid any possible effects produced on the dye leakage rate by the ZOE-based materials.</ce:para>
<ce:para id="p0130">The mechanical behaviors of C&B and Panavia cements were similar in 1 study on the physical properties of fixed prosthodontic resin composite luting agents.
<ce:cross-ref refid="bib32">
<ce:sup>32</ce:sup>
</ce:cross-ref>
Nevertheless, in this study, specimens treated with Panavia 21 cement showed a dye leakage penetration significantly higher than that observed in specimens treated with All Bond 2 dental adhesive and C&B cement. In a recent confocal microscopic study of fiber-post restorations, the ratio between the length of the resin-dentin interfaces observed and the length of the resin-dentin interdiffusion zone (RDIZ) was calculated.
<ce:cross-ref refid="bib33">
<ce:sup>33</ce:sup>
</ce:cross-ref>
It was reported that areas of resin-dentin interdiffusion were more frequently present in All Bond 2 than in Panavia 21 specimens and that the resin tags of the roots treated with All Bond 2 were much longer than those observed in Panavia 21 specimens. The difference in the presence of RDIZ between the 2 adhesives might be explained by the different dentin conditioning procedures that were used. In All Bond 2 groups, the dentin was etched with phosphoric acid, whereas in Panavia 21 groups, a self-etching primer was used.</ce:para>
<ce:para id="p0135">The thickness of the hybrid layer obtained with All Bond 2 adhesive in the cervical areas of human teeth was 1.1 to 2.7 μm in sclerotic dentin and 1.4 to 4.1 μm in sound dentin, whereas the thickness obtained with Phenyl-P self-etching primers was not measurable in sclerotic dentin but was 1.3 μm in sound dentin.
<ce:cross-ref refid="bib34">
<ce:sup>34</ce:sup>
</ce:cross-ref>
From the results of the previously mentioned studies, it can be deduced that the autoetching primer-conditioning technique produced a more subtle and less profound RDIZ than the multiple-stage adhesive system. It was probably for this reason that, in this investigation, the multiple-stage adhesive system, which was able to produce a uniform and thick RDIZ, ensured better sealing than that obtained with the self-etching primer.</ce:para>
<ce:para id="p0140">The new Panavia Fluoro cement leaked less than Panavia 21. The photocuring procedure of the adhesive cement might have improved the coronal seal by a more effective curing reaction of the outer, possibly oxygen-exposed, portion of the adhesive cement. This cement layer, due to its contact with air, might have failed to polymerize completely in the Panavia 21 groups. Quartz fibers were present on the surface of the posts used in combination with All Bond 2 dental adhesive and C&B cement, whereas carbon fiber posts were used in combination with Panavia 21 and Panavia Fluoro cements. These carbon fiber posts were used because the resin matrix of Tech 2000 carbon fiber posts (Isasan) contains a resin obtained by the polymerization of diphenilpropane and metiloxirane. This resin monomer should be compatible with 10-methacriloxy decyldihydrogenphosphate (MDP) that is contained in Panavia 21 dental adhesive, thus producing a chemical link between the adhesive and the post itself. The different materials present on the posts' surfaces did not affect the results of the study because the dentin seal was the only area of interfacial failure in the experimental groups. The interface between the post and the lute did not show any leakage in the experimental groups. Only in the zinc phosphate cement group was dye found at the post-cement interface and in the cement layer of the post.</ce:para>
<ce:para id="p0145">The clinical relevance of dye leakage studies has been questioned.
<ce:cross-ref refid="bib21">
<ce:sup>21</ce:sup>
</ce:cross-ref>
No correlation has ever been established between the results of microleakage studies of restorative materials and the prevalence of secondary caries when the same materials were tested under clinical conditions. In this study, all experimental groups showed extensive leakage and, although significant differences were found among them, the clinical relevance of these differences remains questionable. On the other hand, microleakage tests can evaluate the ability of restorative materials to prevent fluid penetration at the interfaces between dentin and restorative materials.</ce:para>
<ce:para id="p0150">The contact with oral fluids that can occur in the oral environment may produce flexion
<ce:cross-ref refid="bib35">
<ce:sup>35</ce:sup>
</ce:cross-ref>
of fiber-reinforced posts, with the consequent risk of secondary caries and decementation of the composite restorations of endodontically treated teeth. This is so because some fiber-reinforced composites that also are used for fiber-post construction, especially glass and silica fibers, may be hydrolytically unstable.
<ce:cross-ref refid="bib36">
<ce:sup>36</ce:sup>
</ce:cross-ref>
</ce:para>
<ce:para id="p0155">Both adhesives tested were able to avoid contact of the dye solution with the fiber posts, thereby limiting the risk of a reduction of the mechanical properties of the posts themselves.</ce:para>
</ce:section>
<ce:section id="s0025">
<ce:section-title id="st0030">Conclusions</ce:section-title>
<ce:para id="p0160">On the basis of the results of this study, the following conclusions were drawn:
<ce:list id="l0010">
<ce:list-item id="o0010">
<ce:para id="p0165">The coronal seal obtained with the 3-step dental adhesive (All Bond 2) produced significantly less leakage than that obtained with the self-etching primers (Panavia 21 and Panavia Fluoro cement) (
<ce:italic>P</ce:italic>
<.05).</ce:para>
</ce:list-item>
<ce:list-item id="o0015">
<ce:para id="p0170">Light-cured Panavia Fluoro cement showed less leakage than its predecessor (Panavia 21) (
<ce:italic>P</ce:italic>
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</ce:list-item>
<ce:list-item id="o0020">
<ce:para id="p0175">There was no significant difference in leakage scores among groups treated with and without zinc oxide-eugenol-based materials (
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</ce:list-item>
</ce:list>
</ce:para>
</ce:section>
<ce:section id="s0035" view="extended">
<ce:section-title id="st0035">Supplementary Files</ce:section-title>
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<ce:float-anchor refid="mmc3"></ce:float-anchor>
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<abstract lang="en">Abstract: Statement of Problem. The effectiveness of the seal obtained with carbon fiber posts and composite cores is still unclear. Both 3-step dental adhesives and self-etching adhesive primers have been suggested as adhesive systems. Purpose. This confocal microscopic study evaluated the microleakage of teeth endodontically treated and restored with fiber posts and composites with 3 adhesive systems. Material and Methods. A total of 72 human mandibular premolars were endodontically treated and divided into 6 groups of 12 teeth each. The first 3 groups were treated with an endodontic sealer containing zinc oxide-eugenol (ZOE) and restored with temporary filling materials containing ZOE. The last 3 groups were treated with ZOE-free materials. Post spaces were prepared in the root canals. The first group treated with ZOE-based materials was restored with fiber posts cemented with zinc phosphate cement and composite cores without adhesive. The other 2 groups of ZOE-treated teeth were restored with fiber posts cemented with All Bond 2 and Panavia 21 dental adhesives, respectively. The last 3 groups were restored with fiber posts cemented with All Bond 2, Panavia 21, and Panavia Fluoro cement, respectively. The teeth were loaded intermittently at 2 cycles per second in a moist environment and, after 300,000 cycles, immersed in a solution of Rhodamine B dye for 48 hours. A confocal microscope was used to observe the teeth. The ratio between the length of the interfaces observed and the length of the dye penetration was evaluated. Two teeth from each group acted as controls and were not subjected to dynamic loads. Results. All resin cement groups leaked significantly less than the group cemented with zinc phosphate cement. No statistically significant difference was found between the microleakage of teeth treated with ZOE-based and non-ZOE-based materials. Teeth restored with All Bond 2 dental adhesive leaked significantly less than those restored with Panavia cement. Conclusion. The 3-step dental adhesive (All Bond 2) resulted in a better marginal seal than that obtained with the self-etching primers (Panavia 21 and Panavia F). The use of endodontic sealers and temporary filling materials containing ZOE had no detrimental effect on the marginal seal of carbon fiber post/composite resin core restorations. (J Prosthet Dent 2001;85:284-91.)</abstract>
<note>aClinical Professor, Department of Restorative Dentistry, University of Siena.</note>
<note>bProfessor, Department of Dental Materials, University of Siena; and Research Professor, Department of Restorative Dentistry, School of Dental Medicine, Tufts University, Boston, Mass.</note>
<note>cProfessor, Department of Conservative Dentistry, Guy's, King's, and St. Thomas' Dental Institute.</note>
<note>Reprint requests to: Dr Francesco Mannocci, Via Gemignani 3, 56015 Riglione (Pisa), ITALY, Fax: (390)50-316-3235, E-mail: mannocci@sirius.pisa.it</note>
<note>J Prosthet Dent 2001;85:284-91</note>
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   |texte=   Microleakage of endodontically treated teeth restored with fiber posts and composite cores after cyclic loading: A confocal microscopic study
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