Effect of Root Canal Irrigants on Fiber Post Bonding

Using Self-adhesive Composite Cements

Renata Terumi Jitumoria / Bruna Fortes Bittencourtb / Alessandra Reisc / João Carlos Gomesb /
Giovana Mongruel Gomesd

Purpose: To evaluate the effect of different irrigation solutions on the bonding of self-adhesive composite cements
to the root canal during fiber-post cementation.
Materials and Methods: One hundred twenty single-rooted human teeth were endodontically treated. The post
spaces were prepared and specimens were randomly divided into ten groups, according to the combination of the
factors: post space irrigation (distilled water, 2.5% NaOCl, 17% EDTA, 26% polyacrylic acid, and 17% EDTA + 2.5%
NaOCl) and self-adhesive composite cement (RelyX U200 [3M Oral Care] and Multilink Speed [Ivoclar Vivadent]).
The proportion of open dentinal tubules was evaluated by SEM. After fiber post cementation, six slices were ob-
tained from each root (coronal, middle, and apical thirds) for evaluation of push-out bond strength (BS), nanoleak-
age (NL), and Vickers microhardness (VHN) of the composite cement. Data from open dentinal tubules were
submitted to Kruskal-Wallis and Student-Newman-Keuls tests (α = 0.05). Data from BS, NL, and VHN were evalu-
ated by two-way ANOVA and Tukey’s test (α = 0.05).
Results: Irrigation with EDTA, polyacrylic acid, and EDTA + NaOCl increased the proportion of open dentinal tu-
bules. For RelyX U200, NaOCl, distilled water and EDTA resulted in the highest BS and VHN values, while for Multi-
link Speed, these values were higher only for distilled water. Both composite cements presented lower BS and VHN
with polyacrylic acid. NL did not differ between experimental groups (p > 0.05).
Conclusion: For both composite cements tested, distilled water showed better results in push-out and microhardness
tests.
Keywords: adhesive cementation, bond strength, endodontic fiber posts, indentation, nanoleakage, self-adhesive luting.

J Adhes Dent 2019; 21: 537–544. Submitted for publication: 20.10.18; accepted for publication: 15.08.19
doi: 10.3290/j.jad.a43609

polymerization technique, operator skill, and others.20,24,

R etention loss is the main cause of failure in glass-fiber
post cementation.11,19,35 Several factors affect the
bonding quality, including the method of adhesive applica-
35,49,50 In addition, bonding to intra-radicular dentin is a
highly complex and technique-sensitive procedure,45 as it
tion, root anatomy, unfavorable cavity configuration, photo- involves several steps. Therefore, the simplification offered
by self-adhesive composite cements could improve the re-
tention of glass-fiber posts in root canals.45
Self-adhesive composite cements are applied in a single
step and, according to the manufacturers, they do not re-
a PhD Student, Postgraduate Program in Restorative Dentistry, Department of quire root dentin pretreatment.17,18 Their bonding mechan-
Restorative Dentistry, State University of Ponta Grossa, Paraná, Brazil. Per- ism is based on the ability of acidic monomers to deminer-
formed the experiments in partial fulfillment of requirements for a degree,
wrote the manuscript. alize and simultaneously infiltrate the dentin substrate,
b Professor, Department of Restorative Dentistry, School of Dentistry, State Uni- promoting micromechanical retention. Additionally, a chem-
versity of Ponta Grossa, Paraná, Brazil. Proofread the manuscript. ical reaction is expected to occur between the functional
c Professor, Department of Restorative Dentistry, School of Dentistry, State Uni- monomers and calcium in hydroxyapatite.18,22,37,39
versity of Ponta Grossa, Paraná, Brazil. Consulted on and performed statis- The use of rotating instruments to prepare the post space
tical evaluation, contributed substantially to discussion.
before cementation of glass-fiber posts produces a smear
d Professor, Department of Restorative Dentistry, School of Dentistry, State Uni-
versity of Ponta Grossa, Paraná, Brazil. Idea, hypothesis, experimental design, layer, which may jeopardize demineralization of root dentin
proofread the manuscript. by the acidic monomers within the self-adhesive composite
cements.17,26 Under these circumstances, bonding may be
Correspondence: Giovana Mongruel Gomes, Avenida Carlos Cavalcanti 4748,
Universidade Estadual de Ponta Grossa. Uvaranas, Ponta Grossa, Paraná, Brazil influenced by the solution used for post-space cleaning, as
84030-900. Tel: +55-42-3220-3740; e-mail: giomongruel@gmail.com it results in different dentin surface patterns.17,44 According

Vol 21, No 6, 2019 537

Jitumori et al

a b c
Fig 1 SEM micrographs (500X) showing: (a) open-tubule score 0: all dentinal tubules opened; (b) score 1: some tubules opened;
(c) score 2: all tubules occluded.

to the literature, different substances can be used to clean IL, USA) under water cooling. All root canals were instru-
the post space. However, surfaces changes will occur de- mented by the same operator. Canal patency was estab-
pending on the application of an oxidizing agent, such as lished with a 15-K size file (Dentsply Maillefer; Ballaigues,
sodium hypochlorite (NaOCl)1,7,17,28 or a chelating agent, Switzerland) at a 1-mm working length from the apex. End-
e.g. ethylenediaminetetraacetic acid (EDTA),3,7,17,28,48 or odontic instrumentation was performed with ProTaper rotary
even a combination of these solutions,9,32 to promote instruments (Dentsply Maillefer) from size S1 to F3. Irrigation
greater surface cleaning. Some authors also justify the use was performed with 1% NaOCl (Asfer Chemical Industry; São
of polyacrylic acid,3,17 based on its role in the adhesion Caetano do Sul, SP, Brazil) after each instrument change and
mechanism of glass-ionomer cement. with 17% EDTA solution (Biodinâmica; Ibiporã, PR, Brazil) for
However, to the extent of the authors’ knowledge, there 3 min, followed by saline solution. Roots were dried with
is no consensus on the impact of different irrigants on the paper points (Dentsply Maillefer), upon which the apical
bonding efficacy of glass-fiber posts cemented with self- 4 mm were filled with gutta-percha (Tanari; Manacapuru, AM,
adhesive composite cements. Unfortunately, there is a lack Brazil) and calcium-hydroxide canal sealer (Sealer 26,
of standardization and/or specific manufacturer guidelines Dentsply Maillefer) using the vertical condensation tech-
for self-adhesive cements about the most suitable irrigant nique.46 Access cavities were filled with conventional glass-
to be used before cementation procedures. ionomer cement (Vitro Fil, DFL; Rio de Janeiro, RJ, Brazil).
In this context, the aim of this study was to evaluate the
effect of different irrigants (distilled water, NaOCl, EDTA, poly- Post Space Preparation and Experimental Groups
acrylic acid, and EDTA + NaOCl) used in the post space. The After one week of storage in 100% relative humidity at
null hypotheses of this study were that the different irrigants 37 ± 1°C, the root canals were prepared with the corre-
would not affect 1) the push-out bond strengths; 2) the pro- sponding post drill of the fiber post Whitepost DC #2 (FGM;
portion of open dentinal tubules; 3) nanoleakage at the adhe- Joinville, SC, Brazil) to a depth of 10 mm. After post space
sive interface; and 4) microhardness of composite cements. preparation, the specimens were randomly divided into five
experimental groups (n = 24) by restricted randomization
with two random block sizes (www.sealedenvelope.com) ac-
MATERIALS AND METHODS cording to the post space irrigation procedure: 5 ml of dis-
tilled water; 5 ml of 2.5% NaOCl (Asfer Chemical Industry);
Tooth Selection 5 ml of 17% EDTA (Biodinâmica); 2 drops (ca 0.25 ml) of
This study was submitted to and approved by the local Re- 26% polyacrylic acid (Riva Conditioner, SDI; Bayswater, Vic-
search Ethics Committee. One hundred twenty extracted toria, Australia) and 5 ml of 17% EDTA + 5 ml of 2.5%
single-rooted human teeth with a root length of >15 mm NaOCl.
were selected. Eligible teeth had to present a single root All irrigants were delivered into the root canal through a
canal, no caries lesions or root cracks, and no previous 5-ml disposable syringe and a 0.70- x 25-mm needle (BD
endodontic treatment. Precision Glide; Curitiba, PR, Brazil) for 30 s. A final con-
tinuous irrigation with 15 ml of distilled water was per-
Root Canal Preparation formed in all groups, and the post spaces were air dried for
The crowns were sectioned at the cementoenamel junction 5 s at a distance of 2 cm, followed by drying with two #40
using a low-speed diamond saw (Isomet, Buehler; Lake Buff, paper points (Dentsply Maillefer).25

538 The Journal of Adhesive Dentistry

 Jitumori et al

SEM Analysis of Open Dentinal Tubules Table 1 Median scores and interquartile ranges for
Two roots from each irrigant group were randomly used for proportion of open dentinal tubules
this purpose. After post space irrigation, each tooth was
split longitudinally in the mesiodistal direction. The root Irrigant Score
halves were affixed to metallic stubs and dried in colloidal Distilled water 2 (2-2)B
silica for 48 h. Then the samples were gold-sputter coated
(Balzers SCD 050 Sputter Coater, Bal-Tec; Balzers, Liech- 2.5% NaOCL 2 (2-2)B
tenstein) for SEM analysis (SSX 550, Shimadzu; Tokyo, 17% EDTA 1 (1-1)A
Japan) in secondary electron mode. Images at 100X, 500X,
26% polyacrylic acid 1 (1-1)A
and 2000X original magnification were obtained at the coro-
nal, middle, and apical third of each hemi-section. 17% EDTA + 2.5% NaOCl 1 (0-1)A
Using the 500X images, two previously calibrated and
* Different superscript letters indicate statistically significant differences
blinded operators classified the proportion of open dentinal (Student-Newman-Keuls test, p < 0.05). 0: all tubules open; 1: some
tubules, according to the following scores: 0: all tubules tubules open; 2: all tubules occluded.
open, without smear plugs; 1: some tubules were open,
while others were obliterated by smear plugs; 2: all tubules
were obliterated by smear layer (Fig 1).15,26,43 In case of
disagreement between the evaluators, the sample was re-an-
alyzed by both evaluators until a consensus was reached. nanoleakage evaluation of the hybrid layer and determining
the Vickers microhardness of the composite cement.
Post Luting Procedures
After post space irrigation, the remaining roots of each Push-out Bond Strength Test
group were cemented with one of the two self-adhesive Before testing, all slices were photographed on both sides
composite cements used: RelyX U200 (3M Oral Care; St under an optical microscope (magnification 40X, Olympus
Paul, MN, USA) and Multilink Speed (Ivoclar Vivadent; BX 51 model; Tokyo, Japan), in order to calculate the coro-
Schaan, Liechtenstein, Germany). A total of eleven teeth nal and apical post radius using Image J software (National
were used for each cementation system. Institutes of Health; Bethesda, MD, USA). To determine the
The glass-fiber posts (Whitepost DC #2, FGM) were hori- adhesive area, the tapered design of the glass-fiber post
zontally sectioned in the cervical region using a high-speed was considered and the formula of a lateral surface of a
diamond bur under copious water cooling to reduce the post truncated cone was used.25
length to 13 mm. While 10 mm corresponded to the previ- The push-out test was performed in a universal testing
ously prepared post space, the other 3 mm were used as a machine (AG-I, Shimadzu Autograph; Tokyo, Japan) at a
guide to standardize the distance of the light-curing device crosshead speed of 0.5 mm/min. Each slice was pos-
from the coronal root area. All glass-fiber posts were itioned with the most coronal portion side down on a metal-
cleaned with 70% alcohol for 5 s prior to cementation. lic device with a central opening. A cylindrical metallic tip,
The self-adhesive composite cements were handled ac- with the extremity compatible with the post diameter in
cording to the manufacturers’ instructions, introduced into each root canal third, applied a compressive force (50-kg
the root canal using the Centrix syringe (DFL), upon which load cell) on the post in an apical to coronal direction until
the glass-fiber posts were positioned with finger pressure. debonding. The load at post dislodgment was recorded in
The composite cement was photoactivated for 40 s using Newtons (N), and the bond strengths (MPa) were obtained
the LED light-curing unit with a light intensity of 1200 mW/ by dividing the load by the bonding area in mm2.
cm2 (Radii Cal, SDI; Bayswater, Victoria, Australia), main- The failure mode of the dentin slices was analyzed under
taining the light guide tip of the light-curing unit perpendicu- a stereomicroscope (Olympus BX 51 model, Olympus) at
lar to the post. 40X magnification and classified as 1. adhesive between
luting cement and dentin; 2. adhesive between luting ce-
Sample Preparation ment and post; 3. cohesive within luting cement; 4. cohesive
After the cementation procedures, all roots were stored in within the post; 5. cohesive within dentin; 6. mixed failure.
100% relative humidity at 37 ± 1°C for 24 h. The roots
were transversally sectioned into seven 1-mm-thick slices Nanoleakage Analysis by SEM
using a low-speed diamond saw (Isomet, Buehler) under As previously reported, a total of four teeth were randomly
water cooling. The first coronal slice was discarded due to selected for this test. A random slice of each root third
the presence of excess cement, resulting in two slices for (coronal, middle, and apical) was used for each experimen-
each root canal third (apical, middle, coronal). The coronal tal group. The specimens were immersed in a dark con-
side of each slice was identified, and its thickness mea- tainer containing 50 wt% ammoniacal silver nitrate solution
sured using a digital caliper with 0.01-mm accuracy (Mitu- for 24 h at 37°C, then photodeveloped (Carestream; São
toyo Digimatic Caliper; Tokyo, Japan). Paulo, SP, Brazil) for 8 h under indirect fluorescent light.
Seven roots per group were randomly selected for push- The specimens were washed with running tap water, fixed
out bond strength testing; four roots were selected for on metallic stubs, and polished wet using 600-, 1200-,

Vol 21, No 6, 2019 539

Jitumori et al

Table 2 Bond strength means and standard deviations (MPa) for the different experimental groups

Irrigant
Self-adhesive
cement Distilled water NaOCl EDTA Polyacrylic acid EDTA + NaOCl
RelyX U200 15.7 ± 2.9AB 17.7 ± 3.7A 15.4 ± 3.4AB 12.7 ± 3.4BC 13.5 ± 3.0BC

Multilink Speed 13.4 ± 4.6BC 10.7 ± 2.6CD 8.5 ± 2.5D 4.9 ± 1.6E 8.6 ± 2.2D

Different superscript letters indicate statistically significant differences (p < 0.05, Tukey’s test).

Table 3 Means and standard deviations of microhardness (VHN) for the different experimental groups

Irrigant
Self-adhesive
cement Distilled water NaOCl EDTA Polyacrylic acid EDTA + NaOCl
RelyX U200 81.6 ± 15.3A 85.8 ± 12.3A 84.5 ± 12.7A 63.8 ± 6.2BC 66.7 ± 5.1B

Multilink Speed 66.1 ± 8.8B 51.3 ± 8.2C 56.0 ± 5.2BC 54.3 ± 6BC 60.6 ± 4.8BC

Different superscript letters indicate statistically significant differences (p < 0.05, Tukey’s test).

Table 4 Means and standard deviations of nanoleakage (%) for the different experimental groups

Irrigant Main factor

Self-adhesive composite ce-
cement Distilled water NaOCl EDTA Polyacrylic acid EDTA + NaOCl ment
RelyX U200 71.0 ± 22.7 72.5 ± 25.2 72.7 ± 26.6 74.7 ± 25.8 68.0 ± 29.0 71.8 ± 25.1a

Multilink Speed 69.9 ± 22.6 64.0 ± 23.5 74.2 ± 21.1 86.2 ± 15.6 70.8 ± 22.2 73.0 ± 21.7a

Main factor 70.4 ± 22.1A 68.3 ± 24.2A 73.4 ± 23.5A 80.4 ± 21.6A 69.4 ± 25.3A
irrigant

Data with same superscript letters indicate no significant differences within each column; data with same uppercase letters indicate no significant differences
within each row (p < 0.05, Tukey’s test).

1500-, 2000-, 2500-, and 3000-grit silicon carbide papers For microhardness analysis, a 100-g load for 15 s was
(3M Oral Care) for 30 s each. Finally, the samples were applied with a Vickers microhardness tester (Shimadzu
kept in colloidal silica at 37°C for 48 h. Before SEM evalu- HMV2, Newage Testing Instruments; Southampton, PA,
ation (SSX 550, Shimadzu), the specimens were gold sput- USA). Four indentations were made on the self-adhesive
ter-coated (Balzers SCD 050 Sputter Coater). From each composite cement near the dentin, in a clockwise direction
slice, one image at 60X magnification was obtained and (at 3, 6, 9, and 12 o’clock). A minimum distance corre-
analyzed using Image J software (National Institutes of sponding to one indentation diameter was maintained from
Health). Nanoleakage infiltration was calculated as the ratio the dentin. The diagonals of each indentation were mea-
between the sum of the lengths of cement-dentin interface sured employing an optical microscope at 400X magnifica-
infiltrated with silver nitrate and the total perimeter of this tion and the VHN was calculated using the formula:
interface. VHN = 1.8544 F/d2, where 1.8544 is a constant, F is the
force in kgf (0.1 kgf) used in the test; d is the average of
Microhardness Analysis the diagonals of the indentation in mm.
The slice not used in the nanoleakage evaluation served to
evaluate the composite cement microhardness close to the Statistical Analysis
root dentin. These sections were embedded in acrylic resin Data on the proportion of open dentinal tubules were sub-
with the test surface (the most coronal area) facing up, pol- mitted to Kruskal-Wallis and Student Newman Keuls tests
ished wet using 600-, 1200-, 1500-, 2000-, 2500-grit sili- (_ = 0.05). The other images at 100X and 2000X were only
con carbide papers (3M Oral Care), and washed with tap qualitatively evaluated. The data obtained from push-out
water. The samples were stored for 24 h at 37°C. bond strength testing, nanoleakage and microhardness

540 The Journal of Adhesive Dentistry

 Jitumori et al

Distilled water

NaOCI
RelyX U200

EDTA

Polyacrylic acid

EDTA + NaOCI

Distilled water
Multilink Speed

NaOCI

EDTA

Polyacrylic acid

EDTA + NaOCI

0 10 20 30 40 50 60 70 80 90 100
Mixed Adhesive at cement/dentin Adhesive at cement/post Cement cohesive failure Post cohesive failure Dentin cohesive failure

Fig 2 Failure mode distribution.

tests were subjected to two-way ANOVA (post space irriga- Microhardness

tion procedure vs self-adhesive composite cement) and Two-way ANOVA demonstrated that the cross-product inter-
post-hoc Tukey’s test (_ = 0.05) using Dell Statistica 13.2 action (composite cement vs irrigant) was significant
software (Dell; Round Rock, TX, USA). Data from the frac- (Table 3; p < 0.001). The highest VHN values for RelyX
ture pattern were only qualitatively assessed. U200 were obtained for distilled water, NaOCl, and EDTA;
these groups showed statistically significantly greater hard-
ness than did the other irrigant groups. For Multilink Speed,
RESULTS the distilled water group obtained the highest VHN, which
was statistically significantly different from the NaOCl
Degree of Open Dentinal Tubules group. In general, the comparison between the self-adhe-
The statistical analyses showed that there was a significant sive composite cements indicates that the groups ce-
difference between the irrigants (Table 1; p < 0.001). EDTA, mented with RelyX U200 showed statistically significantly
polyacrylic acid, and EDTA + NaOCl effected better smear higher VHN, or values similar to those of Multilink Speed.
layer removal (lower median scores) and thus more numer-
ous open dentinal tubules than upon application of distilled Nanoleakage
water and NaOCl (p < 0.05). Two-way ANOVA showed that the cross-product interaction
(composite cement vs irrigant) was not significant (Table 4;
Push-out Bond Strength p = 0.701), which was also true of the main factors com-
Two-way ANOVA demonstrated that the cross-product inter- posite cement (p = 0.774) and irrigant (p = 0.398). Deposi-
action (composite cement vs irrigant) was significant tion of silver nitrate occurred to a large extent along the
(Table 2; p < 0.001). For RelyX U200, the highest bond perimeter of the cement-dentin interface for all experimen-
strength mean was observed for the NaOCl group, which tal groups (Fig 3).
was statistically similar to that of the distilled water and
EDTA groups. Polyacrylic acid and combined EDTA + NaOCl
presented intermediate values. For Multilink Speed, the DISCUSSION
highest bond strength was observed in the distilled water
group, which was statistically similar to the NaOCl group According to the results obtained, the different irrigants
and higher than that of the other irrigants. The use of poly- affected the proportion of open dentinal tubules, bond
acrylic acid reduced the bond strengths for both self-adhe- strength, and microhardness of the self-adhesive composite
sive composite cements. cements tested; thus, the first, second and fourth hypoth-
Mixed failure mode was predominant for both cements eses must be rejected. However, because there was no
(Fig 2), except for Multilink Speed irrigated with EDTA and statistically significant difference between the nanoleakage
polyacrylic acid, where adhesive failures between cement values obtained from the experimental groups, the third null
and dentin were more frequent. Cohesive failures occurred hypothesis must be accepted.
least frequently.

Vol 21, No 6, 2019 541

Jitumori et al

Fig 3 SEM image of specimens (60X,

bar = 500 μm. P = fiber post, CC =
composite cement, D = dentin) luted with
RelyX U200 (a) and Multilink Speed (b).
CC Silver nitrate depositions were visible at
CC
D D the cement-dentin interface (white arrows).
Moreover, there was greater silver nitrate
infiltration at the Multilink Speed than the
P P RelyX U200 interface.

a b

Previous studies have shown that the use of different loose debris and better rinsing of chemicals used previously
chemical irrigants may influence the adhesion of fiber posts during endodontic treatment may occur. Additionally, al-
to root canal walls using a conventional dual-cured resin- though water does not jeopardize the polymerization of the
based cement.23,29,52 There was no standardization in post self-adhesive cement, it does not improve hybridization and
space cleaning before cementation with self-adhesive com- sealing, as the dentin smear layer is likely to remain in
posite cements.16,43 place.17,32,54 Furthermore, it does not favor chemical bond-
Differences in bonding performance have often been re- ing as it does not expose calcium ions in the dentin surface.
ported in different root canal thirds,1,5 and are common Indeed, for both cements, no reduction of the microhard-
with conventional dual-cure composite cements, but not ness of the self-adhesive cement (an indirect indicator of
with self-adhesive cements.12 The present investigation did the material strength) was observed. This fact, along with
not include root third as another variable, because no sig- frictional bonding, which was not affected by water irriga-
nificant difference among root regions was observed (data tion, was enough to maintain high bond strengths for both
not shown), which is substantiated by several other studies cementation systems. Frictional bonding has been reported
that evaluated self-adhesive composite cements for bond- to be the most important factor for bonding glass-fiber post
ing glass-fiber posts.12,17,32,54,55 to root canals.25,36
SEM evaluation demonstrated that none of the irrigation When NaOCl instead of water was used for irrigation pur-
procedures was able to completely remove the smear layer poses, different changes occurred in root dentin, as NaOCl
along the entire root length. These findings were also ob- is a strong oxidizing agent. NaOCl reacts with a wide variety
served in other studies.47,53 According to the score classifi- of biological molecules such as proteins, amino acids, pep-
cation, the 17% EDTA, 26% polyacrylic acid, and 17% EDTA tides, and lipids,21 acting as a deproteinizing agent and
+ 2.5% NaOCl groups showed more open dentinal tubules in modifying the dentinal substrate surface.8,39 In this case,
the whole post space than did the distilled water and 2.5% chemical bonding and sealing may be improved as organic
NaOCl groups. However, contrary to expectations, better matter is removed, leaving a mineral-rich substrate at the
smear layer removal was not associated with increased surface and giving the composite cement better access for
bond strength of glass-fiber posts to root canals for either interaction with hydroxyapatite in dentin under the smear
composite cement. layer. Frictional bonding is also expected to improve by the
This implies that the bonding of glass-fiber posts to root increased dentin roughness that NaOCl produces.30
canals with self-adhesive composite cements may not be For the self-adhesive cement RelyX U200, the changes
influenced only by hybridization,10 but also by other factors, produced by NaOCl were favorable, and the push-out bond
such as chemical adhesion,22 frictional retention,25 and the strength of this cement to NaOCl-treated dentin did not dif-
cohesive strength of the composite cement. Theoretically, fer from that obtained on dentin irrigated with distilled
these four factors, working synergistically, may provide water. The removal of surface organic content probably al-
superior bonding to fiber posts inside the root canal. How- lowed better chemical bonding of this composite cement
ever, it is possible to improve or jeopardize each one of with the dentin substrate. This composite cement has the
these bonding-related factors depending on the treatment same bonding mechanism as its predecessor, RelyX U100.
of the root canal walls using burs,4,15 irrigation solu- Although they exhibit micromechanical retention, through
tions,1,3,7,9,17,48 and the selection of the composite ce- hybridization, their bonding mechanism may also rely mainly
ment.9,12,13,48 on chemical adhesion to hydroxyapatite,39 which was ex-
By using distilled water as an irrigant, no modification of posed by NaOCl. Therefore, the interaction with hydroxyapa-
the root dentin substrate is expected to occur. Removal of tite may have enhanced the bonding properties of the self-

542 The Journal of Adhesive Dentistry

 Jitumori et al

adhesive cement.21 According to Kambara et al,31 the dentin prior to application of glass-ionomer cements,40 as it
application of a deproteinizing agent such as NaOCl in- is considered a relatively mild acid able to partially remove
creases mineral content and reduces water on the dentin the smear layer, promoting slight demineralization.3,40 An
surface, which facilitates the chemical interaction of RelyX earlier study demonstrated that the use of 25% polyacrylic
U100 with hydroxyapatite. In contrast, self-adhesive ce- acid for 30 s improved the bond strength between RelyX
ments do not induce complete demineralization of the U200 and glass-fiber posts.3 In a lower concentration
smear layer or decalcification/infiltration of dentin.33 (11.5%) with the same application protocol, no differences
However, being a strong oxidizer, NaOCl may affect the in bond strength were observed with the use of RelyX Uni-
mechanical properties of the composite cement employed, cem.17 In the present study, using polyacrylic acid at a con-
either by impairing the polymerization reaction or by denatur- centration of 26% for 30 s, reductions of bond strength
ing some of the organic content of the composite cement were observed for RelyX U200. This discrepancy between
matrix. This did not occur with RelyX U200, as its micro- studies indicates the need for further investigations. How-
hardness was not affected by this irrigant; but significant ever, the lower bond strengths obtained with polyacrylic acid
reductions in microhardness were observed for the self-ad- in combination with the predominant adhesive failure type
hesive composite cement Multilink Speed, probably due to indicate that polyacrylic acid residue in the root canal may
a negative interaction between its components and the have solubilized the composite cement near the interface.
NaOCl remaining on the root dentin. The presence of oxygen The nanoleakage test was also performed to show silver
on the surface, released by NaOCl breakdown, may have nitrate penetration into dentin tubules not completely filled42
impaired proper polymerization of Multilink Speed,2,41 as by the composite cements. According to the results, all the
this reaction is highly dependent on material composition. groups presented statistically similar nanoleakage along the
The other irrigants employed in this study (EDTA, poly- cement-dentin interface. Due to the higher viscosity of self-
acrylic acid, and NaOCl + EDTA) showed better potential to adhesive composite cements55 and the difficulty of stan-
remove the smear layer from root dentin, as they demineral- dardizing root canal anatomy, the authors hypothesize that
ize the dentin substrate. However, as already mentioned nanoleakage occurs irrespective of the composite cement
above, the irrigants which most effectively opened the dentin composition or method used to clean the root dentin space.
tubules (EDTA, polyacrylic acid, and EDTA + NaOCl) were not
usually associated with high overall bond strengths. This
indicates that smear layer presence is not a limiting factor CONCLUSION
for bonding, as verified in previous studies.51,54
In the present study, these three methods of irrigation The methodology used and the results obtained in this
produced similar smear layer removal, but their influence on study indicate that for each self-adhesive composite cement
bond strength of the two tested composite cements dif- tested, there is an optimal irrigation protocol for glass-fiber
fered. For Multilink Speed, these three irrigants produced post cementation. For both composite cements tested, dis-
poor bonding of glass-fiber posts to root canals. The authors tilled water resulted in high push-out bond strength and mi-
hypothesize that better root canal cleaning with increased crohardness values. The bond strength of RelyX U200 com-
smear layer removal left the dentin walls smoother, thus posite cement was less influenced by the different irrigants
reducing the frictional strength of Multilink Speed, which used to clean the post space.
mainly relies on this bonding mechanism for retention.
It is known that frictional retention plays an important role
in push-out tests,25 so that greater substrate roughness ACKNOWLEDGMENTS
should enhance interfacial sliding friction. Multilink Speed The authors are very grateful to FGM Dental Products for the donation
combined lower bond strength with more effective cleaning of glass-fiber posts and Ivoclar Vivadent Brazil for the donation of the
of the post space, which confirms the importance of fric- composite cement employed in this study.
tional retention for glass-fiber posts luted with this material.
For RelyX U200, EDTA application did not jeopardize
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544 The Journal of Adhesive Dentistry