Can intra-radicular cleaning protocols increase the retention of fiberglass posts? A systematic review

Abstract The presence of residues within the root canal after post-space preparation can influence the bond strength between resin cement and root dentin when using fiberglass posts (FGPs). Currently, there is no consensus in the literature regarding what is the best solution for the removal of debris after post-space preparation. This systematic review involved “in vitro” studies to investigate if cleaning methods of the root canal after post-space preparation can increase the retention of FGPs evaluated by the push-out test. Searches were carried out in PubMed (MEDLINE) and Scopus databases up to July2017. English language studies published from 2007 to July 2017 were selected. 475 studies were found, and 9 were included in this review. Information from the 9 studies were collected regarding the number of samples, storage method after extraction, root canal preparation, method of post-space preparation, endodontic sealer, resin cement, cleaning methods after post-space and presence of irrigant activation. Five studies presented the best results for the association of sodium hypochlorite (NaOCl) and ethylenediamine tetra-acetic acid (EDTA), while in the other 4 studies, the solutions that showed improved retention of FGPs were photon-induced photoacoustic streaming (PIPS), Qmix, Sikko and EDTA. The results showed heterogeneity in all comparisons due to a high variety of information about cleaning methods, different concentrations, application time, type of adhesive system and resin cements used. In conclusion, this review suggests that the use of NaOCl/EDTA results in the retention of FGPs and may thus be recommended as a post-space cleaning method influencing the luting procedure.

摘要 纤维桩（fiberglass posts, FGPs）桩道预备后根管内残留的残渣，会影响树脂水门汀与牙根牙本质的粘结强度。目前，学界关于桩道预备后清除残渣的最佳方案尚未达成共识。本系统综述纳入体外研究，旨在探讨桩道预备后根管清洁方法能否通过推出试验提升纤维桩的固位力。检索策略覆盖PubMed（MEDLINE）与Scopus数据库，检索时限截至2017年7月；纳入2007年至2017年7月期间发表的英文文献。初检共获得475篇文献，最终纳入9项研究。提取的研究信息包括样本量、离体牙储存方式、根管预备方式、桩道预备方法、根管封闭剂、树脂水门汀、桩道清洁方案以及冲洗激活方式。其中5项研究显示，次氯酸钠（sodium hypochlorite, NaOCl）与乙二胺四乙酸（ethylenediamine tetra-acetic acid, EDTA）联合使用效果最佳；其余4项研究则表明，光子诱导光声流（photon-induced photoacoustic streaming, PIPS）、Qmix、Sikko及EDTA可提升纤维桩的固位力。由于清洁方法、溶液浓度、作用时长、粘接系统类型及所使用的树脂水门汀存在较高多样性，所有对比分析均呈现结果异质性。综上，本综述提示，次氯酸钠/乙二胺四乙酸联用可提升纤维桩固位力，因此可推荐作为影响粘接流程的桩道清洁方案。