MONOBLOC IN ENDODONTICS

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MONOBLOC IN ENDODONTICS

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CONTENTS Introduction Role of monobloc in Endodontics Classification of monoblocs Clinical significance Characteristics of monblocs Sealability R einforcement Primary monobloc Secondary monobloc Tertiary monobloc

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CONTENTS Controversies Conclusion R eferences

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INTRODUCTION ‘ Monobloc ’ ‘Single unit’ Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398 . DEFINITION A forging or casting made in a single piece, rather than being fabricated from components In orthodontics , introduced in 1902 by Dr. Pierre Robin - united upper and lower acrylic removable appliances T o treat Class II division 1malocclusion & forms forerunner of functional appliances by uniting two functional matrices (i.e., maxilla & mandible ) into single unit 1

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ROLE IN ENDODONTICS ‘ Monobloc ’ R ecent interest in the application of dentin adhesive technology to endodontics Improve the quality of seal in root fillings Strengthen roots 1 2 Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod. Apr 2007; 33(4): 391–398 . Scenario - canal space perfectly filled with a gap-free, solid mass that consist of different materials & interfaces Post systems R oot canal filling materials Generated controversial discussions Potential of adhesive sealers & adhesive post systems to create ‘ MONOBLOCS ‘Single units – reinforce tooth structure’ 2

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CLASSIFICATION Replacement monoblocks created in root canal spaces classified as Primary Monobloc Secondary monobloc 1 2 Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. Tertiary monobloc 3 interfaces present between the bonding substrate and the bulk material core Root canal filling material Post & core systems May be applied to 3

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CLINICAL SIGNIFICANCE Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. Diseased pulps to be replaced by sealing restorative materials – prevent reinfection Rigidity of the root weakened by endodontic & restorative instrumentation S ealing quality & tooth strengthening potential of monoblocks -important Long term prognosis of endodontic treatment 4

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CHARACHTERISTICS OF MONOBLOC Ona M1, Wakabayashi N, Yamazaki T, Takaichi A, Igarashi Y. The influence of elastic modulus mismatch between tooth and post and core restorationson root fracture. Int Endod J. 2013 Jan;46(1):47-52. Sealing quality Improoving degree of bonding/adhesion of root filling material S trengthening Similarity of Elastic modulus of root filling materials to dentin 1 2 5

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SEALABILITY Schwartz RS. Adhesive dentistry and endodontics . Part 2: bonding in the root canal system-the promise and the problems: a review. J Endod . 2006 Dec;32(12):1125-34. Reason for microgaps P oor adhesion & wetting 1 S uccessful RCT - achieve & maintain tight seal, chemically / mechanically, along canal system Prevent microleakage - passage of bacteria, fluids, molecules or ions between a cavity wall and the restorative material Polymerization shrinkage Thermal stresses, occlusal loading /water sorption 2 3 6

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SEALABILITY 4 generations of methacrylate resin–based sealers have been introduced HYDRON use of poly[2-hydroxyethyl methacrylate] as major ingredient 1 R ecent trends in endodontics - development of bonded obturating materials, - attempt provide more effective seal coronally & apically Low viscosity methacrylate resin–based root canal sealers With root filling material that claims to adhere to methacrylate resins Non etching & hydrophilic, no adjunctive use of a dentin adhesive ENDOREZ Self-etching primer & dual-cured resin composite canal Sealer RESILON/EPIPHANY 2 3 C ombination etchant, primer , & sealer into an all-in-one self etching , self-adhesive sealer METASEAL 4 To achieve a monoblock , as advertised by the manufacturer, high bond strengths necessary between dentin & sealer , as well as between the sealer and obturating materia

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SEALABILITY Belli S, Eraslan O, Eskitascioglu G, Karbhari V. Monoblocks in root canals: a finite elemental stress analysis study. Int Endod J. 2011 Sep;44(9):817-26. 4 generations of methacrylate resin–based sealers have been introduced HYDRON use of poly[2-hydroxyethyl methacrylate] as major ingredient 1 R ecent trends in endodontics - development of bonded obturating materials, - attempt provide more effective seal coronally & apically Low viscosity methacrylate resin–based root canal sealers New r oot filling material that claims to adhere to methacrylate resins Non etching & hydrophilic, no adjunctive use of a dentin adhesive ENDOREZ Self-etching primer & dual-cured resin composite canal Sealer RESILON/EPIPHANY 2 3 C ombination etchant, primer , & sealer into an all-in-one self etching , self-adhesive sealer METASEAL 4 7 Since fibre posts are passively retained into the root canal, an adhesive cement important for good seal Due to their ability to bond to tooth structure , resin cements have potential to exhibit less microleakage than other cements Total-Etch Resin Cements Self-Etch Resin Cements Self-Adhesive Resin Cements To achieve a monoblock , high bond strengths necessary between dentin & sealer , as well as between the sealer and obturating material

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STRENGTHENING ROOTS Belli S, Eraslan O, Eskitascioglu G, Karbhari V. Monoblocks in root canals: a finite elemental stress analysis study. Int Endod J. 2011 Sep;44(9):817-26. Root filled teeth more prone to biomechanical failure Loss of tooth structure Clinical failure attributed to physiologic masticatory forces / parafunctional forces repeated over long periods F atigue stress 8

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STRENGTHENING ROOTS Belli S, Eraslan O, Eskitascioglu G, Karbhari V. Monoblocks in root canals: a finite elemental stress analysis study. Int Endod J. 2011 Sep;44(9):817-26. In biomechanical aspect -restoration of root filled teeth with materials having similar MOE to dentin can save remaining tooth structure Allowing some slight flex Favorable dissipation of stress Reducing the likelihood of damage to the root Popularity of fibre posts with Resin cements 9 Adhesive composite cements whose elastic modulus is in the same range of that of both the post and dentin have the potential to reinforce the root

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PRIMARY MONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398 Cementum Dentin Root filling material One interface that extends circumferentially between the material and the root canal wall Hydron MTA 1 2 P olyethylene fibre post-core sys Ribbond 3 10

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PRIMARY MONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. In the late 1970s, Poly HEMA containing root filling material ( Hydron ; Hydron Technologies) marketed HYDRON Interest as a potential successor for sealer-dependent lateral and vertical gutta-percha obturation En masse filling of roots Easy to use Nonirritating A daptable to walls N onsupport bacteria Calcify - extrusion 11

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Became obsolete in the 1980s because discrepancies between manufacturer’s claims and laboratory/clinical findings HYDRON Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. SEALABILITY ? Residual moisture within root canals – Polymerisation hampered Polymerisation in situ ?? Presence of water form soft hydrogels - permeable & leachable Studies demonstrated - Hydron -filled root canals exhibited extensive leakages I njectible 12

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M anufacturer of Hydron did not infer that filling root canals with Hydron helps to strengthen roots and prevent root fractures HYDRON Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. STRENGTH ? Modulus of elasticity of porous poly (HEMA ) hydrogels such as Hydron ranges from 180 to 250 MPa To reinforce roots, the modulus of elasticity of a root filling material would need to approximate that of dentin (i.e., 14,000 MPa ) 13

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PRIMARY MONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. Calcium silicate based material , distributed as ProRoot MTA, Dentsply from 1998 MTA Orthograde obturation with mineral trioxide aggregate - as an apexification material represents a primary monoblock Apexification material Biocompatible Antimicrobial Retreatment not possible 14

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These alkaline biomaterials have gained wide acceptance in endodontic community - good physico -chemical & biological properties MTA Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. SEALABILITY & BOND STRENGTH Hydrophilic , sets in the presence of moisture Setting in situ ?? Adhere to root dentine by forming a crystalline bond by biomineralization Formation of gap-filling apatite deposits accounts for the seal Syringed - carrier Plugged columns Lee MTA block & plugger 15

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MTA SEALABILITY & BOND STRENGTH 16 MTA Lateral condensed GP Thermoplasticized GP

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MTA Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398 STRENGTH ? The compressive EM of Portland cement increases after 14 days to 15,000 Mpa with a w/P ratio of 0.6 MTA theoretically able to strengthen roots EM 14,000 –18,600 MPa Recent study - examined fracture resistance of MTA applied to immature sheep roots - no difference filled with saline versus those filled with MTA 17

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MTA Andreasen JO1, Munksgaard EC, Bakland LKComparison of fracture resistance in root canals of immature sheep teeth after filling with calcium hydroxide or MTA.. Dent Traumatol . 2006 Jun;22(3):154-6. STRENGTH ? 18 Saline Calcium hydroxide MTA

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PRIMARY MONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398 Ultra-high molecular weight polyethylene fibres coated with a dentine bonding agent are used to build-up endodontic posts and cores. POLYETHYLENE FIBRE POST-CORE 19 Woven fibres have a modulus of elasticity similar to that of dentine Fibres adapt to root canal, canal enlargement is not required Polyethylene fibers conditioned with bonding agent, placed in the slot of the root canal, Braided polyethylene fibers

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POLYETHYLENE FIBRE POST-CORE Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398 STRENGTH In clinical conditions MOE of polyethylene fibre reinforced material with an adhesive material like flowable composite has a MOE of 23GPa High MOE and low flexural modulus of polyethylene fibre have a modifying effect on interfacial stresses developed along resin dentin boundary 20

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POLYETHYLENE FIBRE POST-CORE BONDING 21 Reforpost Ribbond Parapost - metal

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POLYETHYLENE FIBRE POST-CORE BONDING & SEALABILITY 22 Zirconia Stainless steel Glass fibre Polyethylene fibre

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POLYETHYLENE FIBRE POST-CORE STRENGTHENING ROOTS 23 Glass fibre post Ribbond fibre post

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PRIMARY MONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. Commercial product was containing bioactive glass of the 45S5 type incorporated into polyisoprene , the matrix polymer of gutta-percha BIOGUTTA Formation of CaP crystals on the material’s surface in a wet environment Self adhesive Good sealing Preliminary studies – push out bond strength 24

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SECONDARY MONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. Cementum Dentin Root filling material Resin cement/ root canal sealer Resilon based systems Fibre re- inforced posts 1 2 2 circumferential interfaces, one between cement & dentin & other between the cement & core material. 25

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SECONDARY MONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. By definition, conventional root canal obturations may be regarded as secondary monoblock systems Sealer does not bond to dentin or gutta percha MOE 175–230 times lower than dentin 26

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SECONDARYMONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. M onoblock concept rekindled in 2004 -Advent of bondable root filling materials RESILON M aterial looks and handles like conventional gutta percha . Unlike gutta percha , Resilon obturators bond to its associated sealer – Epiphany Sealer. Primer & a dual cure sealer (Epiphany) Resilon - polycaprolactone -based, dimethacrylate resin– contains Bioactive glass 27

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Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. SEALABILITY ? Fill the root canal space with Resilon Points & light cure – 40 secs Studies demonstrated - Hydron -filled root canals exhibited extensive leakages Apply self etch primer to the level of the apex with a well fitting paper point Express a small amount of the dual cure sealer – place in canal RESILON Only bondable root filling material works effectively with vertical condensation and lateral condensation techniques and includes pellets for the Obtura * gun system Resilon material only shrinks 0.5%, unlike Gutta Percha , it is physically bonded to the sealer by polymerization - no gaps are present due to shrinkage. Coronal 2 mm of canal filling polymerized with a curing light, - enhancing coronal seal 28

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Bodrumlu E1, Tunga U. The apical sealing ability of a new root canal filling material. Am J Dent. 2007 Oct;20(5):295-8. SEALABILITY ? Studies demonstrated - Hydron -filled root canals exhibited extensive leakages RESILON 29

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Bodrumlu E1, Tunga U. The apical sealing ability of a new root canal filling material. Am J Dent. 2007 Oct;20(5):295-8. ROOT REINFORCEMENT? Studies demonstrated - Hydron -filled root canals exhibited extensive leakages RESILON 30

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SECONDARYMONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. F irst implied existence of a mechanically homogeneous monoblock in reported in 1996 with the bonding of epoxy resin– based, carbon fiber–reinforced posts to root dentin FIBRE POSTS A uthors claim -carbon fiber posts, having MOE similar to that of dentin, could achieve a tooth–post– core monoblock C fibers made to bond to epoxy resins oxidative process Strongest carbon fibers have a tensile modulus 500 –1000 GPa Fibres no longer surface active once post exposed by roughening / with bur Stiffness of carbon fiber lowered by presence of epoxy resin Epoxy resin not bondable to methacrylates under physiological temperatures Beneficial claims of carbon fiber post–root dentin monoblock could not be validated in independent in vitro and retrospective in vivo studies 31

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SECONDARYMONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398 Over the years, carbon fibers in this type of first-generation fiber post replaced glass FIBRE POSTS The epoxy resin embedding matrix replaced with highly cross-linked , methacrylate resin matrices have the potential to bond to methacrylate-based resin cements Different modalities of surface treatments of posts are also available More conducive to bonding to methacrylate-based resins Similarity in the modulus of E lasticity between fiber posts and root dentin 32

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Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–39 Schwartz RS. Adhesive dentistry and endodontics . Part 2: bonding in the root canal system-the promise and the problems: a review. J Endod . 2006 Dec;32(12):1125-34. 8 SEALABILITY & BOND ? Remove obturation with drill FIBRE POST + RESIN Problems with bonding in root canals 33 Etch & rinse Prepare dual cure/self cure primer, coat canal Apply self/dual cure resin cement in canal Place post, remove excess and cure

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SEALABILITY & BOND ? FIBRE POST + RESIN

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TERTIARY MONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398 Cementum Dentin Bondable coating on fiber post/root filling material Resin cement/ Root canal sealr Endorez Fibre posts + external silane Third circumferential interface is introduced between the bonding substrate and the abutment material 34

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TERTIARY MONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. EndoREZ ( Ultradent Products Inc , is a dualcured radiopaque methacrylate sealer ENDOREZ H ydrophilic and self-priming resin sealer, does not require the adjunctive use of a dentin adhesive EndoREZ points resin-coated gutta-percha Used - wet environment of canal Effective penetration of dentinal tubules & adapting walls GP resin coating bondable resin sealer 35

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ENDOREZ Tay FR1, Loushine RJ, Monticelli F, Weller RN, Breschi L, Ferrari M, Pashley D. Effectiveness of resin-coated gutta-percha cones and a dual-cured, hydrophilic methacrylate resin-based sealer in obturating root canals. J Endod . 2005 Sep;31(9):659-64. SEALABILITY ? Mixed material deposited into canal by passive injection Use of resin coated GP cones passively Syringed – Navi tip L eakage & morphologic studies showed - seal of the EndoRez system is mediocre SEALER RESIN TAGS DENTIN Long resin tags could be identified within dentinal tubules May be attributed to Polymerization shrinkage of sealer Weak bond of sealer to prepolymerized coating Inconsistency of resin coating Uneven circumferential thickness or partial detachment Lack of FR for bonding - removal of OI layer - Packing 1 2 3 Tensile B.S Apical seal Improoved Dual-cured self-etching primer/adhesive Problem - rapid polymerization of adhesive in environ with reduced oxygen 36

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TERTIARY MONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. In ActiV GP ( Brasseler USA), the root filling system is marketed as a monoblock system ACTIV GP Stiffer GP cone - function as both the tapered filling cone and as its own carrier core Silanated glass ionomer particles at % - not affect the properties of GP Capability of wet bonding Creates an ionic bond to the dentin GP cones-surface coated with GI fillers 37

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As this system is new, limited information is available ACTIV GP Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398 SEALABILITY ? A pical seals to fluid filtration - comparable to GP & AH Plus Being single-cone technique, coronal leakage to fluid filtration was worse than GP &AH Plus Studies demonstrated - Hydron -filled root canals exhibited extensive leakages Hand file coated with Activ GP sealer & taken to WL Activ GP cone is coated with sealer & slowly inserted into the canal to its working length 38

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ENDOREZ & ACTIV GP Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. STRENGTH ? Bulk of the material inside still consists of thermoplastic GP U nrealistic to expect establishment of a mechanically homogenous unit within root canal with the EndoRez system & Activ GP Elastomeric polymer - flows when stressed 39

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TERTIARY MONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398 C onditioning of post is commonly done chairside , which makes the treatment longer and increases the risk of failure FIBRE POSTS + EXTERNAL SILANE DT Light®SL Coating made of silane and silicate is applied to the post In order to protect its activation before its use in dental practice, an additional protective layer made of MMA is applied F ibre post conditioned with the latest coating technologies in an industrial process, The practitioner no longer needs to condition post as the post is pre-conditioned 40

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FIBRE POSTS + EXTERNAL SILANE Goracci C1, Raffaelli O, Monticelli F, Balleri B, Bertelli E, Ferrari M. The adhesion between prefabricated FRC posts and composite resin cores: microtensile bond strength with and without post- silanization . Dent Mater. 2005 May;21(5):437-44 . BONDING ? 41

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TERTIARY MONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. Further improvement in post adaptation and retention attempted with ‘ANATOMIC POST’ ANATOMIC POSTS Translucent fibre post – covered by a layer of light curing resin, which allows for individual anatomic shaping of post Individualized posts – appearance after light curing outside of patients oral cavity Better fit than prefabricated posts Precise fit – thin uniform layer of cement ideal for post retention 42

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TERTIARY MONOBLOC Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398. Post adapted to lubricated post space & photoactivated to partially polymerize composite ANATOMIC POSTS Efficacy of system not throughly investigated 43 Relined assembly, removed & optimally polymerized Resin cement layer significantly reduced Reduction in resin cement layer – reduction in volumetric shrinkage Reduction of polymerisation shrinkage in low compliance environment ?? Gaps b/t post & relining composite – act as stress raisers result in adhesive failure

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TERTIARY MONOBLOC Belli S, Eraslan O, Eskitascioglu G, Karbhari V. Monoblocks in root canals: a finite elemental stress analysis study. Int Endod J. 2011 Sep;44(9):817-26. ROOT REINFORCEMENT? 44 Secondary monobloc Tertiary monobloc Primary monobloc

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PROBLEMS WITH BONDING IN ROOT CANAL sodium hypochlorite irrigation solution is a strong oxidizing agent and leaves behind an oxygenrich layer on the root dentin surface Elastomeric polymer - flows when stressed

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CLINICAL TIPS Alternattive stratagies to optimize bonding Significance of final rinse – chlorhexidine Importance of moist bonding 45 Smear layer removal- EDTA Effects of irrigants Sodium hyphoclorite / hydrogen peroxide

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CONTROVERSIES Belli S, Eraslan O, Eskitascioglu G, Karbhari V. Monoblocks in root canals: a finite elemental stress analysis study. Int Endod J. 2011 Sep;44(9):817-26. Root canal filling available today have MOE far less compared to dentin Monoblocks aim at achieving a single unit – most root filling materials require additional interfaces 46 Good bond strength of adhesive materials may not imply good sealing

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CONTROVERSIES MBRS + RESIN POINT APICAL FILLING DENTIN FIBRE POST COMPOSITE CORE CERAMIC CROWN RESIN CEMENT Concept of single unit Monobloc hypothetical ?? 47

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“The future of endodontics is bonded” “The goal of being able to bond a canal from the minor constriction to the canal orifice to the occlusal surface is a desirable one .’’ CONCLUSION Review of the available data Contradicting ex vivo and in vivo tests Resin based materials are here to stay Replace conventional materials In parallel - alternative choice 48

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REFERENCES Goracci C1, Raffaelli O, Monticelli F, Balleri B, Bertelli E, Ferrari M . The adhesion between prefabricated FRC posts and composite resin cores: microtensile bond strength with and without post- silanization . Dent Mater. 2005 May;21(5):437-44. Pitout E, Oberholzer TG, Blignaut E, Molepo J. Coronal leakage of teeth root-filled with gutta -percha or Resilon root canal filling material. J Endod 2006; 32: 879–81 . Pameijer CH, Zmener O. Resin materials for root canal obturation . Dental Clinic N America 2010; 325-44 . Radovic I, Monticelli F, Goracci C, Vulicevic ZR, Ferrari M . Self- adhesive resin cements: A literature review. J Adhes Dent 2008; 10: 251–8 . Marending M1, Bubenhofer SB, Sener B, De-Deus G . Primary assessment of a self-adhesive gutta-percha material. Int Endod J. 2013 Apr;46(4):317-22 . Schwartz RS. Adhesive dentistry and endodontics . Part 2: bonding in the root canal system-the promise and the problems: a review. J Endod . 2006 Dec;32(12): 1125-34.

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REFERENCES Franklin R. Tay and David H. Pashley . Monoblocks in root canals - a hypothetical or a tangible goal. J Endod . Apr 2007; 33(4): 391–398 Kim YK, Grandini S, Ames JM, Gu LS, Kim SK, Pashley DH, Gutmann JL, Tay FR. Critical review on methacrylate resin-based root canal sealers . J Endod . 2010 Mar;36(3):383-99 . Belli S, Eraslan O, Eskitascioglu G, Karbhari V. Monoblocks in root canals: a finite elemental stress analysis study. Int Endod J. 2011 Sep;44(9): 817-26. Tay FR1, Loushine RJ, Monticelli F, Weller RN, Breschi L, Ferrari M, Pashley D. Effectiveness of resin-coated gutta-percha cones and a dual-cured, hydrophilic methacrylate resin-based sealer in obturating root canals. J Endod . 2005 Sep;31(9): 659-64 . Ona M1, Wakabayashi N, Yamazaki T, Takaichi A, Igarashi Y. The influence of elastic modulus mismatch between tooth and post and core restorationson root fracture. Int Endod J. 2013 Jan;46(1):47-52

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REFERENCES Andreasen JO1, Munksgaard EC, Bakland LKComparison of fracture resistance in root canals of immature sheep teeth after filling with calcium hydroxide or MTA.. Dent Traumatol . 2006 Jun;22(3):154-6. Pitout E, Oberholzer TG, Blignaut E, Molepo J. Coronal leakage of teeth root-filled with gutta -percha or Resilon root canal filling material. J Endod 2006; 32: 879–81 . Pameijer CH, Zmener O. Resin materials for root canal obturation . Dental Clinic N America 2010; 325-44 . Radovic I, Monticelli F, Goracci C, Vulicevic ZR, Ferrari M . Self- adhesive resin cements: A literature review. J Adhes Dent 2008; 10: 251–8 . Marending M1, Bubenhofer SB, Sener B, De-Deus G . Primary assessment of a self-adhesive gutta-percha material. Int Endod J. 2013 Apr;46(4):317-22 . Schwartz RS. Adhesive dentistry and endodontics . Part 2: bonding in the root canal system-the promise and the problems: a review. J Endod . 2006 Dec;32(12): 1125-34.

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MONOBLOC IN ENDODONTICS

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