Abstract
Objectives
The aim of this study is to evaluate the influence of ionizing radiotherapy on the resin-dentin interface in endodontically treated teeth restored with fiber posts using a dual-cure resin cement performed with the etch-and-rinse (ER) and self-etch (SE) approaches in terms of push-out bond strength (MPa), and to analyze the post/cement/dentin interface using scanning electron microscopy (SEM).
Materials and methods
Seventy-six single-rooted human teeth were used and randomly assigned into two main groups (n = 38): one non-irradiated group (NoRad) and one group subjected to a cumulative radiation dose of 60 Gy (Rad). All root canals were instrumented and were further subdivided into two subgroups (n = 19) following the adhesive approach: ER (RadER; NoRadER) and SE (RadSE; NoRadSE) used for fiber post luting with the universal adhesive and dual cure resin cement. Each root was sectioned perpendicularly to its long axis and sections from the middle third of the roots were chosen for SEM analysis and push-out bond strength test. Two-way ANOVA with post hoc Tukey tests and a dummy variable linear regression analysis were used for data analysis.
Results
Regardless of the adhesive approach, push-out bond strength in irradiated teeth resulted in significantly lower values than non-irradiated teeth (p = 0.0001). There were no significant differences between the ER and SE approaches in non-irradiated teeth (p = 0.955), whereas the ER approach showed significantly higher bond strengths than the SE approach in irradiated teeth (p = 0.0001).
Conclusions
Ionizing radiotherapy resulted in dentin structure disruption and negatively affected the push-out bond strength of fiber posts to intraradicular dentin. The reduction in bond strength was also more significant with the SE approach than with the ER approach.
Clinical relevance
The alterations resulting from root dentin irradiation seem to influence adhesive systems bond strength to dentin, as these changes contribute to lower push-out bond strength in irradiated groups before fiber post luting. Thus, clinicians should prepare patients with a reasonable restorative treatment plan prior to radiotherapy and simultaneously initiate a preventive program during radiotherapy.
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References
Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Maxwll Parkin D, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359-386. https://doi.org/10.1002/ijc.29210
Buglione M, Cavagnini R, Di Rosario F, Sottocornola L, Maddalo M, Vassalli L, Grisanti S, Salgarello S, Orlandi E, Paganelli C, Majorana A, Gastaldi G, Bossi P, Berruti A, Pavanato G, Nicolai P, Maroldi R, Barasch A, Russi EG, Raber-Durlacher J, Murphy B, Magrini SM (2016) Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: dental pathologies and osteoradionecrosis (Part 1) literature review and consensus statement. Crit Rev Oncol Hematol 97:131–142. https://doi.org/10.1016/j.critrevonc.2015.08.010
Jham BC, Da Silva Freire AR (2006) Oral complications of radiotherapy in the head and neck. Braz J Otorhinolaryngol 72(5):704–708. https://doi.org/10.1016/S1808-8694(15)31029-6
Le Q (2007) Nasopharyngeal and oropharyngeal carcinomas: target delineation, therapy delivery and stereotactic boost procedures with intensity-modulated/ image-guided radiation therapy. Front Radiat Ther Oncol 40:208–231. https://doi.org/10.1159/000106037
Schofield CP, Sykes AJ, Slevin NJ, Rashid NZ (2003) Radiotherapy for head and neck cancer in elderly patients. Radiother Oncol 69(1):37–42. https://doi.org/10.1016/S0167-8140(03)00249-4
Silva AR, Alves FA, Antunes A, Goes MF, Lopes MA (2009) Patterns of demineralization and dentin reactions in radiation-related caries. Caries Res 43(1):43–49. https://doi.org/10.1159/000192799
Kielbassa AM, Hinkelbein W, Hellwig E, Meyer-Luckel H (2006) Radiation-related damage to dentition. Lancet Oncol 7(4):326–335. https://doi.org/10.1016/S1470-2045(06)70658-1
Hong CH, Napenas JJ, Hodgson BD, Stokman MA, Mathers-Stauffer V, Elting LS, Spijkervet FKL, Brennan MT (2010) A systematic review of dental disease in patients undergoing cancer therapy. Support Care Cancer 18(8):1007–1021. https://doi.org/10.1007/s00520-010-0873-2
Beech N, Robinson S, Porceddu S, Batstone M (2014) Dental management of patients irradiated for head and neck cancer. Aust Dent J 59(1):20–28. https://doi.org/10.1111/adj.12134
Munoz MA, Garin-Correa C, Gonzalez-Arriagada W, Quintela Davila X, Haberle P, Bedran-Russo A, Luque-Martines I (2020) The adverse effects of radiotherapy on the structure of dental hard tissues and longevity of dental restoration. Int J Radiat Biol 96(7):910–918. https://doi.org/10.1080/09553002.2020.1741718
Walker MP, Wichman B, Cheng AL, Coster J, Williams KB (2011) Impact of radiotherapy dose on dentition breakdown in head and neck cancer patients. Pract Radiat Oncol 1(3):142–148. https://doi.org/10.1016/j.prro.2011.03.003
Maslennikova A, Kochueva M, Ignatieva N, Vitkin A, Zakharkina O, Kamensky V, Sergeeva E, Kiseleva E, Bagratashvili V (2015) Effects of gamma irradiation on collagen damage and remodeling. Int J Radiat Biol 91(3):240–247. https://doi.org/10.3109/09553002.2014.969848
Palmier NR, Madrid CC, Paglioni MP, Rivera C, Martins B, Araujo ALD, Salvojoli JV, Goes MF, Lopes MA, Prado Ribeiro AC, Brandao TB, Santos-Silva AR (2018) Cracked tooth syndrome in irradiated patients with head and neck cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 126(4):335-341 e332. https://doi.org/10.1016/j.oooo.2018.06.005
Lu H, Zhao Q, Guo J, Zeng B, Yu X, Yu D, Zhao W (2019) Direct radiation-induced effects on dental hard tissue. Radiat Oncol 14(1):5. https://doi.org/10.1186/s13014-019-1208-1
Kielbassa AM, Beetz I, Schendera A, Hellwig E (1997) Irradiation effects on microhardness of fluoridated and non-fluoridated bovine dentin. Eur J Oral Sci 105(5 Pt 1):444–447. https://doi.org/10.1111/j.1600-0722.1997.tb02142.x
Goncalves LM, Palma-Dibb RG, Paula-Silva FW, Oliveira HF, Nelson-Filho P, Silva LA, Queiroz AM (2014) Radiation therapy alters microhardness and microstructure of enamel and dentin of permanent human teeth. J Dent 42(8):986–992. https://doi.org/10.1016/j.jdent.2014.05.011
Arid J, Palma-Dibb RG, De Oliveira HF, Nelson-Filho P, De Carvalho FK, Da Silva LAB, Siqueira Mellara T, Da Silva RAB, Faraoni JJ, Queiroz AM (2020) Radiotherapy impairs adhesive bonding in permanent teeth. Support Care Cancer 28(1):239–247. https://doi.org/10.1007/s00520-019-04782-5
Schwartz RS, Robbins JW (2004) Post placement and restoration of endodontically treated teeth: a literature review. J Endod 30(5):289–301. https://doi.org/10.1097/00004770-200405000-00001
Oskoee SS, Bahari M, Kimyai S, Asgary S, Katebi K (2016) Push-out bond strength of fiber posts to ıntraradicular dentin using multimode adhesive system. J Endod 42(12):1794–1798. https://doi.org/10.1016/j.joen.2016.08.025
Naumann M, Koelpin M, Beuer F, Meyer-Lueckel H (2012) 10-year survival evaluation for glass-fiber-supported postendodontic restoration: a prospective observational clinical study. J Endod 38(4):432–435. https://doi.org/10.1016/j.joen.2012.01.003
Breschi L, Maravic T, Cunha SR, Comba A, Cadenaro M, Tjaderhane L, Pashley DH, Tay FR, Mazzoni A (2018) Dentin bonding systems: from dentin collagen structure to bond preservation and clinical applications. Dent Mater 34(1):78–96. https://doi.org/10.1016/j.dental.2017.11.005
Rodrigues RB, Soares CJ, Junior PCS, Lara VC, Arana-Chavez VE, Novais VR (2018) Influence of radiotherapy on the dentin properties and bond strength. Clin Oral Invest 22(2):875–883. https://doi.org/10.1007/s00784-017-2165-4
Soares CJ, Castro CG, Neiva NA, Soares PV, Santos-Filho PC, Naves LZ, Pereira PN (2010) Effect of gamma irradiation on ultimate tensile strength of enamel and dentin. J Dent Res 89(2):159–164. https://doi.org/10.1177/0022034509351251
Da Cunha SR, Ramos PA, Haddad CM, Da Silva JL, Fregnani ER, Aranha AC (2016) Effects of different radiation doses on the bond strengths of two different adhesive systems to enamel and dentin. J Adhes Dent 18(2):151–156. https://doi.org/10.3290/j.jad.a35841
Galetti R, Santos-Silva AR, Antunes AN, Alves Fde A, Lopes MA, De Goes MF (2014) Radiotherapy does not impair dentin adhesive properties in head and neck cancer patients. Clin Oral Invest 18(7):1771–1778. https://doi.org/10.1007/s00784-013-1155-4
Martins CV, Leoni GB, Oliveira HF, Arid J, Queiroz AM, Silva LA, Sousa-Neto MD (2016) Influence of therapeutic cancer radiation on the bond strength of an epoxy- or an MTA-based sealer to root dentine. Int Endod J 49(11):1065–1072. https://doi.org/10.1111/iej.12556
Pfister DG, Spencer S, Adelstein D, Adkins D, Anzai Y, Brizel DM, Bruce JY, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Eisele DW, Fenton M, Foote RL, Galloway T, Gillison ML, Haddad RI, Hicks WL, Hitchcock YJ, Jimeno A, Leizman D, Maghami E, Mell LK, Mittal BB, Pinto HA, Ridge JA, Rocco JW, Rodriguez CP, Shah JP, Weber RS, Weinstein G, Witek M, Worden F, Yom SS, Zhen W, Burns JL, Darlow SD (2020) Head and neck cancers, version 2.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 18(7):873–898. https://doi.org/10.6004/jnccn.2020.0031
Aggarwal V (2009) An in vitro evaluation of effect of ionizing radiotherapy on push-out strength of fiber posts under cyclic loading. J Endod 35(5):695–698. https://doi.org/10.1016/j.joen.2009.01.010
De-Deus G, Souza E, Versiani M (2015) Methodological considerations on push-out tests in Endodontics. Int Endod J 48(5):501–503. https://doi.org/10.1111/iej.12445
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424. https://doi.org/10.3322/caac.21492
Beumer J, Curtis TA, Marunick MA (1996) Maxillofacial rehabilitation, prosthodontic and surgical considerations. In: Medico Dental Media International, pp 43–71
Velo M, Farha ALH, Da Silva Santos PS, Shiota A, Sansavino SZ, Souza AT, Honório HM, Wang L (2018) Radiotherapy alters the composition, structural and mechanical properties of root dentin in vitro. Clin Oral Invest 22(8):2871–2878. https://doi.org/10.1007/s00784-018-2373-6
Lieshout HF, Bots CP (2014) The effect of radiotherapy on dental hard tissue–a systematic review. Clin Oral Invest 18(1):17–24. https://doi.org/10.1007/s00784-013-1034-z
Amaechi BT, Higham SM (2001) In vitro remineralisation of eroded enamel lesions by saliva. J Dent 29(5):371–376. https://doi.org/10.1016/s0300-5712(01)00026-4
Pytko-Polonczyk JJ, Jakubik A, Przeklasa-Bierowiec A, Muszynska B (2017) Artificial saliva and its use in biological experiments. J Physiol Pharmacol 68(6):807–813
Furness S, Worthington HV, Bryan G, Birchenough S, Mcmillan R (2011) Interventions for the management of dry mouth: topical therapies. Cochrane Database Syst Rev 7(12):CD008934. https://doi.org/10.1002/14651858.CD008934.pub2
D’arcangelo C, Cinelli M, De Angelis F, D’amario M (2007) The effect of resin cement film thickness on the pullout strength of a fiber-reinforced post system. J Prosthet Dent 98(3):193–198. https://doi.org/10.1016/S0022-3913(07)60055-9
Aksornmuang J, Nakajima M, Senawongse P, Tagami J (2011) Effects of C-factor and resin volume on the bonding to root canal with and without fibre post insertion. J Dent 39(6):422–429. https://doi.org/10.1016/j.jdent.2011.03.007
Pioch T, Golfels D, Staehle HJ (1992) An experimental study of the stability of irradiated teeth in the region of the dentinoenamel junction. Endod Dent Traumatol 8(6):241–244. https://doi.org/10.1111/j.1600-9657.1992.tb00251.x
Grotz KA, Duschner H, Kutzner J, Thelen M, Wagner W (1997) New evidence for the etiology of so-called radiation caries. Proof for directed radiogenic damage od the enamel-dentin junction. Strahlenther Onkol 173(12):668–676. https://doi.org/10.1007/BF03038449
Kielbassa AM, Munz I, Bruggmoser G, Schulte-Monting J (2002) Effect of demineralization and remineralization on microhardness of irradiated dentin. J Clin Dent 13(3):104–110
Soares C, Moura C, Soares Pb, Naves LZ (2011) Scanning electric microscopy used to analyze the effect of gamma irradiation on enamel and dentin. Microscopy: Science, Technology, Applications and Education. 1:6
Van Meerbeek B, Yoshihara K, Van Landuyt K, Yoshida Y, Peumans M (2020) From Buonocore’s pioneering acid-etch technique to self-adhering restoratives. A status perspective of rapidly advancing dental adhesive technology. J Adhes Dent 22(1):7–34. https://doi.org/10.3290/j.jad.a43994
De Barros Da Cunha SR, Fonseca FP, Ramos P, Haddad CMK, Fregnani ER, Aranha ACC (2017) Effects of different radiation doses on the microhardness, superficial morphology, and mineral components of human enamel. Arch Oral Biol 80:130–135. https://doi.org/10.1016/j.archoralbio.2017.04.007
Pashley DH, Tay FR, Breschi L, Tjaderhane L, Carvalho RM, Carrilho M, Carrilho M, Tezvergil-Mutluay A (2011) Dent Mater 27(1):1-16. https://doi.org/10.1016/j.dental.2010.10.016
Sahafi A, Peutzfeldt A, Asmussen E, Gotfredsen K (2004) Retention and failure morphology of prefabricated posts. Int J Prosthodont 17(3):307–312
Bastos PCA, Farta DE, Bridi EC, Do Amaralet FLB, França FMG, Florio FM, Basting RT (2011) Push-out bond strength and sealing ability of etch-and-rinse and self-etching adhesives used for fiberglass dowel bonding at different depths of the root canals. Rev Odontol UNESP 40(4):174–181
Van Meerbeek B, Yoshihara K, Yoshida Y, Mine A, De Munck J, Van Landuyt KL (2011) State of the art of self-etch adhesives. Dent Mater 27(1):17–28. https://doi.org/10.1016/j.dental.2010.10.023
Rathke A, Haj-Omer D, Muche R, Haller B (2009) Effectiveness of bonding fiber posts to root canals and composite core build-ups. Eur J Oral Sci 117(5):604–610. https://doi.org/10.1111/j.1600-0722.2009.00668.x
Zicari F, Couthino E, De Munck J, Poitevin A, Scotti R, Naert I, Van Meerbeck B (2008) Bonding effectiveness and sealing ability of fiber-post bonding. Dent Mater 7:967–977. https://doi.org/10.1016/j.dental.2007.11.011
Ferrari M, Mannocci F, Vichi A, Cagidiaco MC, Mjor IA (2000) Bonding to root canal: structural characteristics of the substrate. Am J Dent 13(5):255–260
Zhang K, Kim YK, Cadenaro M, Bryan TE, Sidow SJ, Loushine RJ, Ling J, Pashley DH, Tay FR (2010) Effects of different exposure times and concentrations of sodium hypochlorite/ethylenediaminetetraacetic acid on the structural integrity of mineralized dentin. J Endod 36(1):105–109. https://doi.org/10.1016/j.joen.2009.10.020
Elnaghy AM (2014) Effect of QMix irrigant on bond strength of glass fibre posts to root dentine. Int Endod J 47(3):280–289. https://doi.org/10.1111/iej.12145
Rueggeberg FA, Margeson DH (1990) The effect of oxygen inhibition on an unfilled/filled composite system. J Dent Res 69(10):1652–1658. https://doi.org/10.1177/00220345900690100501
Moura AS, Pereira RD, Rached FJJ, Crozeta BM, Mazzi-Chaves JF, Souza-Flamini LE, Cruz Filho AM (2017) Influence of root dentin treatment on the push-out bond strength of fibre-reinforced posts. Braz Oral Res 31:e29. https://doi.org/10.1590/1807-3107BOR-2017.vol31.0029
Naves LZ, Novais VR, Armstrong SR, Correr-Sobrinho L, Soares CJ (2012) Effect of gamma radiation on bonding to human enamel and dentin. Support Care Cancer 20(11):2873–2878. https://doi.org/10.1007/s00520-012-1414-y
Yadav S, Yadav H (2013) Ionizing irradiation affects the microtensile resin dentin bond strength under simulated clinical conditions. J Conserv Dent 16(2):148–151. https://doi.org/10.4103/0972-0707.108198
Madrid Troconis CC, Santos-Silva AR, Brandao TB, Lopes MA, De Goes MF (2017) Impact of head and neck radiotherapy on the mechanical behavior of composite resins and adhesive systems: a systematic review. Dent Mater 33(11):1229–1243. https://doi.org/10.1016/j.dental.2017.07.014
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The authors gratefully thank Dr. Elif Çiğdem Keleş for performing statistical analysis.
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Conceptualization: Elif Delve Başer Can, Esra Can; methodology: Elif Delve Başer Can, Esra Can; ınvestigation: Güher Barut, Vasfiye Işık, Emriye Algül, Gökhan Yaprak; data curation: Elif Delve Başer Can, Güher Barut, Vasfiye Işık; writing-original draft preparation: Elif Delve Başer Can, Esra Can; writing-review and editing: Elif Delve Başer Can, Esra Can; supervision: Esra Can.
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The study protocol was conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Research Ethics Committee of the Yeditepe University (approval number 1265).
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Başer Can, E.D., Barut, G., Işık, V. et al. Push-out bond strength of fiber posts to irradiated and non-irradiated intraradicular dentin. Clin Oral Invest 26, 7057–7069 (2022). https://doi.org/10.1007/s00784-022-04666-9
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DOI: https://doi.org/10.1007/s00784-022-04666-9