Editorial Type:
Article Category: Research Article
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Online Publication Date: 09 Aug 2021

Post-Space Treatment Influences the Bond Strength In Endodontically Treated Teeth: A Systematic Review and Meta-Analysis of In Vitro Studies

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Page Range: E132 – E157
DOI: 10.2341/19-277-LIT
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SUMMARY

Objectives:

This systematic review of in vitro studies investigated the influence of the post-space treatment used to remove the smear layer on the bond strength of the post to root canal dentin.

Methods and Materials:

In vitro studies included in this study were identified from PubMed/MEDLINE, Lilacs, and Scopus databases up until March 2019, without limits on publication year or language. Two reviewers independently selected the studies based on the inclusion and exclusion criteria, extracted the data, and evaluated the risk of bias of all studies. A random effects model was used for pairwise meta-analyses (control vs. post-space preparation groups) at a significance level of p<0.05.

Results:

Of the 2,832 potentially eligible studies, 453 studies were selected for full-text analysis, and 75 were included in this systematic review. Only one study was considered to have a low risk of bias. Overall, post-space treatment significantly improves the bond strength to root canal dentin (p<0.00001).

Conclusion:

Post-space treatment has a positive influence on the bond strength of the post to root canal dentin. In this review, the post-space treatments that improve the adhesive resistance of the post were ethanol, sodium hypochlorite, and ethylene diamine tetra-acetic acid (NaOCl + EDTA), NaOCl + EDTA + ultrasound, erbium-doped yttrium aluminium garnet laser (Er:YAG laser), neodymium-doped yttrium aluminium garnet laser (Nd:YAG laser), and diode laser.

INTRODUCTION

For restoration success in endodontically treated teeth with extensive coronal loss, the use of intraradicular posts is indicated to retain the restoration.1 The post system choice to be used is based on the amount of dental structure remaining, the esthetics, and functional considerations.2,3

Effective adhesion among the intraradicular post, dentin, and cement is necessary for the success and longevity of the restoration.4 However, failures associated with post adhesion have been reported in the literature, especially for fiber posts.2,5,6 Several factors can influence the retention of the intraradicular post such as the root anatomy itself, the materials used in the endodontic treatment, and techniques and materials used for post luting.1,2,4,7 Moreover, obliteration of dentinal tubules resulting from the preparation of the post-space can also influence the adhesion between the intraradicular retainer and root dentin due to modifications in the dentin hybridization.5,6,8–10

Studies have been performed to find the ideal treatment for the post-space, promoting better retention of the intraradicular retainer.5,11–16 Among the post-space treatments, ethylenediaminetetraacetic acid (EDTA) is a valid option for smear layer removal.17 Sodium hypochlorite (NaOCl) is the most common irrigating solution used and can dissolve organic matter in the canal.17

Moreover, Zhang and others18 suggested the use of 35% phosphoric acid as a post-space treatment as the increased bond strength is associated with its potential to remove the smear layer in the post-space. Also, some studies have shown that the use of ultrasound and Nd:YAG, Er:YAG, Er, Cr:YSGG, and diode lasers within the post-space can contribute to disinfecting this space and eliminating the smear layer, thus improving the retention of the intraradicular post.19–22

Some studies have reported that post-space treatments improve post-adhesive resistance,11–13 while other studies have shown that these treatments decrease their resistance.14–16 Thus, there is no consensus in the literature whether the treatments used in the post-space are favorable for adhesion of this retainer.

Therefore, although several studies have attempted to point out the best treatment to be used in the post-space, some controversy remains. Thus, this study aimed to systematically review the literature to verify the influence of the post-space treatments on the bond strength of posts to root canal dentin. The hypothesis tested was that there would be no difference in bond strength to root canal dentin when the post-space is or is not treated.

METHODS AND MATERIALS

This study was conducted and reported according to the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.23,24 The protocol of this systematic review was not registered in any platform, because no platforms exist at this time to register reviews of in vitro studies.

The systematic review was performed by compiling all available in vitro studies to answer the following question: Is there an influence of the post-space treatment on the bond strength of post to root canal dentin in endodontically treated teeth?

Thus, the population, intervention, comparison, and outcomes (the PICOs) for this review included: tooth (population); post-space treatment (intervention); no treatment (comparison), and bond strength (outcome).

Literature Strategy

The PubMed/MEDLINE, Lilacs, and Scopus databases were searched to identify relevant studies up to March 2019 with no limits on publication year or language.

The search strategy used in PubMed/MEDLINE and adapted for other databases was a combination of specific medical subject headings (MeSH) and keywords, as follows: ((((((((((((((((((((((((Tooth, Endodontically Treated) OR Endodontically-Treated Tooth) OR Tooth, Endodontically-Treated) OR Teeth, Endodontically Treated) OR Endodontically-Treated Teeth) OR Teeth, Endodontically-Treated) OR Nonvital Teeth) OR Teeth, Nonvital) OR Devitalized Teeth) OR Teeth, Devitalized) OR Pulpless Teeth) OR Teeth, Pulpless) OR Pulpless Tooth) OR Tooth, Pulpless) OR Devitalized Tooth) OR Tooth, Devitalized) OR Nonvital Tooth) OR root canal dentin) OR dentin) OR root canal) OR endodontic) OR post space)) AND (((((((((((((((((((((Canal Irrigants, Root) OR Irrigants, Root Canal) OR Root Canal Medicaments) OR Canal Medicaments, Root) OR Medicaments, Root Canal) OR Acid, Ascorbic) OR Sodium Ascorbate) OR Ascorbate, Sodium) OR citric acid) OR qmix) OR edta) OR chlorhexidine) OR lasers) OR Hypochlorite, Sodium) OR Sodium Hypochlorite (Solution)) OR Pretreatment) OR Ethanol) OR post space irrigation) OR ultrasonic activation) OR diode laser) OR irrigation protocol)) AND (((((((push out bond strength) OR push-out bond strength) OR dislocation*) OR push-out) OR push out) OR adhes*) OR bond strength). All the identified studies were then imported into Mendeley software (Elsevier Inc, New York, United States) to remove duplicates.

Study Selection

Two reviewers (TB and PF) independently assessed the titles and abstracts of studies that were included if the following inclusion criteria were fulfilled: 1) studies that evaluated the influence of any post-space treatment; 2) studies in which the post-space treatment was applied to root canal dentin; and 3) in vitro studies.

The final decision about the study selection was made after a full-text reading of the previous selected studies, according to the following exclusion criteria: 1) studies in which the treatment was not in the post-space; 2) studies which did not present a control group (solution that has no interference in the adhesion; for example, water); 3) studies that did not provide bond strength values as mean and standard deviation in megapascals (MPa); 4) studies that used experimental materials; 5) studies with contaminated specimens; 6) studies that did not present immediate bond strength data. If any data were not described or were unclear in the primary study, it was requested of the authors by e-mail (at least twice), and the study was excluded if they did not reply. In the case of multiple publications with the same data, only one study was considered. The group data were excluded from studies in which the aged group was stored in a solution other than water. Reference lists of all included studies were also manually checked in order to retrieve all relevant papers.

Disagreements between the reviewers were resolved by consensus or arbitration by an independent review (OBK). The inter-examiner agreement regarding the inclusion criteria was excellent (kappa coefficient=0.88).

Data Extraction

Data extraction was independently performed by two researchers using standardized extraction sheets. The extracted information included the study characteristics (title, authors, year and country), study methodology (sample size, type of tooth, endodontic sealer used, post-time waiting for post luting, post-space treatment used, type of post used, resin cement used, post-time waiting for bond strength test and type of bond strength test) and the outcome (mean bond strength [MPa]) and standard deviation).

Risk of Bias

The risk of bias assessment was evaluated according to the description of the following parameters suggested by previous studies:25,26 randomization of the teeth, sample size calculation, materials used according to the manufacturer's instructions, specimens (roots) with similar dimensions, endodontic treatment performed by a single operator, post-space treatment performed by a single operator, post luting procedures performed by a single operator, blinding of the operator to the testing machine, and failure analysis.

If the study presented a clear description of the parameter, it received a “yes”; if not, it received a “no.” Studies that reported 1 to 3 items were classified as high risk of bias, 4 to 6 as medium risk, and 7 to 9 as low risk. Disagreements between the reviewers were solved by consensus for the final risk of bias classification.

Data Analyses

Meta-analyses were performed using Review Manager software (RevMan version 5.3 software, Cochrane Collaboration; Copenhagen, Denmark). The mean difference with a 95% confidence interval was calculated for the bond strength means from each included study, taking into account two groups: experimental (post-space treatment) and control (no post-space treatment). The pooled-effect estimates were obtained using an inverse variance method and the random effect model (Z-test; p<0.05).

The overall analysis was performed by comparing any post-space preparation with the control group. For studies that evaluated more than one post-space treatment, the type of endodontic sealer, post-time waiting for post luting, type of post, type of cement, thirds of the root, test time, or type of drills, one bond strength mean of each group (experimental and control) was calculated using a formula according to the Cochrane Statistical Guidelines.23

Prespecified subgroup analyses by type of post-space treatment, type of endodontic sealer, post-time waiting for post luting, type of post, type of cement, thirds of the root, test time and type of drills used to prepare the post-space were performed to assess whether these variables modify the bond strength of post to root canal dentin.

Forest plots were created to illustrate the meta-analyses. A modified chi-squared test (Cochran Q test) and the inconsistency I2 test was used to calculate the statistical heterogeneity of the treatment effect among studies.

RESULTS

Search and Selection

The study selection process, conducted according to the PRISMA statement, is depicted in Figure 1. From 2832 potentially eligible studies, 2379 were not included for full-text reading, mainly because the post-space treatment was not applied to root dentin. Thus, 75 studies from 453 screened for full-text analysis were included in the systematic review.5,8,11–16,18,27–92 The main reasons for the exclusion of studies were: studies in which the treatment was not in the post-space and studies that did not present a control group.

Figure 1.Figure 1.Figure 1.
Figure 1. Flow diagram of study selection according to PRISMA statement. Abbreviations: MPa, megapascals.

Citation: Operative Dentistry 46, 3; 10.2341/19-277-LIT

Descriptive Analysis

Descriptive analysis of the included studies is shown in Table 1. All studies were published between 2005 and 2018, with the majority of studies being performed in Brazil (n=35) and Turkey (n=13).

Table 1: Description of Included Studies
Table 1: Table 1: Table 1: Table 1: Table 1: Table 1: Table 1: Table 1:

Regarding language, 70 studies were published in English, two studies in Chinese, two studies in Portuguese and one study in Spanish. Among the included studies, 56 used human teeth and 19 used bovine teeth.

Nine different endodontic sealers were used in the included studies, including epoxy resin-based sealers (n=37), calcium hydroxide-based sealers (n=17), and zinc oxide and eugenol-based sealers (n=6). Most of the studies used AH Plus sealer (n=30), while 14 studies had no information about the endodontic sealer used.

Forty-three (43) different post-space treatments were evaluated in this review, with chlorhexidine being the most used solution (n=28). All post-space treatments in studies included in this systematic review that filled the root canal with epoxy resin-based sealer were evaluated, while only 19 post-space treatments were evaluated in studies using calcium hydroxide sealer. Only 10 post-space treatments were evaluated for studies using zinc oxide and eugenol-based sealer.

Regarding the storage time before post luting, most of the studies stored the specimens for one week (n=32), while the maximum storage period was two weeks and the minimum was 24 hours. Moreover, 16 studies did not have any information about the storage time before post luting.

In analyzing the type of drills used to make the post-space, most of the studies only used the drill of the post systems (n=43), and nine studies did not have this information. Sixty-eight studies (68) used fiber post, four studies used fiber post relining, two studies used carbon fiber post, and one study used cast post.

In total, 41 commercial cements were used, and three of them were not resin cement, as follows: one zinc phosphate cement, one glass ionomer cement, and one resin-modified glass ionomer. The resin cement most used was RelyX ARC (3M Oral Care, St Paul, MN, USA) resin cement (n=19).

The maximum storage time before the bond strength test was two years, and minimum storage time was 24 hours. The most commonly employed method for evaluating bond strength was the push-out test (n=66).

Meta-Analyses

Post-space treatment improved the bond strength of posts to root canal dentin, as significant differences were found between the control and experimental groups (p<0.00001) (Figure 2). A subgroup meta-analysis also showed improved bond strength when post-space treatment was done using ethanol (p<0.0001), NaOCl + EDTA (p=0.0007), NaOCl + EDTA + Ultrasound (p=0.03), Er:YAG laser (p=0.02), Nd:YAG laser (p=0.001), and diode laser (p=0.004) (Figure 3).

Figure 2.Figure 2.Figure 2.
Figure 2. Forest plot of global meta-analysis. Abbreviations: CI, confidence interval.

Citation: Operative Dentistry 46, 3; 10.2341/19-277-LIT

Figure 3.Figure 3.Figure 3.Figure 3.Figure 3.Figure 3.Figure 3.Figure 3.Figure 3.
Figure 3.Figure 3.Figure 3.Figure 3.Figure 3.Figure 3.Figure 3.Figure 3.Figure 3.
Figure 3.Figure 3.Figure 3.Figure 3.Figure 3.Figure 3.Figure 3.Figure 3.Figure 3.
Figure 3. Forest plot of post space treatments analyzed separate. Abbreviations: CI, confidence interval.

Citation: Operative Dentistry 46, 3; 10.2341/19-277-LIT

Moreover, subgroup analyses (endodontic sealer, post-time for post luting, type of post, drills used to make post-space, resin cement, post-waiting time for the test, and thirds of root) were performed (Figure 4). Most factors in the subgroup analyses affected the results of the meta-analysis, except for resin cement, post-waiting time for tests, and different thirds of the root canal.

Figure 4.Figure 4.Figure 4.
Figure 4. Forest plot of analysis subgroup of global data. Abbreviation: CI, confidence interval.

Citation: Operative Dentistry 46, 3; 10.2341/19-277-LIT

High heterogeneity was found in the global meta-analysis and subgroup meta-analyses (I2>50%).

Risk of Bias

The majority of the included studies were scored as having a high risk of bias (n=52),a whereas only one study was scored as low risk of bias.16 The items which were not described in the majority of studies were blinding of the operator of the test machine (97.33%), sample size calculation (97.33%), post luting procedures performed by the same operator (94.67%), and post-space treatment performed by a single operator (90.67%) (Table 2).

Table 2: Risk Bias of the Studies Considering Aspects Reported in Methods & Materials Section
Table 2: Table 2:

DISCUSSION

This systematic review and meta-analysis aimed to verify whether post-space treatments would improve the bond strength of posts to root canal dentin. In general, the post-space treatment has a positive influence on the bond strength of intraradicular posts compared to the control group. A meta-analysis of the data leads to rejecting the null hypothesis, as bond strength to root canal dentin was higher when the post-space was treated.

The formation of debris and residues in the canal during the post-space preparation can affect intraradicular posts adhesion.5,6,8–10 In addition, endodontic sealer residues might also interfere on degree of conversion of cement used for post luting.26,97 Moreover, the presence of the smear layer impairs adequate contact between adhesive systems/cement used for bonding the post and the root canal.94 In this sense, the use of post-space treatment can improve the post adhesion in root canal dentin, removing partial or total debris of the root canal, and promoting the opening of dentinal tubules.18

In total, 43 post-space treatments were evaluated by studies included in this systematic review, but not all treatments increased the bond strength values. Among the post-space treatments analyzed, the treatments that improved the bond strength values were: ethanol (in concentrations ranging between 70% and 100%), NaOCl (1% to 5.25%) + EDTA (17% to 20.3%), NaOCl (2.5%) + EDTA (17%) + Ultrasound, Er:YAG laser, Nd:YAG laser, and diode laser.

Ethanol was used in 13 studies. It is considered a bipolar solvent and may be a good option for dentin cleaning because it dissolves both polar and non-polar compounds.45 Furthermore, this substance acts in controlling humidity in the depth of the root canal, making the collagen matrix from the post-space more hydrophobic due to the substitution of water by ethanol, and thus can improve the adhesive strength of the post and reduce the degradation of the adhesive layer.10 Moreover, the combination of NaOCl + EDTA treatment was evaluated in 17 studies, and this treatment is indicated for smear layer removal due to the intrinsic properties of these two solutions. NaOCl is an excellent proteolytic agent promoting a greater dissolution of organic compounds, thereby cleaning the root canal.17 In addition, EDTA has also shown to be effective in removing this smear layer. EDTA is a demineralizing agent, and has the ability to chelate calcium ions, to dissolve inorganic material such as hydroxyapatite, and it has little or no effect on the organic material.17 The use of ultrasound activation associated with NaOCl + EDTA in this study does not seem to affect the efficacy of this treatment, and the dentist may choose to use or not use this additional treatment.

The post-space preparation with lasers could be able to improve bonding to root canal dentin compared to the control group; however, few studies evaluated laser treatment; only four studies considered Er:YAG laser, two considered Nd:YAG laser, and four compared the diode laser. The treatment with Er:YAG laser increased dentinal permeability, had a thermomechanical effect on the hydrated component of surface dentin leading to ablation and water evaporation, and micro explosions eject organic and inorganic tissue, promoting clean dentinal walls and open tubule orifices.83,95 Studies in the literature showed that Nd:YAG laser irrigation promoted morphological alterations such as melting, resolidification, and formation of small globules in dentin surface.92,96 Furthermore, the diode laser has been recommended in the literature because it is efficient in removing the smear layer and debris from root canals.97,98

Despite not increasing the bond strength of the post to root dentin, chlorhexidine was the most used treatment among the studies included in this meta-analysis. Chlorhexidine has antibacterial action, substantivity, and biocompatibility.29,38,42,44 Also, it is a non-toxic MMP inhibitor, intending to preserve the stability of the bond strength over time.29,56 However, for the post-space treatment, chlorhexidine does not seem to be effective.

Moreover, subgroup analyses were performed evaluating different factors that can affect the efficiency of post-space treatments. For the overall data, the type of endodontic sealer used seems to affect the treatment action. Also, other studies in the literature showed that the type of canal sealer can affect the bond strength of the fiber post.26,93 For the resin-based sealers, the post-space treatments are effective in improving the post bond strength. The resin-based sealer is considered in the literature as the gold standard because this sealer does not affect the post retention.99

On the other hand, different treatments decreased or showed no difference in the bond strength for calcium hydroxide sealers and zinc oxide-eugenol sealers, respectively. In contrast, the literature showed higher bond strength values of a post in root canals filled with a sealer containing calcium hydroxide compared with other sealers; this can be explained by the isobutyl salicylate present in this sealer, which reacts with calcium creating a physiochemical barrier that may have influence on cement adhesion.93,100 However, this sealer seems to affect the post-space treatment because the control group achieved the highest bond strength values of the post. Eugenol-based sealers have lower bond strength values than other sealers because they interfere with polymerization of cement used for post luting.99 The post-space treatment evaluated with this sealer does not seem to affect the post retention. However, this result should be evaluated with caution since only 10 treatments were evaluated for this sealer.

Regarding the storage time before post luting, there is no difference between post-space treatment and the control group, except for the two-days subgroup. However, it should be considered that they do not have a long storage period, and only five studies used two days of storage. This analysis is essential because the prolonged contact of endodontic sealer with dentin walls may affect the adhesion of the post through the penetration of molecules of endodontic sealer in dentinal tubules.101,102 A more extended storage period and more endodontic sealer molecules would be able to penetrate dentin walls, and post-space treatments would be necessary for the removal of these molecules. Therefore, the post-time waiting for post luting is influenced by the type of endodontic sealer used for filling the root canal.103

In the subgroup analysis of the type of post, the fiber post showed that the post-space treatment improved the post retention. In the literature, one systematic review found the same result for fiberglass posts; this study shows that the root canal cleaning can affect the bond strength of the fiberglass post and that NaOCl + EDTA was recommended.104 Other types of posts should be analyzed with caution, as there are few studies included in this present review that used carbon fiber post (n=2), fiber post relining (n=4), or cast post (n=1).

Post-space preparation may interfere in the post retention due to the effect of the drill used, which may remove variable amounts of gutta-percha and dentin, and generate a temperature increase on the root surface, which may form cracks or fractures in the intraradicular dentin.105–108 In this systematic review, the post-space treatment was only efficient for drills provided by the post system's subgroup. Other types of drills should be considered with caution due to the presence of few studies that used each of the following drills: Largo drill (n=4), Largo drill + drill provided by the post system (n=4), Gates Glidden drill + drill provided by the post system (n=7) and Peeso Reamer drill + drill provided by the post system (n=4).

The type of post most used in our systematic review was the fiber post. The main reason for the failure of this type of post is post debonding;109 therefore, the type of cement used for post luting is important. Different types of cement have been analyzed in the literature; however, adhesive cementation achieves higher bond strength than other types of cement.110,111 All the included studies in this review used resin cement for post luting, and the post-space treatment improves the post retention for all types of resin cements. Regarding the post-treatment before luting, most of the papers included in the meta-analysis used silano for post-treatment. Some papersb do not explain what was used for the post-treatment and one67 paper used only alcohol for post-treatment.

For the post-waiting time for test analysis, the immediate (stored between 24 hours and one week) and delayed subgroups (stored between four months and two years) obtained higher results for post retention when the post-space treatment was used compared with the control group. Although there was no difference between the subgroups (immediate and delayed), it is important to take into account length of storage time because studies in the literature suggested the integrity of cement-dentin bonds over time decreased the post bond strength.112 In addition, some treatments were available in the post-space to increase the bond strength value in the delayed condition.5,8,38

The bond strength test most used among the included studies was the push-out test.92 One reason for this is promoting shear stresses at the interface between cement-root dentin and cement-post, and the push-out test generates the best evidence available in the literature.113,114

It is reported in the literature that root thirds affected the bond strength of the post due to regional differences in the concentration, volume, and direction of dentinal tubules in different thirds,115 although others did not show any difference between thirds.44,84 In the present review, the use of post-space treatment was better than the control group, independent of tooth third.

High heterogeneity among studies was found in the meta-analyses, and heterogeneity is expected because this review only considered in vitro studies. There are many differences among experimental designs in in vitro studies such as bond strength test, type of teeth, number of specimens per group, and specific variables such as the endodontic sealers, type of post, type of cement, and post-space treatments. Moreover, a small number of samples and consequently high standard deviations also contribute to heterogeneity.25,116 Among the evaluated studies, only one16 had a low risk of bias. The parameters of sample size calculation, treatments performed by a single operator, and blinding the operator of the testing machine were the most frequently missed or unclear parameters. These findings usually occur in a systematic review of laboratory studies.25,26,97,116

The present study is a systematic review of only in vitro studies, which impacts the interpretation of the findings, thus constituting a limitation of the study. The literature search only being conducted in the PubMed/MEDLINE, Scopus, and Lilacs electronic databases is also a limitation despite the number of obtained studies that can be considered as representative and reasonable. Nevertheless, the obtained results could be considered as a recommendation for clinicians regarding the post-space treatment.

Thus, despite the study limitation, the post-space treatment with ethanol should be preferred due to the the simplicity of the technique and similar results as the more complex techniques, mainly in the situations that the root canal is filled with a resin-based sealer, post-waiting of 2 days using fiber post, and when the post-space preparation was done with the drill provided by post system.

CONCLUSION

This systematic review of laboratory studies indicates, under the limitations of the present meta-analysis, that post-space treatments improve the bond strength of posts to root canal dentin. The treatments with ethanol, NaOCl + EDTA, NaOCl + EDTA + ultrasound, Er:YAG laser, Nd:YAG laser, and diode laser provide higher bonding to root canal dentin. Thus, the clinician can choose the most appropriate treatment to be used among those described above.

    Conflicts of Interest The authors certify that they have no proprietary, financial, or other personal interest of any nature or kind in any product, service, and/or company that is presented in this article. a 11–15, 18, 28, 30–32, 34, 36, 38, 40–44, 46–52, 55–63, 66–71, 73–75, 80–82, 86, 88–92 b 5, 51, 61, 70, 74, 82, 88, 89, 91

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Copyright: © Operative Dentistry, 2021 2021
Figure 1.
Figure 1.

Flow diagram of study selection according to PRISMA statement. Abbreviations: MPa, megapascals.

Figure 2.
Figure 2.

Forest plot of global meta-analysis. Abbreviations: CI, confidence interval.

Figure 3.
Figure 3.

Forest plot of post space treatments analyzed separate. Abbreviations: CI, confidence interval.

Figure 4.
Figure 4.

Forest plot of analysis subgroup of global data. Abbreviation: CI, confidence interval.

Contributor Notes

*Thaís C Bohrer, DDS, MSD graduate student in Oral Sciences (Prosthodontics), Faculty of Odontology, Federal University of Santa Maria, Santa Maria, Brazil.

Patricia E Fontana, DDS, MSD graduate student in Oral Sciences (Prosthodontics), Faculty of Odontology, Federal University of Santa Maria, Santa Maria, Brazil.

Rachel O Rocha, MSD, PhD, associate professor, MDS Graduate Program in Oral Science (Pediatric Dentistry Units), Faculty of Odontology, Federal University of Santa Maria, Santa Maria, Brazil

Osvaldo B Kaizer, MSD, PhD, associate professor, MDS Graduate Program in Oral Science (Prosthodontics Units), Faculty of Odontology, Federal University of Santa Maria, Santa Maria, Brazil.

*Corresponding author: Federal University of Santa Maria, Santa Maria, Brazil, Department of Restorative Dentistry, Faculty of Odontology, Floriano Peixoto Street, 1184, 97015-372, Santa Maria, Brazil; e-mail: thaiscbohrer@hotmail.com

Clinical Relevance

Several factors can influence the retention of posts to root canal dentin. Post-space treatment is one of these factors, which can improve the bond strength of the post to dentin.

Accepted: 02 Sept 2020
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