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Endo Tribune Middle East & Africa Edition No. 2, 2017

A2 ◊Page A1 ENDO TRIBUNE Dental Tribune Middle East & Africa Edition | 2/2017 Fig. 5: Internal view of e.max press onlay restoration Fig. 6: Cemented e.max press restoration Fig. 7: Tooth sample embedded into ortho resin Fig. 8: Tooth sample secured in stabilization ring with In- stron bearing Fig. 9: Axial loading in Instron unit Fig. 10: Tooth fracture/onlay failure Fig. 11: Fracture resistance averaged for each group with standard deviation: graphical. Fig. 12: Digital impression of a pin-augmented substruc- ture. Fig. 13: Milled e.max restoration with pin-bore holes. Conclusions This study explored combining re- tentive titanium pins with indirect e.max press onlay restorations in extracted human molar teeth. Teeth were then subjected to axial load- ing in a universal loading machine. There was no statistical difference in fracture resistance between the two groups. However, the highest frac- ture resistance was displayed from a pin-retained e.max onlay. This may be related to the increased surface area and subsequent bond strength. Observationally, pin-retained e.max onlays fractured in a manner that seemed more controlled than non pin-retained onlays. Digital dentistry could simplify this potential alternative by providing the clinician with the tools required to acquire the digital impression, design and fabricate the final resto- ration. Although pin-retained was termed for the investigative restora- tions, perhaps pin-reinforced would seem more logical. Further investi- gations are required to substantiate the research and identify whether this approach may be considered as a clinical alternative. Conflict of Interest Research was supported by the Schu- lich Dentistry Summer Research Pro- ject and by Research Driven Inc. Les Kalman is the co-owner and Presi- dent of Research Driven Inc. Acknowledgements The authors thank Victoria Yu, a den- tal summer student, who assisted with aspects of the methodology, and Dr. Amin Rizkalla, BSc, MEng, PhD, Associate Professor & Chair of the Division of Biomaterials Science, who facilitated the testing. Editorial note: A complete list of refer- ences is available from the publisher. This article was published in CAD/ CAM international magazine of digi- tal dentistry No. 04/2016. in the fracture resistance between the non pin-retained e.max press restorations and the pin-retained e.max press restorations (Fig. 11). An unpaired t-test result using P < .05 was P = .4443 in this assessment. Data were obtained by using an analysis of variance (ANOVA). Significant dif- ferences were set at a .05 level (Fig. 11). Discussion There was no statistical difference between the control group (non pin- retained restorations) and the test group (pin-retained restorations) in fracture resistance. The results indi- cated that the test group exhibited greater variability. This could be due to pin location, pin length, differenc- es in pin angulations or variations in the width of the onlay prepara- tion margin. The highest fracture resistance value was a pin-retained e.max onlay, which could be related to the increased surface area and subsequent bond strength.[13] Pin- retained e.max onlays had a ten- dency to fracture in a very controlled manner, with much of the tooth-res- toration complex remaining intact. Conversely, non pin-retained e.max onlays typically fractured in such a violent manner that the tooth-resto- ration complex was destroyed. Due to the degree of variability, fur- ther laboratory testing would be warranted with a larger sample size. A clinical investigation, highlighting the procedural aspects, would also be an ideal extension of the research. Further studies should isolate vari- ables and establish a greater sample size. With advances in technology, the digital workflow of records, de- sign and output could be easily im- plemented for pin-retained restora- tions. It has been previously shown that digital impressions have the ability to capture all aspects of a pin- augmented substructures (Fig. 12). [14] It has also been demonstrated that CAD/CAM technology has the precision and accuracy to mill (Fig. 13) the subsequent pin-bored resto- ration from an e.max CAD block.[14] A digital approach seems to repre- sent a simple and predictable chair- side alternative for the clinician. Dr Les Kalman, DDS Assistant Professor, D epartment of Re- storative Dentistry, Schulich School of Medicine and Dentistry; and Chair of Dental Outreach Community Service program, Western University, London, On- tario, Canada. Yasmin Joseph, BSc Undergraduate Student, Faculty of Sci- ence, Western University, London, On- tario, Canada. XP-endo® Shaper - 3D-Shaping - Clinical Cases By FKG Technological advances and manu- facturing processes are allowing the practitioner the ability to get closer to ideal root canal therapy. The “per- fect” file should touch all the walls of the canal without changing its shape while still allowing room for disin- fecting irrigation solutions. The aim is to achieve optimal disinfection in a minimally invasive fashion. Thus both aims of root canal therapy can be achieved ; a healthy surrounding periodontium and a strong root with maximal resistance to fracture. FKG aims to develop advanced endodon- tic instruments that provide dentists with the best shaping ability, even in curved or oval canals. The XP-endo® Shaper is the latest in- strument of the FKG’s range of 3D in- struments. It is the epitome of what incremental innovation can create for modern dentistry; it features the combination of a dual technology and a unique expertise. Firstly, the exclusive MaxWire® al- loy provides the instrument with an exceptional flexibility and an ex- treme resistance to cyclic fatigue. It allows the XP-endo® Shaper to shape and to progress inside the root canal with agility, whilst expanding and contracting its shape, adapting itself to the specific morphology of each canal. In addition, the Booster Tip, thanks to its six cutting edges, guides the instrument easily toward the apical terminus and enables to start the shaping at an ISO diameter of 15, then gradually to increase its work- ing scope to reach an ISO diameter 30. CLINICAL CASE n°1 Pulpectomy on a first upper right molar A 62 years-old caucasian fe- male presented a symptomatic pul- pitis on tooth 16. After a glide path of 15/.02 with a hand file, the canals were shaped us- ing the XP-endo® Shaper. For each canals, the instrument was used by applying 5 light up-and-down movements and then removed and cleaned. Pre-Op Post-Op After irrigating the canal, 5 more up-and-down movements were ap- plied and the final size was verified using a Gutta Percha 30/.04. Finally, the canals were obturated with To- talFill® BC Points™ and TotalFill® BC Sealer™. Dr. Kleber K. T. Carvalho He has completed his graduate course in Dentistry, specialization and Master’s degree in Endodontics at Universidade Metodista de São Paulo – Brazil. He is the coordinator of a specialization course at Funorte – Santo André, São Paulo, Brazil. Dr. Carvalho has authored one book in Endodontics and 8 book chapters. He runs a private practice limited to Endodontics. ÿPage A3

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