Do resin core build-ups obtain the benefits of higher bonding ability from direct or indirect technique?

Purpose This study evaluated the effects of different materials (composite resin system including a photo-cure adhesive (DC) vs. resin cement system including a self-etching primer (PV)) and techniques (direct vs. indirect) for resin core build-up on the bonding performance to root canal dentin.Methods The human teeth were decoronated and root canal preparation was performed. All specimens were randomly divided into four groups according to the combinations of the methods (Direct or Indirect) and the materials (DC: Clearfil DC Core, Kuraray Noritake Dental or PV: Panavia V5, Kuraray Noritake Dental). Micro-tensile bond strength (μTBS) and push-out tests were performed. Scanning electron microscope observations of the interface were also performed, and microcomputed tomography and optical coherence tomography were applied to evaluate the sealing ability.Results The Indirect group had significantly higher μTBSs than the Direct group in the DC group (P = 0.0076). The PV group had significantly higher bond strengths than the DC group in both the Direct and Indirect groups (P < 0.001). The Direct/PV group demonstrated significantly higher push-out bond strength than the Direct/DC group (P < 0.001). In the Direct/PV group, the formation of resin tags was observed even on the apical side of the canal. Microleakage was more clearly observed in the DC group than in the PV group.Conclusions PV has a higher bonding ability to root canal dentin than DC. When using DC, the indirect technique exhibited a higher bonding ability than the direct technique.